“Healthy U changed my life. If I had taken Healthy U when I was 14 years old, I wouldn’t be a teen father today.”

This is the earnest voice of a young man who recently participated in an innovative teen pregnancy prevention program — the first of its kind, designed specifically for young males in a juvenile justice environment.

Developed through funding by the U.S. Department of Health and Human Services, Healthy U is delivered through a tablet-based app, making it an accessible and cost-efficient way to deliver sexual health education. The program is a collaboration between the WestEd Justice & Prevention Research Center; the Oregon Youth Authority (OYA), known for its rehabilitation model in juvenile justice; and Efficacity, a health education company with a history of building media, games, and technology for underserved and high-need populations. WestEd helped develop the app and is studying its impact through a five-year cluster randomized, controlled trial. The study focuses on young males at five OYA facilities and compares changes in sexual knowledge, attitudes, and behavior of those who participate in the Healthy U program with those who do not.

“Based on OYA youth and staff feedback, we’ve learned that this is really the first time that most of these young men have had any sort of systematic approach to sexual health education,” says Staci Wendt, a Senior Research Associate at WestEd who is leading the project with Anthony Petrosino, Director of the WestEd Justice & Prevention Research Center. In fact, only 1 in 10 young men participating in a pilot focus group at OYA reported having any previous sexual health education. “These youth are really starved for this information,” says Wendt.

Although the study’s final findings are not yet available, surveys and focus groups have revealed some significant changes in youths’ attitudes and knowledge. For instance, after participating in Healthy U:

  • 95 percent of the young men indicated that they were more knowledgeable about how to prevent HIV and other sexually transmitted diseases (STDs).
  • 77 percent were more likely to use a condom in the coming year.
  • 11 percent were more likely to abstain from sexual intercourse in the next year.

And in focus groups, says Wendt, many youth say they now feel more prepared to have conversations about these topics with their partners.

Using technology to educate young men in a juvenile justice system

“A lot of sexual health education is aimed at females,” says Wendt. “We’re looking at how we can appropriately target this information to young men and increase their knowledge and engagement.” Educating men in their teenage years is critically important, she notes, partly because children born to teen parents face more challenges and teen parents are at greater risk for dropping out of school and ending up on public assistance.

The need for sexual health education is great, especially among males who end up in juvenile justice systems, notes Wendt. As of the project’s start in 2015, about 12 percent of youth entering OYA reported already being a father. These youth are also at greater risk for HIV and other STDs, says Wendt.

Survey data gathered through the study confirm the need for increased access to sexual health education. Before participating in Healthy U, a significant percentage of youth reported not previously receiving information about: how to resist pressures to have sex (60 percent); pregnancy or birth (52 percent); methods of birth control (37 percent); how to say no to sex (36 percent); and STDs (27 percent).

Reaching males in a juvenile justice system. The young men participating in the Healthy U study are between the ages of 14 and 19 and within three months of being released from an OYA facility. This timing allows for a reliable assessment of their sexual behavior once they are back in the community. Each living unit — the cluster that young men reside in at their OYA facility — is assigned to either the treatment or control group, a step designed to prevent interaction and skewing of results.

“This is really the first time that most of these young men have had any sort of systematic approach to sexual health education.”

OYA staff help facilitate the intervention by passing out tablets and answering any questions youth have about their Healthy U experience. “The app has prompted many conversations that probably wouldn’t have happened otherwise,” says Michael Lambert, OYA Case Coordinator at Rogue Valley Youth Correctional Facility in Southern Oregon. “They’re all very grateful for the information, but wish they’d had access to it sooner.”

Using a tech-based approach. The program is self-directed and self-paced — designed to take only three to four hours to complete — and the tablets don’t require a lot of staff training to implement, says Wendt. “This makes them easier and less costly to use, and more accessible for remote and rural populations such as those living in OYA facilities.”

At OYA facilities, the tablets are novel, and “they really engage this age group,” says Lambert. Privacy is also a plus. Teaching sexual education in a group environment that requires open discussion can discourage youth from asking questions, notes Lambert. “But because they are learning in private with the tablets, they feel more comfortable coming to ask follow-up questions or to seek verification from a trusted adult.”

Creating an engaging platform

Currently, 254 youth are enrolled in the study, and 85 percent of those in the treatment arm have completed the Healthy U program. In addition to strong acceptance of the technology, several other factors may contribute to the high completion rate, says Wendt, such as youth involvement in the development of the program as well as the comprehensiveness and reinforcement of the sexual health messages.

Youth input. The development of the Healthy U app was informed from the beginning by youth, including a youth advisory board, focus groups, and pilots with young men in OYA’s care. For example, two stories included in Healthy U videos were developed using input from young men in an OYA facility who worked with Efficacity to storyboard a video segment incorporating their personal experiences. Getting early input, says Wendt, “helped us to really tailor the information to this population.”

Multiple modules. Aligned to the Centers for Disease Control and Prevention’s National Health Education Standards, the program includes seven modules: puberty in males and females, birth control, pregnancy, STDs, HIV, healthy relationships, and condom negotiation. “The program is extremely in-depth,” says Lambert. “It corrects a lot of misinformation youth have picked up along the way, mostly from their peers.”

The app also provides new information. Lambert says he sees the program’s real impact when the young men repeatedly come to him and ask with alarm, “Is this really true? Why do some condoms not protect me from STDs?” In focus groups, the teens have repeatedly applauded the healthy relationship module — information they hadn’t received before, adds Wendt. “That module provides detailed information about how to talk with a partner about buying and using birth control, and about the effects of birth control on the body,” says Wendt. Another real eye-opener for the teens? “The costs of unplanned teen fatherhood,” she says.

Reinforced messages. The app uses a public health approach, says Wendt, with different formats reinforcing the same message. For example, messages about birth control are delivered through an interactive game, a video of two teens conversing, and a teen speaking directly to the camera about his experience negotiating birth control use with his partner.

All formats are popular, says Lambert: “The teens are silently glued to the screen the whole time.” Although they have up to three weeks to complete the program, he says, most go through material within a few days. “Can I do it again?” is often the first thing they say upon completing it, Lambert says.

Next steps

Heading into year five of the research study, Wendt and her colleagues are finishing up data collection and assessing the impact of the app on behavioral outcomes, such as increases in condom use and birth control use and decreases in unplanned teen fatherhood. The team will share results in journals and present at conferences.

While the study’s final results are still pending, Wendt is pleased with the app’s progress to this point. “Healthy U is providing critical information to a high-risk, high-need population at a formative juncture in their lives — and that’s really the aim of all this work.”

For more information about WestEd’s work with Healthy U, contact Staci Wendt at 562.799.5432 or [email protected]. For more information about Healthy U, contact Beth Wachter at www.healthyucampus.org.

Healthy U is supported by a grant from the U.S. Department of Health and Human Services. Funding was made possible under contract TP2AH000029-01-01 from the U.S. Department of Health and Human Services, Office of the Assistant Secretary for Health, Office of Adolescent Health.