As a nation, the U.S. invests heavily in community-based organizations to conduct interventions, proven through research, to reduce the high rates of unplanned pregnancies and sexually transmitted infections (STIs) and HIV among teens. Much less is invested in helping communities implement these programs with quality. Although many research-based programs exist to address teen pregnancy and STIs, communities face difficulty implementing them and achieving the same outcomes as researchers. This """"""""gap"""""""" is because resources are limited, prevention is complex, and communities often lack the capacity-or the knowledge, attitudes, and skills-needed to implement """"""""off the shelf"""""""" programs well. Common ways to bridge this gap, such as information dissemination, fail to change practice or outcomes at the local level in part because it does not sufficiently address capacity of community practitioners. Therefore, building a community's capacity is a method that could improve the quality of implementation and outcomes. The proposed study will use a randomized controlled design and primary data from middle school youth (960) and program staff from 32 cooperating Boys and Girls Clubs (Clubs) to assess how a capacity building intervention called Getting To Outcomes (GTO) augments the quality of implementation of a research-based intervention to improve teen sexual health (Making Proud Choices, MPC). Specifically, the study will: (1) Assess the utilization of and subsequent effects of GTO on program staff capacity to implement MPC;(2) Assess the degree to which Clubs using GTO show greater improvements in MPC fidelity than Clubs that are not using GTO;and (3) Assess the degree to which Clubs using GTO show greater improvements on teen sexual health outcomes than the comparison Clubs. To address these aims we will collect data on the delivery and utilization of GTO (e.g., method of delivery, duration, topics);staff capacity to implement research-based interventions;observations of program delivery (fidelity monitoring);and youth participants'sexual activity, pregnancy, STIs, condom use, and knowledge/ attitudes towards sex. Analyses will examine differences between intervention and control sites over time, accounting for clustering of youth within site. These outcomes are important to NICHD's focus on providing opportunities for youth to become healthy and productive adults.

Public Health Relevance

The proposed study is particularly relevant because it focuses on teen sexual health outcomes in the face of increasing rates of teen pregnancy and births to teens. It is also relevant to study how research-based interventions are delivered in community settings because while community organizations in the U.S. have a key role in promoting health, they often fail to achieve the outcomes achieved in research trials. High-quality health promotion by a wide variety of community-based organizations is needed in order to fulfill the mission of public health to ensure conditions in which people can be healthy, as outlined by the Institute of Medicine. Specifically, programs to prevent adolescents from acquiring a STI, HIV, and unintentionally becoming pregnant are critical to ensuring healthy adolescent development and transition into adulthood.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Community-Level Health Promotion Study Section (CLHP)
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Haverkos, Lynne
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Rand Corporation
Santa Monica
United States
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