An Intervention to Reduce Risk Factors for Adolescent Pregnancy

Study Overview
=================
Brief Summary
-----------------
Investigators will assess the preliminary effects of Girls Invest, an innovative savings intervention that aims to reduce economic, social, and health behavior risks associated with disproportionately high rates of pregnancy among US Latina adolescents. Girls Invest involves a multidisciplinary conceptual model adapting the most effective prevention strategies from the disciplines of public health and economics. Participants receive a savings account (via our collaborating bank) with $100 deposited in increments based on completion of each module of a gender and life skills training via a mobile app.

Detailed Description
-----------------
Investigators will assess the preliminary effects of Girls Invest, an innovative savings intervention that aims to reduce economic, social, and health behavior risks associated with disproportionately high rates of pregnancy among US Latina adolescents. Recommended models of adolescent pregnancy prevention in the US focus on modifying social norms (e.g., norms supporting early childbearing), as well as sexual health knowledge and skill-building; however, such efforts are not likely effective in reducing economic risk factors (e.g., financial reliance on male partners, low expectations for future career and educational achievements). Girls Invest involves a multidisciplinary conceptual model adapting the most effective prevention strategies from the disciplines of public health and economics to address social and economic risks associated with adolescent pregnancy. Participants receive a savings account (via our collaborating bank) with $100 deposited in increments based on completion of each module of a gender and life skills training via a mobile app. Girls Invest will be evaluated among a community sample of Latina adolescents residing in economically disenfranchised neighborhoods in San Diego County with high rates of adolescent pregnancy. Adolescent pregnancy is a concern in San Diego and other US-Mexico border regions, where rates are higher compared to the rest of the US or elsewhere in Mexico. Compared to other racial/ethnic groups, Latina adolescents of Mexican origin have the highest pregnancy rates. In California, where Latinos constitute 39% of the population, 30% of all Latinas give birth prior to their 20th birthday. Latina adolescents ages 15-22 will be recruited among 16 community-based organizations and schools within low-income neighborhoods of San Diego County region. Half of the sites will be randomized to receive Girls Invest and the remaining assigned to a wait-list control condition (n= 8 sites per arm; total = 200 girls). To assess feasibility and fidelity, investigators will track (via data logs and app-based data) all aspects of recruitment, retention, and intervention completion. In-depth interviews with Girls Invest participants and focus groups with key stakeholders will inform acceptability and scalability of Girls Invest. Participants will complete a questionnaire at baseline and 6 months follow-up to assess evidence of improvements in intermediate outcomes. Regression analyses will assess treatment effects on intermediate outcomes. Investigators hypothesize that at follow-up, compared to control participants, Girls Invest participants will have reduced economic vulnerability (e.g., reduced financial reliance on male partners, improved expectations for future career and educational achievements), decreased social risks for pregnancy (e.g., intentions to delay pregnancy), and improved prioritization, knowledge of, and attitudes supportive of contraceptive use. Study findings will inform a full-scale efficacy trial of Girls Invest.

Official Title
-----------------
Girls Invest: A Mobile-Enabled Economic Empowerment Intervention for Girls

Conditions
-----------------
Behavioral Changes

Intervention / Treatment
-----------------
* Behavioral: Girls Invest Mobile App Intervention
* Other: Savings Account Subsidies


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: age 15-22 years old literate in English have a smart phone with internet access have photo identification willing to open a savings account

Ages Eligible for Study
-----------------
Minimum Age: 15 Years
Maximum Age: 22 Years

Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Girls Invest Intervention<br>Girls Invest intervention participants will have been randomized to receive the intervention immediately upon completion of the baseline survey. Intervention participants will also complete the 6 month follow-up survey. (n=50 dyads; 100 total participants) | Behavioral: Girls Invest Mobile App Intervention<br>* Gender and life skills training: App-based trainings culturally tailored and adapted to this population using our formative work and based on elements from life skills trainings used in previous effective pregnancy prevention interventions among youth. We added sessions focused specifically on financial skill-building. Trainings included app features such as gaming dynamics, and quizzes. Each module estimates 25 minutes to complete. Training modules: The first 3 modules cover gender and cultural norms related to girls' social and economic opportunities, increasing girls' recognition of the importance of financial literacy, independence, and power in decision-making. The last 3 modules cover finance, educational loans, and employment.<br>Other: Savings Account Subsidies<br>* Girls Invest builds upon two broadly accepted economic empowerment strategies: a) savings and b) cash transfers. The most promising economic empowerment interventions for girls have incorporated concrete economic resources along with training on life skills and gender.1-3 Trainings encourage girls to save additional funds (e.g. from family). Participants have online access and can withdraw savings anytime, however, we will assess savings behaviors to consider other account features (e.g. commitment-based savings). In the future, subsidies could be supported via ads in the app and financial support from banks.<br>|
| No Intervention: Wait-List Control Condition Participants<br>Control condition participants will be randomized upon completion of the baseline survey and put on a wait-list to receive Girls Invest behavioral intervention after the 6 month follow-up survey. (n=50 dyads; 100 total participants) | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sexual/Reproductive Health Behaviors | Contraceptive use: Condom use and other contraception use and consistency of use (past 3 months) Sexual Practices: Frequency of sexual activity (past 3 months) | Past 3 months | 
| Economic Vulnerability | Self-reported perceptions of household economic stress (1 item, 5 pt Likert response, piloted by PI; greater values reflect more stress);access to own spending money (yes/no), and employment | Past 6 months | 
| Social Risk Factors | Intimate partner violence (IPV): 12-items; revised Conflict Tactics Scale modified for use among adolescents.Knowledge to identify healthy versus unhealthy relationships (10 items developed by PI) Sexual relationship Power Scale (alpha = 0.84; higher scores reflect greater relationship power); Coercive sexual risk. e.g. Has a male sex partner made you have sex without a condom even though you wanted to use one? Additional items on control over decisions to: a) have sex and b) use contraception (if participant, partner, or both participant and partner decide) | Past 6 months |