Adolescent Sexual and Reproductive Health

California Health Care Collaborative

The Philip R. Lee Institute for Health Policy Studies (PRL-IHPS) researches and evaluates adolescent sexual and reproductive health (ASRH) efforts in California, nationally, and globally. Over the years, PRL-IHPS researchers have used a range of methods to evaluate adolescent reproductive health programs and policies and to research health needs and disparities. We work to identify best practices in sexual health education, clinical service delivery, and other interventions to improve adolescent sexual and reproductive health. Research from PRL-IHPS in adolescent sexual and reproductive health emphasizes the impact of educational and clinical services, community factors, and social and demographic characteristics on adolescent reproductive health outcomes.
Current Projects

CA Adolescent Sexual and Reproductive Health Program Evaluations 

We work with the state Maternal, Child and Adolescent Health Division to evaluate their Adolescent Sexual and Reproductive Health programs to provide quality technical assistance, program evaluation, and training since 1997. 

Currently, we evaluate their Adolescent Sexual Health Education Programs, the California Personal Responsibility Education Program (CA PREP) and the Information and Education Program (I&E) which support local agencies to provide comprehensive sexual health and life skills education to young people. Our team surveys over 10,000 youth annually at more than 300 sites and oversees all evaluation activities to document and assess program outcomes.

We also evaluate the Adolescent Family Life Program (AFLP), an evidence-informed program model that provides expectant and parenting adolescents with comprehensive, strengths-based case management services to enhance protective factors and promote resilience. We have conducted formative and ongoing evaluation efforts to examine how AFLP is being implemented and the quality of the implementation fidelity. The in-depth implementation evaluation uses a mixed method research design to gather qualitative and quantitative data from key stakeholders, including supervisors, case-manager, and diverse groups of expectant and parenting adolescents. 

Past programs that have been evaluated include the Community Challenge Grant program, the Male Involvement Project, and the TeenSMART Outreach program.

In the Know

A 5-year federal grant to design and study an innovative new initiative in Fresno County, which combines existing, in-person, group-based, comprehensive sexual health education with wraparound digital technologies. Youth+Tech+Health designed the app and lead youth centered design workshops, Fresno EOC recruits and implements, and UCSF evaluates. This intervention is being evaluated using a cluster randomized controlled trial in Fresno County. For more information on this evaluation, please see the study protocol. Funded by the Family and Youth Services Bureau.

Promoting Optimal Health for Rural Youth 

Guided by a systems-thinking approach, this program combines the replication of an evidence-based sexual health education curriculum (Positive Prevention Plus) in local school districts in rural Fresno County with additional leverage points in the community to ensure the greatest impact on adolescent health. This includes repeated points of contact with youth for sexual health education (in 9th and 11th grade), authentic engagement with youth in developing project materials, professional learning opportunities for school staff, training on youth-friendliness for local clinics, the development of a referral system for services, and educational workshops for parents and caregivers. UCSF is responsible for project evaluation and quality improvement efforts. Our implementation partners, Fresno EOC and the Fresno County Superintendent of Schools, offer programmatic expertise in health education delivery, school staff professional development, and community engagement. Funded by the Office of Population Affairs.

Binational Perspectives on Adolescent Childbearing and Migration

A US/Mexico binational qualitative study that aims to capture the voices and perspectives of pregnant and parenting adolescents living in Guanajuato, Mexico and Fresno, California. Through focus groups and interviews with adolescents as well as interviews with adult providers, this project explores experiences with and perspectives of prenatal and postnatal care, access to contraception, and migration. For more information about findings and policy recommendations, please see our study brief. Funded by the Health Initiative of the Americas.

Health-E You/Salud iTu Contraceptive App

This study aims to reduce health disparities in contraceptive knowledge, access, unintended pregnancies among sexually active Latina adolescents. Health-E/Salud iTu is an interactive, individually tailored, patient-centered, contraceptive decision support tool available in English and Spanish. It is designed to be used in conjunction with clinical encounter to provide sexual health and contraceptive education, support the contraceptive decision-making process and increase access to patient-centered contraceptive services. Based on user input, the app provides individually tailored contraceptive recommendations asks youth what method(s) they are most interested in. This information is then shared with the provider prior to the face-to-face portion of the visit. In this way, the app prepares youth for the visit and acts as a clinician extender to support the delivery of health education and enhance the quality of patient-centered sexual health care. This intervention is being evaluated using a cluster randomized control trial (CRCT) in 18 school-based health centers throughout Los Angeles County, California. Funded by Patient Centered Outcome Research Initiative (PCORI)

Past Projects

Systematic Review of Adolescent Health and Development Interventions

In conjunction with UCLA’s Blum Center on Poverty and Health, we conducted a systematic review of theory-based interventions in Latin America and globally focusing on four aspects of adolescent health and development: reproductive health and pregnancy, violence, substance use, and idleness (not employed or in school). Across the four areas of interest, we found more rigorously evaluated, theory-based interventions related to adolescent reproductive health in both Latin America and globally compared with youth violence, idleness and substance use. In addition, we found only a few programs targeting a combination of youth behaviors. This is a positive start but demonstrates that the field of integrated youth behavioral change is still in development. Funded by Inter-American Development Bank. 

Adolescent Sexual and Reproductive Health and Development

Adolescent sexual and reproductive health (ASRH) is an area of focus for the World Bank, which recognizes the importance of addressing ASRH as a development issue with important implications for poverty reduction. The World Bank also stresses the need to address factors both within and outside the health sector that impact economic and social well-being. The main objectives of this project were to: gain a deeper understanding of the multi-sectoral determinants of ASRH outcomes and to identify multi-sectoral programmatic and policy options to improve ASRH outcomes. In this project, we conducted a comprehensive review of social, economic and policy determinants of ASRH for two countries, Ethiopia and Nepal, including interviews with key stakeholders in each country. We also conducted a comparative analysis of Demographic and Health Survey data assessing ASRH outcomes and associated socioeconomic indicators in five countries. Funded by the World Bank.
Clinical Services Research.

Clinical Services Research

Protecting Adolescent Confidentiality Under Health Care Reform: The Special Case Regarding Explanation of Benefits: Under the Affordable Care Act, adult children now can stay on their parents' health insurance plans until they reach age 26. But because they are dependents on their parents' health insurance, they are not afforded the same confidentiality protections as if they had individual plans. This brief describes strategies and attempts to achieve a better balance between health care transparency and patient confidentiality.

Decline in Adolescent Female Participation in the Family PACT Program: This study examined the eight percent decline in adolescent female participation in California’s family planning program, Family Planning, Access, Care, and Treatment (Family PACT), between fiscal year 2004-05 and fiscal year 2010-11, as well as possible factors contributing to this decline.

Sex Education Research

Past ProjectsUneven Progress: Sex Education in California Public Schools: This report summarizes a study of California’s school efforts to implement a 2003 state policy that requires that voluntary sex education taught in schools be comprehensive, evidence-based and culturally appropriate. Although California’s public schools have made great strides in the quality of sexuality education and HIV/AIDS prevention, many districts were found to teach inaccurate information that fails to provide young people with crucial health information and violates state law. As a result of this study and a related legal case by the ACLU and American Academy of Pediatrics vs. Clovis Unified School District, as well as statewide advocacy, California’s legislators passed a new law, begun in January, 2016, requiring that all students receive comprehensive sex education throughout the state.

Selected Publications 

Trends in adolescent birth rates in California: Examining the influence of community characteristics through geographic and temporal analysis
(2020 Journal of Adolescent Health).

Perspectives on adolescent pregnancy prevention strategies in the United States: Looking back, looking forward
(2020 Adolescent Health, Medicine and Therapeutics). 

Assessing youth-friendly sexual and reproductive health services: a systematic review (2018 BMC Health Services Research).

Neighborhoods matter. A systematic review of neighborhood characteristics and adolescent reproductive health outcomes (2018 Health & Place).

A Question of Hope: Reducing Latina Teen Childbearing in California: The film aims to capture the insights, choices, and opportunities of young Latina women in California. It is based on findings from a qualitative study comparing the motivations and life experiences of pregnant and parenting Latina teen mothers to young adult Latinas having their first children (“delayers”).

Youth Community Health Assessment of Resources and Trends (CHART) Project: Needs Assessment of Fresno County and Sacramento County.

More Information

For more information on other evaluation activities see the PRL-IHPS Evaluation webpage.

For more information on additional adolescent reproductive health research at UCSF, see the UCSF Bixby Center for Global Reproductive Health webpage.

Adolescent and Young Adult Health National Resource Center

Adolescent Sexual Health Work Group

The PRL-IHPS Adolescent Sexual and Reproductive Health Research Team