Editor’s Note: Elizabeth Zeichner is a former high school teacher and third-year medical student at Emory University School of Medicine. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
It is important to ask about sexual practices with all your adolescent patients, including those who identify as a sexual minority. Even though it may seem counterintuitive, adolescent girls who identify as LGB+ (lesbian, gay, or bisexual) are 2-4 times more likely than heterosexual girls to become pregnant. However, there is a dearth of LGB+ inclusive pregnancy prevention programs.
This week, Pediatrics is early releasing an article, “One-year Follow-up After a Pregnancy Prevention Intervention for LGB+ Teens: An RCT,” by Michele Ybarra, PhD and colleagues at Center for Innovative Public Health Research in San Clemente, California (10.1542/peds.2022-059172). This article reports on a comprehensive mobile health pregnancy prevention program–Girl2Girl–that is the first to be aimed towards LGB+ teen girls.
In the study, 14–18-year-old cisgender LGB+ girls were randomized to receive either the Girl2Girl intervention group or an attention-matched control intervention about non-sexual health topics for 5 months. Content was tailored to each girl based on their sexual identity and prior sexual experiences. The Girl2Girl intervention used an Information-Motivation-Behavioral Skills (IMB) model to determine the content of messaging that participants received about pregnancy prevention. These messages included:
- Information about how people become pregnant and how to prevent it
- Motivations to avoid becoming pregnant (for example, reasons for using condoms)
- Behavioral skills to navigate situations with partners
The authors delivered this information in multiple ways, including:
- Text messages, with links to videos
- Access to an “advice channel”
- Awarding of “badges” when participants demonstrated specific behaviors
- Providing each participant a “Text Buddy,” who is also enrolled in the intervention, to provide mutual support
Over the 12 months after completing the intervention, participants enrolled in Girl2Girl had higher rates of “protected penile-vaginal sex events” and were more likely to use birth control methods besides condoms. One interesting outcome was that the “rate of condom-protected sex acts for the intervention versus control was the highest at 12 months,” which is longer than the 5-month period of intervention. This sustained behavior change suggests that the multiple modalities used in this intervention were enough to lead to longer-term behavior change among adolescents. As interventions were framed in a sex-positive way, rather than being focused on abstinence or delayed onset of sexual behaviors, they were able to identify safe sexual behaviors as they followed participants over time.