Entertainment-Education and Technology for Adolescent Sexual Health (EETASH)

PROJECT ABSTRACT The Centers for Disease Control and Prevention (CDC) reported 26 million new cases of sexually transmitted infections (STIs) in 2018, and nearly half were among youth ages 15-24. Additionally, while adolescent pregnancies have declined over the past decade, rates remain higher in the U.S. than in other developed nations. Compared to non-Hispanic White youth, Black and Latino youth (BLY) have higher rates of common STIs, of HIV, and of unintended pregnancies. Among 13-24-year-olds diagnosed with HIV in 2021, 53% and 27% were Black and Latino, compared to White (14%). Among 15-19-year-old Black and Latino youth in 2021, rates of chlamydia were 5.5 and 1.2 times higher (3,929 and 846 per 100,000) than White youth (708), and rates of gonorrhea were 11.9 and 1.4 times higher (1,610 and 188 per 100,000) than White youth (135). In 2018, births rates among Black and Latina females (ages 15-19) were 26.3 and 26.7 per 1,000, compared to 12.1 among White females. While prevention methods (e.g., condoms, non-barrier contraceptives, HIV PrEP, and STI/HIV testing) are highly effective, BLY report addressable barriers (e.g., low awareness and risk perceptions, low self- efficacy for condom negotiation, and confidentiality concerns). We propose developing a culturally-tailored, age- appropriate, and engaging intervention that combines entertainment-education (EE) and mobile health (mHealth) to increase STI/HIV testing and use of effective STI and unintended pregnancy prevention methods. This intervention will include a 30-minute entertainment-education (EE) video with characters that model the healthy behaviors as well as mHealth components that include additional skills-building videos; comprehensive information about testing and prevention strategies; tools to help individuals and couples choose the right prevention methods for them; and local resources to access sexual and reproductive health (SRH) services. The entire program, including the video and technology elements, will be available in English and Spanish. In Phase I, we will use human-centered design to develop EE and mHealth prototypes in English and Spanish with high feasibility, acceptability, usability, and likely uptake among BLY and SRH service providers and staff at organizations that would implement the intervention. Research activities will include: 1) conducting focus groups (12 groups) with BLY and 12 interviews with SRH providers to develop initial EE storylines and mHealth prototypes; 2) conducting multiple iterative rounds of rapid prototyping with BLY and SRH providers to develop pre-final EE and mHealth prototypes; 3) testing pre-final prototypes in online surveys with BLY (n=200) and SRH providers (n=25); and 4) making final refinements to the EE script using live table reads. In Phase II, we will fully develop the intervention and conduct a randomized controlled trial to evaluate it. We will commercialize the intervention by partnering with organizations, schools, universities, community clinics, and health departments nationwide.