Yo Puedo—A Conditional Cash Transfer and Life Skills Intervention to Promote Adolescent Sexual Health: Results of a Randomized Feasibility Study in San Francisco

Abstract

Purpose We designed and evaluated for feasibility an intervention - Yo Puedo - that addresses social network influences and socioeconomic opportunities in a neighborhood with substantial gang exposure and early childbearing. Methods Yo Puedo combined conditional cash transfers for completion of educational and reproductive health wellness goals with life skills sessions, and targeted youth 16 to 21 years old and same-aged members of their social network. We conducted a 2-arm study with social networks randomized to the intervention or a standard services control arm. We evaluated intervention uptake, adherence and safety; and assessed evidence of effects on behavioral outcomes associated with unintended pregnancy and STI risk. Results Seventy-two social networks comprised of 162 youth enrolled, with 92% retention over six months. Seventy-two percent of youth randomized to the intervention participated in intervention activities: 53% received at least one CCT payment; and 66% came to at least one life skills session. We found no evidence that cash payments financed illicit or high-risk behavior. At six months, intervention participants, compared to controls, had a lower odds of hanging out on the street frequently (OR = 0.54, p = 0.10) and a lower odds of reporting their close friends had been incarcerated (OR = 0.6, p=0.12). They reported less regular alcohol use (OR = 0.54, p=0.04) and a lower odds of having sex (OR = 0.50, p = 0.04). Conclusions The feasibility evaluation of Yo Puedo demonstrated its promise; a larger evaluation of effects on pregnancy and sustained behavioral changes is warranted.

A global comprehensive review of economic interventions to prevent intimate partner violence and HIV risk behaviours

“…Two studies were conducted in sub-Saharan Africa (SSA) [40,41] and one in the USA [42]. In general study design was rigorous, using RCTs in two studies [40,41] and a quasi-experimental design in the other [42].…”

“…In Malawi a study focused on incentivising maintaining HIV status over 12 months for women and men (if HIV-negative at start, maintaining this; if HIV-positive, they automatically received the cash transfer at the end) [41]. Finally, in the USA, a study provided cash transfers on progression through a series of health checks and training programmes [42]. All three studies focused on women and men, 16 years old and older.…”

“…But, when women and men were given the incentive, HIV risk behaviours reduced for women and increased for men [41]. In the USA, the combination of incentives linked to accessing services and progression in training programmes reduced the likelihood that participants had sex [42].

Economic strengthening interventions

…”

Homies with Aspirations and Positive Peer Network Ties: Associations with Reduced Frequent Substance Use among Gang-Affiliated Latino Youth

“…35,36 Yo Puedo was delivered to clusters of small peer networks and is part of a community-based research program, spanning the last 10 years, with Latino youth, community agencies, and high school Wellness Centers in San Francisco's Mission District.…”

Examining subgroup effects by socioeconomic status of public health interventions targeting multiple risk behaviour in adolescence

“…least assertive individualsKim 2011 [86]Middle School SuccessGirls in foster care, who are about to enter middle schoolKitzman 2010 [87]Nurse Family Partnership 2Females less than 29 weeks gestation, with socio-demographic risk characteristicsKomro et al 2008 [88]Project northlandUrban, multi-ethnic and low-income populationLewis 2013 [89]Positive Action (Chicago)Undergraduates engaged in alcohol or sexual risk behaviourLi 2002 [90]imPACTAfrican-American parent-adolescent dyadsLochman 2003 [91]Coping Power 1Targeted at children at risk of aggressive/disruptive behaviourLochman 2004 [92]Coping Power 2Targeted at boys at risk of aggressive or disruptive behaviourLoSciuto 1999 [93]Woodrock Youth Development ProjectDeprived community, with large % of children from families receiving financial assistance from stateMarsden et al 2006 [94]MarsdenUsers of ecstasy, crack cocaine or powder cocaineMcBride-Murray 2014 [95]SAAFRural African AmericanMcCambridge et al 2011 [96]Motivational interviewing 2011Mainly those who had not completed Level 2 education (i.e. not achieved conventional measure of educational attainment on completion of compulsory schoolingMilburn 2012 [97]STRIVENewly homeless youth and their familiesMinnis 2014 [98]Yo PuedoLatino participants aged 16–21 years, residing in San FranciscoMonti 1999 [99]Alcohol Screen and B.I. 1Individuals aged 18–19 years, with drink-related emergency department attendancesMorris 2003 [100]Self-Sufficiency ProjectTargeted at low income single parent families from 2 Provinces in CanadaNewton et al 2009 [101]Climate schoolsIndependent (private) schoolsNirenberg 2013 [102]ROADTargeted to youth with a high risk driving or alcohol prior drug-related police chargeNores 2005 [103]High/Scope PerryHigh risk childrenPalinkas et al 1996 [104]Social skills trainingPregnant and non-pregnant...…”