Estimating the Early Impact of a Multi-Level, City-Wide Youth Sexual Health Initiative

Adolescence is a critical period for young people's sexual and reproductive health (SRH), emphasizing the need for support with regards to the prevention of unintended pregnancy or sexually transmitted infections. Multi-level, community-wide initiatives are a widely promoted approach to support young peoples' SRH, yet research evaluating their impact is scarce, limiting the opportunity for these initiatives to be incorporated into evidence-based practice. This study responds to this evidence gap by estimating the early effects of a city-wide youth sexual health initiative on population-level youth sexual health indicators (condom use, birth control use, combined method use, abstinence, early sex (<15 years), number of sexual partners). A quasi-experimental, difference-in-differences design with propensity weighting was employed using a nearby city as a comparison group and Youth Risk Behavior survey data from from 6,978 high school students. Estimates were generated using logistic regression. Overall, no statistically significant effects on youth sexual health indicators were detected, although the direction of non-significant findings was promising. Effect heterogeneity was detected by grade and race, suggesting that younger and Black/African American youth experienced more favorable impacts of the initiative. This study contributes to the small but growing evaluation research on multi-level, community-wide youth sexual health initiatives and provides a blueprint approach to evaluate similar initiatives using a publicly available data source. Findings highlight the potential for community-wide sexual health initiatives to address disparities in adolescent SRH, support continued effect estimation over longer time periods, and emphasize the value of culturally responsive sexual health programming.