Healthy U: Providing Effective Sexual Health Education to Incarcerated Youth

May 12, 2022

Promising new findings from a WestEd study are validating the effectiveness of Healthy U, an innovative, app-based sexual health program that addresses high rates of pregnancy among teens involved with the justice system. The findings indicate that Healthy U, which is targeted specifically to 14–19-year-old incarcerated males, has significantly and meaningfully increased positive attitudes toward condom use, increased health-protective attitudes toward sexual health behavior, and increased intentions to use condoms and birth control.

This is exciting news, says Staci Wendt, WestEd’s lead researcher on the study, because even as teen pregnancy rates overall have declined, pregnancies remain high among justice-involved youth. These young people often lack exposure to sexual health education, says Wendt, with their school attendance disrupted by cross-school transience or incarceration. But prior to Healthy U, there were no sexual health curricula specifically tailored for incarcerated teens, and males, in particular, lacked interventions. “Yet males play a big role in making sexual health decisions,” says Wendt, “and they are also more likely, compared to females, to be incarcerated and thus missing out on sex education opportunities.”

Healthy U was developed, implemented, and researched through a grant that WestEd received from the U.S. Department of Health and Human Services, Office of Population Affairs. Together with their partners Efficacity (a health education company, which led development and owns the rights to Healthy U) and the Oregon Youth Authority (OYA), WestEd helped develop the app and, over the final three years of the five-year project, conducted a rigorous cluster-randomized controlled study. The findings from that study—based on pre and post surveys of participating youth—show large effect sizes, which persisted across multiple sensitivity analyses.

The study suggests that Healthy U’s positive impact derives in part from the extensive input and feedback from the teens themselves in its design. Moreover, the program, which was delivered on a tablet during the pilot, uses engaging tech formats and affords privacy that eliminates embarrassment. By way of digital animation, video, and interactive games, the app conveys basic knowledge about biology and anatomy, addresses questions about where and how to access birth control options, and—critically—models how to talk with a partner about use of condoms and other birth control options, helping youth acquire the language to do so.

Hungry for this information, teens who get three weeks to complete the program often finish instead in days, then ask, “Can I take it again?” At the OYA pilot sites, staff are struck and gratified by this enthusiasm. They have also found Healthy U to be not only cost effective but indispensable during COVID. While other curricula require contracting with and scheduling in-person educators—impossible during pandemic shutdowns—Healthy U is at the ready anytime. “At a relatively lower cost compared to other sexual health curricula,” says Wendt, “Healthy U eliminates potential gaps in education services for these youth.”

OYA continues to use Healthy U, and interest is spreading among other juvenile justice agencies nationwide. Through Efficacity, juvenile detention facilities can learn about the program, which can now be downloaded into their systems for teen access without a tablet.

For more background, see WestEd’s 2019 R&D Alert article on Healthy U.