Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Corrine Williams

Committee Member

Dr. Mark Swanson

Committee Member

Dr. Robin Vanderpool


West Virginia has the 8th highest rate of adolescent pregnancy in the United States and the rate in Wayne County is significantly higher. Adolescent pregnancies cause negative health outcomes for both the baby and the mother. Adolescent mothers are at an increased risk of anemia, preeclampsia, and preterm labor and babies born to adolescent mothers are more likely to have a low birth weight and to have cognitive impairment. To address this burden, the school board has decided to use the ADAPT-ITT framework on the evidence-based Love Notes adolescent pregnancy prevention curriculum to adapt it to be more culturally relevant to the white, rural population of Wayne County, West Virginia. Marshall University faculty, the Wayne County Health Department, and practitioners from Valley Health Clinics will advise the adaptation process and assist with implementation. The adapted curriculum will be integrated into the 9th grade health class and delivered at the three Wayne County high schools. Health teachers at each school will be trained to deliver the Love Notes curriculum and fidelity will be monitored using audio-visual recordings and standardized scoring included with the program. Formative evaluation measures will include students, teachers, and administrators’ preferences about adaptations to be made as well as acceptability, likeability, and relevancy of the program. Process evaluation measures will include student engagement and participation, student dosage of intervention, and teacher engagement and participation including fidelity. Primary outcome evaluations will be assessed using an interrupted time series with a historic cohort control study design. Short-term outcomes include knowledge and attitudes about contraceptive use, healthy relationships, and sexual harassment/assault. Medium-term outcomes are delayed initiation of first sexual encounter, reduced sexual activity, reduced sexual partners, and increased use of contraceptives. The long-term outcome is decreased rates of adolescent pregnancy

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