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Girl2Girl

Developers

The Center for Innovative Public Health Research

Program Summary

Girl2Girl is a 20-week teen pregnancy prevention program delivered via text messaging to cisgender girls between the ages of 14 to 18 who identify as lesbian, bisexual, or queer ('cisgender' refers to individuals whose current gender identity is the same as the sex they were assigned at birth; CDC, 2023). Girl2Girl content focuses on teen pregnancy prevention, sexually transmitted infection (STI) testing, communication skills, and healthy and unhealthy relationships. In addition to receiving program content, participants have the option to be paired with another participant (a Text Buddy) they can text for support throughout the program.

Intended Population

Girl2Girl was designed for sexually experienced and inexperienced cisgender girls between the ages of 14 to 18 who identify as lesbian, bisexual, or queer. The program was evaluated with young women between the ages of 14 to 17 who identify as lesbian, bisexual, or queer.

Program Setting

Girl2Girl is designed for and evaluated in any setting via text messaging. Text messages will be sent only during specified non-school hours.

Contact and Availability Information

For curriculum, materials, and pricing information, please contact:
Michele Ybarra, Ph.D., at michele@innovativepublichealth.org.

For training and support, please contact:
Michele Ybarra, Ph.D., at michele@innovativepublichealth.org.

Sample of Curriculum Available for Review Prior to Purchase

Yes

Languages Available

English

Monitoring and Evaluation Tools

Monitoring and evaluation tools available

Monitoring and evaluation tool usage required

Program Core Components

Last updated in 2023

The data presented on this page reflects responses from the program’s developer or distributor to a program component checklist that asked them to report on the individual components within their TPP program. The same program component checklist was sent to the developer or distributor of every active TPP program with evidence of effectiveness. The program component table provides data on seven types of program components including content, delivery mechanism, dosage, staffing, format, environment, and intended population characteristics; whether the component was present or optional in the program; whether the component is considered to be core to the program; and the lesson number or activity where the component can be found in the program. For more details, refer to the FAQ.

Category	Component	Core Component	Component present	Notes
Content	Substance use cessation		No
Content	Boundary setting/refusal skills	Yes	Yes (both versions)
Content	Child development		No
Content	Communication skills	Yes	Yes (both versions)
Content	Conflict resolution/social problem solving	Yes	Yes (both versions)
Content	Connections with trusted adults		No
Content	Cultural values		No
Content	Gender identity		No
Content	Gender roles	No	Yes (both versions)	We talk about how some lesbian and bi girls feel hypersexualized by society
Content	Leadership		No
Content	Normative beliefs	Yes	Yes (both versions)
Content	Parenting skills		No
Content	Social competence	No	No
Content	Social influence/actual vs. perceived social norms	Yes	Yes (both versions)
Content	Social support/capital	No	Yes (both versions)
Content	Morals/values		No
Content	Spirituality		No
Content	Volunteering/civic engagement		No
Content	Other	No	No
Delivery mechanism	Method: Anonymous question box		No
Delivery mechanism	Method: Artistic expression		No
Delivery mechanism	Method: Assessment/survey		No
Delivery mechanism	Method: Booster session	No	Yes (both versions)
Delivery mechanism	Method: Case management		No
Delivery mechanism	Method: Cognitive behavioral therapy (CBT)		No
Delivery mechanism	Method: Demonstration	Yes	Yes (both versions)	Via videos
Delivery mechanism	Method: Discussion/debrief		No
Delivery mechanism	Method: Family session		No
Delivery mechanism	Method: Game		No
Delivery mechanism	Method: Home visiting		No
Delivery mechanism	Method: Homework assignment		No
Delivery mechanism	Method: In-session assignment	No	Yes (both versions)	We have a brief weekly quiz (1 question and if you don't get it right, 1 more question)
Delivery mechanism	Method: Introduction	Yes	Yes (both versions)	The first several days are about what the program is and how it works
Delivery mechanism	Method: Lecture	Yes	Yes (both versions)	Most of the messages are didactic
Delivery mechanism	Method: Motivational interviewing	No	Yes (both versions)	Some of the badge messages utilize MI
Delivery mechanism	Method: Music		No
Delivery mechanism	Method: Parent-focused activity		No
Delivery mechanism	Method: Peer-to-peer		Yes (both versions)	Our Text Buddy component is meant to give youth opportunities to process program components together
Delivery mechanism	Method: Public service announcement
Delivery mechanism	Method: Reading	Yes	Yes (both versions)	The messages are text
Delivery mechanism	Method: Role play/Practice	No	Yes (both versions)	Teens are encouraged to talk through some scenarios with their text buddy
Delivery mechanism	Method: Self-guided activity	Yes	Yes (both versions)	They are encouraged to practice putting a condom on a dildo or banana on their own
Delivery mechanism	Method: Service learning		No
Delivery mechanism	Method: Slide show		No
Delivery mechanism	Method: Social media		No
Delivery mechanism	Method: Spiral learning		No
Delivery mechanism	Method: Storytelling		No
Delivery mechanism	Method: Text message	Yes	Yes (both versions)
Delivery mechanism	Method: Video	No	Yes (both versions)	We use videos to enhance the text where appropriate (e.g., a video about how to put on a condom)
Delivery mechanism	Method: Other

Program Objectives

The goal of Girl2Girl is to provide content on teen pregnancy prevention, STI, communication skills, and healthy and unhealthy relationships to cisgender girls between the ages of 14 to 18 who identify as lesbian, bisexual, or queer.

Program Content

Girl2Girl content focuses on teen pregnancy prevention and is guided by the Information-Motivation-Behavioral model. Topics covered through scripted text messages include male and female condom use and access, types of birth control, healthy and unhealthy relationships, and prevention of unintended pregnancy and STI. Additional content includes topics and scenarios relevant to sexual decision making. The program’s content is tailored based on sexual experience and sexual identity. In addition to receiving program content, participants are paired with another participant (a Text Buddy) they can text for support throughout the program.

Program Methods

The program is delivered through text messages.

Program Structure and Timeline

Girl2Girl is a 20-week teen pregnancy prevention program. During the first seven weeks of programming, participants receive four to 12 text messages per day. They then receive one message two or three days per week for the following 12 weeks. The final week of programming is the booster period, which is intended for review of content delivered during program delivery. Participants receive eight to 15 messages during the one-week booster period. All Text Buddy messages are run through a server to protect participants’ privacy.

Staffing

Staffing needed to implement the program includes staff to monitor the Text Buddy conversations, answer participant questions, and recruit and enroll participants.

Staff Training

Formal staff training is not required to implement the program. Staff will monitor the Text Buddy conversations, answer participant questions, and recruit and enroll participants.

Program Materials and Resources

Participants are required to have access to a text-capable phone. Unlimited text messaging plans are encouraged but not required.

Additional Needs for Implementation

None.

Fidelity

The developer will ensure when text messages are sent and their receipt by the intended recipient.

Technical Assistance and Ongoing Support

Girl2Girl is a texting intervention; typically, implementers do not need technical assistance or ongoing support during program implementation. However, implementers can contact Michele Ybarra at michele@innovativepublichealth.org if there is a need for technical assistance or ongoing support.

Allowable Adaptations

Adaptations are allowed in consultation with the developer. To discuss adaptations, contact Michele Ybarra at michele@innovativepublichealth.org.

Adaptation Guidelines or Kit

Reviewed Studies

Citation	High-Quality Randomized Trial	Moderate-Quality Randomized Trial	Moderate-Quality Quasi-Experiment	Low Study Rating	Did Not Meet Eligibility Criteria
Ybarra 2021 Ybarra 2023 Ybarra 2023b	✓

Study Characteristics

Citation	Setting	Majority Age Group	Majority Racial/Ethnic Group	Gender	Sample Size
Ybarra 2021 Ybarra 2023 Ybarra 2023b	Texting	14 to 17	White	Young women	948

Study Findings

Evidence by Outcome Domain and Study

Citation	Sexual Activity	Number of Sexual Partners	Contraceptive Use	STIs or HIV	Pregnancy
Ybarra 2021 Ybarra 2023 Ybarra 2023b		n.a.		n.a.

KEY

Evidence Indication

Favorable findings

Potentially favorable findings

Indeterminate findings

Conflicting findings

Potentially unfavorable findings

Unfavorable findings

Note: n.a. indicates the study did not examine any outcome measures within that particular outcome domain, or the study examined outcome measures within that domain but the findings did not meet the review evidence standards.

Detailed Findings

Citation Details

Citation	Details
Ybarra 2021 Ybarra 2023 Ybarra 2023b	The program was evaluated using a randomized control trial involving cisgender female youth ages 14 to 18 identifying as not exclusively heterosexual, who were recruited across the United States through Facebook and Instagram advertisements. Participants were randomly assigned to either a treatment group that received the 20-week Girl2Girl program or a control group that received similarly intense text messaging for the same length of time with content that was not focused on preventing teen pregnancy. Surveys were administered immediately after enrollment, which was right before the program started (baseline), immediately after the 20-week program ended (five months after study enrollment), and then three months, six months, nine months, and 12 months since program end (eight months, 11 months, 14 months, and 17 months after study enrollment). The study found that at program end, teen girls participating in the program reported having used condoms while having sex significantly more often than the control group had in the past three months (effect size = 0.03) and reported significantly fewer sex acts without a condom in the past three months (effect size = -0.05). Those program effects held for the full sample and the subgroup that was sexually active at baseline (effect sizes = 0.05 and -0.29, respectively, for the subgroup on condom use during sex and having fewer sex acts without a condom). The study also found that at program end, teen girls participating in the program and those in the control group were not significantly different from each other in their reporting of abstaining from penile-vaginal sex in the past three months. Those null findings held for the full sample and the subgroup that was sexually active at baseline. In addition, the study found that for the full sample and the sexually active subgroup, at program end, teen girls participating in the program and those in the control group were not significantly different from each other in their report of pregnancy since program enrollment. The study also examined program impacts at three, six, nine, and 12 months after the program ended on several sexual behavior outcomes for the full sample as well as some subgroups. Findings for these outcomes were not considered because of the inclusion of a covariate that could have been affected by the program, introducing a concern about endogeneity. Additionally, the study examined program impacts on current birth control use (outside of sexual activity), intentions to use condoms, intentions to use birth control, and intentions to abstain from sex. Findings for these outcomes were not considered because they fell outside the scope of the review.

Ybarra 2021

Ybarra 2023

Ybarra 2023b

The program was evaluated using a randomized control trial involving cisgender female youth ages 14 to 18 identifying as not exclusively heterosexual, who were recruited across the United States through Facebook and Instagram advertisements. Participants were randomly assigned to either a treatment group that received the 20-week Girl2Girl program or a control group that received similarly intense text messaging for the same length of time with content that was not focused on preventing teen pregnancy. Surveys were administered immediately after enrollment, which was right before the program started (baseline), immediately after the 20-week program ended (five months after study enrollment), and then three months, six months, nine months, and 12 months since program end (eight months, 11 months, 14 months, and 17 months after study enrollment).

The study found that at program end, teen girls participating in the program reported having used condoms while having sex significantly more often than the control group had in the past three months (effect size = 0.03) and reported significantly fewer sex acts without a condom in the past three months (effect size = -0.05). Those program effects held for the full sample and the subgroup that was sexually active at baseline (effect sizes = 0.05 and -0.29, respectively, for the subgroup on condom use during sex and having fewer sex acts without a condom).

The study also found that at program end, teen girls participating in the program and those in the control group were not significantly different from each other in their reporting of abstaining from penile-vaginal sex in the past three months. Those null findings held for the full sample and the subgroup that was sexually active at baseline. In addition, the study found that for the full sample and the sexually active subgroup, at program end, teen girls participating in the program and those in the control group were not significantly different from each other in their report of pregnancy since program enrollment.

The study also examined program impacts at three, six, nine, and 12 months after the program ended on several sexual behavior outcomes for the full sample as well as some subgroups. Findings for these outcomes were not considered because of the inclusion of a covariate that could have been affected by the program, introducing a concern about endogeneity.

Additionally, the study examined program impacts on current birth control use (outside of sexual activity), intentions to use condoms, intentions to use birth control, and intentions to abstain from sex. Findings for these outcomes were not considered because they fell outside the scope of the review.

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