A population based method of program targeting: Lessons learned from California adolescent sexual health programs

Two common goals of adolescent sexual health programs are to reduce outcome incidence (e.g., prevent unintended pregnancies) and to reduce disparities (e.g., prevent unintended pregnancies in specific populations). However, there is limited literature to guide federal, state or local entities on effective methods for targeting programs to reach these goals.

California has a long history of successful programming, most commonly implemented by supporting local capacity guided by a funding formula. In this presentation, we share a method for creating an index from publically available quantitative data to target local areas in need of adolescent sexual health programming. We utilized small-area geographical targeting, and weighted incidence (i.e., number of births) and disparity indicators (e.g. repeat adolescent births, gonorrhea rate, concentrations of poverty and racial isolation, community rural status) to calculate a needs-based score for program targeting.

Applied to a recent adolescent sexual health funding formula, the current method effectively captures 77% of the adolescent births, 78% of the cases of gonorrhea, 87% of youth in concentrated poverty, 93% of racially isolated youth and 57% of rural youth in California. In comparison, a commonly applied funding criterion captured just 38% of adolescent births, 24% of gonorrhea cases, 27% of youth in concentrated poverty, and 37% of racially isolated youth. A similar percentage of rural youth (54%), however, were captured.

Using a simple relative-risk methodology combining surveillance and population data, funders can improve their program targeting effectiveness and increase the likelihood of reaching youth with the greatest need for sexual health services.