Project Summary/Abstract We propose updating, piloting and testing a socialization and sex education curriculum (STEPS-2) designed for adolescents and young adults with intellectual and developmental disabilities (I/DD). We will test this updated curriculum in a randomized controlled trial (RCT) among 856 adolescents and young adults (aged 18- 27 years) with mild to moderate I/DD who receive services from disability providers in four of the five Developmental Disabilities Regions of the New York State Office for People with Developmental Disabilities. Randomization will be stratified by region, sex (male/female) and age (18-22, 23-27). Half of the participants will be randomized to receive the updated STEPS-2 socialization and sex education curriculum in individualized sessions during home visits, and the other half will receive a group-based intervention on physical exercise and nutrition in a local community center; only one roommate will be eligible to be enrolled from any group living arrangement to minimize spillover effects. Regional Coordinat ors will provide the 6-week long interventions, with interview data collected at baseline (prior to intervention), month 2 (completion of intervention), month 6 and month 12. We project completing recruitment into the RCT during the second quarter of year 3, and completion of month 12 assessments in the third quarter of year 4. The primary outcome will be proportion of participants reporting having had a conversation about sex/reproductive health with a medical provider by month 12, with secondary outcomes including HPV vaccination status, receipt of sex and age-specific preventive health screening, social sexual behaviors, agency over decisions, and, among those sexually active, use of contraception (if not desiring a pregnancy), and use of sexually transmitted infection/HIV protection. Interim measures will be used to assess knowledge and to reduce the likelihood of recall bias for the primary endpoint. Specifically, we aim to: (1) Update and pilot an existing socialization and sex education curriculum (STEPS-2) for 18-27 year olds with I/DD in New York State through a participatory process centering the voices of diverse lived experiences; (2) Test the efficacy of this socialization and sex education curriculum in a randomized intervention trial using intention-to-treat and instrumental variable analyses to adjust for compliance. We hypothesize that at least an additional 10% of the individuals in the experimental group will have had a reproductive health discussion with a medical provider by month 12 compared with the control group; and (3) Test whether the efficacy of the intervention differs by sex and age in stratified analyses. We have powered the study for sex-specific efficacy estimates and will explore whether efficacy differs by age. The findings from this translational study will inform practitioners, advocates, and self-advocates about best practices for reproductive and sexual health education for adolescents and young adults with I/DD as they transition to adulthood.

Project Narrative In the United States, adolescents and young adults with intellectual and developmental disabilities (I/DD) are less likely to receive comprehensive sex education and to use reproductive health services than their non- disabled peers. We will test the efficacy of the STEPS-2 socialization and sex education program on increased access to reproductive health services for individuals aged 18-27 with mild to moderate I/DD in a randomized intervention trial. As one of the first such randomized trials among this population, the findings will inform best practices in sex education to improve the reproductive health of youth with I/DD as they transition from adolescence to adulthood, as well as best practices for incorporating individuals with I/DD in public health research.