Background Innovative interventions to prevent persistently high rates of STIs and pregnancy among Latino youth in the U.S. are needed. We developed Yo Puedo (“I can”), a sexual health intervention that combines conditional cash transfers (CCTs) and life skills, for youth in a high-risk, urban neighbourhood.

Methods Yo Puedo targeted small social networks of youth aged 16 to 21 (both in-school and out-of-school). CCTs were tied to completion of educational goals and use of reproductive health clinical services. We conducted feasibility research through randomization of networks to Yo Puedo or an observational control arm.

Results 72 social networks comprised of 162 youth enrolled in Yo Puedo, with 92% follow-up over six months. At baseline, participants had a mean age of 17 years and one-third were foreign-born. 80% of males and 65% of females had ever had sex (p = 0.06), with males reporting a higher mean lifetime number of partners (5.8 vs. 3.1, p < 0.01). Half (58.2%) of participants had gang-affiliated close friends. Nearly all (94%) participants reported not wanting to become pregnant or get someone pregnant, yet one-third of sexually active youth reported unprotected sex in the past six months. Social networks clustered significantly (intraclass correlations ranged from 0.31–0.92) across sociodemographic and risk profile characteristics; analyses were adjusted for network clustering. 72% of youth randomised to the intervention participated: 53% received at least one CCT payment; 66% came to at least one life skills group. The median amount earned was $30 (range $0-$200). There was little evidence that cash payments financed illicit or high-risk behaviour. A higher proportion of youth who participated, compared to those who did not, had been to a reproductive health clinic at follow-up (p < 0.01).

Conclusions Yo Puedo showed promise as a sexual health intervention for high-risk, urban youth. Targeting youth’s social networks may yield sustained effects over time.