Jay's World of Abstracts 00012

Jay's Introduction

I read the full version of this report months ago and I think it had steered my venturing for effective programming ever since. It can be easy (for me) to be critical of our efforts in the past and the present and how miniscule the progress might seem. This document helps me see that this is a huge problem and all effort is going to look pretty lacking. The changing of attitudes and behavior in even a few teens should be showered with praise for the accomplishment against incredible odds.

This abstract is taken from the published summary of the full report, which is available from www.teenpregnancy.org.

Abstracts

In this context, I would add that it is crucial for such leaders to understand that community-based programs are only part of the solution to the teen pregnancy challenge and that no single effort can be expected to solve this problem by itself. Teen pregnancy is, after all, a very complex problem, influenced by many factors, including individual biology, parents and family, peers, schools and other social institutions, religion and faith communities, the media, and the list goes on. In an ideal world, we would mount efforts to engage the help of all these forces, particularly popular culture, schools, faith communities, parents, and other adults. But we are a long way from doing so, and many communities mistakenly believe that modest community programs can do this single-handedly. In many instances, these programs are fragile and poorly-funded; even apparently “effective” programs often achieve only modest results; and not all teens at risk of pregnancy are enrolled in programs. The simple point is that no single approach can solve this problem alone, whether it be a national media campaign, a new move in faith communities to address this problem, or a welldesigned community program. Advocates of any single approach — especially, in the context of this review, community programs — should therefore be modest in both their promises and their expectations.

In the final analysis, professionals working with youth should not adopt simplistic solutions with little chance of making a dent on the complex problem of teen pregnancy. Instead, they should be encouraged by declining rates and new research showing that some programs are making a difference. They should continue to explore many ways to address the various causes of teen pregnancy. They should replicate those programs that have the best evidence for success, build their efforts around the common elements of successful programs, and continue to explore, develop, and evaluate innovative and promising approaches.

Now, four years later, the research findings are definitely more positive, and there are at least five important reasons to be more optimistic that we can craft programs that help to reduce teen pregnancy. First, teen pregnancy, abortion, and birth rates began to decrease about 1991 and have continued to decline every year since then. Not only have these rates maintained their downward trend, but teen birth rates are now at their lowest recorded level ever. Second, larger, more rigorous studies of some sex and HIV education programs have found sustained positive effects on behavior for as long as three years. Third, there is now good evidence that one program that combines both sexuality education and youth development (i.e., the Children’s Aid Society-Carrera Program) can reduce pregnancy for as long as three years. Fourth, both service learning programs (i.e., voluntary community service with group discussions and reflection) and sex and HIV education programs (i.e., Reducing the Risk) have now been found to reduce sexual risk-taking or pregnancy in several settings by independent research teams. Fifth, there is emerging evidence that some shorter, more modest clinic interventions involving educational materials coupled with one-on-one counseling may increase contraceptive use. All of these findings are most encouraging. Of course, it is still very challenging to design or operate programs that actually reduce adolescent sexual risk-taking and pregnancy over prolonged periods of time. However, we now know it is possible, and we have clearer guidelines for how to do it.

The Problem of Teen Pregnancy

The recent and steady decline in teen pregnancy and birth rates in the United States should provide encouragement that continued progress is possible. However, there remain compelling reasons to increase prevention efforts:

• Despite the declining rates, more than four in ten teen girls still get pregnant at least once before age 20, which translates into nearly 900,000 teen pregnancies per year.
• Despite a leveling off of sexual activity among teens, about two-thirds of all students have sex before graduating from high school — potentially exposing themselves to pregnancy and STDs.
• When teens give birth, their future prospects become more bleak. They become less likely to complete school and more likely to be single parents, for instance. Their children’s prospects are even worse — they have less supportive and stimulating home environments, poorer health, lower cognitive development, worse educational outcomes, more behavior problems, and are more likely to become teen parents themselves.
• Despite indications of better use of contraception by sexually active teens (particularly of condoms at first sex), many do not use contraceptives correctly and consistently every time they have sex.
• As a result of sexual risk-taking, about one in four sexually experienced teens contract an STD each year — some of which are incurable, including HIV, which is, of course, life-threatening.
• Despite recent encouraging trends in teen pregnancy, it is important to remember that each year a new set of teens arrives on the scene, meaning that efforts to prevent teen pregnancy must be constantly renewed. In addition, between 2000 and 2010, the population of teen girls aged 15-19 is expected to increase by nearly 10 percent — which means that even declining rates may not necessarily mean fewer numbers of teen pregnancies and births.

Because the reasons behind teen pregnancy vary, so do the types of programs adults design to combat the problem. When most people think of preventing teen pregnancy, they probably conjure images of sex or abstinence education classes or clinics that offer contraceptive services. Although the most important antecedents of teen pregnancy and childbearing relate directly to sexual attitudes, beliefs, and skills, many influential family, community, cultural, and individual factors closely associated with teen pregnancy actually have little to do directly with sex (such as growing up in a poor community, having little attachment to one’s parents, failing at school, and being depressed). In fact, one program with strong evidence for success in reducing teen pregnancy concentrates on the non-sexual antecedents of teen pregnancy. Simply put, the antecedents to teen pregnancy come in two categories: those that are sexual in nature (such as attitudes toward sex and contraception) and those that are not.

10 Characteristics of Effective Sex and HIV Education Programs

The curricula of the most effective sex and HIV education programs share ten common characteristics. These programs:

1. Focus on reducing one or more sexual behaviors that lead to unintended pregnancy or HIV/STD infection.
2. Are based on theoretical approaches that have been demonstrated to influence other health-related behavior and identify specific important sexual antecedents to be targeted.
3. Deliver and consistently reinforce a clear message about abstaining from sexual activity and/or using condoms or other forms of contraception. This appears to be one of the most important characteristics that distinguishes effective from ineffective programs.
4. Provide basic, accurate information about the risks of teen sexual activity and about ways to avoid intercourse or use methods of protection against pregnancy and STDs.
5. Include activities that address social pressures that influence sexual behavior.
6. Provide examples of and practice with communication, negotiation, and refusal skills.
7. Employ teaching methods designed to involve participants and have them personalize the information.
8. Incorporate behavioral goals, teaching methods, and materials that are appropriate to the age, sexual experience, and culture of the students.
9. Last a sufficient length of time (i.e., more than a few hours).
10. Select teachers or peer leaders who believe in the program and then provide them with adequate training.

However, there are clearer findings regarding particular clinic protocols or programs within health or family planning clinics. These programs — in which youth were provided with information about abstinence, condoms, and/or contraception; were engaged in one-on-one discussions about their own behavior; were given clear messages about sex and condom or contraceptive use; and were provided condoms or contraceptives — consistently increased the use of condoms and contraception without increasing sexual activity.

Community-Wide Initiatives with Many Components

In the past two decades, recognizing the complexity of the problem of teen pregnancy, more communities have put in place multi-component efforts to reduce rates of teen pregnancy. These initiatives typically combine such interventions as media campaigns, increased access to family planning and contraception services, sex education classes for teens, and training in parent/child communication. The research evidence on these initiatives is mixed. Each of the studies reviewed in the report measured effects on teens throughout the community, not just on those teens directly served by programs. The two most effective programs were the most intensive ones, and, in fact, when the interventions ceased, the use of condoms or pregnancy rates returned to pre-program levels, suggesting that such programs need to be maintained in order to have continuing effects. However, one of these two effective programs did not show positive results when it was tried again in a different community. The bottom line seems to be that it is very hard to change adolescent sexual or contraceptive behavior throughout an entire community. When such change is accomplished, it takes intense effort, which must be sustained.

Programs That Focus on Non-Sexual Antecedents

Programs in this category focus on broader reasons behind why teens get pregnant or cause a pregnancy, including disadvantaged families and communities, detachment from school, work, or other important social institutions, and lack of close relationships with parents and other caring adults. For instance, research suggests that teens who are doing well in school and have educa- tional and career plans for the future are less likely to get pregnant or cause a pregnancy. Increasingly, programs to prevent teen pregnancy concentrate on helping young people develop skills and confidence, focus on education, and take advantage of job opportunities and mentoring relationships with adults — thereby helping them create reasons to make responsible decisions about sex. These efforts include service learning, vocational education and employment programs, and youth development programs, broadly defined. Early childhood programs also focus on nonsexual antecedents that may have an impact on the later sexual behavior of their participants.

Youth Development Programs for Adolescents

Service Learning Programs

Service learning programs include two parts:

1. voluntary service by teens in the community (e.g., tutoring, working in nursing homes, and fixing up parks and recreation areas), and
2. structured time for preparation and reflection before, during, and after service (e.g., group discussions, journal writing, and papers).

Vocational Education Programs

Vocational education programs provide young people with remedial, academic, and vocational education sometimes coupled with assistance in getting jobs and other health education and health services. [...] Thus, these studies provide rather strong evidence that programs like these four, which offer academic and vocation education and a few support services and are quite intensive, will not decrease pregnancy or birth rates among disadvantaged teens.

So, what should communities do with this information gleaned from the research literature? Emerging Answers suggests three strategies for employing promising approaches:

1. The best option is to replicate with fidelity (that is, carefully copy) programs that have been demonstrated to be effective with similar populations of teens.
2. The next best option is to select or design programs with the common characteristics of programs that have been effective with similar populations.
3. If a community cannot do either #1 or #2, it should use a careful, deliberate process to select or design new programs and not just rely on accustomed ways of doing things. A useful strategy is to use a process adopted by many of the people who designed the effective programs reviewed above: develop logic models. A logic model (also called a causal or program model) is a concise, causal description of exactly how certain program activities can be expected to affect particular behaviors by teens. At a minimum, a logic model requires that one be specific about what behavior one wants to change. A logic model identifies in the following order: (a) the behaviors to be changed, (b) the precursors or antecedents of these behaviors (i.e., the individual, family, social, and community factors that predispose teens to risky behaviors), and (c) the particular program activities designed to change these antecedents. This way of thinking and planning usually results in programs that have clear goals and orderly and plausible plans for reaching those goals.

In the final analysis, professionals working with youth should not adopt simplistic solutions with little chance of making a dent on the complex problem of teen pregnancy. Instead, they should be encouraged by declining rates and new research showing that some programs are making a difference. They should continue to explore many ways to address the various causes of teen pregnancy. They should replicate those programs that have the best evidence for success, build their efforts around the common elements of successful programs, and continue to explore, develop, and evaluate innovative and promising approaches.