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<title>Jay's World of Abstracts 00012: Emerging Answers</title>
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Answers: Research Findings on Programs to reduce Teen Pregnancy' by Douglas Kirby, Ph.D.">
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<h2 align="right">Jay's World of Abstracts 00012</h2><hr>
<div align="center"><h1>Emerging Answers</h1>
A Summary of Research Findings on Programs to reduce Teen Pregnancy<br>
by Douglas Kirby, Ph.D.</div>
<hr>
<i>[Standard disclaimer: The nature of abstracts are that they are pieces of something larger. Not everyone is going to be happy with my choice of abstracts from any larger work, so if you are dissatisfied, I would refer you to the original document, which should be able to be found on the Internet. I encourage others to make their own abstracts to satisfy their needs.</i>
<h3>Jay's Introduction</h3>
<p>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.</p>
<p>This abstract is taken from the published summary of the full report, which is available from <a href="
http://www.teenpregnancy.org">www.teenpregnancy.org</a>.</p>
<i>I produced this abstract using time paid for by the Quay County Maternal Child and Community Health Council with funds from the New Mexico Department of Health.</i>
<hr>
<h3>Abstracts</h3>
<i>[Page iii-iv]</i>
<p>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.</p>
<p>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.</p>
<i>[Page v-vi]</i>
<p>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.</p>
<i>[Page 3-4]</i>
<h3>The Problem of Teen Pregnancy</h3>
<p>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:
<ul>
<li>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.</li>
<li>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.</li>
<li>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.</li>
<li>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.</li>
<li>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.</li>
<li>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.</li>
</ul>
<i>[Page 5]</i>
<p>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.</p>
<i>[Page 10]</i>
<h3 align="center">10 Characteristics of Effective Sex and HIV
Education Programs</h3>
<p>The curricula of the most effective sex and HIV education
programs share ten common characteristics. These programs:
<ol><li>Focus on reducing one or more sexual behaviors that lead to
unintended pregnancy or HIV/STD infection.</li>
<li>Are based on theoretical approaches that have been demonstrated
to influence other health-related behavior and identify specific
important sexual antecedents to be targeted.</li>
<li>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.</li>
<li>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.</li>
<li>Include activities that address social pressures that influence sexual
behavior.</li>
<li>Provide examples of and practice with communication, negotiation,
and refusal skills.</li>
<li>Employ teaching methods designed to involve participants and
have them personalize the information.</li>
<li>Incorporate behavioral goals, teaching methods, and materials that
are appropriate to the age, sexual experience, and culture of the
students.</li>
<li>Last a sufficient length of time (i.e., more than a few hours).</li>
<li>Select teachers or peer leaders who believe in the program and
then provide them with adequate training.</li></ol>
Generally speaking, short-term curricula � whether abstinenceonly
or sexuality education programs � do not have measurable
impact on the behavior of teens.</p>
<i>[Page 11]</i>
<p>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.</p>
<i>[Page 12-13]</i>
<h3>Community-Wide Initiatives with Many Components</h3>
<p>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.</p>
<h3>Programs That Focus on Non-Sexual Antecedents</h3>
<p>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.</p>
<i>[Pages 13-15]</i>
<h3>Youth Development Programs for Adolescents</h3>
<h4>Service Learning Programs</h4>
<p>Service learning programs include two parts: <ol><li>voluntary
service by teens in the community (e.g., tutoring, working in
nursing homes, and fixing up parks and recreation areas), and <li>structured time for preparation and reflection before, during, and
after service (e.g., group discussions, journal writing, and papers).</ol>
Sometimes the service is part of an academic class. Service learning
programs may have the strongest evidence of any intervention
that they reduce actual teen pregnancy rates while the youth
are participating in the program. Among the programs with the
best evidence of effectiveness are the <i>Teen Outreach Program</i> and
<i>Reach for Health</i> service learning program. Although the research
does not clearly indicate why service learning is so successful, several
possibilities seem plausible: participants develop relationships
with program facilitators, they gain a sense of autonomy and feel
more competent in their relationships with peers and adults, and
they feel empowered by the knowledge that they can make a difference
in the lives of others. All such factors, in turn, may help
increase teenagers� motivation to avoid pregnancy. In addition,
participating in supervised activities � especially after school �
may simply reduce the opportunities teens have to engage in
risky behavior, including unprotected sex.</p>
<h4>Vocational Education Programs</h4>
<p>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. <i>[...]</i> 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.</p>
<i>[Page 18-19]</i>
<p>So, what should communities do with this information
gleaned from the research literature? Emerging Answers suggests
three strategies for employing promising approaches:
<ol><li>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.
<li>The next best option is to select or design programs with the
common characteristics of programs that have been effective
with similar populations.
<li>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.</ol></p>
<p>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.</p>
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