Emerging Answers 2007:

1. Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases By Doulgas Kirby, PH.D. Presenter:

2. This Presentation Will Cover: About the National Campaign Latest data on teen pregnancy Risk and protective factors Characteristics of effective programs Programs that work to prevent teen pregnancy Implications for the field

3. The National Campaign to Prevent Teen and Unplanned Pregnancy • The Campaign’s mission is to improve the well-being of children and families, and in particular, to help ensure that children are born into stable, two-parent families who are committed to and ready for the demanding task of raising the next generation by preventing teen pregnancy • Our specific strategy is to prevent teen pregnancy and unplanned pregnancy among single, young adults

4. 2 in 10 by 2015! New Goal • We celebrated our 10th anniversary in 2005 and set a new national goal: another 1/3 reduction in the teen pregnancy rate over the coming decade • We challenge states to set their own goals

5. Our Strategy Research Research Influence cultural Influence cultural values and messages values and messages Unusual Unusual Partners Partners The NC Teen Voices Teen Voices Strengthen Strengthen state & local programs state & local programs Tolerance & Tolerance & Bipartisanship Bipartisanship

6. Overview of Emerging Answers 2007 • Summarizes the research on • Sexual risk behaviors, factors of influence and consequences • Characteristics of effective programs • What programs and strategies work to prevent teen pregnancy and sexually transmitted diseases (STDs)

7. Teen Pregnancy • 3 in 10 teen girls get pregnant at least once before their 20th birthday • In the U.S. more than 750,000 teen girls were pregnant in 2002 alone

8. National Teen (15- 19) Pregnancy Rates, 1972-2002

9. Teen Pregnancy Rates by Race/Ethnicity, 1990-2002 Birth rates per 1,000 teen girls

10. Teen Birth Rates in the United States, 1940 – 2006* Birth rates per 1,000 teen girls *Data for 2006 are preliminary

11. Teen Birth Rates by Race/Ethnicity 1980-2006* Birth rates per 1,000 teen girls *Data for 2006 are preliminary

12. Sexual Activity • In 2005, about half (47 %) of all high school students reported they have had sexual intercourse • Among high school students, • 68 % of African American, • 51 % of Hispanic, and • 43 % of whites Reported they had ever had sexual intercourse

13. Contraceptive Use • Three quarters of teen girls (74%) and more than eight in ten teen boys (82%) report using contraception the first time they have sex • 83% of teen girls and 90% of teen boys report using contraception the last time they had sex • Condoms and oral contraceptives are the two most commonly used methods of contraception

14. Behaviors that Affect Teen Pregnancy and STD • Teens can avoid pregnancy and reduce the risk of STDs/HIV by: • Abstaining from sex • Limiting the number of sexual partners • Increasing amount of time between sexual partners • Reducing the frequency of sex, using condoms, and being tested and treated for STDs • Being vaccinated against hepatitis B and HPV (human papillomavirus)

15. Behaviors that Affect Teen Pregnancy and STD • In order to effectively reduce teen pregnancy and STDs/HIV communities and organizations should specifically target one or more of the behaviors identified in the previous slide • Communities and organizations should review data on: • Pregnancy and STD rates • Sexual behavior among teens • Cultural beliefs and values • Existing education programs and resources

16. Risk and Protective Factors • More than 500 factors are known to increase (risk factors) or decrease (protective factors) the chances that teens will engage in risky sexual behavior • Some factors involve sexuality directly; others affect sexuality indirectly

17. Risk and Protective Factors • Risk and protective factors are rooted in: • Communities (e.g. exposure to violence and substance use) • Families (e.g. the presence of both biological parents, parents who express and model responsibility values about sex and contraception, a close relationship with parents) • Friends and peers (e.g. poor performance in school, drug use, permissive and unprotected sex) • Romantic partners (e.g. an older boy friend) • Teens themselves (e.g. values, attitudes, perceptions of peer norms, self-efficacy, and intentions about sex or the use of contraception)

18. Risk and Protective Factors • Teen’s own sexual beliefs, values, and attitudes are the factors most strongly related to sexual behavior • Some factors can be more easily modified through programmatic interventions than others • Organizations concerned with preventing teen pregnancy and STDs should focus on the factors most strongly related to sexual behavior

19. Characteristics of Effective Programs • The process of developing the curriculum • The contents of the curriculum itself • The process of implementing the curriculum

20. The Process of Developing the Curriculum • Involved multiple people with expertise in theory, research, and sex and STD/HIV education to develop the curriculum • Assessed relevant needs and assets of the target group • Used a logic model approach that specified the health goals, the types of behavior affecting those goals, the risk and protective factors affecting those types of behavior, and activities to change those risk and protective factors

21. The Process of Developing the Curriculum 4. Designed activities consistent with community values and available resources (e.g. staff time, staff skills, facility space and supplies) 5. Pilot-tested the program

22. The Contents of the Curriculum Itself—Curriculum Goals and Objectives— 6. Focused on clear health goals—the prevention of STD/HIV, pregnancy, or both 7. Focused narrowly on specific types of behavior leading to these health goals (e.g. abstaining from sex or using condoms or other contraceptives), gave clear messages about these types of behavior, and addressed situations that might lead to them and how to avoid them

23. The Contents of the Curriculum Itself —Curriculum Goals and Objectives— 8. Addressed sexual psychosocial risk and protective factors that affect sexual behavior (e.g. knowledge, perceived risks values, attitudes, perceived norms, and self-efficacy) and changed them

24. The Contents of the Curriculum Itself—Activities and Teaching Methodologies— 9. Created a safe social environment for young people to participate 10. Included multiple activities to change each of the targeted risk and protective factors 11. Employed instructionally sound teaching methods that actively involved participants, that helped them personalize the information, and that were designed to change the targeted risk and protective factors

25. The Contents of the Curriculum Itself—Activities and Teaching Methodologies— 12. Employed activities, instructional methods, and behavioral messages that were appropriate to the teen’s culture, developmental age, and sexual experience 13. Covered topics in a logical sequence

26. The Process of Implementing the Curriculum 14. Secured at least minimal support from appropriate authorities, such as departments of health, school districts, or community organizations 15. Selected educators with desired characteristics (whenever possible), trained them, and provided monitoring supervision, and support

27. The Process of Implementing the Curriculum 16. If needed, implemented activities to recruit and retain teens and overcome barriers to their involvement (e.g. publicized the program, offered food or obtained consent) 17. Implemented virtually all activities with reasonable fidelity

28. Effective Programs

29. What was the Criteria for Inclusion in Emerging Answers 2007? • Completed or published between 1990 and 2007 • Conducted in the United States • Targeted middle/high school age teens • Employed an experimental or quasi-experimental design with appropriate statistical analyses • Had a sample size of at least 100 in the combined treatment and control group • Measured impact on teen sexual behavior

30. Emerging Answers 2007 identifies: • 115 program evaluations overall • 15 programs with strongest evidence of success

31. Curriculum-Based Sex and STD/HIV Education Programs • Based on written curriculum • Implemented among groups of young people in school, clinic, or community settings • Education programs focused on both behavior and risk and protective factors that mediate behavior

32. Curriculum-Based Sex and STD/HIV Education Programs Programs with strongest evidence of success: • Becoming a Responsible Teen: An HIV Risk reduction Program for Adolescents • ¡Cuídate! (Take Care of Yourself) The Latino Youth Health Promotion Program • Draw the Line, Respect the Line

33. Curriculum-Based Sex and STD/HIV Education Programs 4. Making Proud Choices: A Safer Sex Approach to HIV/STDs and Teen Pregnancy Prevention 5. Reducing the Risk: Building Skills to Prevent Pregnancy, STD & HIV 6. Safer Choices: Preventing HIV, Other STD, and Pregnancy 7. SiHLE: Sistas, Informing, Healing, Living, Empowering

34. Curriculum-Based Sex and STD/HIV Education Programs: Examples Reducing the Risk • For youth in 9th and 10th grade; variety of racial/ethnic backgrounds • 16-sessions aimed at reducing the number of students having unprotected intercourse by promoting both abstinence and contraceptive use • Delayed initiation of sexual intercourse; also increased condom or contraceptive use among some groups

35. Curriculum-Based Sex and STD/HIV Education Programs: Examples ¡Cuídate! (Take Care of Yourself) • Specifically for Latino youth age 13 to 18 years—boys and girls • Adaptation of the Be Proud! Be Responsible! program • Incorporates salient aspects of Latino culture, specifically familialism (the importance of family) and gender role expectations • Reduced the frequency of sex, number of sexual partners, frequency of unprotected sex, and increased consistent condom use over a one-year period

36. Parent-Teen Programs • Designed to increase parent-child communication, including programs for: • Parents only • Programs for parents and teens together • Homework assignments in school sex education classes requiring communication with parents • Video programs with written materials to complete at home

37. Parent-Teen Programs: Example Keeping it R.E.A.L.! • Mother-adolescent pregnancy and STD/HIV prevention program; serves primarily African American youth aged 11 to 14 years and their mothers • Implemented with Boys and Girls Clubs • For two years the program increased condom use by youth in the program

38. Clinic Protocols and One-on-One Programs • Designed to provide teens with reproductive health care or to improve access to condoms or other contraceptives • Programs with the strongest evidence of success: • Advance Provision of Emergency Contraception • Reproductive Health Counseling for Young Men

39. Clinic Protocols and One-on-One Programs: Example Reproductive Health Counseling for Young Men • Designed to increase teen boys’ knowledge of reproductive health including contraceptive use through the use of a video presentation followed by one-on-one reproductive health counseling • One-hour, single-session, clinic-based intervention • Designed to meet the needs of sexually active and inactive teens, and to promote abstinence as well as contraception • Increased contraceptive use for a year

40. Community Programs with Multiple Components • Community-wide collaborations or initiatives with the goal of reducing teen pregnancy or STDs • Infuse multiple programs rather than just a single program focusing on discreet populations of teens

41. Community Programs with Multiple Components: Example HIV prevention for Adolescents in Low-Income Housing • Community level HIV prevention program • Designed for teens aged 12-17 years; both boys and girls were included in the program, and the population was primarily ethnic minorities • Uses multiple components, including educational brochures, free condoms, skill training workshops, follow-up session, and community activities • Delayed initiation of sex and increased condom use for 18 months

42. Service Learning Programs • Evaluated several times and have been consistently found to be effective at either delaying the initiation of sex or reducing teen pregnancy • Have two components: voluntary or unpaid service in the community and structured time for preparation and reflection before, during, and after service • Often linked to academic instruction in the classroom

43. Service Learning Programs with Strongest Evidence of Success • Reach for Health Community Youth Service Learning • Teen Outreach Program

44. Service Learning Programs: Example Teen Outreach Program (TOP) • Implemented in school classes and communities; can also be implemented after school • Reduced reported teen pregnancy rates during academic year in which teens participated • Results of evaluation indicated reduction due to service learning component not content of the curriculum

45. Multi-Component Programs • Combine programs with intensive sexuality and youth development • Focus on both sexual and nonsexual risk and protective factors

46. Multi-Component Programs with Strongest Evidence of Success • Aban Aya • Children’s Aid Society Carrera Program

47. Multi-Component Programs: Example Aban Aya • Focuses on abstinence, substance abuse, and conflict resolution • 70 lesson over 4 years for grades 5-8; specifically designed for African American youth • Effective only for boys - reduced the incidence of sex and increased condom use • Can be implemented in school or community settings

48. Additional Findings from Emerging Answers

49. Other Findings • Teen girls and young women who receive emergency contraception (EC) from clinics in advance of having sex are not more likely to have sex • They are also more likely to use EC if they do have sex than those who do not receive EC in advance • Some longer sex education videos that are interactive and viewed many times can have a positive effect on teen sexual behavior

50. Other Findings cont. • School-based, school-linked clinics, and school condom-availability programs do not increase sexual activity, but it is not clear whether they increase the use of contraception • Programs for parents and their teens sometimes reduce risky sexual behavior among teens by delaying sex or increasing contraception use