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.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.
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.[Page v-vi]
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.[Page 3-4]
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:
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.[Page 10]
The curricula of the most effective sex and HIV education programs share ten common characteristics. These programs:
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.[Page 12-13]
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 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.[Pages 13-15]
Service learning programs include two parts:
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.[Page 18-19]
So, what should communities do with this information gleaned from the research literature? Emerging Answers suggests three strategies for employing promising approaches:
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.