Impacts of Four Title V, Section 510 Abstinence Education Programs

Introduction

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Background
- Title V, Section 510 Funding
- Other Major Federal Abstinence Funding
Evaluation of Title V, Section 510 Abstinence Education Programs

Authorized under the Social Security Act of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), the Title V, Section 510 Abstinence Education Program was one of the legislative centerpieces that increased both the funding and visibility of abstinence education programs. Since fiscal year 1998, the Title V, Section 510 Abstinence Education Program has allocated $50 million annually for programs that teach abstinence from sexual activity outside of marriage as the expected standard for school-age children. Under the matching block grant program administered by the U.S. Department of Health and Human Services (DHHS), states must match this federal funding at 75 percent, resulting in a total of up to $87.5 million annually for Title V, Section 510 abstinence education programs.

In the Balanced Budget Act of 1997, Congress authorized a scientific evaluation of Title V, Section 510 abstinence education programs. The resulting multi-year evaluation included two major components. The first was an implementation and process analysis that documented the experiences of the organizations and communities that applied for and received the block grants authorized under Title V, Section 510. The second was a rigorous, experimentally based impact evaluation designed to estimate the effects of selected Title V, Section 510 abstinence education programs on teen sexual abstinence and related outcomes.

This report presents the behavioral impact findings of four selected programs that received funding through the Title V, Section 510 grants:

My Choice, My Future! in Powhatan, Virginia;
ReCapturing the Vision in Miami, Florida;
Families United to Prevent Teen Pregnancy (FUPTP) in Milwaukee, Wisconsin; and
Teens in Control in Clarksdale, Mississippi.

Like most programs supported by the Title V, Section 510 grants, these four programs all served youth in school settings, usually in the upper elementary or middle school grades. All programs offered more than 50 contact hours and lasted for one or more school years, making them relatively intense among programs funded by the Title V, Section 510 grant. One of the programs, FUPTP, served youth on a voluntary basis in an after-school setting. The other three programs served youth in classrooms during the school day much like any other course, although ReCapturing the Vision augmented these classroom-based services with a number of extracurricular offerings.

This report examines the impact of these programs on teens' sexual abstinence, their risks of pregnancy and sexually transmitted diseases, and other behavioral outcomes. The report is based on survey data collected in 2005 and early 2006 — four to six years after study enrollment — from more than 2,000 teens who had been randomly assigned to either a program group that was eligible to participate in one of the four programs or a control group that was not.

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Background

By the time Congress enacted PRWORA and authorized funding for abstinence education programs under Title V, Section 510, there was growing concern over the dramatic rise in teen pregnancy and childbirth rates during the late 1980s and early 1990s. By 1991, teen pregnancy and childbirth rates had reached highs of 116.5 and 62.1 per 1,000 women 15 to 19 years of age, respectively. Rates have dropped since that time; for example, by 2004, the teenage birthrate had fallen to 41.1 births per 1,000 women 15 to 19 years of age. However, concerns over the high incidence of births to unwed teen mothers, as well as the broader risks of teen sexual activity, have persisted (Centers for Disease Control and Prevention 2006; Weinstock et al. 2004; Chesson et al. 2004).

Teen Sexual Activity and Its Consequences

In 2005, women 15 to 19 years of age had 831,000 pregnancies, most out of wedlock.
In 2005, 14.3 percent of high school students and 21.4 percent of twelfth grade students had had sex with four or more persons.
In 2005, 37.2 percent of sexually active high school students and 44.6 percent of sexually active twelfth grade students did not use a condom during their last sexual intercourse.
Of the approximately 19 million new STD infections in the U.S. in 2000, nearly half were among persons 15 to 24 years of age.
STDs have been linked to infertility, miscarriages, cervical cancer, increased HIV risk, and numerous other health problems. Their cost is estimated at several billion dollars annually.

Title V, Section 510 Funding

Beginning in fiscal year 1998, the Title V, Section 510 funding provided $50 million of annual federal support for abstinence education programs that teach abstinence from sexual activity outside of marriage as the expected standard for school-age children. In order to receive these grants, states must match $3 of every $4 contributed by the federal government, which results in a total of up to $87.5 million available annually. Upon receipt of federal funding, states have discretion over which programs to fund and at what level. However, all funded programs are required to be consistent with the "A-H" definition of abstinence education prescribed in the Social Security Act (Table I.1).

Table I.1.
A-H Definition of Abstinence Education
Have as its exclusive purpose teaching the social, psychological, and health gains to be realized by abstaining from sexual activity Teach abstinence from sexual activity outside marriage as the expected standard for all school-age children Teach that abstinence from sexual activity is the only certain way to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and other associated health problems Teach that a mutually faithful, monogamous relationship in the context of marriage is the expected standard of sexual activity Teach that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects Teach that bearing children out of wedlock is likely to have harmful consequences for the child, the child's parents, and society Teach young people how to reject sexual advances and how alcohol and drug use increases vulnerability to sexual advances Teach the importance of attaining self-sufficiency before engaging in sexual activity
Source: Title V, Section 510 (b)(2)(A-H) of the Social Security Act (P.L. 104-193).

Originally administered by the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration within DHHS, the Title V, Section 510 funding is currently distributed to states by the Administration of Children and Families (ACF) in the form of grants. These grants are based on a formula that compares the proportion of low-income children in the state to the total number of low-income children in all states. Just two years after the start of the Title V, Section 510 funding, states had funded over 700 programs nationwide. Among the groups that received funding were community-based organizations, school boards, local health departments, faith-based organizations, universities, local coalitions and advocacy groups, consultants, research firms, health care organizations, and non-profit organizations (MCHB 2000). Congress reauthorized the Title V, Section 510 funding in 2002.

Other Major Federal Abstinence Funding

In 2000, Congress increased funding of abstinence education through a federal earmark known as Community Based Abstinence Education (CBAE). Like the Title V, Section 510 programs, the CBAE-funded programs must be consistent with all eight of the "A-H" criteria. However, CBAE differs from Title V, Section 510 in the way that the funding is distributed. Under Title V, Section 510, funding passes through the states before reaching the abstinence education programs; CBAE funding, by contrast, is provided directly from the federal government to community-based programs. Also in contrast to Title V, Section 510, all programs funded by CBAE must specifically target youth between 12 and 18 years of age. Initially administered by MCHB, administration of CBAE was re-assigned to ACF in 2005.

Prior to the enactment of Title V, Section 510, federal funding for abstinence education had been provided mainly though the Adolescent Family Life Act (AFLA) or Title XX of the Public Health Services Act of 1981. Funding through AFLA is modest relative to Title V, Section 510. In fiscal year 2005, the Office of Adolescent Pregnancy Programs awarded about $13 million in Title XX grants to 58 public and private community organizations for projects that specifically promote several abstinence programs for adolescents (DHHS 2006). All programs funded by AFLA must be consistent with the same eight "A-H" criteria spelled out for the Title V, Section 510 funding.

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Evaluation of Title V, Section 510 Abstinence Education Programs

Guiding the evaluation of the Title V, Section 510 programs is a logic model describing how the funded programs aim to reduce teen sexual activity and related risk behaviors (Figure I.1). Beginning in Box A, the logic model assumes that adolescent decision-making is influenced by numerous antecedents, including their own backgrounds and experiences and the characteristics of their schools and communities. Youth decision-making may also be influenced by the formal education services that they receive (Box B). As one of these possible services, the Title V, Section 510 abstinence programs aim to change the health, family-life, and sex education that youth normally receive (Box C). This change, in turn, is hypothesized to have favorable impacts on several intermediate outcomes that may serve as mediators of behaviors (Box D). For example, youth participating in the programs might develop more positive views towards abstinence and marriage or improve their knowledge of sexual activity risks. Through these and other changes, programs are ultimately hypothesized to affect longer-term behavioral outcomes (Box E). Among these outcomes are the rate of sexual abstinence and the potential consequences of sexual activity, such as STDs and pregnancy.

Figure I.1.
Logic Model for Evaluating the Impact of Title V, Section 510 Programs

Logic Model for Evaluating the Impact of Title V, Section 510 Programs. See text.

A series of evaluation reports has studied the pre-behavioral components of the logic model, spanning Boxes A through D. In an initial DHHS study report, Devaney et al. (2001) examined Boxes A and B of the logic model — describing the populations served by the programs and the characteristics and implementation experiences of programs funded through Title V, Section 510. In two subsequent DHHS study reports, Maynard et al. (2005) and Clark and Devaney (2006) examined Boxes C and D of the logic model — measuring the first-year impacts of five selected Title V, Section 510 programs on the services youth received and on selected intermediate outcomes that may influence risk behavior.

Building on these earlier findings, the current report focuses mainly on the behavioral outcomes of youth, summarized in Box E of the logic model. The report addresses three questions:

What impacts do programs have on behavioral outcomes? Do the four selected Title V, Section 510 abstinence education programs affect behavioral outcomes summarized in Box E — rates of sexual abstinence and sexual activity and risks of STDs and pregnancy?
What impacts do programs have on possible mediators of behavior? Do the four programs improve knowledge of pregnancy and STD risks, knowledge of the health consequences of STDs, and other possible mediators of behavior, such as views toward abstinence and relations with peers, which were a focus of earlier DHHS study reports as well?
What are the links between possible mediators and behavior? How well do the potential mediators (Box D), measured after the first program year, predict the rates of sexual abstinence and sexual activity three to five years later? This analysis provides valuable insight into whether the intermediate outcomes that programs seek to affect (such as self-esteem and skill building) are in fact associated with future behavior.

The next chapter (Chapter II) describes the four programs that are the focus of this report, highlighting their common features and key differences. This is followed, in Chapter III, by a description of the research design and analytic methods used to measure the programs' impacts. Chapters IV through VI present the report findings, addressing respectively each of the three research questions listed above. Finally, Chapter VII summarizes the main study findings and considers the implications of these findings for future policy and research.

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