Impacts of Four Title V, Section 510 Abstinence Education Programs

Focal Programs

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Contents

• Overview of the Programs
• Distinguishing Program Features
  • Community Socio-Demographic Characteristics
  • Existing Health, Family Life, and Sex Education Services
  • Program Delivery
  • Program Structure: Duration, Intensity, and Curricula
• Study Implications

Four Title V, Section 510 programs are the focus of this report:

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

This chapter provides a brief overview of these programs, how they were selected, and the features that distinguish them and the communities they serve. It also briefly describes how certain program features have influenced the design of the study and the interpretation of findings.

Overview of the Programs

One of the earliest stages of the evaluation entailed selecting Title V, Section 510 abstinence education programs for the study. The evaluation team first called and met with numerous state officials and experts across the country to identify promising programs for inclusion in the evaluation. Grant applications and program documents provided additional detail on program goals, target population, curriculum used, and funding levels. The evaluation team visited and observed 28 abstinence education programs across the nation. Eleven of these, representing a range of program models and serving different target populations, were invited and agreed to participate in the evaluation.

This report focuses on 4 of these 11 programs. These four programs are called “impact sites” because they had program features and staff capable of supporting a rigorous, experimental-design impact evaluation. (A fifth program — Heritage Keepers® in South Carolina — is also an impact site but is not included in this report because it has a different research design.⁽¹⁾ The remaining six programs were community-wide, systemic-change initiatives that aimed to increase public awareness of the problems of teen sexual activity, change community norms and attitudes, involve parents and encourage stronger parent-child communication, and engage youth in abstinence education and youth development services.

While these community-wide initiatives broaden our understanding of strategies for changing youth behavior, by design they are less able to support a rigorous impact study of program effectiveness.

The four programs are the following:

1. My Choice, My Future!  A three-year, mandatory, classroom-based program, My Choice, My Future! served students, beginning in the eighth grade, who attended Powhatan, Virginia County Schools.
2. ReCapturing the Vision.  A one-year, elective, classroom-based program, ReCapturing the Vision served mainly seventh and eighth grade girls attending selected middle schools in Miami, Florida.
3. Families United to Prevent Teen Pregnancy (FUPTP).  An elective, afterschool program available on a voluntary basis to students between the ages of 8 and 13, FUPTP served students attending selected elementary and middle schools in Milwaukee, Wisconsin.
4. Teens in Control.  A two-year, mandatory, classroom-based program, Teens in Control served students, beginning in the fifth grade, who attended selected elementary schools in the Clarksdale, Mississippi area.

Each of the four programs had qualities commonly found in programs supported by the Title V, Section 510 funding. Each program complied with the “A-H” guidelines, delivered its services in school settings, and focused on upper elementary and middle school youth. The four programs’ curricula also shared a similar focus and had many specific topic areas in common (Table II.1). For example, all four programs taught physical development and reproduction, promoted risk awareness, taught goal-setting and good decision-making, provided instruction about healthy relationships, and helped develop interpersonal and riskavoidance skills.

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Distinguishing Program Features

Despite the programs’ similarities, each program had several other distinguishing features, including community characteristics, existing services, duration and intensity of services, and curriculum used.

Community Socio-Demographic Characteristics

Two of the programs, My Choice, My Future! and Teens in Control, operated in rural communities; however, the communities differed markedly in their socio-demographic makeup (see Table II.2, upper panel). My Choice, My Future! served youth attending Powhatan County Public Schools. The county is about 40 miles west of Richmond, and many of the newer residents commute to the city for work. The median income of the county is above the national average, and a majority of the youth attending the school system are white, non-Hispanic and live in two-parent families. Teens in Control served youth attending selected schools in three county school districts near Clarksdale, Mississippi — Coahoma, West Tallahatchie, and Tunica. In contrast to Powhatan, there is no urban center near these counties and, despite some recent growth in Tunica, the median income remains well below the national average. Most of the youth attending the three school districts are African American and live in single parent households.

The two other programs, FUPTP and ReCapturing the Vision, operated in two large urban settings — Milwaukee, Wisconsin, and Miami-Dade County, Florida, respectively. In both cities, the schools served by the programs were located in low-income neighborhoods characterized by program staff as having high rates of poverty, teen pregnancy, crime, and deteriorating housing. Youth in these schools are predominantly African American, and most live in low-income households with a single parent.

Existing Health, Family Life, and Sex Education Services

Both rural school districts-the Powhatan school district and the districts in Mississippi — offered only a modest degree of health, family-life, and sex education (Table II.2, lower panel). In Powhatan, all eighth grade youth not enrolled in My Choice, My Future! participated in a nine-week health and physical education class. This class covered alcohol, drugs, tobacco, personal safety, communicable and non-communicable diseases, consumerism, mental health, nutrition, and fitness. However, the class did not cover sex education, STDs, contraceptive use, abstinence from sexual activity, or marriage. In ninth grade, these students were enrolled in a health course that covered similar health topics. While the ninth grade course included material on abstinence, it did not cover sex education or contraceptive use. Teens in Control operated in schools that had an even more limited, district-wide health, family-life, and sex education curriculum for elementary and middle school youth. Usual services consisted of occasional presentations by outside organizations that generally consisted of a few sessions over a period of weeks.

Compared to the rural districts, both urban school districts offered a fairly significant set of health, family-life, and sex education services. The Miami Dade County Public Schools, served by ReCapturing the Vision, had a mandated health and sex education curriculum for youth in grades six through eight, which included a week long unit each year on human growth and development taught as part of the science class. The curriculum covered the stages of reproduction and human development and included discussions of contraceptive use. The sixth grade curriculum also covered drug and alcohol prevention, peer pressure, STDs, and the benefits of abstinence from sexual activity. The Milwaukee Public Schools, served by FUPTP, already had a mandatory family life curriculum for kindergarten through grade 12, a curriculum that both program and control group youth experienced. This curriculum included what was described as grade appropriate coverage of comprehensive health education; sexuality and HIV/AIDS; drugs, alcohol, and tobacco; and violence prevention. Abstinence and contraceptive use were covered beginning in fifth grade.

Program Delivery

All four programs began serving youth in elementary and middle school, when few among the target population had become sexually active. Two of the programs — My Choice, My Future! and ReCapturing the Vision — served youth beginning in seventh and eighth grade, when they were, on average, about 13 years of age. The other two programs — Teens in Control and FUPTP — served youth beginning in fourth and fifth grade, when they were, on average, 10 to 11 years of age. ReCapturing the Vision only served girls; the other three programs served both boys and girls.

The four programs also differed by whether they were elective or non-elective. My Choice, My Future! and Teens in Control were both non-elective programs that met during the school day much like any other class. Students could only "opt out" of consideration for the class if their parents gave permission. ReCapturing the Vision was an elective program whereby girls who were identified by school and program staff as potential candidates had the choice of participating or not. After students chose to participate, however, the program had required attendance like any other class. FUPTP was also an elective program, but youth could attend on a voluntary basis.

Program Structure: Duration, Intensity, and Curricula

The four programs differed significantly in duration and intensity and featured a variety of curricula (Figure II.1). My Choice, My Future! served youth for three years, though at a modest level of intensity; it included 30 classroom sessions in the first year, 8 in the second year, and 14 in the third year. Teens in Control was somewhat similar; it served youth for two years and met once a week during the school day. ReCapturing the Vision served youth for only one school year, but the program met daily, making it more intense than the other two classroom-based programs. Finally, FUPTP was an after-school program that met for two and one-half hours daily throughout the school year. The program was available to students as long as they attended the program school, which could have been up to four years in some cases. This made the program both relatively long and intense, assuming youth chose to attend.

My Choice, My Future! used a different curriculum for each of the three years that youth were enrolled in the program. The eighth grade curriculum, Reasonable Reasons to Wait: The Keys to Character, focused on character development, reasons to wait to engage in sex, peer influence, dating, avoiding STDs, relationship skills, and the benefits and ingredients of a strong marriage (Duran 1997). The ninth grade curriculum, the Art of Loving Well: A Character Education Curriculum for Today's Teenagers, featured short stories, poetry, classic fairy tales, and myths that taught about healthy and loving relationships (Boston University 1993). During the final year of the program, tenth graders received the WAIT Training™ curriculum, which focused on relationship skills and risk avoidance. The tenth grade program also featured slide show materials from the Medical Institute for Sexual Health (MISH), which provided information on STDs and instructed students that abstinence is the only sure way to avoid contracting them.

ReCapturing the Vision used two curricula — ReCapturing the Vision and Vessels of Honor — during the one year program. The ReCapturing the Vision curriculum centered on identifying personal strengths and resources, developing strategies for fulfilling personal and career goals, and building critical skills that would help youth achieve positive goals and resist negative influences (Del Rosario 2003). The complementary Vessels of Honor curriculum included six key areas of focus: (1) honorable behavior, (2) effective communication for resisting pressure to engage in sex and other high-risk behaviors, (3) development of good relationships and satisfying social needs and emotional feelings through friendships rather than sex, (4) physical development and its implications for changing pressures, (5) sexual abuse and date rape and how to avoid both, and (6) strategies for choosing a mate and the benefits of a committed marital relationship (Del Rosario 1999). In addition to the class-based lessons and activities, the ReCapturing the Vision program provided a number of complementary services, including home visits by social workers, referrals to local services, after-school tutoring, community service projects, cultural events, a family retreat, an annual Teen Abstinence Rally, and an annual Teen Talk Symposium with celebrity panelists.

FUPTP's abstinence curriculum, A Life Options Model Curriculum for Youth, was delivered as a key component of its after-school activities. This curriculum covered 10 topic areas, nearly all of which have abstinence as a central focus: (1) group-building, (2) self-esteem, (3) values and goal-setting, (4) decision-making skills, (5) risk-taking behavior, (6) communication skills, (7) relationships and sexuality, (8) adolescent development and anatomy, (9) sexually transmitted diseases, and (10) social skills (Rosalie Manor, undated). The unit on relationships and sexuality addressed marriage in addition to abstinence; however, because of the young age of many FUPTP participants, marriage received relatively less attention. In addition to the in-school services, youth and parents in FUPTP could participate in other programming that Rosalie Manor made available; these included periodic parent workshops, a Saturday teen mentoring program, and a seven-week summer program with teen mentors.

Teens in Control used a different curriculum for each of the two years that youth participated in the program. In fifth grade, program group youth received the Postponing Sexual Involvement curriculum (Howard and Mitchell 1990), which was designed to increase the awareness of the risks and pressures associated with early sexual involvement and to develop skills that could help youth remain abstinent. The five topic areas covered in this curriculum focused on the risks of early sexual involvement and the benefits of abstaining from sex until marriage, social and peer pressures to have sex, and the development of specific skills for resisting peer pressure using extensive practice sessions and reinforcement. The sixth graders in the program received the Sex Can Wait curriculum, which covered several key areas: self-concept and self-esteem; the psychological and physical changes during puberty; values; communication skills; information on the risks of STDs; skills for resisting social and peer pressures; and the formulation of career goals, planning how to achieve them, and how sexual abstinence is important for achieving these personal goals.

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Study Implications

Two program features had notable implications for the study design and for this report. The first is the targeting of age groups in the upper elementary or middle school grades. While this is a common program feature of Title V, Section 510 programs, it required the evaluation to include an extended follow-up period so that program impacts on sexual abstinence and activity could be measured. At the time of the final follow-up survey, administered four to six years after youth enrolled in the study sample, the age of the study youth ranged from 12 to 20 years with a mean and modal age of 16 years (Figure II.2). The upper end of this age distribution includes youth primarily from the two programs that served middle school students, ReCapturing the Vision and My Choice, My Future!, while the lower end of this age distribution includes youth primarily from the two programs that served elementary school youth, FUPTP and Teens in Control. Youth in the former two programs averaged 18 years of age at the time of the final follow-up survey; youth in the latter two programs averaged 15 years of age.

Figure II.2.
Age Distribution of the Study Sample at the Time of the Final Follow-Up Survey

Given this age distribution, substantial variation was expected in the rates of sexual abstinence and sexual activity across the study sites at the time of the final follow-up survey (the survey on which findings in this report are based). Youth in the FUPTP and Teens in Control samples were expected to report relatively low rates of sexual activity compared to youth in the other two program sites.

Even at these fairly young ages, however, rates of sexual activity were expected to be at levels such that true program impacts could be detected. For example, according to the CDC's Youth Risk Behavior Survey, 51 percent of teens in Milwaukee, Wisconsin, report having had sex by ninth grade-the grade of the typical youth in the FUPTP study sample. While comparable data are not available for the other program that targeted elementary school youth (Teens in Control), its service area in Mississippi has among the highest rates of teen pregnancy in the state, making it likely that a large fraction of youth in the study sample would be sexually active by the time of the final follow-up survey.

The second program feature with important study implications is the elective versus non-elective nature of the programs, which leads to differences across the programs in both program participation and attendance. As shown in Figure II.3, both My Choice, My Future! and Teens in Control were non-elective school-based programs, and, as with any typical course offered in school, attendance was mandatory among those assigned to the program. In contrast, both ReCapturing the Vision and FUPTP were elective programs, meaning that eligible youth could choose whether or not to participate.

Figure II.3.
Program Participation and Attendance

In the case of ReCapturing the Vision, program staff identified a set of high-risk girls in the spring of seventh grade and invited them to apply to the program. Once girls applied and were randomly assigned to the program, they could have chosen not to participate in the fall of eighth grade because they either faced scheduling conflicts (such as a required math class) or may have changed their minds and decided to take another elective. This happened for 35 percent of the girls assigned to the program group. Attendance was mandatory, however, for all girls who chose to participate.

In the case of FUPTP, the program was not only elective but attendance was also completely voluntary, meaning that youth could attend as many or as few times as they chose. In practice, many students did not participate at all, though this was often for involuntary reasons such as transportation problems or other constraints. As a result, many youth assigned to the program group, 43 percent, did not participate in any FUPTP classes.⁽²⁾ In addition, among those who did participate, only a fraction attended most or all of the classes that were available. Specifically, among the 57 percent of program group youth with any participation, only 11 percent attended more than 80 percent of program services in the first year and 45 percent attended more than half. Even for those youth with low attendance rates, however, the total contact hours were still high because of the program's high intensity (a session available every school day for 150 minutes). Indeed, the average program group youth who participated in FUPTP received an estimated 146 hours of program services in the first year — more than the total annual contact hours for either My Choice, My Future! or Teens in Control.

The substantial nonparticipation among program group youth in ReCapturing the Vision and FUPTP reflects the reality of many abstinence (and other) programs that serve youth on an elective basis, making it an important program feature to include in this study. Consistent with standard research practices, the analysis of program impacts is conducted in two ways. The first presents impacts for all youth that the program intended to serve — that is, those randomly assigned to the program group. The second presents impacts for those who actually participated in the programs. As discussed in the next chapter, while the estimated impacts differ between these two approaches, their associated statistical significance is roughly equal. Thus, the main conclusions from this study differ little when based on one measure or the other.

Endnotes

1.  Specifically, for Heritage Keepers®, the evaluation was designed to measure the impact of adding an abstinence-focused character club to a classroom-based abstinence curriculum rather than to measure the impact of an overall abstinence program versus services as usual. A separate report on the impact of the Heritage Keepers® program is forthcoming [Now available, see link].

2.  This 43 percent rate of nonparticipation reflects an upper bound because the program did not have available attendance records for youth who attended fewer than 25 percent of the classes they had the opportunity to attend. The actual rate of true nonparticipation is therefore lower than 43 percent.

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