Impacts of Four Title V, Section 510 Abstinence Education Programs

Impacts on Sexual Abstinence and Teen Risk Behaviors

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Contents

• Impacts on Abstinence and Sexual Behavior
• Impacts on Other Risky Behavior
• Subgroup Impacts
• Impacts on Participants Only

An earlier DHHS study report (Maynard et al. 2005) examined the impact of the four focal programs near the end of the first school year that youth were enrolled in the study.  At that time, youth in the study averaged only 12 years of age, far too young for researchers to assess the impact of the programs on sexual abstinence and activity.  The earlier report therefore focused on whether the programs had impacts on any of several potential mediators of these behaviors, such as support for abstinence, communication with parents, and refusal skills.  Findings indicated that programs did achieve short-term success on some but not all of these potential mediators; for example, program group youth were significantly more likely than control group youth to report views more supportive of abstinence and less supportive of teen sex, but they displayed no statistically significant differences in their refusal skills or communication with parents.

Using data from a final follow-up survey, collected an average of five years after youth enrolled in the study sample, this chapter examines whether the near-term gains achieved by the programs translated into longer-term impacts on behavior.  Key among these are whether the programs increased the likelihood that youth abstained from sexual intercourse, reduced the extent of sexual activity among youth, and increased their expectations to abstain from sex in the future.  In addition, the chapter examines the impact of the programs on potential consequences of teen sex, such as pregnancy, and risk behaviors that are correlated with teen sex, such as drug and alcohol use.

Findings indicate that, despite the effects seen after the first year, programs had no statistically significant impact on eventual behavior.  Based on data from the final follow-up survey, youth in the program group were no more likely to abstain from sex than their control group counterparts; among those who reported having had sex, program and control group youth had similar numbers of sexual partners and had initiated sex at the same mean age.  Youth in the program group, however, were no more likely to have engaged in unprotected sex than their control group counterparts.  Finally, there were no differences in potential consequences of teen sex, including pregnancies, births, and reported STDs.

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Impacts on Abstinence and Sexual behavior

• Program and control group youth reported similar rates of sexual abstinence.

As seen in Table IV.1, about half of both control and program group youth reported remaining sexually abstinent, and a slightly higher proportion reported having been abstinent during the 12 months prior to the survey (55 percent of control group youth versus 56 percent of program group youth).  This small difference was not statistically significant.

None of the individual programs had statistically significant impacts on the rate of sexual abstinence, whether measured as either always remaining abstinent or being abstinent during the last 12 months.  Across the four sites, differences between the program and control groups were modest (five points or less) and not consistent in direction.  On both measures, ReCapturing the Vision displayed the largest positive difference between the groups, but neither difference was statistically significant.  Teens in Control and FUPTP displayed negative, but not statistically significant, differences on both measures.

Program and control group youth also did not differ in the number of partners with whom they had sex.  Comparing the program and control groups overall, the distributions of the number of reported sexual partners are nearly identical (Figure IV.1).  About one-quarter of all youth in both groups had sex with three or more partners and about one in six had sex with four or more partners.  Distributions for each of the four sites, shown in Appendix Table A.4, likewise show no statistically significant differences between the program and control groups.

Figure IV.1.
Estimated Impacts on Reported Number of Sexual Partners

Source:  Wave 4 Survey of Teen Activities and Attitudes (Mathematica Policy Research, Inc., 2005), administered to youth 42 to 78 months after enrolling in the Title V, Section 510 Abstinence Education Program study sample.

Note:  All estimates are based on weighted regression models.  For details on the covariates, see Appendix Table A.1.  Sample sizes and R-square statistics are in Appendix Tables A.2 and A.3, respectively.  Findings by site, as well as F-tests of the difference in the distribution of the outcome measure between control and program groups, are in Appendix Table A.4.

***p-value (of program-control difference) < 0.01; **p-value < 0.05; *p-value < 0.10, two-tailed test.

Programs did not affect the age at which sexually experienced youth first engaged in sexual intercourse (data not shown).  Based on a question asking non-abstinent youth the age at which they first had sex, the reported mean age at first intercourse is identical between the program and control groups, 14.9 years.^[1]  This age is seemingly young, but recall that the sample is 16 years of age on average at the time of the final follow-up survey.

• Program and control group youth did not differ in their expectations to abstain.

Forty percent of program group youth reported that they expected to abstain from sex until marriage compared with 37 percent of control group youth, a difference that is not statistically significant (Table IV.2).  This pattern is similar for the other two measures — expectations to abstain from sex through high school and as a teenager (until age 20).  On each measure, program group youth had slightly higher expectations than control group youth, but the differences are not statistically significant.

Looking at the individual programs, one program, FUPTP, does display a large and statistically significant impact on expectations to abstain until marriage.  Specifically, 43 percent of youth in the program group for FUPTP reported that they expect to abstain from sex until marriage compared with 33 percent of corresponding control group youth — a statistically significant difference of ten percentage points (p-value = 0.04).  However, on the two other expectations measures, through high school and as teenagers, FUPTP displays no statistically significant impacts.  In fact, the estimated impacts are not positive (-4 and 0, respectively).  Findings for a second program, ReCapturing the Vision, are not statistically significant but the estimated impacts are somewhat large.  On the marriage measure, for example, 41 percent of program group in ReCapturing the Vision reported that they would abstain until marriage compared to 34 percent of control group youth.  The difference, seven percentage points, is not statistically significant (p-value = 0.13).

• Program group youth were no more likely than control group youth to have unprotected sex.

Eight percent of all control group youth and seven percent of all program group youth reported having had sexual intercourse and not using a condom the first time (Figure IV.2).  There are similarly no differences when measured over the last 12 months — 17 percent of youth in both groups reported having had sex in the last 12 months and using a condom only sometimes, and 4 percent reported having had sex in the last 12 months and never using a condom. (Figure IV.3).  For all youth, this latter result is equivalent to about half of recently sexually active youth not always using a condom in the last 12 months.  Across the individual programs, estimated impacts on unprotected sex, measured either at first intercourse or in the last 12 months, were likewise small and statistically insignificant (see Appendix Tables A.5 and A.6, respectively).

Figure IV.2.
Estimated Impacts on Unprotected Sex at First Intercourse

Source:  Wave 4 Survey of Teen Activities and Attitudes (Mathematica Policy Research, Inc., 2005), administered to youth 42 to 78 months after enrolling in the Title V, Section 510 Abstinence Education Program study sample.

Note:  All estimates are based on weighted regression models.  For details on the covariates, see Appendix Table A.1.  Sample sizes and R-square statistics are in Appendix Tables A.2 and A.3, respectively.  Findings by site, as well as F-tests of the difference in the distribution of the outcome measure between control and program groups, are in Appendix Table A.5.

***p-value (of program-control difference) < 0.01; **p-value < 0.05; *p-value < 0.10, two-tailed test.

Figure IV.3.
Estimated Impacts on Unprotected Sex, Last 12 Months

Source:  Wave 4 Survey of Teen Activities and Attitudes (Mathematica Policy Research, Inc., 2005), administered to youth 42 to 78 months after enrolling in the Title V, Section 510 Abstinence Education Program study sample.

Note:  All estimates are based on weighted regression models.  For details on the covariates, see Appendix Table A.1.  Sample sizes and R-square statistics are in Appendix Tables A.2 and A.3, respectively.  Findings by site, as well as F-tests of the difference in the distribution of the outcome measure between control and program groups, are in Appendix Table A.6.

***p-value (of program-control difference) < 0.01; **p-value < 0.05; *p-value < 0.10, two-tailed test.

Programs likewise did not increase rates of unprotected sex when considering other forms of birth control (including those that only protect against pregnancy), such as birth control pills or Depo-Provera.  For example, in both groups, slightly more than half of youth had remained abstinent in the last 12 months (as reported above) and an additional 29 percent of youth reported that they had had sexual intercourse and always used a form of birth control (Figure IV.4).  This leaves only about one in six youth in both groups — 15 percent in the program group and 16 percent in the control group — who reported that they had had sexual intercourse and had not always used a form of birth control.  Across the individual programs, these distributions varied but displayed no statistically significant program impacts (see Appendix Tables A.7 and A.8 for findings at first intercourse and last 12 months, respectively).

Figure IV.4.
Estimated Impacts on Birth Control Use, Last 12 Months

Source:  Wave 4 Survey of Teen Activities and Attitudes (Mathematica Policy Research, Inc., 2005), administered to youth 42 to 78 months after enrolling in the Title V, Section 510 Abstinence Education Program study sample.

Note:  All estimates are based on weighted regression models.  For details on the covariates, see Appendix Table A.1.  Sample sizes and R-square statistics are in Appendix Tables A.2 and A.3, respectively.  Findings by site, as well as F-tests of the difference in the distribution of the outcome measure between control and program groups, are in Appendix Table A.8.

***p-value (of program-control difference) < 0.01; **p-value < 0.05; *p-value < 0.10, two-tailed test.

• Programs had no impact on reported pregnancies, births, or STDs.

Very few youth in the study sample reported ever having been pregnant or ever having had an STD, and there were no statistically significant differences between the program and control groups on these measures (Table IV.3).  Ten percent of youth in both the program and control groups reported having been pregnant or gotten someone pregnant, and roughly half of them (five percent overall) reported that they had had a baby.  With respect to STDs, only a small fraction of youth in both groups, about five percent overall, reported being told by a doctor that they had an STD.  (Equal numbers of youth also reported being tested; not shown.)  Across the individual program sites, rates of all these outcomes varied modestly and displayed no statistically significant program impacts.

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Impacts on Other Risky Behavior

• Program and control group youth reported no differences in their drinking or marijuana use.

As shown in Table IV.4, 16 percent of program group youth and 19 percent of control group youth reported smoking cigarettes in the last month, a difference that is statistically significant (p-value = 0.07).  However, with respect to alcohol and marijuana use, behaviors more closely associated with risk behavior, there are no statistically significant differences between the program and control group youth.  Overall, about one in four youth in both groups reported drinking once a month or more, while 30 percent reported ever having used marijuana.

Alcohol and drug use varied considerably across the program sites, and this is due at least in part to the variation in the ages of the study youth.  Within each site, however, program and control group youth reported no statistically significant differences in either behavior.  Differences between the two groups also varied in direction.  For example, program group youth in ReCapturing the Vision reported rates of alcohol use six percentage points lower than corresponding control group youth, while program group youth in FUPTP reported rates five points higher than corresponding control group youth.  Neither difference is statistically significant (p-values = 0.16 and 0.11, respectively).

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Subgroup Impacts

• For several subgroups examined, programs show no consistent evidence of impacts on sexual abstinence or other behavioral measures.

Estimated impacts across a series of subgroups, summarized in Appendix D, display few statistically significant impacts on any of the behavioral outcomes examined above for the full sample.  Take, for example, the subgroup defined by whether youth have relatively high or low support for abstinence at baseline.  As discussed later in Chapter VI, this measure proves to be an important predictor of sexual abstinence, and it might also be expected to affect the way that youth respond to program messages.  However, as seen in Table IV.5, this is not the case.  Differences between program and control group youth are small in both subgroups defined by the measure and are not statistically significant.  A similar pattern of results is evident for other subgroups, including gender, religiosity, television viewing, and enrollment cohort, with a mix of positive and negative impact estimates that are small and rarely statistically significant (all shown in Appendix D).

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Impacts on Participants Only

As discussed in Chapter II, participation was elective in two sites (ReCapturing the Vision and FUPTP), leading some youth not to participate despite being randomly chosen for the program group.  The implication of this nonparticipation is that the estimates of program impacts for the subsample of participants will be larger than the estimates for the entire sample in these two sites.  However, because there is a corresponding loss of statistical power when estimating impacts for the smaller, participant-only sample, the statistical significance associated with these participant-only impacts is roughly equal to those for the full sample.  Thus, the benefit of examining impacts for the participants-only sample is merely in identifying any notable program-control group differences, regardless of significance, that might have been less evident for the full sample.

As highlighted by Table IV.6, the estimated impacts on a few of the behavioral measures are somewhat notable in size for the participant-only sample, although they are not statistically significant.  (For complete results of the participant-only impact analysis, see Appendix Table A.9.)  With regard to sexual abstinence, for example, participants in ReCapturing the Vision had rates 7 percentage points higher than their control group counterparts.  In contrast, program group youth in FUPTP reported rates of sexual abstinence that were 4 percentage points lower than their control group counterparts and 3 points lower when measured as abstinent in the last 12 months.

Estimated impacts on expectations are also more notable in size when focusing on participants only, though they are rarely statistically significant.  For ReCapturing the Vision, program participants were 9 percentage points more likely to expect to abstain from sex through high school and 11 percentage points more likely to expect to abstain until marriage than their control group counterparts.  However, neither difference is statistically significant (respective p-values = 0.34 and 0.13; not shown).  For FUPTP, participants were 18 percentage points more likely than their control group counterparts to expect to abstain until marriage, a difference that is statistically significant (p-value = 0.04; not shown).  Participants were also six percentage points less likely to expect to abstain through high school; however, this difference is not statistically significant.

Endnote

[1]  This measure of the mean age at first intercourse is based on the subsample of program and control group youth that reported having had sex.  An alternative to this measure is the proportion of youth who report having had sex by a particular age (by age 14, for example).  Regardless of the age cutoff examined, the findings indicate no statistically significant difference between program and control group youth.

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