Impacts of Four Title V, Section 510 Abstinence Education Programs

Knowledge and Perceptions of Risks Associated with Teen Sex

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Contents

• Knowledge of STD and Pregnancy Risks
• Perceptions of Condom and Birth Control Pill Effectiveness

While findings from the prior chapter show no evidence that programs affected behavior, results from an earlier DHHS study report had indicated that programs had statistically significantly impacts on the health, family, and sex education services that youth received (Maynard et al. 2005).  Perhaps most notable among these changes was a reported increase in the value of these services for understanding pregnancy and STD risks.  Using data from the final follow-up survey, this chapter examines whether these changes in services resulted in sustained impacts on knowledge of STDs and the potential risks associated with sexual activity.  In addition, the chapter examines whether programs affected youth perceptions about the effectiveness of condoms or birth control pills for preventing pregnancy and STDs.^[1]

Findings indicate that both program and control group youth had a good understanding of their risks for pregnancy but a less clear understanding of STDs, particularly with respect to their health consequences.  Programs display some modest gains on measures of these outcomes.  On a measure of STD identification, program group youth reported significantly higher average levels of knowledge than their control group counterparts.  One program, My Choice, My Future!, is largely responsible for this result.  My Choice, My Future! also displayed a significant impact on two knowledge scales associated with pregnancy and STD risks.

Additional findings indicate program and control group youth had similar perceptions of condom effectiveness for preventing pregnancy, but program group youth were less likely than control group youth to perceive condoms as effective at preventing STDs.  The same pattern is evident for perceptions of birth control pills.  While program and control group youth had similar perceptions of whether birth control pills are effective for preventing pregnancy, program group youth were less likely than control group youth to perceive them as effective at preventing STDs.  As with the knowledge findings, My Choice, My Future! displays the most consistent evidence of affecting these perceptions.

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Knowledge of STD and Pregnancy Risks

• Study youth correctly identified STDs only about two-thirds of the time.  Programs increased this proportion by a modest amount.

On the final follow-up survey, youth were given a list of 13 diseases and asked whether or not each was a sexually transmitted disease; of these diseases, nine were actual STDs and four were not STDs (see Appendix C for the exact questions).  Youth in the program group identified an average of 69 percent of these diseases correctly, as STDs or not, while youth in the control group identified an average of 67 percent correct.  The difference is statistically significant (Table V.1).  Comparing the four programs on this measure, My Choice, My Future! displays the largest difference by far.  It raised the rate of STD identification by an estimated eight points, from a mean of 75 percent for the control group to a mean of 83 percent for the program group.

Findings remain consistent when examining impacts separately for diseases that are STDs and those that are not.  Overall, program group youth correctly identified a higher percentage of diseases of both types, though only the impact on true STDs remained statistically significant (Table V.1).  This consistency suggests that programs did not simply raise the likelihood that youth believed any disease was transmitted sexually; rather, they had a beneficial long-term impact on STD identification.

• Many study youth understood the risks of pregnancy and STDs from unprotected sex, but they often lacked an understanding of the potential health risks from STDs.  Program and control group youth had similar levels of knowledge.

On a two-item scale measuring their understanding of unprotected sex risks, youth in both the program and control groups had high scores (0.88) (Table V.2).  Program and control group youth likewise reported similar levels of knowledge on a three-item scale measuring their understanding of potential health risks of STDs.  However, their respective mean values on this scale were relatively low, 0.52 and 0.51, and corresponded to a typical youth answering only about half the items of the scale correctly.  (See Appendix C for a list of the questions and coding of responses for these scales).

Despite the lack of an impact on these scales across the four programs, one program, My Choice, My Future!, shows consistent evidence of raising youths’ knowledge.  On both scales shown in Table V.2, the mean among program group youth in My Choice, My Future! was significantly higher than among their control group counterparts, reflecting a gain in knowledge attributable to the program.  Other programs also displayed some statistically significant differences between program and control group youth on the two scales, but these differences are less consistent.  For example, on the measure of knowledge of STD consequences, program group youth in FUPTP reported a mean score that is five points higher than their control group counterparts, a difference that is statistically significant.  However, on the measure of unprotected sex risks, the difference in mean scores is only two points and not statistically significant.  Teens in Control displays a similar pattern between these two scales, except that the differences between the program and control groups are in the opposite (negative) direction.

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Perceptions of Condom and Birth Control Pill Effectiveness

• Most study youth reported that condoms were at least sometimes effective at preventing pregnancy.  Programs had no impact on this perception.

About half of program and control group youth responded that, when used correctly, condoms usually prevent pregnancy (Figure V.1).  Most of the remainder, 38 percent, reported that condoms sometimes prevent pregnancy.  Only three percent of youth thought that condoms never prevent pregnancy, while seven percent reported being unsure.

Figure V.1.
Estimated Impacts on Perceived Effectiveness of Condoms for Preventing Pregnancy

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.10.

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

• Many study youth reported being unsure about whether condoms prevent STDs.  Overall, program group youth were less likely than control group youth to perceive condoms as effective at preventing STDs.

Roughly one-quarter of youth in both the program and control groups reported being unsure about how effective condoms are at preventing chlamydia and gonorrhea or at preventing herpes and HPV (Figure V.2).  In addition, a sizeable fraction in both groups, about one in seven, reported being unsure about condoms’ effectiveness for preventing HIV.  These findings are in sharp contrast to those for pregnancy (above), for which very few youth in either group reported being unsure about their effectiveness.

Youth in the program group were significantly less likely to report that condoms usually prevent STDs than those in the control group.  And, for each STD type, this difference was offset by a significantly higher proportion of program group youth reporting that condoms are never effective at prevention.^[2]  Specifically, programs raised the proportion of youth who reported that condoms never prevent HIV from an estimated 17 to 21 percent; the proportion who reported that condoms never prevent chlamydia and gonorrhea from an estimated 14 to 20 percent; and the proportion who reported that condoms never prevent herpes and HPV from an estimated 15 to 23 percent.

Findings at the site level, detailed in Appendix Tables A.11 through A.13, indicate that two programs, My Choice, My Future! and Teens in Control, are largely responsible for the impacts seen overall.  The My Choice, My Future! findings mirror the overall results most closely — for all STDs examined, youth in the program group were significantly less likely than those in the control group to report that condoms are usually preventive, and they were significantly more likely to report that condoms are never preventive.  For Teens in Control, the same pattern of results holds, though the differences are less often statistically significant.  FUPTP also displayed some statistically significant differences between program and control group youth.  Most notably, program group youth in this site were more likely to report that condoms usually prevent HIV while also more likely to report that condoms never prevent herpes and HPV.

Figure V.2.
Estimated Impacts on Perceived Effectiveness of Condoms for Preventing Sexually Transmitted Diseases:
Prevention of Chlamydia and Gonorrhea

Prevention of HIV

Prevention of Herpes and HPV

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 Tables A.11 through A.13.

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

• Most study youth reported that birth control pills were usually or sometimes effective at preventing pregnancy.  Program and control group youth shared similar perceptions.

Just over half of the youth in both the program and control groups reported that, when used properly, birth control pills usually prevent pregnancy (Figure V.3).  Only three percent of youth in each group reported that birth control pills never prevent pregnancy, and seven percent were unsure about their effectiveness.  At the site level, shown in Appendix Table A.14, program group youth in FUPTP were significantly more likely than control group youth to report birth control pills usually prevent pregnancy.  This difference is not evident in the overall findings because it is offset by small, negative differences in the other three program sites (none are statistically significant).

Figure V.3.
Estimated Impacts on Perceived Effectiveness of Birth Control Pills for Preventing Pregnancy

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.14.

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

• Program group youth were less likely than control group youth to perceive birth control pills as effective at preventing STDs.

More than two out of three study participants reported, correctly, that birth control pills do not prevent STDs.  For each STD investigated, a significantly higher proportion of youth in the program group than the control group reported this was the case (Figure V.4).  For example, 73 percent of program group youth correctly reported that birth control pills never prevent HIV compared to 69 percent of control group youth, a statistically significant difference of four percentage points.

As with several previous measures, My Choice, My Future! is the main source for the difference seen overall in these perceptions (see Appendix Tables A.15 through A.17).  For each STD type, the proportion of program group youth in My Choice, My Future! who reported that birth control pills never prevent STDs was significantly higher than that of the control group.  Differences ranged from 8 to 11 percentage points.  In contrast, the other three program sites display no statistically significant differences between the two groups for any of the STDs examined.

Figure V.4.
Estimated Impacts on Perceived Effectiveness of Birth Control Pills for Preventing Sexually Transmitted Diseases:
Prevention of HIV

Prevention of Chlamydia and Gonorrhea

Prevention of Herpes and HPV

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 Tables A.15 through A.17.

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

Endnotes

[1] These potential mediators of sexual abstinence (knowledge and perceptions) were not measured until the final follow-up survey.  Therefore, this is the first report to examine them.  For updated impact findings on other potential mediators of sexual abstinence — all of which were examined in a prior DHHS study report by Maynard et al. (2005) — see Appendix E.

[2] For each STD category, youth who reported in the never effective category were significantly more likely to have remained abstinent than those who reported into one of the other categories.  This difference merely reflects an association, not evidence of a causal relationship.  Indeed, it is evident among both program and control group youth, suggesting it is related to factors other than program participation.

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