APPENDIX I: HHS ACTIVITIES

The Department of Health and Human Services supports a variety of efforts to help communities develop comprehensive teen pregnancy prevention strategies that reflect five principles: parental and adult involvement, abstinence, clear strategies for the future, community involvement, and a sustained commitment. We estimate that, through our support, at least 30 percent of communities across the country already have teen pregnancy prevention programs in place. This estimate will differ from a simple count of the number of communities served by the following programs due to overlapping sites and other factors (see note below for methodology). Our national strategy will build upon, strengthen, and expand the most promising efforts to assure that every community in the country is working to prevent out-of-wedlock teen pregnancies.

HHS Programs

• The Community Coalition Partnership Program for the Prevention of Teen Pregnancy is one of HHS's most comprehensive and innovative teen pregnancy prevention programs. In 1995, the Centers for Disease Control and Prevention awarded grants to community-wide coalitions in communities with high rates of teen pregnancy. CDC awarded approximately $250,000 per year for two years to 13 communities in 11 states to help these communities mobilize and organize their resources to support effective and sustainable teen pregnancy prevention programs. The next phase begins in FY 1997 when a total of $13.7 million is available to help the 13 community coalition partnerships implement their action plans and evaluate their impact, as well as to support related data collection, evaluation, and dissemination activities.
• The Adolescent Family Life Program (AFL), created in 1981, supports demonstration projects, approximately one-third of which currently provide abstinence-focused educational services to prevent early unintended pregnancies, sexually transmitted diseases, and HIV/AIDS. Most projects provide comprehensive and innovative health, education, and social services to pregnant and parenting adolescents, their infants, male partners, and their families, with a major emphasis on preventing repeat pregnancies among adolescents. In FY 1996, the AFL program funded 17 projects in 14 states, which will be continued in FY 1997. An additional $7.6 million in new funding will be used to enable smaller communities to develop and implement about 40 abstinence-based education programs and about 60 larger prevention demonstration projects, following the abstinence education definition in the welfare law.
• Reproductive Health and Family Planning Services (under Title X of the Public Health Service Act) are provided to nearly 5 million persons each year, nearly one third of whom are under 20 years of age. Abstinence counseling and education are an important part of the Title X service protocol for adolescent clients. To address male involvement in preventing unintended pregnancy, the Title X Family Planning Program will supplement existing community-based programs to develop effective approaches for providing family planning education and services to males.
• Healthy Schools, Healthy Communities, a Health Resources and Services Administration program created in 1994, has established school-based health centers in 27 communities in 20 states and the District of Columbia to serve the health and education needs of children and youth at high risk for poor health, teenage pregnancy, and other problems.
• The Social Services Block Grant (SSBG) (under Title XX of the Social Security Act) provides funding to prevent, reduce, or eliminate dependency; achieve or maintain self-sufficiency; prevent neglect, abuse, or exploitation of children and adults; prevent or reduce inappropriate institutional care; and provide admission or referral for institutional care when other forms of care are inappropriate. SSBG Grants are made directly to the 50 states, the District of Columbia, and Puerto Rico, Guam, the Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands to fund social services tailored to meet the needs of individuals and families residing within that jurisdiction.
• The Community Services Block Grant, which operates in all 50 states, the District of Columbia, and the territories, enables local community agencies to provide low-income populations, including youth at risk, with job counseling, summer youth employment, GED instruction, crisis hotlines, information and referral to health care, and other services.
• The Independent Living Program, run by the Administration for Children and Families, provides funds to states to support activities ranging from educational programs to programs that help young people who are making the transition from foster care to independent living to avoid early parenthood. This program supports activities in all 50 states and the District of Columbia.
• Youth Programs including Runaway and Homeless Youth Programs, Transitional Living Programs, and the Youth Sports Program, address a wide range of risk factors for teen pregnancy. Together, these programs operate in 620 communities in 50 states and the District of Columbia.
• The Community Schools Program was created by the 1994 Violent Crime Control and Law Enforcement Act to support activities during non-school hours for youth in high-risk communities. Funds are awarded to public-private partnerships of community-based organizations to provide a broad spectrum of supervised extracurricular and academic programs after-school and during evenings, weekends and school vacations. Grantees also train teachers, administrators, social workers, guidance counselors, and parent and school volunteers to provide concurrent social services for at-risk students. The Administration for Children and Families awarded $10.15 million in grants to 54 communities in 1997 under this program.
• Healthy Start has 22 demonstration projects operating in 25 states (one project operates in three states) to reduce infant mortality in the highest-risk areas and to improve the health and well-being of women, infants, and their families. Among a broad array of services provided, thousands of teenagers participate in prevention programs exclusively designed for adolescents that encourage healthy lifestyles, youth empowerment, sexual responsibility, conflict resolution, goal setting, and the enhancement of self-esteem.
• Maternal and Child Health Services Block Grant (Title V) funds support a variety of adolescent pregnancy prevention activities in 59 states and jurisdictions that include adolescent pregnancy prevention programs, state adolescent health coordinators, state prenatal hotlines, family planning, technical assistance, and other prevention services. Approximately 85 percent of the block grant funds are distributed under a formula which requires a match by the states. More than $1 billion is generated under this federal-state partnership. Through the block grants, approximately 610 school-based and school-linked centers are supported. In addition, the Maternal and Child Health Bureau administers a program of discretionary grants using 15 percent of the Block Grant appropriation. In FY 1995-96, the Bureau awarded approximately 144 discretionary grants to support adolescent health programs each of which impacts directly or indirectly on the problems of teen pregnancy.
• Empowerment Zones and Enterprise Communities in 105 rural and urban areas in 43 states and the District of Columbia have been awarded grants to stimulate economic and human development and to coordinate and expand support services. As they implement their strategic plans, some sites are including a focus on teenage pregnancy prevention and youth development.
• Health education in schools supports the efforts of every state and territorial education agency to implement school health programs to prevent the spread of HIV and sexually transmitted diseases (STDs). Assistance is also provided to 13 states to build an infrastructure for school health programs. Efforts are targeted at preventing early sexual activity, STDs, HIV, drug and alcohol abuse, tobacco use, and injuries.
• Community and migrant health centers, including family and neighborhood health centers, operate in 1,647 sites in 643 communities in all 50 states, the District of Columbia, and six territories. The centers provide primary and specialized health and related services to medically-underserved adolescents. Some centers include special hours or clinics for adolescent patients.
• Indian Health Service (IHS) provides a full range of medical services for American Indians and Alaska Natives. IHS supports projects targeted at preventing teenage pregnancy, and its prevention and treatment programs also have a special emphasis on youth substance abuse, child abuse, and women's health care.
• Drug treatment and prevention programs include services to prevent first time and repeat pregnancies among teenagers. One hundred twenty-two residential substance abuse treatment programs for pregnant and postpartum women, as well as women with dependent children, receive support to provide family planning, education, and counseling services in 39 States, the District of Columbia, and the Virgin Islands. Also, 25 programs to prevent substance use and other adverse life outcomes serve high-risk female teens in 13 States and the District of Columbia.
• Health Care and Promotion under Medicaid provides Medicaid-eligible adolescents under age 21 with access to a comprehensive range of preventive, primary, and specialty services within its Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program.
• The Medicaid program also funds family planning services at an enhanced match rate for states. The federal government pays 90 percent of state expenditures for Medicaid family planning services, while the state funds the remaining 10 percent. The enhanced match encourages states to fund family planning programs which include patient counseling and education concerning pregnancy prevention and reproductive health.

Evaluation and Research

HHS has conducted research, surveillance, demonstrations, and evaluations on an ongoing basis to gather and provide information and technical assistance on the magnitude, trends, and causes of teenage pregnancy and on prevention programs and approaches that work, including:

• Building and Sustaining Community Partnerships for Teen Pregnancy Prevention: A Working Paper This working paper reviews an extensive literature of various partnership relationships designed to produce change in a range of topical areas. Many of the problems addressed were associated with teenage risk-taking behaviors. Theexamination considered research in the fields of violence prevention, substance abuse prevention, teenage pregnancy prevention, youth development, community development, environmental protection, and general business enterprises. The report is intended to provide the reader with an overview of the literature on partnerships and to help inform the development of future community partnerships to prevent teen pregnancy.
• "Beginning Too Soon: Adolescent Sexual Behavior, Pregnancy, and Parenthood" is a two-volume comprehensive review completed for HHS by Child Trends, Inc. in June, 1995 of the most recent literature on teen sexual behavior, pregnancy and parenthood and the effectiveness of teen pregnancy prevention programs.
• As part of its Youth Risk Behavior Surveillance System, CDC helps states monitor critical health risk behaviors among teenagers, including sexual risk behaviors that result in HIV infection, other STDs, and teen pregnancy. In 1995, 40 states and territories and 16 large cities collected comparable data.
• The upcoming release in 1997 of the new National Longitudinal Study of Adolescent Health (Add HEALTH), a comprehensive study of adolescent health funded by HHS' National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health and other HHS agencies, will provide an opportunity to increase our knowledge about risky behaviors and resiliency factors in adolescents and about environmental influences, including parents, siblings, peers, schools, neighborhoods, and communities. The National Survey of Adolescent Males, supported by NICHD, OPA and other HHS agencies, and the 1995 cycle of the National Survey of Family Growth conducted by NCHS with other HHS support, will also provide relevant information on the behavior of young men and women.
• National Institutes of Health also conducts research and evaluation studies of promising interventions, including the "Adolescent Pregnancy Prevention Program", "Preventing Problem Behavior Among Middle School Students" program, and the "Research on Sexually Transmitted Diseases, Violence, and Pregnancy Prevention" (RSVPP) project.

NOTE:

Measuring the Proportion of Communities with Teen Pregnancy Prevention Programs

Recent declines in the teen birth rate, and indications of further declines in the teen pregnancy rate, suggest that the numerous public- and private-sector efforts across the country to prevent teen pregnancy are having a positive impact. Measuring all the factors that help adolescents postpone premature sexual activity and avoid pregnancy is difficult, however, since individual, family, and community characteristics are all influential. Nevertheless, measuring the proportion of communities that have at least one teen pregnancy prevention program in place (estimated by dividing the number of such communities by the number of communities in the United States) provides a rough sense of how many communities are responding to this problem with specific, targeted prevention efforts.

To develop a sound, albeit conservative, estimate of the proportion of communities with teen pregnancy prevention programs, the estimate includes only those programs supported by HHS. HHS-supported programs that include teen pregnancy prevention services as a component are diverse, ranging from comprehensive health and social services to substance abuse treatment and HIV prevention education. The number of teen pregnancy prevention programs funded by HHS includes those programs funded in FY 1995 (the latest year for which complete information on grants awarded is available).

To determine how many communities have at least one program, the location of each program was identified based on the site of the services provided and/or the location of the grant recipient. Any individual community with more than one program was counted only once. The estimate excludes HHS funding provided directly to states (e.g., Medicaid, Maternal and Child Health Block Grant) which states may use to fund activities in multiple communities.

Since there is no single standard definition for community in the United States, the estimate uses a definition of community based on areas identified by the Commerce Department's Bureau of the Census. This definition includes all incorporated places with a population of 10,000 individuals or more (2,673) and all counties where, excluding these incorporated places, the remaining population reaches 10,000 or more (2,079), for a total of 4,752 communities. Under this definition, for example, Montgomery County, Maryland would consist of four communities, including three incorporated places of 10,000 or more inhabitants (Gaithersburg, Rockville, and Takoma Park) and one community representing the balance of the county's population, which exceeds 10,000.

Using the above calculations, the resulting estimate of the proportion of communities in the United States with HHS-supported teen pregnancy prevention and related programs is at least 30 percent. This proportion represents about 1,410 communities across the country.

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