A National Strategy to Prevent Teen Pregnancy: Annual Report 1999-2000

Introduction

In this 1999-2000 Annual Report, after three years of a National Strategy to Prevent Teen Pregnancy, the U.S. Department of Health and Human Services (HHS) is pleased to report that teen pregnancy and birth rates in this country have declined to record low levels. Trends throughout the 1990s have shown a steady reduction in teen birth rates that is now significant for all 50 states. Rates have declined for all adolescent age groups, for all racial and ethnic groups, and for both first and second births to teens. Clearly we are reaping the benefits of this Administration's strong commitment to our National Strategy and renewed efforts by states, localities, private organizations, parents, and youth.

Although we have come far, we have a considerable distance still to go. U.S. teen pregnancy rates remain among the highest in the industrialized world, and birth rates for Hispanic and black teens continue to be substantially higher than those for non-Hispanic white and Asian or Pacific Island youth. We must remain steadfast in our intention to reduce teen pregnancy.

Yet, while we must not underestimate the need to continue our prevention efforts, the facts are enormously promising. For example:

• Earlier Trends Reversed. By the end of 1999, a record low U.S. birth rate for teens aged 15-17 reversed the 27 percent increase in teen birth rates recorded in the 1980s.

• Lowest Rate in Three Decades for Youngest Teens. The youngest group, aged 10-14, showed the lowest birth rates since 1967, as well as a sharp decline in number of births. The latter decline occurred despite the fact that the population of girls in this age group actually increased during this time period.

• Black Teens Show Greatest Reductions. Throughout the 1990s, black teens have had the largest declines in teen childbearing rates of any group.

The Department issued the National Strategy to Prevent Teen Pregnancy in January 1997, in response to a call from the President and Congress to develop a comprehensive strategy to address the problem of adolescent pregnancy. The request was to demonstrate a cohesive approach to the challenges of teen pregnancy prevention, in general, and specifically, to provide assurance that at least 25 percent of communities in the United States have teen pregnancy prevention programs in operation. The latter requirement is mandated by the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996.

The Strategy relies on some basic principles of teen pregnancy prevention, listed below, and on the support and integration of pregnancy prevention efforts with other positive youth development activities in local communities.

Key Principles. Five key principles shape and guide our National Strategy. Based on ideas shown by research and experience to be essential to all community prevention efforts, these key principles are the cornerstone of the Department's Strategy.

The Five Principles Parents and other adult mentors must play key roles in encouraging young adults to avoid early pregnancy and to stay in school. Abstinence and personal responsibility must be the primary messages of prevention programs. Young people must be given clear connections and pathways to college or jobs that give them hope and a reason to stay in school and avoid pregnancy. Public and private-sector partners throughout communities  including parents, schools, business, media, health and human service providers, and religious organizations  must work together to develop comprehensive strategies. Real success requires a sustained commitment to the young person over a long period of time.

Reporting Our Progress. This annual report is intended to provide information about the efforts of the Department of Health and Human Services to reduce teen pregnancy in the past year. Our previous reports are also available on the HHS website at: http://aspe.hhs.gov/hsp/hspyoung.htm#teenpreg

We also wish to recognize the efforts of others, such as the non-profit National Campaign to Prevent Teen Pregnancy, individual states and communities, foundations, other non-governmental entities, parents, youth, and other caring adults.

Trends in Teen Births and Pregnancies

At the end of the third year of our National Strategy to Prevent Teen Pregnancy, the news continues to be good  and getting better:  Teen birth rates are still steadily declining, according to the latest data compiled from the Department's National Center for Health Statistics (NCHS). These declines cut across ages (both younger and older adolescents), states, races and ethnic groups; moreover, fewer teenagers are having second children.

Last year's report provided analyses through 1998 based on preliminary birth data.⁽¹⁾ This year we are happy to report that the preliminary results were validated with publication of the final data file for 1998, suggesting that the decade of the 1990s has been one of real success in reducing teen birth rates.⁽²⁾ Moreover, rates continued to decline in 1999 based on preliminary data.⁽³⁾ Our nation continues to move toward improving prevention efforts for this most vulnerable population.

Trends and variations in teen birth rates are based on information reported on the birth certificates of all babies born in the United States, provided to the National Center for Health Statistics (NCHS) by the state health departments through the Vital Statistics Cooperative Program. NCHS and the states share costs for collecting and processing the data. The most recent analyses were based on more than 97 percent of all U.S. births through 1999. More information on the collection and reporting of teen birth data is presented in Appendix I.

Teen Birth Rates Continue to Fall. Both national and state-level teen birth rates have fallen steadily since 1991. For teenagers aged 15-19, the birth rate dropped 20 percent, from 62.1 births per 1,000 in 1991 to 49.6 in 1999, a record low. As of 1997, 49 states had declines that were statistically significant (Rhode Island's decline was the exception), as noted in last year's Report to Congress. However, this year we are happy to report that through 1998, all 50 states had reductions in their teen birth rates that were statistically significant.⁽²⁾

The 1990s: A Decade of Declining Teen Birth Rates. The NCHS figures show that from 1991 through the end of 1998, teen birth rates dropped 20 percent or more in 13 states, as well as in the District of Columbia and the Virgin Islands. In five of these states, teen birth rates declined by more than 25 percent.

Record Lows Reverse Earlier Trends. A U.S. record low birth rate for younger teens (aged 15-17) by the end of 1999 essentially reversed the 27 percent increase in teen birth rates that occurred in the late 1980s.^(2,3,4,5) Birth rates fell more for younger than for older teenagers. Rates differ substantially by age: in 1999, the rate for older teens (aged 18-19) was 80.2 per 1,000 women, more than two-and-a-half times the rate of 28.7 per 1,000 for the younger teens. The U.S. birth rate for teenagers aged 15-19 declined 3 percent from 1998 (when the rate was 51.1 per 1,000) to 1998, and 20 percent from 1991 to 1999.⁽³⁾ The birth rate for teens aged 15-17 fell 6 percent between 1999 (when it was 30.9 per 1,000) and 1999, and 26 percent between 1991 (when it was 38.7 per 1,000) and 1999.^(2,3,5) The rate for older teens aged 18-19 declined 15 percent since 1991 (94.4 per 1,000).

The birth rate for the youngest age group, 10-14 years, fell to 0.9 births per 1,000 in 1999, its lowest level in more than three decades (0.9 in 1967). Moreover, the number of births to this age group fell to 9,049, down 30 percent from its recent high in 1994 (12,901 births). The decline in the number of births is due entirely to the drop in the birth rate  down from 1.4 per 1,000 in the early 1990s; whereas the number of girls aged 10-14 increased during this period

Drop in Births to Unmarried Teens. For the fourth consecutive year, birth rates for unmarried teenagers declined in 1998. Since 1994, the rate for unmarried teens 15-17 years has fallen 16 percent, and the rate for those 18-19 has dropped 8 percent. However, despite these declines in birth rates, the proportion of births to unmarried teenagers continued to increase in 1998 and 1999: non-marital births accounted for 88 percent of births to girls aged 15-17, and for 74 percent of births to young women aged 18-19. These proportional increases in non-marital births reflect a greater decline in total teen births than in non-marital teen births.

Decline in Birth Rates for Teens of All Racial and Ethnic Backgrounds. Birth rates for black teenagers have dropped steeply in the 1990s. In fact, the largest declines in teen childbearing since 1991 have been for black teenagers.

• The overall rate for black teens aged 15-19 fell 30 percent from 1991 (when it was 115.5 per 1,000) to 1999 (81.1), compared to a 20 percent drop for all teens in this age group.
• The rate for young black teenagers (aged 15-17) dropped 38 percent from 84.1 per 1,000 in 1991 to 52.1 in 1999.
• The rate for older black teenagers declined 23 percent from 1991 to 1999, from 158.6 to 122.9 per 1,000.

Birth rates have also fallen since 1991 for non-Hispanic white teenagers. The overall rate fell 21 percent for white teens aged 15-19, from 43.4 per 1,000 to 34.1 in 1999, and the decline in rates was greater for younger than for older teens.

The rate for American Indian teenagers declined 20 percent during 1991-99 (from 85.0 to 67.7 per 1,000), while the rate for Asian or Pacific Islander teens, consistently the lowest of all groups, fell 17 percent (from 27.4 to 22.8 per 1,000). Teen birth rates have declined for Hispanic teenagers as well, but the declines did not begin until after 1994. Nevertheless, the rate dropped 14 percent between 1994 (107.7 per 1,000) and 1999 (93.1). Birth rates continue to be substantially higher for Hispanic and black youth than for non-Hispanic white and Asian or Pacific Islander teens. Since 1994, Hispanic teens have had higher rates than any other group.

Fewer Teenage Mothers Have Second Child. In recent NCHS reports, a key finding has been that the rate of second births to teenagers who already have one child declined from 221 per 1,000 in 1991 to 174 in 1996-97 (21 percent), and then rose slightly to 175 in 1998.^(2,4) In other words, the proportion of teen mothers who gave birth to a second child fell from 22 to 17 percent in the 1990s. Because these second teen births are associated with the most adverse outcomes for the mothers and their children, this finding is particularly encouraging.

First Births to Teens Falling Since 1994. About four-fifths of births to teenagers are first births, accounting for 78 percent of teen births in 1998. After little change in the first-birth rate for childless teens from 1991 to 1994 (when the rate hovered around 50 per 1,000), this rate then declined 13 percent between 1994 and 1998 (to 43 per 1,000).

Declining Teen Pregnancy Rates. The estimated teen pregnancy rate (as differentiated from the birth rate, reported above) for 1996 is 99 pregnancies per 1,000 women aged 15-19, down 15 percent since 1991 (116) and the lowest level recorded since Federal data collection begin in 1976.⁽⁶⁾  The decline in the 1990's reverses the 11-percent rise from 1986 to 1991. (The most recent year for which pregnancy rates are available is 1996.) Between 1991 and 1996, pregnancy rates fell 15 and 12 percent, respectively, for teenagers 15-17 and 18-19 years. Rates have fallen for non-Hispanic white, non-Hispanic black, and Hispanic teenagers.⁽⁶⁾

Building Partnerships

Partnership building is gaining momentum across the country, as local communities work together toward building more sustainable supports for children, youth and families. From the start, partnership building has been a cornerstone of the Department's National Strategy to Prevent Teen Pregnancy. Out of these coalitions and collaborations, prevention efforts can be created with the resources and contribution of all key stakeholders in a community. Because research tells us that youth reared in the most supportive, nurturing environments are least likely to engage in behavior that leads to teen pregnancy, this building of sustainable partnerships for youth development is key to reducing the teen birth rate.

HHS partnerships involve national, state, and local organizations; schools; health and social service organizations; community-based organizations; business; religious institutions; tribes and tribal organizations; federal, state, and local governments; parents and other family members; and teens themselves. At HHS, we recognize that building these partnerships is not a simple task, that it takes considerable time, energy, effort, and commitment. Continuing energy and commitment are necessary to sustain these partnerships over time. The payoff in the integration of services, pooling of resources, and the building of community is significant, given the considerable challenges that must be addressed  some common and some unique to each community. Barriers to collaboration include differences in racial, ethnic, linguistic, religious, class and/or educational backgrounds. Collaboration can best be accomplished when partners are able to align on a common goal.

The following highlight and update HHS' efforts to build and strengthen partnerships in communities across the country this past year.

Get Organized: A Guide to Preventing Teen Pregnancy. This three-volume guide for states and communities to use in their fight against teen pregnancy was developed in partnership with the National Campaign to Prevent Teen Pregnancy  a private nonprofit, nonpartisan organization formed in response to the President's 1995 State of the Union challenge to parents and leaders across the country to come together in a national effort to reduce teen pregnancy. In October 1999, HHS Secretary Donna Shalala and Campaign President Isabel Sawhill announced the release of this comprehensive guide. The Secretary noted that although the teen pregnancy rate is declining, four out of 10 girls become pregnant before they are 20 years old, with some girls having multiple births during their teen years. She emphasized the critical importance of promoting prevention and providing guidance to young people.

"Get Organized" stresses a long-term, localized approach to teen pregnancy prevention, with careful evaluation plans built into prevention efforts. Chapters in the Guide cover: "Promising Approaches", "Involving Teen Boys and Young Men", "Involving Parents", "Involving the Faith Community", "Involving Health Care Professionals", and "Involving the Business Community." Other chapters address issues that often challenge community leaders in their efforts to prevent teen pregnancy such as: how to conduct a community needs assessment, how to raise funds for prevention programs, how to create an effective teen pregnancy prevention message, and how to move forward in the face of conflict.

The Guide is available in hard copy, for a nominal fee, from the National Campaign to Prevent Teen Pregnancy (http://www.teenpregnancy.org). Early in 2000, the Department made the guide available at no cost through the HHS website. The guide can be found and downloaded at:  http://aspe.hhs.gov/hsp/hspyoung.htm#teenpreg.

The Girl Power! Campaign. Girl Power! is a national public education campaign to help encourage and motivate 9- to 14-year-old girls. Multiple and varied partnerships have been part of Girl Power! since it started in 1996, helping to accomplish its goal of empowering girls to reach their full potential. Studies show that girls at this age have a tendency to lose self-confidence and self-worth. During this critical phase, many girls become less physically active, perform less well in school, and neglect their own interests and aspirations. Girls become more vulnerable to negative outside influences and to mixed messages about risky behaviors during these years. The Girl Power! Campaign focuses on increasing skills and competence in academics, arts, sports, and other beneficial activities. Encouraging girls to develop their skills and sense of self is one way to ensure they will make healthier choices for their lives.

New products of the Girl Power! Campaign include a Community Education Kit featuring resources for Girl Power! programs and "BodyWise," an information packet for middle school educators focused on eating disorders. The Community Education Kit is designed for use by coaches, teachers, business leaders and other caring adults who are helping girls make the most of their lives. The kit was developed by the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Prevention. The kit can be previewed and downloaded from the Girl Power! web site at http://www.health.org/gpower. Individual components or the entire kit can also be ordered by calling SAMHSA's National Clearinghouse for Alcohol and Drug Information at 1-800-729-6686.

"We want to tell every parent and every caring adult to listen to girls, to encourage them, to help them set high standards, and to provide them with opportunities," said Secretary Shalala in April 2000, when the kit was released. "The Community Education Kit will help everyone who works with girls create programs with the message that girls have the right to be the best they can be  confident, fulfilled, and true to themselves."

Since the Girl Power! campaign was launched in 1996, its goals have been to provide accurate health information and positive messages to girls and their caregivers; to raise public awareness about substance abuse and risky behaviors; to help girls develop the skills they need to resist unhealthy influences and make positive choices; and to support girls and the adults who care about them. The campaign also challenges caring adults to reach out to young girls at this transitional age when they are forming their values and attitudes and help them pursue opportunities to build skills and self-esteem through sports, academics, the arts and other endeavors.

Girl Power!, sponsored by the U.S. Department of Health and Human Services with leadership from the Office of the Secretary, the Office on Women's Health, and the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention has partnered with more than 5,000 community-based programs and organizations, including more than 60 national endorsing organizations and 300 state and local affiliations, to develop and implement unique Campaign promotional materials, public service announcements, and an award-winning web site (http://www.health.org/gpower). The Girl Power! web site has received more than 29 million "hits" since its inception at the end of 1996; the average web visitor stays more than nine minutes at the site. Another component of this effort is "Girl Neighborhood Power! Building Bright Futures for Success," described in the "Supporting Promising Approaches" chapter of this document.

Joint Work Group on School-Based Teen Pregnancy Prevention. The Centers for Disease Control and Prevention's Division of Adolescent and School Health supports nine national associations in their work helping state and local education staff, health policy makers, school administrators, maternal and child health professionals, school health professionals, and other school personnel prevent teen pregnancies. The nine national, non-governmental organizations are the American Association of Maternal and Child Health Programs, American School Health Association, American Association of School Administrators,* Association of State and Territorial Health Officials, Council of Chief State School Officers, National Association of State Boards of Education, National Conference of State Legislatures, National Education Association, and the National School Boards Association.

Note: * The American Association of School Administrators was previously funded by CDC; however, this organization no longer receives funding.

After two years of gathering information about the needs of their respective groups, Joint Work Group members are coordinating efforts to motivate and assist these groups in developing and implementing school-based teen pregnancy prevention policies and programs. This year, the Joint Work Group will provide on-site, customized technical assistance for three competitively selected states that convene teams composed of state and local education and health policymakers, administrators, and other school personnel. Technical assistance will include development, implementation, or expansion of state action plans to build team members' capacity to address school-based teen pregnancy prevention policies and programs, and to develop partnerships with local communities. Technical assistance activities include support for:

• Funding and resources for teen pregnancy prevention.
• Partnerships among schools, communities and families.
• Collaboration between state and local organizations.
• Schools, youth development, and teen pregnancy prevention.
• Evaluating the impact of teen pregnancy on academic achievement.
• Developing social marketing strategies.
• Evaluating teen pregnancy prevention programs and policies.

In the year following technical assistance training, the Joint Work Group will compile reports to be shared with state team leaders and will communicate with state leaders to discuss progress and identify additional needs. Technical assistance activities will be expanded to additional states in subsequent years.

The Centers for Disease Control and Prevention (CDC) Community Coalition Partnership Programs for the Prevention of Teen Pregnancy. With support from and in partnership with CDC, 13 communities with high rates of teen pregnancy are working to reduce these rates. The 13 demonstration projects began in 1995. Currently in the second phase, these coalitions of local public and private agencies and community organizations are implementing action plans, testing promising interventions, building financial and programmatic sustainability, and conducting site-specific evaluations. CDC will be working with these innovative communities for the next several years. Further details about the promising approaches and evaluation efforts of this program are discussed later in this report.

The Indian Health Service (IHS). As a direct care organization, IHS has traditionally focused on services related to teen pregnancy, such as appropriate prenatal and neonatal care. IHS continues to increase its work in partnership with federal, state, and local organizations to develop and implement strategies that deal with all issues surrounding teen parenthood, including prevention.

Supporting Promising Approaches

HHS has continued to ensure that at least 25 percent of communities have teen pregnancy prevention programs in place  as mandated by section 905 of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996.

In FY 1999, at least 35 percent of communities had teen pregnancy prevention programs in place. This is a conservative estimate because it represents only HHS funded programs that flow directly to communities. HHS also supports other teen pregnancy prevention efforts through its various state block grant programs. For example, two of the purposes of Temporary Assistance for Needy Families (TANF; which replaced Aid to Families with Dependent Children, AFDC) are to prevent out-of-wedlock pregnancies and to encourage the formation and maintenance of two-parent families. In support of these goals, states may use TANF funds for a wide variety of teen pregnancy prevention programs, serving both welfare recipients and the general population. In addition, there are numerous activities supported by funding sources outside of HHS.

Abstinence Education

Abstinence education is funded by the Department through two programs. In 1996, the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) created a program entitled the Abstinence Education Grant Program, funded under Section 510 of Title V of the Social Security Act. The grants funded under this program must meet specific criteria defined in the legislation. In addition, the Department has been funding abstinence education through its Adolescent Family Life Program (AFL) since 1981.

Abstinence Education Grant Program. The HHS Health Resources and Services Administration's Maternal and Child Health Bureau (MCHB) is responsible for the administration of the Abstinence Education Grant Program (Section 510 of Title V of the Social Security Act). The law provides for a mandatory annual appropriation of $50 million for each fiscal year (FY), 1998 through 2002. Annual submission of a State application and an annual report are required prior to allocation of funds. Fifty-three States and Territories received Abstinence Education Grant funding in Year 1 of the program (FY 1998), and fifty-two States and Territories received funding in Year 2 (FY 1999). (California, subsequently decided to return both FY 1998 and FY 1999 Abstinence Education Grant funding.) Fifty-three States and Territories received FY 2000 Abstinence Education Grant funding. The final annual reports for the FY 1999 Abstinence Education Grants and the Year 4 (FY 2001) applications were to have been submitted to MCHB by mid-July 2000. In April 2000, MCHB completed an annual program summary for FY 1999. Key findings reported by States and Territories are summarized below.

• Most frequently funded activities were: community-based projects (44 States/Territories); program evaluations (40); technical assistance and training (37); program monitoring (37); state media campaigns (31); and advisory councils/steering committees (25).
• Most frequent state contractual awards were: community-based organizations (38 States/Territories); local boards of education, school districts and schools (29); and youth serving organizations (27).
• Most frequently funded local program activities were: social skills instruction, character-based education, and assets building (37 States/Territories); school-based programs (34); adult mentoring, counseling and supervision (33); curriculum development and implementation (31); and parent education groups (31).
• Age groups most frequently served by States and Territories were: 13-14 year olds (47); and 9-12 year olds (46).
• Populations most frequently targeted by States and Territories were: parents (43); at-risk youth populations, such as youth of color, out-of-school youths, and youth in areas with high rates of out-of-wedlock pregnancies (37); teachers and youth serving professionals (26); and males (25).

In addition, a national evaluation of Abstinence Education programs is being funded and managed separately. See "Abstinence-Only Education Programs  National Evaluation," in the "Research and Evaluation Activities" chapter of this document.

Adolescent Family Life Program. The Adolescent Family Life (AFL) Program was enacted in 1981 as Title XX of the Public Health Service Act. Its approach to adolescent pregnancy prevention, as required by statute, has always been abstinence-based; promoting the postponement of sexual activity as the most effective way for adolescents to prevent pregnancy and sexually transmitted diseases (STDs), including HIV infection. This intent has been further reinforced by Congressional requirements, beginning in FY 1997, that specified portions of the Title XX appropriation be used to support prevention projects using the abstinence-only definition under PRWORA. In FY 1999, $9.1 million of the total $17.7 million AFL appropriation was spent to support 72 prevention projects in fulfillment of this requirement. An additional $5 million was spent to continue support for 17 prevention, care and combination projects originally funded in FY 1995, as well as $1 million to support research grants.

Family Planning

Title X National Family Planning Program. The Department is a primary provider of subsidized family planning services, serving nearly 4.5 million persons annually. The Title X program has always played an important role in adolescent pregnancy prevention; approximately 30 percent of those receiving services are under 20 years of age. In addition to clinical services, outreach and education  including counseling to encourage continued postponement of sexual activity for adolescent clients who are not yet sexually active  are also important components of Title X services for adolescents.

Community Collaboratives

The Community Coalitions Partnership Program and Girl Neighborhood Power! are two programs that help communities develop and maintain collaborations for planning, implementing and evaluating prevention strategies among different sectors of the community.

Community Coalition Partnership Program for the Prevention of Teen Pregnancy. Since 1995, the Centers for Disease Control and Prevention (CDC) has supported demonstration projects in 13 communities with high rates of teen pregnancy (Boston, Chicago, Jacksonville, Kansas City, Milwaukee, Oklahoma City, Orlando, Philadelphia, Pittsburgh, Rochester, San Antonio, San Bernardino, and Yakima, WA).

Eleven of these communities are actively working with Latino and other minority youth and neighborhoods, as part of their overall plan to prevent teen pregnancy. Phase II of the demonstration began in 1997 and continues for five years. In this phase, coalitions of local public and private agencies and organizations, leaders, and residents are working to implement their action plans, field test promising interventions, build toward financial and programmatic sustainability of their programs, conduct site-specific evaluations, and participate in cross-site evaluations.

Each of the 13 demonstration communities have continued their efforts to develop and strengthen, neighborhood coalitions. They continue to mobilize and organize community resources in support of comprehensive, effective and sustainable programs for the prevention of initial and repeat teen pregnancies. The communities are pursuing a wide variety of strategies to provide health, education, employment, recreation and other youth development services, programs and opportunities for youth and their families.

Girl Neighborhood Power! Building Bright Futures for Success (GNP). This five-year national demonstration program, forms part of the Department's Girl Power! effort (see "The Girl Power! Campaign" in the "Building Partnerships" chapter of this document). Administered by the Maternal and Child Health Bureau, Health Resources and Services Administration, the program began in October 1997 and is funded through a cooperative agreement among several agencies within the Department. Girl Neighborhood Power! major goals are: (1) promoting the health and well-being of girls between the ages of nine and fourteen years; (2) preventing the onset of health risk behaviors among girls during their adolescence; (3) encouraging connectedness between girls and the communities in which they live and supporting the growth of the girls' citizenship; (4) developing leadership skills in girls; and (5) fostering communities' and neighborhoods' investments in their youth. Four community partners and one national leadership consortium are funded through this initiative: Crispus Attucks Association, York, Pennsylvania; Girls Incorporated, Memphis, Tennessee; the City of Madison, Wisconsin; Youth and Family Services, Incorporated, Rapid City, South Dakota; and the national leadership consortium, housed at Healthy Mothers, Healthy Babies Coalition, Incorporated, Alexandria, Virginia. Community organizations are required to serve a minimum of four low-income neighborhoods, to demonstrate local commitment through a broad-based coalition of community agencies and parents, and to provide creative programming for the positive development of participating girls. Program elements must include: community service; journal-keeping; before and after school activities; career development; health education, and mentoring. Prevention of teen pregnancy and substance abuse are goals for all four projects. Each grantee receives $200,000 in Federal support, and is expected to match this amount by an additional 25 percent each year beginning in Project Year II.

Youth Development

In recent years, recognition has grown of the critical importance of primary and secondary prevention of youth risk behavior, through youth development approaches targeting all youth, and particularly high-risk youth.

Raising Responsible and Resourceful Youth. In early May 2000, the President and First Lady showed their continued commitment to children and youth by hosting the "White House Conference on Teenagers: Raising Responsible and Resourceful Youth." Topics discussed included new scientific research on youth brain development; changing demographics; perceptions and realities about parents' role in their teens' lives; impact of new media on youth and on parenting; challenges and anxieties of today's teenagers and their families; and what parents, communities and young people can do to build a safe and successful path to adulthood. The conference stressed the importance of positive approaches in preventing adolescent risk behaviors. For example, parents and youth spending time together in family activities was highlighted as a foundation for the prevention of adolescent sexual activity, drug use, and other risky behaviors.

Safe Schools/Healthy Students Initiative. In April, more than $41 million in grants to 23 communities were announced to make schools safer, to foster children's healthy development, to prevent aggressive and violent behavior, and to prevent drug and alcohol use among U.S. youth. These 23 new, three-year grants are in addition to 54 grants given last year. This collaborative initiative among the Departments of Education, Justice, and HHS helps urban, rural, suburban and tribal school districts link prevention activities and community-based services and to provide community-wide approaches to violence prevention and healthy child development.

State Youth Development Collaboration Projects. The Family and Youth Services Bureau (FYSB) provides more than $1 million in funding to provide positive youth development. FYSB funds nine states to develop and support innovative youth development strategies: Arizona, Colorado, Connecticut, Iowa, Maryland, Massachusetts, Nebraska, New York, and Oregon. The grants support efforts that focus on all youth, including vulnerable youth in at-risk situations. Youth development programs have been shown to promote youth self-efficacy, build competencies and encourage young people to delay child- bearing. Each state has designed a unique plan for implementing the project on the basis of identified youth needs and prior state activities with regard to youth development.

Programs for Boys and Young Men

Traditionally, adolescent girls have been the focus of most teen pregnancy research and prevention programs. In recent years, adolescent boys and young men have been recognized as deserving a share of that focus. The National Strategy, together with the Administration's Fatherhood Initiative, have continued to work on ways to expand the Department's efforts to target boys and young men. Research has shown that young men recognize unintended pregnancy as a serious problem and its prevention as a joint responsibility; nevertheless, drawing them into family planning/reproductive health information and service programs continues to be difficult. For the past three years, the Office of Population Affairs has funded several research grants aimed at improving our knowledge of what works for males, through the development of new program models.

Title X Male Involvement Grants. The Office of Population Affairs funds 10 research grants to support community based organizations in developing, implementing, and testing approaches for involving young men in family planning education and reproductive health services programs. The 10 research grants, funded through the Title X Family Planning Program, are currently in their third year. An additional 20 grants have been funded as delegate agencies to existing Title X grantees. While the original 10 projects were primarily community-based models that used their existing youth development and adult mentoring programs as incentives to draw young men into reproductive health and family planning education activities, the mix of program types has now become more comprehensive. In addition to the community based models, a number of projects are based on a clinical model that provides comprehensive health care services, including reproductive health and family planning on site, and many are school based (using established curricula such as Wise Guys), on site, and offer referrals for reproductive health and family planning services and specialized counseling.

Promoting Male Involvement in Pregnancy Prevention: Federal, State and Local Strategies. The Department has sponsored several meetings to identify innovative male involvement strategies that might be shared with a larger audience. Specific strategies designed to inform and collaborate with stakeholders and other community based partners include creative use of the media and social marketing, regional and state forums and summits, peer-to-peer networking opportunities, and technical assistance. The goal is to promote and support a view of boys and men as responsible members of families.

Welfare Reform

The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 created the Temporary Assistance for Needy Families (TANF), replacing the former Aid to Families with Dependent Children (AFDC). Two of the primary goals of TANF are preventing out-of-wedlock pregnancies and encouraging the formation and maintenance of two-parent families; consequently, TANF funds may be used to support teen pregnancy prevention efforts. TANF also requires unmarried minor parents to stay in school and live at home, or in an adult-supervised setting in order to receive assistance. The law supports the creation of Second Chance Homes, which provide teen parents with skills to become good role models and providers of their children, giving them guidance in parenting and in avoiding repeat pregnancies. The Administration's FY 2001 budget includes $25 million to Second Chance Homes. In addition, HHS' other programs are working together to look at welfare reform in the context of their programmatic activities.

Bonus to Reward Decrease in Illegitimacy Ratio. Welfare reform included an incentive for states to reduce the incidence of out-of-wedlock childbearing and encourage the development of new approaches to pregnancy prevention. Awards for the first year of the Bonus to Reward Decrease in Illegitimacy Ratio were announced in September 1999. Alabama, the District of Columbia, California, Massachusetts and Michigan all received awards of $20 million each. The decrease in the ratio of out-of-wedlock to total births ranged from 5.7 percent in California to 1.5 percent in Massachusetts. This provision is targeted toward all women, not just teenage mothers; however, in measuring state decreases in out-of-wedlock births, this measure would also include births among unmarried teens. Consistent with the purpose of TANF, the funds can be used to support a wide variety of programs extending beyond needy families.

Guide to States: Helping Families Achieve Self-Sufficiency. The Administration for Children and Families has developed a guide for states entitled Helping Families Achieve Self-Sufficiency. This guide offers suggestions on how best to use TANF funds for services to children and families (including teen pregnancy prevention efforts). The guide can be found at: http://www.acf.dhhs.gov/programs/ofa/funds2.htm

Effects of Welfare Reform on Parenting Teens. In addition, the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Substance Abuse Prevention is supporting an initiative on teen parents and welfare reform that generates knowledge on the effects of welfare reform on parenting teens, and measures the effects of preventive interventions on teen parents and their children. The four objectives in support of this goal are: (1) prevention or reduction of alcohol, tobacco, and drug use; (2) improvement in academic performance; (3) reduction of subsequent pregnancies; and (4) improvement in life skills and general well-being. SAMHSA awarded cooperative agreements to 10 Study Sites, and one Coordinating Center in September 1998, and these projects have enrolled more than 1,700 pregnant or parenting teens, to date. Baseline data are currently being analyzed, and contain interesting information with regard to teen pregnancy that will be disseminated to the field as soon as analyses are completed.

Repeat Pregnancies. The Adolescent Family Life (AFL) program will make approximately $4 million available during FY 2000 for demonstration projects to provide health and social services to pregnant and parenting adolescents, their infants and their families. An important component of these projects will be prevention of repeat pregnancies, STD/HIV infection, substance abuse and violence using a youth development approach to build on adolescents' sense of self-worth and self-efficacy through cultural understanding, sports and recreation, visual and performing arts, and other activities.

Research and Evaluation Activities

The Department continues to support research and evaluation related to the prevention of teen pregnancy. This commitment includes investment in the creation and maintenance of data sets, long-term research to follow trends in important areas, and the design and evaluation of preventive interventions.

The data sets used to conduct research in the area of teen pregnancy are vital to the Department's mission to prevent teen pregnancy. The Department continues to invest resources to gather and maintain high-quality, comprehensive data. These data serve as a critical foundation for the information we now have with regard to teen pregnancy, and for the information we will need in the future. A brief description of each data set is included in Appendix IV.

The Department also continues to fund Sociometrics, a small business, to archive data sets and make them available for other researchers to use for specific purposes. In addition, Sociometrics maintains a collection of teen pregnancy prevention programs that are in a "ready to use" format, including teachers' guides, student information and evaluation tools.

Research and Evaluation Activities

The Department's research and evaluation activities cover a wide spectrum of topics including adolescent patterns of sexual behavior, intent to become pregnant, the impact of the media on adolescents, and attitudes toward and feelings about sexuality, relationships, contraceptive use, pregnancy and childbearing. These efforts are wide-ranging, and include areas such as HIV prevention, which often enhances teen pregnancy prevention. The Department strives to fund studies that address the needs of adolescents from a myriad of backgrounds including youth in high-risk situations, such as those in foster care, in resource-poor inner cities, and those who are homeless or living in fragile families. Research funding is also spent designing, implementing and evaluating pregnancy prevention programs, so that resources may be used to replicate programs that are demonstrably effective. The Department's efforts include newly funded projects, ongoing research, and the publication of final reports and research findings. The following is an overview of the Department's activities in the past year.

National Survey of Family Growth. In December of 1999, the National Center for Health Statistics (NCHS) awarded a contract to the Institute for Social Research of the University of Michigan (ISR-UM) to conduct Cycles 6, 7, and 8 of the National Survey of Family Growth (NSFG). The Pretest/Pilot Study for the NSFG will be conducted in FY 2001. The study will test a number of ways to improve the quality of data on sexual activity, pregnancy, and parenting, using interviews with 600 males and 600 females. In FY 2002, 19,000 men and women, including 4,500 male and female teenagers, will be interviewed. This study, which will greatly improve the reliability of data on teen sexual activity and pregnancy, as well as our knowledge of how consistently both teens and adults use contraception, will be available in FY 2003 (Cycle 6). The Department is also looking toward the future with the goal of conducting two new cycles in 2005 and 2008. These cycles have the potential to include even larger samples, interviews of prisoners and the military, and biomarkers to test for sexually transmitted diseases. DHHS is currently seeking funding to fulfill these ambitious plans.

Media Influences. Responding to a need to examine the role that media play in the lives of adolescents, the National Institutes of Health (NIH) has initiated a set of research projects which will examine the influence that media  TV, movies, music, the internet and magazines  have on adolescents' sexual behaviors. The goal of this effort is to support research in three basic areas: (1) What kinds of sexual content do youth most often notice, and how do they interpret what they see and hear?; (2) Does that media content affect their sexual beliefs and behavior?; and (3) How could the mass media be used to promote responsible sexual behavior among youth? One grant has been awarded at this time and more grants are expected to be funded over the next year.

Counseling to Prevent Unintended Pregnancy. The U.S. Preventive Services Task Force (USPSTF) was first convened by the U.S. Public Health Service in 1984 to systematically review the evidence of effectiveness of a wide range of clinical preventive services, including counseling to prevent unintended pregnancy. In 1989, the Task Force published its first Guide to Clinical Preventive Services, which was updated in 1995. That same year, responsibility for the Task Force was moved to what is now the Agency for Healthcare Research and Quality (AHRQ). AHRQ's broad programs of research bring practical, science-based information to medical practitioners, consumers and other health care purchasers.

The Task Force was reconvened in 1998 and will serve through 2002, to update the 1995 recommendations and to evaluate evidence on preventive interventions not assessed previously, with the goal of releasing a third edition of the Guide to Clinical Preventive Services by late 2002. The Task Force is currently updating its recommendations on counseling to prevent unintended pregnancy. The report will focus on the effectiveness of counseling in primary care settings for improving contraceptive use or reducing risky sexual activity for women of all reproductive ages, including teens. Please see http://www.ahcpr.gov/clinic/uspstfab.htm for more information.

Understanding Trends in Sexual, Contraceptive and Fertility Behavior. The Assistant Secretary for Planning and Evaluation (ASPE) is funding Child Trends, Inc. to conduct a research project to clarify the trends in sexual, contraceptive, and fertility behavior among contemporary adolescents. To better understand current teen sexual behavior, researchers will use data from the National Survey on Family Growth to describe multiple aspects of sexual activity, partner characteristics, and contraceptive use. Using monthly event history data, the study will observe trends in behavior between 1991 and 1995. Trend information will be presented for multiple population subgroups, including by race/ethnicity, age, and parity (whether or not they had a prior teen birth).

Abstinence-Only Education Programs-National Evaluation. ASPE continues to work with Mathematica Policy Research to conduct the National Evaluation of the Abstinence-Only Education Programs that were established under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The National Evaluation is funded under the Balanced Budget Act of 1997 (see also "Abstinence Education," in the "Supporting Promising Approaches" chapter of this document). The process of site selection was completed and data collection began in the fall of 1999. The evaluation's three primary goals are: (1) to document and understand the nature and underlying theories of the abstinence-only education strategies that are being implemented; (2) to determine the extent to which, and in what ways, various abstinence-only education strategies affect youth behaviors; (3) to examine strategies for creating systemic change in communities.

There are two major study components. To measure the effectiveness of targeted abstinence-only education initiatives, the study relies on an experimental design that compares program participants with a comparable group of youth not offered abstinence-only education. To examine strategies for creating systemic change through more comprehensive community initiatives, the study will monitor key aspects of program implementation and operation, and track community and school indicators of youth behaviors and outcomes. Please see the following web site for more information: www.mathematica-mpr.com/3rdLevel/abstinence.htm.

Girl Neighborhood Power! (GNP) Evaluation. During the last year, the national leadership consortium has sub-contracted with a social science research organization to develop a plan for a national evaluation which will supplement individual evaluation efforts initiated in local partners' sites. It has also begun planning a site development guide to facilitate the replication of the GNP model in additional communities. During the current year, three sites received supplemental funding to deepen the level of collaborative activities in their communities on behalf of girls aged 9-14.

Positive Youth Development in the United States: Research Findings on Evaluations of Positive Youth Development Programs. This long-awaited document, finalized in 1999, examines existing evaluations of positive youth development programs and summarizes the state of the field. Funded by the Assistant Secretary for Planning and Evaluation (ASPE), the report is also known as the Positive Youth Development Project. The project reviewed 77 programs located in community, school, and family settings, or in a combination of these settings. The review concluded that prevention of youth problem behaviors and positive youth behavior outcomes can result from a wide range of youth development approaches. Authors of the report are with the Social Development Research Group at the University of Washington. The report can be found at http://aspe.hhs.gov/hsp/PositiveYouthDev99/index.htm.

Update on Ongoing Projects

Detailed descriptions of the following projects may be found in last year's report (http://aspe.hhs.gov/hsp/hspyoung.htm#teenpreg). These ongoing projects include:

Adolescent Sexual Activity. NICHD and NCHS continue to support research that tracks adolescent sexual activity. Please see the following web sites for more information: http://www.cdc.gov/nchs/NSFG.htm and http://www.cdc.gov/nchs/births.htm and http://www.nichd.nih.gov/about/cpr/dbs/supported.htm.

(See also: Ventura SJ, Mosher WD, Curtin SC, Abma JC, Henshaw S.  Trends in Pregnancies and Pregnancy Rates by Outcome:  Estimates for the United States, 1976-96.  Vital and Health Statistics; Series 21, No. 56.  Hyattsville, Maryland:  National Center for Health Statistics.  2000.)

Young Women's First Intercourse. NCHS supports ongoing research that explores the feelings that adolescent girls have about their sexual experiences, specifically first intercourse. Please see the following web site for more information: http://www.cdc.gov/nchs/NSFG.htm.

Contraceptive Use. NCHS also continues to investigate trends in contraceptive use among young people. Please see the following web site for more information: http://www.cdc.gov/nchs/NSFG.htm.

(See also: Ventura SJ, Mosher WD, Curtin SC, Abma JC, Henshaw S.  Trends in Pregnancies and Pregnancy Rates by Outcome:  Estimates for the United States, 1976-96.  Vital and Health Statistics; Series 21, No. 56.  Hyattsville, Maryland:  National Center for Health Statistics.  2000.)

Male Involvement. The Department continues to be committed to supporting research on male involvement. Including males in the examination of teen pregnancy means investigating how men feel about their sexuality and sexual relationships, attitudes of males regarding what it means to be a man, and attitudes toward and use of contraceptives. Further, male involvement can incorporate issues not directly involving sexuality, such as family relationships and parenting, career and educational goals and opportunities, among a host of other issues that directly affect young men in the United States. As we reported earlier in this chapter, the Department is supporting the expansion of the NSFG to a sixth cycle, which will be conducted in 2002 and will include, for the first time, a national sample of men 15-49 years of age. In addition, the NICHD-supported National Survey of Adolescent Males has documented factors related to male responsibility in sexual behavior, contraceptive use, sexual initiation, and the declining approval of premarital sex among adolescent boys.

Attitudes Toward Sexual Activity. The NIH, through its support of the AddHEALTH project (see Appendix IV), continues to contribute to our knowledge of adolescents' attitudes towards sexual activity. Studies of the impact of individual, family, and neighborhood influences on the initiation of first sexual intercourse find family influences of paramount importance. In addition, researchers have studied the impact of school friendship networks and "leading crowds" in schools on the chances that a young woman will initiate sexual activity; the impact of taking a "virginity pledge" on subsequent abstinence from sexual activity; the effects of maternal communication about sex and birth control, maternal expectations for their daughters' sexual behavior, and parent-child relationships on adolescent sexual behavior and pregnancy; influences of parenting practices, such as eating meals together, supervision and monitoring, and styles of decision-making, on adolescent sexual behavior; and the use of dual methods of birth control to prevent both pregnancy and sexually transmitted diseases.

A third wave of interviews with the young people as they enter adulthood will be fielded in 2000. Please see the following web site for more information:  http://www.nichd.nih.gov/cpr/dbs/res_add.htm

Community Coalition Partnerships Program. The Centers for Disease Control and Prevention (CDC) continues to support its 13 community demonstration projects to conduct site-specific evaluations, and to participate in cross-site evaluations. These evaluations include process and progress evaluation, and additionally, in six of the communities, enhanced evaluations of the impact of the program, or of specific program components. In October 1999, supplemental funds to support the integration of HIV, STD and teen pregnancy prevention strategies were awarded to four communities participating in the Program. The four communities funded were Boston, MA; Orlando, FL; Philadelphia, PA; and Yakima, WA. Funded efforts enable the integration of planning, service delivery and evaluation at the state and local level. Integrated approaches also focus on those who are disproportionately affected by HIV infection, other STDs and unintended pregnancy. The funds are used for developing, implementing and evaluating either innovative approaches to service delivery or for developing intervention messages and strategies for minority youth to influence personal decision making and behavior change. Please see:  http://www.cdc.gov for more information.

Appendices

Variations in Teenage Birth Rates, 1991-98

See the report: National Vital Statistics Reports, "Variations in Teenage Birth Rates, 1991-98:  National and State Trends", Vol 48, No. 6, April 24, 2000.  The report in PDF format (190K).  [If you do not have the browser "plug-in" for the Portable Document Format (PDF), you can download and install the Reader for your type of computer from the Adobe Acrobat web site.].  News release concerning this issue from the National Vital Statistics Reports.

Measuring the Proportion of Communities with Teen Pregnancy Prevention Programs

Record declines in the teen birth rate, and further decline 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 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. In FY 1999, at least 35 percent of communities had HHS supported teen pregnancy prevention and related programs compared with 34 percent in FY 1998. This proportion represents about 1677 communities across the country.

To develop a sound, albeit conservative, estimate of this proportion, the estimate includes only those programs supported by HHS through funds that flow directly to communities. HHS supported programs which 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. In this report, the number of teen pregnancy prevention programs funded by HHS includes those programs funded in the year FY 1999 (including the latest year for which complete information on grants awarded is available).

To determine the number of communities with 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. A 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, TANF) 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.

HHS Programs

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 and personal responsibility, clear strategies for the future, community involvement, and a sustained commitment.

HHS Programs

Girl Neighborhood Power!  Building Bright Futures for Success is challenging America's communities to become active partners in assisting 9- to 14-year-old girls to successfully navigate adolescence and achieve maximum potential. The initiative, administered by HRSA, strives to combine several elements including strong "no use" messages about tobacco, alcohol, and illicit drugs with an emphasis on physical activity, nutrition, abstinence, mental health, social development, and future careers.

The Center for Disease Control and Prevention's Community Coalition Partnership Program for the Prevention of Teen Pregnancy has supported demonstration grants for the prevention of teen pregnancies since 1995. Coalitions of local and public and private agencies and organizations in communities with high rates of teen pregnancy have been working over the last two years to develop community action plans, coordinate efforts to reduce teen pregnancy, identify gaps in current programs and services, target existing resources, and design evaluation plans. 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. For FY 1998, a total of $13.7 million was made 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.

State Children's Health Insurance Program (SCHIP) was established by the Balanced Budget Act of 1997 under Title XXI of the Social Security Act. This program, administered by the Health Care Financing Administration (HCFA), enables states to provide health insurance coverage to uninsured targeted low-income children. States have the opportunity to involve communities as they design and implement their SCHIP programs so that the new programs, including teen pregnancy prevention programs, may be an additional avenue to provide services to adolescents at risk.

The Abstinence Only Education Program was part of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 to enable states to provide abstinence education through activities such as mentoring, counseling, and adult supervision designed to promote abstinence from sexual activity until marriage. The program, administered by the Health Resources and Services Administration (HRSA), has a mandatory appropriation of $50 million for each Fiscal Year from 1998 through 2002.

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. These services are provided by 84 grantees with more than 4,000 clinic locations.

These sites offer reproductive health services including family planning and diagnosis of sexually transmitted diseases, either on site or by referral. The program has also launched an adolescent male initiative called the "Young Men/Family Planning Partnership Training Program." Under this initiative, Title X clinics employ male high school students as interns while also providing training in clinic operation and peer education; assisting in identifying career paths in allied health and related occupations; and increasing their use of services in a family planning setting.

Healthy Schools, Healthy Communities, a Health Resources and Services Administration program created in 1994, has established school-based health centers in 26 communities in 20 states to serve the health and education needs of children and youth at high risk for poor health, teenage pregnancy, and other problems. For the first three years of the program, $1 million each year was provided to fund health education and promotion programs that were coordinated with the health services grants.

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, 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 each 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 500 communities in 50 states and the District of Columbia.

Healthy Start, administered by HRSA, has 62 projects 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 (including state prenatal hotlines), thousands of teenagers participate in prevention programs exclusively designed for adolescents. The programs 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 health programs in 59 states and jurisdictions, including adolescent pregnancy prevention programs, state adolescent health coordinators, family planning, technical assistance, and other prevention services.

The Adolescent Family Life Program (AFL), created in 1981, supports research into the causes and consequences of adolescent pregnancy; demonstration projects that provide health, education, and social services to pregnant and parenting adolescents, their children, male partners, and families; and programs aimed at promoting abstinence among pre-adolescents and adolescents as the most effective way of preventing adolescent pregnancies, sexually transmitted diseases, and HIV/AIDS. In FY 1999, the AFL program funded 89 projects in 34 states and the District of Columbia. AFL is administered by the Office of Population Affairs.

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 local 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 3,032 community-based sites through 685 center grantees 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 for 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.

The Temporary Assistance for Needy Families (TANF) block grant program replaced the former Aid to Families with Dependent Children. Two of the primary goals of TANF are preventing out-of-wedlock pregnancies and encouraging the formation and maintenance of two-parent families. TANF funds may be used to support teen pregnancy prevention efforts.

HHS Funded Data Sets

National Survey of Family Growth. The National Survey of Family Growth (NSFG), conducted by the National Center for Health Statistics (NCHS), is based on personal interviews with a national sample of women 15-44 years of age in the United States. Its main function is to collect data on factors affecting pregnancy and child bearing. Please see http://www.cdc.gov/nchs/nsfg.htm for more information.

National Survey of Adolescent Males. The National Survey of Adolescent Males (NSAM), conducted by the Urban Institute and supported by the National Institute of Child Health and Human Development (NICHD), provides data exclusively on teenage males ages 15-19, specifically their contraceptive and sexual behavior. This data set complements the data on teenage females which is available from the NSFG. Please see http://www.nichd.nih.gov/cpr/dbs/res_national3.htm for more information.

National Longitudinal Study of Adolescent Health. The National Longitudinal Study of Adolescent Health (Add Health), conducted by the Carolina Population Center, University of North Carolina and supported by the NICHD and seventeen other federal agencies, is a school based study of adolescents in grades 7 to12 which provides information on physical, mental, and emotional health status, and health behaviors, including sexual behavior and contraceptive use. It provides the first comprehensive view of the health and health behaviors of adolescents and the antecedents personal, interpersonal, familial, and environmental of these outcomes. This study will follow-up with these young people in to their late teens and early 20s. Please see http://www.cpc.unc.edu/addhealth/ for more information.

Youth Risk Behavior Surveillance System. The Youth Risk Behavior Surveillance System (YRBSS), established by the Centers for Disease Control and Prevention (CDC), monitors the prevalence of youth behaviors that most influence health. This national school-based survey focuses on priority healthrisk behaviors established during youth that result in the most significant mortality, morbidity, disability, and social problems during both youth and adulthood. Please see http://www.cdc.gov/nccdphp/dash/yrbs/ov.htm for more information.

National Longitudinal Survey of Youth. The NLSY, supported by the NICHD and the Bureau of Labor Statistics, is a national sample of approximately 12,000 men and women who were aged 14 to 21 in 1979. The sample is oversampled for the black and Hispanic population. Data have been collected annually through 1994 and every other year beginning in 1996 on topics include employment, fertility, marriage, divorce, child care, and infant health. In 1986, and biannually since then, data were collected from and about the children of the female respondents. Please see http://stats.bls.gov/nlshome.htm for more information.

National Vital Statistics System. The National Vital Statistics System (NVSS), operated by the National Center for Health Statistics (NCHS), CDC, is based on the collection of individual record data for every birth registered in the United States. Data are collected by each State and transmitted to NCHS through the Vital Statistics Cooperative Program (VSCP). Under this program, NCHS partially supports State costs of producing vital statistics through a contract with each State. Please see http://www.cdc.gov/nchs/births.htm for more information.

Footnotes

1. Martin JA, Smith BL, Mathews TJ, Ventura SJ. Births and Deaths: Preliminary Data for 1998. National Vital Statistics Reports; Vol. 47, No. 25. Hyattsville, Maryland: National Center for Health Statistics. 1999.
2. Ventura SJ, Martin JA, Curtin SC, Mathews TJ, Park MM. Births: Final Data for 1998. National Vital Statistics Reports; Vol. 48, No. 3. Hyattsville, Maryland: National Center for Health Statistics. 2000.
3. Curtin SC, Martin JA., Births: Preliminary Data for 1999. (National Vital Statistics Reports), Vol. 48, No. 14. Hyattsville, Maryland: National Center for Health Statistics, 2000.
4. Ventura SJ, Mathews TJ, Curtin SC. Declines in Teenage Birth Rates, 1991-97: National and State Patterns. National Vital Statistics Reports, Vol. 47, No. 12. Hyattsville, Maryland: National Center for Health Statistics. 1998.
5. Ventura SJ, Curtin SC, Mathews TJ. Variations in Teenage Birth Rates, 1991-98: National and State Trends. National Vital Statistics Reports, Vol. 48, No. 6. Hyattsville, Maryland: National Center for Health Statistics. 2000.
6. Ventura SJ, Mosher WD, Curtin SC, Abma JC, Henshaw S. Trends in Pregnancies and Pregnancy Rates by Outcome: Estimates for the United States, 1976-96. Vital and Health Statistics; Series 21, No. 56. Hyattsville, Maryland: National Center for Health Statistics. 2000.