A National Strategy to Prevent Teen Pregnancy

Despite the recent decline in the teen birth rate, teen pregnancy remains a significant problem in this country. Most teen pregnancies are unintended. Each year, about 200,000 teens aged 17 and younger have children. Their babies are often low birth weight and have disproportionately high infant mortality rates. They are also far more likely to be poor. About 80 percent of the children born to unmarried teenagers who dropped out of high school are poor. In contrast, just 8 percent of children born to married high school graduates aged 20 or older are poor.

The U.S. Department of Health and Human Services (HHS) has responded to a call from the President and Congress for a national strategy to prevent out-of-wedlock teen pregnancies and to a directive, under the new welfare law, to assure that at least 25 percent of communities in this country have teen pregnancy prevention programs in place.

Building on our previous work in this area, our national strategy is designed to:

I.  Strengthen the national response to prevent out-of-wedlock teen pregnancies.

II.  Support and encourage adolescents to remain abstinent.

Our national strategy will build on existing public and private-sector efforts and on initiatives in the new welfare law by helping to provide the tools needed to develop more strategic and targeted approaches to preventing out-of-wedlock teen pregnancies. It will strengthen ongoing efforts across the nation by increasing opportunities through welfare reform; supporting promising approaches; building partnerships; improving data collection, research, and evaluation; and disseminating information on innovative and effective practices.

This strategy will also send the strongest possible message to teens that postponing sexual activity, staying in school, and preparing for work are the right things to do. In particular, our new Girl Power! public education campaign will engage the Department's teen pregnancy prevention programs in efforts to promote abstinence among 9- to 14-year-old girls.

KEY PRINCIPLES

As we move forward in implementing the national strategy, we will adhere to and promote the five principles that research and experience tell us are key to promising community efforts:

1. Parental and Adult Involvement: Parents and other adult mentors must play key roles in encouraging young people to avoid early pregnancy and to stay in school.
2. Abstinence: Abstinence and personal responsibility must be primary messages of prevention programs.
3. Clear Strategies for the Future: 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.
4. Community Involvement: Public and private-sector partners throughout communities, including parents, schools, business, media, health and human services providers, and religious organizations, must work together to develop comprehensive strategies.
5. Sustained Commitment: Real success requires a sustained commitment to the young person over a long period of time.

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The National Strategy

• 1999-2000 Annual Report to Congress
• 1998-1999 Annual Report to Congress
• 1997-1998 Annual Report to Congress

Strengthen the National Response to Prevent Out-of Wedlock Teen Pregnancies

Teen pregnancy is a problem that impacts nearly every community. The responsibility to solve this problem lies with all of us, including families, communities, and young people themselves. In calling for a national strategy, Congress has recognized the critical importance of assuring that every community, large or small, urban or rural, is working to find solutions to this problem.

As part of the national strategy, we will use new resources to strengthen, integrate, and support additional teen pregnancy prevention and other youth-related activities in communities across the country. Further, we will work with our partners to identify additional promising efforts and disseminate information about them to other communities.

A. Increase Opportunities Through Welfare Reform

The 1996 welfare law calls for additional efforts to prevent out-of-wedlock teenage pregnancies and to assure that communities engage in local efforts to prevent teenage pregnancy. These additional efforts are a critical component of our national strategy. As President Clinton has said, "Nobody should get pregnant or father a child who isn't prepared to raise the child, love the child, and take responsibility for the child's future." HHS will work with the states to provide guidance, to capture lessons learned from these welfare reform initiatives, to identify successful and innovative strategies, and to disseminate that information to all interested parties. [Additional information about the Welfare Reform law and how it is being implemented can be reviewed at web pages of the Administration for Children and Families on that topic.]

Personal Responsibility for Minor Parents. Under the new welfare law, unmarried minor parents will be required to stay in school and live at home, or in an adult-supervised setting, in order to receive assistance. The law also supports the creation of Second Chance Homes for teen parents and their children who might be at risk of abuse if they remained in their own homes. Second Chance Homes are expected to provide teen parents with the skills they need to become good role models and providers for their children, giving them guidance in parenting, child development, family budgeting, and proper health and nutrition, and in avoiding repeat pregnancies.

Abstinence Education. The new welfare law provides $50 million a year in new funding for state abstinence education activities, beginning in FY 1998. States will be able to target these funds to high-risk groups, such as teenage boys and girls most likely to have children out-of-wedlock. These new funds will be available through the Maternal and Child Health Block Grant.

Incentives for States. Under the new welfare law, HHS will award a bonus to as many as five states in the country that have the largest decrease in out-of-wedlock births while also having abortion rates lower than in 1995. The bonus will equal $20 million per state if five states qualify, and $25 million per state if fewer states qualify.

The Toughest Possible Child Support Enforcement. Through tougher child support enforcement, we will send the strongest possible message to young girls and boys that parenthood brings responsibilities and obligations and that they should not have children until they are ready to provide for them. The 1996 welfare law includes the child support enforcement measures President Clinton proposed in 1994 ­ the most sweeping crackdown on non-paying parents in history. The new measures include: streamlined efforts to name the father in every case; employer reporting of new hires to locate non-paying parents who move from job to job; uniform interstate child support laws; computerized state-wide collections to speed up payments; and tough new penalties, like drivers' license revocation, for parents who fail to pay.

B. Support Promising Approaches

HHS-supported programs that include teen pregnancy prevention are just a part of the myriad and diverse teen pregnancy prevention efforts located in communities across the country. However, HHS plays an important leadership role in sponsoring innovative and promising strategies tailored to the unique needs of individual communities. Excluding HHS-funded programs that reach communities through states (e.g., Medicaid and the Maternal and Child Health Block Grant), HHS-supported programs that include teen pregnancy prevention reach an estimated 30 percent of communities in the United States. This represents about 1,410 communities across the country that receive funding from HHS. (See HHS Activities: Programs, Evaluation and Research for overview of HHS teen pregnancy prevention activities and the methodology used to develop this estimate).

The five principles of promising strategies described above are reflected in the teen pregnancy prevention programs HHS supports, including the key demonstration programs of the Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs (OPA). Additional funding for these programs in FY 1997 will enable communities across the country to expand their teen pregnancy prevention efforts.

The Community Coalition Partnership Program for the Prevention of Teen Pregnancy is one of HHS's most comprehensive and innovative teen pregnancy prevention programs. The CDC launched the program in 1995 by awarding grants to 13 communities with high rates of teen pregnancy located in 11 states. The funds have been used to strengthen existing community-wide coalitions and to develop community action plans. 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.

C. Build Partnerships

Building partnerships among all concerned citizens is essential to preventing teen pregnancy, which President Clinton has described as "our most serious social problem." Tackling this problem will require a comprehensive, focused, and sustained effort from all sectors of society. Therefore, HHS will initiate a broad partnership-building process to implement the national strategy and to solicit nationwide commitment and involvement in the goal of preventing out-of-wedlock teen pregnancies. The feedback from this process will allow us to refine the national strategy as well as to improve our ongoing efforts. By building partnerships among national, state, and local organizations; schools; health and social services; businesses; religious institutions; federal, state and local governments; tribes and tribal organizations; parents; and adolescents, we will be able to unite in our efforts to send a strong message of abstinence and personal responsibility to young people and to provide them with opportunities for the future.

An important partner in this effort will be the National Campaign to Prevent Teen Pregnancy. In his January 1995 State of the Union Address, President Clinton challenged "parents and leaders all across this country to join together in a national campaign against teen pregnancy to make a difference." A group of prominent Americans responded to that challenge, forming the National Campaign to Prevent Teen Pregnancy ("Campaign"). The President has pledged the help of the Executive Branch in this non-partisan, private-sector effort.

The mission of the Campaign is to prevent teen pregnancy by supporting the values and stimulating actions that are consistent with a pregnancy-free adolescence. The Campaign is designed to support the efforts of local communities and to make sure that local community efforts are based on research about what works. The Campaign is helping to build partnerships with the media, the business sector, and others, and HHS looks forward to working with the Campaign in implementing the national strategy.

The strategy will also include a partnership effort with federal, state, and community organizations that work on behalf of teenagers with disabilities. Teens with learning disabilities, mental retardation, mental illness, and physical disabilities present a unique set of challenges in preventing out-of-wedlock pregnancies. Mainstream programs can be highly effective, but the unique characteristics of teenagers with disabilities also must be taken into account in developing and implementing these programs. As part of the national strategy, HHS will work to address the special challenges in preventing out-of-wedlock teen pregnancies among young men and women with disabilities. The strategy will address issues such as program access, the need for targeted materials, and opportunities for education and skills-building to give teens with disabilities a positive future and a better chance of avoiding teen pregnancy.

D. Improve Data Collection, Research, and Evaluation

Data collection, research, and evaluation are all critical for contributing to our understanding of the magnitude, trends, and causes of teen pregnancies and births; for developing targeted teen pregnancy prevention strategies; and for assessing how well these strategies work, whether on a local, state, or national level. As part of the national strategy, HHS will work to strengthen each of these important activities.

Data Collection and Surveillance. National statistics on teen birth patterns, including state-by-state data, are now available nearly a full year earlier than in prior years, a result of a more timely approach to collecting, compiling, and publishing vital statistics data. The new system builds on advances in computer and communications technology as well as the CDC's National Center for Health Statistics' (NCHS) long-standing collaboration with state vital statistics offices. Preliminary teen birth rates from the new system for 1995 were published in October 1996 and future statistics will be reported semiannually. (See Teen Birth Data ). The CDC also provides consultation to states and local areas to enable them to compute estimates of teen pregnancy and other related indicators.

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) 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.

Research and Evaluation. While promising approaches to reduce teenage pregnancy have been identified, a comprehensive review of teen pregnancy programs funded by HHS and conducted by Child Trends, Inc. indicates that most interventions have not been rigorously evaluated to assess their impact or to identify the components that contribute to program success or failure. Using our demonstration programs, we will work with our partners to increase our understanding of what works and what does not. For example, the CDC's Community Coalition Partnership Program for the Prevention of Teen Pregnancy is helping each community to incorporate evaluation into its teen pregnancy prevention strategy. In addition, the National Institutes of Health is sponsoring research on interventions to prevent teen pregnancy.

The Child Trends report also indicates that further research is needed in a number of areas of normal adolescent development, including why certain adolescents engage in high-risk behaviors, why some adolescents are able to negotiate safely to adulthood, and what factors influence adolescent sexual behavior, including media influences and cultural norms. In addition to its own research studies and demonstration projects, HHS will provide information from its new survey data, (e.g., Add HEALTH), to help researchers answer these questions.

E. Disseminate Information on Innovative and Effective Practices

Sharing information about promising and successful approaches is critical to the replication and expansion of teen pregnancy prevention efforts across the country. Policy makers, program administrators, tax payers, media producers, community leaders, parents, and adolescents all need to know about the approaches most likely to be successful in preventing teen pregnancy.

HHS will continue to work with its partners to highlight innovative practices at the federal, state, and local levels and to disseminate new research and evaluation findings. For example, at a White House press conference in June, HHS released "Preventing Teen Pregnancy: Promoting Promising Strategies: A Guide for Communities" highlighting five teen pregnancy programs that evaluation shows to be promising. (See Examples of Promising Program Strategies). Ongoing efforts include outreach to 105 Empowerment Zones and Enterprise Communities to encourage and help them to include teenage pregnancy prevention in their community development strategies. The Department will also disseminate new information on the developmental needs of youth and on the use of broad-based activities to help teenagers avoid risky behaviors leading to teen pregnancy. In addition, HHS currently supports a variety of resource centers, clearinghouses, and toll-free hotlines at both the state and national level that provide information and technical assistance to state and community-based health, social service, and youth-serving agencies. (See Program Contacts and Other Resources.

Support and Encourage Adolescents to Remain Abstinent

To reach adolescent populations at risk for premature sexual activity and pregnancy, we must develop comprehensive efforts specifically tailored to the unique needs, interests, and challenges of each group, including targeted messages that work. Although the national strategy must send the strongest possible message to all teens that postponing sexual activity, staying in school, and preparing to work are the right things to do, the research shows that girls and boys experience some aspects of early adolescence in different ways, because they encounter different social, cultural, physiological and psychological challenges. Therefore, different approaches will be required to meet the unique needs of different adolescent populations, including disabled teens who are at increased risk of pregnancy. As a result, an important component of the national strategy will be to determine the best ways to reach different groups of young boys and girls.

The national strategy will place a special emphasis on encouraging abstinence among 9- to 14-year-old girls. The research tells us that this a critical age for reinforcing self confidence and positive values and attitudes among girls. In 1997, HHS will use its new Girl Power! campaign to address premature sexual activity among girls aged 9-14, promoting a strong abstinence message. The Girl Power! campaign, launched in November, 1996, is a multi-phased, national public education campaign designed to galvanize parents, schools, communities, religious organizations, health care providers, and other caring adults to make regular sustained efforts to reinforce girls' self-confidence, by providing them with positive messages, meaningful opportunities, and accurate information on a variety of key health issues. The Girl Power! abstinence education initiative includes: engaging all HHS teen pregnancy prevention and related youth programs in sustained efforts to promote abstinence among 9- to 14-year-old girls, and developing and implementing a national media campaign to involve parents and caring adults in sending a strong abstinence message across the country.

The national strategy will also focus on boys and young men. Significantly less is known about the decision-making behavior of boys around motivations for abstinence, sexual activity, and fatherhood. Through the national strategy, HHS will increase our understanding of these factors and work to develop effective prevention strategies, particularly those promoting abstinence, for boys. These efforts will include working with the Administration's Fatherhood Initiative to ensure that men, including pre-teen and teenage boys, receive the education and support necessary to postpone fatherhood until they are emotionally and financially capable of supporting children. The strategy will also build on existing Departmental efforts, such as the Title X Family Planning Adolescent Male Initiative and other Title X-funded projects to support male-oriented community-based organizations in promoting responsible behavior among teenage boys.

Finally, the Department will work with national youth-serving organizations to use their networks to promote activities that encourage abstinence among girls and boys. With their important efforts in stimulating parental and community involvement, these programs will help provide the sustained commitment necessary to help prevent teen pregnancy.

APPENDIX I: HHS Activities: Programs, Evaluation and Research

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.

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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.

APPENDIX II: Teen Birth Data

In October 1996, the National Center for Health Statistics (NCHS) inaugurated a new statistical series designed to provide more timely release of national and state-level birth statistics(1). These data will provide state and local health officials with a timely first-look at trends in these important measures of their community's health status. NCHS will publish data from the new statistical series on a semi-annual basis. The next report will be issued in early spring of 1997, and will cover the period July 1995-July 1996.

The October release included births for 1995 and U.S. birth rates for teenagers 15-19 years old. The data covered "all races" and white, black, American Indian, Asian or Pacific Islander, and Hispanic subgroups. The October report also provided data on the percent of all births occurring to teenagers in each state, by race and Hispanic origin. Other state-level birth data available from the preliminary report include births to unmarried mothers, low birth weight, prenatal care beginning in the first trimester, and births by cesarean delivery.

After NCHS completes final processing of birth data for a given year, additional, more-detailed statistical tabulations can be produced. In December 1996, NCHS published a report of state-level birth rates for teenagers which is included in this appendix (2). The report includes data for teenage subgroups 15-19, 15-17, and 18-19 years, and by race and Hispanic origin of the mother. The report describes the recent declines in U.S. birth rates for teenagers and the extent to which rates in individual states have also declined. The December report focuses on the period 1990-94. NCHS expects to update this report with rates for 1995 in late spring of 1997.

Reports showing state-level data in conjunction with national statistics can be very useful for state and local public health and other officials as they monitor trends in their states and compare them with trends in neighboring states. In addition, the rates in NCHS' teen birth rate report can help to assess the extent to which programs to reduce teenage pregnancy are succeeding. To assist in the comparison of state-level data, the December report includes maps of teen birth rates, showing the various levels of the rates as well as the 1991-94 trend in the rates.

The authors also note that some of the differences in overall rates by state reflect differences in the composition of the teenage populations by race and Hispanic origin, since birth rates for Hispanic and black teenagers are more than double the rates for non-Hispanic white teenagers. To examine state variations while controlling for population differences in race and ethnicity, the report includes standardized birth rates for each state. The standardized rates for many states with high Hispanic or black populations are lower than the actual rates.

Note on Teen Pregnancy Data:

HHS has published national estimates of teenage pregnancy for the years 1976-92. National data on teen pregnancy are updated on a regular basis as soon as the required data on births and estimates for abortions and fetal losses can be assembled for a given year. National rates for 1993 and 1994 are expected to be available in 1997. State-level teen pregnancy statistics have been published for 1980 and 1990-92. Updates of state rates for 1993 and 1994 are anticipated for 1997.

(1) Rosenberg HM, Ventura SJ, Maurer JD, Heuser RL, Freedman MA. Births and Deaths: United States, 1995. Monthly Vital Statistics Report, Vol. 45, No. 3, Supplement 2. Hyattsville, Maryland: National Center for Health Statistics. 1996.

(2) Ventura SJ, Clarke SC, Mathews TJ. Recent Declines in Teenage Birth Rates in the United States: Variations by State, 1990-94. Monthly Vital Statistics Report, Vol. 45, No. 5, Supplement. Hyattsville, Maryland: National Center for Health Statistics. 1996. NOTE: This file is available only in the Adobe Acrobat ® PDF (Portable Document Format). It can be viewed by using Acrobat Reader. If you do not have this program, you can download a copy with installation instructions here.

APPENDIX III: Examples of Promising Program Strategies

NOTE: Descriptions of the following five programs are excerpted from "Preventing Teen Pregnancy: Promoting Promising Strategies: A Guide for Communities," a report by HHS released at a White House press conference on June 13, 1996.

Children's Aid Society's
Adolescent Pregnancy Prevention Programs

Approach: Comprehensive, Multi-Faceted

Description: This program looks beyond sex education to the whole child, offering youngsters a variety of opportunities and a broad-spectrum of services as well as positive role models. The seven major components of the program include: career awareness; family and sex education; medical and health services; mental health services; academic assessment and homework help; self-esteem through the performing arts; and fostering lifetime participation in individual sports activities. The Children's Aid Society has another program in Harlem which, in addition to the above, guarantees youth in the program who graduate from high school or get a General Equivalency Diploma admission to New York City's Hunter College.

Goals of the Program: The primary goal of the program is to assist youth in avoiding unintended pregnancy and making responsible sexual decisions.

Location: 10 New York communities and 17 cities across the country

Population Served: Youth ages 10 through 20

Early Findings: For the six New York City sites employing this model, early data show--

• Participants have educational aspirations that are higher than those reported in national samples of high school students.
• Participants have better outcomes four years after entering high school when compared to the New York City public school Class of 1994.
• Participants have substantially lower rates of alcohol use when compared to national samples of adolescents in the same age group.
• Participants are less likely to be sexually active, and those who eventually do become sexually active are more likely to have used contraception when compared to national samples.

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Teen Outreach Program

Approach: Life Options

Description: The Teen Outreach Program National Replication and Dissemination Project is managed by the Cornerstone Consulting Group, Inc.,  and combines curriculum-based, facilitator-guided, small group discussions with volunteer service in the community. Issues addressed in the small group discussions include: self-understanding, communication skills, human growth and development, parenting issues, and family interaction. Some health and sex education is included. Facilitators serve as mentors and link youth to volunteer activities.

Goals of the Program: The program seeks to prevent early pregnancy and encourage school achievement.

Location: Nationwide and in Canada, mostly located in schools

Population Served: Youth ages 11 through 19

Early Findings: Early data show a reduction in teenage pregnancy as well as in school suspension and drop-out rates. The volunteering and classroom curriculum appear to be working although greater site volunteer hours and older students were associated with more positive outcomes.

Contact:

The Cornerstone Consulting Group
One Greenway Plaza, Suite 550
Houston, TX 77046
713 627-2322
713 623-3006 (fax)
lalvim@cornerstone.to

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Postponing Sexual Involvement

Approach: Abstinence and Delayed Sexual Initiation

Description: The Postponing Sexual Involvement Curriculum, developed by the Emory University School of Medicine and Grady Memorial Hospital Teen Services Program, provides teens with the skills they need to resist peer pressure and early sexual involvement. The curriculum offers a clear message that favors abstinence and postponing sexual involvement, but also provides information about contraception. Skill-building exercises conducted by slightly older peer educators are key elements of the program.

Goals of the Program: The program provides youth with basic factual information and decision-making skills related to reproductive health. Teenagers in the program gain skills to deal with social and peer pressures that lead them into early sexual involvement.

Location: Atlanta, GA and other sites nation-wide.

Population Served: Youth ages 13 to 14

Early Findings: Compared to non-participants, a significantly smaller proportion of youth participating in the program reported being sexually active by both the 12- and 18-month follow-up periods, even though a slightly higher proportion of the participants had been sexually active before receiving the program's curriculum. The effect on delayed first sexual activity was true for both male and female participants. The impact on delayed sexual activity among females was particularly strong. In addition, the evaluation also found higher contraceptive use among those program participants who were sexually active.

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I Have A Future

Approach: Life Options and Opportunity Development

Description: "I Have A Future" is a community-based intervention that uses a comprehensive set of activities to expand life options for high-risk youth living in public housing projects. The focus of the program is on abstinence, community, and self-esteem. The three parts of the program include: equipping adolescents with the basic information they need about health, human sexuality, and drug and alcohol use; providing a comprehensive array of adolescent health services, with a focus on abstinence and a very strong emphasis on parental and community involvement; and assisting young people to enhance their life-options through activities that improve their job skills, self-reliance, values, and self-esteem.

Goals of the Program:

• Developing a replicable community-based, life-enhancement program that promotes a significant reduction in the incidence of early pregnancy and child bearing among high-risk adolescents;
• Improving knowledge, attitudes and behaviors related to personal health and human sexuality; and,
• Enhancing the ability of high-risk adolescents to overcome environmental barriers to attaining the skills necessary to pursue meaningful employment and educational opportunities with the promise of upward mobility.

Location: Public housing projects in Nashville, TN

Population Served: Youth ages 10 through 17

Early Findings: Those who participated in the program had fewer pregnancies, higher self esteem, fewer self-reports of delinquent behaviors, and a greater sense of a promising future. Preliminary analyses of the I Have A Future Program have also found positive effects on intermediate outcomes such as pro-social attitudes, sexual and contraceptive knowledge, self-esteem, perceived life options, and psychosocial maturity, when comparing the active participants to the comparison group of youth from two other public housing projects.

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Quantum Opportunities Program

Approach: Life Options and Opportunity Development

Description: The Quantum Opportunities Program (QOP), a four-year demonstration program launched in 1989, was designed to test the ability of community-based organizations to improve the lives of low-income high school students. The project used Opportunities Industrial Centers in five communities to deliver an intensive package of services to youth during the four years of high school. Services included educational activities, community service activities, and development activities to help youth learn more about health issues, arts, careers and college planning.

QOP was a relatively small national demonstration program. At each site, there were 50 students--25 randomly assigned to the project and 25 to a control group. The young people received small stipends for participating in and completing approved activities. The program also established accrual accounts to collect matching funds that youth could use for additional training or education after they graduated from high school. Staff members were also given financial incentives to meet the program's participation goals.

The Ford Foundation and the Department of Labor are currently funding replications of the program.

Goals of the Program: To test the ability of community-based organizations to "foster achievement of academics and social competence among high school students from families receiving public assistance."

Location: Philadelphia, PA; Oklahoma City, OK; San Antonio, TX; Saginaw, MI; and Milwaukee, WI. (Milwaukee was later dropped from the study)

Population Served: Students entering the 9th grade

Early Findings: QOP made significant improvements in the lives of participating youth over a two-year period. Results compiled one year after the program was completed show significant differences between QOP participants and control group members. Specifically, QOP members were more likely to be high school graduates, more likely to be enrolled in secondary schools, less likely to be high school dropouts, and less likely to have children. They were also more likely to be involved in community service, to be more hopeful about the future, and more likely to consider their lives a success.

Key Program Contacts and Resources

HHS Programs

Centers for Disease Control and Prevention

Community Partnership Programs for the Prevention of Teen Pregnancy
For information call: 404-639-3286

Office of Population Affairs

Adolescent Family Life Program and the Title X Family Planning Program
For information call: 301-594-4000

Health Resources and Services Administration

Healthy Start; Community and Migrant Health Centers;
Healthy Schools, Healthy Communities; and
Maternal and Child Health Block Grant
For information call: 301-443-3376

Administration for Children and Families

Youth Programs (Runaway and Homeless Youth, Community Schools, etc.)
For information call: 202-401-9215

Substance Abuse and Mental Health Services Administration

Drug Treatment and Prevention Programs
For information call: 301-443-8956

Health Care Financing Administration

Medicaid Bureau
For information call: 410-786-3393
Enterprise Zones/Economic Communities

For information call: 202-401-3951

National Institute of Child Health and Human Development

Add HEALTH and the National Survey of Adolescent Males
For information call: 301-496-5133

National Center for Health Statistics

National Survey of Family Growth and Monthly/Semi-Annual Vital Statistics Reports
For information call: 301-436-7551

Hotlines and Referral Numbers

National AIDS Hotline (CDC)
1-800-342-AIDS (English)
1-800-344-SIDA (Spanish)
1-800-243-7889 (TDD)

Sexually Transmitted Diseases Hotline (CDC)

1-800-227-8922

Office of Population Affairs Clearinghouse (OPA)

301-654-6190
301-215-7731 (to order by facsimile)

National Center On Child Abuse and Neglect (ACF)

703-385-7565 or 1-800-394-3366

National Clearinghouse on Families and Youth (ACF)

301-608-8098
301-608-8721 (to order by facsimile)

National Clearinghouse on Alcohol and Drug Information (SAMHSA)

1-800-729-6686 (English)
1-800-487-4889 (TDD)

HHS On-Line

HHS Home Page

Access to consumer information on a variety of issues and links to specific HHS agencies.

Girl Power!

Materials, information, and products for girls, parents, and caring adults.

Research Reports

Beginning Too Soon: Adolescent Sexual Behavior, Pregnancy, and Parenthood. A 1995 two-volume report reviewing recent research and describing interventions and evaluations. Written by Kristin Moore, Brent Miller, Barbara Sugland, Donna Ruanne Morrison, Connie Blumenthal, Dana Glei, and Nancy Snyder of Child Trends, Inc. for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services. Copies available from Child Trends at 202-362-5533. Also available at the Internet address http://aspe.hhs.gov/.

Trends in the Well-Being of America's Children and Youth. A 1996 report written by Child Trends, Inc. for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services. Copies available by faxing requests to Child Trends at 202-362-5533 or ASPE at 202-690-5514.

Report to Congress on Out-of-Wedlock Childbearing. A 1995 report prepared by the U.S. Department of Health and Human Services and university researchers that provides a comprehensive overview of nonmarital childbearing among women of all ages. Copies available by faxing requests to ASPE at 202-690-5514 or to Stephanie Ventura, NCHS, at 301-436-7066 (DHHS Pub. No. (PHS) 95-1257). Also available at the Internet address

http://www.cdc.gov/nchswww/products/pubs/pubd/other/miscpub/miscpub.htm

The Best Intentions: Unintended Pregnancy and the Well-Being of Children and Families. A 1995 report by the Institute of Medicine. Copies available from the National Academy Press at 1-800-624-6242.

Great Transitions: Preparing Adolescents for a New Century. The 1995 concluding report of the Carnegie Council on Adolescent Development funded by the Carnegie Corporation of New York. Copies available from the Carnegie Council on Adolescent Development at 202-429-7979.

Sex and America's Teenagers. A 1994 report by the Alan Guttmacher Institute. Contact the Alan Guttmacher Institute at 202-296-4012.