The Department continues to be committed to learning what approaches have an effect on teen pregnancy and its related antecedents so that better interventions can be effectively designed. HHS continues to support ongoing evaluations and seeks to incorporate evaluation in HHS funded demonstration projects and programs. To expand knowledge in this area, the Department supports a number of efforts.
Abstinence-Only Education Programs-National Evaluation. The Department, through the Office of the Assistant Secretary for Planning and Evaluation (ASPE), is responsible for conducting an evaluation of the state abstinence-only education grants described in the Promising Approaches section of this report. The Balanced Budget Act of 1997 set aside funding to evaluate a select number of sites receiving funding from this program. In August, 1998, a contract was awarded for a three-year multi-site effort to improve knowledge about programs aimed at preventing teen sexual activity and its negative consequences. The process of site selection is well underway and is expected to be completed by the fall of 1999. Data collection will begin in the fall of 1999. The evaluation will focus on approximately twelve sites: eight sites will involve random assignment experiments of particular programs and four sites will involve a rigorous evaluation of a comprehensive community
approach to abstinence-only education. Outcomes of interest will include—but will not be limited to—the four performance measures identified in the Department's program guidance. These four measures are:
- The rate of pregnancy to teenagers aged 15 to 17
- The proportion of adolescents aged 17 years and younger who engage in sexual intercourse
- The incidence of sexually transmitted diseases among youths aged 15-19
- The rate of births to teenagers aged 15-17
Teenage Pregnancy Prevention Program Evaluation. There continues to be more to learn about what works to prevent teen pregnancy. Current knowledge about pregnancy prevention programs needs to be expanded to delineate which strategies are the most promising, which aspects of which programs demonstrate the strongest impact, and which programs are successful in affecting behavior across various
communities and population characteristics, such as ethnicity and socioeconomic status. To contribute to the expansion of this knowledge base, ASPE provided grants to enhance three existing evaluations of teen pregnancy prevention interventions that were rigorous in design and already had funding. Results from these three evaluations are expected in the Winter of 1999. The following are brief descriptions of the evaluations.
• California Adolescent Sibling Pregnancy Prevention Program (UCSD)
Researchers from the University of California, San Diego are evaluating the California Adolescent Sibling Pregnancy Prevention Program (CASSP) which targets the siblings of pregnant and parenting teens. The evaluation is providing important information about a significant subpopulation of girls who have been shown to be at elevated risk for teen pregnancy. There are two goals to the enhanced evaluation: (1) to analyze the differential impact of specific services and (2) to analyze community level factors that may be contributing to the risk of pregnancy for this population. The research around these two questions should add meaningfully to the knowledge base about solid teen pregnancy prevention practices. Basic knowledge about the high risk of the siblings of pregnant and parenting teens was funded under an earlier NIH grant.
• Inwood House
Inwood House is a wellestablished agency in New York City that has long-standing pregnancy prevention programs as well as an array of services for pregnant and parenting adolescents in middle through senior high school. The research team is currently comparing three differing levels of intervention (and no intervention) with respect to outcomes for students transitioning into high school. One of the interventions is an "abstinence plus" program funded by the AFL program. Abstinence plus programs promote abstinence as the most desirable method of preventing teen pregnancy, but these programs also provide other types of prevention information to sexually active teens.
The researchers are using ASPE funds to improve the quality of the abstinence program's comparison group while establishing comparison groups for the other two levels of intervention. This enhanced study will provide an important comparison of interventions provided by the same agency, and undergirded by the same philosophical approach toward working with adolescents. The interventions differ in their emphasis on abstinence and in the breadth and intensity of services they provide.
• Institute for Health Policy Studies (UCSF)
The Center for Reproductive Health Policy Research, at the Institute for Health Policy Studies (UCSF), is conducting a large scale evaluation of the California Community Challenge Grant Program. This program funds 112 sites in the state to provide services to pregnant and parenting teens and teen pregnancy prevention programs. Each site has implemented its own program and is given a choice of a variety of modules to complete process, outcome or impact evaluations. This has allowed the Center to provide an alternative to the "one size fits all" evaluation approach which would be less appropriate for these community-driven programs. The enhancement of the evaluation is developing comparison groups for these communities.
Community Coalition Partnerships Program. CDC's 13 community demonstration projects, described previously, are conducting sitespecific evaluations, and participating in crosssite 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.
• Process and Progress Indicators
Each of the demonstration sites is engaged in efforts to monitor its process and progress. In partnership with CDC and the Academy for Educational Development, the demonstration sites have collectively defined Cross Site Process Indicators for Adolescent Pregnancy Prevention in the following areas: (1) needs and assets
assessment; (2) health outcomes; (3) defining the program; (4) project administration; (5) positioning for financial sustainability. The analysis of the crosssite indicators over the life of the project will enhance the communities' capacity to evaluate and strengthen their programs. Furthermore, the documentation of these aspects of program development may also benefit other communities seeking to address teen pregnancy.
• Enhanced Evaluation Activities
Six of the 13 communities receive supplemental funding to support evaluations of the impact and outcome the demonstration projects have had in their communities. The studies underway include the following:
- Longitudinal study measuring the timing and frequency with which youth use the activities and services supported by the coalitions.
- An examination of changes in birth and STD rates in school populations based on whether the schools are in an intervention or comparison area.
- Annual surveys of adult knowledge, attitudes and behaviors with regards to youth development activities and issues in the intervention and comparison communities.
- Longitudinal study of parents and their children who participate in parentchild communication programs to assess changes in communication and connectedness.
- Survey of households in intervention and comparison communities assessing community and neighborhood resources, family and youth assets, and adolescent risk behaviors to assess changes in interorganizational relationships among key community agencies in intervention and comparison communities.
Girl Neighborhood Power! (GNP) Evaluation. The GNP initiative, described
earlier in this report, has also stressed the importance of evaluation. Each project is responsible for developing and implementing its own evaluation for determining how successfully it has achieved its goals and objectives. In addition, the sites have together developed and agreed on the use of a common form to document and monitor project activities. Supplemental funding is being provided by the Office on Women's Health so that community partners will be able to use a common set of variables to explore how they influenced participating girls and their families, to measure the degree of community investment in programming for girls, and to explore how their projects' activities have affected participating neighborhoods.
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