A National Strategy to Prevent Teen Pregnancy: Annual Report 1999-2000. Research and Evaluation Activities

06/01/2000

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, 1976-96Vital 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, 1976-96Vital 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.

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