What the Research Tells Us. In the past year, the Department has supported research related to teen pregnancy that provides or will provide new information regarding the role of:
- Trends in contraception,
- First sexual intercourse,
- Youth development programs, and
- How adolescents make decisions.
The Department has also taken steps in developing new demonstration programs and evaluation efforts. Below is a sampling of this work.
Connections Count. Parents play influential roles in their children's sexual behaviors. Connections count, and young people who feel more integrated into their families and communities are less likely to engage in a number of risky behaviors.
According to the National Longitudinal Study of Adolescent Health (AddHealth)4, adolescents who report a sense of connection to parents, family, and school, and who have a higher grade point average, are more likely than their peers to delay having sexual intercourse. Adolescents who delay first intercourse are also more likely to have taken a pledge to remain virgins until they are married, and to report that their parents disapprove of their having sex and using contraception. Compared to those who have been pregnant, sexually experienced girls who have not been pregnant are more likely to report being more involved in activities with their parents.
AddHealth is a school-based study of the health-related behaviors of adolescents in grades 7-12. 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. Over eighty investigators are using the AddHealth data to examine a wide range of adolescent health risks and behaviors. The research on connection was published in a Fall 1997 article in the Journal of the American Medical Association. AddHealth was funded by the National Institute of Child Health and Human Development and seventeen other Federal agencies.
Adolescent Decision Making. The Department funded the National Academy of Sciences to hold a workshop of national experts to identify the major lessons learned from the last decade of research on adolescent decision making- particularly as they bear on efforts to reduce high-risk behaviors among adolescents. Attendees discussed the results of research on efforts to intervene in adolescent high-risk behaviors, and discussed the implications of this research for alternative approaches to reducing high-risk behavior among the nation's youth, especially in the areas of substance abuse, smoking, and sexuality. A summary of this workshop will be available later this year.
Sexual Activity of Males and Females. There was no increase between 1988 and 1995 in the proportion of male and females ages 15 to 19 who have ever had sexual intercourse. In fact, when data sets for female and male teens are combined, there was a statistically significant decline in this proportion.
Based on data on 15- to 19-year-old teens from the National Survey of Family Growth (NSFG) and the National Survey of Adolescent Males (NSAM), recent research shows that 50 percent of female teens and 55 percent of male teens report they have had sexual intercourse at least once. While the proportion of female teens reporting initiating sexual intercourse before age 15 has risen from 11 percent to 19 percent, current sexual activity-the proportion of teens who have had sex in the last three months-has dropped for female and male teens. Recent analysis shows that although 55 percent of male teens and 50 percent of female teens were categorized as sexually experienced in 1995, the proportion who had intercourse in the last three months was 38 percent for both males and females.5
Further research is underway to determine the factors associated with these patterns, including frequency and regularity of sex. NSAM is also looking at the sexual behavior of young men in their twenties, whose partners are likely to be teenagers.
The National Survey of Family Growth (NSFG) is a multipurpose survey based on personal interviews with a national sample of women 15-44 years of age in the civilian, non-institutionalized population of the United States. Its main function is to collect data on factors affecting pregnancy and women's health in the United States. The NSFG is conducted by the National Center for Health Statistics (NCHS). The National Survey of Adolescent Males (NSAM), conducted by the Urban Institute and supported by NICHD, provides unique data on the contraceptive and sexual behavior of males aged fifteen to nineteen, complementing data on teenage women available from the NSFG.
The next NSFG is scheduled for 2000. NCHS, NICHD, OPA, the CDC HIV program, and ACF's Children's Bureau are funding this effort. About 11,800 females ages 15-44 will be interviewed. NCHS plans to increase the size of the sample of females aged 15-19 from 1,400 interviews in 1995 to 2,500 interviews in the year 2000. In addition, if sufficient funds are obtained, 1,600 interviews with males aged 20-24 are planned. Having male and female teens in the same data set is expected to ease the task of analyzing teen sexual experience and contraceptive use.
Trends in Contraceptive Use. According to analysis of the NSFG, the principal trend in contraceptive method choice in 1988-1995 was an increase in condom use, especially among black, Hispanic, or unmarried women who were younger than 25. Use of the condom at first intercourse dramatically increased in the 1980s and 1990s. Furthermore, the increase in condom use was accompanied by a decrease in use of other methods that do not prevent HIV and STDs.
Eight percent of all black teens were using injectable or implant contraception, which are very effective against pregnancy but not against STDs. The use of injectable and implant contraception and the sharp increase in condom use at first intercourse and afterward may explain the decline in the birth rates for black teens.6
For white teens, declines in current sexual activity as well as the increases in condom use may be significant factors in declines in birth rates.
Other research from the NSFG identified predictors of inconsistent contraceptive use. While 85 percent of pill users rely solely on the pill, 15 percent also use another method. Overall, 16 percent of users are inconsistent in their pill-taking. Among users of the pill only, Hispanic and non-Hispanic black women have a significantly greater likelihood of inconsistent use, as do those who recently began use and those who have had an unintended pregnancy. For dual method users, the odds are significantly elevated among women whose income is less than 250 percent of the Federal poverty level and among new users. This suggests that service providers may need to better address consistency of pill-taking among women who have characteristics associated with inconsistent use.7
Young Women's First Intercourse. Twenty-four percent of women aged 13 or younger at the time of their first premarital intercourse report the experience to have been nonvoluntary, compared with 10 percent of those aged 19-24 at first premarital intercourse. However, researchers have found that women's experiences are more complex than simply voluntary or nonvoluntary. Researchers asked women to rate how much they wanted their first intercourse to occur on a scale of 1-10. Using the NSFG, NCHS and other researchers found that about one-quarter of respondents who reported their first intercourse as voluntary gave a low value to how much they had wanted the experience to occur. Women whose first partner was seven or more years older than themselves were more than twice as likely as those whose first partner was the same age or younger to choose a low value (36 percent vs. 17 percent).
Women whose partner had been seven or more years older were also less likely than other women to have used contraceptives at first intercourse. This important research suggests that measures that take into account degrees of wantedness may help elucidate relationships between sexual initiation, contraceptive use, and teenage pregnancy. This research was conducted by staff at the National Center for Health Statistics and Child Trends, Inc. 8
Focusing on Boys and Young Men. The Department is supporting a study to identify abstinence-based pregnancy prevention programs that target boys or both boys and girls. Traditionally, adolescent pregnancy prevention research and programs have focused on adolescent girls. It is becoming increasingly apparent, however, that adolescent boys and young men must share that focus. To date, there is limited information about the abstinence models that exist, especially for boys. Identified programs and teen pregnancy prevention literature will be used to develop a framework to assess the types of programs and their impacts. Information on strategies will be disseminated to state, local and community policy-makers. This project is funded by the Office of the Assistant Secretary for Planning and Evaluation.
Abusive Intimate Relationships Among Adolescents. This study on preventing abusive intimate relationships among adolescents will involve a literature review as well as analysis of data sets concerning adolescent partner violence. Focused discussion groups will include health care providers, experts on adolescents, and teens to identify promising approaches to prevention and intervention concerning abusive adolescent relationships. The study will also identify data needs in this area. This project will be completed in January 1999. It is funded by the Office of the Assistant Secretary for Planning and Evaluation and the Administration for Children and Families.
HHS Support for Evaluation
Learning what approaches have an effect on teen pregnancy and its related antecedents is a critical part of designing effective interventions. Several efforts are underway to expand our knowledge base in this area.
Conducting Evaluations. The Department 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.
The evaluation will focus on six sites: five sites will involve random assignment experiments of particular programs and one site 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 performance measures include 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 to 19; and the rate of births to teenagers aged 15 to 17. The evaluator will be required to document the activities undertaken by the program, as well as, to the extent possible, other influences on the subjects of the study. This evaluation is being overseen by the Office of the Assistant Secretary for Planning and Evaluation, in partnership with the National Institutes of Child Health and Development, the Health Resources and Services Administration, and the Office of Population Affairs.
Also, the Office of the Assistant Secretary for Planning and Evaluation issued a grant announcement on May 6, 1998, seeking applications for funding to augment existing teen pregnancy prevention program evaluations that are rigorous in design and already have funding. The primary goal of the proposed grants is to further the understanding of teen pregnancy prevention interventions and the extent to which these interventions meet their goal of reducing teen pregnancies. It is anticipated that two to three one-year grants will be awarded with approximately $100,000 to $150,000 for each grant.
Supporting Demonstrations. Demonstration projects are an important tool for learning about innovative interventions and approaches. Several demonstration efforts are described in other parts of this report. For information on the community collaboration projects, see the Promising Approaches section.
The implementation and evaluation of a home visiting initiative targeted to teenage parents on welfare was supported by the Administration for Children and Families (ACF), in partnership with the Henry J. Kaiser Family Foundation. Demonstration activities were intended to: (1) strengthen family life and help AFDC (now TANF) families achieve the maximum self-support consistent with the maintenance of parental care and protection of children; and (2) add to current knowledge regarding the effectiveness of strategies designed to improve social, personal, health, and economic outcomes among welfare-dependent teenage parents and their children. Research findings on early lessons from the Home Visiting Demonstration are expected by fall of 1998 with final impact findings to be available by the end of 1998.
In addition, the Department 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. The Substance Abuse and Mental Health Services Administration (SAMHSA) plans to award approximately nine cooperative agreements later this fiscal year.
Getting the Word Out
While the data, evaluation, and research findings described above are making major contributions to our knowledge base, their value is limited if they are not available to those who can benefit from them. The Department has undertaken several efforts to disseminate and provide access to the research it supports and the data it collects, including:
- At the July 29,1997, Building Partnerships meeting, a session was held on how to use data. Participants included researchers; those involved in teenage pregnancy prevention programs at the national, state, and local level; and representatives from non-profit organizations with programs on teen pregnancy. In addition, NSFG staff have made twelve university presentations to describe their data set and encourage academic and other researchers to use these data.
- Many of the findings described above were presented at professional meetings in a variety of disciplines. Such meetings included the 1997 and 1998 Population Association of America Meetings, the 1997 American Public Health Association Meeting, and meetings of the Society for Research on Adolescence, and the Society for Adolescent Medicine.
- Journals and other scholarly publications are mechanisms to reach wide audiences. A few examples of this include the 1997 article in the Journal of the American Medical Association (JAMA) on the Findings of the AddHealth Study and the January/February 1998 issue of Family Planning Perspectives devoted entirely to articles using the 1995 NSFG.
- The principal investigators for AddHealth gave two well-received Congressional briefings-one for Senate staff and one for House staff in early 1998.
- The Internet is a fast growing resource for information. Many of the aforementioned studies are available on the Internet. The FastStats web site (http://www.cdc.gov/nchswww/faststats/faststats.htm) provides easy information from the vital statistics and the NSFG. The AddHealth web site (http://www.cpc.unc.edu/addhealth) provides a guide to this survey and related research. The YouthInfo web site (http://youth.hhs.gov) provides links to all youth related activities in the Department.