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Science and Success, Second Edition: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV and Sexually Transmitted Infections
Full Study Report [pdf]
Executive Summary [html] [pdf]
Self Center (School-linked health center)
Program Components
- School-linked health center (SLHC) near a high school and a junior high school
- Free reproductive and contraceptive health care at the SLHC
- SLHC staff working daily in participating schools
- SLHC staff providing sex education lessons in each homeroom and in the clinic
- Daily hours for individual and group counseling by social worker and/or nurse (SLHC staff) in the school health suite
For Use With
- Junior and senior high school students
- Urban female youth
- Black female youth
- Economically disadvantaged female teens
Evaluation Methodology
- Quasi-experimental design, including treatment and comparison conditions, at four inner-city junior and senior high schools in Baltimore, Maryland
- Urban youth (n=3,646 at baseline; n=2,950 at final follow-up), in grades seven through 12
- Pretest in the fall and follow-up surveys each spring of the next three years
Evaluation Findings
- Delayed initiation of sexual intercourse – females
- Reduced incidence of unprotected sex – females
- Increased use of contraception – females
- Increased receipt of reproductive health care
- Long-term: Reduced teen pregnancy rates
Evaluators' comments: The rapid effect on clinic use, exerted by an intervention program designed to supplement the basic sex education program already in place, suggests that it was the accessibility of the staff and of the clinic, rather than any "new" information about contraception that encouraged the students to obtain services.
Source: Zabin, Hirsch, Smith et al, 1986
Program Description
As originally implemented in Baltimore, Maryland, the program is an adolescent health clinic offering reproductive health care, including contraceptive counseling and pregnancy testing we well as other medical services and referral. The center is located very near to junior and senior high schools. The program is designed to provide year-round contraceptive and reproductive health services and education to students.[23]
In the model program, a team from the clinic, consisting of a nurse practitioner and a social worker, make presentations at least once a year in each homeroom. These discussions deal with services offered in the clinic and with other reproductive and sexual health topics. The clinic staff then spends several hours each day in the school health suite, available to students for counseling or group discussions. In the afternoon, these same health professionals provide services in the reproductive health clinic near the schools. Any student can drop in to talk, to receive counseling and education, or to participate in group discussions. Staff places strong emphasis on developing personal responsibility, setting goals, and communicating with parents. Reproductive health services are available free of charge to students who enroll in the clinic and remain in school. This program is intended to augment school-based sex education.[23]
Evaluation Methodology
In evaluation, 1,201 black students in the two participating schools were compared with 1,749 black students with similar backgrounds attending schools not participating in the program. At baseline, 3,646 students completed the survey. The socioeconomic status of participants and comparison youth was similar. Almost 90 percent of youth qualified for the school lunch program. Prior to baseline, almost 92 percent of males and 54 percent of females in ninth grade had initiated sex. About 47 percent of females in seventh and eighth grades had also initiated sex. Among sexually active youth, 56 percent of those in junior high and 73 percent of senior high students reported using contraception at most recent sex. Evaluation relied on self-administered student surveys—a pretest in the fall before the program began and follow-up surveys in the spring of the succeeding three years. At final follow-up, 2,950 students completed the survey.[23]
Outcomes
- Knowledge—Over the course of the program, the proportion of participating females who correctly identified the fertile period during the menstrual cycle increased significantly from 30 to 44 percent, versus an increase from 31 to 38 percent among comparison females.[23]
- Attitudes and perceptions—The proportion of participating females who believed that less effective contraceptive methods could prevent pregnancy dropped significantly from 38 to 24 percent, relative to a drop from 47 to 44 percent among comparison females. Among male participants, the proportion believing that less effective methods could prevent pregnancy dropped significantly from 53 to 34 percent, while the proportion of comparison males who believed in less effective methods rose from 50 to 60 percent.[23]
- Behavior—
- Delayed initiation of sexual intercourse—Significantly more young women who were exposed to the program for three years delayed the initiation of sexual intercourse, by a median of seven months, compared to those not exposed to the program. At age 14, about two-thirds more teenage women had initiated sex before the program started as had done so after three years of exposure to the program. Delay in initiating sex was smaller for young women with only one or two years of exposure to the program.[23]
- Increased use of reproductive health care prior to initiating sex—Significantly more program students attended a family planning clinic before initiating sex and during the first months of sexual activity, compared to non-program youth.[23]
- Reduced incidence of unprotected sex—Use of no contraceptive method at most recent sex was reduced to extremely low levels among young women exposed to the program. Less than 20 percent of these young women failed to use contraception in the months following first coitus. This finding held even among seventh and eighth grade students, whose age is often associated with poor use of contraception. Among comparison young women, up to 49 percent reported no use of contraception.[23]
- Increased use of contraception—Sexually active youth exposed to the program for two years were significantly more likely to report using birth control pills at most recent sex, compared to non-program youth. Program females' reports of pill use rose from 33 to 50 percent, while reports of pill use by comparison females rose only from 33 to 36 percent.[23]
Long-Term Impact
- Reduced teen pregnancy rate among high school females—By the program's third and final year, the pregnancy rate among high school students in program schools had dropped by 30 percent, while it had risen by 58 percent among students in non-program schools.[24]
- Reduced pregnancy rate among younger females—Among the youngest students, the pregnancy rate decreased slightly in program schools while it increased dramatically in non-program schools.[23,24]
For More Information, Contact
Source/Citation:
Alford S. Science and Success, Second Edition: Sex Education and Other Programs That Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2008.
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