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06.04.2009
Resources

Talking Points on Science-Based Approaches and Programs

Also available in [PDF] format. Order publication online.

Science-Based Approaches (SBAs) have a number of specific characteristics. First, the development and implementation of an SBA must be fully informed by rigorous research. Second, an SBA must use strategies accepted in the scientific community as thorough and reliable. Third, the evaluation of an SBA must have shown it to be effective in achieving positive and intended outcomes, thereby suggesting that the approach will achieve similar outcomes when applied to populations similar to the original target group. Programs that fit these criteria are often published in peer-reviewed journals, helping the reader to know that the evaluation was rigorous.

In particular, a science-based approach in teen pregnancy prevention is a curriculum and/or program that has been shown to:

  1. Reduce the incidence of unwanted sexual health outcomes, such as pregnancies and sexually transmitted infections (STIs) among youth exposed to the program relative to a control or comparison group; and/or
  2. Influence the sexual behavior of youth in a desired direction. For example, it might successfully: reduce the percent of youth who initiate sex by a certain age; reduce the incidence of unprotected sex among sexually active program participants; reduce the number of sexual partners among sexually active youth; increase the number of sexually active youth who consistently use condoms or contraception; and/or increase the number of sexually active youth who remain in a monogamous relationship. These changes must be measured in relation to a control or comparison group.

Talking points, like the ones listed here, can help program planners and advocates effectively educate and persuade organizations and decision makers to rely on science-based approaches and programs for teen pregnancy prevention. These talking points may not answer every question, but they can help make clear, coherent arguments for science-based programs and approaches.

The left column features critical talking points. The column on the right provides background information that may be useful in responding to questions or challenges.

 Basic Talking Points

 You Need to Know…

1. Preventing teen pregnancy and sexually transmitted infections (STIs) among youth should be a priority for our community.
  • The NCHS reports a 5 percent national increase between 2005 and 2007 in teenage birthrates in the U.S; from 40.5 to 42.5 births per 1,000 young women aged 15-19. Nearly half a million 15- to 19- year old women (445,045) gave birth in 2007.1
  • Among industrialized countries, the United States has among the highest rates of teen birth and STIs.
  • Rates of teen pregnancy and sexually transmitted infections (STIs) are higher in the United States than in other developed countries. For example, in the United States:
    • the teen birth rate is over 9 times greater than in the Netherlands;
    • the HIV rate among teens is 4.5 times greater than in Germany;
    • the teen gonorrhea rate is 30 times higher than rates in the Netherlands.2
  • European youth initiate sex at about the same general age as do U.S. youth but they report fewer sexual partners and use protection more consistently. In many European countries, adults believe that teens have the right to complete, accurate information about their sexual health, that they deserve respect, and that they have the responsibility to protect themselves. Adults also believe that society has the responsibility to provide young people with the tools they need to safeguard their health.2
2. ‘Abstinence-only’ programs are ineffective in changing behaviors related to teen pregnancy and/or STIs.
  • For many years“abstinence-only programs” received federal funding and were popular with schools; however, evaluations and meta-analyses have reported no evidence that these programs are effective in changing teens’ sexual behaviors or in reducing the incidence of teen pregnancy or STIs.3,4 In fact, there is evidence that youth exposed to abstinence-only programs are less likely than their peers to protect themselves against STIs and teen pregnancy.5,6,7
  • One popular abstinence-only program, “Baby Think It Over,” uses expensive simulator dolls. However, evaluation has shown that it has no effect on teens’ sexual behaviors or sexual health outcomes.5
  • The federal government’s own evaluation of five of the “most promising” abstinence-only programs found that these programs had no effect – youth who received them  were no more likely to abstain from sex and did not have fewer sexual partners than youth who were not in the programs.4
  • In a recent review commissioned by the National Campaign to Prevent Teen and Unplanned Pregnancy of all sex education programs that met a set of rigorous scientific standards, researcher Douglas Kirby, PhD, found that no abstinence-only program has shown with strong evidence that it positively affects sexual behavior among youth.8
3. To find programs that are effective, communities should use three elements to guide their choice, adaptation, and use of prevention programs. These three elements are a) evaluated programs, b) research on risk and protective factors, b) science, and c) the community’s core values.
  • Using these three factors as guidelines can help communities and organizations use their time and resources most effectively.
  • The only sex education programs that have been proven through scientifically reliable research methods to reduce teen pregnancy or STI rates and/or sexual risk behaviors are those that emphasize both delaying sex and also using contraception.9,10
  • Core values that empower youth to make healthy choices include:
    • respecting young people;
    • acknowledging their right to accurate information and confidential health care; and
    • believing that youth can and will act responsibly when they also have the tools they need to make responsible decisions.
4. Experts have identified a number of effective, science-based programs that reduce sexual risk taking behaviors and/or improve teens’ sexual health outcomes (rates of pregnancy or STIs).
  • Research has shown that programs that only produce changes in attitudes, beliefs, and/or knowledge have no long-term effect on sexual risk behaviors.11
  • A science-based program is one that has been proven to reduce risky sexual behavior and increase healthy sexual behavior among youth and/or to improve sexual health outcomes (rates of teen pregnancy and/or STIs).
  • In its publication Science & Success, Advocates for Youth has identified 26 science-based programs in the Unites States, not one of which is “abstinence-only” or “abstinence-only-until-marriage”. With the exception of three youth development programs, all of these programs provide complete and accurate sexual health information. All 26 programs provide youth with opportunities to build skills and self-confidence. All 26 programs trust youth to make wise choices. When comparing program youth to control youth, among the 26 programs:
    • 14 helped youth delay or postpone their first sexual experience;
    • 14 increased sexually active youth’s use of condoms;
    • 9 increased their use of contraception;
    • 9 decreased the number of teen births or rates of teen pregnancy;
    • 7 increased use of contraception and delayed initiation of sex;
    • 5 decreased the teen pregnancy/teen birth rate and delayed initiation of sex; and
    • 4 reduced the incidence of STIs.9,10
5. To be proven effective, programs must meet rigorous evaluation standards.
  • Among other criteria, all the programs recognized by Advocates for Youth in Science & Success used at least a quasi-experimental evaluation design that assessed at least 100 youth in comparing those receiving the program with those not receiving it.9,10
  • Evaluators must have collected data from both treatment and comparison groups before and after the intervention and at least three months after the program.9,10 In some effective programs, evaluators continued to collect data for several years after the program.10
  • Evaluation must have found that the program positively affected sexual health outcomes and/or improved at least two sexual risk behaviors among program youth compared to non-program youth.9,10
6. Several programs exist that are proven effective for diverse populations, ages, and locales.
  • Assessing factors such as race, gender, age, sexual experience, sexual orientation, and geographic location can help a community identify an appropriate program for its teens.10
  • Each teen sub-group is equally important and deserves appropriately targeted services, especially when a sub-group experiences disproportionately higher rates of teen pregnancy or STIs.  
  • For instance, because teen pregnancy rates are higher among African-American and Latino teens,12there may be a greater need for targeted programs. Specific programs have been found effective with urban Hispanics, urban and rural black youth, pregnant and parenting teens, sexually experienced teens, and sexually inexperienced teens.10
7. Americans overwhelmingly support the use of programs that provide youth with comprehensive information about sexual health.
  • A 2007 national poll conducted by an independent research firm found that 73 percent of adults and 56 percent of teens believe that young people need more information about delaying sex and about using contraception.13
  • A 2004 poll found that:
    • 95 percent of parents of junior high youth and 93% of parents of high school youth believed that schools should teach about birth control and other methods of preventing pregnancy;
    • 100 percent of junior high parents believed that schools should teach about STIs other than HIV and AIDS;
    • 99 percent of high school parents believed schools should teach about HIV and AIDS;
    • 98 percent of high school parents believe schools should teach about STIs other than HIV/AIDS.14
  • One independent study found that a majority of voters in nearly every demographic category (including Democrats, Republicans, and independents as well as Catholics and evangelical Christians) supported comprehensive sex education in schools.15
8. Preventing teen pregnancy, STIs, and HIV costs far less than providing services and programs for teen parents and their children, and treatment of STIs and HIV/AIDS.
  • Compared to spending on prevention, governments spend a disproportionate amount on treatment and care services related to negative sexual health outcomes.
    • In 2004, the federal government spent approximately $9.1 billion on services related to teen childbearing; $8.6 million of this was spent on birth-related care for teens ages 17 and younger.16
    • Over half (52 percent) of all mothers on welfare had their first child as a teenager.17
    • In 2000, the cost of treating STIs among 15- to 24-year-old youth was $6.5 billion.18
  • Between 1982 and 2007, federal and state governments spent over $1.5 billion on ‘abstinence-only’ programming.19 Yet these programs have not been shown to be effective at delaying sexual initiation or reducing sexual risk-taking.
  • When evaluating one teen pregnancy and STI prevention curriculum, researchers found that for every dollar invested in the program, $2.65 in total medical and social costs were saved.20 In 2005, Amarol and Foster estimated taxpayer money saved in teen pregnancies prevented by Family PACT, a teen pregnancy prevention program in California. They found that had this program not been successful in helping young people prevent teen pregnancy, the subsequent births to teens would have cost over $1.1 billion after two years and $2.2 billion after five years.21

Written by Elizabeth Umbro, MPP, Advocates for Youth Intern; with contributions from Laura Davis, MA; Barbara Huberman, RN, MEd; Tom Klaus, MS, and Sue Alford, MLS. © 2009 Advocates for Youth

References:

  1. Hamilton B et al.  “Births:  Preliminary Data for 2007.” National Vital Statistics Reports 2009; 57(12): 1-23.
  2. Alford S. Adolescent Sexual Health in Europe and the U.S. – Why the Difference? Washington, DC: Advocates for Youth, 2008. http://www.advocatesforyouth.org/storage/advfy/documents/fsest.pdf; accessed 1/5/2009
  3. Hauser D. Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact [Title V State Evaluations]. Washington, DC: Advocates for Youth, 2004; http://www.advocatesforyouth.org/index.php?option=com_content&task=view&id=623&Itemid=177; accessed 4/28/2008.
  4. Trenholm C, Devaney B, Fortson K, Quay L, Wheeler J, Clark M. Impacts of Four Title V, Section 410 Abstinence Education Programs. Princeton NJ: Mathematica Policy Research, 2007.
  5. Barnett JF, Hurst CS. Abstinence education for rural youth: an evaluation of the Life’s Walk program. Journal of School Health 2003;73:264-268.
  6. Barnett JE. An Evaluation of an Abstinence-Only Sex Education Program in Rural Communities. Presentation at the 2002 annual meeting of the American Educational Research Association.
  7. Bearman PS, Brückner H. Promising the future: virginity pledges and first intercourse. American Journal of Sociology 2001; 106:859-912.
  8. Kirby D. Emerging Answers 2007. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2007.
  9. Alford S, Cheetham N. Hauser D. Science and Success in Developing Countries: Holistic Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2005; http://www.advocatesforyouth.org/storage/advfy/documents
    /sciencesuccess_developing_es.pdf
    ; accessed 4/28/2008.
  10. Alford S et al. Science and Success: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. 2nd Edition. Washington, DC: Advocates for Youth, 2008
  11. Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2001.
  12. The Guttmacher Institute. U.S. Teenage Pregnancy Statistics: National and State Trends by Race and Ethnicity. New York, NY: Author, 2006
  13. National Campaign to Prevent Teen Pregnancy. With One Voice 2007: America’s Adults and Teens Sound Off about Teen Pregnancy. Washington, DC: Author, 2007.
  14. National Public Radio, Kaiser Family Foundation, Kennedy School of Government. Sex Education in America: NPR/Kaiser/Kennedy School Poll. Menlo Park, CA: Kaiser Family Foundation, 2004.
  15. Peter D. Hart Research Associates. Memorandum: Application of Research Findings, written to Planned Parenthood Federation of American and National Women’s Law Center, 12 July 2007. Washington, DC: Author; http://www.nwlc.org/pdf/7-12-07interestedpartiesmemo.pdf; accessed 4/28/2008.
  16. Chesson HW, Blandford JM, Gift TL, Tao G, Irwin KL. The estimated direct medical cost of sexually transmitted diseases among American Youth, 2000. Perspectives on Sexual and Reproductive Health 2004; 36(1):11-19; http://www.guttmacher.org/pubs/psrh/full/3601104.pdf; accessed 4/28.2008.
  17. National Campaign to Prevent Teen Pregnancy. Not Just Another Single Issue: Teen Pregnancy’s Link to Other Critical Social Issues. Washington, DC: Author, 2002.
  18. Howell M. The History of Federal Abstinence-Only Funding. Washington, DC: Advocates for Youth, 2007; http://www.advocatesforyouth.org/storage/advfy/documents/
    fshistoryabonly.pdf
    ; accessed 4/28/2008.
  19. Amaral G, Foster DG. Cost-Benefit Analysis of the California Family PACT Program for Calendar Year 2002. San Francisco: Center for Reproductive Health Research and Policy, 2005.
  20. Wang LY et al. Economic evaluation of safer choices: a school-based HIV, STD and pregnancy prevention program. Abstr Search Tools 1999 Natl HIV Prev Conf Natl HIV Prev Conf 1999 Atlanta Ga. 1999 Aug 29-Sep 1; (abstract no. 146).
  21. Amaral G, Foster DG. Cost-Benefit Analysis of the California Family PACT Program for Calendar Year 2002. San Francisco: Center for Reproductive Health Research and Policy, 2005.

Funding for this publication was made possible (in part) by a Cooperative Agreement (Grant #: 5U58/DP324962-03 REVISED) with the Centers for Disease Control and Prevention (CDC).  Any part of this publication may be copied, reproduced, distributed, and adapted, without permission of the authors or the publisher, provided that the materials are not copied, distributed, or adapted for commercial gain and provided that the authors and Advocates for Youth are credited as the source on all copies, reproductions, distributions, and adaptations of the material.

This publication is a part of the Strategies for Organizational Success series.

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