How do the findings in Emerging Answers differ from its predecessor, No Easy Answers, published in 1997?

The research findings in Emerging Answers are generally more positive. Evaluation research completed since 1997 shows that more programs to prevent teen pregnancy are making a real difference in encouraging teens to remain abstinent or use contraception when they have sex. In particular, larger, more rigorous studies of some sex and HIV education programs have found sustained positive effects on behavior for as long as three years. Service learning programs (i.e., voluntary community service with group discussions and reflection) that do not mention sex at all have now been found to reduce sexual risk-taking or pregnancy in several settings by independent research teams. And one program that combines such things as tutoring, work and sports-related activities, with family life and sex education, and comprehensive medical care including mental health and reproductive health services has had a positive impact on sexual and contraceptive behavior, pregnancy, and births among girls for as long as three years (p. V).

Which programs have strong evidence of success?

Eight programs have strong evidence of effectiveness - five are sex and HIV education programs, two are service learning programs, and one is an intensive program with both sexuality and youth development components (p. 88).

What does Emerging Answers say about sex and HIV education programs?

Several sex and HIV education programs delay the onset of sex, reduce the frequency of sex, reduce the number of sexual partners among teens, or increase the use of contraception. Two independent studies have found that one program, Reducing the Risk, delayed the onset of intercourse and increased the use of contraceptives among some groups of youth. Four other programs - Safer Choices; Becoming a Responsible Teen; Making A Difference: An Abstinence Approach to STD, Teen Pregnancy, and HIV/AIDS Prevention; and Making a Difference: A Safer Sex Approach to STD, Teen Pregnancy, and HIV/AIDS Prevention - have also been shown to delay sex or increase contraceptive use (p. 88).

Do programs to prevent teen pregnancy have to focus on sex?

No. Because the reasons behind teen pregnancy vary, so do the types of programs designed to combat the problem. Although the most important antecedents of teen pregnancy and childbearing relate directly to sexual attitudes, beliefs, and skills, many factors closely associated with teen pregnancy actually have little to do directly with sex (such as growing up in a poor community, having little attachment to one's parents, or failing at school) (p. 25). In fact, certain service learning programs - which may not focus on sexual issues at all - have the strongest evidence of any intervention that they reduce actual teen pregnancy rates while the youth are participating in the programs. The service learning programs with the best evidence of success are the Teen Outreach Program and Reach for Health (p. 108).

Are there successful programs that focus on both sex and other factors?

Yes. The Children's Aid Society-Carrera Program - a long-term, intensive program that combines such things as tutoring, work and sports-related activities, with family life and sex education, and comprehensive medical care including mental health and reproductive health services - significantly delayed the onset of sex, increased the use of contraception, and reduced pregnancy and birth rates among girls. The program did not reduce sexual risk-taking among boys. This is the first and only rigorous study to date that has found a positive impact on sexual and contraceptive behavior, pregnancy, and births among girls for as long as three years (p. 112).

Do sex and HIV education programs increase sexual activity?

No. The overwhelming weight of evidence shows that sex education that discusses both the benefits and limitations of contraception does not hasten the onset of sex, increase the frequency of sex, nor increase the number of sexual partners. In fact, some sex and HIV improve all of these measures (p. 89).

Do abstinence-only programs discourage contraceptive use?

Abstinence-only programs are not designed to affect contraceptive use. So far, only one study has measured the impact of an abstinence-only program on contraceptive use and it did not show a significant impact one way or the other. In addition, programs with a strong abstinence message that also teach about contraceptives for sexually active youth do not decrease contraceptive use (p. 87).

Does Emerging Answers suggest that communities use only the eight programs with the most evidence of success?

While there are a number of effective programs, there are no "magic bullets" for preventing teen pregnancy (p. 171). And, indeed, the programs with the strongest evidence for success may work with some populations better than others. Moreover, communities choose to develop particular prevention programs for many reasons other than research - including, for example, compatibility with the community's religious traditions, available resources, community standards, and the personal values and beliefs of the leaders in charge.

What does Emerging Answers say about abstinence-only programs?

The jury is still out on abstinence-only programs. Because very little rigorous evaluation of abstinence-only programs has been completed - and because those few studies that have been completed do not reflect the great diversity of abstinence-only programs currently offered - the primary conclusion that can be drawn is that the evidence is not conclusive about abstinence-only programs. However, these few early results about abstinence-only programs are not encouraging (p. 85). Findings about abstinence-only programs may change in the future because a rigorous, federally-funded study of some of these programs is currently underway (p. 88).

What about the recent study on "virginity pledges"?

Recent publicity has focused attention on a study of the effect of virginity pledges, which suggested that, in some circumstances among certain populations, virginity pledges were associated with later initiation of sex as well as less use of contraception at first sex for those pledgers who did have sex. This study is not included in Emerging Answers because it was not a program evaluation with an experimental or quasi-experimental design and, therefore, did not meet the criteria for inclusion. Instead, it was based on survey data and provides weaker evidence for a causal impact (p.88).

Has a cost-benefit analysis ever been conducted on a teen pregnancy prevention program?

Yes. One evaluation of the Safer Choices sex education program estimated that for every dollar invested in the Safer Choices program, $2.65 in total medical and social costs was saved (p. 91).

What does Emerging Answers say about family planning services?

Family planning clinics probably prevent a large number of teen pregnancies - although there is remarkably little evidence to support this common-sense view. However, several rigorous studies have consistently indicated that when clinics provide quality educational materials, discuss the adolescent patient's sexual and condom or contraceptive behavior, give a clear message about that behavior, and incorporate other components into the clinic visit, clinics can increase condom or contraceptive use among those who attend certain clinics, although not always for a prolonged period of time (p. 172).

Are school-based and school-linked clinics and school condom-availability programs successful?

While substantial percentages of sexually experienced female students in schools with school-based clinics obtain contraceptives from those clinics, and while students obtain large numbers of condoms from schools when schools provide those condoms in private locations and with few restrictions, studies measuring the impact of such programs have produced mixed results. However, studies have consistently shown that making condoms or other contraceptives available in schools does not hasten or increase sexual activity (p. 172).

Does Emerging Answers suggest that programs are the only answer to preventing teen pregnancy?

No. Prevention programs can be an important part of the answer, and it is encouraging that research is revealing more about what makes the successful ones work. However, it is crucial for leaders to understand that although effective programs can help reduce teen pregnancy, it is naive to think that they can completely solve the problem by themselves (p. 2).

How were studies chosen for inclusion in Emerging Answers?

To be included in Emerging Answers, a program evaluation had to meet several standards, the most important of which were to have:

• been completed in 1980 or later,
  
• been conducted in the United States or Canada,
  
• been targeted at adolescents of middle school or high school age,
  
• employed an experimental or quasi-experimental design,
  
• had a sample size of at least 100 in the combined treatment and control group, and
  
• measured impact on sexual or contraceptive behavior, pregnancy, or childbearing (p. 83).

Who is Douglas Kirby?

Douglas Kirby, Ph.D, is a member of the National Campaign's Board of Directors and is Chairman of the its Task Force on Effective Programs and Research. He is also Senior Research Scientist at ETR Associates, a California-based non profit organization dedicated to improving the well-being of individuals, families and communities through education, training, and research. In the interest of full disclosure, Dr. Kirby wanted to make it clear that ETR Associates developed - and continues to market - two of the eight programs (Reducing the Risk and Safer Choices) his review concludes have the strongest evidence of effectiveness.

About the National Campaign to Prevent Teen Pregnancy

Founded in 1996, the National Campaign is a private, nonprofit, nonpartisan organization with a goal to reduce the teen pregnancy rate by one-third between 1996 and 2005. For more information please contact Bill Albert (202-478-8510) or visit the Campaign's website at www.teenpregnancy.org.