Preventing Pregnancy and Improving Health Care Access Among Teenagers: An Evaluation Of the Children's Aid Society-Carrera Program
CONTEXT: Despite the recent declines in rates of teenage pregnancy, relatively little is known about the few programs that have been successful
Preventing Pregnancy and Improving Health Care Access Among Teenagers: An Evaluation Of the Children's Aid Society-Carrera Program
CONTEXT: Despite the recent declines in rates of teenage pregnancy, relatively little is known about the few programs that have been successful in reducing adolescent pregnancy.
METHODS: Six agencies in New York City each randomly assigned 100 disadvantaged 13-15-year-olds to their usual youth program or to the intervention being tested—the Children's Aid Society-Carrera program, a year-round after-school program with a comprehensive youth development orientation. Both program and control youth were followed for three years. Multivariate regression analyses assessed the effects of program participation on the odds of current sexual activity, use of a condom along with a hormonal contraceptive, pregnancy and access to good health care.
RESULTS: Seventy-nine percent of participants remained in the program for three full years. Female program participants had significantly lower odds than controls of being sexually active (odds ratio, 0.5) and of having experienced a pregnancy (0.3). They had significantly elevated odds of having used a condom and a hormonal method at last coitus (2.4). However, participation in the program created no significant impact on males' sexual and reproductive behavior outcomes. Nonetheless, program participants of both genders had elevated odds of having received good primary health care (2.0-2.1).
CONCLUSIONS: This program is one of only four whose evaluation has successfully documented declines in teenage pregnancy using a random-assignment design. Better outcomes among males may be achieved if programs reach them even earlier than their teenage years.
Perspectives on Sexual and Reproductive Health, 2002, 34(5):244
Despite recent declines, the United States still has one of the highest teenage pregnancy rates among industrialized nations.1 While a growing number of programs have improved contraceptive prevalence or affected sexuality-related behaviors, few high-quality evaluations have documented programs' success in reducing teenage pregnancies and births, and even fewer have been able to delay the age of sexual debut. This article reports on the results achieved by a three-year, random-assignment evaluation of a Carrera-model teenage pregnancy prevention program.
The past 20 years have been filled with acrimony over how to best approach the problem of teenage pregnancy, but few successful strategies have emerged from this debate. Program evaluation has been sorely neglected and is frequently limited to measuring knowledge change or assessing intentions to remain abstinent. Moreover, many evaluations have lacked comparison groups, which has made it impossible to be sure that the programs themselves produced the observed outcomes.
What programs have been successful in reducing rates of teenage pregnancy? Two are early childhood or elementary school interventions. The Seattle Social Development Project used teacher training and parenting classes in elementary schools to increase children's sense of attachment to their school and family, while also increasing their social skills.2 Some 18 schools were nonrandomly assigned to receive the intervention or not. By age 18, young people from the program schools were less likely to have had intercourse and also had lower pregnancy rates than those from control schools.
A second program, the Abecedarian project, randomly assigned children to receive interventions during preschool, elementary school, both or neither.3 Children in preschool received year-round, full-day child care from infancy through kindergarten, while those in the elementary school intervention worked with a home-school resource teacher whose objective was to increase parental involvement in the child's learning. The children in intervention classrooms had lower birthrates than children in the control group at age 21 and had delayed childbearing by more than one year.
Two communitywide projects have lowered teenage pregnancy rates. In one, pregnancy rates in a rural South Carolina county were tracked from 1977 to 1988 to detect changes created by an intervention that featured sexuality education training for school staff, classroom training in decision-making skills for students and the school nurse's providing transportation to a family planning clinic and dispensing condoms.4 Compared with another part of the county and with three similar counties, the intervention area had lower rates of teenage pregnancy; furthermore, these rates returned to previously high levels after the program ended. A second evaluation of this program described in more detail the interventions used to achieve these results.5
The other community-based intervention, Plain Talk, attempted to increase adults' communication skills in teenage sexuality issues and to motivate adults to encourage adolescent contraceptive use.6 Pregnancy rates among participants dropped over a three- or four-year period, but the research design did not include comparison communities or random assignment.
Clinic-based interventions have also proved useful. The Self Center, a Baltimore clinic, sent staff into a nearby high school to recruit teenage clients and to offer education and counseling. A 28-month follow-up showed that black female clients from the high school had lower pregnancy rates than black females attending two matched comparison schools.7
Educational and job-related interventions can be successful strategies to reduce teenage pregnancy rates and birthrates. The Youth Incentive Entitlement Pilot Projects offered part-time jobs during the school year and full-time summer jobs if participants stayed in school.8 