Science and Success, Second Edition: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV and Sexually Transmitted Infections

Full Study Report [HTML] [PDF]
Executive Summary [HTML] [PDF]

Program Components

• Clinic-based contraceptive education, counseling, and services for adolescents
• Tailored services to meet the psychosocial information, reassurance, and support needs of youth under age 18
• Personal Information Form, completed by the teenage client
• Increased counseling time, including an extra five minutes for initial phone contact and an extra 15 to 20 minutes for one-on-one counseling
• Lasting six weeks, including two-part first appointment and later follow-up appointment
• First appointment divided into two visits: 1) one-on-one education and counseling in the first visit, including use of videos and other visual aids; 2) medical services in the second visit no more than two weeks later for examination and contraceptive prescription
• Follow-up appointment six weeks after the second half of the first session
• Encouragement of involvement by parents, friends, and/or partner, while ensuring one-on-one counseling for the client
• Reassurance as to confidentiality and strict maintenance of confidentiality
• Training for counselor educators as well as for regular clinic staff
• Training on adolescent psychosocial development for every staff member

For Use With

• Suburban and rural, white, teenage females, age 17 and younger
• Developmentally delayed teenage females

Evaluation Methodology

• Quasi-experimental design, with treatment and comparison groups of non-randomly selected patients in six pre-selected family planning clinics in non-metropolitan Pennsylvania
• Females ages 17 or younger (n=1,256) divided into treatment (n=518) and control (n=738) groups
• Survey at the initial visits and follow-up visit (Knowledge Quiz), at the conclusion of the index visit (Patient Satisfaction Survey), follow-up survey completed by staff at all follow-up visits (Method-Use Questionnaire), and No-Show/Continuation Report, completed for all clients enrolled in the study
• Data collected at enrollment, at three to eight months after baseline, and at nine to 20 months after baseline

Evaluation Findings

• Increased use of contraception
• Increased contraceptive compliance
• Long-term: Decreased pregnancy rate

Evaluators’ comments: Tailoring family planning services to the special psychosocial needs of teenagers has beneficial effects on most outcomes and undesirable effects on none… The cost of the intervention was in the extra personnel time needed to counsel and instruct patients… However, the extra time spent on counseling and education and the earlier return visit represented an investment that paid off in patients’ improved skill and success in using contraceptives.
Winter, Breckenmaker, 1991

Program Description

This pregnancy prevention protocol for family planning clinics and other reproductive health care providers works to meet the special psychosocial needs of family planning clients who are under the age of 18. Such special needs include:

• Education geared to an adolescent’s level of cognitive development;
• Reassurance of confidentiality;
• Extra time for counseling, especially to address teens’ concerns about contraceptive methods and to answer questions about difficulties with a contraceptive method;
• Information and reassurance regarding medical exams; and
• Medical services.[47]

A Personal Information Form, completed by the teenage client, helps counselors identify young women who are at higher risk for pregnancy than are other young women. These include young women who:

• Are age 17 or younger;
• Are developmentally delayed;
• Have no plans for the future;
• Believe that a pregnancy would be okay;
• Lack parental support;
• Have sexual intercourse infrequently;
• Are involved in short-term relationships; or
• Do not initiate the clinic visit themselves.

The Personal Information Form also allows the teen to identify worries or fears related to her visit or to using contraception, so that the counselor can discuss these issues with the teen.[47]

The teenage woman has longer than usual with a counselor for one-on-one education about contraception and sexual health. She returns within two weeks for the second half of the initial visit. At that time, the teen receives medical services, such as pelvic exam and/or pregnancy and STI tests and a prescription for the method of contraception she has chosen. She is also scheduled for another return visit in six weeks when she can ask any additional questions and discuss with a counselor any problems she has encountered with her chosen contraceptive method. The teen is encouraged to make appointments for additional return visits at about six months and one year in the future.[47]

Evaluation Methodology

The evaluation was designed to assess three broad components of the intervention: 1) the knowledge that clients acquired; 2) their feelings about the clinic; and 3) their experience with family planning—particularly their use of contraception and contraceptive continuation and whether they experienced unintended pregnancy. Four survey tools provided data—the Knowledge Quiz, the Patient Satisfaction Survey, The Method Use Questionnaire, and the No-Show/Continuation Report.[47]

The intervention was evaluated using a pretest/post-test design with intervention and non-intervention groups of non-randomly selected clients in six family planning clinics. During a two-month baseline phase, six clinics administered the Patient Satisfaction Survey and the Knowledge Quiz. At the end of this phase, staff from the three clinics designated as experimental sites attended a two-day training. During the next six months, clients attending the experimental sites received services as outlined by the experimental protocols. Clients included both first-time visitors and those making an annual (repeat) visit. The three comparison clinics continued their usual service delivery practices. Clients filled out forms at both experimental and comparison clinics at six months and one year after each client’s index visit.[47]

Adolescent females, ages 17 and under, participated in the study (n=1,256 total; n=251 enrolled at baseline; and n=1,010 enrolled during the treatment phase). A few 18-year-old women were enrolled if counselors felt they were developmentally delayed or at especial risk for unintended pregnancy for other reasons. Overall, 62 percent of participants were making their first visit to a family planning clinic while the rest were making an annual (repeat) visit. Almost all clients were white; one percent was black and less than one percent was Hispanic. More than 40 percent were age 17. Almost 34 percent were age 16. About 16 percent were age 15. About 22 percent were Roman Catholic, the largest single religious affiliation in the sample and reflective of the community demographic.[47]

Outcomes

• Knowledge—Analysis showed that knowledge scores were initially high at both experimental and control sites and that contraceptive knowledge of clients improved more across time at experimental than at control sites (scores rose from 83 to 87 at experimental sites while holding stead at 82 at control sites).[47]
• Behavior Outcomes—
  • Contraceptive use, original method—Clients at experimental sites were significantly more likely at six-month follow-up to be still using their initial contraceptive method, relative to clients from comparison sites (92 versus 85 percent, respectively). The difference was even larger for clients for whom the index visit was a first-ever visit for family planning (95 versus 83 percent, respectively). At 12-month follow-up, original method use remained significantly higher among clients from experimental sites relative to clients from comparison sites (90 versus 81 percent, respectively).[47]
  • Contraceptive use, any method—Clients at experimental sites were significantly more likely to report use of any method at six-month follow-up, compared to clients from comparison sites (97 versus 92 percent, respectively). At 12-month follow-up, use of any method remained higher among clients from experimental sites than from comparison sites, but the difference was no longer statistically significant.[47]
  • Contraceptive continuation among clients experiencing method problems—Clients who had problems with their contraceptive method were significantly more likely at experimental sites than at comparison sites to report continuing their method (79 versus 56 percent). The percentage difference was even more significant among those whose index visit was their first-ever family planning visit (83 versus 55 percent). The percentage of clients experiencing method difficulties and continuing use of the method remained significantly higher among those from experimental sites than comparison sites at 12-month follow-up (71 versus 40 percent).[47]

Long-Term Impact

• Reduced pregnancy rates—Pregnancy rates were calculated in two ways: as a proportion of the continuing sample (n=740) and as a proportion of treatment phase sample (n=1,010). The 45 pregnancies identified among study participants, both experimental and comparison, represent 5.4 percent of the continuation sample and 4.5 percent of the treatment sample. With considerable consistency, the pregnancy rate among clients from the experimental sites was lower than that among clients at the comparison sites. Significant findings include the following:
  • Four percent of continuing clients from experimental sites had a pregnancy versus eight percent at comparison sites.[47]
  • Three percent of all clients from experimental sites had a pregnancy versus six percent at comparison sites.[47]
  • Three percent of continuing 16- to 17-year-old clients at experimental sites had a pregnancy, versus eight percent at comparison sites.[47]
  • Nearly three percent of all 16- to 17-year-old clients at experimental sites had a pregnancy, versus nearly six percent at comparison sites.[47]

For More Information or to Order, Contact

• Sociometrics, Program Archive on Sexuality, Health & Adolescence: Phone, 1.800.846.3475; Fax, 1.650.949.3299; E-mail, This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; Web, http://www.socio.com