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May 2006 Monthly Monitor

Advocates for Youth's Youth of Color Initiative

Feature: Teen Pregnancy Prevention

The problem of adolescent pregnancy must be considered in its greater social context. For many young people, early pregnancy and childbearing accompany broader social, economic, cultural, and psychological issues, including poverty, school failure, and sexual abuse. A further complication is that adult men are frequently the fathers of children born to teenage women.[1,2]

These complexities pose particular challenges to pregnancy prevention program planners. It must be recognized that there is no "magic solution" to teen pregnancy, nor will a single intervention work for all teens. Communities should not expect lower pregnancy and birth rates immediately, because the prevention process is time-consuming, and requires affirmation from young people and a serious commitment of financial resources. To reach a broad teen audience, programmers need to implement a combination of strategies, and involve all key members of the community.

While there is still much to learn about the causes and consequences of early pregnancy, program planners can benefit greatly from the research and the lessons learned from the numerous programs already in place across the country. This document summarizes key ingredients of successful teen pregnancy prevention programs and may be used as a guide for developing new strategies and strengthening existing interventions.

General Principles

The following principles are important for program implementation:

• Set clearly defined and realistic program goals and objectives. They may relate to delayed initiation of sexual intercourse, increased and more effective contraceptive use, reduced rates of pregnancy and childbearing among participants, and/or increased rates of school completion.
• Encourage community collaboration. Parents, neighborhood organizations, schools, health providers, and youth agencies can provide critical support during all phases of program design and implementation. The media, business sector, religious organizations, and policy makers also play an important role in the prevention partnership.
• Involve youth in needs assessment, program design, implementation, and evaluation. Teens can be involved in a variety of activities including agency advisory boards, community outreach efforts, and program planning and review.
• Create activities that are both age and developmentally appropriate. Interventions should be tailored for younger, middle, and older adolescents and should account for varying levels of cognitive development.
• Provide culturally appropriate program activities. Activities should be relevant to young people and should reflect an understanding of and sensitivity to the racial and ethnic backgrounds of participants.
• Coordinate messages to target both young women and men. It is important to emphasize joint responsibility, sexual communication, assertiveness, and refusal skills. Either gender-specific or coed programs can reach both young women and men.
• Offer long-term and consistent support. Programs should be tailored to individual participants. While some young people need little support to prevent a pregnancy, others will require more comprehensive interventions over a sustained period of time.
• Provide information on both abstinence and contraception and ensure access to contraceptive services. Messages on abstinence and postponement of sexual activity are important for those who have not yet initiated sexual intercourse and should be presented as viable options for those who are already sexually active. Sexually active teens also require accessible and affordable contraceptive and reproductive health services. Still other adolescents may need additional interventions to strengthen their motivation to prevent or delay too-early childbearing.

Program Strategies

Pregnancy prevention programs must account for the varying levels of risk among teens. When developing specific interventions, the following issues are important to consider:

Sexuality Education

All young people need comprehensive sexuality education to prepare them for healthy adult relationships. Sexuality education programs should increase adolescents' knowledge and help them to explore attitudes, feelings, and values about human development, relationships, dating, gender roles, sexual orientation, sexual behavior, and healthy sexual decision-making. Educational programs are most effective when they:

• Provide accurate information on both abstinence and contraception,[3]
• Are developmentally appropriate,[4]
• Encourage skill development, including decision-making, assertiveness and negotiation skills as well as life skills, training and goal setting.[5,6]

Contraceptive Services

A sensitive, well-trained, and non-judgmental staff person plays an important role by helping teens learn about and decide to use contraception effectively and consistently. The first contact with a family planning service provider is critical in setting the stage for future visits. Family planning staff should utilize a guided counseling process to help a teen decide which method of contraception is most appropriate, including abstinence. This type of counseling is particularly useful for teens who receive a negative pregnancy test during a pregnancy scare.[7] In addition, the role of men should be addressed in family planning settings. Although men are influential in contraceptive use and acceptance among young women, they are seldom specifically engaged in prevention efforts.

Comprehensive sexual and reproductive health services for adolescents should include gynecological exams; contraceptive methods; pregnancy testing; and screening, treatment, and/or referral for sexually transmitted diseases including HIV and AIDS.

Teen-friendly services are most effective when they:

• Guarantee confidentiality,[8]
• Offer accessible hours,[8] including walk-in appointments and flexible and extended hours during evenings and weekends,
• Offer a convenient setting where teens naturally congregate,[8]
• Provide free-of-charge or affordable services (on a sliding fee scale),[8]
• Offer directive contraceptive education and counseling,[9]
• Offer to delay the pelvic exam at the initial visit. [10]

Motivational Opportunities and Related Services

For those teens at highest risk of pregnancy, effective prevention strategies include improving educational and economic opportunities and/or intervening in the numerous social and psychological factors associated with sexual risk-taking. Strategies should be designed for the individual young people and need to include access to

• Psychosocial counseling, including treatment for sexual abuse, drug and alcohol use, and/ or family distress,[11,12,13]
• Mentoring programs for youth to develop a close relationship with an adult,[14]
• Educational opportunities, including tutoring and access to higher education,[15]
• Recreational activities such as sports, drama, and social clubs,[15]
• Vocational and job skills, including job placement,[15]
• Community service opportunities.[16]

Call to Action

Based upon these program strategies and principles, communities may want to assess adolescent needs, review service availability, identify gaps and resources, and develop comprehensive plan of action for adolescent pregnancy prevention. This plan should address ways to develop new programs, strengthen existing efforts, or better coordinate activities and referral networks so that all teens have access to a wide array of prevention services. To be most effective, community-wide program efforts must be supported by expanded financial resources, increased public awareness, and the implementation of favorable policies at the national, state, and local levels.

* This feature summarizes Components of Promising Teen Pregnancy Prevention Programs, by L. Davis, [Issues at a Glance], Washington, DC: Advocates for Youth, 1996.

References

1. Landry DJ, Forrest JD. How old are U.S. fathers? Fam Plann Perspect 1995;27:159-161.
2. Males M. School-age pregnancy: why hasn't prevention worked? J Sch Health 1993;63:429-432.
3. Frost JJ, Forrest JD. Understanding the impact of effective teenage pregnancy prevention programs. Fam Plann Perspect 1995;27: 188-195.
4. Girls Incorporated. Truth, Trust and Technology: New Research on Preventing Adolescent Pregnancy. Indianapolis IN: Girls Inc. 1991.
5. Howard M, McCabe JB. Helping teenagers postpone sexual involvement. Fam Plann Perspect 1990;22:21-26.
6. Kirby D, Barth RP, Leland N. Fetro JV. Reducing the Risk: impact of a new curriculum on sexual risk-taking. Fam Plann Perspect 1991;23:253-263.
7. Zahin LS, Emerson MR, Ringers PA, Sedivy V. Adolescents with negative pregnancy test results. JAMB 1996;275:113-117.
8. Brindis C. Adolescent Pregnancy Prevention: A Guidebook for Communities. Palo Alto Calif: Health Promotion Resource Center, Stanford Center for Research in Disease Prevention, 1991.
9. Nathanson C, Becker MH. The influence of client-provider relationships on teenage women's subsequent use of contraception. Amer J Pub Health 1985;75: 33-38.
10. Armstrong KA, Stover MA. SMART START: an option for adolescents to delay the pelvic examination and blood work in family planning clinics. J Adolesc Health 1994;15:389-395.
11. Moore KA, [et al]. Adolescent Pregnancy Prevention Programs: Interventions and Evaluations. Washington, DC: Child Trends 1995.
12. Berenson AB, San Miguel, VV. Wilkinson GS. Violence and its relationship to substance use in adolescent pregnancy. J Adolesc Health 1992;13:470-74.
13. Boyer D, Fine D. Sexual abuse as a factor in adolescent pregnancy and child maltreatment. Fam Plann Perspect 1992;24:4-11+.
14. Tiemey JP, Grossman JB, Resch NL. Making a Difference: An Impact Study of Big Brother/Big Sisters. Philadelphia PA: Public/Private Ventures, 1995.
15. Carrera MA, Dempsey P. Philliber W. Philliber S. Evaluating a comprehensive pregnancy prevention program. Fam Life Ed 1992;11(1):4-9.
16. Philliber S. Allen JP. Life Options and Community Service: Teen Outreach Program. In Miller BC, Card JJ, Paikoff RL, Peterson JL. Preventing Adolescent Pregnancy: Model Programs and Evaluations. Newbury Park, CA: Sage Publications, 1992.

Capacity Building & Professional Development

The next Women of Color Advocacy Institute is being offered during the 2006 HIV Prevention Leadership Summit (HPLS) to anyone interested in attending. The Women of Color Advocacy Institute provides training to increase the advocacy leadership capacity of women of color in underserved communities. This training will help ensure women living with HIV and AIDS are well equipped with the knowledge and skills to serve as members of local planning councils, as well as other groups charged with improving HIV and AIDS, STD and substance abuse prevention and health initiatives for women of color with, and at risk for, HIV and AIDS. The trainings are designed for community-based organizations, program managers and direct service providers.

Details of the training are as follows:
When: Tuesday, June 6, 2006
Time: 9:00 a.m. to 5:00 p.m.
Where: Hilton Anatole Hotel, Dallas, TX

For additional information, please contact Shawna Johnson, Women of Color Policy Associate: telephone: (202) 483-6622 ext. 363; or e-mail: sjohnson@nmac.org.

Funding Opportunities

Minority Community Health Partnership HIV and AIDS Demonstration Grants Program seeks to improve the health status relative to HIV and AIDS of targeted minority populations through health promotion and education activities. To receive consideration, applications must be received by the Office of Public Health and Science (OPHS) Office of Grants Management no later than June 19, 2006. For more information on the grant, please visit http://www.grants.gov/search/search.do?mode=VIEW&oppId=9349

Request for Applications for the HIV Prevention Program for Young Women Attending Minority Institutions--Historically Black Colleges and Universities, Hispanic Serving Institutions, and Tribal Colleges and Universities. The office on Women’s Health has an opportunity for minority institutions to develop and implement a HIV/AIDS/STD prevention education program targeting young women on campus. The proposed HIV prevention program must address HIV prevention from a women's health gender-based, women-centered, women-friendly, women-relevant, holistic, multi-disciplinary, cultural perspective. Information and services provided must be culturally and linguistically appropriate for young minority women.

To receive consideration, applications must be received by the Office of Public Health and Science (OPHS) Office of Grants Management no later than June 05, 2006. For more information, please visit http://www.grants.gov/search/search.do?mode=VIEW&oppId=9351

Announcements

Advocates for Youth is hiring for the position of Program Manager, Young Women of Color Initiatives. The Program Manager will oversee Advocates' Young Women of Color Initiatives, including an Office of Minority Health cooperative agreement, a Young Women of Color Leadership Council, and a peer education program. Activities include: providing technical assistance and training for community-based organizations; recruiting, training, and maintaining council members and peer educators; assisting with local council development; developing material for a Web site; and conducting workshops and presentations to national, state, and local audiences. For more information, please visit http://www.advocatesforyouth.org/about/employment.htm

Harassment of gay students in school still too commonplace: The Gay, Lesbian and Straight Education Network, or GLSEN, announced findings from the 2005 National School Climate Survey (NSCS), the only national survey to document the experiences of students who identify as lesbian, gay, bisexual and transgender (LGBT) in America's schools. The survey reveals that anti-LGBT bullying and harassment remain commonplace in America's schools. Seventy five percent of students heard derogatory remarks such as "faggot" or "dyke" frequently or often at school, and nearly nine out of ten (89.2%) reported hearing "that's so gay" or "you're so gay" -- meaning stupid or worthless-- frequently or often. Physical harassment and assault are also too frequently reported. Overall, LGBT students were twice as likely as the general population of students to report they were not planning to pursue any post-secondary education. The average GPA for LGBT students who were frequently physically harassed was half a grade lower than that of LGBT students experiencing less harassment (2.6 versus 3.1).

On a positive note, the report indicates that trained and supportive staff, the presence of Gay Student Alliance clubs, and anti-bullying policies all lead to reductions in harassment. For more information, visit http://www.glsen.org/cgi-bin/iowa/all/news/record/1927.html

For Resources on Teen Pregnancy Prevention, please check out the following:

• Advocates for Youth at http://www.advocatesforyouth.org/teenpregnancy.htm

You can help Advocates for Youth with a contribution today. To donate, visit http://www.advocatesforyouth.org/about/donatetoday.htm

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