1 This represents Federal programs that we know states use to fund these activities. States may be using other funds, but we do not have the reporting capability to know.
² Several other federal programs fund family planning services, including Title V MCH Block Grant, Title XX SSBG, TANF and TANF bonuses for reduction in illegitimacy rates.
³ An estimated 90% of the total expenditures goes for services.
⁴ Includes projects that also have a care component for pregnant and parenting teens.
⁵ This is the total amount of federal funding available. Not all states and territories have applied for funding in each year. In 2001, the total amount awarded was $43.5 million.
⁶ The required state match is $3 for every $4 Federal dollars. The total amount will vary with the amount of Federal funds awarded.
⁷ This is the Special Projects of Regional and National Significance community-based abstinence education grant program. The FY 01 budget included an advance appropriation of $30 million for the SPRANS program for 2002. The FY 02 Labor/HHS appropriation included an additional $10 million for a total of $40 million in FY 2002.

3. Do you feel the funding streams for abstinence, family planning, and adolescent life programs are sufficiently flexible to provide opportunities for a broad array of program approaches that address teen pregnancy prevention and teen sexuality?

Through the abstinence, family planning and adolescent life programs, along with other programs at HHS, a range of teen pregnancy prevention activities are funded. While the uses of abstinence funding through the Title V state program, the SPRANS community-based program and the Adolescent Family Life program, have been Congressionally prescribed, the Department’s health agencies have a variety of funding streams for the prevention of adolescent risk behaviors. States and communities can use these funds quite flexibly to improve overall adolescent outcomes. In addition states receive federal block grant funding, such as TANF, that can be used to provide a range of pregnancy prevention services.

Chairman HERGER. And at this time if the witnesses for our second panel would please have a seat at the table.

On the second panel this morning, we will be hearing from Gale Grant, director of the Virginia Abstinence Education Initiative in Richmond, Virginia; Elayne Bennett, president of Best Friends Foundation, which is the subject of a recent "Washington Times" article that I would like included in the hearing record.

[The Washington Times article follows:]

D.C.'s Best

Chairman HERGER. Rebecca Maynard, university trustee professor of education and social policy at the University of Pennsylvania in Philadelphia.

And, Mrs. Johnson, would you like to introduce the next witness?

Mrs. JOHNSON. I certainly would, Mr. Chairman, and thank you very much for this opportunity.

There is not very many of us that really change people's lives, and I am please to introduce RoseAnne Bilodeau, who really has changed the lives of so many kids in my hometown. She came into a neighborhood that was gang-ridden, one of the most dangerous, one of the poorest neighborhoods in a city with a lot of problems, and she has created opportunity for those kids. Over 8-1/2 years only two instances in which one of those young people was involved in a pregnancy.

You know, I have visited a lot of young parents' programs. And who is there? The girls with their babies. I visit this program, and who is there? The girls and the boys. They did a poetry book. Most of the poems were written by the boys.

So we can do it. We can take this opportunity to help families in our society grow in such a way that they don't become at risk and into the Department of Children and Families and all the family agencies. But we have to be smarter. And I just am so thrilled to have RoseAnne Bilodeau here, who has done such a wonderful job of impacting the lives of young people and their parents. Thank you for being here.

Chairman HERGER. Thank you, Mrs. Johnson.

We also have Dr. Joe McIlhaney, president of the Medical Institute for Sexual Health in Austin, Texas; and Sarah Brown from the National Campaign to Prevent Teen Pregnancy in Washington, D.C.

Again, I would like to welcome each of you, and if we could begin with the testimony. Ms. Grant.

STATEMENT OF GALE E. GRANT, DIRECTOR, ABSTINENCE EDUCATION INITIATIVE, VIRGINIA DEPARTMENT OF HEALTH, RICHMOND, VIRGINIA

Ms. GRANT. Good morning, and thank you, Chairman Herger and other members of the Committee for allowing me to be here today. I am Gale Grant, director of the Virginia Abstinence Education Initiative which operates through the Virginia Department of Health.

Having been involved in teen pregnancy prevention for quite a number of years for personal reasons, primarily because I was born to a 15-year-old. And also when I went to graduate school I focused on human development, and have really studied the life span from infancy to older age to elderly. I focused in though on the adolescent period, preadolescence and adolescence, because I had particular interest in that, and particularly adolescent sexuality and the issues related to that.

During my work in teen pregnancy prevention I saw grueling work, and I love the work, trying to work with girls and their families, and young men, to have some impact on what would happen to those young people as they were being parented, either as a girl emancipated herself or if she stayed in the home with other family members. And I found that I just felt like I was spinning my wheels. So many times it was so difficult to prevent the second pregnancy. And I decided to take a step back and look at how did we get here? And that led me to much more emphasis in primary prevention and actually started hearing about abstinence education and looking into what that was all about. I realized that until we deal with teens engaging in sexual activity, we truly cannot have an impact on teen pregnancies. We must deal with the source and the sexual activity, young people engaging in sexual activity that leads to pregnancies and other consequences of that activity.

Consequently, I felt very prepared, after spending pretty much most of the 1980s training people in abstinence education around the State for this job as Director of the Abstinence Education Initiative for Virginia. And in Virginia we took a different approach with our monies. We decided that we wanted to look at the impact of teaching abstinence until marriage education. So we designed a large quasi-experimental longitudinal study. We did receive some flack around the State for doing that because we just didn't take our dollars and throw them out there, let people apply and do good as people want to do a lot of times with monies like this. They want to help kids, which is of some merit, but we really wanted to take an empirical approach to this.

So we had a request for proposal process, which was competitive, and funded six agencies to provide abstinence until marriage education. We provide a great deal of training to those agency staff. We provide technical assistance. And consequently, we have what we believe is the foundation for a very strong quasi-experimental evaluation, because we don't have random assignment to control and treatment groups, but we do have match comparisons.

And what we are finding right now, we are looking at our preliminary data, first year, and annual follow-up, and we are finding that we have very strong linkages between our pre- and post-test, we are not losing kids from the time that they take our pre-test to the time they take our post-test. We have fairly good strong linkages from year one to year two, from when kids take that post-test that first year they are in our programs, and then when they take their annual follow-up, which we give them every year, along with a booster session after they have left that primary year, the first year they come in, we provide booster sessions for young people each subsequent year, and we are finding that we have good strong compatibility between our program and our comparison group, and that our scales on our survey are very reliable and strong.

One of the major findings I wanted to share with you right now is that two of our four projects with our longitudinal data are showing significant pre-post movement on most or all of our short-term predictors, and I have those predictors listed in my written testimony, as compared to our comparison group which showed no change at all. The other two projects did not show short-term change on our short-term measures.

It is interesting to us in Virginia, as we look at our data and start to analyze, because with respect to our prediction model and our evaluation model, we would expect that those programs would show change in the short-term predictors if they really, really are good predictors of behavioral intent, to show change in our short-term predictors. If they really are good predictors to also show change in the longer term in terms of our behavioral data. And I feel, I would like to say, that what we are finding with our model is that those factors that predict behavioral intent for young people leaning towards sexual activity were showing that our construct, our picking up those factors, and that right now from year one to year two--and we have other years to follow with these kids--that we are showing some change in terms of kids not transitioning from a virgin to non-virgin status. And I hope that wasn't confusing, but that is our dependent variable in Virginia. We are trying to keep kids from moving from virginal to non-virginal status in terms of our design.

Thank you.

[The prepared statement of Ms. Grant follows:]

Chairman HERGER. Thank you very much for your testimony, Ms. Grant. Now Mrs. Bennett.

STATEMENT OF ELAYNE G. BENNETT, PRESIDENT AND CHIEF EXECUTIVE OFFICER, BEST FRIENDS FOUNDATION

Mrs. BENNETT. Thank you so much for inviting me here.

Chairman Herger and Congresswoman Johnson, my name is Elayne Bennett. I am the President, founder, CEO, instructor, chief cook and bottle washer, I guess, of the Best Friends Foundation.

I want to tell you how we at Best Friends have found a way to reduce sexual activity and pregnancies among teenage girls. We have accomplished through a long-term program that is presented during the school day. It is initiated, operated and financed at the local level, and it teaches abstinence. That is the message we believe young girls want to hear.

When Marian Howard of Atlanta's Emory University asked 1,000 teenage mothers what they wanted to learn in sex education, 82 percent of them said how to say no without hurting my boyfriend's feelings. Best Friends' girls learn how to say no, and we don't particularly care whether they hurt their boyfriends' feelings.

A recent survey conducted--that is actually something you can laugh at I hope.

[Laughter.]

Mrs. BENNETT. A recent survey conducted by the American Association of University Women--it is the foundation of AAUW--survey conducted on 2000 11- to 17-year-old girls found that the vast majority said that sex and how to say no in emotionally-charged relationships was their number one concern. And the National Campaign to Prevent Teen Pregnancy found that 93 percent of teens said that, "It is important for teens, for us, to be given a strong message from society that we should abstain from sex until we are at least out of high school."

The abstinence message, as everyone knows, is hard to get across when much of the popular culture, movies, magazines, television, and in many cases sex ed. in public schools is giving the opposite view. Of the 58 television shows monitored by "U.S. News & World Report" almost half contain sexual acts or references to sex. A study by Robert Lichtner & Associates found a sexual act or reference occurred on average of every 4 minutes on shows during prime time. Media Research Center found portrayals of premarital sex outnumbered sex within marriage by eight to one on television. So is it any wonder that between 1960 and the early 1990s there was a 450 percent rise in out-of-wedlock births, that among industrialized nations the U.S. has the highest teen birth rate and one of the highest child poverty rates, which is related to high poverty rates among single mothers, and particularly those who became mothers as teenagers. Teenage pregnancies are costing our economy more than 7 billion annually and 49 billion is going to families begun by unwed teenage mothers.

Now I recently added a page here because I know the issue is funding for abstinence and abstinence-only education, so I am going to quickly just cite a few things. The press is obviously on an alarmist campaign regarding Federal expenditures on abstinence education. A case in point was an article in "New York Times" a few months ago. The article compared Federal funding for abstinence education with Federal funding for HIV prevention education. It notes that beginning in 1996 Congress set aside 250 million for 5 years to fund abstinence education programs. But what it doesn't make clear is that the 250 million is a cumulative 5-year figure, not an annual expenditure of 250 million. This was, I believe, intentionally confusing to the reader. It accuses this administration of allocating to abstinence education, "A figure which dwarfs contraceptive education expenditures." This again is gratuitously misleading. In fact, the 50 million from Title V and the 17.1 million from Maternal and Child Health or SPRANS, Special Projects of Regional and National Significance, totals 67 million for abstinence education. This is dwarfed by the 274 million spent on Title X Family Planning Clinics. This 274 million, coupled with the 220 million a year spent on 1,000 school-based health clinics, which either dispense contraception or refers students to community clinics which do. This is 500 million on two relatively small programs and does not even count the millions allocated within the States. Twenty-three States require that sex ed. be taught; 47 recommend or require--either recommend or require, and all 50 require AIDS education programs.

One of the things I would also just like to add, that--

Chairman HERGER. If you could sum up your testimony.

Mrs. BENNETT. I will. I will sum it up right now. Sorry.

Chairman HERGER. Thank you.

Mrs. BENNETT. I would just like to tell you quickly how we have been successful because we focus on a character-building in-school curriculum with an abstinence-only philosophy, an intensive peer support structure, and long-term adult involvement. We address the issue of sexual abuse, by emphasizing that sexual abuse is wrong and never the victim's fault. We do know that many young girls, their first sexual experience is by adult men 21 and older. But we foster self respect by promoting self control and telling girls they have a place to go, they have someone to talk to, and that they can stop if they have begun sexual activity. And most sexual activity among middle-schoolers, particularly in the inner city, is not by the young girl's choice.

Chairman HERGER. I thank you for your testimony.

Mrs. BENNETT. That is it.

Chairman HERGER. And your full testimony will be submitted for the record.

Mrs. BENNETT. We have copies of 10-page testimony showing our research, which is quite impressive. Thank you.

[The prepared statement of Mrs. Bennett follows:]

Chairman HERGER. Thank you very much, Mrs. Bennett. Now our next witness will be Sarah Brown, director of National Campaign to Prevent Teen Pregnancies. Ms. Brown.

Ms. BROWN. Good morning, Chairman Herger, Ranking Member Cardin, and members of the Subcommittee. Let me greet in particular Congresswoman Nancy Johnson, who is a wonderful leader of our congressional bipartisan House Advisory Panel, and we are very grateful to you for your interest in our work.

My name is Sarah Brown. I am the director of the National Campaign to Prevent Teen Pregnancy, and on behalf of Isabel Sawhill, our president, and former governor Tom Kean of New Jersey, our chairman, I want to thank you for inviting me here today.

We commend this Subcommittee for focusing on teen pregnancy prevention in the context of welfare reform. As many of you well know, reducing teen pregnancy is a highly effective way to make progress on a number of related social issues: child poverty, welfare dependency, out-of-wedlock childbearing and responsible fatherhood.

Written testimony and many of the documents and citations referred to in the testimony back up these points I am going to cover, and I hope they will be entered into the record.

The good news, as we have heard this morning already, is that teen pregnancy and birth rates have declined steadily over the past decade. They are now at record low levels. But as many people have pointed out, we still have a long, long way to go. Four in 10 girls in this country become pregnant before they turn 20. Two in 10 go on to become single mothers, therefore, obviously, contributing to our high levels of out-of-wedlock childbearing. So there is no reason for complacency.

Why are the rates of teen pregnancy going down? Chairman Herger, you posed that question at the beginning of this hearing. Basically there are only two possible explanations: a smaller proportion of teens are having sex and/or contraceptive use among sexually active teens has increased. Unfortunately, the exact contribution of these two factors just can't be nailed down precisely, but a reasonable conclusion supported by all of us is that both less sex and more contraception are making an important contribution to the decline.

Another important question: what community-level programs actually prevent teen pregnancy? Fortunately, we now have some answers here, and having been in this field for a long time, it is lovely to be able to sit in front of this Subcommittee and offer some good news. This past May, the National Campaign released a comprehensive research review entitled "Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy." Let me give you a very few of the highlights.

First, there are some programs that work. Interestingly, some focus on sex and some don't at all. There are three types found to be effective. One cluster includes a variety of sex and HIV education programs that have been shown to delay sex and/or increase contraceptive use for up to 30 months. These effective programs have some very definable, well-described characteristics, and as a number of people have already said, the evidence is clear that teaching young people about sex and sexuality does not increase sexual activity. It was a reasonable important question to ask, but the jury is now "in" on this question: It does not.

A second cluster includes two youth development programs (which we also talked about this morning), that offer opportunities for community service, adult mentoring and so forth. They are very impressive in their results. It is not exactly clear why they are so effective, but we can talk about that later if you would like.

A third category of programs found effective combine good sexuality education, family planning services, and a vigorous youth development program. I think we are going to hear from one such model from New Britain, Connecticut, in just a minute.

Having this array of effective programs gives us another piece of good news. Communities now have choices. When they want to reduce teen pregnancy, they can look at a rich array of options, and they can pick ones to suit their budgets, their local values and their situation.

What do we know about abstinence education? Our review finds in this case that the jury is "out" on abstinence-only or abstinence-until-marriage education, and this is for two particular reasons: very little rigorous research of these programs have been completed, and the few studies that do show positive effects are really not capturing the rich array of programs that are currently offered. I know that Dr. Maynard, who is testifying next, is going to be talking about her important work in this area.

I would like to add that I think it is critically important that our evaluations of abstinence programs answer two questions. First, do they delay first sexual intercourse? And for those program participants who do become sexually active, are they less likely to use contraception?

Although some may find this second question beside the point, I would argue that it is no different than asking whether sex education programs might actually encourage young people to have sex. Our first goal must always be to do no harm. Now, having said this, remember, there is enormous public support for abstinence messages for school-age youth in particular. Remember too, the reality is that many teens in high school become sexually active, whether we like it or not. At present, about 65 percent of high school seniors have had sex, so we need to offer services for them and information, but all in a context of abstinence as their first and best choice.

One final comment. What are the implications for Welfare Reform reauthorization in all of this? As a general matter, States and communities need adequate resources to prevent teen pregnancy. They need access to good information about what works. They need a clear signal from the Federal Government that teen pregnancy prevention is important and is directly linked to the other goals of Welfare Reform. And they need flexibility to design strategies that suit their local situations and cultures. This is consistent with the devolution philosophy underlying the rest of Welfare Reform, and it is consistent with the view that family and community values rather than Federal mandates should be the primary influence regarding what we should do about such sensitive issues as teen sexuality.

Thank you for inviting me here today.

[The prepared statement of Ms. Brown follows:]

Chairman HERGER. Thank you very much, Ms. Brown. And I would like to again remind all our witnesses, as well as our members, that we do have 5 minutes. All of your testimony, without objection, will be submitted for the record.

And with that, we would like to hear from Dr. Rebecca Maynard, university trustee professor of education and social policy, University of Pennsylvania, Philadelphia, Pennsylvania. Dr. Maynard.

Dr. MAYNARD. Thank you, Chairman Herger and members of the Committee for giving me the opportunity to submit testimony on this important issue.

I am both professor of education at the University of Pennsylvania, and the director of the National Title V Abstinence Education Program Evaluation being conducted by Mathematica Policy Research under a contract to the U.S. Department of Health and Human Services.

I am going to talk about three topics. The, first very briefly, is the need for scientifically rigorous research to improve policies and practice. The second is the ways in which the Federal support for abstinence education has changed the local conversations and approaches to reducing teen sexual activity. And third, I want to talk about what the National Title V Program Evaluation evaluation is going to contribute to our knowledge.

You have heard the evidence of why we need to continue to invest in careful research. What I would tell you is that the 1996 Welfare Reforms have really heightened public awareness about the nature and the extent of these problems that you have heard about, and it has fostered a number of efforts to address them, including the provision of $50 million annually in support for the Title V abstinence education programs. And while we don't yet have definitive evidence linking this specific reform or any other specific reform to the favorable trend in the teen birth rate, what we do know is that Title V has fostered three major changes at the State and local level that I want to talk a little bit about.

First, Title V has expanded and changed the conversation about the role of abstinence education in local communities and schools. The most striking evidence of this is the tenfold increase in the proportion of high schools in this country that are requiring the teaching of abstinence as the sole way to prevent pregnancy and sexually transmitted diseases.

The second is that Title V has fostered the development of many new strategies for promoting abstinence and expanding the concept of abstinence education. Abstinence programs are no longer "just say no." The earliest grass roots abstinence education programs tended to be classroom based, short term, and emphasized the benefits of abstinence and the negative consequences of sex. But many of the current programs, including the Best Friends program you heard about here in Washington, D.C., and nationwide, take a much broader approach, often including extensive mentoring components, including educational and cultural enrichments, and teaching about healthy friendships and marital relationships--things that many of you have been alluding to. We also have a number of abstinence-only initiatives that are community wide systemic change efforts.

Third, Title V has been a huge boost to the abstinence-until-marriage movement. The Federal funds have leveraged at least $50 million again in local funds to support more than 700 abstinence-until-marriage programs nationwide. And, if additional funds were available, it is really clear that many current programs would grow and that new programs would emerge, particularly in communities that have these more intensive, youth development focus abstinence programs. There are lines at the door, and people are ready to expand and to add new programs.

All of this is happening because Congress identified the promotion of abstinence education as an important strategy for preventing teen sexual activity and non-marital pregnancies and births. And, the evaluation of Title V is going to provide the much needed scientific evidence about which of these program models are effective, for whom and under what conditions. I want to emphasize our focus on, which programs are effective, for whom, and under what condition?

I want to note six features of the study that we are conducting that are central to the credibility and the utility of the findings we are going to be able to share with you beginning in about another year. First, we are measuring program impacts using scientifically-rigorous experimental design methods. This is the only means of insuring with any degree of certainty how successful the programs are overall, and for key subgroups of youth.

Second the impact evaluation is examining five quite different programmatic strategies geared in part to the needs of the communities in which they are operating, so we are respecting local autonomy and values.

Third, we have designed our student surveys to ensure that program and control youth apply common definitions when answering question about sexual activity. This is really important because the abstinence education programs have changed how people think about sexual activity.

We're using interviewers who are independent of the programs to collect all of our student data, which is important because we need to avoid problems of under reporting of sexual activity due to students' linkages with the program staff.

Fifth, we are following youth for between 18 and 36 months after sample enrollment to allow us to observe more of them as they reach the age when they are making these critical decisions about whether to engage in sex.

And sixth, we are using large samples in all of our sites to protect against the possibility that we would fail to detect true program impact simply because we have low statistical power.

We are going to release our first results in 2003 when we will have follow-up data for the entire study sample.

The one final statement, I want to make a plea to Congress to continue to support youth risk avoidance and pregnancy prevention initiatives, but I also want to encourage you to support other scientifically rigorous studies to complement what we are learning. We are going to learn something very important, but it is a small piece of what we need to know.

Thank you.

[The prepared statement of Dr. Maynard follows:]

Chairman HERGER. Thank you very much, Dr. Maynard. And now Ms. RoseAnne Bilodeau, Greater New Britain Teenage Pregnancy Prevention, Incorporate, New Britain, Connecticut. Ms. Bilodeau.

Ms. BILODEAU. Good morning, Mr. Chairman, and honorable Committee members. It is with a deep sense of honor that I appear before you today to share our teen pregnancy prevention findings from Connecticut's Sixth District, Congresswoman Johnson's hometown of New Britain.

My name is RoseAnne Bilodeau, and I am the founder and executive director of Greater New Britain Teen Pregnancy Prevention, Incorporated, which is more commonly known as the Pathways/Senderos Center.

We originated 8-1/2 years ago as a neighborhood-based coed teen pregnancy prevention youth and family center. We are an independent private, non-for-profit organization. Our mission is to eliminate teen pregnancy by addressing its root causes, assuring high school graduation and promoting adult self-sufficiency. We provide long-term comprehensive holistic services by creating a parallel family structure with neighborhood youth and parents. Our motto is "diplomas before diapers."

Our board of directors is comprised mostly of successful businessmen, bankers, lawyers and a few other community stakeholders, such as the superintendent of the schools, the director of Family Planning, local clergy and leadership from both the Democrat and Republican parties. Almost 60 percent of our board of directors are men.

Our annual evaluation, conducted by Philliber Research Associates, documents that only two of our participants have ever created a pregnancy, which 100 percent of our participants remain in school, and only 25 percent of our kids have ever been involved in a physical fight, only 4 percent have ever carried a weapon, and only 8 percent have tried cigarette smoking.

Our program population is 50 youth. They range in age from 10 to 18 years old, and as Congresswoman Johnson indicated, we are one of New Britain's greater poverty-stricken areas. All of our children are Latino, mostly are Puerto Rican, while the others come from Peru, Colombia, Mexico, and Panama. For most, English is a second language. At least 80 percent of our preteens come from families that were started by teen parents. Some of the children are being raised by their biological parents, while others are raised by single grandmothers or mothers who may be married to a stepfather, single or living with a boyfriend.

Our TANF-dependent families were affected by the first wave of Connecticut's welfare reform. All of our parents are currently employed in low-paying entry-level jobs, many as certified nursing assistants. Our families are members of the working poor, people who run out of food frequently while trying to make ends meet. At Pathways/Senderos we provide clothing and food pantries. We distribute at least a bag of groceries a day.

Our program model and philosophy are based upon the work of Dr. Michael Carrera and the Children's Aid Society, which was recently identified as being an extremely effective intervention by the National Campaign's "Emerging Answers" report. We believe that by participating in a safe environment with a parallel family structure every day after school and during the summer, that young vulnerable teens can develop the skills and inner fortitude necessary to avoid negative, risk-taking behaviors, and instead engage in activities that encourage academic success, making the right choices, and eventually attaining self-sufficient adulthood. We provide a pathway of hope.

Ours is a child-focused family systems intervention which involves us with families for years. Our primary service components emphasize education, career, vocational exploration, community service projects, family life and sex education, arts and lifelong sporting activities. We have also started a business of our own, titled Barcodes aRe Us, which is a bulk-mailing service. We train and employ our age-eligible youth who maintain at least a C average in school. Our business also provides a source of revenue for our program.

Our board of directors is finalizing a year-long strategic planning process which will identify an expansion of our scope of services to include additional children from the elementary grades. Currently we recruit from the sixth grade. Our intake data, since welfare reform, indicates that the children now spend less time with their parents and have greater exposure to and involvement with risk-taking behaviors than did their peers prior to welfare reform. We would like to reach out to these younger children who might not be properly supervised when they are out of school. We would like to involve children at an earlier age with our philosophy of hard work, cooperation, making the right choices and team effort.

Although we currently save the youth who are most likely to fall between the cracks, we believe we could be so much more successful in moving poverty-stricken children and their families forward if we had the resources to serve more children at an earlier age. Pathways/Senderos assists vulnerable families by providing intensive long-term multi-faceted services. Over time we have seen many families slowly overcome the barriers created by undeveloped education, limited skill training and lack of English language skills. With our daily involvement the children flourish and prosper. As they grow in this positive manner, the rest of the family follows, including parents and extended family.

Pathways/Senderos is also credited by the local clergy with contributing to the stabilization of our highly-transient inner city neighborhood. When we first arrived local gangs controlled the area and neighborhood teens either joined a gang for protection or stayed in their apartments for safety. The police cleaned out the gangs and Pathways/Senderos replaced them as an option of choice for the neighborhood teens.

We have created a positive peer group which carries on when we are not there on some of the weekends and during school hours. Our youngsters bond as a family and strive together to become responsible civic-minded self-sufficient citizens. It is this long-term holistic approach which not only averts teen pregnancy, but does so much more, that has persuaded our inner city poverty-stricken children to make the right choices and aspire to a life of success.

Thank you for your time and attention.

[The prepared statement of Ms. Bilodeau follows:]

Chairman HERGER. Thank you very much, Ms. Bilodeau. What an impressive program, and we thank you for coming and sharing that with us.

And now Dr. Joe S. McIlhaney, Jr., M.D., president, Medical Institute for Sexual Health, Austin, Texas. Dr. McIlhaney.

Dr. MCILHANEY. Thank you, Chairman Herger and other distinguished members of the panel. I am a gynecologist and actually am comfortable being on a panel with five wonderful women.

I left a rewarding medical practice in 1995 to spend the rest of my medical career helping women and men avoid the problems I saw every day in my medical practice, sexually transmitted disease (STD), non-marital pregnancy and emotional damage of inappropriate sexual behavior.

You probably know that one-third of pregnancies in America are born out-of-wedlock and that those drive much of the problems that we see in this country, poverty, child health, education, crime, much more that has been mentioned already. I have some of those statistics in my written testimony.

We could go on and on with how dramatically these non-marital pregnancies and the problems from them impact all of America, every element of our society. We must dramatically reduce its occurrence.

In the 1970s and 1980s the primary efforts were to emphasize contraceptive use, but the pregnancy rates continued to climb. The first governmental legislation to fund abstinence promotion was the Title XX program initiated in the mid 1980s. There is some suggestion of success of these efforts as they matured, in that teen sexual activity began declining in 1990. A non-governmental abstinence program was proven to work by the ADD Health, National Longitudinal Study on Adolescent Health, Study, the biggest study ever done on American adolescence. It showed that kids who took pledges of abstinence, that those pledges were the biggest influence in the lives of those children who were delaying the onset of sexual activity. That ADD Health Study also showed that 10 percent of American boys and 15 percent of American girls in their adolescent girls were taking those pledges. The pledges were at first ridiculed by the scientific community. No more.

In addition to these efforts, there are studies accumulating of specific abstinence programs which are showing surprising success. You have already heard from members of this panel about some of them, and others of them are mentioned in our written testimony. As a result of these efforts, teen sexual activity has been decreasing since 1990. Today, as you know, over 50 percent of students in high schools across the country are still virgins, and during this same period of time teen birth rates have been declining, as we have heard.

The chart I put here on out-of-wedlock birth rates from 1980 to 1999 clearly suggest that abstinence efforts have played a major role in this healthy trend. Almost all efforts to encourage sexual abstinence, particularly Title XX and Title V, have been directed toward teens. And as the chart shows, that red chart at the bottom, that it is the group, the teens in which out-of-wedlock birth rates have fallen. If these decreased birth rates were primarily due to increased contraceptive rates, birth rates among unmarried women in their 20s should also have fallen because they obviously had at least equal access to contraceptives as the teens did. It was only the age group in which abstinence efforts had been focused that has experienced not only reduced pregnancy rates, but also reduced rates of sexual activity.

[The chart follows:]

It is of great importance to note, however, the there is a major problem which is often disastrously overlooked in discussing the problem of out-of-wedlock pregnancy, and that is the epidemic of sexually transmitted disease. When I gave testimony before this same Committee in 1996, I highlighted those problems. They are still with us. Fifteen point five Americans get a new sexually-transmitted disease every year. The result is that today 70 million Americans are living with a sexually-transmitted disease. Sixty-five million of those are infected with incurable STDs because they are viral. One specific example literally tears at our hearts, and that is that 50 percent of women having sex, who are between the ages of 18 and 22, right now half of them are infected with human papillomavirus (HPV), the virus that causes 99 percent of cervical cancer, a cancer which is killing between 4,000 and 5,000 American women a year, more than die of AIDS.

When I started practicing in 1968 there were only two STDs you worried about. Today there are over 25 STDs we worry about, and more people are infected today. In those days 1 in 47 teens was infected with an STD. Today one in four teens is infected with an STD.

The reason we must include the problem of sexually transmitted disease when we talk about out-of-wedlock pregnancy is that the contraceptive techniques more reliable for preventing pregnancy, DepoProvera and oral contraceptives, provide no protection from STD transmission, and this is the reason it is so convenient to ignore the STD problem when discussing out-of-wedlock pregnancy. To be honest about physical problems that can result from out-of-wedlock sexual activity, we must always discuss both of these problems.

The only technique that provides any protection from the STDs are condoms. However, a major National Institute of Health panel reviewed the world's data on this subject, and this scientific panel this year reported that if condoms are used 100 percent of the time, they will reduce the risk of HIV and gonorrhea, gonorrhea in men; they do not reduce the risk of HPV, which is the most common STD and causes cancer, and we don't know whether they reduce the risk of other STDs or not. So this is information that we just must understand.

And unfortunately, sex is sexist. When people become infected with diseases, it is the women that suffer. I am just about through. And we all know that it is the women who suffer from out-of-wedlock pregnancies. They are the ones, not the men, that submit their bodies to the surgical procedure called abortion. They are the ones that deliver the babies and then often are left with those babies to raise as enormous personal, educational and economic sacrifice. Many students of American culture are of the opinion that these problems are the most damaging on the American culture of all the problems we have, and I agree.

Finally, for the health of individuals in all society, we need to emphasize marriage as a core element of society and emphasize its importance as the ultimate answer for these health problems plaguing our country and other countries, by the way, around the world. A major step in accomplishing this is TANF reauthorization, and additional TANF funds being earmarked for abstinence and marriage efforts, not just limited to adolescence either.

And finally, Title V funds for abstinence education should not only be continued but increased. If these steps are not taken, there is significant danger that the promising trends that we see over here, decreasing sexual activity and decreasing teen pregnancy, will reverse. We need a cultural transformation regarding sexual activity for the protection of all society, and you as leaders can play a huge role in this happening.

Thank you, sir.

[The prepared statement of Dr. McIlhaney follows:]

Chairman HERGER. And now to inquire, the gentlelady from Connecticut, Mrs. Johnson.

Mrs. JOHNSON. Thank you very much, Mr. Chairman. And I thank the panel for all of their information. It certainly is helpful to be able to have the breadth of view that so many of you have provided along with the concrete experiences from the rest of you.

Elayne Bennett, I was interested that your program has so many more female participants than male participants, and in the long run, I hope that won't be true.

Mrs. BENNETT. But that is because it was designed for girls. We only target girls. Girls are our only members.

Mrs. JOHNSON. I think that that is a cultural bias that was unfortunate. Males are responsible for sexual behavior is just as important as--

Mrs. BENNETT. We now have a Best Men program.

Mrs. JOHNSON. Well, I do understand that, and I am glad you are doing that, but I think this whole idea that women are responsible and men don't have to be is terribly destructive in our lives, and so I am glad you have a Best Friends. I personally think it is better to have the boys and girls together, because in the end, relational strength in America in the long term of your life depends on being able to talk intimately.

Mrs. BENNETT. We did research on this, and we asked them. The girls said they preferred to have their own session back in 1987 when we began at Langley High. And we did some sample sessions, and the boys took over, and the girls said nothing, and the boys ran the session.

Mrs. JOHNSON. Yes. I do appreciate that that is a problem and remember that from those kinds of programs when I was that age. But I think it is something we have to be challenged by rather than comply with.

But I was wondering, what do you see as the barriers to your program participating in an evaluation such as the one Dr. Maynard is doing?

Mrs. BENNETT. Well, we have an extensive evaluation, 15 years worth, and we just actually are publishing our comparison study that compares our girls' behavior with the Youth Risk Behavior Surveillance study--

Mrs. JOHNSON. I appreciate that. I just wonder why you can't participate in Dr. Maynard's evaluation because it does help us.

Mrs. BENNETT. Okay, I will tell you.

Mrs. JOHNSON. It has been of concern to us.

Mrs. BENNETT. Because the study that Mathematica proposed wanted to do comparison of girls within the school, their sexual activity behavior of girls in the same school. We wanted a comparison school study because the Best Friends' philosophy, we train all the teachers, all who are mentors in the school. We have the principals attend two 2-day training conferences. All the materials are in the schools. The whole philosophy is reach out to your friend; help make your friend a better person. The best kind of friend to have is that person who does that.

The evaluation proposed by Rebecca Maynard--and we worked for 2 years on this, and I am very sorry we could not participate, actually. My academic board voted against it. I was excited about it because I want a definitive study showing how effective abstinence is, and how effective, frankly, we have been. But we could not allow a comparison of girls within the school who have been, you know, the ripple effect, who see their friends who want to be in our program. We have a waiting list in schools. So what you would be doing is asking girls in a Best Friends' school where we have been 5 and 6 and 7 years, where all the teachers have been trained, where the sexual activity has declined because girls see what is happening with the core group of Best Friends' girls. We wanted a matched sample.

Mrs. JOHNSON. So you didn't want a comparison between the girls who were participating in the program and those who were on the waiting list basically.

Mrs. BENNETT. Exactly. We wanted a comparison with girls who had not had a Best Friends Program in their school so we could get the clear dramatic benefit.

Mrs. JOHNSON. But they are different bodies of information that could have been sought through those different comparisons.

Mrs. BENNETT. We were told there was no money to have a comparison school survey, and that is what--actually, I wanted to do both, the girls within the school and the matched sample, the matched school comparison, and we were told there was no money to do that and we could not do that. And that was why the academic board voted it down.

Mrs. JOHNSON. I only have very little time, and I want to get to Dr. Maynard, because I think this is an important issue. Dr. Maynard?

Dr. MAYNARD. Well, I think reasonable people can differ. I am very sad that we don't have Best Friends in the evaluation, but will say that we have some wonderful programs in the evaluation, and we will learn a lot from the evaluation that we are doing, and there may be opportunities down the road to do other similarly controlled evaluations of other programs.

Mrs. JOHNSON. What percentage of all the abstinence programs have been evaluated either by you or other sort of objective outsiders?

Dr. MAYNARD. I would say there are no really strong evaluations of abstinence programs that have been done to date, I mean where there are large samples, long-term follow-up, external data collectors, et cetera. We have only five programs in the evaluation that we are doing. They were carefully selected because of the strengths of the programs, the diversity of the programs, and the diversity of settings. So we did as much as we could to build a broad information base from the evaluation, given the resource constraints we had. We were also constrained by going to those sites where we could do the controlled comparison design. We felt strongly that in an area as controversial as this, there is absolutely no point in spending public dollars on an evaluation that will be discredited by those who do not favor the results. That is not a good use of public money. So we want to do this at the highest standard.

Mrs. JOHNSON. Thank you.

Chairman HERGER. Thank you very much for your testimony. The gentleman from Maryland, Mr. Cardin, to inquire.

Mr. CARDIN. Thank you, Mr. Chairman. Let me again thank all the witnesses. This has certainly been extremely helpful to us.

Dr. Maynard, we really do look forward to the results of your evaluation. The difficulty, as I see it, and it is not your fault, is that we are not going to have good information before Congress has to act on TANF reauthorization. We need to act next year, and your work will not be completed until after we have had to make decisions on reauthorization. So I guess would just ask for you to share as much information as you can during this process, so that we can have the benefit of your work as we move through this process.

I guess my concern, looking at the different statistics, Dr. McIlhaney, I will just make one point about the chart that you raise, and that is that the trend line on teenage pregnancy started to drop before the Federal funds were available for the target programs for abstinence programs. I mention that because I am not sure we know why we have been successful. We know there is multiple factors, as I indicated in my opening statement. I just really want to raise the concern of abstinence-only programs I and of itself, because I think it does raise certain problems. I said in my opening statement that I support abstinence, and I think it is a bipartisan strong support in this Congress to support abstinence as the first line of attack against teenage pregnancy and for values that we believe are important. So I think there is no question about it.

I am concerned that when you isolate, whether through funding or through trying to determine how an abstinence program in and of itself works, it is not reality. And I think the public understands it.

And, Ms. Brown, I appreciate the work that your organization has done, and one of the surveys that recently came out--and let me just give this number. When it was asked, given three choices, the choice that the overwhelming majority of Americans think is the right choice, whether they be teenagers or whether they be adults, is that teens should not be sexually active. The teens who are should have access to birth control or protection. That is where America is. That is what most Americans believe, 73 percent of the adult population, 56 percent of the teenage population, and the teenage population is skewed more to believing sex is okay than the adult population.

I mention that because I think we are denying reality when we try to pigeonhole teenagers into a limited program and not giving all the information. Abstinence should be combined with sex education. Ms. Brown, you point out what we all know now to be the case, that sex education doesn't increase sex. It should be combined. Abstinence should be combined with constructive activities for teenagers, so they don't get in trouble, whether it is through sexual activities or through drugs or through alcohol or violence, it should be combined with constructive activities. Abstinence should be combined with other services that are available to teenagers, and that is basically the commitment we made to our States in 1996 through TANF, which was flexibility. Don't pigeonhole how States have to respond. Don't tell them they have to set up a program for a limited purpose so that we can express our views. Let the States do what they believe is correct in order to accomplish the overall objectives. And I guess that is one of my major concerns.

And the last point, Ms. Brown, that you point out, the realities of the situation. Two-thirds of our high school seniors have engaged in sexual activities. That is the facts. We would all like to see that number lower. We all would like to see that number lower. We should work to get that number lower. We know there is going to be a large number of teenagers who are going to be involved in sexual activities, and to just put our head in the sand and say that is not going to happen, I think is naive.

So I guess my concern is that the Congress has expressed a goal of reducing teenage pregnancies. That is our goal. We want to be successful in doing that. And the best way to do it, is to allow the States to be able to move forward with abstinence education and contraceptive information and any other tool that they can in order to try to reduce teenage births. And I think sometimes it is counterproductive that we try to pigeonhole how programs have to be developed at the local level to satisfy our parochial favorite programs to reduce teenage pregnancy.

Thank you, Mr. Chairman.

Chairman HERGER. Thank you, Mr. Cardin. Now the gentleman from Louisiana, Mr. McCrery to inquire.

Mr. MCCRERY. Thank you, Mr. Chairman.

I don't disagree with what Mr. Cardin has said, and I agree with him that reality today is that too many teenagers engage in sexual activities, but I think what we would like to do is create a different reality, and that is what these programs, these abstinence programs are trying to do. In the meantime, I don't disagree with you that we have to address what is before us, but I think the purpose of these programs is to create a different reality.

And Ms. Grant and Mrs. Bennett, why do you all believe that teens should be taught abstinence as the primary way to avoid the negative consequences of teen pregnancy. Ms. Grant?

Ms. GRANT. Primarily, when I look at young people in sexual activity, a lot of times we quote statistics and we merge a lot of things together. But those young people who have not yet engaged in sexual activity, we need to bring a message to them and support skill building, education, that helps them postpone sexual activity for as long as possible, which for me is primary prevention. That is primary. Then there is early intervention, and it goes on down the line towards treatment.

And I think earlier in the comments there was a statement about how do we determine which kid needs what? I think as a Nation you bring the primary message first and foremost. There are those young people--and they clearly surface--who will need more intensive intervention on down that progression and that continuum from prevention to intervention. And that then you tailor messages to meet those sub-populations. But I think what has happened historically, as I looked at this and worked in this, is that for those kids who were not yet thinking about engaging in sexual activity, who weren't there yet, we didn't have anything for those young people. And I think abstinence-until-marriage education gave a context for young people to deal with sexuality education and issues around relationships, negotiating relationships, that they didn't have before. So I think that is primarily why we need it.

In the Virginia Health Department we have a continuum. We work from abstinence-until-marriage education all the way up to our family planning services, and so we have a continuum that we look at, and we all work together. We are trying to have a comprehensive model that this doesn't become a either/or. These dollars for abstinence education did not displace the family planning dollars. It did not displace other dollars. It was an addition to, and I think it met a void and is meeting a void to help us provide a continuum in terms of service delivery.

Mr. MCCRERY. Before Mrs. Bennett responds, I just want to ask you about, I think you say in your testimony that you don't have sufficient data really to give results on abstinence education today, but can you give us some impressions that you have from watching the program and other data that would lead you to some conclusions as to the effectiveness of the program?

Ms. GRANT. Right now what we see in our data, and what I have prepared in my written package, is just looking at our first-year data, and then moving on to our second-year follow up. We started with seventh and eighth graders, so naturally, knowing that the number of young people in our data set, in our target population, report lower rates of sexual activity, we are waiting to see, and hoping to be able to continue our longitudinal study as these kids age into solo dating, pairing off, what happens in those rates. We are hoping that we can keep our transition rates low, but that is yet to be determined as we look at this, so I really can't share.

What we see in short term right now looks good, but that is very short term and we are talking about kids who don't engage in the sexual activity that much, so that is why I am very reserved about that, because we need time. We need time and resources to be able to really critically look at this.

Mr. MCCRERY. Thank you. Mrs. Bennett, do you want to respond to the first question?

Mrs. BENNETT. Well, and I agree with Ms. Grant.

We have had time and we have had resources at Best Friends. We have completed our comparison study that is going to be published, as comparing the CDC data, the Youth Risk Behavior Survey, which is given here in the D.C. Public Schools. We have been in the D.C. Public Schools since 1987. CDC found that 17.8, nearly 18 percent of seventh grade girls in D.C. are sexually active. That doubles to 32.8 percent of eighth grade girls, so that is nearly a third of the girls here right down the street, who are sexually active in eighth grade. We compared those schools, in many cases same schools, but with the girls from Best Friends. Four point two percent of our seventh grade schools--and we began early in fourth or fifth like you were talking about--4.2 are sexually active in the seventh grade, 5.6 in the eighth grade. So we don't even have that doubling. I mean we could expect, if we followed the trend, that we would have 8 or 9 percent of our girls sexually active by eighth grade. We have 5.6 percent. So we know we are on to something that works. We know that with every fiber of our being. Our teachers will tell you that. Our parents will tell you that.

We have 1,000 girls here in D.C. Public Schools. We have 5,000 girls nationwide. And the reason is, it is not just about abstinence from sex, you know, that is not the issue. The issue is the larger picture. It is about self control. It is about saying early on, what kind of life do you want?

And then we have a tremendous impact on drug and alcohol use as well. These two issues can't be separated out from sexual activity. If you are drinking at 12 and 13 and 14, you are sexually active. We see that. I was just in a huge conference in suburban Montgomery County. Girls are drinking. They are binge drinking. They are sexually active at seventh and eighth and ninth grade, and these are in our most prestigious private schools. So this is not, first of all, it's very clear to me, this is not an issue only that is pertinent to the urban areas, it is not a socioeconomic issue. This is an issue that transcends all families, no matter what their socioeconomic status. It is about character. It is about what we want for our children. It is about how we stand as a Nation, what our standards are, and are we going to expect our children to strive for some high aspirations. Low aspirations, you get low performance. We know that as teachers. And if as adults, if we give them our best, if we say, "This is what we expect," children respond in kind. And we need to begin at 7 and 8 years of age.

We also know, a thing that I discovered that I did not anticipate when I began, is we have reduced sexual abuse by 66 percent among our girls. Many of our girls, and I am not just talking inner city, Montgomery County, out of 25 fifth grade girls, 5 had been sexually abused in the fifth grade, and we were not even allowed in Montgomery County to discuss sex. We came in and talked about friendship. We talked about self respect, were not even allowed to use the three-letter word of sex. By accident, a survey was given, have you ever been forced to have--5 of the 20 girls in a middle class community in Montgomery County. So we know there is something else going on there, if we can get to our children early.

Also our little girls, look at the data, watch Brittney Spears, look at what is happening, look at the message. I chaperon for a seventh grade dance. I have a 12-year-old son. The girls are dressing like street walkers. It is cool. That is the way they think they should look. When they dress like street walkers, what are the boys supposed to think?

Oral sex is going on at Catholic school dances. We have been able--that has dropped, that activity seems to be curtailing somewhat, but we have some real issues here. We have to decide what we want our children to hear from us.

Mr. MCCRERY. Thank you, Mr. Chairman.

I applaud all of you who are working on this problem, and I am glad that you are starting a program for boys because I think boys need to be part of the solution as well.

Chairman HERGER. I want to thank each of you. I have been very liberal with the time, on both sides, and that is because this issue is so, as a parent, as virtually all of us are parents here, this is an issue and an area that is of great concern to all of us, regardless of which way or combination that we address this in our work of reauthorizing this legislation next year. We want to come up with the programs that are going to be the most effective, however that is.

With that, there are several who would like to go for a second round of questions. So, Mr. Cardin, would you like to inquire?

Mr. CARDIN. Thank you, Mr. Chairman.

Ms. Brown, I just want to get focused on what this Committee can do. We have TANF reauthorization next year. It provides significant resources to our States. The philosophy of 1996 was to provide most of that in basically a block grant type of format with broad national goals, with maximum flexibility to States to try to configure how they could arrange use of these funds in order to get people off of cash assistance, to get people self sufficient, and to reduce teenage births, pregnancies.

I guess your focus is on reducing or preventing teen pregnancy. How can we be constructive in TANF reauthorization to assist in your efforts?

Ms. BROWN. I am so glad you asked. There is some material in my written statement on this, but let me just hit the high points. We made several suggestions. First of all, obviously, we need to maintain funding for TANF and not allow the net resources to decline for any number of reasons, which you all understand very well. We need to maintain the flexibility of TANF as well. There are, unfortunately in my view, not enough TANF dollars going to teen pregnancy prevention. The current estimate is only about 1 percent. Those are still precious monies in this field so we need to retain the flexibility that allows stats to tap into that funding source in ways that suit their culture and their citizens.

We need to get increased information to States and communities about community-level programs that work. Interestingly, the question we are most often asked at the National Campaign is, "What do I do?" From the Pittsburgh Health Department, from Cloverdale, California, from all over: "What do I do?" As you know, we try mightily to answer that question and other credible groups do, too, but we need a much larger more organized source to get this information out.

Of course the second question people always ask is, "How do I pay for what works?" And I think that is back to the TANF question in part.

We might even want to consider a block grant for teen pregnancy prevention within the overall effort. There is some justification for that. We can talk more with you about that in the future if you would like to.

We also think that there is merit in asking the Federal Government to pay more attention to State level efforts to prevent teen pregnancy. They are all required to have it in their TANF plans, but I have yet to see a real hearing, or a high-profile publication saying, "What are States doing in this area? What is working? What are they trying?" Actually, you asked these questions a lot this morning. "What is going on? How do you decide what to do?" There is a way of getting that information under the existing statute, and I think we need to do more.

And then generally in the total body of the law, I think we do need to retain a focus on a strong abstinence message, as everybody has agreed this morning, but never at the expense of family planning and good information about reproduction to adolescents and to others, and all within a context of flexibility and accountability.

Mr. CARDIN. There are two approaches that we could take aimed directly at reducing teen pregnancy, and that is we could offer competitive funds to encourage States to come forward with innovative programs and try to fund them in that way, or we could use a bonus arrangement, which we have used, based upon performance of States in accomplishing the goal.

Do you have preference as to, we have a limited amount of dollars, which approach would be a better approach?

Ms. BROWN. Well, there are merits in both approaches. On balance, I would probably go for competitive proposals from States, not just for innovative programs, although we certainly need those, but to build on what we already know. There is, as I said earlier, a lot of good news, and we need to take this good news and say, "Fine, we actually have some successful programs we can point to." This program profiled in Connecticut is an example of great success with very hard to reach kids. It is quite expensive, of course, but there are others for lower-risk kids that are less expensive and could be applied to large numbers of youth. So I think, yes, we need more innovation, but I really think we need to build on successes.

We also need to find a way to work more with the media. You know, I love programs and I love school programs, but if you talk to the average teenager and say, "What is shaping your attitudes and views and the social script in your head?" They will often talk an enormous amount about the television shows, Internet sites and magazines that they consume in huge quantities. So part of this money also has to go, in my view, to finding ways to influence popular culture through these hugely influential institutions, which are the media, in order to complement the efforts of individual community programs.

We need both. Doing just one without the other, I think, is insufficient.

Mr. CARDIN. That is very helpful, particularly on sharing of information, and that is one of the things that I think all of us would agree we have programs that work. We need to get that information out, and we need to evaluate programs a lot faster than the current system has been operating. I know it started a new direction in 1996, but it is useful if we could get information shared in a more expeditious way than we have in the past.

Thank you, Mr. Chairman.

Chairman HERGER. Thank you, Mr. Cardin.

I have a couple closing questions. Dr. McIlhaney, in your testimony, you had some chilling, I believe, comments that people simply don't talk about these very serious health consequences, whether it be the venereal diseases or others, of early sexual activities. Why do you suppose that we don't hear more about these issues, and is there some way that we can better spread this very important information?

Dr. MCILHANEY. I think it is vital, as I said to include the warnings and information and education about the sexually transmitted diseases, along with the messages about out-of-wedlock pregnancy.

I was just sitting here, I was just listening, and there was not a word, as we talked about efforts to reduce teen pregnancy, in talking about what at the same time we have the problems of STD in those same people who have the pregnancies, and the contraceptives just flat don't work, the ones commonly used. And I think it is a disaster.

It is difficult to talk about sexual issue, I think, in our society. As a matter of fact, the numbers I gave you, and so many more I could give you, have been in the newspapers. They just get dropped. And I think it is just absolutely vital that we include that information as we talk about teen pregnancy every time. And as a matter of fact, I strongly advocate that any program that is having success in reducing pregnancy be sure they are also testing for STD among their young people, and older single people too, because they also are suffering these problems.

I would like to just say one thing about the success of programs. If our programs, who emphasize contraceptives, were working or had been working, we wouldn't be here talking because, because those rates that we see over there would not have kept climbing during the 1980s, because it was during the 1980s that by far the dominant programs were those programs that were strongly advocating contraceptive use. And we see those pregnancy rates kept climbing. The STD rates did keep climbing too. And so obviously, is that mandates that we make some changes in what we are doing.

The one light in this tunnel of darkness of not just teen pregnancy, but pregnancy among older people, younger adults, the one light is the issue about sexual abstinence, because it is beginning to show that there maybe is a way.

The problem with saying that there are programs that work, and I am on the Research Task Force for the National Campaign with Doug Kirby, that wrote "Emerging Answers", and he and I, I keep arguing with him. I say, Doug, the other statistical evidence of success, and that is a technical calculation, but the actual dramatic drop in pregnancy rates, we are just not seeing with the programs that are mixing the messages. Where we are really seeing startling results sometimes, and there is not enough of it yet, I totally agree with that, are the programs that are good abstinence programs that are gradually beginning to emerge, that is a new area, but those programs are gradually beginning to emerge, and we are seeing some surprising statistics with some of them, but I think that all of them must start including education about STDs and testing.

As a matter of fact, Johns Hopkins, a couple of years ago, said that every single sexually active adolescent must be tested for chlamydia every 6 months. I mean, they are that concerned about this problem. Are we doing that in all our programs, you know? If we are not, then we are really not giving the kind of care we should.

Chairman HERGER. Thank you very much, doctor. And I think the point is here, even with the protection, the diseases are still being transmitted and I believe that is something that is not being talked about enough.

Dr. MCILHANEY. That is right. May I say one more thing, sir?

Chairman HERGER. Yes.

Dr. MCILHANEY. Very briefly. I mentioned marriage in my testimony, and that is three of the four goals of TANF funding mentions marriage strongly. The reason is that the biggest risk for a person becoming infected with a sexually transmitted disease is how many sexual partners they have had in their lifetime. We have good evidence that when people are single and sexually active, they almost always continue to have more and more sexual partners, which therefore dramatically increases a risk of STD.

The biggest study on sexual practice in America came out of the University of Chicago a few years ago, and it showed that married rarely, few married people have sex outside of their marriage. They usually have sex only with that one partner, their marriage partner, which is a huge public and personal health message, and that is why marriage I think is so wisely including in TANF funding, and also why so many abstinence programs, for example, do talk about marriage to you.

Chairman HERGER. Thank you, doctor. Now, I will go to the gentlelady from Connecticut, Mrs. Johnson.

Mrs. JOHNSON. Thank you, Mr. Chairman.

I just wanted to get your opinions, as you are sitting here as a group, about the importance of the connectivity factor of not just talking to kids about abstinence and sexuality and sexually transmitted diseases, as important as all those things are, but connecting them into doing well in school and why that matters and career choices, connecting them into their families, and their families into support services and into their mothers' aspirations and so on.

I mean, I appreciate, of course, that the latter is nicer, but I mean in terms of affecting the lives of these kids, what should we be looking at, because after all, welfare reform is a systems issue, and we have to opportunity to have a systems focus. And I am asking your advice on how broadly we should try to focus our effort to prevent teen pregnancy? We will just take in order anyone who wants to comment. Ms. Grant. Keep it brief so we can just run down the whole panel, anyone who wants to.

Ms. GRANT. I think your earlier statements about connectivity really spoke to, really in answers to the question I think, we cannot isolate young people or just parents and say, "We will have a program specifically for you," that even the latest research around kids and risk behaviors and some of the PSAs that we are seeing now, talk about that shift that we have in society where young people want to hear from their parents. They are not asking to hear from their peers on critical issues. They want their parents to talk to them, and they clearly state they are listening. So I think our efforts, you know, we are always behind the ball trying to catch up with it, and I think we really need to look at that and bring that into the forefront, that then how do we structure strategies that encourage that?

In Virginia, what we are doing through our initiative is we are not just targeting young people, we are training medical professionals to talk about these issues as kids come into clinical settings. We are spending time educating parents through radio while they are listening to the traffic report and that kind of thing, to try to say, "Hey, kids want to hear from you", and to tell kids, "Go talk to your parents about this", and make those connections from a State-wide perspective. That is what we are trying to do.

Mrs. JOHNSON. Let's keep it brief since we have so many to hear from.

Mrs. BENNETT. Goal setting, telling our young people that they should have dreams, and how to kind of reach their dreams with a plan. Our girls set goals starting in the fifth or sixth grade, what they are going to have, what they want to achieve academically, what they want in their lives. It is amazing how many girls say they want to be married someday, and they want a house, and they want a family.

What we, and you are exactly right, it is not just about talking about STDs, it is not just about limiting at-risk behavior. It is about the big picture, and we have discovered that kids, children, no matter what their background, their own home background, they have dreams and goals, and if we can, which I think we do a very good job of in Best Friends, we have the goal setting activities. We have the individual mentoring. We have the community service. And then we have fun, the singing and the dancing, fun dancing, fun singing, the jazz choir, the jazz dance troupe, all of those kinds of things that are fun. Kids want to have fun. Show them how to have fun without negative behavior.

Ms. BROWN. I think you are absolutely right, it is this larger context that really makes the difference. We often say it is not just about body parts, it is about values and relationships and feelings and families.

We have four bodies of information now that shed light on this youth development approach. The Adolescent Health Survey--a federally funded adolescent health survey--showed that strong connections between teenagers and their schools and strong connections between teenagers and their families were some of the most highly protective factors against adolescent pregnancy. That has gotten a lot of press.

We also now have all the information I summarized for you today from "Emerging Answers" on youth development programs. They get the biggest results in reducing teen pregnancy. Some of them don't actually even address sex, but they give these kids a lot to say yes to.

And finally, the National Academy of Sciences released a report just last week on community-level programs for youth that goes into a large number of databases about all these different programs, what risk factors they address and what their outcomes are, and it is very consistent, Mrs. Johnson, with just the kind of thing you are saying.

Finally, the most popular publication that the Campaign has released to this day--and we are moving 600,000 pieces this year--is "Ten Tips for Parents to Help Their Children Avoid Teen Pregnancy." It offers very simple advice like: talk to your kids; know what they are watching, reading and listening to; be clear about your own values; and so on. This pamphlet remains to this day the piece of information everybody most wants from the National Campaign.

Dr. MAYNARD. I would just add to this that while I think the evidence on connectivity is really out there, we have had 40 years of erosion of the American family and communities, I think that, for some time to come, we need to be on a dual track where we are working to promote connectivity and have those more intensive youth development focused programs where we can. But, we don't want to leave behind the kids who are still living in communities and in families where we may not be able to achieve all that we would like on the connectivity front.

Ms. BILODEAU. Ours is a family systems program, and that is where our greatest emphasis is, is on building strong families and on encouraging children to gain educational skills. As I indicated, at least 80 percent of our kids come from families that were started by teen parents, and therefore you have families that do not necessarily value education, do not have a work ethic that combines education as a way of moving forward, but rather people who tend to stay in low-paying jobs.

We believe that the key to teen pregnancy prevention is education, and that the better a kid does in school, the more likely it is that they are going to stay in school, and the greater their reasons are going to be to avert early sexual activity and teen pregnancy.

When we first started our program for the first couple of years, at least 10 to 20 percent of incoming sixth graders did not know the alphabet. That is where we put our emphasis. Now we have an alphabet test as part of the intake process. We receive our primary funding from the Connecticut Department of Social Services, and so I tell the kids that the State makes us do it, that is the only way we can get the money is if they do the alphabet for us.

Recently, in the past couple of years, well, really in the past year, we have not seen that happen. We have the superintendent of schools on our board, and so that information obviously did get passed back to the superintendent of schools. But with poverty-stricken children, the children who are most apt to become teen parents, they have to have the concrete, tangible, every-day support that moves them from the bottom of the class--you know schools do tracking, everybody tracks; our kids are always tracked with the groups that is least likely to succeed. You have to break that mentality for them and for the schools and for the whole community, who expects our kids to be the gang bangers, the pregnant teens, the drug addicts and the drug runners. That is what our neighborhood has always been about. We have to break people's perceptions, and not just the kids and not just the parents, but the whole community has to value those children who are most likely to fall through the cracks. And then that is how you create a continuity and a bonding, so that those children don't belong just to a family, they belong to a larger community, and that they, our kids are growing up believing that they too will be the mayor.

When we go to visit Nancy's office, I always tell them, "Look around because I expect in a few years to see one of you here," and they look at it that way. Hope for the future, that is the key.

Dr. MCILHANEY. It is almost not necessary to add anything, but I will. The health, hope and happiness of our society and of so many people in this country are really being hurt. I totally agree with you, Congressman Johnson, that the connectivity, the environment that our kids live in, that we all live in, really is the vital thing that must be transformed, and the central element of that is the family and marriage, because that is the core of our culture.

Unfortunately today, what I think all of us have found is that parents often feel disempowered. They don't believe their kids will listen to them. They really don't believe they have that kind of influence, and we have some statistical information that is really helpful, and we use it a lot, I think all of us do. The ADD Health Study, the biggest study ever done on adolescence showed that of all the risky behaviors, drugs, sex, alcohol, running away from home, all of them, that the kids that were doing the best were those kids who had connectedness with their parents. We need to empower parents.

And my belief, I think probably the belief of all of us, is it is going to take leadership, and that is one thing at the end of my testimony I said, you as leaders in this country can make such an enormous difference. As Rebecca said, the whole discussion in this area about sex changed when Congress allocated money, and it really started in some sense back in the 1980s with the Title XX Program.

So how we all are in this together. We need to consider all the risky behaviors because there is good evidence that impact one of them. We have to impact all of them, and the one that usually gets left out is sex. We need to include that in our encouragement and guidance to young people.

And finally, Elayne mentioned the AAUW, American University Women's report that those kids basically all said that no one in their whole environment, not their parents, medical people, their boyfriends or girlfriends--and these were girls--encouraged them not to be involved in sexual activity. So we have got to start at the top, and come and surround young people with a world that supports them in avoiding these problems so that they have hope for the future.

Chairman HERGER. Thank you very much. I want to thank each of our witnesses for their outstanding testimony. I trust that the witnesses would respond to additional questions on these issues for the record.

Again, it has been a very interesting hearing, one that is very important not only to the members of this Committee, but certainly to the Nation, to the parents, and the young people of this Nation.

With that, this Subcommittee stands adjourned. Thank you.

[Whereupon, at 12:07 p.m., the hearing was adjourned.]
[Questions submitted from Chairman Herger to the panel, and their responses follow:]

Virginia Abstinence Education Initiative
Richmond, Virginia 23219

1.  I understand from your testimony about the evaluations your program is undergoing, but I’d like to know more abut the programs themselves.  Please describe the abstinence education programs in Virginia.  For example, how do teens come into your programs?  Do you involve parents of the teens in these programs?  How about teens who have already had kids – is part of your program preventing subsequent births to teens who have already had one or more babies?  Is your program only about girls, or are boys involved, too?  What is the source of your funding?

VIRGINIA ABSTINENCE EDUCATION INITIATIVE
Program Descriptions

• Reasons of the Heart

Organization:  Alliance for Children & Families (Lynchburg, VA)
Director:  Maureen Duran
Localities:  Fairfax County, Fauquier County, and Loudoun County
Target Population:  7^th graders**

Description:  Utilizes original materials and classic film clips to help youth (in school, after school, detention and probation homes) examine the impact of character on sexual decision making and choosing abstinence until marriage. The Reasonable Reasons to Wait curriculum will be implemented in health classes teaching youth the value of abstaining until marriage.

• Individuals Abstaining ‘til Marriage

Organization:  Alliance for Children & Families of Central Virginia
Location:  Lynchburg, VA
Director:  Joan Foster
Localities:  Pittsylvania County and City of Lynchburg
Target Population:  7^th graders**

Description:  Utilizes the Wait Training! curriculum and peer mentors to promote the abstinence until marriage message in both the school and  after school settings. Community based programming will be provided for participants during the summer.

• Very, Important, Person (VIP)

Organization:  Horizons Unlimited Ministries, Inc. of Hampton, VA
Location:  Newport News, VA
Director:  June Sullivan
Localities:  Newport News (East End and Denbigh areas)
Target Population:  7^th graders**

Description:  Utilizes the Reasonable Reasons to Wait curriculum to help youth appreciate their ability to abstain from sexual activity until marriage because they have value and can relate to others with integrity and purity. 

• I Can Abstain Now

Organization:  Sussex Rural Abstinence Project with Social Services Department County of Sussex, VA as lead agency and fiscal agent.
Location:  Sussex, VA
Director:  Melody Walker
Locality:  Sussex County
Target Population:  7^th graders**

Description:  Utilizes the Families United to Prevent Teen Pregnancy and Managing Pressures Before Marriage curricula to teach skills to resist the pressures to become sexually active and remain abstinent until marriage.  Peer mentors and adult leaders will be trained and supported in modeling appropriate behaviors for participants.  Parent education and a community-based resource center are additional components of the program.

• My Choice, My Future!

Organization:  Powhatan Partners In Prevention Coalition with Powhatan County Health Department, of Powhatan, VA as the lead agency and fiscal agent.
Location:  Powhatan, VA
Director:  Ginell Ampey-Thornhill
Locality:  Powhatan County
Target Population:  7^th graders**

Description:  Utilizes the Reasonable Reasons to Wait and Wait Training! curricula to motivating youth to choose and maintain an abstinent lifestyle. The program will be implemented through the health and physical education classes. This program is part of a federally funded evaluation.

**This is the initial point of contact with students.  Students receive abstinence educational sessions ranging from 12 to 18 weeks in duration. All program participants are given a program booster in subsequent grades.  To date we have students receiving abstinence education instruction in 7^th through 11^th grades.

Participants in the school-based programs are given consent to participate by their parents.  The abstinence educational sessions are taught during the health education classes.  All of the abstinence education curricula have been reviewed for compliance with the Standards of Learning guidelines established by the Virginia Dept. of Education.

Parental involvement is limited in these programs, but Parent Information Nights are offered at the beginning of the school year and most of the programs have activities and events that are structured for teen and parent attendance.

Because these programs are primarily school based there are students who may be pregnant or parenting in the classes. These students continue to participate in the classes and if necessary are referred to school staff for additional services. The participants in these programs are both male and female.

The Virginia Abstinence Education Initiative is funding through Title V – Abstinence Only dollars.  Virginia receives $828,619 in federal funds that is matched with $375,098 General Funds and in-kind dollars from abstinence education program providers and added value generated by our media campaign.  Additional funds are provided through the Department of Social Services TANF dollars in the amount of $211,000.

Gale Grant
Director

Best Friends Foundation
Washington, DC 20008 
December 6, 2001

The Honorable Wally Herger
Chairman
House Committee on Ways and Means
Subcommittee on Human Resources
Washington, D.C. 20515

Dear Chairman Herger:

Thank you for the opportunity to provide the subcommittee with additional information about the programs of the Best Friends Foundation and our efforts to prevent teenage pregnancies.

As you know, the Best Friends Foundation, a 501(c)(3) organization incorporated in the District of Columbia, was founded in 1987 and now reaches more than 5,500 girls through its Best Friends program and about 500 boys through the recently created Best Men program. The programs operate in 23 cities and 14 states, including the Virgin Islands. Our message is very simple: Enjoy adolescence by abstaining from sexual activity until high school, and illegal drugs, and alcohol.

While that message may not be new, the method in which it is delivered is profoundly different. And we have had great successes.

Now, let me address the questions you raised in your letter of Nov. 19:

1. How do youths come into your program? Are other members of their family involved, such as the young person's parent(s) or siblings?

Students may enter the Best Friends (girls) or Best Men (boys) program beginning in the fifth or sixth grade.  Every effort is made to take an entire class of   students. If that is not possible, a random sampling is done.   We work to make certain that the Best Friends program is representative of the entire student body and there is no stereotyping of the group (we have a carefully balanced mix of high achievers, middle achievers and at risk students. Once they join the program, each girl and boy is invited back to the program at the start of the next school year. Indeed, experience has shown that a blend of students consisting of high and average achievers, along with those who fall below the mark, provides a productive learning environment.

The support of family is very important to the success of the programs. Best Friends/Best Men parents give permission for their child to participate. We are happy to report that we have received 100% parent permission Each school holds a parent information meeting at the beginning of the school year, which includes a video about the Best Friends/Best Men program. Best Friends/Best Men staff are on hand to answer any questions. At the end of each school year, families celebrate the commitment of their children at the Family and School Recognition Ceremony-about 80-90 percent of the parents attend the event. Each Best Friends/Best Men participant acknowledges his/her parents with a symbol of gratitude. In 15 years of operation, only two parents did not allow their children to participate in the program, and no parents ever have removed their children from the program.

2. What are the primary sources of funding for the Best Friends program?

The Best Friends Foundation operates the Best Friends/Best Men program in seven schools in D.C. and two in Maryland, paying for all of their instruction and materials, field trips, and the annual Family and School recognition ceremony with funds raised from the private sector. Our funders include the Bradley Foundation. the Robert Wood Johnson Foundation, the Case Foundation, the Kellogg Foundation, the Marriott Foundation and American Standard. We also raise funds from our Annual Donor Dinner. The cost of providing the Best Friends/Best Men program is approximately $250 -600 per student. Additionally, a number of schools and school systems around the country have replicated the Best Friends/Best Men program, using their own funding.  We have established a National Training and Technical Assistance Center, which develops the curriculum, monitors and evaluates the effectiveness of each program and trains educators. We require that our model be followed and that all educators providing instruction be trained by the Best Friends Foundation. The replication sites' funding sources include local education dollars; local and state grants, including money from state "Drug Free Schools" grants; Title V grants and grants from private foundations and companies.

Because the programs take place during the school day, the Best Friends/Best Men curriculum is taught by teachers who are, in most cases, employed by the school system. Teachers and other school staff members volunteer to serve as mentors to participants.

3. How does your program address peer pressure so that young people reinforce one another to abstain from sex? What do the young people say about this?

The Best Friends/Best Men program’s primary goal is to help adolescents gain self-respect, make positive decisions, and support one another in postponing sex and in rejecting illegal drug and alcohol use. Our program works because participants become part of an intensive peer support group based on friendship. We emphasize that friends must help each other make good decisions and that friends sometimes must intervene in each other's lives. We create a group within a school-usually 30-40 students-that puts peer pressure on its members not to have sex. In an anonymous survey of Best Friends girls following the 1999-2000 school year, we found that 30 percent of our fourth- and fifth-graders, 36 percent of our sixth-graders, 48 percent of our seventh-graders, and 60 percent of our eighth-graders helped a friend make a decision about sex. When we first started the Best Friends program in 1987, testing the concept with 10th-graders at a Virginia high school, more than 73 percent of the students surveyed said they would like to belong to a group that supported one another in waiting to have sex at least until after high school graduation. More recently, one student commented: "It was hard to say 'no' until I became a Best Friends girl. I have all these friends in Best Friends that check on me and say, 'How you doin'?' One time I was going to go with this guy who had this great 'line,' but they wouldn't let me. I'm glad. He got another friend of mine pregnant and left her alone. She's sad. We watch out for each other at Best Friends. I can say 'no' in seven different ways."

The program also "deglamorizes" the barrage of sexual images that come from popular culture. We present the students with an upbeat message, one that emphasizes the joys of pre-teen and teenage years free from the complications of sexual activity, and we give them something to "yes" to: good grades, self-respect, and, for those who stay in the program through high school, college scholarships. The program is designed to reach children in early adolescence, when their attitudes toward life are forming and when they need to discuss their personal concerns with and receive support from friends and respected adults.

The messages which are taught in the Friendship module include the best kind of friend is the one that makes you a better person and friends help each other make the right decisions

4. I think we have seen from Dr. McIlhaney's testimony, and most of us know intuitively, that abstinence is the only way to prevent the risk of pregnancy and the spreading of sexually transmitted diseases. Yet, some people claim that the abstinence message puts young people at risk. Is there any evidence of that? What does your experience suggest?

There is no evidence that teaching-as the Best Friends/Best Men program does-that abstinence from sex is the only 100 percent guarantee against pregnancy and sexually transmitted diseases is putting young people at risk. That claim cannot be made regarding teaching students about various contraceptive devices and practices.  Recent research published by Child Trends data is showing there is a decrease in the use of contraception and subsequent sexual activity. There is no definitive research on sex-ed programs that focus on contraceptive education. There has been a flurry of attempts by the contraception advocates attempting to say that abstinence education results in participants not using contraception once they have decided to become sexually active. This is a flawed study and has been seized upon by those who wish to see all abstinence funding eliminated. The contraception lobby would do far better to focus their efforts on why, after years of participation in their education programs, sexually active students are not using contraceptives and why STDs are at epidemic proportions.  It is important to remember that since the advent of sex education classes in schools in the 1960s, the number of out-of-wedlock births in the U.S. rose 450 percent by the early 1990s. Only since 1995, when there was a concerted push for abstinence education, have teenage and out-of-wedlock births started to fall.

Our curriculum includes a section on AIDS and STDs, giving candid information about the most common STDs, the symptoms, treatments, and consequences. Young people are not put at risk through an abstinence-only message but rather through confusing messages that say sex is okay as long as you use a condom or birth control. 

The experience of the Best Friends/Best Men program has been that young people want to hear the abstinence message. When Emory University's Marian Howard asked 1,000 teenage mothers what they wanted to learn in sex education classes, 82 percent of them said "how to say 'no' without hurting my boyfriend's feelings." A recent survey conducted by the American Association of University Women Foundation of 2,000 11- to 17-year-old girls found that the vast majority said that sex and how to say "no" in emotionally charged relationships was their number one concern. And the National Campaign to Prevent Teen Pregnancy found that 98 percent of teens said "it is important for teens to be given a strong message from society that they should abstain from sex until they are at least out of high school."

And we have proof of the success of our program. An independent evaluation of data from a Centers for Disease Control survey of D.C. public school students and data collected from Best Friends girls attending D.C. public schools found that 18.5 percent of the seventh-graders and nearly 35 percent of the eighth-graders in the CDC survey were sexually active compared with 4.2 percent of seventh-graders and 5.6 percent of eighth-graders in the Best Friends program. Additionally, in a spring 2000 survey of Best Friends participants, 92 percent of the girls said they want to wait until at least high school graduation to have sex; 69 percent want to wait until marriage.

The Best Friends/Best Men program works because its message is simple-abstain from sex, drugs, alcohol, and violence-and supported by caring adults and fellow students. As Aristotle said: "The best friend to have is the one around whom you are a better person." We are striving to mold young people into friends who make others better people.

I refer to you once again; to look at the YRBS study which compares the Best Friends sexual activity rates to children not in the program. I implore that you please call us for accurate information on abstinence education. Please understand this is a message that both our teenage girls (boys and girls ) need to hear. It is very difficult for kids who do not want to be sexually active when all the efforts are directed to contraception sex ed methodology. Please read Robert Blum ADD health survey. It clearly demonstrated that parental disapproval for teenagers is a protective factor in the onset of sexual activity. This was a valid study and the contraceptive lobby has successfully buried this information.

Thank you again, Mr. Chairman, for giving the Best Friends Foundation this opportunity to contribute to the discussion on this extremely important topic.

I am available for meetings or phone conferences at your convenience.

Sincerely,

Elayne  Bennett
Founder, President and CEO

National Campaign to Prevent Teen Pregnancy
Washington, DC 20036
November 29, 2001

Rep. Wally Herger
Chairman, Committee on Ways and Means
Subcommittee on Human Resources
Washington, DC

Dear Chairman Herger,

Thank you for the opportunity to testify about teen pregnancy prevention before your subcommittee. We commend the subcommittee for focusing on teen pregnancy which affects so many young people.  As I mentioned at the hearing, the National Campaign to Prevent Teen Pregnancy strongly believes that reducing teen pregnancy is a highly effective way to make progress on a number of related social issues: child poverty, welfare dependency, out-of-wedlock childbearing, and responsible fatherhood.

In a letter dated November 19, 2001, you asked me to respond to several additional questions.  Below, please find your questions and my responses.

1.  In your testimony, you mentioned that culture and family environments of teens can be very powerful in determining their behavior.  What do you think we can do to affect these influences, particularly with respect to the media and popular culture?

Teen pregnancy is rooted in broad social phenomena, including the images portrayed in the entertainment media, the values articulated by parents and other adults, and popular teen culture most of all.  The task of preventing teen pregnancy is often complicated by a culture that too often sends young people messages that having sex at an early age is just fine, that getting pregnant at a young age is no big deal, that contraception is not all that important, that “everybody is doing it,” and that parents have lost their children to peers and popular culture.

With respect to parents, the primary challenge is to convince them that they matter.  Over two decades of research confirms that families --- and particularly parents --- are an important influence on whether teenagers become pregnant or cause a pregnancy.  In a variety of ways, parental behavior and the nature of parent/child relationships influence teens’ sexual activity and use of contraception.  While parents cannot necessarily determine whether their children have sex, use contraception, or become pregnant, the quality of their relationships with their children can make a real difference.

A recent National Campaign survey illustrates this challenge.  Teens cited parents more than any other source as having the most influence over their sexual decision-making.  But, adults believe that peers influence teens’ sexual decision-making more than parents.   The inescapable conclusion is that many parents do not recognize how influential they are in this area or how many opportunities they have to shape their children’s behavior.  Kids report to us time and time again that they want to hear from their parents about sex, love, and relationships but often do not.  Adults need to be clear about their own values and communicate them to young people.

Teen pregnancy prevention is as much about moral and religious values as it is about public health.  Teens, like adults, make decisions about their sexual behavior based in part on their values about what is right and wrong, what is proper and what is not.  New research from the National Campaign makes clear that religious faith is associated with delayed sexual activity among some groups of teens. Survey data also recently released by the National Campaign indicate that morals, values, and/or religious beliefs affects teens decisions about whether to have sex more than concern about STDs, fear of pregnancy, or other reasons.  And research from the nonprofit organization Child Trends shows that the primary reason that virgin teen girls say they abstain from sex is that having sex would be against their religious or moral values.

Clearly, peers also shape teens’ environment.  Research and common sense show that peer influence can play an important role in the sexual behavior of teens.  Accordingly, teens need accurate information about what their peers are doing (or not doing) because what they think other teens are doing has an impact on their behavior.  Teens need to understand that not everyone is “doing it,” and that many teens who are sexually active wish they had waited longer. 

Teens who are abstinent should speak about their choice, to the extent they are comfortable, so that their peers will not so often overestimate the level of sexual activity around them.  Teens who are careful users of contraception should also speak out so that the use of contraception is not so mysterious or surrounded by so much misinformation.  Teen girls need to tell each other the sex doesn’t guarantee a loving relationship. Teen boys need to tell each other that having sex is no way to prove manhood.  Being a father too soon leads to major financial burdens, legal risks, and a lifetime of personal complexities.  Teen parents need to speak to their peers about the difficulties that early pregnancy and parenthood have posed for them.

As noted above, reducing teen pregnancy requires a change in social values and popular culture.  The entertainment media has a major influence on popular culture and, therefore, working with this sector is essential. According to a recent study by the Kaiser Family Foundation, 99 percent of households in the United States have televisions, and two-thirds of kids aged 8 and older have a television in their own rooms.  This study also reported that young people aged 8-18 spend an average of 28 hours per week watching television — which is twice as much time, over the course of a year, as they spend in school.  Given the extraordinary amount of time that young people spend consuming media, it is clear that we cannot solve the problem of teen pregnancy without the help of the media.  Conveying responsible messages through the entertainment media is both powerful and efficient.  By reaching millions every minute and shaping popular culture, the media must be --- and often is --- a force for good.

We should encourage the media to show that sex has consequences.  Many teens say that although the media shows them a lot about sex, it rarely portrays real consequences.  For our part, the National Campaign suggests that the media show teens doing the right thing --- saying “no” to sex or saying “no” even if they’ve said “yes” before.  Show teens making the case to each other that postponing sexual involvement is their best choice for many reasons, including emotional ones.  Show sexually active teens doing the right thing --- using contraception and dealing directly with the fears and myths surrounding it.  Show parents being parental, not passive --- talking with their kids about sex, love, and values from an early age; setting limits on early dating and on the toxic older guy/younger girl combination; providing supervision and setting curfews; and addressing the power of peer influence.  And we suggest the media show adults setting honorable examples in their own sexual behavior if for no other reason than because it affects the behavior of their children and teenagers.

How does the National Campaign get its messages before the entertainment media?  Since our inception, we have been working closely with the writers and producers of TV shows, magazines, and websites, focusing primarily on influencing the content of entertainment media.  To encourage media leaders to weave prevention messages into the content of their work, we offer specially tailored face-to-face briefings to key editors, scriptwriters, and producers about the problem of teen pregnancy and its solutions.  We discuss with them various messages well suited to their shows or magazines, and talk about different ways that these messages can be presented in their media.

One final point about the current culture and teen pregnancy.  We have noted a distinct unwillingness among adults --- and in the culture generally --- to take a clear stand on whether teen pregnancy is or is not okay.  In recent National Campaign polling fully one-third of adults said they do not think that the kids in their communities are getting a clear message from the adults in their lives that teen pregnancy is wrong.  This may be due to a reluctance of adults to take a stand that has a values component, it may reflect a popular culture that is increasingly tolerant of unwed pregnancy and childbearing, it may be that some adults are fearful of offending those teens who are already pregnant or parenting or that they might inadvertently stigmatize the children of teen mothers, or it may simply be that many parents are uncomfortable talking to their children about sex and values. 

But if we can’t even simply say that teen pregnancy and parenthood is in no one’s best interest, how can we be surprised at the high rates of teen pregnancy in this country?  Fundamentally, teen pregnancy is a question of values, standards, social norms, and what a society prescribes as the best pathway from childhood to adult life.  If we are to make continued and lasting progress in reducing teen pregnancy we need to offer more straight talk to young people --- and conversations with them --- about the critical need to postpone pregnancy and parenthood until adulthood.

2.  A report released by the National Institutes of Health shows condoms are not necessarily effective in preventing most sexually transmitted diseases.  Is your organization sharing this important information with teens?   Do you believe that should become a key part of any family planning curriculum?

Teens need to know that abstinence is their best choice for preventing pregnancy and avoiding sexually transmitted diseases (STDs).  They also need to be given accurate information about the relative effectiveness of various methods of contraception and the National Campaign has been at the forefront of communicating both messages.  The recent report from the National Institutes of Health makes clear what many of those concerned about the well being of youth have been saying for some time --- condoms are not 100 percent effective at preventing pregnancy and that the jury is still out about their efficacy in preventing many STDs. The clear national consensus --- among adults and teens alike --- is that middle and high school kids, in particular, should be given a clear message that abstinence from sexual intercourse is the right thing to do because of the numerous important consequences.

Nonetheless, contraception is still a very important part of reducing teen pregnancy.  A sexually active teen who does not use contraception at all has a 90 percent chance of getting pregnant within one year.  However, we must be careful to put this remedy into perspective. Some teens, like many young adults, overestimate the effectiveness of condoms and many have difficulty consistently using the array of contraceptive methods currently available.  For example, among young women aged 15-19 relying on oral contraception as their only form of birth control, only about 70 percent took a pill every day during a three-month period. Moreover, nearly one-third of teen girls were completely unprotected the last time they had sex, and between 30 and 38 percent of teens who use contraception are not consistent users. 

Despite the availability of the pill for more than three decades, despite the fact that many teens now have access to copious amounts of information about contraception from schools, magazine articles, and websites, despite the availability of non-prescription methods in virtually every drugstore, the vast majority (78 percent) of pregnancies among teens are unintended.  Improving the degree of access that teens have to contraception might improve this statistic, but there is no reason to think that this approach alone will be sufficient.  Increasing access that teens have to contraception is important --- to be sure, without sustained attention to contraception over the past years, teen pregnancy rates today might be even higher --- but, again, this is still only one of many remedies required.

3.  I appreciate your point about “what works.”  However, the prevailing wisdom used to be that 5 million families had to be on welfare because they couldn’t work.  That logic proved to be flawed.  As Dr. McIlhaney mentioned, the prevailing wisdom also used to be that smoking rates would never decline significantly because it was too ingrained in our culture.  That has certainly changed too.  Given the limited availability of abstinence education should we try to overturn the prevailing wisdom once again by expanding the availability of abstinence education?

As a general matter, the National Campaign strongly agrees with the sentiment of this question.  That is, abstinence is the first and best choice for teens.  Our polling data clearly indicate that the majority of adults and teens support providing teens with a strong abstinence message and research makes clear that abstinence has made a significant contribution to declining teen pregnancy and birth rates during the 1990s.   We offer our support for a strong abstinence message for teens, however, with three important caveats:

• While American adults and teens clearly feel that young people should be given a strong abstinence message, the research on the effectiveness of abstinence programs, is not as clear.  As Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy, a comprehensive research review recently published by the National Campaign makes clear, the jury is still out on the effectiveness of specific programs or curricula for conveying abstinence-only messages to young people.  All of this leads us to be cautious about massive public funding of programs that do not yet have clear, scientific evidence of their effectiveness.
• It is also true that even when given strong advice to remain abstinent, some young people will not do so: for example, currently 65 percent of high school seniors have had sex.  More of these young people can --- and should --- be encouraged to abstain from sex, but experience suggests that some (perhaps most) will continue to be sexually active.   For these young people, the national consensus is that easily available contraception can reduce the chances of pregnancy and STDs.  Put another way, American adults and teens clearly feel that abstinence is better than contraception, but using contraception is better than getting pregnant too soon.  And, importantly, whatever the level of support for abstinence, it can never come at the expense of support and contraceptive services for sexually active teens.
• In the absence of good program evaluation data, and given both the great sensitivity of teen sexuality issues and the great diversity of American culture, the federal government should not dictate precisely what states and communities should do to promote abstinence.  While there is considerable consensus about the importance of preventing teen pregnancy, there is somewhat less consensus about how to go about it and the answers may vary in different communities and for different teens.  Setting performance goals and expectations is a good idea. Rigidly prescribing how to achieve these goals is not.  Consistent with the devolution philosophy underlying the 1996 welfare reform legislation, states and communities require flexibility in designing strategies to reduce teen pregnancy in order to accommodate differing local circumstances. In a country as big and diverse as America, and on an issue as complex and sensitive as teen pregnancy, it is important to allow multiple approaches.

Sincerely,

Sarah S. Brown
Director

University of Pennsylvania
Philadelphia, Pennsylvania 19104
November 30, 2001

Mr. Wally Herger, Chairman
Subcommittee on Human Resources
Committee on Ways and Means
House of Representatives
Washington, DC  20515
Via e-mail

Dear Mr. Herger:

I appreciate your offering me the opportunity to testify before your committee on November 15, 2001. The following are my responses to your requests for clarification and additional information in support of my testimony.

Request 1:  Please elaborate on your statement that there need to be more evaluations and funding for research on a variety of approaches to deal with the problems of teen pregnancy and STD transmission. 

The national evaluation of Title V abstinence education program is the first major effort to gather scientifically rigorous evidence about the efficacy of this particular approach to reducing teenage sexual activity, exposure to STDs, and pregnancy.  While there have been studies of a wide range of particular programs directed in whole or part at these same goals, the earlier research is of variable quality, inconsistent in its coverage of program approaches, and therefore of limited usefulness as a guide to designing effective national policies. 

These shortcomings of past research were well documented in the recent review of teen pregnancy program evaluation findings by Dr. Douglas Kirby for the National Campaign to Prevent Teen Pregnancy.  To be sure, Kirby’s review of the research identifies statistically reliable evidence that several intervention strategies, tested in particular settings, have reduced teen sexual activity and pregnancy rates.  However, this review identifies even more instances where studies have been unable to find clear evidence that the interventions favorably affected the key outcomes and some instances where the programs had adverse impacts.  The only way to generate the scientific knowledge base needed to support smart policy development is to systematically assess a range of policy relevant approaches to the problems under varied implementation settings and using scientifically rigorous study designs. 

Request 2:  Please elaborate on your statement: “We have no definitive evidence linking any of the TANF teen pregnancy and nonmarital birth prevention provisions with favorable trends in teen pregnancy.”

The decline in teen birth rates and the leveling off of nonmarital birth rates during the 1990s could be related to those particular policy changes directed specifically at addressing teen pregnancy and nonmarital births.  However, at the same time that these particular policy changes were being made and the favorable trends emerging, other potentially important factors were also shifting.  Concurrent with the decline in the teen birth rate, increasing numbers of states were experimenting with other welfare reform elements now central to TANF and its broader focus on responsible behavior—the institution of time limits, the strengthening of child support enforcement, the stepping up of work requirements and support, and the institution of family caps.  The 1990s also was a period of strong economic growth and changing demographics among the teenage population.  These myriad other changes could also have had important effects on teen pregnancy trends.  At this point, there have been too many simultaneously changing factors to establish definitive causal links between the teen pregnancy aspects of welfare policy change and the trends in teen and nonmarital birth rates, or to predict the relative contribution of particular policy changes. 

Request 3:  Are the abstinence programs you have observed mandatory or voluntary programs?  Are family planning curricula typically offered on a voluntary or mandatory basis?  What are the implications of the manner in which these programs are offered for your study findings?

Based on the observations my colleagues at Mathematica Policy Research, Inc., and I have been making, I would say that both abstinence programs and programs offering family planning curricula to youth operate in one of two ways.  Where services are provided through community groups or as an extra-curricula activity within the school setting, participation is usually entirely voluntary and generally the parent must provide active consent.  In contrast, in cases where the programs are offered as a part of the core curricula within the school setting, they generally use a passive consent process.  For example, parents will be notified about the program/class and informed about its content and they will be given the opportunity to request that their child not participate.  However, in some cases, schools do require active parental consent for students to participate in any type of health or sex education curriculum.

The implication of this pattern of service delivery for our study is simply that we need to be careful to document the nature of both the abstinence programs we are studying and the counterfactual services youths would be receiving if the federally-supported programs were not available to them. This information provides the context for interpreting the study findings and judging the extent to and circumstances under which they can be generalized.   

Request 4:  Please provide more specifics regarding your statement that “demand for abstinence programs frequently exceeds current capacity, as evidenced by program waiting lists and requests for programs to expand to new sites.”  Is there a demand by young people to become involved in these programs?  Are the programs voluntary?

Our experience suggests that abstinence education programs embedded within well-run broader youth development and/or service programs, such as mentoring programs, activity clubs, or after school programs, tend to be very popular among youth and their parents.  Such programs often have limited capacity and as a result have waiting lists. 

Some of the more dynamic, school-based programs also are in high demand by school administrators. For example, principals in Miami, Florida, have expressed a wish that ReCapturing the Vision could serve more than the 20 to 30 girls per school it presently serves and the program director has been asked to bring the program into more schools, both within the district and throughout the state.  This program is among those where we have clear evidence that, not only are school administrators eager to expand services, but that there are many more youths who would participate in the program voluntarily if they were offered the option.

Many schools where curriculum is offered in only one or two grade levels have expressed interest in extending the curriculum to lower and/or to older grade levels.  School-based curricula programs tend to be voluntary on the part of parents, not students.  However, our observation is that middle school youths generally are quite receptive to the programs.  The response of older youths to purely curriculum-based programs is more mixed. 

Request 5:  Do you agree with Dr. McIlhaney’s argument that it is too early to have concrete evidence about the success of abstinence education programs, but that “as was the case with the effects of smoking cessation initiatives, the data will come in time?”

It would be great if we had definitive evidence about the effectiveness of the Title V abstinence education programs now.  However, Title V is delivering services largely to middle school youths, and these services are geared to preventing behaviors throughout the teenage years and even into young adulthood.  For this reason, it simply is not possible to know at this time how effective these programs ultimately will prove to be.  We need to wait and see how successful they are in getting youths to abstain from sexual activity as they move well into their teen years.  The national Title V evaluation being conducted by Mathematica Policy Research, Inc., under contract to the U.S. Department of Health and Human Services will provide strong evidence on this issue by 2005, when its final report is due.

I hope these responses are helpful to you.  Please let me know if I can be of further assistance.

Sincerely,

Rebecca A. Maynard
University Trustee Chair Professor

Medical Institute for Sexual Health
Austin, Texas  78716-2306
November 28, 2001

Hon. Wally Herger, Chairman
House Of Representatives
Committee on Ways And Means
Subcommittee on Human Resources
Washington, DC 20515

Attn: Ryan Work

Sent by e-mail

Dear Rep. Herger:

Thank you very much for your letter of  November 19, 2001, and for your kind words.

We are pleased to provide for the record the following answers to the questions posed in your letter.

1.  Do you have any recommendations about areas in the welfare reform law we might improve to further our efforts to prevent teen pregnancy and delay sexual activity among young people?  What more can or should we do?

A.  While three of the four declared purposes of TANF relate to promoting marriage, preventing and reducing the incidence of out-of-wedlock pregnancies, and encouraging the formation and maintenance of two-parent families, only a very small percentage of TANF funds have been spent to date for these purposes.  We recommend that a specified percentage of TANF funding be designated for these issues, not just for teens, but also for other affected groups which fall within the purview of the enumerated goals of TANF.  Furthermore, since the data, as discussed in greater detail in my testimony dated November 15, 2001 submitted to this committee, clearly shows that abstinence outside of marriage is the healthiest behavior, and the only approach which adequately confronts both the pregnancy and disease issues, we recommend that at least half of the funding allocated for these three purposes be reserved for furtherance of abstinence outside marriage as the desired normative behavior.  We are not advocating that sums presently being funded for other worthy causes, if needed, be diminished, but only that some significant TANF funding be designated for these three purposes. 

B.  As to Title V funding, strong evidence supports the conclusion that at least some of the programs being funded by the $50,000,000.00 per year allocation are beginning to realize very positive results.  To discontinue this program now, prior to the extensive evaluation presently underway is completed, would not only severely hamper, if not destroy, these programs, but might also negate the meaning and usefulness of the pending evaluation.  Clearly, these programs need to be renewed, and, if available, additional spending made available for abstinence programs through Title V, SPRANS, or other sources, so that parity with other type programs is achieved.  There were a number of programs which were approved under both Title V and SPRANS, but which did not receive requested funding due to the shortage of available funds.

C.  Since, as noted, abstinence is the only totally effective manner to deal with both out-of-wedlock and disease issues, and constitutes the only truly healthy behavior in this area, efforts should be made to emphasize abstinence outside of marriage as the desired choice and normative behavior for all legislation dealing with sexual behavior and its effects, including health legislation.

2.  We often hear about the link between teen sexual activity and pregnancy and therefore welfare receipt.  But clearly, there are serious health consequences even if teens don’t become pregnant.  Can you comment on some of the costs to individuals and society of that—both in terms of the obvious personal costs to teens and the tangible costs like increased Medicaid and other health care spending? Only abstinence can effectively and completely address these sorts of issues, correct?

We agree that only abstinence can effectively and completely address these sorts of issues. 

The total costs to individuals and society, other than those directly related to out-of-wedlock pregnancies, of teen and other out-of-wedlock sexual activity, although difficult to accurately determine or even estimate, are of enormous proportion.  These expenditures fall into several categories which include the following:

A.  Direct medical and related costs

A 1997 report of the Institute Of Medicine’s Committee on Prevention and Control of Sexually Transmitted Diseases, entitled The Hidden Epidemic, Confronting Sexually Transmitted Diseases, states, in the Introduction to its Summary,

“Of the top ten most frequently reported diseases in 1995 in the United States, five are sexually transmitted diseases (STDs) (CC 1996c).  With approximately 12 million new cases of STDs occurring annually (CDC, DSTD/HIVP, 1993), rates of curable STDs in the United States are the highest in the developed world.  In 1995, STDs accounting for 87 percent of all cases reported among the top ten most frequently reported diseases in the United States (CDC, 1996c).  Despite the tremendous health and economic burden of STDs, the scope and impact of the STD epidemic are under appreciated and the STD epidemic largely hidden from public discourse.  Public awareness and knowledge regarding STDs are dangerously low but there has not been a comprehensive national public education campaign to address this deficiency.  The disproportionate impact of STDs on women has not been widely recognized.  Adolescents and young adults are at greatest risk of acquiring an STD, but STD prevention efforts for adolescents remain unfocused and controversial in the United States.”

As to the economic consequences of STDs, the report states, at page 7,

“The costs of a few STDs have been estimated *** but no comprehensive, current analysis of the direct and indirect costs of STDs is available.  *** the committee estimates that the total costs for a selected group of major STDs and related syndromes, excluding HIV infection, were approximately $10 billion in 1994.  This rough, conservative estimate does not capture the economic consequences of several other common and costly STDs and associated syndromes such as vaginal bacteriosis and trichomoniasis.  The estimated annual cost of sexually transmitted HIV infection in 1994 was approximately $6.7 billion.  Including these costs raises the overall cost of STDs in the United States to nearly $17 billion in 1994.  These cost estimates underscore the enormous burden of STDs on the U.S. economy.  (emphasis added).

In a report dated December, 1998 prepared for the Kaiser Family Foundation by the American Social Health Association, entitled, “Sexually Transmitted Diseases in America:  How Many Cases and at What Cost?,  the panel calculated that the “actual number of new cases of STDs is approximately 15 million annually,” and that this could be as high as 20 million new cases per year.   This report confirmed the very high cost of  STDs.  An unpublished study by our office reaches the same conclusion.

B.  Other costs—As noted, there are many costs, monetary or other, in addition to those related to pregnancies, which can be traced to or at least associated with sexual activity outside marriage.  These include:

1.  Loss of work time and productivity due to having an STD.

2.  Psychological and emotional damage and stress, including suicide and other self-inflicted damage.  For example, in a study entitled Premature Sexual Activity as an Indicator of Psychological Risk published in the February 1991 issue of the journal Pediatrics, non-virgin girls in the teen group evaluated were 6.3 times more likely to have attempted suicide (31.9% compared to 6.9%).

3.  Involvement in other risky behavior—For example, non-virgin boys and girls were more than six times as likely to have used alcohol, were 3.8 (boys) to 7.2 (girls) times more likely to have smoked cigarettes, and 4.8 (boys) and 10.4 (girls) times more likely to have used marijuana.  Premature Sexual Activity as an Indicator of Psychological Risk, supra, p. 144.

4.  Damaged relationships caused by one partner (married or otherwise) having an STD.  “Sexually Transmitted Diseases in America:  How Many Cases and at What Cost?, supra, p. 23.

5.  Pre-term labor.

6.  Infertility.  Between 30 and 40 percent of couples who require in vitro fertilization because of the woman’s infertility are required to do so because of a prior STD infection.  The cost of this procedure, both monetarily and emotionally, is very high.

7.  Miscellaneous others.  As noted in “Sexually Transmitted Diseases in America:  How Many Cases and at What Cost?, supra, p. 23.

“In addition to the economic impact of STDs, the panel noted that STDs have a high human cost in terms of pain, suffering and grief.  Complications of chlamydia and gonorrhea can lead to chronic pain, infertility and tubal pregnancies, which can affect a woman’s health and well-being throughout her lifetime.  The harmful impact of STDs on infants leads to long-term emotional suffering and stress for families which cannot be captured in dollar terms.  Unlike other diseases, STDs often cause stigma and feelings of shame for patients diagnosed with these infections.” (emphasis added)

Thank you for including us among those testifying on this important issue, and the opportunity to respond to the inquiries in your letter.  Please do not hesitate to let us know if we can be of further service.

Sincerely,

Joe S. McIlhaney, Jr., M.D.
President

[Submissions for the record follow:]

Abstinence Educators' Network, Inc., Mason, OH, Melanie Howell, statement