Statement of Rebecca A. Maynard, Ph.D., University Trustee Chair Professor,
University of Pennsylvania, and Director, National Title V Abstinence Education Program Evaluation,
and Amy Johnson, Ph.D., Senior Researcher, Mathematica Policy Research, Inc.

Testimony Before the Subcommittee on Human Resources
of the House Committee on Ways and Means

Hearing on Teen Pregnancy Prevention

November 15, 2001

Thank you for giving us the opportunity to submit testimony on this important issue and to share some information based on our experiences from the national evaluation of Title V abstinence education programs being conducted by Mathematica Policy Research, Inc., under contract to the U.S. Department of Health and Human Services.  We will focus our remarks on three main topics.  First, we will discuss the need for scientifically rigorous research to improve future policies and practice aimed at reducing teen sexual activity and its adverse consequences, including nonmarital childbearing and sexually transmitted diseases (STDs).  Second, we will discuss important ways in which federal support for abstinence education has changed local conversations and approaches to reducing teen sexual activity. Third, we will describe what the national evaluation of Title V abstinence education programs will contribute to our knowledge base and when we will report study findings.

The Need for Investing in Careful Research

Teen pregnancy and birth rates have declined steadily since the early 1990s.  However, five years after passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), teen sexual activity and its consequences remain important issues, particularly nonmarital and unintended births and sexually transmitted diseases.  We need to pay close attention to some of the significant efforts launched in recent years to combat these problems.  We need to build on their successes.  We also need to learn about and respond to those areas where efforts are not achieving their intended goals.

Despite the steady decline in the teen birth rate between 1991 and the present—from a high in 1991 of 62 births per 1,000 females age 15 to 19, to 49 births per 1,000 last year¹ many concerns persist:

• Nearly half of all high school students and more than two-thirds of graduating seniors in this country have had sexual intercourse.²
• One in five high school seniors reports having had sex with four or more partners.²
• More than 40 percent of teens failed to use any protection against STD infections during their last sexual encounter.²
• An estimated 25 percent of sexually active teens will contract a sexually transmitted disease this year.
• Nearly 500,000 babies are born each year to teens, more than 80 percent of whom are not married.³

The 1996 welfare reforms heightened the public’s awareness of the nature and extent of problems associated with teen sexual activity, teen childbearing, and nonmarital childbearing.  The reforms also fostered targeted efforts to discourage sex among teenagers, to reduce teen pregnancies and births, and to promote stronger family relationships.  Specifically, the reforms did the following:

• Required state welfare plans to focus on out-of-wedlock and teen childbearing and offered a total of $20 million in bonuses to states that were especially successful in reducing their nonmarital birth ratio.
• Increased the emphasis on statutory rape laws and required minor parents to live in supervised settings.
• Allowed use of federal Temporary Assistance to Needy Families (TANF) funds to support family planning services.
• Provided $50 million annually in federal support for Title V abstinence education programs, which is matched by roughly $38 million in state and local funds.

At this point, we have no definitive evidence linking any of these provisions with favorable trends in teen pregnancies and births.  However, we have abundant evidence that the federal support of abstinence education, in particular, has focused attention at the state and local level on the problems of teenage sexual activity and nonmarital childbearing, and that this focus has led to expansion in the number and variety of abstinence education programs. An important complement to these policy and program initiatives is the investment by the U.S. Department of Health and Human Services in a rigorous research study of Title V abstinence education programs.  The study will fill a small, but very important, portion of the knowledge gap by helping us understand how best to design and implement abstinence programs that are successful in reducing nonmarital sexual activity and childbearing.

Changes at the Local Level as a Result of Abstinence Education Funding

The federal government’s commitment of $50 million annually to support abstinence education through the Title V Block Grant Program has had three major impacts.  First, it has expanded and changed the conversation about the role of abstinence education in local communities and schools. Second, it has fostered the development of new strategies for promoting abstinence among youth. Third, it has increased significantly the number of abstinence education service providers and the number of youth they serve.

One only needs to read the newspapers to be aware of the heightened focus, at both the state and the local level, on health, sex education, and abstinence education policies.  However, the numbers provide more concrete evidence of change.  In 1988, only 2 percent of school districts reported teaching abstinence as the sole way to prevent pregnancy and sexually transmitted diseases; by 1999, 23 percent reported such policies.⁴  Today, 23 states incorporate contraception into their curricula, and 26 states teach abstinence.⁵  In part, this increased emphasis on abstinence reflects the fact that, in many communities, it is the only strategy for reducing teen pregnancies that is consistent with local norms and values.  In other cases, abstinence education programs are viewed as important complements to other existing strategies focused on curbing high rates of sexual activity, pregnancies, and nonmarital births.

Title V funding has fostered the development of myriad new strategies for promoting abstinence and expanded the concept of abstinence education.  The earliest grassroots abstinence education programs tended to be more homogeneous, classroom-based programs focusing on the benefits of abstinence and the negative consequences of sex outside of marriage.  In contrast, many of the current programs—including Best Friends here in Washington, DC, and ReCapturing the Vision in Miami, Florida—take a broader approach, linking abstinence and other healthy behavioral choices for young people. The major quality distinguishing them from many other youth development initiatives in our country is their clear, consistent message that abstinence is the healthiest choice and the only way to prevent unintended pregnancies and sexually transmitted diseases.

Contrary to popular opinion, the vast majority of current Title V abstinence education programs offer much more than a “just say no” message.  As noted previously, many have extensive youth development and mentoring components; they often include educational and cultural enrichments; and they frequently incorporate curricula and experiences designed to teach about healthy friendships and marital relationships. 

The majority of the Title V abstinence education programs target most of their services on identifiable groups of youth.  The following table illustrates the range of such programs: 

TABLE 1
ILLUSTRATIVE TARGETED TITLE V ABSTINENCE EDUCATION PROGRAMS

Other programs are using Title V monies to increase public awareness, shape attitudes, and change behavior throughout the community.  Many community-wide programs also complement their public education and messaging efforts with more targeted services to provide particular groups of youth with the skills and values needed to remain abstinent.  The following are examples of such efforts:

TABLE 2
ILLUSTRATIVE TITLE V COMMUNITY-WIDE ABSTINENCE EDUCATION PROGRAMS

The $50 million annual federal investment in abstinence education through Title V has been a huge boost to the abstinence-until-marriage movement.  Federal program funds have leveraged at least that much again in local matching funds to support more than 700 programs nationwide.  And, funds for abstinence education through the Special Projects of Regional and National Significance (SPRANS) grant program administered by the Health Resources and Services Administration recently added another $20 million to support 49 additional grantees operating a similar range of programs.⁶

If additional funds were available, it is clear that many current programs would grow and that new programs would emerge.Particularly in communities with the more intensive youth-development programs, demand for abstinence programs frequently exceeds current capacity, as evidenced by program waiting lists and requests for programs to expand to new sites.  Many communities with classroom-based programs are interested in beginning them earlier and/or running them longer.  One of the biggest future challenges is knowing which models and delivery strategies will work best for a particular community or with a particular group of youth—issues that are central to the ongoing evaluation of Title V abstinence education programs we are conducting.

What Will the National Evaluation of Title V Abstinence Education Programs Contribute?

Congress identified the promotion of abstinence education as an important strategy for preventing teen sexual activity, nonmarital pregnancies and births, and sexually transmitted diseases.  The central focus of the Congressionally mandated study of the Title V programs is to provide much-needed, scientifically rigorous evidence about which program models are effective, for whom, and in what local contexts.  The study will measure the success of different program models in altering youths’ attitudes and intentions about nonmarital sex, reducing sexual activity among teens, convincing youth who have had sex to become abstinent, and lowering exposure to sexually transmitted diseases and nonmarital births. 

The Title V program evaluation findings should have much greater credibility than findings from previous research, because of critical features of the study design and implementation:

1.  We are measuring program impacts using scientifically rigorous, experimental design methods.  This is the ONLY means of measuring with a known degree of certainty how successful the programs are overall and for key subgroups of youth.  Findings based on any other evaluation design could be readily dismissed for their weak study design and the potential for “selection bias.”  This would include results based designs that relied on comparisons of pre- and post-program outcomes for program youth; comparisons of outcomes for program youth with those for youths in the program site who, for some reason, do not participate in the program; and comparisons of outcomes for program youth with those for youth in another school or district.

2.  The impact evaluation is examining five quite different programmatic strategies geared, in part, to the needs of the communities in which they are operating.  For example, the programs in two sites serve mainly youth from single-parent households; these programs are intensive and include strong components on relationship development and maintenance, and appreciation of the institution of marriage.  In another site, many youth live in large, multi-generational households often isolated from the broader community.  The program in this community is delivered through the schools and emphasizes both basic knowledge development and peer pressure management components. Youth in another two sites live in communities that mirror “middle America.” The program in one of these sites is a low-cost, school-based intervention, while that in the other site is a more comprehensive and intensive youth development initiative.  By measuring impacts for a range of program models we promote the goal of identifying and documenting effective abstinence education strategies appropriate to varied local needs and contexts.

3.  We have designed student surveys to ensure that program and control youth apply common definitions when answering questions about sexual activity and abstinence.  Participation in abstinence education programs sometimes leads youth to change their definitions of what constitutes sexual activity and abstinence.  Failure to address such program-induced changes in definitions could result in a downward bias in the reporting of abstinence by program youth relative to control youth and thereby limit our ability to detect true program impacts.  It is, therefore, essential that we clearly ask about the specific behaviors of interest.

4.  We use interviewers who are independent of the programs to collect all student survey data for the study.  Research shows that youth are especially likely to underreport sexual activity and other risk-taking behaviors on surveys linked to or administered by program staff.  Reporting accuracy can be improved through carefully designed surveys administered by independent professionals in neutral settings.

5.  We are following youth for between 18 and 36 months after sample enrollment.  This follow-up permits the study to measure behavior changes, not just changes in reported intentions.  It also allows us to observe more youth as they reach the age when they are at substantial risk of engaging in sexual activity.

6.  We have enrolled samples of 400 to 700 youth per site.  Large sample sizes protect against the possibility that we would fail to detect true impacts of the programs, simply because the study lacked statistical power. Small samples have a very high probability of missing all but very large program impacts.

7.  We are establishing a foundation for longer-term assessment of systemic change resulting from community-wide programs.  Changing community norms and values is a cumulative process that takes time.  As part of the Title V program evaluation, we are documenting the operational strategies of a select group of such programs.  However, it may take many years to reliably link operational success to changes in community norms and youths’ behaviors.  Fortunately, some of these projects have instituted indicator-tracking systems that will support their ongoing efforts to gather evidence of cumulative changes in local behaviors beyond the period when the national evaluation of Title V programs is ongoing.

We are committed to conducting a scientifically rigorous, responsible evaluation that will inform future decisions about effective intervention strategies and policies to support and promote them.  Results based on only part of our study sample are susceptible to missing all but very large program impacts. Thus, evidence on the short-term effects of the various program strategies in changing norms, attitudes, and behaviors will not be available until we have data for the full study sample, early in 2003.  The final impact findings will be available early in 2005.  Throughout the study period, we are monitoring program operational experiences and the local community context, as well as other related research that emerges.

The Title V program evaluation will generate some very important information to guide future policy and program initiatives.  It is important, however, that there be other similarly rigorous studies to fill other critical knowledge gaps about the causes of youths’ risk-taking behaviors, about ways we can promote healthier life choices among youth, and about strategies to mitigate the adverse outcomes youth encounter.

1.  Child Trends.  Facts at A Glance, Washington, DC:  Child Trends,  August 2001.  The original data are from National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD.

2.  Centers for Disease Control.  “Youth Risk Behavior Surveillance—United States, 1999.”  CDC Mortality and Morbidity Weekly Report Summaries, vol. 49, SS05, June 9, 2000 and vol. 47, no. 36,  September 18, 1998 (www.cdc.gov/mmwr/PDF/SS/SS4905.pdf and www.cdc.gov/mmwr/PDF/wk/mm4736.pdf, respectively).

3.  Child Trends.  Facts at A Glance, Washington, DC:  Child Trends, August 2001.

4.  Darrroch, J.E., D.J. Landry, and S. Singh.  “Changing Emphases in Sexuality Education in the U.S. Public Secondary Schools, 1988-1999.”  Family Planning Perspectives, vol. 32, no.5, September/October 2000, pp. 204-211.

5.  Wertheimer, R., J. Jager, and K. Moore.  “State Policy Initiatives for Reducing Teen and Adult Nonmarital Childbearing:  Family Planning to Family Caps.”  New Federalism Issues and Options for States, Series A, No.  A-43.  Washington, DC:  Urban Institute, November 2000.

6.  Lawler, Michele.  “Abstinence Education Grant Program, Health Resources and Services Administration, U.S. Department of Health and Human Services.”  Presentation at the Abstinence Clearinghouse International Conference, Miami, FL, July 26, 2001.