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Chil&mandYouthServicesReview,Vol.19,Nos.5/6,pp.437454, 1997 Copyright @ 1997ElsevierScimceM PrintedintheUSA.AUrightsremved 0197409/97 $17.00+ .00
PII S0190-7409(97)00026-1
Youth Development Programs Douglas I$irby Karin Coyle
ETR Associates Youthdevelopment programsrepresentan alternativewayto reduceteenage pregnancy.Theseprogramsdo notfocuson sexuality,as do traditionalpregnancypreventionprograms.Instead,theystriveto improveadolescents’ life skills,beliefin theirfuture,opportunities, or “lifeoptions”moregenerally. Thatis, theyaddressmotivationto avoidearlychildbearing. Researchon the antecedents of adolescentsexualbehaviorsandpregnancyrates,as wellas the experiencein thiscountryandothercountries,suggestthatyouthdevelopment approachesmaybeeffective. We revieweightstudiesthat haveevaluatedyouthdevelopmentprograms. Althoughtherigorofthesestudiesvariesgreatly,theycollectively suggestthat someyouthdevelopmentprogramsmayeffectivelyreduceadolescentpregnancyor birthrates. Traditional sexuality education programs and family planning programs are designedto provideyouths with the knowledge,attitudes,and skills to avoid sexual intercourseor to use contraceptionproperly, and to provide reasonable access to effective methods of contraception.Although these attributesare critical for avoidanceof unprotectedsex, they are not sufficient. Without motivation,youths are not likely to use their knowledge and skills to avoid pregnancy,nor are they likely to seek access to contraceptives. Recognizingthat motivationto avoid pregnancyis critical to avoiding pregnancy,manyprofessionalsconcernedwith youthsand with adolescent pregnancyare beginningto adopt a youth developmentapproach to adolescent pregnancy.A youth developmentapproach is more holistic than are traditional approaches that focus upon improving adolescent sexual Thisarticlehasheenadapted fromD.Kirby,NoEasyAnswers:ResearchFindingson ProD.C.:National Campaign toPrevent Teen gramsto ReduceTeenPregnancy,(Washington, Pregnancy inWashington, 1997). Reprints maybeobtained fromDouglas Kirby,Ph.D.,Research Director, ETRAssociates, P.O.Box1830,SantaCruz,California 95061[[email protected]] 437
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knowledge,attitudes,norms, and skills, and even on improvingadolescent access to contraceptives.Indeed,one of the underlyingprinciplesof youth developmentis to help prepareyoungpeoplefor adult life, notjust to keep them problem-free(CommunityNetwork for Youth Development,1994). A youth developmentframework provides mechanismsfor youths to fulfill their basic needs, includinga sense of safety and structure,a sense of belongingand group membership,a sense of self-worthand contribution, a sense of independenceand control over one’s life, a sense of closeness and relationshipswith peers and nurturing adults, and a sense of competence. Once these needs are fulfilled, youths can more effectively build competenciesnecessary to become successfuland productiveadults, and they may become more motivatedto avoid early childbearing(Pittman & Cahill, 1991). Fulfilling these needs cannot be done quickly or sporadically; thus, some youth developmentprograms strive to change multiple facets of adolescents’lives over a continuous and prolonged period of time. Youth developmentapproachesto reducingadolescentpregnancyare not new. In the early 1980s(and perhapsbefore),professionalsin the field recognizedthe importanceof programs that improved life options (Dryfoos, 1983).The life options approach to reducing adolescentpregnancy was givenconsiderablesupportin the 1987studytitled Risking the Future and prepared by the National ResearchCouncilof the NationalAcademy of Sciences(Hayes, 1987). More recently,there has been a rapid growth of interest in youth developmentprograms.For example, some nationalnonprofitorganizations concernedwith youthshave recognizedyouthdevelopmentas a promising approachto reducingteen pregnancy(for example,the NationalCampaign to Prevent Teen Pregnancy) (Kirby, 1997). Additionally,some national foundationsare funding the developmentand evaluationof large evaluations of youth developmentapproaches(for example, the Children’sAid Societyin New York City) (Philliber, 1996).Further, some states are redirecting adolescentpregnancypreventionfunds to youth developmentprograms. In California, for example, the Department of Education has a multimilliondollar initiativeto developand implementyouthdevelopment programsto prevent teen pregnancy;a newly created Office of Community Challenge Grants has a large initiative to develop and implement community-basedyouth developmentprogramsto reduce pregnancy;and, finally, the Office of Family Planning has a male initiativethat includes
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youth developmentapproachesfor males. Finally, some federal agencies are funding youth developmentprograms and syntheses of their effects (for example, the National Institute for Child Health and Human Development). There are at least three broad reasons why youth developmentprograms have gained such popularity. Professionals in the field have increasinglyrecognizedthat (1) effective sexualityeducationprogramsand access to condoms and other forms of contraceptionare important, but further improvementsin these programswill have only modest impact on teen pregnancy;(2) several types of evidencesuggestthat youth development programs may be effective; and (3) youth developmentprograms may addressother risk behaviorsthat plaguemanyadolescents. The remainderof this paper presents and discussesthree kinds of evidence suggestingthat youth developmentprogramsmay reduceadolescent pregnancy, including (1) research on the antecedents of teenage pregnancy, (2) the declines in childbearingamong adolescentsin the United States and youngwornenin developingcountriesduring the past five decades, and (3) the evaluation results (often preliminary)of several youth developmentprograms. Antecedents of Adolescent Sexual and Contraceptive Behaviors and Pregnancy
During the past three decades researchers have conducted hundreds of studies of the antecedentsof adolescent sexual behavior,pregnancy,and childbearing, which have been surnmarized in numerous reports (see, Kirby, 1997; Miller, 1995; Moore et al., 1995; Santelli & Beilenson, 1992). The results of the research in this area demonstratethat there are a multitudeof antecedentsthat are related to one or more sexual or contraceptive behaviors, pregnancy, and childbearing,includingcharacteristics of the adolescentsthemselves,of their peers and sexual partners, of their families,and of their communitiesand states (Kirby, 1997).No singleone of these antecedents is highly related to behavior; rather, each of many antecedentsis weakly(or occasionallymoderately)relatedto behavior. The antecedentscan be divided roughly into three groups. The first group includes some of the antecedentsthat are most strongly related to sexual behaviors--thebiologicalantecedents,such as gender, age, testos-
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terone level, and pubertal timing. They are both causally and moderately related to adolescentsexual behavior.For all practicalpurposes,however, thesecannotbe modifiedby socialprograms. The second group includes various attitudes and beliefs directly related to sexual behavior--forexample, beliefs, personal values, perceived norms, and intentions regarding sexual behaviors, pregnancy,and childbearing. Althoughthe results differ with the study, most of these antecedents are weakly or moderatelyrelated to actual sexual and contraceptive behaviors. These are the antecedentsthat are most commonlyaddressed by sexualityeducationprograms. Finally, the third group includesa remarkablylarge proportionof the remaining risk factors, those involving some aspect or manifestationof social disorganization:for example, violent crime, poverty, unemployment, family marital disruption, parents’ lack of education, poor childrearing practices, inappropriatesexual pressure and even abuse, engagement in other problembehaviorsand deviance,poor educationalperformance, and low expectations for the future. Depending on the study and level of analysis, some of these antecedentsare stronglyrelated to sexual behavior, pregnancy, or childbearing, while others are only weakly related. It is this third group of risk factors that are addressed, in part, by youthdevelopmentprograms. The full list of antecedentsin this third group can be used to paint a picture of the youths who are most likely to engage in unprotectedsexual intercourseand to becomepregnant(or to impregnateothers).Clearly,not all youths who engage in unprotected sex and become pregnant (or impregnateothers) have most of the characteristicsin the compositepicture below; indeed many youthsexperiencingunintendedpregnancyhave only a few of the followingcharacteristics.Nevertheless,all of the characteristics in the followingcompositepicturedo increasethe odds of unprotected sex and pregnancy. Youths at greatest risk are more likely to live in communitieswith high residentialturnover (Brewster et al., 1993),low levels of education (Brewsteret al., 1993),high poverty rates (Brewster, 1994),high divorce rates (Brewster et al., 1993) and high rates of adolescent non-marital births (Brewster et al., 1993).Similarly,the parents of these youths have lower levels of education(Mooreet al., 1995),are poorer (Brewsteret al., 1993;Miller et al., 1994),are more likelyto have experienceda divorceor separation or to be single (Miller et al., 1994;Wu & Martinson, 1993),
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and their mothers are more likely to have given birth as adolescents (Sonensteinet al., 1992).In addition,their parents’childrearingpractices are poorer (Feldman & Brown, 1993;Jaccard, Dittus, & Grodon, 1996), and the adolescentsreceive less support or supervisionfrom their parents (Ensrninger, 1990). The youths themselves invest less effort in school (Ohannessian& Crockett, 1993), do more poorly in school (Brewster et al., 1993; Ohannessian & Crockett, 1993; Robbins, Kaplan, & Martin, 1985),and have lower expectationsfor their fhture (Whitley& Schofield, 1986).Even in elementaryschool they are more aggressiveand less well liked by their peers (Underwood, Kupersmidt, & Coie, 1996). They are more likely to use alcohol and drugs excessively,and to engage in other unconventionaland unhealthful behaviors (Costa et al., 1995; HercogBaronet al., 1990;Serbin et al., 1991).They experiencesexualpressureor even abuse (Boyer & Fine, 1992;Miller, Monson,& Norton, 1995).They begin datingwhen they are very young(Koyle,et al., 1989)and, if female, have a relationshipwith an older male (Alan GuttrnacherInstitute, 1994). As a result of all these factors, they are more likely either to want to have a child or to be ambivalentabout havinga child, and these positiveor ambivalentfeelings toward early childbearingaffect their sexual and contraceptivebehaviorsand their actualchildbearing(Zabin, 1994). Although 85% of pregnancies among 15- to 19-year-oldsare unintended (AGI, 1994), many teenagers have ambivalentfeelings about becomingpregnant.These ambivalentfeelingshave been exploredin several highly acclaimed ethnographicstudies. For example, in a study of inner city adolescentfemales who gave birth, Leon Dash discoveredthat many of them had intentionallydecided to become pregnant and have a baby. They gave several reasons, such as to keep a boyfriend,to share the love of a child, and to add more meaningto their lives (Dash, 1989).Anderson (1994)foundthat amonginner-cityyouths,youngmalesengagein sex and father children to prove their sexual prowess, while girls engagein sex to catch a youngman and fulfill dreams(oftenunrealistic)of a better future. Zabin’sstudyof high-riskadolescents17 or youngerwho attendedtwo Baltimoreclinics for pregnancy tests indicates that ambivalencetoward pregnancy is more widespread. About half of those adolescent females were ambivalentabout becoming pregnant and a few wanted to become pregnant (Zabin, 1994). Furthermore, the young females who were ambivalent about early childbearing were just as likely to become mothers during the following two years as the young females who wanted to be-
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come pregnant.This suggeststhat motivationto avoid pregnancymust be rather strong in order for adolescentsconsistentlyand effectively to use contraceptionif they are havingsex. In the past decade, researchers have begun to look more closely at youthswho do not engage in risky behaviorsdespite being exposedto the same risks (for example, Rutter, 1985;Werner & Smith, 1992).This research suggests that there are factors that contribute to a sense of resiliency among these youths, and that these factors “protect” them from turning to risk-takingbehaviors. One of the key protective factors of resilientyouthsis a sense of purposeand future. In sum, the compositepicture above of youths who are disproportionately likely to engage in unprotected sex, the risk factors on which that picture is based, the ethnographicstudiesthat providea more detailedunderstandingof motivation(or lack of motivation)to avoid pregnancy,and the resiliencyliterature all strongly suggestthat programsfocusingexclusively upon sexual knowledge,attitudes, skills, and contraceptiveaccess are not likely to have a large impact on adolescentpregnancy.The data also suggestthat youth developmentprograms,which address severalnonsexual aspects of adolescents’lives--especiallyaspects which, in turn, affect motivationto avoid early childbearing--mayreduce sexual risk-taking behaviorand adolescentpregnancy. The Historical Experience of Developing Countries and the United States
There are dramatic statistics suggesting that improving young women’s educationand life optionsreduce their pregnancyand birth rates. In many countriesthroughoutthe world, as youngwomen’seducationallevels have increased,their employmentopportunitiesalso increasedand their fertility rates declined (PopulationReference Bureau, 1995).Women who obtain more formal education are more likely to delay both marriage and childbearing than are their peers with less formal education(McCauley& Salter, 1995).And UNICEFhas estimatedthat one extra year of schoolingfor girls reducessubsequentfertility rates by 5 to 10%(UNICEF, 1996). In the United States, there has been a period when adolescentpregnancy and birth rates declinedmarkedly.The birth rates for 15-to 19-year olds declined from 90.3 per 1,000 15-19year old women in 1955to 53.0
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in 1980(Hayes, 1987).Comparablefigures for pregnanciesare not available becauseof limiteddata on abortionsduringthat time. Althoughthe causes of this decline in adolescentbirth rates (and presumablypregnancyrates) are not fully understood,it is known that during this period, increasinglylarge percentagesof young women in the United States decided to forgo early marriage and childbearing in pursuit of highereducationand more challengingprofessionalcareers. For example, in 1960 about 38!X0of adolescent females aged 16 to 24 who graduated from high schoolduring the preceding 12 monthsenteredcollege,while in 1980 this percentage had increased to 52% (U.S. Bureau of the Census and U.S. Departmentof Labor, 1996). This explanationfor the decline in the U.S. adolescentbirth rate is also supported by the research on protective factors discussed above. Womenwho had higher educationalaspirationswere more likely to avoid teen pregnancy(Plotnick& Butler, 1991),and for every additionalyear of schooling, African-Americanwomen delayed their first births by more than a year, while white and Latino women delayedtheir childbearingfor nearly a year (Kahn & Anderson, 1992). Youth Development Approaches with Results on Impact
This review of youth developmentprograms includeseight studies meeting two criteria: (1) the programevaluatedwas a youth developmentprogram broadly defined, and did not focus primarily on sexuality’,and (2) the studyprovidedat least minimalevidencefor the impactof the program on sexual or contraceptivevalues, behavior,pregnancyrate, or birth rate. Because few youth developmentprograms have been evaluated,this review includessome programswith very weak evaluationdesignsand preliminarydata. The primary componentsof the eight programsare summarizedin table 1. The programsvaried in the numberand type of componentsdefined as essentialprogramelements.
that focusupon someaspectof sexualityare reviewedin a separatearticleby the IPrograrns sameauthorsin this sameissue,
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Table1 Key Componentsof SelectedYouth DevelopmentProgranw*
*Someof theseprogramsmayhaveprovidedmostof thesecomponents.However,in this table,a programis creditedwitha componentonlyif that programhas identifiedthat componentas a key componentof the program.
For example,the Youth Incentive Entitlement Pilot Projects (YIEPP) had only one key component,namely, the provisionof employment,whereas the programimplementedby the Children’sAid Societyin New York City features multiplekey components(discussionof contraception,provision of medical and reproductivehealth services, provision of academic support, help in getting employmentand actual provision of employment).
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None of the studiesconductedthus far have examinedin any rigorousway which of the componentsare most effective in changing risk behaviors. Each of the eight programsis describedmore fully below. Best Friends. The Best Friends program is an intensive, long-term programfor girls in grades 5 to 12.It is designedto foster self-respectand to promoteresponsiblebehavior,especiallyabstinencefrom sexual intercourse, alcohol,and drugs. Because one of its most importantgoals is for all girls in the program to abstain from sexual intercourseuntil marriage, girls must remain sexually abstinentto remain in the program.The theme of sexualabstinenceis emphasizedin the program’smultiplecomponents: group discussionsheld every three weeks during the schoolday on topics important to adolescents (such as, relationships, physical fitness, and sexuallytransmitteddiseases,includingHIV); role-modelpresentationsby women from the communitywho discuss importantdecisions they made in their lives; weeklymeetingsbetweeneach girl and her mentor(a female member of the school faculty); weekly fitness and nutrition classes after school; special cultural events and communityservice projects; and endof-year recognition ceremonies honoring each girl for her achievements duringthe year. A comparisonof girls in Best Friends in Washington,D.C. and other girls in Washington D.C., revealed that girls in the program were less likely to have participatedin sex or to become pregnant.The strength of this evidence,however,is reducedby the small samplesize, lack of a good comparisongroup, use of different questions to measure sexual activity, and unknown validity of answers to questions about sexual experience amongmembersof the programgroup. Community of Caring. The Communityof Caring program is a comprehensiveK to 12 school-basedprogram that focuses on five important values: caring, trust, respect, responsibility,and family. The program is based on the belief that if youths understand these values, accept them, and base their behavioron them, they will then engagein more pro-social behaviorand less risk-takingbehavior--especiallyin less unprotectedsexual intercourse. To inculcate these values in youths, the Communityof Caring program works with schools, communities,and families. Within schools, the program strives to change school climate and structure. For example, teachers modify the way they teach by including lessons and activities that reinforce the five core values, and by systematicallyrewarding students for actions that reflect the core values. In addition,the
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schoolssponsor student forums and other activitiesthat reinforcethe values. In the community, the Community of Caring program works as a partner with businesses and community groups-students perform community service, and community organizationssupport the program. To involvefamilies, the program sponsorsparent forums and other activities aimedat helpingparents supportthe core valuesin the homeenvironment. The impactof this programhas not yet been well evaluated.However, data from one evaluation suggeststhat it increased student acceptanceof abstinence from sex, increased actual abstinence from alcohol, and improved grades (Balickiet al., 1991).The methodsemployedin that study were limited by a small number of participatingschools, lack of random assignmentof schools, and failure to measure sexual and contraceptive behaviors. Youth Incentive Entitlement Pilot Projects (YIEPP). YIEPP targeted youths from low-income households who were still enrolled in high school(Olsen & Farkas, 1990).It was part of a nationalexperimentbegun in the late 1970sto guaranteejobs to economicallydisadvantagedyouths. All youth still enrolled in school and residing in the participatingcommunities were offered part-timejobs duringthe schoolyear and full-timejobs in the summer, with the requirement that they remain in school. Both types of jobs were minimumwage. The evaluation compared eight matched community sites with and without YIEPP. Notably, it evaluated the impact not on the participating youths,but upon all the youths in the participatingcommunities.This was deemed appropriatebecause the program increased the employmentopportunitiesfor all youths in the participatingcommunities,not just those who participated in the program. Using sophisticated statistical techniques, the study concluded that increasing economic opportunity decreasedadolescentbirth rates amongblacks(the only group studied). Teen Outreach Program (Allen,Philliber,& Hoggson,1990;Philliber and Allen, 1992;Allen, Philliber,Herrling,and Kuperminc,in press). The primaryaim of the Teen Outreach Program(TOP) is to foster the positive developmentof adolescents. TOP uses both volunteer work and small group/classroomdiscussion.Specifically,youths involvedin the program (1) participate in individualand group service projects that impact their communities;(2) engagein discussionsthat enhancetheir personalgrowth and developmentby exploring their values as well as their relationships with family and peers and by developingvaluablelife skills such as com-
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munications,decision making, and goal setting; and (3) use a process of reflectivediscussion to connect learning from the school and TOP classrooms to the service work and their lives. Designed as a nine-monthprognml partkipants typicallymeet in the small groupsfor approximatelyan hour each week, and perform a minimumof 20 hours of volunteerwork duringthe programyear. The evaluationsof this programhave providedsome of the most consistent and strongest evidence that a youth developmentprogram has reduced teen pregnancy.The program has been evaluated for a number of years using common data collected from TOP sites across the nation. From 1984 to 1995, sites identified a local comparisongroup using random assignment procedures when feasible, and using similar students when random assignmentwas not feasible. A total of 9,116 studentsparticipated in this evaluation.Because of the limitationsof the comparison group, TOP was also evaluatedusing a more rigorousdesign in which all studentswere randomlyassignedto receiveTOP or to be part of a control group; from 1991 to 1995,a total of 695 students in 25 sites nationwide participatedin this more rigorous evaluation.Althoughthere exist limitations of the evaluationstudies, they consistentlysuggestthat the program reducedpregnancyrates during the year in which the youths participated. Data also indicate that the program was effective in reducingcourse failure, schoolsuspension,and schooldropoutrates. Severalsuggestionshave been given for these possible positive results: the participantsdeveloped ongoing relationships with caring program facilitators; both supervision and alternative activities reduced the opportunityfor participants to engage in problem behaviors;and the volunteerexperiencesimprovedself-esteemand encouragedparticipantsto think abouttheir future. Quantum Opportunities Project (QOP) (Hahn, 1994).The QOP project is a multiyearprogramstartingin the 9th grade and continuingthrough the high school years. This program was designedto “foster achievement of academic and social competence among high school students from families receiving public assistance.” The program included educational activities(such as tutoring, computer-basedinstruction,homework assistance); service activities (such as communityservice projects, assistance at public events, regularjobs); and developmentactivities(curriculumon life and family skills, and college and job planning).Participantsreceived small stipends and bonus payments for participation and completion of activities, and matching funds for approved activities after high school.
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Specifically,the program guaranteed up to 250 hours of education, 250 hours of service and 250 hours of developmentactivitieseach year from 9th to 12thgrade. Studentsreceivedhourly stipendsrangingfrom $1.00to $1.33per hour. A $100 bonus was providedafter completionof 100hours of programming.An equal amount was placed in an interest-bearingaccount for participants,which was availablefor use for an approvedactivity after high school (such as college or training). Incentives also were used for programstaff. The programwas evaluatedusing a longitudinal,experimentaldesign involvingmultiple sites. The sample included 250 youths (50 from each site) that were selectedrandomlyfrom lists of 8th grade studentsin families receiving public assistance. Within each site, half the students were randomly assigned to the treatment group and half were assigned to the control group. Each site was then required to recruit the youths for participationin the program.Participantscompletedstudy questionnairessix times over a period of four years (fall 1989to fall 1993).A total of 219 youthscompletedthe baseline surveyin the fall of 1989;170students(88 experimental and 82 control) completed the final questionnaire in fall 1993. According to Hahn and his colleagues (1994), there was no evidenceof responsebias attributableto attrition. The evaluation revealed several positive results. For example, program participantshad a significantlylower birth rate than had the control group. Similarly,membersof the experimentalgroup were more likely to have graduated from high school and be enrolled in a post-secondary school than were members of the control group. Further, a significantly greater proportionof youths in the programcomparedwith youths in the control group agreed with the statements“I am hopeful about the future” and “mylife has been a success.” Summer Training and Education Program (STEP) (Walker et al., 1992).The STEP program targeted 14- and 15-year-oldswho resided in poor urban areas and were seriouslybehind academically.During each of two successivesummers,the program provided90 hours of work experience, 90 hours of academic support focusing on remedial reading and math and using innovative instructional methods, and 18 hours of life skills educationthat included sexualityeducation.During the school year between the two summers, the program provided 5 to 15 hours of other support with limited one-on-one adult contact, recreation, and other noneducationactivities.
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The evaluationof STEP was one of the most rigorous in the field of pregnancyprevention.About 4,800 youthsin a summerjob programwere randomly assigned to treatment and control groups and tracked for five years. Thus, the evaluationmeasuredthe impact of the academicsupport, the life skillseducation,and the additionalsupport.Despitethe large sample size and the powerfuldesign,these componentsdid not have a consistent and statisticallysignificantimpact on sexual activity,use of contraception, or pregnancy.Math and reading scores did improve during the first summer, but this positive outcome vanished during the following academicyears. ZHave A Future (Greene, Smith, & Peters, 1995).The programcalled “I Have a Future” targeted African American adolescentsaged 10 to 17 living in public housingprojects. Meharry MedicalCollegeestablishedit in 1987 as a model program to reduce risk behaviors as well as unemployment,and to increase life optionsfor youths.The programincludesa service component and numerous experiential modules. As part of the servicecomponent,program staff implementspecificactivitiesfor youths and their familiesand provideongoingcase management.The experiential modulesincludeFamily Life Education,the EntrepreneurProgram(which has a peer educator/counselorcomponent), Pre-EmploymentTraining, Prosocial Skills (substanceuse prevention),CHARM (ChoosingHow to Adorn and Refine Myself), MATURE (Males Adorning, Thinking, and Using Refined Energies), and Conflict Resolution. The program is groundedin an African value system that promotes seven principles(the Nguzo Saba), includingunity, self-determination,collectivework and responsibility,cooperativeeconomics,purpose, creativity,and faith. These principles,first introducedby MaulanaKerengain the 1960s,are incorporated in all experientialmodules, and form the basis for discussionsregardingcommunityresponsibilityand respect for personal rights and the rights of others. The program was evaluated using a longitudinal,quasi-experimental design involvingfour public housing sites in Nashville,Tennessee.Two of the sites received the program and the other two served as matched controls. Participants completed a self-report questionnairethree times during the study:before programimplementation(pretest), approximately 13 months after the pretest, and approximately17 months after the first posttest.Althoughthe study has severallimitations(such as selectionbias, attrition,changein data collectionproceduresover time), the data indicate
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that the program had a positive impact on participants’acceptanceof the Saba). The data also suggestthat youths who seven principles(the ZVguzo reportedmore life optionsengagedin fewer delinquentbehaviors.Finally, the study found that youths who participated in numerous sessions had muchlower pregnancyrates than had youthsin the comparisongroup. Children’s Aid Society in New York Ci@ (Carrera & Dempsey, 1994; Kaye & Philliber, 1995).One of the most comprehensiveprogramsis that developedand implementedby the Children’sAid Society in New York City. It is based upon the philosophythat it is importantto influencemultiple facets of youths’ lives over a continuous and prolonged period of time. It includes several components.Family life and sex education for both teens and parents cover standardtopics such as reproduction,contraception, and STDS including AIDS, as well as gender and family roles love, intimacy,body image and roles and responsibilitiesin relationships. Medical and health services include reproductivehealth services, annual physical exams, and mental health and counseling services. Dance and dramatic productionshelp teens and their parents explore issues such as racism, family roles, and topics related to self-esteem.Opportunitiesto participatein a variety of sports provideopportunityto master new skills. The job club providestwo hours a week to learn about careers and build work skills, and then job opportunitiesare provided to youth. Staff provide tutoring and help with homework.And finally, college admissionis guaranteed to many of the program participants who complete high school.In the process of providingthese services,staff and volunteersdevelop ongoing relationshipswith the youth in the program, and staff attemptto teach valuesthroughrole modeling,rather than throughlecturing. Currentlythis programis being rigorouslyevaluated,but the results of that evaluationare not yet available.However, a previouscomparisonof the high-risk program participants in New York City with two different populations(that is, all New York City studentsof similar age and a national sample of youth of similar age) indicatesthat the program participants had higher high schoolgraduationrates, lower alcoholuse, later initiationof intercourse,greater use of condomsif sexuallyexperienced,and lower pregnancy rates than had the comparison youths (Kaye and Philliber, 1995).Because of the weak evaluationdesign, these positive findings shouldbe viewedcautiously.They are, nevertheless,encouraging.
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Summary and Conclusions
The results of the research on antecedentsof adolescent sexuai and contraceptivebehavior, pregnancy, and births rates strongly demonstrate that many factors other than knowledge,beliefs, attitudes,skills, and contraceptiveaccess are related to these behaviors.Taken together,this body of research suggests that to have a more marked impact on adolescent childbearing,these risk factors must be addressed. Althoughstudies of the change in birth rates in developingcountries and the declinein the teen pregnancyrate in this countryare only correlational in nature, they provide some evidence that the pursuit of higher education and careers may enhance adolescents’ motivation to avoid childbearing,and may actuailyreducetheir birth rates. There are few studies of youth developmentprograms with experimental or quasi-experimentaldesigns, and severaiof their results are very limitedrnethodologicaily.Their results, however,are encouraging.All but one of the studiessuggeststhat youth developmentprogramsthat focus on education,employment,and/or life optionsmore generailymay markedly reduce adolescent pregnancy rates. Given the cost of adolescent pregnancy,this approachholds promise and shouldbe further explored.None-theless,because the STEP project was not successfulin reducing sexual risk-takingbehavioror pregnancy,additionalresearch is needed to determinewhichcomponentsare most criticaito reducingpregnancyrates. Some of these youth developmentprogramsare relativelycostly on a per-youth basis. Beeause they have other positive outcomes, however, such as increasingeducation,improvingemployment,reducing substance use, and reducing incarceration,they may be very cost-effectivein the long run. Clearly,these types of programwarrantfurther developmentand rigorousevaluation. References
AlanGuttrnacherInstitute.(1994).Sexand america’s teenagers. New York: AlanGuttrnacher Institute. AllenJ.P., PhilliberS., & HoggsonN. (1990).School-basedpreventionof teenagepregnancyandschooldropout:Processevaluationof thenationalreplicationof the teenoutreachprogram.American Journal of Community Psychology, 18(4), 505-524.
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Anderson E. (1994). Sex codes among inner-city youth. in M. Smith (cd.) SexuaZi~, poverty, and the inner city (pp. 1-36).MenloPark, CA: Henry J. Kaiser Family Foundation. Balicki, B.J., Goldenberg, D., Keel, K.S., Burnette, J., & Yates, T. (1991). An evaluation of the Community of Caring-In-Schools Initiative. Final report. Columbia, Maryland: The Center for Health Policy Studies. Boyer, D., & Fine, D. (1992). Sexual abuse as a factor in adolescent pregnancy and child maltreatment. Family Planning Perspectives, 24(l), pp. 4-11. Brewster, K. (1994). Race differences in sexual activity among adolescent women: The role of neighborhood characteristics. American Sociological Review, 59, pp. 408-424. Brewster, K., Billy, J.O., & Grady, W.R. (1993). Social context and adolescent behavior: The impact of community on the transition to sexual activity. Social Forces, 71, pp. 713-740. Carrera, M., & Dempsey. (1994). Carrera/Dempsey replication programs: 1993-94 summary of client characteristics and outcomes. Accord, NY: Philliber Associates. Community Network for Youth Development. (1994). Background paper: Youth development. Unpublished paper. Redwood City, CA: Community Network for Youth Development. Costa, F.M., Jessor, R., Donovan, J.E., & Fortenberry, J.D. (1995). Early initiation of sexual intercourse: The influence of psychosocial unconventionality. Journal of Research on Adolescence, 5(l), 91-121. Dash, L. (1989). When children want children. New York: Penguin Books. Dryfoos, J. (1983). Review of intenentions in the field of prevention of adolescent pregnancy. Preliminary report to the Rockefeller Foundation, New York. Esminger, M.E. (1990). Sexual activity and problem behaviors among black, urban adolescents. Child Development, 61, 2032-2046. Feldman, S., & Brown, N. (1993). Family influences on adolescent male sexuality: the mediational role of self-restraint. Social Development, 2, 15-35. Greene. L.W., Smith, M.S., & Peters S.R. (1995, June). “I Have a Future” comprehensive adolescent health promotion: Cultural considerations in program implementation and design. Journal of Health Care for the Poor and Undeserved, 267-281. Hahn, A., Leavitt, T, & Aaron, P. (1994). Evaluation of the Quantum Opportunities Program (QOP): Did the program work?. Waltham, MA: Center for Human Resources, Brandeis University. Hanson, S.L., Morrison, D.R. & Ginsberg, A.L. (1989). The antecedents of teenage fatherhood. Demography, 26(5), pp. 579-596. Hayes, C.D. (cd). (1987). Risking the future: Adolescent sexuality, pregnancy, and childbearing. Washington, D.C.: National Academy Press.
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Hercog-Baron, R., Harris, K.M., Armstrong, K., Furstenberg, F., & Shea, J. (1990). Factors differentiating effective use of contraception among adolescents. Advances in Adolescent Mental Health, Vol. 4. JessicaKingsley Publishing, Inc. D.C.:National Institute of Medicine. (1995). The best intentions. Washington,
AcademyPress. Jaccard,J., Dittus,P.J.,& Gordon,V.V.(1996).Maternalcorrelatesof adolescentsexualandcontraceptive behavior.Family Planning Perspectives, 28(4). pp. 159-165,185. Kahn,J.R., & Anderson,K.E. (1992).Intergenerational patternsof teenage fertility.Demography, 29(l), 39-57. Kaye,J., & Philliber,S. (1995).Comprehensive adolescent pregnancy prevenAidSociety. tion programs: Are they working? New York:TheChildren’s Kirby,D. (1997).No easy answers. WashingtonDC:NationalCampaignto PreventTeenPregnancy. Koyle,P, Jensen,L., Olsen,J., & Cundick,B. (1989).Comparisonof sexual behaviorsamongadolescentshavingan early,middle,and late first intercourse experience.Youthand Society, 20(4), 461-475. McCauley,A.P., & Salter,C. (1995).Meeting the neea%of young adults. populationreports,SeriesJ, No 41. Baltimore:JohnsHopkinsSchoolof Public Health,PopulationInformation Program. Miller,B.C.(1995).Riskfactorsforadolescentnonmaritalchildbearing. In report to congress on out-of-wedlock childbearing (DHHSPublicationNo. 951257). Miller,B.C.,Monson,B.H.,& Norton,M.C.(1995). The effects of forced sexual intercourse on white female adolescents. Child Abuse & Neglect, 19, 12891301.
Miller,B.C., Norton,M.C.,Curtis,T., Hill,E.J.,Schvaneveldt, P. & Young, M.H.(1994).The timing of sexual intercourse among adolescents: family, peer, and other antecedents. Paperpresentedat the Societyfor Researchon Adolescence. Moore,K.,Sugland,B.,Blumenthal, C.,Glei,D.& Snyder,N. (1995).Aa%lescent pregnancy prevention programs: interventions and evaluations. Washington, D.C.: ChildTrends,Inc. Ohannessian, C.,& Crockett,L. (1993).A longitudinal investigation of therelationshipbetweeneducationalinvestmentandadolescentsexualactivity.Journal ofAaWescent Research, 8(2), 167-182.
Olsen, R.J., & Farkas,G. (1990).The effectsof economicopportunityand familybackgroundon adolescentcohabitationand childbearingamonglowincomeblacks.Journal of Labor Economics, 8, 341-362. Philliber,S.Personalcommunication. November22, 1996. Philliber,S., & Allen,J.P. (1992).Lifeoptionsandcommunityservice:teen outreachprogram.InMiller,B.C.,Card,J.J,Paikoff,R.L.,& Peterson,J.L.(E&.),
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Preventing adolescent pregnancy: model programs and evaluations. (pp. 139155). Newbury Park, CA: Sage Publications. Pittman, K.J., & Cahill, M. (undated). Pushing the Boundaries of Education: The Implications of a Youth Development Approach to Education Policies, Structures, and Collaborations. Undated, pp. 17-28. Plotnick, R.D., & Butler, S.S. (1991). Attitudes and adolescent nonmarital childbearing: evidence from the National Longitudinal Survey of Youth 1991, Journal of Adolescent Research, 6(4), 470-492. Population Reference Bureau. (1995). New perspectives on populations: Lessons from Cairo. Washington, D.C.: Population Reference Bureau. Robbins, C., Kaplan, H.B., & Martin, S.S. (1985). Antecedents of pregnancy among unmarried adolescents. Journal of Marriage and the Family, 47, 567-583. Rutter, M. (1985). Resilience in the face of adversity: protective factors and resistance to psychiatric disorder. British Journal of Psychiatry, 147, 598-611, Santelli, J.S., & Beilenson, P. (1992). Risk Factors for Adolescent Sexual Behavior, Fertility, and Sexually Transmitted Diseases. Journal of School Health, 62(7), 271-279. Serbin, L.A., Peters, P.L., McAffer, V.J., & Schwartzman, A.E. (1991). Childhood aggression and withdrawal as predictors of adolescent pregnancy, early parenthood, and environmental risk for the next generation. Canadian Journal of Behavioral Science, 23(3), 318-331. Sonenstein, F.L., Pleck, J.H., & Ku, L.C. (1992). Cost and opportunity factors associated with pregnancy risk among adolescent males. Paper presented at the Annual Meeting of Population Association of America, Denver, Colorado, April 30, 1992. Underwood, M.K., Kupersmidt, J.B., & Coie, J.D. (1996). Childhood peer sociometric status and aggression as predictors of adolescent childbeming. Journal of Research on Adolescence, 6(2), 201-223. United Nations Children’s Fund. (1996). The state of the world’s children, Oxford: Oxford University Press. U.S. Bureau of the Census, & U.S. Department of Labor. (1996). College enrollment of high school Graduates, various years. Walker, G., & Vilella-Velez, F. (1992) Anatomy of a demonstration. Philadelphia, PA: Public/Private Ventures. Werner, E. & Smith, R. (1992). Overcoming the odds: High-risk childrenjiom birth to adulthood. Ithaca, NY: Cornell University Press. Whitley, B.E., & Schofield, J.W. (1986), A meta-analysis of research on adolescent contraceptive use. Popular Environment, 173-203. Wu, L.L., & Martinson B.B. (1993). Family Structure and the Risk of a Premarital Birth. American Sociological Review, 58, 210-232. Zabin, L.S. (1994). Subsequent risk of childbearing among adolescents with a negative pregnancy test. Family Planning Perspectives, 26(5), 212-217.
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Youth Development Programs Douglas I$irby Karin Coyle
ETR Associates Youthdevelopment programsrepresentan alternativewayto reduceteenage pregnancy.Theseprogramsdo notfocuson sexuality,as do traditionalpregnancypreventionprograms.Instead,theystriveto improveadolescents’ life skills,beliefin theirfuture,opportunities, or “lifeoptions”moregenerally. Thatis, theyaddressmotivationto avoidearlychildbearing. Researchon the antecedents of adolescentsexualbehaviorsandpregnancyrates,as wellas the experiencein thiscountryandothercountries,suggestthatyouthdevelopment approachesmaybeeffective. We revieweightstudiesthat haveevaluatedyouthdevelopmentprograms. Althoughtherigorofthesestudiesvariesgreatly,theycollectively suggestthat someyouthdevelopmentprogramsmayeffectivelyreduceadolescentpregnancyor birthrates. Traditional sexuality education programs and family planning programs are designedto provideyouths with the knowledge,attitudes,and skills to avoid sexual intercourseor to use contraceptionproperly, and to provide reasonable access to effective methods of contraception.Although these attributesare critical for avoidanceof unprotectedsex, they are not sufficient. Without motivation,youths are not likely to use their knowledge and skills to avoid pregnancy,nor are they likely to seek access to contraceptives. Recognizingthat motivationto avoid pregnancyis critical to avoiding pregnancy,manyprofessionalsconcernedwith youthsand with adolescent pregnancyare beginningto adopt a youth developmentapproach to adolescent pregnancy.A youth developmentapproach is more holistic than are traditional approaches that focus upon improving adolescent sexual Thisarticlehasheenadapted fromD.Kirby,NoEasyAnswers:ResearchFindingson ProD.C.:National Campaign toPrevent Teen gramsto ReduceTeenPregnancy,(Washington, Pregnancy inWashington, 1997). Reprints maybeobtained fromDouglas Kirby,Ph.D.,Research Director, ETRAssociates, P.O.Box1830,SantaCruz,California 95061[[email protected]] 437
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knowledge,attitudes,norms, and skills, and even on improvingadolescent access to contraceptives.Indeed,one of the underlyingprinciplesof youth developmentis to help prepareyoungpeoplefor adult life, notjust to keep them problem-free(CommunityNetwork for Youth Development,1994). A youth developmentframework provides mechanismsfor youths to fulfill their basic needs, includinga sense of safety and structure,a sense of belongingand group membership,a sense of self-worthand contribution, a sense of independenceand control over one’s life, a sense of closeness and relationshipswith peers and nurturing adults, and a sense of competence. Once these needs are fulfilled, youths can more effectively build competenciesnecessary to become successfuland productiveadults, and they may become more motivatedto avoid early childbearing(Pittman & Cahill, 1991). Fulfilling these needs cannot be done quickly or sporadically; thus, some youth developmentprograms strive to change multiple facets of adolescents’lives over a continuous and prolonged period of time. Youth developmentapproachesto reducingadolescentpregnancyare not new. In the early 1980s(and perhapsbefore),professionalsin the field recognizedthe importanceof programs that improved life options (Dryfoos, 1983).The life options approach to reducing adolescentpregnancy was givenconsiderablesupportin the 1987studytitled Risking the Future and prepared by the National ResearchCouncilof the NationalAcademy of Sciences(Hayes, 1987). More recently,there has been a rapid growth of interest in youth developmentprograms.For example, some nationalnonprofitorganizations concernedwith youthshave recognizedyouthdevelopmentas a promising approachto reducingteen pregnancy(for example,the NationalCampaign to Prevent Teen Pregnancy) (Kirby, 1997). Additionally,some national foundationsare funding the developmentand evaluationof large evaluations of youth developmentapproaches(for example, the Children’sAid Societyin New York City) (Philliber, 1996).Further, some states are redirecting adolescentpregnancypreventionfunds to youth developmentprograms. In California, for example, the Department of Education has a multimilliondollar initiativeto developand implementyouthdevelopment programsto prevent teen pregnancy;a newly created Office of Community Challenge Grants has a large initiative to develop and implement community-basedyouth developmentprogramsto reduce pregnancy;and, finally, the Office of Family Planning has a male initiativethat includes
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youth developmentapproachesfor males. Finally, some federal agencies are funding youth developmentprograms and syntheses of their effects (for example, the National Institute for Child Health and Human Development). There are at least three broad reasons why youth developmentprograms have gained such popularity. Professionals in the field have increasinglyrecognizedthat (1) effective sexualityeducationprogramsand access to condoms and other forms of contraceptionare important, but further improvementsin these programswill have only modest impact on teen pregnancy;(2) several types of evidencesuggestthat youth development programs may be effective; and (3) youth developmentprograms may addressother risk behaviorsthat plaguemanyadolescents. The remainderof this paper presents and discussesthree kinds of evidence suggestingthat youth developmentprogramsmay reduceadolescent pregnancy, including (1) research on the antecedents of teenage pregnancy, (2) the declines in childbearingamong adolescentsin the United States and youngwornenin developingcountriesduring the past five decades, and (3) the evaluation results (often preliminary)of several youth developmentprograms. Antecedents of Adolescent Sexual and Contraceptive Behaviors and Pregnancy
During the past three decades researchers have conducted hundreds of studies of the antecedentsof adolescent sexual behavior,pregnancy,and childbearing, which have been surnmarized in numerous reports (see, Kirby, 1997; Miller, 1995; Moore et al., 1995; Santelli & Beilenson, 1992). The results of the research in this area demonstratethat there are a multitudeof antecedentsthat are related to one or more sexual or contraceptive behaviors, pregnancy, and childbearing,includingcharacteristics of the adolescentsthemselves,of their peers and sexual partners, of their families,and of their communitiesand states (Kirby, 1997).No singleone of these antecedents is highly related to behavior; rather, each of many antecedentsis weakly(or occasionallymoderately)relatedto behavior. The antecedentscan be divided roughly into three groups. The first group includes some of the antecedentsthat are most strongly related to sexual behaviors--thebiologicalantecedents,such as gender, age, testos-
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terone level, and pubertal timing. They are both causally and moderately related to adolescentsexual behavior.For all practicalpurposes,however, thesecannotbe modifiedby socialprograms. The second group includes various attitudes and beliefs directly related to sexual behavior--forexample, beliefs, personal values, perceived norms, and intentions regarding sexual behaviors, pregnancy,and childbearing. Althoughthe results differ with the study, most of these antecedents are weakly or moderatelyrelated to actual sexual and contraceptive behaviors. These are the antecedentsthat are most commonlyaddressed by sexualityeducationprograms. Finally, the third group includesa remarkablylarge proportionof the remaining risk factors, those involving some aspect or manifestationof social disorganization:for example, violent crime, poverty, unemployment, family marital disruption, parents’ lack of education, poor childrearing practices, inappropriatesexual pressure and even abuse, engagement in other problembehaviorsand deviance,poor educationalperformance, and low expectations for the future. Depending on the study and level of analysis, some of these antecedentsare stronglyrelated to sexual behavior, pregnancy, or childbearing, while others are only weakly related. It is this third group of risk factors that are addressed, in part, by youthdevelopmentprograms. The full list of antecedentsin this third group can be used to paint a picture of the youths who are most likely to engage in unprotectedsexual intercourseand to becomepregnant(or to impregnateothers).Clearly,not all youths who engage in unprotected sex and become pregnant (or impregnateothers) have most of the characteristicsin the compositepicture below; indeed many youthsexperiencingunintendedpregnancyhave only a few of the followingcharacteristics.Nevertheless,all of the characteristics in the followingcompositepicturedo increasethe odds of unprotected sex and pregnancy. Youths at greatest risk are more likely to live in communitieswith high residentialturnover (Brewster et al., 1993),low levels of education (Brewsteret al., 1993),high poverty rates (Brewster, 1994),high divorce rates (Brewster et al., 1993) and high rates of adolescent non-marital births (Brewster et al., 1993).Similarly,the parents of these youths have lower levels of education(Mooreet al., 1995),are poorer (Brewsteret al., 1993;Miller et al., 1994),are more likelyto have experienceda divorceor separation or to be single (Miller et al., 1994;Wu & Martinson, 1993),
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and their mothers are more likely to have given birth as adolescents (Sonensteinet al., 1992).In addition,their parents’childrearingpractices are poorer (Feldman & Brown, 1993;Jaccard, Dittus, & Grodon, 1996), and the adolescentsreceive less support or supervisionfrom their parents (Ensrninger, 1990). The youths themselves invest less effort in school (Ohannessian& Crockett, 1993), do more poorly in school (Brewster et al., 1993; Ohannessian & Crockett, 1993; Robbins, Kaplan, & Martin, 1985),and have lower expectationsfor their fhture (Whitley& Schofield, 1986).Even in elementaryschool they are more aggressiveand less well liked by their peers (Underwood, Kupersmidt, & Coie, 1996). They are more likely to use alcohol and drugs excessively,and to engage in other unconventionaland unhealthful behaviors (Costa et al., 1995; HercogBaronet al., 1990;Serbin et al., 1991).They experiencesexualpressureor even abuse (Boyer & Fine, 1992;Miller, Monson,& Norton, 1995).They begin datingwhen they are very young(Koyle,et al., 1989)and, if female, have a relationshipwith an older male (Alan GuttrnacherInstitute, 1994). As a result of all these factors, they are more likely either to want to have a child or to be ambivalentabout havinga child, and these positiveor ambivalentfeelings toward early childbearingaffect their sexual and contraceptivebehaviorsand their actualchildbearing(Zabin, 1994). Although 85% of pregnancies among 15- to 19-year-oldsare unintended (AGI, 1994), many teenagers have ambivalentfeelings about becomingpregnant.These ambivalentfeelingshave been exploredin several highly acclaimed ethnographicstudies. For example, in a study of inner city adolescentfemales who gave birth, Leon Dash discoveredthat many of them had intentionallydecided to become pregnant and have a baby. They gave several reasons, such as to keep a boyfriend,to share the love of a child, and to add more meaningto their lives (Dash, 1989).Anderson (1994)foundthat amonginner-cityyouths,youngmalesengagein sex and father children to prove their sexual prowess, while girls engagein sex to catch a youngman and fulfill dreams(oftenunrealistic)of a better future. Zabin’sstudyof high-riskadolescents17 or youngerwho attendedtwo Baltimoreclinics for pregnancy tests indicates that ambivalencetoward pregnancy is more widespread. About half of those adolescent females were ambivalentabout becoming pregnant and a few wanted to become pregnant (Zabin, 1994). Furthermore, the young females who were ambivalent about early childbearing were just as likely to become mothers during the following two years as the young females who wanted to be-
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come pregnant.This suggeststhat motivationto avoid pregnancymust be rather strong in order for adolescentsconsistentlyand effectively to use contraceptionif they are havingsex. In the past decade, researchers have begun to look more closely at youthswho do not engage in risky behaviorsdespite being exposedto the same risks (for example, Rutter, 1985;Werner & Smith, 1992).This research suggests that there are factors that contribute to a sense of resiliency among these youths, and that these factors “protect” them from turning to risk-takingbehaviors. One of the key protective factors of resilientyouthsis a sense of purposeand future. In sum, the compositepicture above of youths who are disproportionately likely to engage in unprotected sex, the risk factors on which that picture is based, the ethnographicstudiesthat providea more detailedunderstandingof motivation(or lack of motivation)to avoid pregnancy,and the resiliencyliterature all strongly suggestthat programsfocusingexclusively upon sexual knowledge,attitudes, skills, and contraceptiveaccess are not likely to have a large impact on adolescentpregnancy.The data also suggestthat youth developmentprograms,which address severalnonsexual aspects of adolescents’lives--especiallyaspects which, in turn, affect motivationto avoid early childbearing--mayreduce sexual risk-taking behaviorand adolescentpregnancy. The Historical Experience of Developing Countries and the United States
There are dramatic statistics suggesting that improving young women’s educationand life optionsreduce their pregnancyand birth rates. In many countriesthroughoutthe world, as youngwomen’seducationallevels have increased,their employmentopportunitiesalso increasedand their fertility rates declined (PopulationReference Bureau, 1995).Women who obtain more formal education are more likely to delay both marriage and childbearing than are their peers with less formal education(McCauley& Salter, 1995).And UNICEFhas estimatedthat one extra year of schoolingfor girls reducessubsequentfertility rates by 5 to 10%(UNICEF, 1996). In the United States, there has been a period when adolescentpregnancy and birth rates declinedmarkedly.The birth rates for 15-to 19-year olds declined from 90.3 per 1,000 15-19year old women in 1955to 53.0
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in 1980(Hayes, 1987).Comparablefigures for pregnanciesare not available becauseof limiteddata on abortionsduringthat time. Althoughthe causes of this decline in adolescentbirth rates (and presumablypregnancyrates) are not fully understood,it is known that during this period, increasinglylarge percentagesof young women in the United States decided to forgo early marriage and childbearing in pursuit of highereducationand more challengingprofessionalcareers. For example, in 1960 about 38!X0of adolescent females aged 16 to 24 who graduated from high schoolduring the preceding 12 monthsenteredcollege,while in 1980 this percentage had increased to 52% (U.S. Bureau of the Census and U.S. Departmentof Labor, 1996). This explanationfor the decline in the U.S. adolescentbirth rate is also supported by the research on protective factors discussed above. Womenwho had higher educationalaspirationswere more likely to avoid teen pregnancy(Plotnick& Butler, 1991),and for every additionalyear of schooling, African-Americanwomen delayed their first births by more than a year, while white and Latino women delayedtheir childbearingfor nearly a year (Kahn & Anderson, 1992). Youth Development Approaches with Results on Impact
This review of youth developmentprograms includeseight studies meeting two criteria: (1) the programevaluatedwas a youth developmentprogram broadly defined, and did not focus primarily on sexuality’,and (2) the studyprovidedat least minimalevidencefor the impactof the program on sexual or contraceptivevalues, behavior,pregnancyrate, or birth rate. Because few youth developmentprograms have been evaluated,this review includessome programswith very weak evaluationdesignsand preliminarydata. The primary componentsof the eight programsare summarizedin table 1. The programsvaried in the numberand type of componentsdefined as essentialprogramelements.
that focusupon someaspectof sexualityare reviewedin a separatearticleby the IPrograrns sameauthorsin this sameissue,
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Table1 Key Componentsof SelectedYouth DevelopmentProgranw*
*Someof theseprogramsmayhaveprovidedmostof thesecomponents.However,in this table,a programis creditedwitha componentonlyif that programhas identifiedthat componentas a key componentof the program.
For example,the Youth Incentive Entitlement Pilot Projects (YIEPP) had only one key component,namely, the provisionof employment,whereas the programimplementedby the Children’sAid Societyin New York City features multiplekey components(discussionof contraception,provision of medical and reproductivehealth services, provision of academic support, help in getting employmentand actual provision of employment).
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None of the studiesconductedthus far have examinedin any rigorousway which of the componentsare most effective in changing risk behaviors. Each of the eight programsis describedmore fully below. Best Friends. The Best Friends program is an intensive, long-term programfor girls in grades 5 to 12.It is designedto foster self-respectand to promoteresponsiblebehavior,especiallyabstinencefrom sexual intercourse, alcohol,and drugs. Because one of its most importantgoals is for all girls in the program to abstain from sexual intercourseuntil marriage, girls must remain sexually abstinentto remain in the program.The theme of sexualabstinenceis emphasizedin the program’smultiplecomponents: group discussionsheld every three weeks during the schoolday on topics important to adolescents (such as, relationships, physical fitness, and sexuallytransmitteddiseases,includingHIV); role-modelpresentationsby women from the communitywho discuss importantdecisions they made in their lives; weeklymeetingsbetweeneach girl and her mentor(a female member of the school faculty); weekly fitness and nutrition classes after school; special cultural events and communityservice projects; and endof-year recognition ceremonies honoring each girl for her achievements duringthe year. A comparisonof girls in Best Friends in Washington,D.C. and other girls in Washington D.C., revealed that girls in the program were less likely to have participatedin sex or to become pregnant.The strength of this evidence,however,is reducedby the small samplesize, lack of a good comparisongroup, use of different questions to measure sexual activity, and unknown validity of answers to questions about sexual experience amongmembersof the programgroup. Community of Caring. The Communityof Caring program is a comprehensiveK to 12 school-basedprogram that focuses on five important values: caring, trust, respect, responsibility,and family. The program is based on the belief that if youths understand these values, accept them, and base their behavioron them, they will then engagein more pro-social behaviorand less risk-takingbehavior--especiallyin less unprotectedsexual intercourse. To inculcate these values in youths, the Communityof Caring program works with schools, communities,and families. Within schools, the program strives to change school climate and structure. For example, teachers modify the way they teach by including lessons and activities that reinforce the five core values, and by systematicallyrewarding students for actions that reflect the core values. In addition,the
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schoolssponsor student forums and other activitiesthat reinforcethe values. In the community, the Community of Caring program works as a partner with businesses and community groups-students perform community service, and community organizationssupport the program. To involvefamilies, the program sponsorsparent forums and other activities aimedat helpingparents supportthe core valuesin the homeenvironment. The impactof this programhas not yet been well evaluated.However, data from one evaluation suggeststhat it increased student acceptanceof abstinence from sex, increased actual abstinence from alcohol, and improved grades (Balickiet al., 1991).The methodsemployedin that study were limited by a small number of participatingschools, lack of random assignmentof schools, and failure to measure sexual and contraceptive behaviors. Youth Incentive Entitlement Pilot Projects (YIEPP). YIEPP targeted youths from low-income households who were still enrolled in high school(Olsen & Farkas, 1990).It was part of a nationalexperimentbegun in the late 1970sto guaranteejobs to economicallydisadvantagedyouths. All youth still enrolled in school and residing in the participatingcommunities were offered part-timejobs duringthe schoolyear and full-timejobs in the summer, with the requirement that they remain in school. Both types of jobs were minimumwage. The evaluation compared eight matched community sites with and without YIEPP. Notably, it evaluated the impact not on the participating youths,but upon all the youths in the participatingcommunities.This was deemed appropriatebecause the program increased the employmentopportunitiesfor all youths in the participatingcommunities,not just those who participated in the program. Using sophisticated statistical techniques, the study concluded that increasing economic opportunity decreasedadolescentbirth rates amongblacks(the only group studied). Teen Outreach Program (Allen,Philliber,& Hoggson,1990;Philliber and Allen, 1992;Allen, Philliber,Herrling,and Kuperminc,in press). The primaryaim of the Teen Outreach Program(TOP) is to foster the positive developmentof adolescents. TOP uses both volunteer work and small group/classroomdiscussion.Specifically,youths involvedin the program (1) participate in individualand group service projects that impact their communities;(2) engagein discussionsthat enhancetheir personalgrowth and developmentby exploring their values as well as their relationships with family and peers and by developingvaluablelife skills such as com-
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munications,decision making, and goal setting; and (3) use a process of reflectivediscussion to connect learning from the school and TOP classrooms to the service work and their lives. Designed as a nine-monthprognml partkipants typicallymeet in the small groupsfor approximatelyan hour each week, and perform a minimumof 20 hours of volunteerwork duringthe programyear. The evaluationsof this programhave providedsome of the most consistent and strongest evidence that a youth developmentprogram has reduced teen pregnancy.The program has been evaluated for a number of years using common data collected from TOP sites across the nation. From 1984 to 1995, sites identified a local comparisongroup using random assignment procedures when feasible, and using similar students when random assignmentwas not feasible. A total of 9,116 studentsparticipated in this evaluation.Because of the limitationsof the comparison group, TOP was also evaluatedusing a more rigorousdesign in which all studentswere randomlyassignedto receiveTOP or to be part of a control group; from 1991 to 1995,a total of 695 students in 25 sites nationwide participatedin this more rigorous evaluation.Althoughthere exist limitations of the evaluationstudies, they consistentlysuggestthat the program reducedpregnancyrates during the year in which the youths participated. Data also indicate that the program was effective in reducingcourse failure, schoolsuspension,and schooldropoutrates. Severalsuggestionshave been given for these possible positive results: the participantsdeveloped ongoing relationships with caring program facilitators; both supervision and alternative activities reduced the opportunityfor participants to engage in problem behaviors;and the volunteerexperiencesimprovedself-esteemand encouragedparticipantsto think abouttheir future. Quantum Opportunities Project (QOP) (Hahn, 1994).The QOP project is a multiyearprogramstartingin the 9th grade and continuingthrough the high school years. This program was designedto “foster achievement of academic and social competence among high school students from families receiving public assistance.” The program included educational activities(such as tutoring, computer-basedinstruction,homework assistance); service activities (such as communityservice projects, assistance at public events, regularjobs); and developmentactivities(curriculumon life and family skills, and college and job planning).Participantsreceived small stipends and bonus payments for participation and completion of activities, and matching funds for approved activities after high school.
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Specifically,the program guaranteed up to 250 hours of education, 250 hours of service and 250 hours of developmentactivitieseach year from 9th to 12thgrade. Studentsreceivedhourly stipendsrangingfrom $1.00to $1.33per hour. A $100 bonus was providedafter completionof 100hours of programming.An equal amount was placed in an interest-bearingaccount for participants,which was availablefor use for an approvedactivity after high school (such as college or training). Incentives also were used for programstaff. The programwas evaluatedusing a longitudinal,experimentaldesign involvingmultiple sites. The sample included 250 youths (50 from each site) that were selectedrandomlyfrom lists of 8th grade studentsin families receiving public assistance. Within each site, half the students were randomly assigned to the treatment group and half were assigned to the control group. Each site was then required to recruit the youths for participationin the program.Participantscompletedstudy questionnairessix times over a period of four years (fall 1989to fall 1993).A total of 219 youthscompletedthe baseline surveyin the fall of 1989;170students(88 experimental and 82 control) completed the final questionnaire in fall 1993. According to Hahn and his colleagues (1994), there was no evidenceof responsebias attributableto attrition. The evaluation revealed several positive results. For example, program participantshad a significantlylower birth rate than had the control group. Similarly,membersof the experimentalgroup were more likely to have graduated from high school and be enrolled in a post-secondary school than were members of the control group. Further, a significantly greater proportionof youths in the programcomparedwith youths in the control group agreed with the statements“I am hopeful about the future” and “mylife has been a success.” Summer Training and Education Program (STEP) (Walker et al., 1992).The STEP program targeted 14- and 15-year-oldswho resided in poor urban areas and were seriouslybehind academically.During each of two successivesummers,the program provided90 hours of work experience, 90 hours of academic support focusing on remedial reading and math and using innovative instructional methods, and 18 hours of life skills educationthat included sexualityeducation.During the school year between the two summers, the program provided 5 to 15 hours of other support with limited one-on-one adult contact, recreation, and other noneducationactivities.
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The evaluationof STEP was one of the most rigorous in the field of pregnancyprevention.About 4,800 youthsin a summerjob programwere randomly assigned to treatment and control groups and tracked for five years. Thus, the evaluationmeasuredthe impact of the academicsupport, the life skillseducation,and the additionalsupport.Despitethe large sample size and the powerfuldesign,these componentsdid not have a consistent and statisticallysignificantimpact on sexual activity,use of contraception, or pregnancy.Math and reading scores did improve during the first summer, but this positive outcome vanished during the following academicyears. ZHave A Future (Greene, Smith, & Peters, 1995).The programcalled “I Have a Future” targeted African American adolescentsaged 10 to 17 living in public housingprojects. Meharry MedicalCollegeestablishedit in 1987 as a model program to reduce risk behaviors as well as unemployment,and to increase life optionsfor youths.The programincludesa service component and numerous experiential modules. As part of the servicecomponent,program staff implementspecificactivitiesfor youths and their familiesand provideongoingcase management.The experiential modulesincludeFamily Life Education,the EntrepreneurProgram(which has a peer educator/counselorcomponent), Pre-EmploymentTraining, Prosocial Skills (substanceuse prevention),CHARM (ChoosingHow to Adorn and Refine Myself), MATURE (Males Adorning, Thinking, and Using Refined Energies), and Conflict Resolution. The program is groundedin an African value system that promotes seven principles(the Nguzo Saba), includingunity, self-determination,collectivework and responsibility,cooperativeeconomics,purpose, creativity,and faith. These principles,first introducedby MaulanaKerengain the 1960s,are incorporated in all experientialmodules, and form the basis for discussionsregardingcommunityresponsibilityand respect for personal rights and the rights of others. The program was evaluated using a longitudinal,quasi-experimental design involvingfour public housing sites in Nashville,Tennessee.Two of the sites received the program and the other two served as matched controls. Participants completed a self-report questionnairethree times during the study:before programimplementation(pretest), approximately 13 months after the pretest, and approximately17 months after the first posttest.Althoughthe study has severallimitations(such as selectionbias, attrition,changein data collectionproceduresover time), the data indicate
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that the program had a positive impact on participants’acceptanceof the Saba). The data also suggestthat youths who seven principles(the ZVguzo reportedmore life optionsengagedin fewer delinquentbehaviors.Finally, the study found that youths who participated in numerous sessions had muchlower pregnancyrates than had youthsin the comparisongroup. Children’s Aid Society in New York Ci@ (Carrera & Dempsey, 1994; Kaye & Philliber, 1995).One of the most comprehensiveprogramsis that developedand implementedby the Children’sAid Society in New York City. It is based upon the philosophythat it is importantto influencemultiple facets of youths’ lives over a continuous and prolonged period of time. It includes several components.Family life and sex education for both teens and parents cover standardtopics such as reproduction,contraception, and STDS including AIDS, as well as gender and family roles love, intimacy,body image and roles and responsibilitiesin relationships. Medical and health services include reproductivehealth services, annual physical exams, and mental health and counseling services. Dance and dramatic productionshelp teens and their parents explore issues such as racism, family roles, and topics related to self-esteem.Opportunitiesto participatein a variety of sports provideopportunityto master new skills. The job club providestwo hours a week to learn about careers and build work skills, and then job opportunitiesare provided to youth. Staff provide tutoring and help with homework.And finally, college admissionis guaranteed to many of the program participants who complete high school.In the process of providingthese services,staff and volunteersdevelop ongoing relationshipswith the youth in the program, and staff attemptto teach valuesthroughrole modeling,rather than throughlecturing. Currentlythis programis being rigorouslyevaluated,but the results of that evaluationare not yet available.However, a previouscomparisonof the high-risk program participants in New York City with two different populations(that is, all New York City studentsof similar age and a national sample of youth of similar age) indicatesthat the program participants had higher high schoolgraduationrates, lower alcoholuse, later initiationof intercourse,greater use of condomsif sexuallyexperienced,and lower pregnancy rates than had the comparison youths (Kaye and Philliber, 1995).Because of the weak evaluationdesign, these positive findings shouldbe viewedcautiously.They are, nevertheless,encouraging.
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Summary and Conclusions
The results of the research on antecedentsof adolescent sexuai and contraceptivebehavior, pregnancy, and births rates strongly demonstrate that many factors other than knowledge,beliefs, attitudes,skills, and contraceptiveaccess are related to these behaviors.Taken together,this body of research suggests that to have a more marked impact on adolescent childbearing,these risk factors must be addressed. Althoughstudies of the change in birth rates in developingcountries and the declinein the teen pregnancyrate in this countryare only correlational in nature, they provide some evidence that the pursuit of higher education and careers may enhance adolescents’ motivation to avoid childbearing,and may actuailyreducetheir birth rates. There are few studies of youth developmentprograms with experimental or quasi-experimentaldesigns, and severaiof their results are very limitedrnethodologicaily.Their results, however,are encouraging.All but one of the studiessuggeststhat youth developmentprogramsthat focus on education,employment,and/or life optionsmore generailymay markedly reduce adolescent pregnancy rates. Given the cost of adolescent pregnancy,this approachholds promise and shouldbe further explored.None-theless,because the STEP project was not successfulin reducing sexual risk-takingbehavioror pregnancy,additionalresearch is needed to determinewhichcomponentsare most criticaito reducingpregnancyrates. Some of these youth developmentprogramsare relativelycostly on a per-youth basis. Beeause they have other positive outcomes, however, such as increasingeducation,improvingemployment,reducing substance use, and reducing incarceration,they may be very cost-effectivein the long run. Clearly,these types of programwarrantfurther developmentand rigorousevaluation. References
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