Emerging Answers 2007: Research Findings on Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases By Doulgas Kirby, PH.D. Presenter:

This Presentation Will Cover: About the National Campaign Latest data on teen pregnancy Risk and protective factors Characteristics of effective programs Programs that work to prevent teen pregnancy Implications for the field

The National Campaign to Prevent Teen and Unplanned Pregnancy The Campaign’s mission is to improve the well-being of children and families, and in particular, to help ensure that children are born into stable, two-parent families who are committed to and ready for the demanding task of raising the next generation by preventing teen pregnancy Our specific strategy is to prevent teen pregnancy and unplanned pregnancy among single, young adults

New Goal We celebrated our 10th anniversary in 2005 and set a new national goal: another 1/3 reduction in the teen pregnancy rate over the coming decade We challenge states to set their own goals 2 in 10 by 2015! When we were founded in 1996, we set a 10-year goal for a one-third reduction in the teen pregnancy rate. Many people thought that was too ambitious and such progress was impossible. Well, our nations’ teens proved them wrong…and by the latest data, it looks like the nation will indeed meet this goal. So we set another goal. TO PUT IT SIMPLY 4 IN 10 girls pregnant before age 20 (in 1991) 3 IN 10 girls pregnant before age 20 (currently) 2 IN 10 girls pregnant before age 20 (goal for 2015) We also challenged states to set their own 10 year goals

Our Strategy Research Influence cultural values and messages Unusual Partners Partners The NC Teen Voices Teen Voices Strengthen Strengthen state & local programs state & local programs Tolerance & Tolerance & Bipartisanship Bipartisanship

Overview of Emerging Answers 2007 Summarizes the research on Sexual risk behaviors, factors of influence and consequences Characteristics of effective programs What programs and strategies work to prevent teen pregnancy and sexually transmitted diseases (STDs)

Teen Pregnancy 3 in 10 teen girls get pregnant at least once before their 20th birthday In the U.S. more than 750,000 teen girls were pregnant in 2002 alone -In 2000 (latest year for which data is available for teen pregnancy rate) Nevada had the highest rate of teen pregnancy with 113 per 1,000 teen girls; North Dakota had the lowest teen pregnancy rate with 42 per 1,000 teen girls. - In 2000 (latest year for which data is available for number of teen pregnancy) the teen pregnancy rate by Race/Ethnicity: Non-Hispanic Whites 55 per 1,000, 153 per 1,000 African Americans, and Hispanics 138 per 1,000 teen girls.

National Teen (15- 19) Pregnancy Rates, 1972-2002 -The most recent data on the teen pregnancy rate is from 2002. In 2002, the teen pregnancy rate was at an all-time low of 75.4 pregnancies per 1,000 teen girls aged 15-19. The rate dropped 36% between 1990 and 2002.

Teen Pregnancy Rates by Race/Ethnicity, 1990-2002 Birth rates per 1,000 teen girls -Teen pregnancy rates, and rates of decline, vary substantially among the largest racial/ethnic subgroups. Between 1996 and 2000, teen pregnancy rates declined 29% for non-Hispanic Whites and 19% for Hispanics. From 1992 to 2000, the rate of teen pregnancy for African Americans declined 29%.

Teen Birth Rates in the United States, 1940 – 2006* Birth rates per 1,000 teen girls -In 2006, the preliminary birth rate for girls increased for the first time in 15 years (since 1991). -The rate in 2006 is 41.9 per 1,000 teen girls (aged 15-19) up from a final birth rate of 40.5 per 1,000 in 2005, there was an increase of 3% between 2005 and 2006.   -Given the recent increase in teen births, the teen birth rate still decreased 32% between 1991 and 2006. *Data for 2006 are preliminary

Teen Birth Rates by Race/Ethnicity 1980-2006* Birth rates per 1,000 teen girls -The 2006 preliminary birth rate rates by Race/Ethnicity: -Non-Hispanic White teens is 26.6 -Non-Hispanic Black teens is 63.7 -American Indian teens is 54.7 -Asian/Pacific Islander teens is 16.7 -Hispanic teens is 83.0 -All rates are per 1, 000. -Non-Hispanic White teens is up 3% from 25.9 in 2005. -Non-Hispanic Black teens is up 5% from 60.9 in 2005. -American Indian teens up 4% from 52.7 in 2005. -Asian/Pacific Islander teens is down 2% from 17.0 in 2005. -Hispanic teens is up 2% from 81.7 in 2005. -Teen birth rates, and rates of decline, vary substantially among the largest racial/ethnic subgroups. Between 1991 and 2005, teen birth rates declined 48% for African-Americans, 37% for Native Americans, 40% for non-Hispanic Whites, 38% for Asian/Pacific Islanders, and 22% for Hispanics. The decline for all teens was 34%. However, there was a slight increase in the teen birth rate for all teens in between 2005 and 2006. This increase occurred among all racial/ethnic groups, except for Asian and Pacific Islander teens. The increase was the greatest among African American teens (4%) and was the least among Hispanic teens (2%). -note: Hispanic and Non-Hispanic Whites rate began in 1990 due to changes made with birth certificates. Before 1990 data on mother's race and Hispanic ethnicity were not reported separately on the birth certificate. *Data for 2006 are preliminary

Sexual Activity In 2005, about half (47 %) of all high school students reported they have had sexual intercourse Among high school students, 68 % of African American, 51 % of Hispanic, and 43 % of whites Reported they had ever had sexual intercourse -The percentage of high school students who have had sex decreased 13.3 percent between 1991 and 2005 Source: Youth Risk Behavior Survey 2005

Contraceptive Use Three quarters of teen girls (74%) and more than eight in ten teen boys (82%) report using contraception the first time they have sex 83% of teen girls and 90% of teen boys report using contraception the last time they had sex Condoms and oral contraceptives are the two most commonly used methods of contraception -The proportion of teen girls who report using contraception at last sex varies by race/ethnicity. 89 percent of white girls, 74 percent of African-American girls, and 63 percent of Hispanic girls used one or more methods of contraception at last sex (2002 National Survey of Family Growth).

Behaviors that Affect Teen Pregnancy and STD Teens can avoid pregnancy and reduce the risk of STDs/HIV by: Abstaining from sex Limiting the number of sexual partners Increasing amount of time between sexual partners Reducing the frequency of sex, using condoms, and being tested and treated for STDs Being vaccinated against hepatitis B and HPV (human papillomavirus)

Behaviors that Affect Teen Pregnancy and STD In order to effectively reduce teen pregnancy and STDs/HIV communities and organizations should specifically target one or more of the behaviors identified in the previous slide Communities and organizations should review data on: Pregnancy and STD rates Sexual behavior among teens Cultural beliefs and values Existing education programs and resources

Risk and Protective Factors More than 500 factors are known to increase (risk factors) or decrease (protective factors) the chances that teens will engage in risky sexual behavior Some factors involve sexuality directly; others affect sexuality indirectly -Doug Kirby has done extensive work documenting risk and protective factors. Chapter 3 in Emerging Answers provides a brief snapshot of this work, and includes some of the key risk and protective factors. -Risk and protective factors include those things that are extremely difficult, if not impossible, to change such as community disorganization, family structure, parental education, etc. However, there are also factors that can be influenced or changed by programs.

Risk and Protective Factors Risk and protective factors are rooted in: Communities (e.g. exposure to violence and substance use) Families (e.g. the presence of both biological parents, parents who express and model responsibility values about sex and contraception, a close relationship with parents) Friends and peers (e.g. poor performance in school, drug use, permissive and unprotected sex) Romantic partners (e.g. an older boy friend) Teens themselves (e.g. values, attitudes, perceptions of peer norms, self-efficacy, and intentions about sex or the use of contraception)

Risk and Protective Factors Teen’s own sexual beliefs, values, and attitudes are the factors most strongly related to sexual behavior Some factors can be more easily modified through programmatic interventions than others Organizations concerned with preventing teen pregnancy and STDs should focus on the factors most strongly related to sexual behavior

Characteristics of Effective Programs The process of developing the curriculum The contents of the curriculum itself The process of implementing the curriculum -After identifying the risk and/or protective factors that you would like to target, you should identify a curriculum that targets these behaviors. If you want to design your own program, keep these characteristics in mind. -Dr. Kirby has also identified 17 characteristics of effective programs. These characteristics are particularly helpful if you’d like to assess your program, or if you are trying to create a program, or decide which program might have the best chance of success in your community. Encourage providers to use programs that have been proven to be effective, but if this is not possible to consider the 17 characteristics as they either design or assess their own program. These characteristics fall into 3 distinct categories. Development, content, and implementation

The Process of Developing the Curriculum Involved multiple people with expertise in theory, research, and sex and STD/HIV education to develop the curriculum Assessed relevant needs and assets of the target group Used a logic model approach that specified the health goals, the types of behavior affecting those goals, the risk and protective factors affecting those types of behavior, and activities to change those risk and protective factors

The Process of Developing the Curriculum 4. Designed activities consistent with community values and available resources (e.g. staff time, staff skills, facility space and supplies) 5. Pilot-tested the program

The Contents of the Curriculum Itself —Curriculum Goals and Objectives— 6. Focused on clear health goals—the prevention of STD/HIV, pregnancy, or both 7. Focused narrowly on specific types of behavior leading to these health goals (e.g. abstaining from sex or using condoms or other contraceptives), gave clear messages about these types of behavior, and addressed situations that might lead to them and how to avoid them

The Contents of the Curriculum Itself —Curriculum Goals and Objectives— 8. Addressed sexual psychosocial risk and protective factors that affect sexual behavior (e.g. knowledge, perceived risks values, attitudes, perceived norms, and self-efficacy) and changed them

The Contents of the Curriculum Itself —Activities and Teaching Methodologies— 9. Created a safe social environment for young people to participate 10. Included multiple activities to change each of the targeted risk and protective factors 11. Employed instructionally sound teaching methods that actively involved participants, that helped them personalize the information, and that were designed to change the targeted risk and protective factors

The Contents of the Curriculum Itself —Activities and Teaching Methodologies— 12. Employed activities, instructional methods, and behavioral messages that were appropriate to the teen’s culture, developmental age, and sexual experience 13. Covered topics in a logical sequence

The Process of Implementing the Curriculum 14. Secured at least minimal support from appropriate authorities, such as departments of health, school districts, or community organizations 15. Selected educators with desired characteristics (whenever possible), trained them, and provided monitoring supervision, and support

The Process of Implementing the Curriculum 16. If needed, implemented activities to recruit and retain teens and overcome barriers to their involvement (e.g. publicized the program, offered food or obtained consent) 17. Implemented virtually all activities with reasonable fidelity

Effective Programs

What was the Criteria for Inclusion in Emerging Answers 2007? Completed or published between 1990 and 2007 Conducted in the United States Targeted middle/high school age teens Employed an experimental or quasi-experimental design with appropriate statistical analyses Had a sample size of at least 100 in the combined treatment and control group Measured impact on teen sexual behavior -Evidence of programs’ effects on teen sexual behavior is only as strong as the research methods used to evaluate those programs. Fourteen criteria were used to judge the research methods used by the studies in this review and the strength of the evidence they produce: 1.Use of experimental or quasi-experimental designs versus analyses of data obtained without such designs 2. Use of random assignment of individual teens or groups of teens (such as classrooms or schools)—experimental versus quasi-experimental designs 3. Sample size—number of individual teens in the study 4. Number of clusters of teens or geographic areas assigned to intervention or comparison groups 5. Long-term follow-up 6. Attrition and response rates 7. Measurement of pregnancy and STD 8. Measurement of behavior 9. Measurement of factors affecting sexual behavior 10. Correct statistical analyses 11. Publication of results 12. Replication of studies 13. Independent external evaluators 14. Sampling of programs

Emerging Answers 2007 identifies: 115 program evaluations overall 15 programs with strongest evidence of success -7 curriculum-based sex and STD/HIV education programs -1 Mother-adolescent program -2 clinic protocols and one-on-one programs -1 community programs with multiple components -2 service learning -2 multi-component programs with intensive sexuality and youth development components

Curriculum-Based Sex and STD/HIV Education Programs Based on written curriculum Implemented among groups of young people in school, clinic, or community settings Education programs focused on both behavior and risk and protective factors that mediate behavior -Two thirds of the 48 programs studied were successful—that is they had a significant positive impact on at least one aspect of sexual behavior or lowered the rates of pregnancy, childbearing, or STD. Results showed that 15 of 32 (47%) programs delayed the initiation of sex, 6 of 21 (29%) reduced the frequency of sex, and 11 of 24 (46%) reduced the number reduced the number of sexual partners. None of the programs hastened the initiation of sex. In addition, 15 of 32 (47%) of the programs increased condom use, 4 of 9 (44%) increased the use of other contraceptives, and 15 of 24 (63%) reduced sexual risk through changes in a combination of types of behavior. Thus, strong evidence shows that these programs do not increase sexual activity and, moreover, that some of them reduce sexual activity, increase the use of condoms or other contraceptives, or both.

Curriculum-Based Sex and STD/HIV Education Programs Programs with strongest evidence of success: Becoming a Responsible Teen: An HIV Risk reduction Program for Adolescents ¡Cuídate! (Take Care of Yourself) The Latino Youth Health Promotion Program Draw the Line, Respect the Line

Curriculum-Based Sex and STD/HIV Education Programs 4. Making Proud Choices: A Safer Sex Approach to HIV/STDs and Teen Pregnancy Prevention 5. Reducing the Risk: Building Skills to Prevent Pregnancy, STD & HIV 6. Safer Choices: Preventing HIV, Other STD, and Pregnancy 7. SiHLE: Sistas, Informing, Healing, Living, Empowering

Curriculum-Based Sex and STD/HIV Education Programs: Examples Reducing the Risk For youth in 9th and 10th grade; variety of racial/ethnic backgrounds 16-sessions aimed at reducing the number of students having unprotected intercourse by promoting both abstinence and contraceptive use Delayed initiation of sexual intercourse; also increased condom or contraceptive use among some groups -Reducing the Risk was evaluated six months and 18 months after the program ended. -School-based program; primarily for 9th and 10th grade students, co-educational program, been used with students from a variety of racial/ethnic backgrounds. -Uses role-playing to help teens avoid unprotected sex. -Results lasted up to 18 months depending on the study.

Curriculum-Based Sex and STD/HIV Education Programs: Examples ¡Cuídate! (Take Care of Yourself) Specifically for Latino youth age 13 to 18 years—boys and girls Adaptation of the Be Proud! Be Responsible! program Incorporates salient aspects of Latino culture, specifically familialism (the importance of family) and gender role expectations Reduced the frequency of sex, number of sexual partners, frequency of unprotected sex, and increased consistent condom use over a one-year period -¡Cuídate!/ Take Care of Yourself: The Hispanic Youth Health Promotion Program. (adapted form Be Proud! Be Responsible!) -HIV prevention program that brings in aspects of Latino culture (importance of family, gender role expectations, etc) -Emphasizes abstinence and condom use as effective methods for stopping the spread of STDs, including HIV. Six 50 minute lessons. -It was evaluated with Puerto Rican youth in Philadelphia. At 12-month follow-up survey, adolescents were less likely to report engaging in sexual intercourse, having multiple partners, or engaging in unprotected sex. -Spanish speakers were more than five time more likely to have used a condom at last intercourse and had a greater proportion of protected sex compared to the control group. -Program materials are available in both Spanish and English.

Parent-Teen Programs Designed to increase parent-child communication, including programs for: Parents only Programs for parents and teens together Homework assignments in school sex education classes requiring communication with parents Video programs with written materials to complete at home

Parent-Teen Programs: Example Keeping it R.E.A.L.! Mother-adolescent pregnancy and STD/HIV prevention program; serves primarily African American youth aged 11 to 14 years and their mothers Implemented with Boys and Girls Clubs For two years the program increased condom use by youth in the program -this is the program with the strongest evidence of success -Keepin’ it R.E.A.L. is a mother-adolescent pregnancy and STD/HIV prevention program. REAL stands for Responsible, Empowered, Aware, Living. The goal of the program is to promote abstinence among teens and to enhance communication about sex between mothers and their teen children. Who participated -This program was evaluated in 11 Boys and Girls Clubs of America sites in metro Atlanta between 1996 and 2001. -Fairly young teens – 11-14 years old; majority were African American; and 60% were boys. -Mean age of the mother was 38 years old and most were single moms. Intervention For the first two intervention – they had seven sessions, that were two hours each – over a 14 week period In the social cognitive theory group (SCT) intervention, the mothers and adolescents attended four sessions together and three separately the life skills (LSK) group was guided by problem behavior theory which posits that problem behaviors co-occur within adolescents and are based on common underlying psychological attributes or predisposition; mothers and adolescents attended each of the 7 sessions session separately. The control group who received a one hour HIV education session, which was a 20 minute videotape and discussion. -For both intervention groups, the sessions were designed to be interactive and include role-plays, demonstrations, and other activities. Take-home activities were also included with each session. At one meeting, adolescents and their parents present skits with puppets using scripts they have written. -For the SCT intervention, participants had to set a personal goal that would be set by the next session. -For the LSK intervention, went more intensive - They also visited senior centers and participated in community service activities with the goal of increasing community involvement. They visited a worksite. They took an overnight trip to a historically black college or university in order to get them thinking about their future and showcase successful role models. -Evaluation – (N = 582 youth and 470 mothers) -They did follow up assessments at 4, 12, and 24 months -They were not able to impact initiation of sex – it actually increased over the 2 year period. -Those is the LSK group/more intensive group, had increased condom use (2 years) -Mothers – increased their level of self efficacy and their comfort talking with their teens and they also had more discussions with their teens. ---However, the teens did not increase their comfort level talking with their mothers about these topics.

Clinic Protocols and One-on-One Programs Designed to provide teens with reproductive health care or to improve access to condoms or other contraceptives Programs with the strongest evidence of success: Advance Provision of Emergency Contraception Reproductive Health Counseling for Young Men

Clinic Protocols and One-on-One Programs: Example Reproductive Health Counseling for Young Men Designed to increase teen boys’ knowledge of reproductive health including contraceptive use through the use of a video presentation followed by one-on-one reproductive health counseling One-hour, single-session, clinic-based intervention Designed to meet the needs of sexually active and inactive teens, and to promote abstinence as well as contraception Increased contraceptive use for a year -One-on-one counseling with a clinic practitioner – which is guided by the young man’s interests. -At one year follow up, program participants were more likely to use an effective contraceptive. -Sexually active female partners of program participants were also more likely to use effective contraception at the follow-up. -This program can be implemented in a hospital or clinic setting.

Community Programs with Multiple Components Community-wide collaborations or initiatives with the goal of reducing teen pregnancy or STDs Infuse multiple programs rather than just a single program focusing on discreet populations of teens

Community Programs with Multiple Components: Example HIV prevention for Adolescents in Low-Income Housing Community level HIV prevention program Designed for teens aged 12-17 years; both boys and girls were included in the program, and the population was primarily ethnic minorities Uses multiple components, including educational brochures, free condoms, skill training workshops, follow-up session, and community activities Delayed initiation of sex and increased condom use for 18 months -HIV prevention community program implemented 1998 and 2000 in 15 low-income housing developments in Wisconsin, Virginia and Washington State. -Goal of the program was not only education for the youth – but also to change peer and social norms. -Boys and Girls were separated for two 3-hour skill training workshops. They received $20 for participating. They had follow up sessions. Some youth were nominated to a peer council that planned various community activities ( small media projects, social events, talent shows, musical performances, and festivals). -Parents were also offered a 90-minute workshop. -At 18 month follow-up, those who participated delayed the initiation of sex and increased condom use for 18 months.

Service Learning Programs Evaluated several times and have been consistently found to be effective at either delaying the initiation of sex or reducing teen pregnancy Have two components: voluntary or unpaid service in the community and structured time for preparation and reflection before, during, and after service Often linked to academic instruction in the classroom While it is not certain why service learning has positive effects on reducing sexual activity and teen pregnancy, there are several possible explanations: participants developed ongoing relations with caring program facilitators; 2) some may have developed greater autonomy and felt more competent in their relationships with peers and adults 3) some may have been encouraged to learn they could make a difference in the lives of others; 4) the volunteer experience encouraged youths to think more about their future – all of which might have increased motivation to avoid pregnancy.

Service Learning Programs with Strongest Evidence of Success Reach for Health Community Youth Service Learning Teen Outreach Program

Service Learning Programs: Example Teen Outreach Program (TOP) Implemented in school classes and communities; can also be implemented after school Reduced reported teen pregnancy rates during academic year in which teens participated Results of evaluation indicated reduction due to service learning component not content of the curriculum -TOP operates in 75 areas of the US and serves over 10,000 kids – probably more. In fact, New York Mayor Bloomberg recommended that the TOP program be expanded across New York City as a way to fight poverty. -The primary goal of TOP is to prevent high risk behaviors such as school failure and teen pregnancy. The main message is that teens can and do make important contributions to the community. -The program is for high school students and developmentally appropriate curriculum for 12-13 year olds; 14 year olds, 15-16 year olds, and 17-19 year olds. The program operates a full academic year and ideally continue in additional years -There are three program components: Supervised community service with a minimum of 20 hours/year. The average is 37 hrs/year. There is also a classroom or group discussion focused on values, relationships, dealing with family stress, goal setting, decision making, and of course, sexuality including lessons on abstinence and contraception. Material about sexuality comprises less than 15% of the overall curriculum. The third component is service learning whereby through informal and formal reflection in group settings, youth make connections between school learning, their community services, and their own personal growth. -An evaluation of the program between 1991-1995 with nearly 350 students in 25 urban and rural high schools found that…. -When compared to a control group, youth that participated in TOP had: 33% lower teen pregnancy rates. 60% lower school dropout rates. -TOP had a greater effect on girls than boys. The more hours a teen volunteered, the less likely that teen was to become pregnant or cause a pregnancy. -The researchers did a follow up study with high risk youth and found that it was actually more effective with high risk youth – for example with young women who were already parenting. -Background notes: The evaluation did not include younger teens and was conducted with youth in grades 9-12….in this particular evaluation 67 percent of the teens were African American, 19 Caucasian, and 11 percent Hispanic. 85% of participants were female. COST - $100-$700 per youth for class of 18-25 youth (depending on whether group facilitator is paid or volunteer).

Multi-Component Programs Combine programs with intensive sexuality and youth development Focus on both sexual and nonsexual risk and protective factors

Multi-Component Programs with Strongest Evidence of Success Aban Aya Children’s Aid Society Carrera Program

Multi-Component Programs: Example Aban Aya Focuses on abstinence, substance abuse, and conflict resolution 70 lesson over 4 years for grades 5-8; specifically designed for African American youth Effective only for boys - reduced the incidence of sex and increased condom use Can be implemented in school or community settings -It encourages abstinence from sex, teaches students how to avoid drugs and alcohol, and how to resolve conflicts non-violently. -It includes about 70 lessons over 4 year period between grades 5-8 . -The program is Afro-centric and incorporates themes of unity, self determination, sense of self, and cultural pride. -It incorporates story telling and proverbs, as well as African and African American history and literature. -Three program interventions were tested with boys and girls in 12 Chicago area schools and two of the interventions were found to be effective with boys only– the intervention included parent, school-wide, and community components. Boys who participated had reduced the incidence of sex and increased condom use. They also experienced less of an increase in violent behavior, school delinquency, and drug use when compared to boys in the control group. The program can be implemented during school time and in community settings.

Additional Findings from Emerging Answers

Other Findings Teen girls and young women who receive emergency contraception (EC) from clinics in advance of having sex are not more likely to have sex They are also more likely to use EC if they do have sex than those who do not receive EC in advance Some longer sex education videos that are interactive and viewed many times can have a positive effect on teen sexual behavior

Other Findings cont. School-based, school-linked clinics, and school condom-availability programs do not increase sexual activity, but it is not clear whether they increase the use of contraception Programs for parents and their teens sometimes reduce risky sexual behavior among teens by delaying sex or increasing contraception use

Other Findings cont. Most programs that are effective at changing behavior give a clear message about avoiding risky sexual behavior, either by abstaining from sex or by using contraception Results from these evaluations suggest that when the original programs are carefully replicated in similar settings with similar populations of young people, the program’s effects on teen sexual behavior can also be replicated

A Note About Abstinence-Only Programs The jury is still out: the current research is inconclusive There is no strong evidence that programs that stress abstinence as the only acceptable behavior for unmarried teens Delays the initiation of sex; Hastens the return to abstinence; or, Reduces the number of sexual partners

Bottom Line on Research There are no “magic bullets” – teen pregnancy is a complex problem Communities can choose from a variety of successful approaches: some that focus on sex and some that do not Programs can’t shoulder the burden alone – parents, faith communities, the media, and others all play crucial roles

What the Study Doesn’t Say: Abstinence-only programs don’t work All sex education and service learning programs work That the 15 identified programs are the solution to teen pregnancy

What Can You Do? Implement existing programs with fidelity If careful replication is not possible, select or design programs that incorporate the key characteristics of effective programs If neither of these strategies is possible, develop a new program using the characteristics of effective programs

What Can You Do? Use science-based programs and evaluate for behavior change Teen pregnancy is not just a “girl” thing – work with teen boys and young men Involve other sectors: businesses, educators, faith communities, child welfare community Support and encourage parents to do more to help Recognize the powerful role of media -There are still no “magic bullets” – teen pregnancy is a complex problem. -Communities can choose from a variety of successful approaches: some that focus on sex and some that do not. -Programs can’t shoulder the burden alone – parents, faith communities, the media, and others all play crucial roles.

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