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WHAT WORKS FOR ADOLESCENT REPRODUCTIVE HEALTH: Lessons from Experimental Evaluations of Programs and Interventions Victoria Ball, B.A. & Kristin A. Moore, Ph.D. May 2008

OVERVIEW The reproductive health of American adolescents has been, and continues to be, a matter of serious concern. America’s teen birth rate – already the highest among developed nations1,2 – is again on the rise, and rates of sexually transmitted diseases among American teens are very high.3,4 As such, the development and identification of effective interventions to help youth avoid negative reproductive health outcomes is of great importance.

WHAT WORKS To identify programs that work and isolate the components of programs that contribute to programs’ success, we have synthesized findings from the Child Trends database of experimental evaluations of social interventions for children and youth - LINKS.5 LINKS currently includes more than 50 programs whose effects on reproductive health have been experimentally evaluated. An analysis of these programs revealed the following themes:

ƒ Many different types of programs have been shown to positively affect reproductive health outcomes. Not only school- and community-based sex education programs, but also clinic-based programs, youth development programs, service-learning programs, early childhood programs, and programs for young mothers have been found to improve reproductive health outcomes. (See table.)

ƒ Comprehensive sex education can improve adolescent reproductive health. Of the 21 comprehensive sex education programs that have been experimentally evaluated, 11 had a significant positive impact on the behavior of the youth studied or important subgroups of the sample.6

ƒ High-quality, intensive early childhood interventions can positively affect reproductive health outcomes later in life. The long-term impacts on reproductive health of two early childhood programs – the Carolina Abecedarian Program and the High/Scope Perry Pre-School Program – have been experimentally evaluated. Both programs had positive impacts years after the programs ended. Abecedarian participants were found less likely to become teen parents and Perry Pre-School participants had fewer non-marital births. Additionally, the Nurse-Family Partnership – a program providing assistance to young mothers – was found to have long-term impacts on the children of mothers involved in the program. These children had fewer sexual partners over a decade after services were provided to their mothers.

1 ƒ Providing adolescent mothers with guidance and support while their children are young appears to decrease subsequent pregnancies and births. The impacts on reproductive health outcomes of two programs designed to assist adolescent mothers were experimentally evaluated. Both programs led to decreases in repeat pregnancies and birth and more time between births by the mothers.7

ƒ Programs that incorporate community service have been shown to positively affect participants’ reproductive health. The impacts on reproductive health outcomes on two programs involving community service were experimentally evaluated. Both programs had positive impacts. Reach For Health led to delays in the initiation of sexual intercourse, and the Teen Outreach Program led to decreased rates of pregnancy.

ƒ At-risk youth are reachable. Many of the most successful reproductive health interventions specifically target minority youth from low-income areas. Successful interventions targeting high-risk youth include Becoming A Responsible Teen, Reach For Health, SiHLE, and the Be Proud! Be Responsible! family of programs.

ƒ Several sex education programs involving fewer than 15 hours of contact time have been found to positively affect reproductive health outcomes, including initiation of sexual intercourse, frequency of intercourse, and use of condoms. Programs include Becoming A Responsible Teen, Be Proud! Be Responsible!, and Making Proud Choices.

ƒ Several programs are successful for one gender, but not the other. Two sex education curricula – Draw the Line/Respect the Line and Teen Talk – have been found to have greater impacts on males than on females. Three other programs – Postponing Sexual Involvement, CAS-Carrera, and Youth Corps – have been found to have greater impacts on females than on males.

ƒ Several programs are successful at one site or in one evaluation, but not in another, indicating that curriculum and programming are not the sole elements of a successful intervention. Implementation methods, staffing, and tailoring programs to meet the needs of the population being served are all important considerations. Programs that have had differential success at different sites or in different evaluations include Be Proud! Be Responsible!, Postponing Sexual Involvement, Washington State Client Centered Pregnancy Prevention Programs, the Teenage Parent Demonstration, and the Quantum Opportunities Program.

WHAT DOESN’T WORK ƒ Three programs involving job training and placement have had their impacts on reproductive health outcomes evaluated. None of these programs had a positive impact on any behavioral outcome.8

ƒ No abstinence-based interventions have yet been shown to positively affect any behavioral outcomes. Six abstinence-based interventions have had their impacts on behavioral outcomes experimentally evaluated. None has had an impact on initiation of sexual intercourse, frequency of sexual activity, number of sexual partners, use of condoms, use of contraceptives, pregnancies, births, or STD contraction.9

ƒ None of these six abstinence-based interventions have been shown to negatively affect any behavioral outcomes, either. In particular, in spite of their exclusive focus on abstinence, none have served to significantly decrease condom or contraceptive use.

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ƒ Programs that fail to teach condom use skills do not appear to have an impact on condom use. Some 31 programs have had their impact on condom use experimentally evaluated. The seven programs that have been found to positively affect this outcome are all sex education curricula that specifically teach condom use skills.10

MIXED REVIEWS ƒ Though many programs have been shown to positively affect condom use, very few experimentally evaluated programs have been shown to have a positive impact on the acquisition of STDs. To some extent, this reflects the fact that relatively few studies have assessed this outcome.11

ƒ Programs that have impacts on knowledge, beliefs, attitudes, and/or intentions do not necessarily have an impact on behavior. The impact on both behavioral and psychosocial outcomes of 26 programs has been experimentally evaluated. Ten of the 18 programs that positively affected at least one psychosocial outcome failed to have an impact on any behavioral outcomes. Most often, this was the result of programs that increased student knowledge failing to result in changes in behavior.12

Based on this analysis, it seems that the ideal reproductive health program is one that understands the realities and needs of its participants. The success that several programs have had with at-risk populations provides evidence that tailoring program content for specific communities can reap rewards.

Additionally, the ideal sex education program will teach its participants the specific skills and behaviors necessary to achieve positive reproductive health outcomes. The fact that only those programs that teach condom use skills have had an impact on condom use provides support for programs focusing on specific skills and behaviors; and the existence of so many programs that affect participant knowledge and attitudes but not behavior further underscores this point. On the other hand, early childhood programs’ focuses on school success and positive development have also been found to have positive impacts on reproductive health years later. Programs that combine youth development with specific knowledge and skills can also be successful.

As yet, there is no one “ideal” program model when it comes to positively affecting adolescent reproductive health. A variety of program models, and intervening at a variety of times across the life course, have been proven successful to some extent for some outcomes and some populations. As noted, several of these programs are those that do not explicitly focus on reproductive health issues, but instead seek to improve development in general. The success of these programs suggests the value of high-quality interventions across the life course as a means to improve all youth outcomes, including reproductive health.

NEEDED RESEARCH The existence of programs that have been proven successful with only one gender of participant indicates the need for further efforts to render program content relevant and appropriate for all program participants. Future research needs to address:

ƒ Culturally appropriate and more highly effective approaches,

ƒ Programs that effectively engage high-risk adolescents, and

ƒ Programs that prevent both pregnancy and STDs.

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ENDNOTES

1 Centers for Disease Control and Prevention. (2007). Adolescent Reproductive Health. Department of Health and Human Services. Retrieved, from the World Wide Web: http://www.cdc.gov/reproductivehealth/adolescentreprohealth/index.htm 2 Teen Births (2008). Child Trends. Retrieved, from the World Wide Web: http://www.childtrendsdatabank.org/indicators/13TeenBirth.cfm 3 Centers for Disease Control and Prevention. (2008). Nationally Representative CDC Study Finds 1 in 4 Teenage Girls Has a Sexually Transmitted Disease. Retrieved, from the World Wide Web: http://www.cdc.gov/stdconference/2008/media/release-11march2008.htm 4 Centers for Disease Control and Prevention. (2007). Sexually Transmitted Diseases. Department of Health and Human Services. Retrieved, from the World Wide Web: http://www.cdc.gov/nchs/fastats/stds.htm 5 http://www.childtrends.org/links 6 Those comprehensive sex education programs that have been successful include Becoming A Responsible Teen, Reach For Health, Be Proud! Be Responsible!, Safer Choices, Draw the Line/Respect the Line, Postponing Sexual Involvement, Teen Talk, ¡Cuídate!, Making Proud Choices!, FOCUS, Focus on Kids, and SiHLE.[want to say what that is?] 7 Those programs include the Nurse-Family Partnership and an untitled health care program for first-time adolescent mothers and their infants. 8 Those job training/placement programs that have been unsuccessful include Job Corps, JOBSTART, and STEP. 9 The six experimentally evaluated abstinence-based programs are My Choice, My Future!, ReCapturing the Vision, Teens in Control, Families United to Prevent Teen Pregnancy, Heritage Keepers Life Skills Education, and Making a Difference. 10 The seven programs that have had an impact on condom use are Becoming A Responsible Teen, Be Proud! Be Responsible!, Safer Choices, ¡Cuídate!, Making Proud Choices, Focus on Kids, and SiHLE. 11 SiHLE was found to increase condom use and reduce chlamydia; impacts were not found for gonorrhea or trichomonas. 12 The 10 programs that positively affected a psychosocial outcome, but failed to affect a behavioral outcome, are All4You, Project SNAPP, YAPP, Project CHARM, My Choice, My Future!, Heritage Keepers Life Skills Education, Making a Difference, Enhanced Managing Pressures Before Marriage, ASSESS, and AIDS-Preventive Intervention.[want to say what the acronyms stand for?]

© 2008 Child Trends. May be reprinted with citation. The support of the Edna McConnell Clark Foundation and The Stewart Trust is gratefully acknowledged. Note: As funds become available, Child Trends will be expanding this line of work to conduct meta-analyses.

4 Experimental Evaluations of Social Programs that Examined Impacts on One or More Reproductive Health Outcomes and Whether They Were Found to Work, Not Proven to Work, or Had Mixed Findings (Source: http://www.childtrends.org/links)

OUTCOME AREA NOT PROVEN TO WORK MIXED FINDINGS FOUND TO WORK Initiation of Sexual Intercourse -Abstinence education programs: -Abstinence education programs: -Sex Education Programs: -My Choice, My Future!, a three- -Making A Difference, an abstinence- -Becoming A Responsible Teen year program for 8th, 9th, and 10th based program for African American (BART), an HIV education and graders adolescents, delayed the initiation of skills training program for African -ReCapturing the Vision, a one- sexual intercourse in the short-term, but American high school students year program for 8th grade girls not in the long-term. -Teens in Control, a two-year -Supplementing sex education with program for 5th and 6th graders -Sex education programs: community service: -Families United to Prevent -Draw the Line/Respect the Line, an -Reach For Health, a program for Teen Pregnancy (FUPTP), an STD and pregnancy prevention African American and Hispanic abstinence-focused after-school program for middle school students, middle school students program for 8-13 year-olds delayed initiation of sexual intercourse -Heritage Keepers Life Skills among males, but not females. Education, a character-based -Postponing Sexual Involvement program for 6th-12th grade students (PSI), a middle school program that focuses on delaying sexual activity, has -Sex education programs: had some success with females, but not -All4You, a program for students in males. alternative high schools that includes -Project Taking Charge, a pregnancy classroom curriculum as well as prevention program for high-risk 7th service-learning activities graders, appeared to delay the initiation - Be Proud! Be Responsible!, an of sexual intercourse, but this trend did HIV education and skills training not achieve significance. program for African American -Teen Talk, a pregnancy prevention adolescents program for teens, delayed initiation of - Healthy For Life Project (HFL), a intercourse among males, but not risky behavior prevention program for females. middle school students -McMaster Teen Program, a -Adult Identity Mentoring (AIM), a pregnancy prevention program for program designed to help at-risk middle school students adolescents articulate future goals, led to -Project SNAPP, an AIDS and less frequent increased rates of abstinence pregnancy prevention program for in the short-term, but not in the long-term. middle school students -Safer Choices, a sexuality education -REAL Men, a program designed to program for high school students provide fathers with the skills necessary to communicate with their sons about HIV -Programs designed to increase parent- prevention, led to increased rates of child communication about sex: abstinence at the 6-month follow-up, but -Enhanced Managing not the 3-month or 12-month follow-ups. Pressures Before Marriage, a series of homework assignments for middle school students to complete with their parents -Facts & Feelings, a series of sexuality-related videos for adolescents to watch with their parents

-A program designed to reduce antisocial behaviors: -The Montreal Prevention Experiment, an intervention for parents and antisocial boys

Frequency of Sexual Activity -Abstinence education programs: -Sex education programs: -Sex education programs: -Making a Difference, an abstinence- -All4You, a program for students in -Becoming A Responsible Teen based program for African American alternative high schools that includes (BART), an HIV education and adolescents classroom curriculum as well as skills training program for African service-learning activities, led to American high school students -Sex education programs: initial decreases in frequency of sexual -¡Cuídate!, an HIV risk-reduction -ARREST, a program for inner-city, activity that were no longer significant curriculum for Latino adolescents minority adolescents at the 12-month or 18-month follow-up -Postponing Sexual Involvement points.

5 OUTCOME AREA NOT PROVEN TO WORK MIXED FINDINGS FOUND TO WORK (PSI), a middle school program that -Be Proud! Be Responsible!, an HIV focuses on delaying sexual activity education and skills training program -Project SNAPP, an AIDS and for African American adolescents, pregnancy prevention program for significantly decreased frequency of middle school students sexual activity at one project site, but -Safer Choices, a sexuality education not another. program for high school students -Draw the Line/Respect the Line, an STD and pregnancy prevention -Clinic-based programs: program for middle school students, -ASSESS, a safe-sex education significantly decreased frequency of program for young teens sexual intercourse among males, but -Reproductive health not females. counseling for young men -Making Proud Choices, a safe-sex -Adolescents who participated in program for African American extended HIV counseling had sex no adolescents, significantly decreased less frequently than adolescents who frequency of sexual activity among participated in standard counseling students who were sexually (AIDS Education and Counseling experienced before entering the in an Office Setting). program.

-Adult Identity Mentoring (AIM), a program designed to help at-risk adolescents articulate future goals, led to less frequent intercourse among males, but not among females.

Number of Sexual Partners -Abstinence education programs: -Sex education programs: -Sex education programs: -My Choice, My Future!, a three- -Be Proud! Be Responsible!, an HIV -¡Cuídate!, an HIV risk-reduction year program for 8th, 9th, and 10th education and skills training program curriculum for Latino adolescents graders for African American adolescents, -A study on Varying the Timing of -ReCapturing the Vision, a one- significantly decreased number of an HIV-Prevention Intervention year program for 8th grade girls sexual partners at one project site, but found that delivering intervention -Teens in Control, a two-year not another. content during seven 1.5 hour program for 5th and 6th graders -Draw the Line/Respect the Line, an sessions worked better than deliver- -Families United to Prevent STD and pregnancy prevention ing it during three 3.5-hour sessions. Teen Pregnancy (FUPTP), an program for middle school students, abstinence-focused after-school significantly decreased number of -Group therapy for recently divorced program for 8- to 13- year-olds sexual partners among males, but not mothers and their children: -Heritage Keepers Life Skills females. -New Beginnings Education, a character-based -FOCUS, a curriculum for female program for 6th-12th grade students youth, led to lower numbers of sexual -Children of poor, unmarried women who partners for subjects who were participated in the Nurse-Family sexually inexperienced at baseline, but Partnership (NFP) (a home-visiting -Sex education programs: not for subjects who were sexually program for low-income first-time -All4You, a program for students in experienced at baseline. mothers) had significantly fewer sexual alternative high schools that includes -Project CHARM, an HIV risk- partners than children of poor, unmarried classroom curriculum as well as reduction program for pregnant control group women. service-learning activities adolescents, significantly decreased -ARREST, a program for inner-city, number of sexual partners in the short- minority adolescents term, but not in the long-term -Postponing Sexual Involvement (PSI), a middle school program that focuses on delaying sexual activity -Project SNAPP, an AIDS and pregnancy prevention program for middle school students -Safer Choices, a sexuality education program for high school students -The Youth AIDS Prevention Project (YAPP), a prevention program for African American middle school students

-Clinic-based programs: -ASSESS, a safe-sex education Program for young teens -Adolescents who participated in extended HIV counseling had no fewer partners than adolescents who participated in standard counseling (AIDS Education and Counseling in an Office Setting). 6 OUTCOME AREA NOT PROVEN TO WORK MIXED FINDINGS FOUND TO WORK Use of Condoms for STD and/or -Abstinence education programs: -Clinic-based programs: -Sex education programs: Pregnancy -My Choice, My Future!, a three- -ASSESS, a safe-sex education -Becoming A Responsible Teen Prevention year program for 8th, 9th, and 10th program for young teens, had (BART), an HIV education and graders an early impact on condom skills training program for African -ReCapturing the Vision, a one- use, but no long-term impact. American high school students year program for 8th grade girls -A health belief model -Be Proud! Be Responsible!, an -Teens in Control, a two-year intervention for high-risk HIV education and skills training program for 5th and 6th graders adolescent females increased program for African American -Families United to Prevent condom use, but clients adolescents Teen Pregnancy (FUPTP), an remained inconsistent users. -¡Cuídate!, an HIV risk-reduction abstinence-focused after-school curriculum for Latino adolescents program for 8-13 year-olds -Sex education programs: -Focus on Kids, an AIDS- -Making A Difference, an -All4You, a program for students in prevention program from low- abstinence-based program for African alternative high schools that includes income African American children American adolescents classroom curriculum as well as -Making Proud Choices, a safe-sex -Heritage Keepers Life Skills service-learning activities, led to program for African American Education, a character-based initial increases in condom use that adolescents program for 6th-12th grade students were no longer significant at the 12- -Safer Choices, a sexuality month or 18-month follow-up points. education program for high school -Sex education programs: -Youth AIDS Prevention Project students -ARREST, a program for inner-city, (YAPP), a prevention program for -SiHLE, an HIV-prevention inter- minority adolescents African American middle school vention for African American -Draw the Line/Respect the Line, an students, did not increase the use of female adolescents STD and pregnancy prevention condoms among students, but did -A study on Varying the Timing of program for middle school students increase the use of condoms in con- an HIV-Prevention Intervention -FOCUS, a curriculum for female junction with contraceptive foam. found that delivering intervention youth content during seven 1.5 hour -Healthy For Life Project (HFL), a -Condom Promotion Videos for College sessions worked better than deliver- program to prevent risky behavior for Students had mixed success promoting ing it during three 3.5-hour sessions. middle school students condom use. -Postponing Sexual Involvement (PSI), a middle school program that -REAL Men, a program designed to focuses on delaying sexual activity provide fathers with the skills necessary to -Project CHARM, an HIV risk- communicate with their sons about HIV reduction program for pregnant prevention, led to increased condom use at adolescents the 12-month follow-up, but not the 3- -Project SNAPP, an AIDS and month or 6-month follow-ups. pregnancy prevention program for middle school students -Neither a didactic nor a discussion- based AIDS prevention program worked to increase condom use among delinquent and abused adolescents (AIDS-Preventive Intervention).

-An intensive after-school youth development program with sex education component: -CAS-Carrera

-Clinic-based programs: -PARTNERS Project, a prevention program designed for sexually active Hispanic women and their partners -Adolescents that participated in extended HIV counseling were no more likely to use condoms than adolescents that participated in standard counseling (AIDS Education and Counseling in an Office Setting).

Use of Contraception -Abstinence education programs: -Sex education programs: -Sex education programs: -My Choice, My Future!, a three- -Postponing Sexual Involvement -Safer Choices, a sexuality year program for 8th, 9th, and 10th (PSI), a middle school program that education program for high school graders focuses on delaying sexual activity, students -ReCapturing the Vision, a one- significantly increased use of year program for 8th grade girls contraception among females in one -Clinic-based programs: -Teens in Control, a two-year study. -Reproductive Health Counseling program for 5th and 6th graders -Teen Talk, a pregnancy prevention for Young Men 7 OUTCOME AREA NOT PROVEN TO WORK MIXED FINDINGS FOUND TO WORK -Families United to Prevent program for teens, significantly Teen Pregnancy (FUPTP), an increased use of contraception among abstinence-focused after-school males, but not females. program for 8-13 year-olds -Heritage Keepers Life Skills -Youth development programs with sex Education, a character-based education component: program for 6th-12th grade students -CAS-Carerra significantly increased use of contraception among females, -Sex education programs: but not males. -All4You, a program for students in -The Washington State Client- alternative high schools that includes Centered Pregnancy Prevention classroom curriculum as well as Program significantly increased use of service-learning activities contraception among teenagers at one -McMaster Teen Program, a of three sites. pregnancy prevention program for middle school students -Project SNAPP, an AIDS and pregnancy prevention program for middle school students

-Clinic-based programs: -PARTNERS Project, a prevention program designed for sexually active Hispanic women and their partners -Family planning clinic support services

Pregnancies and Births -Abstinence education programs: -Sex education programs: -Sex education programs: -My Choice, My Future!, a three- -SiHLE, an HIV-prevention inter- -FOCUS, a curriculum for female year program for 8th, 9th, and 10th vention for African American youth graders female adolescents, led to marginally -ReCapturing the Vision, a one- significant decreases in pregnancies. -Youth development programs: year program for 8th grade girls -Teen Outreach Program -Teens in Control, a two-year -Youth development programs: program for 5th and 6th graders -CAS-Carerra significantly decreased -Early childhood programs: -Families United to Prevent pregnancies and births among females, -Carolina Abecedarian Teen Pregnancy (FUPTP), an but not males. Program, a child-care and abstinence-focused after-school -Quantum Opportunities Program, pre-school program for program for 8-13 year-olds an intensive, multi-component high-risk children -Heritage Keepers Life Skills intervention for disadvantaged high -High/Scope Perry Pre- Education, a character-based school students, significantly decreased School Program for program for 6th-12th grade students childbearing at one of five sites. poverty-stricken African American children -Sex education programs: -Programs combining job placement with -All4You, a program for students in education and support services: -Programs for young mothers: alternative high schools that includes -The Teenage Parent Demonstration -Low-income first-time mothers classroom curriculum as well as (TPD) significantly decreased assigned to the Nurse-Family service-learning activities pregnancies and births at one of three Partnership (NFP) home-visiting -McMaster Teen Program, a sites. program significantly decreased pregnancy prevention program for -Youth Corps, a program for young subsequent pregnancies and births middle school students adults out of school, significantly relative to mothers in a control -Postponing Sexual Involvement decreased pregnancies among African group. (PSI), a middle school program that American females, but not among -Adolescent mothers assigned to focuses on delaying sexual activity white or Hispanic females. receive special health care were -Project SNAPP, an AIDS and significantly less likely to have pregnancy prevention program for another child than were mothers in a middle school students control group (Untitled Health Care Program for First-Time -Clinic-based programs: Adolescent Mothers and their -Family planning clinic support Infants). services

-Programs combining job placement with education and support services: -Job Corps, a program for disadvantaged youth and young adults -JOBSTART, a program for high school dropouts -STEP, a summer program for low-achieving adolescents. 8 OUTCOME AREA NOT PROVEN TO WORK MIXED FINDINGS FOUND TO WORK Contracting STDs -Abstinence education programs: -Sex education programs: -Sex education programs: -My Choice, My Future!, a three- -SiHLE, an HIV-prevention inter- -FOCUS, a curriculum for female year program for 8th, 9th, and 10th vention for African American youth graders female adolescents, led to decreases in -ReCapturing the Vision, a one- the acquisition of chlamydia, but not year program for 8th grade girls trichomonas or gonorrhea. -Teens in Control, a two-year program for 5th and 6th graders -Clinic-based programs: -Families United to Prevent -ASSESS, a safe-sex education Teen Pregnancy (FUPTP), an program for young teens, showed some abstinence-focused after-school evidence of reducing STD program for 8-13 year-olds contraction. -Heritage Keepers Life Skills Education, a character-based program for 6th-12th grade students

-Sex education programs: -Postponing Sexual Involvement (PSI), a middle school program that focuses on delaying sexual activity -Project SNAPP, an AIDS and pregnancy prevention program for middle school students

-Clinic-based programs: -A health belief model intervention for high-risk adolescent females

9 Experimental Evaluations of Social Programs that Examined Impacts on One or More Reproductive Health Outcomes and Whether They Were Found to Work, Not Proven to Work, or Had Mixed Findings (Source: http://www.childtrends.org/links)

OUTCOME AREA NOT PROVEN TO WORK MIXED FINDINGS FOUND TO WORK Psychosocial Variables Communication -Sex education programs: -Programs specifically designed to -Postponing Sexual Involvement increase parent-child communication (PSI), a middle school program that about sex: -Programs specifically designed to focuses on delaying sexual activity, -Enhanced Managing Pressures increase parent-child communication did not increase likelihood of Before Marriage, a series of about sex: parent-teen communication about sex. homework assignments for middle -The Family/Media Approach to -Project Taking Charge, a school students to complete with their HIV Prevention increased teens’ pregnancy prevention program for parents, increased the likelihood of sexual communication skills. th high-risk 7 graders, did not increase parent-teen communication about sex, -REAL Men, a program designed to the likelihood of parent-teen but did not increase teens’ comfort provide fathers with the skills communication about sex, nor teens’ level with such communication. necessary to communicate with comfort level with such -Facts & Feelings, a series of their sons about HIV prevention, led communication. sexuality-related videos for to increased discussion of sex- adolescents to watch with their related topics. -Clinic-based programs: parents, initially increased the -Saving Sex For Later increased -ASSESS, a safe-sex education likelihood of parent-teen parent-child communication about program for young teens, did not communication about sex, but this risky behaviors. increase the likelihood of parent-teen increase did not persist over time. communication about sex. -Sex education programs: -Family planning clinic support -Sex education programs: -Becoming A Responsible Teen services did not increase teens’ -Safer Choices initially increased the (BART), an HIV education and comfort level with parent-teen likelihood of parent-teen skills training program for African communication about sex. communication about sex, but this American high school students, increase did not persist over time. increased teens’ sexual -A youth development program with sex communication skills. education component: -Youth AIDS Prevention Project -The Washington State Client- (YAPP), a prevention program for Centered Pregnancy Prevention African American middle school Programs did not increase the students, made students more com- likelihood of parent-teen fortable talking to their parents communication about sex. about sex and related issues.

Knowledge & Beliefs -Abstinence education programs: -Abstinence education programs: -Abstinence education programs: -ReCapturing the Vision, a one- -Making A Difference!, an -My Choice, My Future!, a three- year program for 8th- grade girls abstinence-based program for African year program for 8th, 9th, and 10th -Teens in Control, a two-year American adolescents, increased graders program for 5th and 6th graders students’ knowledge about HIV, but -Families United to Prevent not about condoms. -Sex education programs: Teen Pregnancy (FUPTP), an -All4You, a program for students in abstinence-focused after-school -Sex education programs: alternative high schools that includes program for 8- to13- year-olds -In some studies, Postponing Sexual classroom curriculum as well as -Heritage Keepers Life Skills Involvement (PSI), a middle school service-learning activities Education, a character-based program that focuses on delaying -Becoming A Responsible Teen program for 6th- to 12th-grade students sexual activity, increased students’ (BART), an HIV education and knowledge in the short term, but, in skills training program for African -Sex education programs: no studies did it increase students’ American high school students -Focus on Kids, an AIDS- knowledge in the long term. -Be Proud! Be Responsible!, an prevention program from low- -Project Taking Charge, a HIV education and skills training income African American children pregnancy prevention program for program for African American high-risk 7th graders, increased adolescents -Clinic-based programs: students’ knowledge about anatomy -Draw the Line, Respect the Line, -A health belief model intervention and STDs, but not about an STD and pregnancy prevention for high-risk adolescent females complications caused by adolescent program for middle school students pregnancy. -Making Proud Choices!, a safe -Programs designed to increase parent- sex program for African American child communication about sex: adolescents -Enhanced Managing Pressures -Project CHARM, an HIV risk- Before Marriage, a series of reduction curriculum for pregnant homework assignments for middle adolescents school students to complete with their -Project SNAPP, an AIDS and parents pregnancy prevention program for middle school students -Safer Choices, a sexuality 10 OUTCOME AREA NOT PROVEN TO WORK MIXED FINDINGS FOUND TO WORK education program for high school students -Teen Talk, a pregnancy prevention program for teens -Youth AIDS Prevention Project (YAPP), a prevention program for African American middle school students -A discussion-based AIDS prevention program for delinquent and abused youth (AIDS- Preventive Intervention)

-An intensive out-of-school time youth development programs with sex education component: -CAS-Carrera -Summer Training and Education Program (STEP), a summer program for low-achieving adolescents

-Clinic-based programs: -ASSESS, a clinic-based safe-sex education program for young teens -Clinic-Based AIDS Education Programs for Adolescent Females -Reproductive Health Counseling for Young Men

-Programs designed to increase parent- child communication about sex: -Family/Media Approach to HIV Prevention

Attitudes -Sex education programs: -Sex education programs: -Abstinence education programs: -Project SNAPP, an AIDS and -All4You, a program for students in -Making A Difference!, an pregnancy prevention program for alternative high schools that includes abstinence-based program for middle school students classroom curriculum as well as African American adolescents -Project Taking Charge, a service-learning activities, had mixed -Heritage Keepers Life Skills pregnancy prevention program for success impacting attitudes. Education, a character-based high-risk 7th graders -In some studies, Postponing Sexual program for 6th-12th grade students -Teen Talk, a pregnancy prevention Involvement (PSI), a middle school program for teens program that focuses on delaying -Sex education programs: sexual activity, improved students’ -Be Proud! Be Responsible!, an -Clinic-based programs: attitudes in the short term, but, in no HIV education and skills training -Clinic-Based AIDS Education studies did it improve students’ program for African American Programs for Adolescent Females attitudes in the long term. adolescents -A health belief model intervention -Safer Choices, a sexuality education for high-risk adolescent females program for high school students, did -Clinic-based programs: not have a positive impact on -Reproductive Health Counseling -Programs designed to increase parent- students’ attitudes toward sex, but it for Young Men child communication about sex: did have a positive impact on their -Enhanced Managing Pressures attitudes toward condom use. Before Marriage, a series of -Both a didactic and a discussion- homework assignments for middle based AIDS prevention program school students to complete with their worked to improve attitudes among parents delinquent and abused youth in the short term, but neither had a lasting impact (AIDS-Preventive Intervention).

-Clinic-based programs: -ASSESS, a safe-sex education program for young teens, did not have a positive impact on students’ attitudes toward abstinence, but it did have a positive impact on their attitudes toward condom use.

11 OUTCOME AREA NOT PROVEN TO WORK MIXED FINDINGS FOUND TO WORK Intentions -Abstinence education programs: -Abstinence education programs: -Abstinence education programs: -My Choice, My Future!, a three- -Families United to Prevent -Making A Difference!, an year program for 8th, 9th, and 10th Teen Pregnancy (FUPTP), an abstinence-based program for graders abstinence-focused after-school African American adolescents -ReCapturing the Vision, a one- program for 8-13 year-olds, had year program for 8th grade girls mixed impacts on students’ intentions -Sex education programs: -Teens in Control, a two-year to remain abstinent. -All Stars, a risk reduction program program for 5th and 6th graders -Heritage Keepers Life Skills for middle school students Education, a character-based -Be Proud! Be Responsible!, an -Sex education programs: program for 6th-12th grade students, HIV education and skills training -All4You, a program for students in had mixed impacts on students’ program for African American alternative high schools that includes intentions to remain abstinent. adolescents classroom curriculum as well as -Project CHARM, an HIV risk- service-learning activities -Sex education programs: reduction curriculum for pregnant -Making Proud Choices, a safe sex -In some studies, Postponing Sexual adolescents program for African American Involvement (PSI), a middle school -A discussion-based AIDS adolescents program that focuses on delaying prevention program for delinquent -Project Taking Charge, a sexual activity, had a short-term and abused youth (AIDS- pregnancy prevention program for positive impact on students’ Preventive Intervention) high-risk 7th graders intentions, but, in no studies did it have a long-term positive impact. -Programs designed to increase parent- -Clinic-based programs: -Youth AIDS Prevention Project child communication about sex: -ASSESS, a clinic-based safe-sex (YAPP), a prevention program for -Enhanced Managing Pressures education program for young teens African American middle school Before Marriage, a series of students, did not have a positive homework assignments for middle -Programs designed to increase parent- impact on students intentions to have school students to complete with child communication about sex: sex or to use condoms, but it did have their parents -Facts & Feelings, a series of a positive impact on their intentions to sexuality-related videos for use condoms in conjunction with -Condom Promotion Videos for adolescents to watch with their contraceptive foam. College Students parents -Youth development programs with a sex education component: -Students in Adult Identity Mentoring (AIM), a program designed to help at-risk adolescents articulate future goals, were more likely to report an intention to abstain from intercourse at a short-term follow-up, but not a long-term follow- up. -The Washington State Client- Centered Pregnancy Prevention Program had a positive impact on students’ intentions at one of three teenage sites.

Self-Efficacy -Sex education programs: -Sex education programs: -Enhanced Managing Pressures Before -Project SNAPP, an AIDS and -All4You, a program for students in Marriage, a series of homework pregnancy prevention program for alternative high schools that includes assignments for middle school students middle school students classroom curriculum as well as to complete with their parents service-learning activities, had mixed success impacting self-efficacy. -Condom Promotion Videos for -Safer Choices, a sexuality College Students education program for high school students, did not have a positive impact on students’ self-efficacy in refusing sex, but it did have a positive impact on students’ self-efficacy for condom use.

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