Evaluation of Abstinence Education Programs Funded Under Title V, Section 510

Contents

• Evaluation of Section 510 Abstinence Education Programs
• Early Implementation and Operational Lessons
• More Lessons to Come
• Analysis and Reporting Plans

In 1996, Congress authorized $50 million annually for five years to promote abstinence education.  This funding was established through a new formula grant program authorized under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996.  The funding became available to states in 1998 and is administered by the Maternal and Child Health Bureau.  States must provide $3 in matching funds for every $4 in federal funds, resulting in a total of up to $87.5 million available annually for such state programs.  Abstinence education programs funded through this new grant program teach an unambiguous abstinence message to youth.  Programs receiving these abstinence education funds may not endorse or promote contraceptive use.

This report presents interim findings from an independent, federally funded evaluation of the abstinence education programs authorized under PRWORA and defined under Title V, Section 510 (b)(2)(A-H) of the Social Security Act.  This report draws most heavily on four years of implementation experiences in a selected group of abstinence education programs funded under Section 510.  Later reports from the evaluation will present estimates of short- and longer-term program impacts, as well as studies on special topic areas.

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Evaluation of Section 510 Abstinence Education Programs

The evaluation addresses three important questions: 

1. What are the nature and underlying theories of the abstinence education programs?
2. What are the implementation and operational experiences of local communities and schools that have received abstinence education funding? and
3. What are the impacts of abstinence education programs on the attitudes and intentions of youth to remain abstinent, on their sexual activity, and on their risks of pregnancy and sexually transmitted diseases (STDs)?

The first stage of the evaluation entailed selecting programs for study.  The evaluation team first visited and observed numerous abstinence education programs across the nation.  Eleven of these, representing a range of program models and serving different target populations, were then selected for in-depth analysis.  Five of the 11 are referred to as targeted programs:  they target services to specific, identifiable groups of youth.  The remaining six are community-wide, systemic-change initiatives, which use the abstinence education funding to increase public awareness of the problems of teen sexual activity, to change community norms and attitudes, to encourage stronger parent-child communications, and to engage youth in abstinence education and support services.

The evaluation includes an extensive implementation and process analysis and an impact analysis.  The implementation and process analysis uses program documents, program observations, focus groups with program participants and parents, and interviews with program staff and community leaders to document and understand the abstinence education programs implemented in the 11 sites.  The impact analysis uses longitudinal survey data for groups of youth randomly assigned to program and control groups in the 5 targeted program sites.  Enrollment in the impact evaluation study samples spanned three school years and was just completed in fall 2001.  Therefore, the follow-up data that are necessary for the impact analysis are not available for inclusion in this report.

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Early Implementation and Operational Lessons

The first four years of Section 510 funding for abstinence education have generated a wealth of experience on how local grantees have designed and implemented abstinence education programs.  Among the early lessons are the following:

1. Section 510 abstinence funds are changing the local landscape of approaches to teenage pregnancy prevention and youth risk avoidance.  Despite an initial debate in some states over whether and how to spend abstinence education block grant funds, all states applied for funding at some point, and most are using monies in innovative ways to promote abstinence from sexual activity as the healthiest choice for youth.
2. Most abstinence education programs offer more than a single message of abstinence.  Examples of curricula and program components from sites participating in the federally funded evaluation indicate the diverse, creative, and often complex nature of many initiatives.

3. Most participants report favorable feelings about their program experience.  Youth respond especially positively to staff who show strong and unambiguous commitment to the program message.  They also like programs that deliver an intensive set of youth development services to enhance and support the abstinence message.
4. Abstinence education programs face real challenges addressing peer pressure and the communication gulf between parents and children.  Sexual activity often elicits only casual mention among youth, and is tolerated and even promoted by their peer culture.  Many programs attempt to address peer pressure through parents.  Yet, engaging parents has proven to be extremely challenging.
5. Local schools are valuable program partners, but establishing these partnerships is sometimes difficult.  Their broad access to youth makes schools logical and important partners for many programs, but some schools resist collaboration with abstinence programs.  Sometimes schools resist because of competing priorities; at other times, resistance stems from debate about health and sex education policies.

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More Lessons to Come

Congress has authorized a scientifically rigorous, independent evaluation of the abstinence education programs funded under Title V Section 510 to determine the extent to which abstinence programs achieve six specific goals:

1. Strengthen knowledge and attitudes supportive of abstinence
2. Induce more youth to embrace abstinence from sexual activity as a personal goal
3. Reduce sexual activity among youth
4. Persuade sexually experienced youth to become and remain abstinent
5. Lower the risk of STDs
6. Lower the risk of nonmarital pregnancies

Obtaining clear and definitive evidence on the success of abstinence education programs in achieving these goals is a difficult task that requires time.  Over the past four years, the evaluation effort has laid the foundation for a careful, comprehensive, and rigorous impact study and has successfully implemented the research design in the five targeted program sites.  Study enrollment is completed, and longitudinal tracking of youth through surveys and school records is ongoing.

Critical features of the impact study design now under way are the following:

• The impact evaluation uses an experimental design.  In each site, program effectiveness will be measured by comparing outcomes of eligible youth who were randomly assigned to the program or to a control group.  The experimental design offers the only means of measuring, with a known degree of certainty, how successful the programs are overall and how well they serve key subgroups of youth.  Other evaluation designs are vulnerable to selection bias, which can seriously undermine the credibility of their results.
• The impact evaluation has large sample sizes of between 400 and 700 youth per site.  Large sample sizes protect against failing to detect true program impacts simply because the study lacked statistical power.  Three years of study enrollment (fall 1999 through fall 2001) were necessary to achieve adequate sample sizes.
• The study sample is being followed for up to 36 months.  Because so few youth engage in sexual activity before entering high school, outcome estimates based on middle school youth will miss program impacts on behaviors that could emerge later.  The follow-up period for the evaluation is such that almost two-thirds of the study sample will be 14 to 18 years of age by the time of the final survey.

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Analysis and Reporting Plans

Study enrollment began in fall 1999 and continued through fall 2001.  Youth are surveyed at or close to study enrollment (wave 1), between 6 and 12 months following enrollment (wave 2), and then 18 to 36 months later (wave 3).  In sites where program participation might be expected to affect school performance, school records will be collected through spring 2004.  Throughout, data on program operations are being collected through observations, executive interviews, program documents, and focus groups.

A report on the effectiveness of the programs in achieving their short-term goals of changing knowledge, attitudes, and near-term behavioral choices will be completed in early 2003, after Wave 2 survey data are available for the full study sample.  The final study evaluation report will be completed in summer 2005.  During intervening periods, the team will prepare a limited number of special-focus reports that address particular questions of interest to Congress or the U.S. Department of Health and Human Services.