A 27-Month Evaluation of a Sexual Activity Prevention Program in Boys & Girls Clubs across the Nation
St Pierre, Tena L., Mark, Melvin M., Kaltreider, D. Lynne, Aikin, Kathryn J., Family Relations
The United States continues to have the highest adolescent pregnancy rate among industrialized nations; more than one million teenage girls become pregnant each year (Moore, 1989). The profound medical, psychological, and social risks associated with teenage childbearing have resulted in a multitude of programs that attempt to prevent adolescent pregnancy. Empirical evaluations of these programs have produced mixed and inconsistent results (Hofferth & Miller, 1989).
In particular, findings for sexual abstinence programs have been disappointing. Most evaluations have included primarily white middle-class junior and senior high school students and assessed only participants' short-term beliefs, attitudes, and knowledge (e.g., Olsen, Weed, Ritz, & Jensen, 1991; Olson, Wallace, & Miller, 1984). Any changes found in sexual attitudes have been modest (Olsen, Weed, Daly, & Jensen, 1992).
Sexual behavior has rarely been measured in evaluations of abstinence. only programs. In studies in which sexual behaviors were assessed, only one published evaluation (Jorgensen, Potts, & Camp, 1993) found desired behavioral effects, specifically on a six-month follow-up measure of sexual behavior for a very small number of youths who were virgins before the program. Other studies reported either no changes in sexual behaviors (Donahue, 1987; Jorgensen, 1991; Miller et al., 1993) or an increase in precoital sexual activity during the treatment period (Christopher & Roosa, 1990).
Results of these evaluations suggest that abstinence-only pregnancy prevention programs may be ineffective in reducing sexual activity and pregnancy risk. This finding has led some researchers (Christopher & Roosa, 1990; Roosa & Christopher, 1990) instead to advocate for multicomponent programs that have demonstrated success in reducing teenage pregnancy by emphasizing abstinence but also offering the alternative of contraceptives for those teens who choose to become sexually active (Howard & McCabe, 1990; Vincent, Clearie, & Schluchter, 1987; Zabin, Hirsch, Smith, Streett, & Hardy, 1986; Zabin et al., 1988)
One example of such a multicomponent program is Postponing Sexual Involvement (PSI; Howard & McCabe, 1990). PSI is based on the social influence model of prevention and is led by older teens. According to the theory underlying this model, young people engage in negative health behaviors, including sexual activity, because of societal and peer influences. Therefore, in addition to learning factual information, teens in the PSI program discuss social and peer pressures to engage in sexual activity and practice skills to help them resist these pressures.
The PSI Educational Series classroom component, which strongly urges teens to postpone having sex, was offered in combination with a human sexuality classroom component that taught factual information about reproductive health, including contraceptives and how to use them. Referral to contraceptive counseling and services also was provided for teens who made the decision to engage in sexual activity. Evaluation results found that the PSI program was effective in helping teens delay initial sexual intercourse (Howard & McCabe, 1990). Eighth-grade program participants who had not had sexual inter. course prior to the program were significantly more likely to postpone having coitus through the end of the ninth grade than those who did not participate in the program.
Although the 5-session PSI program (without the 5-session human sexuality component) is being widely disseminated and touted by the popular press as an effective abstinence program (e.g., Klein, 1934; Newman, 1994; Shinkle, 1992a, 1992b), Howard and McCabe (1992) concede that PSI's effectiveness without the human sexuality component is not known. Moreover, Howard and McCabe advocate that adolescents be offered PSI in combination with information about reproduction, sexually transmitted diseases, and contraceptives so that teens who do become sexually active can protect themselves from disease and pregnancy. …