Friday, June 6, 1997
David D. Bellis
U.S. General Accounting Office

(First Slide--No. 1)

Good afternoon and, again, welcome to the General Accounting Office. In recent years, the GAO has reported on teen pregnancy--and programs designed to prevent pregnancy,-- teen mothers and AFDC,--and community strategies to help at-risk teens. This afternoon, I’ll draw on this work---and the work of others, and--first--talk briefly about some of the consequences of teen sexual activity. Then, discuss different approaches local communities are using to design and deliver abstinence programs.

Teen sexual activity is dangerous. According to the Institute of Medicine, 5 of the top 10 most frequently reported diseases are sexually transmitted. Of the 12 million new cases reported annually, about 3 million are among teens. This means about 13% of our young people between the ages of 13 and 19 contact a Sexually Transmitted Disease. While some of these diseases can be cured easily if detected early--such as gonorrhea--others--like HIV and hepatitis B-- cannot be cured and can be transmitted years after the initial infection. Because the infected teens are poor users of health care and many STDs are asymptomatic, often the easy-to-treat diseases go untreated. Infertility, cancer and even death can follow many of these infections. The cost of STDs among teens is about $4.25 billion a year.

(Next Slide--No. 2)

Unfortunately, early sexual activity also clusters with other behaviors that have serious and costly consequences. In a recent study, sexually active teens were also regular users of alcohol and tobacco and also reported using marijuana. The cumulative effect of these behaviors can lead to greater isolation among friends and family--and--a mistrust of institutions in their community available to help them.

The most tragic consequence of teen sexual behavior is pregnancy. While recent reports show the hopeful sign of declining pregnancies among teens, nearly a million young women between 15 and 19--about 12% of this group--became pregnant in 1992. Not all pregnancies, however, come to full term. More than a third end in an abortion,--and about half result in a birth. Most of births to teen mothers occur out-of-wedlock--yet only between 1 to 3 percent of these infants are placed for adoption. Rates of child abuse for teen mothers are more than twice that of mothers who are 20 to 21. In Illinois, for example, 1 in 4 reports of child abuse involve a teen mother. Approximately 5 percent of the children who remain with a teen mother will end up in foster care--this at an estimated cost of $900 million per year.

(Next Slide--No. 3)

Since the majority of the teen mothers are from economically disadvantaged homes, the birth of a child to a teen can be another blow to a young and already difficult life. We reported that from 1976 to 1992, almost half of all single women receiving AFDC were or had been teen mothers. Almost 8 in 10 young girls who had a child while a teen had at least one spell on public assistance within 5 years of the child’s birth. We also found this group were less likely to have a high school diploma, eventually have larger families and never be married. According to a recent study from the Robin Hood Foundation, the cost to the U.S. taxpayer for adolescent childbearing is nearly $7 billion a year.

But there is some good news. Adolescents, especially young teens under 15, are participating in greater numbers in efforts designed to postpone sexual activity. Further, programs with abstinence as a key principle have evolved considerably since the early 1980’s and they are expanding.

(Next Slide--No. 4)

However, trying to describe the diversity of these programs is reminiscent of the story of the three blind men asked to identify what they’re touching as they each explored a different part of the same elephant. We can, nevertheless, talk about these programs in 3 ways--first--the different settings in which we find abstinence programs--second--the range of content areas that can be covered, and--third--the different instructional strategies used to get the message across.

Communities are comprised of different institutions--there are schools, public and private youth serving agencies and other community organizations, clinics and medical facilities and--homes. We can look to all of these for abstinence programs. 

(Next Slide--No. 5)

Most teens attend school, and--at one point or another--have experienced some type of sex education. Estimates are that at least 85% of our schools teach sex education. Most have been integrated into the school’s health curriculum. By in large, parental support for school sex education programs is high. It was reported recently that only 2% of the parents of Virginia’s high scholars opted out of their school’s sex ed program. Some schools, as Joy Dryfoos points out in her book, Adolescents At-Risk, offer additional class electives once a teen has completed the required health education sequence. Other variations exist. Schools can identify students they believe are at particular risk for negative outcomes and offer them specially targeted programs. Because many of these youth are multi-problem teens, programs often target academic areas as well as other behavioral issues. Schools are also offering "off-school hour" classes that are open to all students or targeted to specific groups. Regardless of the scope, schools are currently the mainstay setting for many of these programs. 

Community-based organizations--such as the YM and YWCA and the Girl and Boy Scouts, and other more locally-based agencies can offer these programs. These organizations must rely on their existing membership and their standing in the community to attract teens. In addition, religious organizations such as Catholic Charities and local churches of all denominations are playing a more active role in developing youth support programs. Church-based organizations often recruit not only from their own members but through other neighborhood organizations.

(Next Slide--No. 6)

Though controversial, clinics can offer abstinence programs. In a recent GAO study, we reported that the goal of most school-based health centers was to provide primary care, physical exams and injury treatment with a growing number of centers offering immunization and mental health services. In addition, we found many school health centers provided a variety of reproductive services--though the majority did not distribute contraceptives. Establishing these types of centers can cause turmoil in communities but we found sites that sought open communication among all interested parties could overcome many of the communities’ concerns.

An often forgotten setting for this type of intervention is the home. The work of David Olds and his colleagues and an earlier GAO report have shown that delivering preventive services in the home can be an effective strategy--especially for teen mothers. Home visiting may have some interesting applications for abstinence programs. Using the relatively safe environment of the home, program staff work with teens on a variety of health and risk issues. Research has shown that this approach can delay the birth of additional children. The majority of these efforts, however, are part of broader programs for teens and often are linked to other service sites such as hospitals and schools.

(Next Slide--No. 7)

Most programs--regardless of the setting--use commercially developed curriculum packages. Some sites have adapted their program content from a number of different packages. While some efforts focus on a limited number of content areas, most cover a variety of different topics. Generally, the foundation is fact-based information on health and reproduction and the risks associated with not only early sex, but with other behaviors as well--such as drug and alcohol use. Abstinence programs usually stress personal responsibility and exercises designed to build self-esteem. This is reinforced with strategies on how to "say no",, and other techniques to resist the pressures to engage in sex. Programs also offer information on responsible adult behavior--including job or career possibilities. Some programs actively enlist the help of parents to bridge the gap between a school or center and the home.

Most curricula organize their content material in such a way that programs will use a number of different teaching strategies. In addition to direct presentation by a teacher or leader, most programs use a variety of reinforcing and skill practicing techniques--such as role playing or skits--to give teens the opportunity to explore new behaviors and get feed-back from other participants. These techniques help develop peer support and foster group cohesiveness. The use of role models--either older teens or volunteer adults--can further reinforce program goals. 

(Next Slide--No. 8)

The number of different experiences a program can provide a teen is only limited by a developer’s imagination. Programs have attempted to mix what kids would call "fun stuff" with the program’s other materials. Special outings to parks, museums, and cultural events can reinforce the sense of belonging to a positive peer group and, at the same time, offer an experience that might otherwise be unavailable. Programs have also offered financial incentives both for consistent participation and for meeting the goals of the program itself. These can come as a monthly allowance or be held out as a long-range reward in the form of scholarships. 

As a final thought... there is no "magic bullet" to meet the challenges ahead. However--as we look at some encouraging trends in the national data and begin to systematically shift through what we know about programs for teens--I am reminded of how fortunate I was to grow up in a seemingly easier--and less dangerous time. And in the shadow of a New York institution. There--a wise and frequently quoted scholar resided--extolling wisdom that often eluded even him.

Yogi’s words seem fitting for today’s topic. In this case, "not knowing where we’re going" or not stopping long enough to put into practice what we’ve learned--can make the "somewhere else" a place we’d not wish for our nation’s children . . . and that would surely include my family’s four teenagers.

Thank you.

"Abstinence Education Grants and Welfare Reform"

The Consequences of Teen Sexual Behavior and How Teens Get Help

What are the consequences and costs of teen sexual behavior?
What are the different characteristics of abstinence programs?

Consequences of Teen Sexual Activity

Early Activity Associated With Other Serious Health Risks

--Of teens who are sexually experienced:
--66% consumed alcohol on a regular basis
--69% smoked cigarettes regularly
--87% used marijuana

Consequences of Teen Sexual Activity

Public Costs Associated With Teen Births

--Over 80% of teen mothers are from poor/low income homes
--$7.0 billion in supports costs for teen births
--Almost 50% of welfare recipients had a child as a teen
--77% of teens who give birth enter welfare system within 5 years

Abstinence Programs

Programs’ Approaches Vary

--Setting
--Program Content
--Instructional Strategy

Program Approaches

School-Based

--Traditional Classroom
--Targeted classes or groups
--After school programs

Program Approaches

Clinic-Based

--School clinics
--Free-standing clinics

Program Approach

Menu of Program Content Areas

--Health and reproduction
--Self esteem building/Personal responsibility
--Career options/Pre-employment skills
--Building resistance skills/Other risk factors
--Community service
--Parental education
--Enhance school performance

Other Program Considerations

--Stipends
--Scholarships
--Cultural and special activities

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