Despite recent declines, the United States still has one of
the highest teenage pregnancy rates among industrialized
nations.1 While a growing number of programs have improved
contraceptive prevalence or affected sexuality-related
behaviors, few high-quality evaluations have documented
programs’ success in reducing teenage pregnancies and
births, and even fewer have been able to delay the age of
sexual debut. This article reports on the results achieved
by a three-year, random-assignment evaluation of a Carreramodel
teenage pregnancy prevention program.
The past 20 years have been filled with acrimony over
how to best approach the problem of teenage pregnancy,
but few successful strategies have emerged from this debate.
Program evaluation has been sorely neglected and is
frequently limited to measuring knowledge change or assessing
intentions to remain abstinent. Moreover, many evaluations
have lacked comparison groups, which has made
it impossible to be sure that the programs themselves produced
the observed outcomes.
What programs have been successful in reducing rates
of teenage pregnancy? Two are early childhood or elementary
school interventions. The Seattle Social Development
Project used teacher training and parenting classes
in elementary schools to increase children’s sense of attachment
to their school and family, while also increasing
their social skills.2 Some 18 schools were nonrandomly assigned
to receive the intervention or not. By age 18, young
people from the program schools were less likely to have
had intercourse and also had lower pregnancy rates than
those from control schools.
A second program, the Abecedarian project, randomly
assigned children to receive interventions during preschool,
elementary school, both or neither.3 Children in preschool
received year-round, full-day child care from infancy through
kindergarten, while those in the elementary school intervention
worked with a home-school resource teacher whose
objective was to increase parental involvement in the child’s
learning. The children in intervention classrooms had lower
birthrates than children in the control group at age 21 and
had delayed childbearing by more than one year.
Two communitywide projects have lowered teenage pregnancy
rates. In one, pregnancy rates in a rural South Carolina
county were tracked from 1977 to 1988 to detect
changes created by an intervention that featured sexuality
education training for school staff, classroom training in
decision-making skills for students and the school nurse’s
providing transportation to a family planning clinic and
dispensing condoms.4 Compared with another part of the
county and with three similar counties, the intervention
area had lower rates of teenage pregnancy; furthermore,
these rates returned to previously high levels after the program
ended. A second evaluation of this program described