On Second Thought: An Evaluation of an Adolescent Pregnancy Prevention Program in Central Pennsylvania Open Access

BeLieu, Rachel Catherine (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/nv935352z?locale=en


Background: Formal sex education and adolescent pregnancy prevention have gone through several incarnations since first introduced in the 1970s. Over time, evaluation efforts have shown that comprehensive education programs, that include information on preventing STIs and pregnancy through the use of contraceptives, are more effective than programs that only promote abstinence. Furthermore, programs that teach social skills such as sex refusal, condom negotiation, and resistance of peer pressure are more effective than those only providing information.

Objective: To determine if significant changes in knowledge, attitudes, behaviors, intentions, and self-efficacy are seen in On Second Thought program participants between pre-test and post-test; to determine if changes from pre-test to post-test are associated with varying levels of intervention exposure and implementation fidelity; and to identify problem areas in program implementation and evaluation and recommend improvements.

Methods: On Second Thought is an adolescent pregnancy prevention program consisting of 7 90-minute sessions, covering topics of STIs, pregnancy, drugs and alcohol, relationships, self-esteem, and peer pressure. Program participants took pre-tests and post-tests assessing knowledge, attitudes, behaviors, self-efficacy, and intentions surrounding program topics. Facilitators also recorded program attendance, participation, and intervention fidelity. Post-test responses were compared to pre-test responses for participants to assess change, and change between pre-test and post-test was compared for those with differential intervention exposure.

Results: Greater intervention exposure was significantly associated with improvements in metrics relating to knowledge, attitudes, and behaviors. Students attending a greater number of successful sessions were more likely to show desirable change between pre-test and post-test on items dealing with STIs, condoms, and pregnancy. They were more likely to agree that early pregnancy would negatively affect their goals, and they were less likely to report using drugs or alcohol or having sex within the last 30 days.

Discussion: Despite poor data quality and a small sample size, this evaluation found significant effects of the intervention on a range of different metrics. Perhaps most importantly, intervention exposure was associated with changes in reported behaviors, a finding often not seen in evaluations of short-term, classroom-based pregnancy prevention programs such as this one.

Table of Contents

Abstract. iv

Acknowledgements. vi

List of Figures. x

List of Tables. x

Chapter 1: Introduction. 1

Section 1.1: Introduction and Rationale. 1

Section 1.2: Problem Statement. 1

Section 1.3: Purpose Statement. 2

Section 1.4: Objectives. 2

Section 1.5: Significance. 3

Section 1.6: Definition of Terms. 3

Chapter 2: Background and Literature Review.. 5

Section 2.1: Teen Sexual Activity. 5

Section 2.2: Teen Pregnancy. 6

Section 2.3: STIs among Adolescents. 8

Section 2.4: Drug Use among Adolescents. 9

Section 2.5: Interventions. 11

2.5.1: History and Policy. 11

2.5.2: Current State. 13

2.5.3: Theories and Models. 14

Section 2.6: Evaluation of Interventions. 16

2.6.1: Studies Using National Data. 16

2.6.2: Meta-Analyses. 17

2.6.3: Evaluation of Individual Interventions. 19

Chapter 3: Methods. 23

Section 3.1: Context. 23

Section 3.2: Intervention. 24

Section 3.3: Study Design. 27

3.3.1: Participants. 28

3.3.2: Measures. 28

3.3.3: Instruments. 30

Section 3.4: Analysis. 33

3.4.1: Demographic Data. 33

3.4.2: Intervention Exposure. 33

3.4.3: Pre-Test and Post-Test Responses. 35

Section 3.5: Ethics. 36

3.5.1: Consent. 36

3.5.2: Confidentiality. 37

Chapter 4: Results. 38

Section 4.1: Characteristics of Participants. 38

4.1.1: Age. 39

4.1.2: Race/Ethnicity. 40

4.1.3: Sex. 42

Section 4.2: Intervention Exposure. 42

4.2.1: Fidelity Monitoring. 42

4.2.2: Attendance and Participation. 45

4.2.3: Successful Sessions. 47

Section 4.3: Pre-Test Scores. 49

4.3.1: Scores and Percent Correct. 49

4.3.2: Distribution of Response Values. 52

4.3.3: Composite Items. 53

4.3.4: Demographic Variation. 54

Section 4.4: Post-Test Scores. 57

4.4.1: Scores and Percent Correct. 57

4.3.2: Distribution of Response Values. 58

4.3.3: Composite Items. 59

Section 4.5: Change from Pre- and Post-Tests. 60

4.5.1: Missing Tests. 60

4.5.2: Changes. 62

Section 4.6: Effect of Intervention Exposure. 68

4.6.1: Numeric Change in Score. 68

4.6.2: Positive Change. 69

4.6.3: Correct Responses on Post-Test. 69

4.6.4: Average Scores. 73

Chapter 5: Discussion. 75

Section 5.1: Demographic Characteristics. 75

Section 5.2: Intervention Exposure. 76

Section 5.3: Test Scores. 77

Chapter 6: Recommendations and Conclusion. 82

Section 6.1: Recommendations for Program Implementation. 82

Section 6.2: Recommendations for Further Evaluation. 83

Section 6.3: Conclusion. 85

Bibliography. 87

Appendices. 90

Appendix 1: Fidelity Monitoring Forms. 90

Appendix 2: Pre/Post-Test. 98

Appendix 3: Facilitator Instructions for Test Administration. 100

Appendix 4: Parental Opt-Out Permission Form.. 101

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