When Dr. John Santelli looks at a line graph showing the steep decline in U.S. teen pregnancy and birth rates from 1991 to 2005, he sees something more than numbers and statistics. A professor at Columbia University’s Mailman School of Public Health, Santelli sees a story about how to prevent young people from becoming parents at too young an age.

“The patterns are consistent with young people waking up and being more concerned about protecting themselves from HIV, STDs and pregnancy,” Santelli says. “The major effort that youth workers and clinicians and schools and parents put on in the late 80s and throughout the 90s focusing on that triple threat explains a lot of those national trends.”

Today, while U.S. teen pregnancy and birth rates remain low, the line graph has reached a plateau. And U.S. rates are still higher than those of other developed nations. Those facts have led the federal government, states and communities to renew their efforts to combat teen pregnancy. The good news is that we know more than ever about how to influence young people’s decisions about sex, relationships and childbearing.

Start Young

Santelli believes that teen pregnancy prevention begins at home in early childhood, when parents are instilling values and social skills and monitoring their children’s behavior closely.

Though that influence continues into adolescence, Santelli says, “Most parents are not prepared to be the final educator. They’re much more effective when they work with health educators and youth workers who may have more specific expertise.”

Youth workers may have an even greater role to play in educating young people from families racked by poverty or abuse, where early education about healthy relationships and sexuality may not occur.

So when should youth workers step in to support parents’ efforts or fill in gaps? Earlier is better, says Jim Jaccard, professor of psychology at Florida International University in Miami, who has studied adolescent risk-taking and programs that aim to prevent teen pregnancy.

In the United States, half of all teens have sex for the first time by age 16. As high school progresses, more and more teens begin having sex, according to figures from the Centers for Disease Control and Prevention: about 30 percent by ninth grade, 40 percent by 10th grade, 50 percent by 11th grade, and 60 percent by 12th grade.

The CDC doesn’t survey middle schoolers, but Jaccard finds that fewer than 1 in 10 young people he works with in New York are having sex in the seventh grade. That number jumps to 1 in 5 by eighth grade.

“If your focus is on prevention and trying to prevent early adolescent intercourse, to me the message is that sixth and seventh grade is a very important time to be intervening,” he says.

Young people at that age, he says, are not yet entwined in romantic relationships. They’re starting to pull away from their parents, but they aren’t fully asserting their independence yet, and they haven’t begun to experience the disillusionment with school, family and career options that older high-school-age adolescents often go through.

Combine Approaches

Across the spectrum of adolescent development, Santelli says youth-serving organizations ought to consider combining two approaches that have proven successful at preventing teen pregnancy and STDs. The first provides reproductive health education and services, with the goal of delaying teen’s first sexual experiences. Teens learn about pregnancy and how HIV and other STDs are transmitted, and are taught about condoms and contraception.

“The best [of these] programs are ones that talk to kids about being ready, in terms of having a condom but also being ready to have sex, and knowing when you’re not ready,” Santelli says. “If you’re an empowered young person you can say no. You can also say we have to use a condom.”

The second approach uses a Positive Youth Development philosophy to empower youth through community service and other activities that encourage their overall growth as people. Such programs may work with youth over a number of years, perhaps all the way through middle school and high school.

Both approaches can work on their own, Santelli says. But by combining sex education and PYD, as does the Carrera method promoted by the Children’s Aid Society in New York, programs may have an even greater effect.

“A lot of the successful work of youth workers and youth programs is getting kids into a better social environment where they can grow up and be the kind of effective, educated, empowered adults we want to see,” Santelli says. “And if they get to that state, they’re not going to become statistics.”

Resources

Teen Pregnancy Prevention Research Evidence Review, U.S. Department of Health and Human Services, Office of Adolescent Health

“Sex and HIV Education Programs for Youth: Their Impact and Important Characteristics” (PDF, 1.2 MB), ETR Associates

“Get Organized: A Guide to Preventing Teen Pregnancy,” National Campaign to Prevent Teen and Unplanned Pregnancy

Interventions With Evidence of Success Database, National Campaign to Prevent Teen and Unplanned Pregnancy

“Guidelines for Comprehensive Sexuality Education,” 3rd edition (PDF, 723.73 KB), Sexuality Information and Education Council of the United States