Abstinence Education
Assessing the Accuracy and Effectiveness of Federally Funded Programs Gao ID: GAO-08-664T April 23, 2008Among the efforts of the Department of Health and Human Services (HHS) to reduce the incidence of sexually transmitted diseases and unintended pregnancies, the agency provides funding to states and organizations that offer abstinence-until-marriage education. GAO was asked to testify on the oversight of federally funded abstinence-until-marriage education programs. This testimony is primarily based on Abstinence Education: Efforts to Assess the Accuracy and Effectiveness of Federally Funded Programs, GAO-07-87 (Oct. 3, 2006). In this testimony, GAO discusses efforts by (1) HHS and states to assess the scientific accuracy of materials used in abstinence-until-marriage education programs and (2) HHS, states, and researchers to assess the effectiveness of abstinence-until-marriage education programs. GAO also discusses a Public Health Service Act requirement regarding medically accurate information about condom effectiveness. GAO focused on the three main federally funded abstinence-until-marriage programs and reviewed documents and interviewed HHS officials in the Administration for Children and Families (ACF) and the Office of Population Affairs (OPA). To update certain information, GAO contacted officials from ACF and OPA.
Efforts by HHS and states to assess the scientific accuracy of materials used in abstinence-until-marriage education programs have been limited. As of October 2006, HHS's ACF--which awards grants under two programs that account for the largest portion of federal spending on abstinence education--did not review its grantees' education materials for scientific accuracy, nor did it require grantees of either program to do so. Not all states that receive funding from ACF had chosen to review their program materials for scientific accuracy. OPA reviewed the scientific accuracy of grantees' proposed education materials, and any inaccuracies found had to be corrected before those materials could be used. The extent to which federally funded abstinence-until-marriage education materials are inaccurate was not known, but OPA and some states reported finding inaccuracies. GAO recommended that the Secretary of HHS develop procedures to help assure the accuracy of abstinence-until-marriage education materials. An ACF official reported that ACF is currently implementing a process to review the accuracy of Community-based grantees' curricula and has required those grantees to sign assurances that the materials they propose using are accurate. The official also reported that, in the future, state grantees will have to provide ACF with descriptions of their strategies for reviewing the accuracy of their programs. As of August 2006, HHS, states, and researchers had made a variety of efforts to assess the effectiveness of abstinence-until-marriage education programs, but a number of factors limit the conclusions that can be drawn about the programs' effectiveness. ACF and OPA have required their grantees to report on various outcomes used to measure program effectiveness. To assess the effectiveness of its grantees' programs, ACF has analyzed national data on adolescent birth rates and the proportion of adolescents who report having had sexual intercourse. Additionally, 6 of the 10 states in GAO's review worked with third-party evaluators to assess the effectiveness of abstinence-until-marriage programs in their states. However, the conclusions that can be drawn are limited because most of the efforts to evaluate program effectiveness have not met certain minimum criteria that experts have concluded are necessary for such assessments to be scientifically valid. Additionally, the results of some efforts that do meet such criteria have varied. While conducting work for its October 2006 report, GAO identified a legal matter that required the attention of HHS. Section 317P(c)(2) of the Public Health Service Act requires certain educational materials to contain medically accurate information about condom effectiveness. GAO concluded that this requirement would apply to abstinence education materials prepared and used by federal grant recipients, depending on their substantive content, and recommended that HHS adopt measures to ensure that, where applicable, abstinence education materials comply with this requirement. The fiscal year 2007 program announcement for the Community-based Program provides information about the applicability of this requirement, and future State and Community-based Program announcements are to include this information.
GAO-08-664T, Abstinence Education: Assessing the Accuracy and Effectiveness of Federally Funded Programs
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Testimony:
Before the Committee on Oversight and Government Reform, House of
Representatives:
United States Government Accountability Office:
GAO:
For Release on Delivery:
Expected at 10:00 a.m. EDT:
Wednesday, April 23, 2008:
Abstinence Education:
Assessing the Accuracy and Effectiveness of Federally Funded Programs:
Statement of Marcia Crosse:
Director, Health Care:
GAO-08-664T:
GAO Highlights:
Highlights of GAO-08-664T, a testimony before the Committee on
Oversight and Government Reform, House of Representatives.
Why GAO Did This Study:
Among the efforts of the Department of Health and Human Services (HHS)
to reduce the incidence of sexually transmitted diseases and unintended
pregnancies, the agency provides funding to states and organizations
that offer abstinence-until-marriage education.
GAO was asked to testify on the oversight of federally funded
abstinence-until-marriage education programs. This testimony is
primarily based on Abstinence Education: Efforts to Assess the Accuracy
and Effectiveness of Federally Funded Programs, GAO-07-87 (Oct. 3,
2006). In this testimony, GAO discusses efforts by (1) HHS and states
to assess the scientific accuracy of materials used in abstinence-until-
marriage education programs and (2) HHS, states, and researchers to
assess the effectiveness of abstinence-until-marriage education
programs. GAO also discusses a Public Health Service Act requirement
regarding medically accurate information about condom effectiveness.
GAO focused on the three main federally funded abstinence-until-
marriage programs and reviewed documents and interviewed HHS officials
in the Administration for Children and Families (ACF) and the Office of
Population Affairs (OPA). To update certain information, GAO contacted
officials from ACF and OPA.
What GAO Found:
Efforts by HHS and states to assess the scientific accuracy of
materials used in abstinence-until-marriage education programs have
been limited. As of October 2006, HHS‘s ACF”which awards grants under
two programs that account for the largest portion of federal spending
on abstinence education”did not review its grantees‘ education
materials for scientific accuracy, nor did it require grantees of
either program to do so. Not all states that receive funding from ACF
had chosen to review their program materials for scientific accuracy.
OPA reviewed the scientific accuracy of grantees‘ proposed education
materials, and any inaccuracies found had to be corrected before those
materials could be used. The extent to which federally funded
abstinence-until-marriage education materials are inaccurate was not
known, but OPA and some states reported finding inaccuracies. GAO
recommended that the Secretary of HHS develop procedures to help assure
the accuracy of abstinence-until-marriage education materials. An ACF
official reported that ACF is currently implementing a process to
review the accuracy of Community-based grantees‘ curricula and has
required those grantees to sign assurances that the materials they
propose using are accurate. The official also reported that, in the
future, state grantees will have to provide ACF with descriptions of
their strategies for reviewing the accuracy of their programs.
As of August 2006, HHS, states, and researchers had made a variety of
efforts to assess the effectiveness of abstinence-until-marriage
education programs, but a number of factors limit the conclusions that
can be drawn about the programs‘ effectiveness. ACF and OPA have
required their grantees to report on various outcomes used to measure
program effectiveness. To assess the effectiveness of its grantees‘
programs, ACF has analyzed national data on adolescent birth rates and
the proportion of adolescents who report having had sexual intercourse.
Additionally, 6 of the 10 states in GAO‘s review worked with third-
party evaluators to assess the effectiveness of abstinence-until-
marriage programs in their states. However, the conclusions that can be
drawn are limited because most of the efforts to evaluate program
effectiveness have not met certain minimum criteria that experts have
concluded are necessary for such assessments to be scientifically
valid. Additionally, the results of some efforts that do meet such
criteria have varied.
While conducting work for its October 2006 report, GAO identified a
legal matter that required the attention of HHS. Section 317P(c)(2) of
the Public Health Service Act requires certain educational materials to
contain medically accurate information about condom effectiveness. GAO
concluded that this requirement would apply to abstinence education
materials prepared and used by federal grant recipients, depending on
their substantive content, and recommended that HHS adopt measures to
ensure that, where applicable, abstinence education materials comply
with this requirement. The fiscal year 2007 program announcement for
the Community-based Program provides information about the
applicability of this requirement, and future State and Community-based
Program announcements are to include this information.
To view the full product, including the scope and methodology, click on
[hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-08-664T]. For more
information, contact Marcia Crosse at (202) 512-7114 or crossem@gao.gov.
[End of section]
Mr. Chairman and Members of the Committee:
I am pleased to be here today as you examine federally funded
abstinence-until-marriage education programs. Reducing the incidence of
sexually transmitted diseases (STD) and unintended pregnancies among
adolescents has been an important objective of the Department of Health
and Human Services (HHS). Among its efforts to do so, HHS funds
abstinence-until-marriage education programs. These programs are
delivered by a variety of entities, including schools, human service
agencies, and faith-based organizations. Studies have raised concerns
about the accuracy of the educational materials that are incorporated
into these programs, as well as the effectiveness of the programs
themselves. My remarks today are primarily based on our October 2006
report on the oversight of federally funded abstinence-until-marriage
programs, Abstinence Education: Efforts to Assess the Accuracy and
Effectiveness of Federally Funded Programs (GAO-07-87).[Footnote 1] In
that report, we recommended that the Secretary of Health and Human
Services develop procedures to help assure the accuracy of such
materials. Today, I will discuss findings from our report on (1)
efforts by HHS and states to assess the scientific accuracy of
materials used in abstinence-until-marriage programs, and (2) efforts
by HHS, states, and researchers to assess the effectiveness of
abstinence-until-marriage education programs as well as updates on
selected information. I will also discuss a legal matter that came to
our attention during the course of our work regarding the applicability
of section 317P(c)(2) of the Public Health Service Act to Abstinence
Education programs. We recommended in a letter dated October 18, 2006,
that HHS adopt measures to ensure that, where applicable, abstinence-
until-marriage education materials comply with the requirement that
educational materials specifically designed to address STDs contain
medically accurate information about condom effectiveness in preventing
the STDs the materials were designed to address.[Footnote 2]
For our assessment of the accuracy and effectiveness of abstinence-
until-marriage education programs, we focused our review on the three
main federally funded abstinence-until-marriage programs: the
Abstinence Education Program (State Program), the Community-Based
Abstinence Education Program (Community-Based Program), and the
Adolescent Family Life (AFL) Program. The State Program and the
Community-Based Program are both administered by HHS's Administration
for Children and Families (ACF); AFL is administered by HHS's Office of
Population Affairs (OPA). According to HHS, funding for the three
abstinence-until-marriage programs was about $165 million in fiscal
year 2007.
In order to describe the efforts to assess the scientific accuracy of
program materials, we reviewed published reports, program
announcements, Federal Register notices, agency Web sites, and other
documents related to abstinence-until-marriage education. We did not
assess the criteria used to determine the scientific accuracy of
education materials or the quality of the reviews. We interviewed
officials from ACF and OPA. We also interviewed officials from the 10
states that received the largest share of federal funding (together
accounting for 51 percent of the total funding in fiscal year 2005)
through the State Program for abstinence-until-marriage education.
[Footnote 3]
To describe efforts by HHS, states, and researchers to assess the
effectiveness of abstinence-until-marriage education programs, we
focused on efforts that examined the extent to which these programs
achieved their program goals. In general, these goals include teaching
adolescents to abstain from sexual activity until marriage in order to
avoid unintended pregnancies, STDs, and related health problems. As
part of our review, we compared these efforts to the design
characteristics that experts have identified as important for a
scientifically valid study of program effectiveness.[Footnote 4] We
reviewed journal articles and other published reports, agency budget
submissions, program announcements, agency and grantee performance
reports, Federal Register notices, agency Web sites, and other
documents related to abstinence-until-marriage education.[Footnote 5]
We also interviewed officials from ACF, OPA, the Centers for Disease
Control and Prevention (CDC), the National Institutes of Health (NIH),
the Office of the Assistant Secretary for Planning and Evaluation
(ASPE), and 10 states that received the largest share of federal
funding for abstinence-only education through the State Program in
fiscal year 2005. We focused our review on efforts to assess the
scientific accuracy of materials and the effectiveness of the programs
during fiscal year 2006. We conducted this work from October 2005
through September 2006 and during April 2008 in accordance with
generally accepted government auditing standards. Those standards
require that we plan and perform the audit to obtain sufficient,
appropriate evidence to provide a reasonable basis for our findings and
conclusions based on our audit objectives. We believe that the evidence
obtained provides a reasonable basis for our findings and conclusions
based on our audit objectives.
To assess the applicability of section 317P(c)(2) of the Public Health
Service Act to abstinence-until-marriage education programs, we
reviewed the statute, pertinent legislative history, and relevant
program guidance. In addition, we solicited the views of HHS officials
on this issue.
In summary, we found that efforts by HHS and states to assess the
scientific accuracy of materials used in abstinence-until-marriage
education programs had been limited. ACF did not review its grantees'
education materials for scientific accuracy and did not require that
grantees of either the State Program or the Community-Based Program do
so. In addition, not all states that received funding through ACF's
State Program chose to review their program materials for scientific
accuracy. Five of the 10 states in our review conducted such reviews.
In contrast to ACF, OPA did review the scientific accuracy of AFL
grantees' proposed educational materials and any inaccuracies found had
to be corrected before the materials could be used. While we reported
that the extent to which federally funded abstinence-until-marriage
education materials are inaccurate was not known, in the course of
their reviews OPA and some states reported that they had found some
inaccuracies in abstinence-until-marriage education materials. For
example, one state official described an instance in which abstinence-
until-marriage materials incorrectly suggested that HIV can pass
through condoms because the latex used in condoms is porous. To address
concerns about the scientific accuracy of materials used in abstinence-
until-marriage programs, we recommended that the Secretary of HHS
develop procedures to help assure the accuracy of such materials, and
HHS agreed to consider this recommendation. In April 2008, an ACF
official reported that, in response to our recommendation, ACF began
requiring in fiscal year 2007 that community-based grantees sign
written assurances that the materials they propose using are accurate.
This official also reported that, starting in fiscal year 2008,
grantees of the State Program will also be required to sign these
written assurances. In addition, this official reported that ACF is
implementing a process to review the accuracy of the proposed curricula
of fiscal year 2007 Community-based grantees. The ACF official reported
that the curricula will be reviewed by a research analyst to ensure
that all statements are referenced to source documents, and then by a
healthcare professional who will compare the information in the
curricula to information in the source documents. The official also
reported that, in the future, ACF will require states to provide the
agency with descriptions of their strategies for reviewing the accuracy
of their abstinence-until-marriage education programs.
HHS, states, and researchers have made a variety of efforts to assess
the effectiveness of abstinence-until-marriage education programs;
however, a number of factors limit the conclusions that can be drawn
about the effectiveness of abstinence-until-marriage education
programs. To assess the effectiveness of their abstinence-until-
marriage education programs, ACF and OPA have required their grantees
to report on various outcomes. For example, as of fiscal year 2006,
states that received funding through the State Program were required to
report annually on four measures of the prevalence of adolescent sexual
behavior in their state, such as the rate of pregnancy among
adolescents aged 15 to 17 years. To assess the effectiveness of both
its State and Community-Based Programs, ACF also analyzed trends in
adolescent behavior, as reflected in national data on birth rates among
teens and the proportion of surveyed high school students reporting
that they have had sexual intercourse. OPA required grantees of the AFL
Program to develop and report on outcome measures that demonstrated the
extent to which grantees' programs are having an effect on program
participants. Further, 6 of the 10 states in our review that received
funding through the State Program worked with third-party evaluators to
assess the effectiveness of abstinence-until-marriage education
programs in their states. Several factors, however, limit the
conclusions that can be drawn about the effectiveness of abstinence-
until-marriage education programs. Most of the efforts to evaluate the
effectiveness of abstinence-until-marriage education programs that we
described in our report did not meet certain minimum criteria--such as
random assignment of participants and sufficient follow-up periods and
sample sizes--that experts have concluded are necessary in order for
assessments of program effectiveness to be scientifically valid.
During the course of our work on abstinence-until-marriage education,
we identified a legal matter that required the attention of HHS.
Section 317P(c)(2) of the Public Health Service Act requires
educational materials specifically designed to address STDs to contain
medically accurate information about condom effectiveness in preventing
the diseases the educational materials are designed to address. We
concluded that this requirement would apply to abstinence-until-
marriage education materials prepared by and used by federal grant
recipients, depending upon the substantive content of those materials.
In other words, in materials otherwise meeting the statutory criteria,
HHS' grantees are required to include information on condom
effectiveness, and that information must be medically accurate. At the
time of our review, an ACF official reported that materials prepared by
abstinence-until-marriage education grantees were not subject to
section 317P(c)(2). Therefore, we recommended in a letter dated October
18, 2006, that HHS reexamine its position and adopt measures to ensure
that, where applicable, abstinence-until-marriage education materials
comply with this requirement. The fiscal year 2007 Community-Based
Program announcement states that mass produced materials that as their
primary purpose are specifically about STDs are required to contain
medically accurate information regarding the effectiveness or lack of
effectiveness of condoms in preventing the STDs the educational
materials are designed to address. An ACF official also told us that
future State and Community-Based Program announcements would include
this language.
Background:
Statistics reported by CDC show that many high school students engage
in sexual behavior that places them at risk for unintended pregnancy
and STDs. In 2005, 46.8 percent of high school students reported that
they have had sexual intercourse, with 14.3 percent of students
reporting that they had had sexual intercourse with four or more
persons. CDC also has reported that the prevalence of certain STDs--
including the rate of chlamydia infection, the most frequently reported
STD in the United States--peaks in adolescence and young adulthood.
At the time of our 2006 report, HHS's strategic plan included the
objectives to reduce the incidence of STDs and unintended pregnancies
and to promote family formation and healthy marriages. These two
objectives supported HHS's goals to reduce the major threats to the
health and well-being of Americans and to improve the stability and
healthy development of American children and youth. Abstinence-until-
marriage education programs were one of several types of programs that
supported these objectives. The State Program, the Community-Based
Program, and the AFL Program provide grants to support the recipients'
own efforts to provide abstinence-until-marriage education at the local
level. These programs must comply with the statutory definition of
abstinence education (see table 1).[Footnote 6]
Table 1: Definition of Abstinence Education:
Abstinence education refers to an educational or motivational program
that:
A. has, as its exclusive purpose, teaching the social, psychological,
and health gains to be realized by abstaining from sexual activity.
B. teaches abstinence from sexual activity outside marriage as the
expected standard for all school age children.
C. teaches that abstinence from sexual activity is the only certain way
to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and
other associated health problems.
D. teaches that a mutually faithful monogamous relationship in context
of marriage is the expected standard of human sexual activity.
E. teaches that sexual activity outside of the context of marriage is
likely to have harmful psychological and physical effects.
F. teaches that bearing children out-of-wedlock is likely to have
harmful consequences for the child, the child's parents, and society.
G. teaches young people how to reject sexual advances and how alcohol
and drug use increases vulnerability to sexual advances; and;
H. teaches the importance of attaining self-sufficiency before engaging
in sexual activity.
Source: Social Security Act, § 510(b)(2) (codified at 42 U.S.C. §
710(b)(2)).
[End of table]
The State Program, administered by ACF, provides funding to its
grantees--states--for the provision of abstinence-until-marriage
education to those most likely to have children outside of
marriage.[Footnote 7] States that receive grants through the State
Program have discretion in how they use their funding to provide
abstinence-until-marriage education. Funds are allotted to each state
that submits the required annual application based on the ratio of the
number of low-income children in the state to the total number of low-
income children in all states. States are required to match every $4
they receive in federal money with $3 of nonfederal money and are
required to report annually on the performance of the abstinence-until-
marriage education programs that they support or administer. In fiscal
year 2007, 40 states, the District of Columbia, and 3 insular areas
were awarded funding.
The Community-Based Program, which is also administered by ACF, is
focused on funding public and private entities that provide abstinence-
until-marriage education for adolescents from 12 to 18 years old. The
Community-Based Program provides grants for school-based programs,
adult and peer mentoring, and parent education groups. For fiscal year
2007, 59 grants were awarded to organizations and other entities.
Grantees are required to report to ACF, on a semiannual basis, on the
performance of their programs.
The AFL Program also supports programs that provide abstinence-until-
marriage education.[Footnote 8] Under the AFL Program, OPA awards
competitive grants to public or private nonprofit organizations or
agencies, including community-based and faith-based organizations, to
facilitate abstinence-until-marriage education in a variety of
settings, including schools and community centers. In fiscal year 2007,
OPA awarded funding to 36 grantees. Grantees are required to conduct
evaluations of certain aspects of their programs and report annually on
their performance.
Five organizational units located within HHS--ACF, OPA, CDC, ASPE, and
NIH--have responsibilities related to abstinence-until-marriage
education. ACF and OPA administer the three main federal abstinence-
until-marriage education programs. CDC supports abstinence-until-
marriage education at the national, state, and local levels. CDC, ASPE,
and NIH are sponsoring research on the effectiveness of abstinence-
until-marriage programs.
Federal and State Efforts to Assess the Scientific Accuracy of
Materials Used in Abstinence-until-Marriage Education Programs Have
Been Limited:
In October 2006 we reported that efforts by HHS and states to assess
the scientific accuracy of materials used in abstinence-until-marriage
education programs had been limited.[Footnote 9] ACF--whose grants to
the State and Community-Based Programs accounted for the largest
portion of federal spending on abstinence-until-marriage education--
did not review its grantees' education materials for scientific
accuracy and did not require grantees of either program to review their
own materials for scientific accuracy. In addition, not all states
funded through the State Program chose to review their program
materials for scientific accuracy. In contrast to ACF, OPA reviewed the
scientific accuracy of grantees' proposed educational materials and
corrected inaccuracies in these materials.
ACF Neither Reviewed Nor Required Grantees to Review Program Materials
for Scientific Accuracy, Although Some State Grantees Had Conducted
Such Reviews:
As of October 2006, there had been limited efforts to review the
scientific accuracy of educational materials used in ACF's State and
Community-Based Programs--the two programs that accounted for the
largest portion of federal spending on abstinence-until-marriage
education. ACF did not review materials for scientific accuracy in
either reviewing grant applications or in overseeing grantees'
performance. Prior to fiscal year 2006, State Program and Community-
Based Program applicants were not required to submit copies of their
proposed educational materials with their applications. While ACF
required grantees of the Community-Based Program--but not the State
Program--to submit their educational materials with their fiscal year
2006 applications, ACF officials told us that grantee applications and
materials were only reviewed to ensure that they addressed all aspects
of the scope of the Community-Based Program, such as the A-H definition
of abstinence education.[Footnote 10] Further, documents provided to us
by ACF indicated that the agency did not review grantees' educational
materials for scientific accuracy as a routine part of its oversight
activities. In addition, ACF also did not require its grantees to
review their own materials for scientific accuracy.
While not all grantees of the State Program had chosen to review the
scientific accuracy of their educational materials, officials from 5 of
the 10 states in our review reported that their states chose to do so.
These five states used a variety of approaches in their reviews. For
example, some states contracted with medical professionals--such as
nurses, gynecologists, and pediatricians--to serve as medical advisors
who review program materials and use their expertise to determine what
is and is not scientifically accurate. One of the states required that
all statistics or scientific statements cited in a program's materials
be sourced to CDC or a peer-reviewed medical journal. Officials from
this state told us that if statements in these materials could not be
attributed to these sources, the statements were required to be removed
until citations were provided and materials were approved.
As a result of their reviews, officials from two of the five states
reported that they had found inaccuracies. One state official cited an
instance where materials incorrectly suggested that HIV can pass
through condoms because the latex used in condoms is porous. State
officials who have identified inaccuracies told us that they informed
their grantees of inaccuracies so that they could make corrections in
their individual programs. Some of the educational materials that
states reviewed were materials that were commonly used in the Community-
Based Program.
While there had been limited review of materials used in the State and
Community-Based Programs, grantees of these programs had received some
technical assistance designed to improve the scientific accuracy of
their materials. For example, ACF officials reported that the agency
provided a conference for grantees of the Community-Based Program in
February 2006 that included a presentation focused on medical accuracy.
OPA Reviewed Materials Used by AFL Program Grantees for Scientific
Accuracy:
As of 2006, in contrast to ACF, OPA reviewed for scientific accuracy
the educational materials used by AFL Program grantees, and it did so
before those materials were used. OPA officials said that after grants
were awarded, a medical education specialist (in consultation with
several part-time medical experts) reviewed the grantees' printed
materials and other educational media, such as videos. OPA officials
explained that the medical education specialist must approve all
proposed materials before they are used. On many occasions, OPA
grantees had proposed using--and therefore OPA has reviewed--materials
commonly used in the Community-Based Program. For example, an OPA
official told us that the agency had reviewed three of the Community-
Based Program's commonly used curricula and was also currently
reviewing another curriculum commonly used by Community-Based Program
grantees.
OPA officials stated that the medical education specialist had
occasionally found and addressed inaccuracies in grantees' proposed
educational materials. OPA officials stated that these inaccuracies
were often the result of information being out of date because, for
example, medical and statistical information on STDs changes
frequently. OPA addressed these inaccuracies by either not approving
the materials in which they appeared or correcting the materials
through discussions with the grantees and, in some cases, the authors
of the materials. In fiscal year 2005, OPA disapproved of a grantee
using a specific pamphlet about STDs because the pamphlet contained
statements about STD prevention and HIV transmission that were
considered incomplete or inaccurate. For example, the pamphlet stated
that there was no cure for hepatitis B, but the medical education
specialist required the grantee to add that there was a preventive
vaccine for hepatitis B. In addition, OPA required that a grantee
correct several statements in a true/false quiz--including statements
about STDs and condom use--in order for the quiz to be approved for
use. For example, the medical education specialist changed a sentence
from "The only 100% effective way of avoiding STDs or unwanted
pregnancies is to not have sexual intercourse." to "The only 100%
effective way of avoiding STDs or unwanted pregnancies is to not have
sexual intercourse and engage in other risky behaviors."
While OPA and some states had reviewed their grantees' abstinence-
until-marriage education materials for scientific accuracy, these types
of reviews have the potential to affect abstinence-until-marriage
education providers more broadly, perhaps creating an incentive for the
authors of such materials to ensure they are accurate. As of October
2006, the company that produced one of the most widely used curricula
used by grantees of the Community-Based Program had updated its
curriculum. A representative from that company stated that this had
been done, in part, in response to a congressional review that found
inaccuracies in its abstinence-until-marriage materials.
To address concerns about the scientific accuracy of materials used in
abstinence-until-marriage education programs, we recommended that the
Secretary of HHS develop procedures to help assure the accuracy of such
materials used in the State and Community-Based Programs.[Footnote 11]
We recommended that in order to provide such assurance, the Secretary
could consider alternatives such as (1) extending the approach
currently used by OPA to review the scientific accuracy of the factual
statements included in abstinence-until-marriage education to materials
used by grantees of ACF's Community-Based Program and requiring
grantees of ACF's State Program to conduct such reviews or (2)
requiring grantees of both programs to sign written assurances in their
grant applications that the materials they propose using are accurate.
In its written comments on a draft of our report, HHS stated that it
would consider requiring grantees of both ACF programs to sign such
written assurances to the accuracy of their materials. In April 2008,
an ACF official reported that, in response to our recommendation, ACF
began requiring in fiscal year 2007 that community-based grantees sign
written assurances that the materials they propose using are accurate.
This official also reported that, starting in fiscal year 2008,
grantees of the State Program will also be required to sign these
written assurances. In addition, this official reported that ACF is
implementing a process to review the accuracy of the proposed curricula
of fiscal year 2007 Community-based grantees. The ACF official reported
that the curricula will be reviewed by a research analyst to ensure
that all statements are referenced to source documents, and then by a
healthcare professional who will compare the information in the
curricula to information in the source documents. The official also
reported that, in the future, ACF will require states to provide the
agency with descriptions of their strategies for reviewing the accuracy
of their abstinence-until-marriage education programs.
A Variety of Efforts Were Made to Assess the Effectiveness of
Abstinence-until-Marriage Education Programs, but a Number of Factors
Limit the Conclusions That Can Be Drawn:
HHS, states, and researchers have made a variety of efforts to assess
the effectiveness of abstinence-until-marriage education programs;
however, a number of factors limit the conclusions that can be drawn.
ACF and OPA have required their grantees to report on various outcomes
used to measure the effectiveness of grantees' abstinence-until-
marriage education programs. To assess the effectiveness of the State
and Community-Based Programs, ACF has analyzed national data on
adolescent birth rates and the proportion of adolescents who report
having had sexual intercourse. As of October 2006, other organizational
units within HHS were funding studies designed to assess the
effectiveness of abstinence-until-marriage education programs in
delaying sexual initiation, reducing pregnancy and STD rates, and
reducing the frequency of sexual activity. Despite these efforts,
several factors limit the conclusions that can be drawn about the
effectiveness of abstinence-until-marriage education programs. Most of
the efforts to evaluate the effectiveness of abstinence-until-marriage
education programs that we reviewed have not met certain minimum
criteria that experts have concluded are necessary in order for
assessments of program effectiveness to be scientifically valid, in
part because such designs can be expensive and time-consuming to carry
out. In addition, the results of some efforts that meet the criteria of
a scientifically valid assessment have varied.
HHS, States, and Researchers Have Made a Variety of Efforts to Assess
the Effectiveness of Abstinence-until-Marriage Education Programs:
ACF has made efforts to assess the effectiveness of abstinence-until-
marriage education programs funded by the State Program and the
Community-Based Program. One of ACF's efforts has been to require
grantees of both programs to report data on outcomes, though the two
programs have different requirements for the outcomes grantees must
report.[Footnote 12] As of fiscal year 2006, State Program grantees
were required to report annually on four measures of the prevalence of
adolescent sexual behavior in their states, such as the rate of
pregnancy among adolescents aged 15 to 17 years, and compare these data
to program targets over 5 years. States also were required to develop
and report on two additional performance measures that were related to
the goals of their programs.[Footnote 13] Also as of fiscal year 2006,
ACF required Community-Based Program grantees to develop and report on
outcome measures designed to demonstrate the extent to which grantees'
community-based abstinence-until-marriage education programs were
accomplishing their program goals.[Footnote 14] In addition to outcome
reporting, ACF required grantees of the Community-Based Program to
report on program "outputs," which measure the quantity of program
activities and other deliverables, such as the number of participants
who are served by the abstinence-until-marriage education programs.
As of October 2006, OPA also had made efforts to assess the
effectiveness of the AFL Program. Specifically, OPA required grantees
of the AFL Program to develop and report on outcome measures, such as
participants' knowledge of the benefits of abstinence and their
reported intentions to abstain from sexual activity, that were used to
help demonstrate the extent to which grantees' programs were having an
effect on program participants. To collect data on outcome measures,
OPA required grantees to administer, at a minimum, a standardized
questionnaire to their program participants, both when participants
begin an abstinence-only education program and after the program's
completion. OPA officials told us that they were planning to aggregate
information from certain questions in the standardized set of
questionnaires in order to report on certain performance measures as
part of the agency's annual performance reports; the agency expected to
begin receiving data from grantees that were using these questionnaires
in January 2007.
To help grantees measure the effectiveness of their programs, both ACF
and OPA required that grantees use independent evaluators and have
provided assistance to grantees in support of their program evaluation
efforts. ACF and OPA required their grantees to contract with third-
party evaluators, such as university researchers or private research
firms, who were responsible for helping grantees develop the outcome
measures they were required to report on and monitoring grantee
performance against those measures. Unlike ACF, OPA required that these
third-party evaluations incorporate specific methodological
characteristics, such as control groups of individuals that did not
receive the program and sufficient sample sizes to ensure that any
observed differences between the groups were statistically valid. Both
ACF and OPA have provided technical assistance and training to their
grantees in order to support grantees' own program evaluation efforts.
ACF also analyzed trends in adolescent behavior, as reflected in
national data on birth rates among teens and the proportion of surveyed
high school students reporting that they have had sexual
intercourse.[Footnote 15] ACF used these national data as a measure of
the overall effectiveness of its State and Community-Based Programs,
comparing the national data to program targets. In its annual
performance reports, the agency has summarized the progress being made
toward lowering the rate of births to unmarried teenage girls and the
proportion of students (grades 9-12) who report having ever had sexual
intercourse.
Some states have made additional efforts to assess the effectiveness of
abstinence-until-marriage education programs. Specifically, we found
that 6 of the 10 states in our review that received funding through
ACF's State Program had made efforts to conduct evaluations of selected
abstinence-until-marriage programs in their state. All 6 of the states
worked with third-party evaluators, such as university researchers or
private research firms, to perform the evaluations, which in general
measured self-reported changes in program participants' behavior and
attitudes related to sex and abstinence as indicators of program
effectiveness. Four of these states had completed third-party
evaluations as of February 2006, and the results of these studies
varied.[Footnote 16] Among those 4 states, 3 states required the
abstinence programs in their state to measure reported changes in
participants' behavior as an indicator of program effectiveness--both
at the start of the program and after its completion. The 3 states
required their programs to track participants' reported incidence of
sexual intercourse. Additionally, 2 of the 4 states required their
programs to track biological outcomes, such as pregnancies, births, or
STDs. In addition, 6 of the 10 states in our review required their
programs to track participants' attitudes about abstinence and sex,
such as the number of participants who make pledges to remain
abstinent.
Besides ACF and OPA, other organizational units within HHS have made
efforts to assess the effectiveness of abstinence-until-marriage
education programs. As of 2006, ASPE was sponsoring a study of the
Community-Based Program and a study of the State Program. The study of
the State Program was conducted by Mathematica Policy Research, Inc.
(Mathematica) and completed in 2007. It examined the impact of five
programs funded through the State Program on participants' attitudes
and behaviors related to abstinence and sex.[Footnote 17] Like ASPE,
CDC has made its own effort to assess the effectiveness of abstinence-
until-marriage education by sponsoring a study to evaluate the
effectiveness of two middle school curricula--one that complies with
abstinence-until-marriage education program requirements and one that
teaches a combination of abstinence and contraceptive information and
skills. The agency expects to complete the study in 2009. Likewise, NIH
has funded studies comparing the effectiveness of education programs
that focus only on abstinence with the effectiveness of sex education
programs that teach both abstinence and information about
contraception. As of October 2006, NIH was funding five studies, which
in general were comparing the effects of these two types of programs on
the sexual behavior and related attitudes among groups of either middle
school or high school students.
In addition to the efforts of researchers working on behalf of HHS and
states, other researchers--such as those affiliated with universities
and various advocacy groups--have made efforts to study the
effectiveness of abstinence-until-marriage education programs. This
work includes studies of the outcomes of individual programs and
reviews of other studies on the effectiveness of individual abstinence-
until-marriage education programs. In general, research studies on the
effectiveness of individual programs have examined the extent to which
they changed participants' demonstrated knowledge of concepts taught in
the programs, declared intentions to abstain from sex until marriage,
and reported behavior related to sexual activity and abstinence. As of
October 2006, the efforts to study and build a body of research on the
effectiveness of most abstinence-until-marriage education programs had
been under way for only a few years, in part because grants under the
two programs that account for the largest portion of federal spending
on abstinence-until-marriage education--the State Program and the
Community-Based Program--were not awarded until 1998 and 2001,
respectively.
Several Factors Limit the Conclusions That Can Be Drawn about the
Effectiveness of Abstinence-until-Marriage Education Programs:
Most of the efforts of HHS, states, and other researchers to evaluate
the effectiveness of abstinence-until-marriage education programs
included in our review have not met certain minimum criteria that
experts have concluded are necessary in order for assessments of
program effectiveness to be scientifically valid. In an effort to
better assess the merits of the studies that have been conducted on the
effectiveness of sexual health programs--including abstinence-until-
marriage education programs--scientific experts have developed criteria
that can be used to gauge the scientific rigor of these evaluations.
The reports of two panels of experts,[Footnote 18],[Footnote 19] as
well as the experts we interviewed in the course of our previous work,
generally agreed that scientifically valid studies of a program's
effectiveness should include the following characteristics:
* An experimental design that randomly assigns individuals or schools
to either an intervention group or control group, or a quasi-
experimental design that uses nonrandomly assigned but well-matched
comparison groups. According to the panel of scientific experts
convened by the National Campaign to Prevent Teen Pregnancy,
experimental designs or quasi-experimental designs with well-matched
comparison groups have at least three important strengths that are
typically not found in other studies, such as those that use aggregated
data: they evaluate specific programs with known characteristics, they
can clearly distinguish between participants who did and did not
receive an intervention, and they control for other factors that may
affect study outcomes. According to scientific experts, studies that
include experimental or quasi-experimental designs should also collect
follow-up data for a minimum number of months after subjects receive an
intervention. In addition, experts have reported that studies should
have a sample size of at least 100 individuals for study results to be
considered scientifically valid.
* Studies should assess or measure changes in biological outcomes or
reported behaviors instead of attitudes or intentions. According to
scientific experts, biological outcomes--such as pregnancy rates, birth
rates, and STD rates--and reported behaviors--such as reported
initiation and frequency of sexual activity--are better measures of the
effectiveness of abstinence-until-marriage programs, because adolescent
attitudes and intentions may or may not be indicative of actual
behavior.
Many of the efforts by HHS, states, and other researchers that we
identified in our review lack at least one of the characteristics of a
scientifically valid study of program effectiveness. Most of the
efforts to assess the effectiveness of these programs have not used
experimental or quasi-experimental designs with sufficient follow-up
periods and sample sizes. For example, ACF used, according to ACF
officials, grantee reporting on outcomes in order to monitor grantees'
performance, target training and technical assistance, and help
grantees improve service delivery. However, because the outcomes
reported by grantees have not been produced through experimentally or
quasi-experimentally designed studies, such information cannot be
causally attributed to any particular abstinence-until-marriage
education program. Further, none of the state evaluations we reviewed
that had been completed included randomly assigned control groups.
Similarly, some of the journal articles that we reviewed described
studies to assess the effectiveness of abstinence-until-marriage
programs that also lacked at least one of the characteristics of a
scientifically valid study of program effectiveness. In these studies,
researchers administered questionnaires to study participants before
and after they completed an abstinence-until-marriage education program
and assessed the extent to which the responses of participants changed.
[Footnote 20] These studies did not compare the responses of study
participants with a group that did not participate in an abstinence-
until-marriage education program.
Like the lack of an experimental or quasi-experimental design, not
measuring changes in behavioral or biological outcomes among
participants limits the conclusions that can be drawn about the
effectiveness of abstinence-until-marriage education programs. Most of
the efforts we identified in our review used reported intentions and
attitudes in order to assess the effectiveness of abstinence-until-
marriage programs. For example, as of 2006, neither ACF's community-
based grantees nor OPA's AFL grantees were required to report on
behavioral or biological outcomes, such as rates of intercourse or
pregnancy. Similarly, the journal articles we reviewed were more likely
to use reported attitudes and intentions--such as study participants'
reported attitudes about premarital sexual activity or their reported
intentions to remain abstinent until marriage--rather than their
reported behaviors or biological outcomes to assess the effectiveness
of abstinence-until-marriage programs.
According to scientific experts, HHS, states, and other researchers
face a number of challenges in applying either of these criteria.
According to these experts, experimental or quasi-experimental studies
can be expensive and time-consuming to carry out, and many grantees of
abstinence-until-marriage education programs have insufficient time and
funding to support these types of studies. Moreover, it can be
difficult for researchers assessing abstinence-until-marriage education
programs to convince school districts to participate in randomized
intervention and control groups, in part because of sensitivities to
surveying attitudes, intentions, and behaviors related to abstinence
and sex. Similarly, experts, as well as state and HHS officials, have
reported that it can be difficult to obtain scientifically valid
information on biological outcomes and sexual behaviors. For example,
experts have reported that when measuring a program's effect on
biological outcomes--such as reducing pregnancy rates or birth rates--
it is necessary to have large sample sizes in order to determine
whether a small change in such outcomes is the result of an abstinence-
until-marriage education program.
Among the assessment efforts we identified are some studies that meet
the criteria of a scientifically valid effectiveness study. However,
results of these studies varied, and this limits the conclusions that
can be drawn about the effectiveness of abstinence-until-marriage
education programs. Some researchers have reported that abstinence-
until-marriage education programs have resulted in adolescents
reporting having less frequent sexual intercourse or fewer sexual
partners.[Footnote 21] For example, in one study of middle school
students, participants in an abstinence-until-marriage education
program who had sexual intercourse during the follow-up period were 50
percent less likely to report having two or more sexual partners when
compared with their nonparticipant peers.[Footnote 22] In contrast,
other studies have reported that abstinence-until-marriage education
programs did not affect the reported frequency of sexual intercourse or
number of sexual partners.[Footnote 23] For example, one study of
middle school students found that participants of an abstinence-until-
marriage program were not less likely than nonparticipants at the 1
year follow-up to report less frequent sexual intercourse or fewer
sexual partners.[Footnote 24] Experts with whom we spoke emphasized
that there were still too few scientifically valid studies completed as
of 2006 that could be used to determine conclusively which, if any,
abstinence-until-marriage programs are effective.
We identified two key studies that experts anticipated would meet the
criteria of a scientifically valid effectiveness study. Experts and
federal officials we interviewed stated that they expected the results
of these two federally funded studies to add substantively to the body
of research on the effectiveness of abstinence-until-marriage education
programs. One of these key studies--the final Mathematica report,
contracted by ASPE, on the State Program--has been completed.[Footnote
25] In this report, the researchers found that youth who participated
in the abstinence-until-marriage education programs were no more likely
than control group youth to have abstained from sex, and among those
who reported having had sex, they had similar numbers of sexual
partners and had initiated sex at the same average age. The youth in
abstinence-until-marriage education programs also were no more likely
to have engaged in unprotected sex than control group youth. The second
key study we identified is CDC's research on middle school programs,
which is still ongoing. In addition, since October 2006, a third key
report was released, presenting the 2007 analysis of the National
Campaign to Prevent Teen and Unplanned Pregnancy of the available
research on abstinence-until-marriage education programs. This report
stated that studies of abstinence programs have not produced sufficient
evidence of effectiveness, and that efforts should be directed toward
further evaluation of these programs.[Footnote 26]
Statutory Requirement to Include Information on Condom Effectiveness
Would Apply to Certain Abstinence-until-Marriage Education Materials:
During the course of our work on abstinence-until-marriage education,
we identified a federal statutory provision--section 317P(c)(2) of the
Public Health Service Act--relevant to the grants provided by HHS's
State Program, Community-Based Program, and AFL Program.[Footnote 27]
This provision requires that educational materials prepared by HHS's
grantees, among others, that are specifically designed to address STDs,
contain medically accurate information regarding the effectiveness or
lack of effectiveness of condoms in preventing the diseases the
materials are designed to address.
At the time of our review, an ACF official reported that materials
prepared by abstinence-until-marriage education grantees were not
subject to section 317P(c)(2). However, we concluded that this
requirement would apply to abstinence-until-marriage education
materials prepared by and used by federal grant recipients, depending
upon the substantive content of those materials. In other words, in
materials specifically designed to address STDs, HHS's grantees are
required to include information on condom effectiveness, and that
information must be medically accurate. Therefore, we recommended in a
letter dated October 18, 2006, that HHS reexamine its position and
adopt measures to ensure that, where applicable, abstinence education
materials comply with this requirement.[Footnote 28]
In a letter to us dated January 16, 2007, ACF responded that it would
take steps to "make it clear to grantees that when they mass produce
materials that as a primary purpose are specifically about STDs those
materials are required by section 317P(c)(2) of the Public Health
Service Act to contain medically accurate information regarding the
effectiveness or lack of effectiveness of condoms in preventing the
sexually transmitted disease the materials are designed to address."
The fiscal year 2007 Community-Based Program announcement states that
mass produced materials that as their primary purpose are specifically
about STDs are subject to this requirement. The announcement also
states that mass produced materials are considered to be specifically
designed to address STDs if more than 50 percent of the content is
related to STDs. An ACF official also told us that future State and
Community-Based Program announcements would include this
language.[Footnote 29]
Mr. Chairman, this completes my prepared remarks. I will be happy to
answer questions you or other Committee Members may have.
Contact and Acknowledgments:
For further information regarding this testimony, please contact Marcia
Crosse at (202) 512-7114 or crossem@gao.gov. Contact points for our
Offices of Congressional Relations and Public Affairs may be found on
the last page of this statement. Major contributors to this report were
Kristi Peterson, Assistant Director; Kelly DeMots; Cathleen Hamann;
Helen Desaulniers; and Julian Klazkin.
[End of section]
Footnotes:
[1] GAO, Abstinence Education: Efforts to Assess the Accuracy and
Effectiveness of Federally Funded Programs, GAO-07-87 (Washington,
D.C.: Oct. 3, 2006). This report is available online at [hyperlink,
http://www.gao.gov].
[2] 42 U.S.C. § 247b-17(c)(2) (2000); see GAO, Abstinence Education:
Applicability of Section 317P of the Public Health Service Act, B-
308128 (Washington, D.C.: Oct. 18, 2006). This letter is available
online at [hyperlink, http://www.gao.gov].
[3] The 10 states that received the largest share of funding in fiscal
year 2005 through the State Program were Arizona, Florida, Georgia,
Illinois, Louisiana, Michigan, New York, North Carolina, Ohio, and
Texas.
[4] See Douglas Kirby, Emerging Answers: Research Findings on Programs
to Reduce Teen Pregnancy (Washington, D.C.: National Campaign to
Prevent Teen Pregnancy, 2001). The experts identifying the design
characteristics of a scientifically valid study for the National
Campaign to Prevent Teen Pregnancy were drawn from institutions that
include the National Institutes of Health, the Medical Institute for
Sexual Health, the Alan Guttmacher Institute, the Institute for
Research and Evaluation, and various universities. See David Satcher,
The National Consensus Process on Sexual Health and Responsible Sexual
Behavior: Interim Report (Atlanta: Morehouse School of Medicine, 2006).
The panel convened by former Surgeon General David Satcher included
experts from a variety of organizations, including the Medical
Institute for Sexual Health, the Alan Guttmacher Institute, and the
American Academy of Pediatrics. In addition, characteristics of a
scientifically valid study have been identified by other experts in the
field of evaluation research. For example, see Carol H. Weiss,
Evaluation (Upper Saddle River: Prentice Hall, 1998).
[5] For a more detailed description of our literature review
methodology, see [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-87].
[6] 42 U.S.C. § 710(b)(2). This definition is also referred to as the A-
H definition. This statutory provision defines abstinence education for
purposes of the State Program. Annual appropriations acts and program
announcements have extended this definition to the Community-Based and
AFL Programs. See, e.g., Departments of Labor, Health and Human
Services, and Education, and Related Agencies Appropriations Act, 2006,
Pub. L. No. 109-149, 119 Stat. 2833, 2855-56.
[7] Funds are also provided through the State Program to the District
of Columbia and insular areas, which include U.S. territories and
commonwealths. In this statement, we refer to U.S. territories and
commonwealths as "insular areas." When we refer to "states," we are
referring to all grantees of the State Program--including states,
insular areas, and the District of Columbia.
[8] See 42 U.S.C. § 300z et seq. In this statement, when we use the
term AFL Program, we are referring only to the abstinence-until-
marriage component of the AFL Program. The AFL Program also supports
other projects for pregnant and parenting adolescents, their infants,
male partners, and family members. The purpose of these projects is to
improve the outcomes of early childbearing for teen parents, their
infants, and their families.
[9] See [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-87].
[10] HHS officials told us that if ACF finds inaccurate statements
during this more general review process or if inaccuracies are brought
to their attention at any time during the grant period, ACF officials
work with the grantees to take corrective action.
[11] See [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-87].
[12] This reporting is a part of ACF's efforts to collect evaluative
information about these programs. These efforts include both
performance measurement--the ongoing monitoring and reporting of
program accomplishments toward pre-established goals--and program
evaluation--individual systematic studies to assess how well a program
is working.
[13] For example, in fiscal year 2002, state grantees developed such
measures as the percentage of teens surveyed who show an increase in
participating in structured activities after school hours; the
percentage of live births to women younger than 18, fathered by men age
20 and older; the percentage of program participants proficient in
refusal skills; the percentage of high school students who reported
using drugs or alcohol before intercourse; and the percentage of high
school students who had sexual intercourse for the first time before
age 13.
[14] The fiscal year 2006 program announcement for the Community-Based
Program provided examples of outcome measures that grantees could use,
including increased knowledge of the benefits of abstinence, the number
of youths who commit to abstaining from premarital sexual activity, and
increased knowledge of how to avoid high-risk situations and risk
behaviors.
[15] Data on teen birth rates and adolescents' reported sexual behavior
are contained in the National Vital Statistics System and the Youth
Risk Behavior Surveillance System, respectively. The former is a
national data set of public health statistics reported by states to
CDC, and the latter is a national data set based on nationwide surveys
administered to high school students by CDC.
[16] See, for example, LeCroy & Milligan Associates, Inc., Abstinence
Only Education Program: Fifth Year Evaluation Report, a report prepared
for the Arizona Department of Health Services (2003); Patricia Goodson
et al., Abstinence Education Evaluation: Phase 6, a report prepared for
the Texas Department of State Health Services (2005); MGT of America,
Evaluation of Georgia Abstinence Education Programs Funded Under Title
V, Section 510, a report prepared for the Georgia Department of Human
Resources (2005); Thomas E. Smith, It's Great to Wait: An Interim
Evaluation, a report prepared for the Florida Department of Health
(2001).
[17] The five abstinence-until-marriage education programs studied were
My Choice, My Future! in Powhatan, Virginia; ReCapturing the Vision in
Miami, Florida; Teens in Control in Clarksdale, Mississippi; Families
United to Prevent Teen Pregnancy in Milwaukee, Wisconsin; and Heritage
Keepers in Edgefield, South Carolina.
[18] See Kirby. This panel included experts from NIH, the Medical
Institute for Sexual Health, the Alan Guttmacher Institute, the
Institute for Research and Evaluation, and various universities.
[19] See Satcher. This panel included experts from a variety of
organizations, including the Medical Institute for Sexual Health, the
Alan Guttmacher Institute, and the American Academy of Pediatrics.
[20] See, for example, S. M. Fitzgerald et al., "Effectiveness of the
Responsible Social Values Program for 6th Grade Students in One Rural
School District," Psychological Reports, vol. 91 (2002), and J. E.
Barnett and C. S. Hurst, "Abstinence Education for Rural Youth: An
Evaluation of the Life's Walk Program," The Journal of School Health,
vol. 73, no. 7 (2003).
[21] See E. A. Borawski et al., "Effectiveness of Abstinence-only
Intervention in Middle School Teens," American Journal of Health
Behavior, vol. 29, no. 5 (2005). See also T. L. St. Pierre et al., "A
27-Month Evaluation of a Sexual Activity Prevention Program in Boys &
Girls Clubs Across the Nation," Family Relations, vol. 44, no. 1
(1995).
[22] See Borawski et al., "Effectiveness of Abstinence-only
Intervention in Middle School Teens,".
[23] See N. G. Harrington et al., "Evaluation of the All Stars
Character Education and Problem Behavior Prevention Program: Effects on
Mediator and Outcome Variables for Middle School Students," Health
Education & Behavior, vol. 28, no. 5 (2001). See also J. B. Jemmott
III, L. S. Jemmott, and G. T. Fong, "Abstinence and Safer Sex HIV Risk-
Reduction Interventions for African American Adolescents: A Randomized
Controlled Trial," Journal of the American Medical Association, vol.
279, no. 19 (1998).
[24] See Harrington et al., "Evaluation of the All Stars Character
Education and Problem Behavior Prevention Program: Effects on Mediator
and Outcome Variables for Middle School Students."
[25] See Trenholm at al., Impacts of Four Title V, Section 510
Abstinence Education Programs: Final Report, a report prepared for
ASPE, 2007. According to several scientific experts, Mathematica's
study is an important one, in part because of its sound design: the
study randomly assigns and compares control groups with groups
receiving abstinence-until-marriage education and uses surveys to
follow up with program participants for several months after their
completion of a program.
[26] See Douglas Kirby, Emerging Answers 2007: Research Findings on
Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases
(Washington D.C.: National Campaign to Prevent Teen and Unplanned
Pregnancy, 2007).
[27] 42 U.S.C. § 247b-17(c)(2). Section 317P(c)(2) states that "...
educational and prevention materials prepared and printed ...for the
public and health care providers by the Secretary (including materials
prepared through the Food and Drug Administration, the Centers for
Disease Control and Prevention, and the Health Resources and Services
Administration) or by contractors, grantees, or subgrantees thereof,
that are specifically designed to address STDs...shall contain
medically accurate information regarding the effectiveness or lack of
effectiveness of condoms in preventing the STD the materials are
designed to address. Such requirement only applies to materials mass
produced for the public and health care providers, and not to routine
communications."
[28] See GAO, B-308128, Oct. 18, 2006.
[29] OPA reported that, as a matter of policy, it has required since
1993 that AFL Program materials that include information regarding STDs
contain medically accurate information regarding the effectiveness or
lack of effectiveness of condoms in preventing the STDs addressed in
the materials. Further, OPA reported that, since November 2006, OPA has
taken additional steps to inform grantees about OPA's policy and the
need to be compliant with the requirements of Section 317P(c)(2) of the
Public Health Service Act.
[End of section]
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E-mail: fraudnet@gao.gov:
Automated answering system: (800) 424-5454 or (202) 512-7470:
Congressional Relations:
Ralph Dawn, Managing Director, dawnr@gao.gov:
(202) 512-4400:
U.S. Government Accountability Office:
441 G Street NW, Room 7125:
Washington, D.C. 20548:
Public Affairs:
Chuck Young, Managing Director, youngc1@gao.gov:
(202) 512-4800:
U.S. Government Accountability Office:
441 G Street NW, Room 7149:
Washington, D.C. 20548:
