Adolescents' Knowledge And Beliefs About Pregnancy: The Impact Of "Enabl"

Adolescence, Fall, 2000 by Elizabeth Mayfield Arnold, Thomas Edward Smith, Dianne F. Harrison, David W. Springer

ABSTRACT

Finding effective ways to prevent adolescent pregnancy is a concern of public health officials, educators, social workers, parents, and legislators. Numerous programs exist, but there is debate as to whether it is the specific program itself or other factors that are responsible for participants' successful outcomes. Using a quasi-experimental design, this study sought to determine which factors predicted changes in knowledge and beliefs among middle school students (N = 1,450) after exposure to Postponing Sexual Involvement (PSI), the curricular component of Education Now and Babies Later (ENABL), a pregnancy prevention program. It was found that the single most important predictor of improvement in knowledge and beliefs about pregnancy prevention was PSI itself, not background variables. The findings contradict some of the previous studies on factors impacting teenage pregnancy and lend support for the continued examination of ENABL as a promising component of pregnancy prevention efforts.

Modest reductions in pregnancy rates among American teenagers have recently been reported (Ensley, 1997). However, teenage pregnancy remains a social problem that continues to concern parents, educators, and legislators. This concern is amplified by the finding that although the age at first coitus for American adolescents is comparable to that for adolescents in other Western countries, pregnancy rates among the former are far higher (Jones et al., 1985). Thus, social workers, other public health officials, and school personnel are aware of the need to implement programs to prevent adolescents from becoming parents at an age when they generally lack adequate psychosocial and financial resources.

Two main problems plague efforts to reduce teenage pregnancy: the translation of knowledge gained in pregnancy prevention programs into behavioral changes, and, second, the development of programs that provide adolescents with information and support to help them abstain from sexual behavior or use contraception when they do have sexual intercourse. In addition, providing evidence that a particular program produces changes in an adolescent's sexual behavior is difficult, because extraneous factors cannot be entirely controlled.

This article examines the findings of a recent evaluation of an abstinence-based pregnancy prevention curriculum, Postponing Sexual Involvement (PSI). PSI is the central component of a nationally recognized pregnancy prevention program, Education Now and Babies Later (ENABL). ENABL involves an interdisciplinary effort by social workers, public health officials, and school staff to implement the PSI curriculum in the public school system (for example, social workers are involved in advocating for PSI, which at times has involved battling resistance to teaching any type of pregnancy prevention in the schools). Developed by Marion Howard of Emory University Medical School, PSI is based on the social inoculation model, which theorizes that adolescents engage in potentially harmful behaviors, such as sexual intercourse, because they lack adequate knowledge (Howard & McCabe, 1990). According to Kirby (1992), "social inoculation theory postulates that there exists a process of social inoculation that is analogous to physiological inoculation--people develop a resistance to social pressure when they can recognize the various forms of pressure, becoming motivated to resist that pressure, and then practice resisting weak forms of that pressure" (pp. 282-283). Thus, PSI teaches students the skills believed to be necessary to abstain from sexual behavior, and they are given the opportunity to practice these strategies with their peers. The goal is for students to use these skills in situations where they may consider engaging in sexual activity. However, ENABL was recently evaluated in California, and no long-term impact on any of the variables influencing the decision to have sex was found at 17 months (Kirby, Korbi, Barth, & Cagampang, 1997).

In this study, students were exposed to the PSI curriculum, and a discriminant function analysis was used to determine which factors most likely impacted knowledge and beliefs about sexual behavior. While some believe that the effectiveness of sexuality education programs can be determined by examining changes in knowledge, attitudes, and self-reported behavior, others assert that the impact of such programs cannot be quantified (Sex Information and Education Council of the United States, 1992). Nevertheless, for younger students, the preliminary indicator of a program's success is usually its ability to impact skills or attitudes (Card, Niego, Mallari, & Farrell, 1996). Gains in knowledge do not necessarily produce change in behavior, but they are believed to be the necessary precursor. For example, greater knowledge about condoms has been found to be related to behavioral change among adolescents (Wilson, Kastrinakis, D'Angelo, & Getson, 1994). Measurement of knowledge and beliefs immediately after exposure to the curriculum allows one to determine whether students learned the content. Although longitudinal studies enable researchers to examine behavioral changes, additional variables intervene to obscure outcomes.