impact of an increase in family planning services on the teenage population of Philadelphia, The

Family Planning Perspectives, Mar 1995 by Hughes, Mary Elizabeth, Furstenberg, Frank F Jr, Teitler, Julien O

In the analyses above, we considered all of the clinics jointly. Because some areas may have exhibited more change than others, we compared the time trend in the city as a whole with each of the catchment areas separately. This analysis demonstrated no clinic-specific pattern of change over time that departed from that observed in the full sample. While the magnitudes of the various effects, especially for the attitudinal measures, varied somewhat, the direction, statistical significance, and relationship of the wave and wave-area indicators to each other were similar. We thus found no evidence that there were any subtle area-specific effects obscured in our analysis of the full sample.

Discussion

Taken as a whole, the results are unequivocal--there is no evidence of differential change by area, suggesting that Philadelphia's RESPECT project did not have a measurable impact on reproductive behavior, attitudes and knowledge among teenagers in its target population. Of the wide array of outcome measures, only five show statistically significant trend differences by area between 1988 and 1991 and they are in inconsistent directions, suggesting that the variation may be due to chance. Regardless of whether individual trends reached statistical significance, the overall pattern of results does not support any sustained impact from the project.

In fact, clinic use actually declined in the catchment areas relative to the entire city, although this trend differential was not statistically significant. There is some slight evidence, again not statistically significant, of a more favorable trend in contraceptive use in the catchment areas; however, without any concomitant change in clinic knowledge and use, it is difficult to attribute this increase to an effect of the RESPECT project. Finally, the most pronounced changes over time occurred not just in the catchment areas but throughout the city-notably, the increases in contraceptive use at first intercourse, in the proportion who believe clinics should be in schools and who know that clinics provide free contraception, and to a more limited degree, the decline in the proportion who had recently engaged in sexual activity.

Our findings do not imply that the RESPECT clinics were ineffective as providers of reproductive health services. They may have served the needs of their clients quite well. Rather, our results indicate that the increase in clinic resources did not measurably affect the experience of teenagers in the entire targeted population.

There are two limitations to our study that may qualify our results. First, although the association between the project and its target population is closer in our design than in most previous population investigations, several factors may distort the differential dosage assumption fundamental to our geographic comparison. For instance, the RESPECT clinics may have served teenagers drawn from outside the defined catchment areas. This is especially likely if, to preserve anonymity, teenagers seek family planning services in areas of the city outside their residential neighborhoods. The clinics' outreach efforts may also have reached teenagers from many different areas of the city, for instance, if teenagers brought friends from other areas to the group sessions.