Executive Summary from Care to Wait End of Year 1 Report

Adolescent Family Life Prevention Demonstration Project
End of Year Report - 2009

I. Executive Summary
This multi-site model provides a powerful research design: the enriched model is the family-based CARE to Wait program (20 hours) which both parents and 12-14 year-old youth attend together as compared to the primary abstinence education program for youth, which is a 20 hour track for 12–14 year old youth only using the youth curriculum from the CARE to Wait (CTW) program. Five years of research show youth 12-14 years old who attend CTW with their parents and complete baseline, 6- 12- and -24 month surveys, enhance self-efficacy, refusal skills, relationships and communication with parents, have fewer high risk peers and lower risky sexual behaviors, an index which includes abstinence. These factors were shown to be significantly improved in the experimental families over randomized control families.

The model is being tested in 18 paired sites which are randomized into youth only or enriched family based sites. The target population is accessed through six sponsoring organizations: Pueblo County (2 sites) and Washington/Morgan Counties (2 sites) through County extension programs in Colorado (rural and urban mixed populations); La Clinica del Pueblo, community health care agency in northern New Mexico, primarily Hispanic and rural/small town (2 sites); Eastern Shore Community Services in Virginia with African American and mixed populations (2 sites); Garrett County Health Department in Maryland (4 sites) with mixed populations; and the Elijah Network and Family Alliance in Dade County, Florida (6 faith-based sites – 3 matched pairs of African American, Hispanic, and mixed populations). Data from the project will inform researchers if program effects differ when parents are involved in the intervention.

This project will provide valuable information to the research base of prevention programming, particularly in the areas of adolescent health behaviors including abstinence education. This project will show what kinds of differences, if any, can be made by having families involved in participating with their youth in programs. It will show if family involvement affects long term program impacts. The diversity of the sites will also provide valuable information on how programs are received across a broad scope of demographic situations and whether family programs vs. youth only programs differ in their impact across cultures.

As of September 30th, 136 adults and 266 youth have participated in the baseline surveys from 16 sites, of these 262 were used in this analysis. Significant differences were found on parent’s age, with the youth-only group having older parents (d = .24, p = .09), and on confidence to use refusal skills, with the youth-only group having lower scores on this variable (d = .36, p = .36).
Ninety-eight youth and 91 parents have completed six month surveys. Given the small number of 6 month follow-up surveys administered before September 30, 2009, it is encouraging that a significant change was observed at post-test on participants’ attitudes and intentions related to abstinence, with this effect being larger in the enriched group as compared to the youth-only group. Sexual risk taking declined significantly in both groups showing the intervention had an effect for both youth in the enriched and youth only interventions in this variable. Significant improvements in family relationships also were observed in both groups; parent monitoring and parent-youth communication about sex and intimacy also improved significantly more in the enriched (family) intervention than in the youth-only group. Overall, these trends provide preliminary support for the efficacy of the Care to Wait program.
 
Table 1: Care to Wait Participation Numbers as of August 30, 2009

 
Table 2: Sample Demographics of Care to Wait Participants

 
II. Outcome Objectives of Care to Wait

Outcome Objective 1. Primary abstinence education program. By August 30, 2009, youth ages 12 to 14, from nine diverse sites, will have participated in (11 weekly sessions) 20 hours of Care to Wait youth classes provided by trained staff at the sites, and will increase:
(a) their skills in refusal, communication, and decision making
Results to Date: Teens participating in the two programs showed improvement in the quality of their relationship with their parents, F(1,72) = 5.76, p = .008, partial eta2=.092.
(b) their association with low risk peers
Results to Date: No statistically significant changes were observed on this measure.
(c) their knowledge of the benefits of abstaining from sex until marriage, and will have a commitment to abstinence and a rate of risky sexual activity
Results to Date: Statistically significant improvements were observed on conservative attitudes, F(1,71) = 11.89, p = .001, partial eta2 = .143. Similarly, a statistically significant decrease was observed on the measure of sexual risk taking behaviors, F(1,58) = 11.72, p = .001, partial eta2 = .168.

Outcome Objective 2. Intensive Parental/Family Involvement. By August 31, 2009, 180 parents or other adult family members in nine diverse sites will participate with their middle school youth in a minimum of 20 hours of Care to Wait parent/youth classes(11 weekly sessions) as conducted by trained site staff.
2a. Parents will increase in:
(a) their monitoring, positive relationships, and communication with youth
Results to Date: No statistically significant changes were observed on these variables.
(b) their knowledge of abstinence and healthy relationships in marriage, and ability to communicate with their youth about their sexual decision making
Results to Date: No statistically significant changes were observed on these variables.
2b. Youth, participating with parents, will increase:
(a) their skills in refusal, communication, and decision making
Results to Date: Statistically significant differences were observed in rates of sexual communication with their parents, with the youth in the enriched family program exhibiting greater improvement, F(1,40) = 4.48, p = .04, partial eta2 = .101.
(b) their association with low-risk peers
Results to Date: No statistically significant changes were observed on this measure.
(c) their knowledge of the benefits of abstaining from sex until marriage; they will have a greater commitment to abstinence and a lower rate of risky sexual activity
Results to Date: Statistically significant differences were observed on the measure of risk perception, with the youth in the enriched family program exhibiting improvement and the youth-only group declining, F(1,60) = 7.03, p = .01, partial eta2 = .105. Statistically significant differences were observed on measures of conservative attitudes, with the youth in the enriched family program exhibiting greater improvement, F(1,60) = 4.88, p = .03, partial eta2 = .075.

Note: Although it was not a stated objective, statistically significant differences were observed on the measure of youths’ perceptions of parental monitoring, with the youth in the enriched family program exhibiting improvement and the youth only group’s perceptions declining, F(1,61) = 5.08, p = .028, partial eta2 = .077.

Outcome Objective 3. Comparison of Primary Abstinence Education (Youth Only) with Youth in Enriched Family-Based Intervention. By August 2009, 180 12-14 year old youth from nine sites participating in the Primary Abstinence Education program will have completed the intervention (Objective 1) and youth in nine matching, randomly selected sites participating in the Enriched Family based model (Objective 2) will have completed their 20-hour intervention (Objective 2). By August 2013, the youth participating with families will exhibit more positive results (see objectives 1 and 2) than youth in the primary abstinence education program.

Summary of Goals and Objectives. Of the above, the principal long-term intervention goal is that participating youth will delay sexual intercourse, ideally until marriage. The following outcome objectives are most strongly aligned with this aim; the first two reflect the performance measures for AFL prevention demonstration programs. Previous evaluations of Care to Wait (CtW) have found an enriched model to have the intended impact, in comparison to a control group. In the current project, we hypothesized that the enriched (family) program will have more impact than the youth-only intervention because previous findings showed that changes in youth participants’ sexual attitudes and risk taking were mediated by changes in parent-reported communication about intimacy and sex as well as parent monitoring. That is, support for effective parent involvement can reduce adolescent sexual risk taking. And in fact, youth in the enriched family program were significantly more likely to endorse abstinence than their peers in the youth-only program. Also in support of our hypotheses, group differences favoring youth enrolled in the enriched program were found on measures of family communication about intimacy and sex as well as effective parental monitoring (see below).

III. Discussion of the data and information collected. The results described must be viewed as preliminary given the small sample sizes in each group. Given the young age of our participants, we put more emphasis on changing attitudes toward abstinence at this juncture than we do changes in risky sexual behavior, given how few 12-14 year olds are sexually active. Thus, it is encouraging that a significant change was observed at posttest on participants’ attitudes and intentions related to abstinence, with this effect being larger in the enriched group as compared to the youth-only group. Sexual risk taking declined significantly in both groups which indicates that this variable was positively affected in both the youth only and enriched family intervention.
Significant improvements in family relationships also were observed in both groups; parent monitoring and parent-youth communication about sex and intimacy also improved significantly more in the enriched (family) intervention than in the youth-only group. Overall, these trends provide preliminary support for the efficacy of the Care to Wait program. No changes in global parent or youth self-efficacy were observed. In previous studies, efficacy in refusal skills and parental monitoring were significant results (at 12 months), but have not yet shown a similar change. In general, then, the findings are encouraging but longer-term data with more cohorts needs to be collected before one could conclude that the program is having the intended effects.