This project surveyed and assessed Title XX Adolescent Family Life (AFL)-funded research to assist in developing a new AFL research agenda that is applicable to prevention and care demonstration projects.
Funded by the Office of Population Affairs, U.S. Department of Health and Human Services
In 2008 OPA funded Lorraine Klerman, Dr.P.H., of The Heller School for Social Policy and Management at Brandeis University to assess investigator-initiated research funded by AFL and develop recommendations for future research priorities. Upon Dr. Klerman’s death, Sumru Erkut, Ph.D., and Alice Frye, Ph.D., of the Wellesley Centers for Women took over the task of completing the project. The recommendations on funding priorities for the Adolescent Family Life Program were developed based on: 1) a review of research AFL has funded that revealed some gaps in knowledge; 2) a recognition of social and technological developments in the 21st century that influence adolescent lives and reproductive behavior; 3) feedback from a survey of professionals in the fields of teen pregnancy prevention and services to pregnant and parenting teens commissioned for this contract; and 4) input from experts in the field that included John Santelli, Douglas Kirby, Maria Idali Torres, Loral Patchen, Sarah Brown, Lynne Haverkos, Alison Spitz, Laurie Nsiah-Jefferson, Pat Paluzzi, Susan Newcomer, and Trina Menden Anglin. Linda Charmaraman, Jennifer Grossman, and Ineke Ceder provided additional input.
Identified Gaps in Knowledge
Study Design. A notable lack is in the area of large-scale mixed-method qualitative and process studies of adolescent sexual behavior and consequences, particularly studies that include in-depth, valid measures of social and institutional context that can be linked to quantitative outcomes. Also, expanding the focus on multilevel studies that include context would benefit from continued emphasis.
Study of diverse samples. More studies with minority samples are needed, especially studies that include Native Americans and Asian Americans, Hispanics, members of the African diaspora, including samples from relatively recent refugee and immigrant communities, and multiracial adolescents. Because minority groups contain internal heterogeneity, there is a need for larger-sample studies that focus on intra-racial and intra-ethnic variability.
Risk Area. The influence of technology (internet, social networking, mobile devices, etc.) on social relationships and also the availability of sexual stimuli—and thus risk—appear poised to grow exponentially in the future. Studies utilizing such technologies to understand online peer cultures and how youth explore their worlds, get health information from each other and from “trusted sources” using technology and media are needed. A focus on examinations of media influences on adolescent sexual mores and behavior are important, particularly studies that examine the impact of exposure to visual and also written pornography.
Recommendations for Research Priority Areas
A. Services for Pregnant and Parenting Adolescents
1. Inventory of available services and their outcomes
(longitudinal studies of more than three years) post-birth time periods for the baby who is the focus of the intervention. The prenatal period should be included as a category for short-term outcomes, especially with respect to outcomes such as preterm delivery, low-birth weight, and breastfeeding. The compilation should take into consideration demographic differences among parents.
2. Best practices associated with program entry and persistence
What are the best practices for identifying needs, recruiting eligible parents, enrolling and retaining them in programs, and assessing long-term program outcomes? What program and service provider characteristics, including awareness, knowledge, and skills of staff and leadership, are associated with positive outcomes? Studies in this area should include a focus on the ways best practices may vary by the cultural milieu of the target population, as well as the ways physical, social, and political environment influence the best program implementation approaches.
3. Role of other programs focusing on high-risk families for serving pregnant or parenting adolescents
Early Head Start, the Nurse-Family Partnership, and other publicly and privately supported programs enroll and serve large numbers of teenagers. We do not know whether these are operating in locations that also have programs that exclusively serve teenagers. If they do, are the teenagers enrolled in both types of programs? In what ways do their services differ? If teenagers choose one or the other type of program, what factors influence that choice? Are the outcomes for teenagers in programs that serve diverse high-risk clients comparable to outcomes of those that exclusively serve teenagers? Are the costs comparable?
4. Pregnant or parenting teenagers who do not receive services
Some adolescents give birth and care for their children seemingly without engaging with teen pregnancy and parenting programs. It is important to know how many teenagers fall through the cracks, how they manage, and why they are not receiving services. How do outcomes for teens and their children vary for teens who do and do not receive program services? What factors influence lack of access to or utilization of care, and how does that vary by different demographic groups? Are there teen attitudes about pregnancy or parenting that influence utilization of services? What services are specifically available for teen mothers and fathers who are homeless or without any close family to support them?
5. Media influences
The impact of “reality” programming has been a specific focus of only a few studies of pregnant and parenting adolescents. What messages do pregnant and parenting adolescents receive from “reality” television? How are pregnant and parenting teen mothers and fathers portrayed in those programs? Are any demographic groups more frequently portrayed than others? Are there differentials by type of media, media outlets, etc.?
6. A 21st-century update
An important context for adolescent parenthood is historical time. Most follow-up studies of teenage parents are based on cohorts originally recruited well before welfare reform, healthcare reform, and other institutional and structural changes that influence the lives of adolescent parents. When possible, such studies should use subsamples from longitudinal data already being collected by several agencies and organizations. The state-by-state differences in implementing healthcare, contraceptive availability and types of contraceptive coverage, and the legal context of access/minor rights offer a unique opportunity to assess the impact of different provisions of changes in healthcare coverage and implementation.
B. Pregnancy Prevention Studies
1. Contextual Influences
Some studies have made an effort to examine the influence of context on risks for teenage pregnancy by incorporating multilevel approaches. New studies should follow this trend by continuing to make use of school, neighborhood, census, and state level quantitative data so that individual risks can be understood within their realistic circumstances. Race, ethnicity, social class, sexual orientation, religion, urbanicity of residence, and geographic region continue to be important social contexts that influence adolescents’ sexual and parenting behaviors alone and in interaction with each other. An intersectionality perspective that highlights the unique developmental needs of adolescents and their children who have multiple identities (e.g., a disabled white teen mother who lives in a rural area) can be a useful framework for designing research on risk and protective factors as well as for designing interventions for both male and female adolescents. Are there measurable ways to examine the sexual risk climate of a community, such as assessing access to bars, nightclubs, and liquor stores, preponderance of low-rent hotels, parks, or abandoned buildings where teens may be able to congregate privately? The family context, often extending beyond the historical focus on the nuclear family unit, and how it relates to other settings and influences adolescent behavior, is also crucial. What community, cultural, educational, and interpersonal resources, knowledge, attitudes, beliefs, and behaviors can increase parents’ effectiveness as sexuality educators for both their sons and daughters?
2. Intergenerational transmission of teenage parenting
Many of the children of teenage parents themselves become teenage parents. This is also true in extended family networks that contain multiple generations of teen parents. How do the behaviors of parents and kin networks whose teenaged children do not become involved in a pregnancy before completing high school or marriage differ from the behavior of mothers and fathers and kin networks whose offspring do become involved in a pregnancy too early? How does involvement and behavior of family caretakers outside of the nuclear family influence the intergenerational transmission of teen pregnancy?
3. Immigrant families and adolescent pregnancy
Many researchers have commented on the immigrant paradox, which finds that first generation immigrants (those born abroad but who give birth in the U.S.) have better pregnancy outcomes than second or third generation immigrants. Do second and third generation immigrant youth also assimilate to sex outside of marriage, early sexual initiation, and non-use of contraceptives? How does this assimilation process occur?
4. Second pregnancy prevention
What factors promote a second unintended pregnancy and what types of interventions are most effective with adolescents who have already had a child, across different demographic groups? What is the effectiveness rate of different programs in preventing second pregnancies? What qualities characterize adolescent fathers who are involved in more than one pregnancy? What types of interventions are effective in reducing young men’s rates of being responsible for more than one pregnancy?
C. Research priorities that are relevant to both pregnant and parenting adolescents and pregnancy prevention
1. Cross-agency collaboration
Cross-agency collaboration was a priority suggested by the representatives of three federal agencies (NICHD, CDC, and MCHB) that include research related to reproductive issues for teenagers and young adults in their research portfolio. The representatives noted that they have been in informal consultation with each other and OPA, and would welcome instituting more formal collaboration. Working in collaboration, agencies that fund research on reproductive health can jointly fund large-scale mixed-methods longitudinal studies with large minority subsamples.
2. New technologies
What are the types of new technologies (e.g., social media, texting) that have been used and can be used to implement interventions directed at teen sexual activity and pregnant and parenting teens? How does their effectiveness compare with more traditional methodologies for implementing interventions? Does the effectiveness of new technology-based interventions vary by sex, age, educational level, urbanization, and other demographic characteristics of targeted adolescents? What roles can parents play in the interface of new technologies/media influences and teen sexual behavior? What roles do online resources and social networks play in the lives of pregnant and parenting teens? Do these teens utilize the internet for gathering resources on healthy pregnancy and parenting skills? Do pregnant and parenting teens join social support groups online? Are there any best practices? What factors play into access to these resources?
3. Media influences
Studies of the impact of sexually promiscuous and/or pregnant characters/celebrities on TV/movies/online and in print media are needed, particularly focusing on how these characters and messages are talked about within families and among peers, and whether real time and/or virtual conversations about media characters play mediating or moderating roles in how behavior is influenced.
Final Report: Assessment of the Adolescent Family Life Research Program and Recommendations for the Future.
