Chapter 2, Section 6: Multi-Component

Since there are so many antecedents to adolescent pregnancy, a variety of adolescent pregnancy prevention approaches are needed to effectively reach diverse populations of youth. Some approaches work for some groups of youth, while others do not. It makes sense that some of the most promising approaches address sexual and non-sexual antecedents to teen pregnancy in a variety of ways. Multi-component programs include classroom instruction, school-wide activities, provision of contraception, media campaigns, and may even include service provision by multiple providers (Kirby, 1997). Multi-component programs can directly address the reproductive health and sexual behavior of teens, while also helping them develop as individuals in more holistic ways. Simplistic solutions will not stem the tide of teen pregnancy. When designing a program, it is important that agencies take a close look at the risk factors and potential protective factors they can foster in their youth, while being realistic about which ones can be effectively addressed.

While using a multi-component approach appears to be desirable for a number of reasons, simply having multiple components will not assure that your program will work (Kirby, 1997). The most effective programs tend to be the most intensive and programs must be maintained for continued success. A few multi-component programs have shown success, but when they ended, use of condoms and/or pregnancy rates returned to their pre-program levels (Kirby, 1997). It is clear that multi-component programs need sustained effort and long-term commitment. The Children’s Aid Society-Carrera Program is a primary example of how a multi- component program can work. This program combines sexuality education, comprehensive health care, including mental health and reproductive health services. In addition, this program incorporates job-readiness activities, sports activities, and artistic self-expression.

The Children’s Aid Society-Carrera Program actively addresses sexual behavior of youth, while working on other fronts to create resiliency, skills, and opportunities for personal and professional growth. This program was found to be highly effective with females, but not effective for males over a three-year period (Philliber et al., 2002; Kirby, 2001). Part of its strength is its intensity and duration, which makes this program expensive.

Many multi-component programs have not reduced the incidence of teen pregnancy or changed sexual behaviors. Replication of programs and more research is needed to get a clearer picture of attributes that make multi-component programs effective with specific populations of youth.

Research Demonstrates

Antecedents of adolescent pregnancy exist at the individual, family, and community level and include biological, psychological, social, economic, and political factors. A multidisciplinary approach looks at a variety of these factors when developing programs, so suggestions from any of the previous sections can all be part of a multi-component approach. The following are additional points that are important to consider when providing multi-component programming:

• Address issues on multiple fronts on an ongoing basis. The most effective programs involve teens for many months or years. Intensive long-term programs that address both the reproductive health needs and other emotional and social needs of youth can have a substantial long-term impact on pregnancy prevention (Kirby, 2001). Programs that can sustain intensity for at least five years will have greatest impact on social norms because new teens come into the mix each year and are influenced by the established norms of the group (National Campaign to Prevent Teen Pregnancy, 1999).
• Work with parents and community leaders (National Campaign to Prevent Teen Pregnancy, 1999, 2003). Effective programs emphasize building a healthy family and community. Research shows connections between youth who have close relationships with their parents, and choose sexual abstinence or postponement, have fewer sexual partners, and practice consistent use of contraception (National Campaign to Prevent Teen Pregnancy, 1999). Close connection to caregivers, particularly mothers, is shown to have a strong positive effect on young people. It is optimal that youth get messages at home that are consistent with those of your program. Getting parents actively involved can be challenging and requires creative thinking from program staff. Any opportunity to assist parents in healthy communication about sexuality with their children will greatly enhance program messages.
• Start prevention efforts before young people begin to feel sexual pressure (National Campaign to Prevent Teen Pregnancy, 1999, 2003). Reports by teens show that they feel pressure about sex by the start of middle school. The Henry J. Kaiser Family Foundation survey (1998) found that teens were dealing with complex sexual situations by ages 13 or 14. These situations often involved alcohol and drug use, relationships moving too fast, and other pressure situations that require forethought and skills to navigate. Mid-adolescence is too late–young people begin to reject messages about postponing sexual involvement by age 15. Programs need to reach youth before they are already in those situations.
• Conduct outreach in non-traditional spaces. Some of the teens at highest risk are least likely to be attending school (National Campaign to Prevent Teen Pregnancy, 1999). Research indicates that school attendance correlates with fewer pregnancies. Those not attending school at all are more likely to have or cause a teenage pregnancy. It is important to meet both male and female teens where they are. This may mean doing street outreach to specific hang-out areas or connecting to other recreational spaces in the community. For older males, it could mean outreach in the workplace.
• Deal with issues related to drug and alcohol use (National Campaign to Prevent Teen Pregnancy, 1999). Drug and alcohol use is often associated with sexual risk-taking by teens. Teens who engage in one type of risky behavior are more likely to engage in other risky behaviors. Youth who start drinking or experimenting with drugs at an early age are also likely to have early sexual experiences (Kandel, 1990). One study of 14 to 21 year olds who had unplanned pregnancies found that 33 percent of the girls had been drinking when they had sex. The same study found that 91 percent of the sexual encounters were unplanned (Flanigan et al., 1990). The National Center on Addiction and Substance Abuse at Columbia University (1999) reports that nearly one quarter (23 percent) of sexually active teens and young adults ages 15 to 24 report having unprotected sex because of the use of alcohol or drugs at the time. Additionally, 29 percent said they “did more than they had planned” due to alcohol or other substance use. Males were more likely than females to report using alcohol or drugs at their last sexual encounter (CDC, 1999).
• Include a community service component. Of all broader youth development approaches, service-learning programs have shown the most promising success (Kirby, 2001). Service learning, with opportunities for reflection on the experience, gives young people an opportunity to connect to their community and to give back, which helps them develop their sense of identity, competence, and connectedness to others.
• Involve youth in developing programs that meet their needs and keep them involved over the long term. When youth feel a sense of ownership over the program they will be more invested in it and more likely to stay involved. Everyone benefits from young people’s input in creating programs that interest and excite them.
• Create leadership opportunities for youth. In order to build skills, confidence, and a sense of control over their lives, youth need opportunities to lead, to take responsibility, and to make a difference. Build on young people’s strengths and give them opportunities to excel. Building on their assets will increase self-esteem, self-worth, and motivate them to mature into healthy adults (Lezin, 2002).

Implementation Tips

• Work specifically with teens on skills to help them communicate effectively with adults and encourage them to communicate with parents or caregivers.
• Include parents as much as possible in your programming.
• Find out where young people in your community spend their free time (whether they are in school or out) and target your media messages to those areas (pamphlets, flyers, etc.).
• Talk often, specifically about drug and alcohol use, its consequences, and potential negative outcomes.
• Seek sponsorship for programs from local businesses that can offer training or career readiness experiences for your teens.
• Partner with organizations that offer job-readiness or summer job opportunities.
• Build partnerships with local faith organizations by asking leaders there what they believe would be helpful to their teens.

Multi-Component Programming Program Assessment .pdf

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