Multi-site randomized controlled trial shows sizable reductions in teen pregnancy and births, and increases in high school graduation and college enrollment.

Description of the intervention:  Sponsored by the Children’s Aid Society, the Carrera Adolescent Pregnancy Prevention program is a comprehensive youth development program for economically disadvantaged teens who enter the program at ages 13-15 and participate through the end of high school.  The program teaches teens sexual literacy, while emphasizing their potential to be successful and happy through the pursuit of education and/or stable employment.

The program is provided at local community centers, and includes the following five main activities:

• Daily academic assistance—featuring individual assessment of teens’ academic needs, development of an individualized academic plan, one-on-one or small group tutoring by trained educational professionals, as well as assistance with PSAT/SAT preparation and college applications.
• Once or twice weekly job club—during which teens learn to complete job applications, open a bank account, write a resume, and interview for a job.  Teens receive a small hourly wage for time spent in job club, which they must deposit into a savings account.  Those who are old enough are encouraged to obtain summer jobs and, assuming they maintain good grades, part-time jobs during the school year.
• Once or twice weekly family life/sex education—led by a reproductive health counselor who provides age-appropriate lessons on contraception, pregnancy, physiology, gender roles, and sexual orientation.  Abstinence is emphasized as the most desirable behavior for young people.
• Once or twice weekly arts activities (e.g. music, dance, writing, or drama workshops); and
• Once or twice weekly individual sports activities—(e.g. tennis, swimming, martial arts).

In addition to these five activities, the program connects all participants with free dental, mental health, and medical care through alliances with local health care providers.  A key component is reproductive health care, including physical exams, testing for sexually transmitted infections, provision of a range of contraceptive options, and counseling.  Program staff follow-up with teens to ensure they receive needed health services.

During the school year, program activities run all five weekdays, generally for about three hours after school per day.  Summer activities include assistance in finding jobs, recreational/cultural activities, and maintenance meetings to reinforce young people’s sexuality education and academic skills.

Each site is staffed by part-time activity leaders and by a full-time coordinator who receive extensive training from the program developer.  In addition, a full-time community organizer handles day-to-day logistics at each site and encourages teens’ attendance through continuous contact with them or their families outside of program hours.  The program also encourages parents’ involvement by providing classes that address their particular needs (e.g. parenting classes, health education, computer training, or English as a second language classes).

The program costs approximately $4,500 per teen per year to implement (2006 dollars).

Click here for more information on the Carrera Adolescent Pregnancy Prevention Program.  (The program now works with 10-12 year-olds in addition to 13-15 year-olds; the evidence below, however, applies only to the 13-15 year-olds.)

EVIDENCE OF EFFECTIVENESS

Study

Randomized controlled trial of 1,163 economically disadvantaged teens (average age 14.3) who were not parenting or pregnant, and were recruited to participate in youth activities at 12 urban community centers across the country (six of which were located in New York City).  These teens were randomly assigned to a group that could participate in the Carrera program or to a control group that could not, but could participate in a center’s typical youth programs (usually recreational activities).

45% of sample members were either African American or Caribbean black and 29% were Hispanic.  58% were from single or no-parent households, and 37% lived with adults who were either unemployed or received entitlement benefits such as public assistance or Medicaid.

On average, Carrera group teens attended program activities for 12 hours per month during the study’s three-year follow-up period.  At the end of the third year, 70% of the Carrera group teens were still involved in the program.

Effects of the Carrera program three years after random assignment, at average age 17.  These results apply to all teens assigned to the Carrera group, both those who attended program activities and those who did not.

Effects on sexuality, pregnancy, and child-bearing:

• For Carrera group females (compared to control group females)
  
  
  • 40% less likely to have ever been pregnant (15% of Carrera group females had been pregnant vs. 25% of control group females).
  • 50% less likely to have ever given birth (5% vs. 10%).
  • More than twice as likely to be using Depo-Provera -- a hormonal contraceptive -- at last intercourse (22% vs. 9%).
    
    
• For Carrera group males (compared to control group males)
  
  
  • No effect on the likelihood of causing a pregnancy or fathering a child.

• No significant effect on youths’ (males and females) condom use or likelihood of having had sex. 

Effects on other outcomes for Carrera group members (compared to the control group):

• 16% more likely to have had some work experience (89% of the Carrera group had work experience vs. 77% of the control group).
• Positive effects on some educational outcomes (PSAT scores and college visits) but not others (e.g. grades)
• No significant effects on substance abuse or on any measures of delinquency, such as arrests or fighting.

Effects of the Carrera program seven years after random assignment, at average age 21 (versus the control group).  These findings on educational outcomes apply to all teens assigned to the Carrera group at the six New York City sites, both those who attended program activities and those who did not.  (Resource constraints prevented follow up with sample members at all 12 sites, as well as the collection of data on a broader set of outcomes.) 

Carrera group members were:

• 30% more likely to have graduated high school or obtained a G.E.D. (86% of New York City Carrera teens had graduated or obtained a G.E.D. vs. 66% of the control group); and
• 37% more likely to be enrolled in college (63% vs. 46%)
• These effects appear to be roughly similar for males and females.

Discussion of study quality (click here for a glossary of terms)

• The study had reasonably low attrition and a long-term follow-up: Outcome data were obtained for 81% of the original sample at the 3-year follow-up, and high school graduation/college enrollment data were obtained for 75% of the New York City sample at the 7-year follow-up.
• The study measured outcomes using an intention-to-treat analysis.
• Prior to the intervention, there were no significant differences between the Carrera and control groups in their demographic characteristics or previous sexual experience.
• The study evaluated the Carrera program as it is typically implemented in community youth agencies across the country, providing evidence of the program’s effectiveness in real-world settings.
• Study limitation: Outcomes were measured through teens’ self-reports on written surveys administered by the researchers, and for the most part were not corroborated by more objective measures.  One important exception was that New York City Carrera group participants’ self-reported pregnancies and births were corroborated by their medical records.  Also, at the 7-year follow-up, the study obtained data on educational outcomes for a smaller percentage of control group members than Carrera group members (68% versus 82%).  Statistical analyses suggest that this difference in follow-up rates did not undermine the equivalence of the two groups in their observed characteristics.  However, it is still possible that this difference may have caused unobservable differences between the two groups at the 7-year follow-up, leading to inaccurate estimates of the program's effects on educational outcomes. 

Sources (click on linked authors’ names for their contact information)

Philliber, Susan, Jackie Kaye, and Scott Herrling.  “The National Evaluation of the Children’s Aid Society Carrera-Model Program to Prevent Teen Pregnancy.”  Philliber Research Associates, May 2001.  Click here for a link to this study.

Philliber, Susan, Jacqueline Williams Kaye, Scott Herrling and Emily West.  “Preventing Pregnancy and Improving Health Care Access Among Teenagers:  An Evaluation of the Children’s Aid Society-Carrera Program.”  Perspectives on Sexual and Reproductive Health, Vol. 34, No. 5, 2002, pp. 244-251.

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