Research of Note for November 2003

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While the federal and state governments find ways to save money by cutting programs, it is more important than ever for youth programs to evaluate what they are doing and find out what works and what doesn’t. Two of the articles below help do just that, while a third raises interesting questions about why kids who are victims of violence are so similar to those who are not.

Helping Teen Moms

Improving Services for Pregnant and Parenting Teens
Claire Brindis, Dr. P.H., and Susan Philliber, Ph.D.
The Prevention Researcher, Vol. 10, September 2003.
Issue on Teen Mothers available for $7 at 66 Club Road, Suite 370, Eugene, OR 97401-2464 or at

Although births to teenagers have declined in recent years, teen birth rates are still higher in the United States than in other developed Western nations. Teen childbearing often arises from poverty and results in a chain of events that foster poverty. A key part of that chain is dropping out of school – and the younger a teen mother is, the more likely that she will never graduate from high school. While teen pregnancy is a problem for girls from all economic and ethnic backgrounds, teen mothers are usually poor and ethnic minorities.

This study examined key findings from 16 programs for pregnant and parenting teens, and concluded that despite considerable attention and effort, we have “achieved only marginal success” in developing programs to help young mothers. The programs offered various services, including prenatal care, child care, parenting training, sex education, academic help, job training and counseling, mentoring, case management, home visitation and transportation.

Education and Employment

The key to success is keeping girls in school and helping them find jobs. Six of the programs helped to increase employment and four helped to decrease welfare dependency among the girls. Nevertheless, only a minority of the young mothers completed school, found jobs or avoided welfare, and the number of those who succeeded was not much higher for program participants than for those who did not participate. For example, 48 percent of the young mothers participating in the Teen Parent Demonstration program got jobs, compared with 43 percent of the young mothers who did not participate. These results were statistically significant but hard to get excited about.

Repeat Pregnancy

All 16 programs encouraged the use of contraceptives, but only one succeeded in increasing contraceptive use among the girls participating. In fact, in the New Chance Program, the girls receiving the services used contraceptives less often than did the girls not receiving services. Most programs found high rates of second pregnancies within two years.

Six programs reported a decrease in pregnancies among participants, while five had no change, and two had more pregnancies among girls in the programs than girls not in them. That kind of record means that what looks like success could simply reflect something that occurred by chance.

Pregnancy and Child Health Status

Only a few programs measured the health of the mother or child, but they tended to show some success. Girls who participated in the programs tended to have fewer pregnancy complications, and there were some declines in the girls’ use of alcohol, tobacco and other drugs during pregnancy.


Some programs provided many different kinds of services (such as prenatal care, sex education and job counseling), and others focused on fewer issues. The more comprehensive programs tended to be more effective, although some programs with just a few service components had more successful outcomes than those with many service components.

A major problem in these programs is that girls’ attendance is poor and many girls drop out. The mothers have many legitimate reasons for being unable to attend, such as new pregnancies, homelessness and other family crises, illness and lack of childcare.

Overall, the authors conclude that these programs too often underestimate the difficulty of their task. The girls often live with serious problems, such as sexual abuse and substance abuse. They are influenced by the pregnancy of their siblings. They are sexually involved with older males. These all make it difficult to help girls break out of the cycle of poverty and failure.
The article ends with a discussion of conceptual models intended to help design more effective programs, and to evaluate them to make sure they work.

Figuring Out When To Just Say No, Then Saying It

The role of assertiveness and decision-making in early adolescent substance initiation: Mediating processes

Linda Trudeau, Catherine Lillehoj, Richard Spoth and Cleve Redmon
Journal of Research on Adolescence, Vol. 13, No. 3, 2003, pgs. 301-328.
Available free from Trudeau at Institute for Social and Behavior Research, ISU Research Park, Building 2, Suite 500, 2625 North Loop Drive, Iowa State University, Ames, IA 50010 or at

Does it work to “just say no” to drugs? Does knowing how to make decisions help kids make the right decisions? This study examined how adolescents’ decision-making capabilities and their willingness to be assertive to get what they need affect the likelihood that they will smoke, drink alcohol or use marijuana.

The authors studied how teens’ decision-making capabilities and assertiveness in 7th grade affected their beliefs about the consequences of substance use and their likelihood of refusing them six months later. It also evaluated substance use a year and a half later.

The study included 357 seventh grade boys and girls from rural Midwestern schools, with an average age of 12.3 years. Ninety-seven percent were white. Three out of four lived with both biological parents, and 23 percent qualified for free or reduced-cost school lunches.

Assertiveness was measured in terms of how the teens said what they wanted to say (“No,” for example) rather than following the decisions of others. Decision-making skills were defined as strategies to gather information, weigh pros and cons, solve problems and choose appropriate actions.

The study found that young adolescents who are more assertive and have better decision-making skills are more likely to perceive substance use as having worse consequences. They are therefore less likely to initiate substance use than their less assertive peers or those with poorer decision-making skills. Girls who were more assertive and had better decision-making skills were more likely to refuse substances offered to them. This was not true for boys.

Boys who started smoking, drinking or using drugs at an early age were less likely to perceive the consequences as negative and less likely to intend to say no to substance use in the future.

Since many substance abuse prevention programs focus on increasing teens’ decision-making skills and assertiveness, this research highlights some ways in which these programs might be effective. Unfortunately, the report has a very technical and academic style that makes it difficult to read and understand. In addition, the rural, overwhelmingly white sample makes it impossible to say whether the findings are relevant to youth in other communities.

Are Victims of Violence Just Like Everyone Else?

Adolescent Assault Injury: Risk and Protective Factors and Locations of Contact for Intervention

Tina L. Cheng, M.D., M.P.H.; Donald Schwarz, M.D., M.P.H.; Ruth A. Brenner, M.D., M.P.H.; and colleagues
Pediatrics, Vol. 112, October 2003, pgs. 931-938.
Available free from Dr. Cheng at 9616 Accord Dr., Potomac, MD or at

Adolescent violence is often studied, but research rarely focuses on kids who have been injured in day-to-day violence. This study attempts to reveal more about adolescents who go to the hospital for the treatment of injuries resulting from assaults. It excludes victims of sexual assault, child abuse or injuries related to legal intervention.

The study included 147 boys and girls from ages 12 to 19 who were assaulted, 133 kids of the same age, race and gender who were unintentionally injured, and 133 who were not injured at all. The study was conducted at a children’s hospital in Washington, D.C., and a private hospital in a nearby suburb. Ninety-five percent of the youths were African-American, 69 percent were male, and 77 percent lived in Washington.

The youths had suffered many different kinds of injuries; just over one-third were caused by weapons. Victims of violence were more likely to live in a group home and much more likely to live without a parent, compared with kids in the two other groups.
A goal of the study was to find out what activities or traits might protect these adolescents from violent injury. Surprisingly, the kids who were assaulted were just as likely to attend church as were the kids injured by accident or not injured at all, and they participated in the same kinds of extracurricular activities.

The researchers looked at the usual litany of problem behaviors and found no significant differences in smoking cigarettes or marijuana, using alcohol, cocaine or other drugs, being sexually active, or having a history of behavioral and emotional problems. The only significant difference was that victims of violence were more likely to have had more than one sexual partner in their lifetimes, but that difference was small (46 percent of violence victims compared with 40 percent of accident victims and 36 percent of uninjured patients).

Physical fighting was quite common among the adolescents, but victims of violence had had more fights in their lifetimes, more fights in the past year and more fight injuries, and were more likely to have been shot or injured by a weapon. On the other hand, there were no differences between violence victims and other kids in the hospitals in terms of carrying a weapon, having access to a weapon, being involved in a gang, being involved with police, having a history of being threatened, or witnessing someone being threatened, mugged or sexually assaulted.

The somewhat surprising results show that kids who are victims of violence are not that different from their classmates, except in terms of fighting. The usual warning signs of drug use, sexual activity and behavioral problems do not predict who will end up being injured seriously enough to go to the hospital for treatment.

On the other hand, the violence victims are being compared with other kids who are also in the hospital, so that might help explain why there are so few differences that set these kids apart. And, since the hospitals are in Washington and a nearby community, it may be that a pervasive culture of violence results in kids who are victims because of where they live rather than what they do.