Abstinence Education: Assessing the Accuracy and Effectiveness of
Federally Funded Programs (23-APR-08, GAO-08-664T).		 
                                                                 
Among the efforts of the Department of Health and Human Services 
(HHS) to reduce the incidence of sexually transmitted diseases	 
and unintended pregnancies, the agency provides funding to states
and organizations that offer abstinence-until-marriage education.
GAO was asked to testify on the oversight of federally funded	 
abstinence-until-marriage education programs. This testimony is  
primarily based on Abstinence Education: Efforts to Assess the	 
Accuracy and Effectiveness of Federally Funded Programs,	 
GAO-07-87 (Oct. 3, 2006). In this testimony, GAO discusses	 
efforts by (1) HHS and states to assess the scientific accuracy  
of materials used in abstinence-until-marriage education programs
and (2) HHS, states, and researchers to assess the effectiveness 
of abstinence-until-marriage education programs. GAO also	 
discusses a Public Health Service Act requirement regarding	 
medically accurate information about condom effectiveness. GAO	 
focused on the three main federally funded			 
abstinence-until-marriage programs and reviewed documents and	 
interviewed HHS officials in the Administration for Children and 
Families (ACF) and the Office of Population Affairs (OPA). To	 
update certain information, GAO contacted officials from ACF and 
OPA.								 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-08-664T					        
    ACCNO:   A81847						        
  TITLE:     Abstinence Education: Assessing the Accuracy and	      
Effectiveness of Federally Funded Programs			 
     DATE:   04/23/2008 
  SUBJECT:   Adolescent health					 
	     Education program evaluation			 
	     Educational grants 				 
	     Educational research				 
	     Evaluation criteria				 
	     Federal aid to states				 
	     Federal funds					 
	     Federal grants					 
	     Federal/state relations				 
	     Locally administered programs			 
	     Materials research 				 
	     Policy evaluation					 
	     Program evaluation 				 
	     Sexually transmitted diseases			 
	     State programs					 
	     Teenage pregnancy					 

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GAO-08-664T

   

     * [1]Background
     * [2]Federal and State Efforts to Assess the Scientific Accuracy

          * [3]ACF Neither Reviewed Nor Required Grantees to Review Program
          * [4]OPA Reviewed Materials Used by AFL Program Grantees for Scie

     * [5]A Variety of Efforts Were Made to Assess the Effectiveness o

          * [6]HHS, States, and Researchers Have Made a Variety of Efforts
          * [7]Several Factors Limit the Conclusions That Can Be Drawn abou

     * [8]Statutory Requirement to Include Information on Condom Effec
     * [9]Contact and Acknowledgments

          * [10]Order by Mail or Phone

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Testimony: 

Before the Committee on Oversight and Government Reform, House of 
Representatives: 

United States Government Accountability Office: 
GAO: 

For Release on Delivery: 
Expected at 10:00 a.m. EDT:
Wednesday, April 23, 2008: 

Abstinence Education: 

Assessing the Accuracy and Effectiveness of Federally Funded Programs: 

Statement of Marcia Crosse: 
Director, Health Care: 

GAO-08-664T:

GAO Highlights: 

Highlights of GAO-08-664T, a testimony before the Committee on 
Oversight and Government Reform, House of Representatives.

Why GAO Did This Study: 

Among the efforts of the Department of Health and Human Services (HHS) 
to reduce the incidence of sexually transmitted diseases and unintended 
pregnancies, the agency provides funding to states and organizations 
that offer abstinence-until-marriage education. 

GAO was asked to testify on the oversight of federally funded 
abstinence-until-marriage education programs. This testimony is 
primarily based on Abstinence Education: Efforts to Assess the Accuracy 
and Effectiveness of Federally Funded Programs, GAO-07-87 (Oct. 3, 
2006). In this testimony, GAO discusses efforts by (1) HHS and states 
to assess the scientific accuracy of materials used in abstinence-until-
marriage education programs and (2) HHS, states, and researchers to 
assess the effectiveness of abstinence-until-marriage education 
programs. GAO also discusses a Public Health Service Act requirement 
regarding medically accurate information about condom effectiveness.

GAO focused on the three main federally funded abstinence-until-
marriage programs and reviewed documents and interviewed HHS officials 
in the Administration for Children and Families (ACF) and the Office of 
Population Affairs (OPA). To update certain information, GAO contacted 
officials from ACF and OPA.

What GAO Found: 

Efforts by HHS and states to assess the scientific accuracy of 
materials used in abstinence-until-marriage education programs have 
been limited. As of October 2006, HHSï¿½s ACFï¿½which awards grants under 
two programs that account for the largest portion of federal spending 
on abstinence educationï¿½did not review its granteesï¿½ education 
materials for scientific accuracy, nor did it require grantees of 
either program to do so. Not all states that receive funding from ACF 
had chosen to review their program materials for scientific accuracy. 
OPA reviewed the scientific accuracy of granteesï¿½ proposed education 
materials, and any inaccuracies found had to be corrected before those 
materials could be used. The extent to which federally funded 
abstinence-until-marriage education materials are inaccurate was not 
known, but OPA and some states reported finding inaccuracies. GAO 
recommended that the Secretary of HHS develop procedures to help assure 
the accuracy of abstinence-until-marriage education materials. An ACF 
official reported that ACF is currently implementing a process to 
review the accuracy of Community-based granteesï¿½ curricula and has 
required those grantees to sign assurances that the materials they 
propose using are accurate. The official also reported that, in the 
future, state grantees will have to provide ACF with descriptions of 
their strategies for reviewing the accuracy of their programs. 

As of August 2006, HHS, states, and researchers had made a variety of 
efforts to assess the effectiveness of abstinence-until-marriage 
education programs, but a number of factors limit the conclusions that 
can be drawn about the programsï¿½ effectiveness. ACF and OPA have 
required their grantees to report on various outcomes used to measure 
program effectiveness. To assess the effectiveness of its granteesï¿½ 
programs, ACF has analyzed national data on adolescent birth rates and 
the proportion of adolescents who report having had sexual intercourse. 
Additionally, 6 of the 10 states in GAOï¿½s review worked with third-
party evaluators to assess the effectiveness of abstinence-until-
marriage programs in their states. However, the conclusions that can be 
drawn are limited because most of the efforts to evaluate program 
effectiveness have not met certain minimum criteria that experts have 
concluded are necessary for such assessments to be scientifically 
valid. Additionally, the results of some efforts that do meet such 
criteria have varied. 

While conducting work for its October 2006 report, GAO identified a 
legal matter that required the attention of HHS. Section 317P(c)(2) of 
the Public Health Service Act requires certain educational materials to 
contain medically accurate information about condom effectiveness. GAO 
concluded that this requirement would apply to abstinence education 
materials prepared and used by federal grant recipients, depending on 
their substantive content, and recommended that HHS adopt measures to 
ensure that, where applicable, abstinence education materials comply 
with this requirement. The fiscal year 2007 program announcement for 
the Community-based Program provides information about the 
applicability of this requirement, and future State and Community-based 
Program announcements are to include this information.

To view the full product, including the scope and methodology, click on 
[hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-08-664T]. For more 
information, contact Marcia Crosse at (202) 512-7114 or [email protected].

[End of section]

Mr. Chairman and Members of the Committee: 

I am pleased to be here today as you examine federally funded 
abstinence-until-marriage education programs. Reducing the incidence of 
sexually transmitted diseases (STD) and unintended pregnancies among 
adolescents has been an important objective of the Department of Health 
and Human Services (HHS). Among its efforts to do so, HHS funds 
abstinence-until-marriage education programs. These programs are 
delivered by a variety of entities, including schools, human service 
agencies, and faith-based organizations. Studies have raised concerns 
about the accuracy of the educational materials that are incorporated 
into these programs, as well as the effectiveness of the programs 
themselves. My remarks today are primarily based on our October 2006 
report on the oversight of federally funded abstinence-until-marriage 
programs, Abstinence Education: Efforts to Assess the Accuracy and 
Effectiveness of Federally Funded Programs (GAO-07-87).[Footnote 1] In 
that report, we recommended that the Secretary of Health and Human 
Services develop procedures to help assure the accuracy of such 
materials. Today, I will discuss findings from our report on (1) 
efforts by HHS and states to assess the scientific accuracy of 
materials used in abstinence-until-marriage programs, and (2) efforts 
by HHS, states, and researchers to assess the effectiveness of 
abstinence-until-marriage education programs as well as updates on 
selected information. I will also discuss a legal matter that came to 
our attention during the course of our work regarding the applicability 
of section 317P(c)(2) of the Public Health Service Act to Abstinence 
Education programs. We recommended in a letter dated October 18, 2006, 
that HHS adopt measures to ensure that, where applicable, abstinence- 
until-marriage education materials comply with the requirement that 
educational materials specifically designed to address STDs contain 
medically accurate information about condom effectiveness in preventing 
the STDs the materials were designed to address.[Footnote 2] 

For our assessment of the accuracy and effectiveness of abstinence- 
until-marriage education programs, we focused our review on the three 
main federally funded abstinence-until-marriage programs: the 
Abstinence Education Program (State Program), the Community-Based 
Abstinence Education Program (Community-Based Program), and the 
Adolescent Family Life (AFL) Program. The State Program and the 
Community-Based Program are both administered by HHS's Administration 
for Children and Families (ACF); AFL is administered by HHS's Office of 
Population Affairs (OPA). According to HHS, funding for the three 
abstinence-until-marriage programs was about $165 million in fiscal 
year 2007. 

In order to describe the efforts to assess the scientific accuracy of 
program materials, we reviewed published reports, program 
announcements, Federal Register notices, agency Web sites, and other 
documents related to abstinence-until-marriage education. We did not 
assess the criteria used to determine the scientific accuracy of 
education materials or the quality of the reviews. We interviewed 
officials from ACF and OPA. We also interviewed officials from the 10 
states that received the largest share of federal funding (together 
accounting for 51 percent of the total funding in fiscal year 2005) 
through the State Program for abstinence-until-marriage education. 
[Footnote 3] 

To describe efforts by HHS, states, and researchers to assess the 
effectiveness of abstinence-until-marriage education programs, we 
focused on efforts that examined the extent to which these programs 
achieved their program goals. In general, these goals include teaching 
adolescents to abstain from sexual activity until marriage in order to 
avoid unintended pregnancies, STDs, and related health problems. As 
part of our review, we compared these efforts to the design 
characteristics that experts have identified as important for a 
scientifically valid study of program effectiveness.[Footnote 4] We 
reviewed journal articles and other published reports, agency budget 
submissions, program announcements, agency and grantee performance 
reports, Federal Register notices, agency Web sites, and other 
documents related to abstinence-until-marriage education.[Footnote 5] 
We also interviewed officials from ACF, OPA, the Centers for Disease 
Control and Prevention (CDC), the National Institutes of Health (NIH), 
the Office of the Assistant Secretary for Planning and Evaluation 
(ASPE), and 10 states that received the largest share of federal 
funding for abstinence-only education through the State Program in 
fiscal year 2005. We focused our review on efforts to assess the 
scientific accuracy of materials and the effectiveness of the programs 
during fiscal year 2006. We conducted this work from October 2005 
through September 2006 and during April 2008 in accordance with 
generally accepted government auditing standards. Those standards 
require that we plan and perform the audit to obtain sufficient, 
appropriate evidence to provide a reasonable basis for our findings and 
conclusions based on our audit objectives. We believe that the evidence 
obtained provides a reasonable basis for our findings and conclusions 
based on our audit objectives. 

To assess the applicability of section 317P(c)(2) of the Public Health 
Service Act to abstinence-until-marriage education programs, we 
reviewed the statute, pertinent legislative history, and relevant 
program guidance. In addition, we solicited the views of HHS officials 
on this issue. 

In summary, we found that efforts by HHS and states to assess the 
scientific accuracy of materials used in abstinence-until-marriage 
education programs had been limited. ACF did not review its grantees' 
education materials for scientific accuracy and did not require that 
grantees of either the State Program or the Community-Based Program do 
so. In addition, not all states that received funding through ACF's 
State Program chose to review their program materials for scientific 
accuracy. Five of the 10 states in our review conducted such reviews. 
In contrast to ACF, OPA did review the scientific accuracy of AFL 
grantees' proposed educational materials and any inaccuracies found had 
to be corrected before the materials could be used. While we reported 
that the extent to which federally funded abstinence-until-marriage 
education materials are inaccurate was not known, in the course of 
their reviews OPA and some states reported that they had found some 
inaccuracies in abstinence-until-marriage education materials. For 
example, one state official described an instance in which abstinence- 
until-marriage materials incorrectly suggested that HIV can pass 
through condoms because the latex used in condoms is porous. To address 
concerns about the scientific accuracy of materials used in abstinence- 
until-marriage programs, we recommended that the Secretary of HHS 
develop procedures to help assure the accuracy of such materials, and 
HHS agreed to consider this recommendation. In April 2008, an ACF 
official reported that, in response to our recommendation, ACF began 
requiring in fiscal year 2007 that community-based grantees sign 
written assurances that the materials they propose using are accurate. 
This official also reported that, starting in fiscal year 2008, 
grantees of the State Program will also be required to sign these 
written assurances. In addition, this official reported that ACF is 
implementing a process to review the accuracy of the proposed curricula 
of fiscal year 2007 Community-based grantees. The ACF official reported 
that the curricula will be reviewed by a research analyst to ensure 
that all statements are referenced to source documents, and then by a 
healthcare professional who will compare the information in the 
curricula to information in the source documents. The official also 
reported that, in the future, ACF will require states to provide the 
agency with descriptions of their strategies for reviewing the accuracy 
of their abstinence-until-marriage education programs. 

HHS, states, and researchers have made a variety of efforts to assess 
the effectiveness of abstinence-until-marriage education programs; 
however, a number of factors limit the conclusions that can be drawn 
about the effectiveness of abstinence-until-marriage education 
programs. To assess the effectiveness of their abstinence-until- 
marriage education programs, ACF and OPA have required their grantees 
to report on various outcomes. For example, as of fiscal year 2006, 
states that received funding through the State Program were required to 
report annually on four measures of the prevalence of adolescent sexual 
behavior in their state, such as the rate of pregnancy among 
adolescents aged 15 to 17 years. To assess the effectiveness of both 
its State and Community-Based Programs, ACF also analyzed trends in 
adolescent behavior, as reflected in national data on birth rates among 
teens and the proportion of surveyed high school students reporting 
that they have had sexual intercourse. OPA required grantees of the AFL 
Program to develop and report on outcome measures that demonstrated the 
extent to which grantees' programs are having an effect on program 
participants. Further, 6 of the 10 states in our review that received 
funding through the State Program worked with third-party evaluators to 
assess the effectiveness of abstinence-until-marriage education 
programs in their states. Several factors, however, limit the 
conclusions that can be drawn about the effectiveness of abstinence- 
until-marriage education programs. Most of the efforts to evaluate the 
effectiveness of abstinence-until-marriage education programs that we 
described in our report did not meet certain minimum criteria--such as 
random assignment of participants and sufficient follow-up periods and 
sample sizes--that experts have concluded are necessary in order for 
assessments of program effectiveness to be scientifically valid. 

During the course of our work on abstinence-until-marriage education, 
we identified a legal matter that required the attention of HHS. 
Section 317P(c)(2) of the Public Health Service Act requires 
educational materials specifically designed to address STDs to contain 
medically accurate information about condom effectiveness in preventing 
the diseases the educational materials are designed to address. We 
concluded that this requirement would apply to abstinence-until- 
marriage education materials prepared by and used by federal grant 
recipients, depending upon the substantive content of those materials. 
In other words, in materials otherwise meeting the statutory criteria, 
HHS' grantees are required to include information on condom 
effectiveness, and that information must be medically accurate. At the 
time of our review, an ACF official reported that materials prepared by 
abstinence-until-marriage education grantees were not subject to 
section 317P(c)(2). Therefore, we recommended in a letter dated October 
18, 2006, that HHS reexamine its position and adopt measures to ensure 
that, where applicable, abstinence-until-marriage education materials 
comply with this requirement. The fiscal year 2007 Community-Based 
Program announcement states that mass produced materials that as their 
primary purpose are specifically about STDs are required to contain 
medically accurate information regarding the effectiveness or lack of 
effectiveness of condoms in preventing the STDs the educational 
materials are designed to address. An ACF official also told us that 
future State and Community-Based Program announcements would include 
this language. 

Background: 

Statistics reported by CDC show that many high school students engage 
in sexual behavior that places them at risk for unintended pregnancy 
and STDs. In 2005, 46.8 percent of high school students reported that 
they have had sexual intercourse, with 14.3 percent of students 
reporting that they had had sexual intercourse with four or more 
persons. CDC also has reported that the prevalence of certain STDs-- 
including the rate of chlamydia infection, the most frequently reported 
STD in the United States--peaks in adolescence and young adulthood. 

At the time of our 2006 report, HHS's strategic plan included the 
objectives to reduce the incidence of STDs and unintended pregnancies 
and to promote family formation and healthy marriages. These two 
objectives supported HHS's goals to reduce the major threats to the 
health and well-being of Americans and to improve the stability and 
healthy development of American children and youth. Abstinence-until- 
marriage education programs were one of several types of programs that 
supported these objectives. The State Program, the Community-Based 
Program, and the AFL Program provide grants to support the recipients' 
own efforts to provide abstinence-until-marriage education at the local 
level. These programs must comply with the statutory definition of 
abstinence education (see table 1).[Footnote 6] 

Table 1: Definition of Abstinence Education: 

Abstinence education refers to an educational or motivational program 
that:

A. has, as its exclusive purpose, teaching the social, psychological, 
and health gains to be realized by abstaining from sexual activity. 

B. teaches abstinence from sexual activity outside marriage as the 
expected standard for all school age children. 

C. teaches that abstinence from sexual activity is the only certain way 
to avoid out-of-wedlock pregnancy, sexually transmitted diseases, and 
other associated health problems. 

D. teaches that a mutually faithful monogamous relationship in context 
of marriage is the expected standard of human sexual activity. 

E. teaches that sexual activity outside of the context of marriage is 
likely to have harmful psychological and physical effects. 

F. teaches that bearing children out-of-wedlock is likely to have 
harmful consequences for the child, the child's parents, and society. 

G. teaches young people how to reject sexual advances and how alcohol 
and drug use increases vulnerability to sexual advances; and;

H. teaches the importance of attaining self-sufficiency before engaging 
in sexual activity.

Source: Social Security Act, ï¿½ 510(b)(2) (codified at 42 U.S.C. ï¿½ 
710(b)(2)).

[End of table]

The State Program, administered by ACF, provides funding to its 
grantees--states--for the provision of abstinence-until-marriage 
education to those most likely to have children outside of 
marriage.[Footnote 7] States that receive grants through the State 
Program have discretion in how they use their funding to provide 
abstinence-until-marriage education. Funds are allotted to each state 
that submits the required annual application based on the ratio of the 
number of low-income children in the state to the total number of low- 
income children in all states. States are required to match every $4 
they receive in federal money with $3 of nonfederal money and are 
required to report annually on the performance of the abstinence-until- 
marriage education programs that they support or administer. In fiscal 
year 2007, 40 states, the District of Columbia, and 3 insular areas 
were awarded funding. 

The Community-Based Program, which is also administered by ACF, is 
focused on funding public and private entities that provide abstinence- 
until-marriage education for adolescents from 12 to 18 years old. The 
Community-Based Program provides grants for school-based programs, 
adult and peer mentoring, and parent education groups. For fiscal year 
2007, 59 grants were awarded to organizations and other entities. 
Grantees are required to report to ACF, on a semiannual basis, on the 
performance of their programs. 

The AFL Program also supports programs that provide abstinence-until- 
marriage education.[Footnote 8] Under the AFL Program, OPA awards 
competitive grants to public or private nonprofit organizations or 
agencies, including community-based and faith-based organizations, to 
facilitate abstinence-until-marriage education in a variety of 
settings, including schools and community centers. In fiscal year 2007, 
OPA awarded funding to 36 grantees. Grantees are required to conduct 
evaluations of certain aspects of their programs and report annually on 
their performance. 

Five organizational units located within HHS--ACF, OPA, CDC, ASPE, and 
NIH--have responsibilities related to abstinence-until-marriage 
education. ACF and OPA administer the three main federal abstinence- 
until-marriage education programs. CDC supports abstinence-until- 
marriage education at the national, state, and local levels. CDC, ASPE, 
and NIH are sponsoring research on the effectiveness of abstinence- 
until-marriage programs. 

Federal and State Efforts to Assess the Scientific Accuracy of 
Materials Used in Abstinence-until-Marriage Education Programs Have 
Been Limited: 

In October 2006 we reported that efforts by HHS and states to assess 
the scientific accuracy of materials used in abstinence-until-marriage 
education programs had been limited.[Footnote 9] ACF--whose grants to 
the State and Community-Based Programs accounted for the largest 
portion of federal spending on abstinence-until-marriage education-- 
did not review its grantees' education materials for scientific 
accuracy and did not require grantees of either program to review their 
own materials for scientific accuracy. In addition, not all states 
funded through the State Program chose to review their program 
materials for scientific accuracy. In contrast to ACF, OPA reviewed the 
scientific accuracy of grantees' proposed educational materials and 
corrected inaccuracies in these materials. 

ACF Neither Reviewed Nor Required Grantees to Review Program Materials 
for Scientific Accuracy, Although Some State Grantees Had Conducted 
Such Reviews: 

As of October 2006, there had been limited efforts to review the 
scientific accuracy of educational materials used in ACF's State and 
Community-Based Programs--the two programs that accounted for the 
largest portion of federal spending on abstinence-until-marriage 
education. ACF did not review materials for scientific accuracy in 
either reviewing grant applications or in overseeing grantees' 
performance. Prior to fiscal year 2006, State Program and Community- 
Based Program applicants were not required to submit copies of their 
proposed educational materials with their applications. While ACF 
required grantees of the Community-Based Program--but not the State 
Program--to submit their educational materials with their fiscal year 
2006 applications, ACF officials told us that grantee applications and 
materials were only reviewed to ensure that they addressed all aspects 
of the scope of the Community-Based Program, such as the A-H definition 
of abstinence education.[Footnote 10] Further, documents provided to us 
by ACF indicated that the agency did not review grantees' educational 
materials for scientific accuracy as a routine part of its oversight 
activities. In addition, ACF also did not require its grantees to 
review their own materials for scientific accuracy. 

While not all grantees of the State Program had chosen to review the 
scientific accuracy of their educational materials, officials from 5 of 
the 10 states in our review reported that their states chose to do so. 
These five states used a variety of approaches in their reviews. For 
example, some states contracted with medical professionals--such as 
nurses, gynecologists, and pediatricians--to serve as medical advisors 
who review program materials and use their expertise to determine what 
is and is not scientifically accurate. One of the states required that 
all statistics or scientific statements cited in a program's materials 
be sourced to CDC or a peer-reviewed medical journal. Officials from 
this state told us that if statements in these materials could not be 
attributed to these sources, the statements were required to be removed 
until citations were provided and materials were approved. 

As a result of their reviews, officials from two of the five states 
reported that they had found inaccuracies. One state official cited an 
instance where materials incorrectly suggested that HIV can pass 
through condoms because the latex used in condoms is porous. State 
officials who have identified inaccuracies told us that they informed 
their grantees of inaccuracies so that they could make corrections in 
their individual programs. Some of the educational materials that 
states reviewed were materials that were commonly used in the Community-
Based Program. 

While there had been limited review of materials used in the State and 
Community-Based Programs, grantees of these programs had received some 
technical assistance designed to improve the scientific accuracy of 
their materials. For example, ACF officials reported that the agency 
provided a conference for grantees of the Community-Based Program in 
February 2006 that included a presentation focused on medical accuracy. 

OPA Reviewed Materials Used by AFL Program Grantees for Scientific 
Accuracy: 

As of 2006, in contrast to ACF, OPA reviewed for scientific accuracy 
the educational materials used by AFL Program grantees, and it did so 
before those materials were used. OPA officials said that after grants 
were awarded, a medical education specialist (in consultation with 
several part-time medical experts) reviewed the grantees' printed 
materials and other educational media, such as videos. OPA officials 
explained that the medical education specialist must approve all 
proposed materials before they are used. On many occasions, OPA 
grantees had proposed using--and therefore OPA has reviewed--materials 
commonly used in the Community-Based Program. For example, an OPA 
official told us that the agency had reviewed three of the Community- 
Based Program's commonly used curricula and was also currently 
reviewing another curriculum commonly used by Community-Based Program 
grantees. 

OPA officials stated that the medical education specialist had 
occasionally found and addressed inaccuracies in grantees' proposed 
educational materials. OPA officials stated that these inaccuracies 
were often the result of information being out of date because, for 
example, medical and statistical information on STDs changes 
frequently. OPA addressed these inaccuracies by either not approving 
the materials in which they appeared or correcting the materials 
through discussions with the grantees and, in some cases, the authors 
of the materials. In fiscal year 2005, OPA disapproved of a grantee 
using a specific pamphlet about STDs because the pamphlet contained 
statements about STD prevention and HIV transmission that were 
considered incomplete or inaccurate. For example, the pamphlet stated 
that there was no cure for hepatitis B, but the medical education 
specialist required the grantee to add that there was a preventive 
vaccine for hepatitis B. In addition, OPA required that a grantee 
correct several statements in a true/false quiz--including statements 
about STDs and condom use--in order for the quiz to be approved for 
use. For example, the medical education specialist changed a sentence 
from "The only 100% effective way of avoiding STDs or unwanted 
pregnancies is to not have sexual intercourse." to "The only 100% 
effective way of avoiding STDs or unwanted pregnancies is to not have 
sexual intercourse and engage in other risky behaviors." 

While OPA and some states had reviewed their grantees' abstinence- 
until-marriage education materials for scientific accuracy, these types 
of reviews have the potential to affect abstinence-until-marriage 
education providers more broadly, perhaps creating an incentive for the 
authors of such materials to ensure they are accurate. As of October 
2006, the company that produced one of the most widely used curricula 
used by grantees of the Community-Based Program had updated its 
curriculum. A representative from that company stated that this had 
been done, in part, in response to a congressional review that found 
inaccuracies in its abstinence-until-marriage materials. 

To address concerns about the scientific accuracy of materials used in 
abstinence-until-marriage education programs, we recommended that the 
Secretary of HHS develop procedures to help assure the accuracy of such 
materials used in the State and Community-Based Programs.[Footnote 11] 
We recommended that in order to provide such assurance, the Secretary 
could consider alternatives such as (1) extending the approach 
currently used by OPA to review the scientific accuracy of the factual 
statements included in abstinence-until-marriage education to materials 
used by grantees of ACF's Community-Based Program and requiring 
grantees of ACF's State Program to conduct such reviews or (2) 
requiring grantees of both programs to sign written assurances in their 
grant applications that the materials they propose using are accurate. 
In its written comments on a draft of our report, HHS stated that it 
would consider requiring grantees of both ACF programs to sign such 
written assurances to the accuracy of their materials. In April 2008, 
an ACF official reported that, in response to our recommendation, ACF 
began requiring in fiscal year 2007 that community-based grantees sign 
written assurances that the materials they propose using are accurate. 
This official also reported that, starting in fiscal year 2008, 
grantees of the State Program will also be required to sign these 
written assurances. In addition, this official reported that ACF is 
implementing a process to review the accuracy of the proposed curricula 
of fiscal year 2007 Community-based grantees. The ACF official reported 
that the curricula will be reviewed by a research analyst to ensure 
that all statements are referenced to source documents, and then by a 
healthcare professional who will compare the information in the 
curricula to information in the source documents. The official also 
reported that, in the future, ACF will require states to provide the 
agency with descriptions of their strategies for reviewing the accuracy 
of their abstinence-until-marriage education programs. 

A Variety of Efforts Were Made to Assess the Effectiveness of 
Abstinence-until-Marriage Education Programs, but a Number of Factors 
Limit the Conclusions That Can Be Drawn: 

HHS, states, and researchers have made a variety of efforts to assess 
the effectiveness of abstinence-until-marriage education programs; 
however, a number of factors limit the conclusions that can be drawn. 
ACF and OPA have required their grantees to report on various outcomes 
used to measure the effectiveness of grantees' abstinence-until- 
marriage education programs. To assess the effectiveness of the State 
and Community-Based Programs, ACF has analyzed national data on 
adolescent birth rates and the proportion of adolescents who report 
having had sexual intercourse. As of October 2006, other organizational 
units within HHS were funding studies designed to assess the 
effectiveness of abstinence-until-marriage education programs in 
delaying sexual initiation, reducing pregnancy and STD rates, and 
reducing the frequency of sexual activity. Despite these efforts, 
several factors limit the conclusions that can be drawn about the 
effectiveness of abstinence-until-marriage education programs. Most of 
the efforts to evaluate the effectiveness of abstinence-until-marriage 
education programs that we reviewed have not met certain minimum 
criteria that experts have concluded are necessary in order for 
assessments of program effectiveness to be scientifically valid, in 
part because such designs can be expensive and time-consuming to carry 
out. In addition, the results of some efforts that meet the criteria of 
a scientifically valid assessment have varied. 

HHS, States, and Researchers Have Made a Variety of Efforts to Assess 
the Effectiveness of Abstinence-until-Marriage Education Programs: 

ACF has made efforts to assess the effectiveness of abstinence-until- 
marriage education programs funded by the State Program and the 
Community-Based Program. One of ACF's efforts has been to require 
grantees of both programs to report data on outcomes, though the two 
programs have different requirements for the outcomes grantees must 
report.[Footnote 12] As of fiscal year 2006, State Program grantees 
were required to report annually on four measures of the prevalence of 
adolescent sexual behavior in their states, such as the rate of 
pregnancy among adolescents aged 15 to 17 years, and compare these data 
to program targets over 5 years. States also were required to develop 
and report on two additional performance measures that were related to 
the goals of their programs.[Footnote 13] Also as of fiscal year 2006, 
ACF required Community-Based Program grantees to develop and report on 
outcome measures designed to demonstrate the extent to which grantees' 
community-based abstinence-until-marriage education programs were 
accomplishing their program goals.[Footnote 14] In addition to outcome 
reporting, ACF required grantees of the Community-Based Program to 
report on program "outputs," which measure the quantity of program 
activities and other deliverables, such as the number of participants 
who are served by the abstinence-until-marriage education programs. 

As of October 2006, OPA also had made efforts to assess the 
effectiveness of the AFL Program. Specifically, OPA required grantees 
of the AFL Program to develop and report on outcome measures, such as 
participants' knowledge of the benefits of abstinence and their 
reported intentions to abstain from sexual activity, that were used to 
help demonstrate the extent to which grantees' programs were having an 
effect on program participants. To collect data on outcome measures, 
OPA required grantees to administer, at a minimum, a standardized 
questionnaire to their program participants, both when participants 
begin an abstinence-only education program and after the program's 
completion. OPA officials told us that they were planning to aggregate 
information from certain questions in the standardized set of 
questionnaires in order to report on certain performance measures as 
part of the agency's annual performance reports; the agency expected to 
begin receiving data from grantees that were using these questionnaires 
in January 2007. 

To help grantees measure the effectiveness of their programs, both ACF 
and OPA required that grantees use independent evaluators and have 
provided assistance to grantees in support of their program evaluation 
efforts. ACF and OPA required their grantees to contract with third- 
party evaluators, such as university researchers or private research 
firms, who were responsible for helping grantees develop the outcome 
measures they were required to report on and monitoring grantee 
performance against those measures. Unlike ACF, OPA required that these 
third-party evaluations incorporate specific methodological 
characteristics, such as control groups of individuals that did not 
receive the program and sufficient sample sizes to ensure that any 
observed differences between the groups were statistically valid. Both 
ACF and OPA have provided technical assistance and training to their 
grantees in order to support grantees' own program evaluation efforts. 

ACF also analyzed trends in adolescent behavior, as reflected in 
national data on birth rates among teens and the proportion of surveyed 
high school students reporting that they have had sexual 
intercourse.[Footnote 15] ACF used these national data as a measure of 
the overall effectiveness of its State and Community-Based Programs, 
comparing the national data to program targets. In its annual 
performance reports, the agency has summarized the progress being made 
toward lowering the rate of births to unmarried teenage girls and the 
proportion of students (grades 9-12) who report having ever had sexual 
intercourse. 

Some states have made additional efforts to assess the effectiveness of 
abstinence-until-marriage education programs. Specifically, we found 
that 6 of the 10 states in our review that received funding through 
ACF's State Program had made efforts to conduct evaluations of selected 
abstinence-until-marriage programs in their state. All 6 of the states 
worked with third-party evaluators, such as university researchers or 
private research firms, to perform the evaluations, which in general 
measured self-reported changes in program participants' behavior and 
attitudes related to sex and abstinence as indicators of program 
effectiveness. Four of these states had completed third-party 
evaluations as of February 2006, and the results of these studies 
varied.[Footnote 16] Among those 4 states, 3 states required the 
abstinence programs in their state to measure reported changes in 
participants' behavior as an indicator of program effectiveness--both 
at the start of the program and after its completion. The 3 states 
required their programs to track participants' reported incidence of 
sexual intercourse. Additionally, 2 of the 4 states required their 
programs to track biological outcomes, such as pregnancies, births, or 
STDs. In addition, 6 of the 10 states in our review required their 
programs to track participants' attitudes about abstinence and sex, 
such as the number of participants who make pledges to remain 
abstinent. 

Besides ACF and OPA, other organizational units within HHS have made 
efforts to assess the effectiveness of abstinence-until-marriage 
education programs. As of 2006, ASPE was sponsoring a study of the 
Community-Based Program and a study of the State Program. The study of 
the State Program was conducted by Mathematica Policy Research, Inc. 
(Mathematica) and completed in 2007. It examined the impact of five 
programs funded through the State Program on participants' attitudes 
and behaviors related to abstinence and sex.[Footnote 17] Like ASPE, 
CDC has made its own effort to assess the effectiveness of abstinence- 
until-marriage education by sponsoring a study to evaluate the 
effectiveness of two middle school curricula--one that complies with 
abstinence-until-marriage education program requirements and one that 
teaches a combination of abstinence and contraceptive information and 
skills. The agency expects to complete the study in 2009. Likewise, NIH 
has funded studies comparing the effectiveness of education programs 
that focus only on abstinence with the effectiveness of sex education 
programs that teach both abstinence and information about 
contraception. As of October 2006, NIH was funding five studies, which 
in general were comparing the effects of these two types of programs on 
the sexual behavior and related attitudes among groups of either middle 
school or high school students. 

In addition to the efforts of researchers working on behalf of HHS and 
states, other researchers--such as those affiliated with universities 
and various advocacy groups--have made efforts to study the 
effectiveness of abstinence-until-marriage education programs. This 
work includes studies of the outcomes of individual programs and 
reviews of other studies on the effectiveness of individual abstinence- 
until-marriage education programs. In general, research studies on the 
effectiveness of individual programs have examined the extent to which 
they changed participants' demonstrated knowledge of concepts taught in 
the programs, declared intentions to abstain from sex until marriage, 
and reported behavior related to sexual activity and abstinence. As of 
October 2006, the efforts to study and build a body of research on the 
effectiveness of most abstinence-until-marriage education programs had 
been under way for only a few years, in part because grants under the 
two programs that account for the largest portion of federal spending 
on abstinence-until-marriage education--the State Program and the 
Community-Based Program--were not awarded until 1998 and 2001, 
respectively. 

Several Factors Limit the Conclusions That Can Be Drawn about the 
Effectiveness of Abstinence-until-Marriage Education Programs: 

Most of the efforts of HHS, states, and other researchers to evaluate 
the effectiveness of abstinence-until-marriage education programs 
included in our review have not met certain minimum criteria that 
experts have concluded are necessary in order for assessments of 
program effectiveness to be scientifically valid. In an effort to 
better assess the merits of the studies that have been conducted on the 
effectiveness of sexual health programs--including abstinence-until- 
marriage education programs--scientific experts have developed criteria 
that can be used to gauge the scientific rigor of these evaluations. 
The reports of two panels of experts,[Footnote 18],[Footnote 19] as 
well as the experts we interviewed in the course of our previous work, 
generally agreed that scientifically valid studies of a program's 
effectiveness should include the following characteristics: 

* An experimental design that randomly assigns individuals or schools 
to either an intervention group or control group, or a quasi- 
experimental design that uses nonrandomly assigned but well-matched 
comparison groups. According to the panel of scientific experts 
convened by the National Campaign to Prevent Teen Pregnancy, 
experimental designs or quasi-experimental designs with well-matched 
comparison groups have at least three important strengths that are 
typically not found in other studies, such as those that use aggregated 
data: they evaluate specific programs with known characteristics, they 
can clearly distinguish between participants who did and did not 
receive an intervention, and they control for other factors that may 
affect study outcomes. According to scientific experts, studies that 
include experimental or quasi-experimental designs should also collect 
follow-up data for a minimum number of months after subjects receive an 
intervention. In addition, experts have reported that studies should 
have a sample size of at least 100 individuals for study results to be 
considered scientifically valid. 

* Studies should assess or measure changes in biological outcomes or 
reported behaviors instead of attitudes or intentions. According to 
scientific experts, biological outcomes--such as pregnancy rates, birth 
rates, and STD rates--and reported behaviors--such as reported 
initiation and frequency of sexual activity--are better measures of the 
effectiveness of abstinence-until-marriage programs, because adolescent 
attitudes and intentions may or may not be indicative of actual 
behavior. 

Many of the efforts by HHS, states, and other researchers that we 
identified in our review lack at least one of the characteristics of a 
scientifically valid study of program effectiveness. Most of the 
efforts to assess the effectiveness of these programs have not used 
experimental or quasi-experimental designs with sufficient follow-up 
periods and sample sizes. For example, ACF used, according to ACF 
officials, grantee reporting on outcomes in order to monitor grantees' 
performance, target training and technical assistance, and help 
grantees improve service delivery. However, because the outcomes 
reported by grantees have not been produced through experimentally or 
quasi-experimentally designed studies, such information cannot be 
causally attributed to any particular abstinence-until-marriage 
education program. Further, none of the state evaluations we reviewed 
that had been completed included randomly assigned control groups. 
Similarly, some of the journal articles that we reviewed described 
studies to assess the effectiveness of abstinence-until-marriage 
programs that also lacked at least one of the characteristics of a 
scientifically valid study of program effectiveness. In these studies, 
researchers administered questionnaires to study participants before 
and after they completed an abstinence-until-marriage education program 
and assessed the extent to which the responses of participants changed. 
[Footnote 20] These studies did not compare the responses of study 
participants with a group that did not participate in an abstinence-
until-marriage education program. 

Like the lack of an experimental or quasi-experimental design, not 
measuring changes in behavioral or biological outcomes among 
participants limits the conclusions that can be drawn about the 
effectiveness of abstinence-until-marriage education programs. Most of 
the efforts we identified in our review used reported intentions and 
attitudes in order to assess the effectiveness of abstinence-until- 
marriage programs. For example, as of 2006, neither ACF's community- 
based grantees nor OPA's AFL grantees were required to report on 
behavioral or biological outcomes, such as rates of intercourse or 
pregnancy. Similarly, the journal articles we reviewed were more likely 
to use reported attitudes and intentions--such as study participants' 
reported attitudes about premarital sexual activity or their reported 
intentions to remain abstinent until marriage--rather than their 
reported behaviors or biological outcomes to assess the effectiveness 
of abstinence-until-marriage programs. 

According to scientific experts, HHS, states, and other researchers 
face a number of challenges in applying either of these criteria. 
According to these experts, experimental or quasi-experimental studies 
can be expensive and time-consuming to carry out, and many grantees of 
abstinence-until-marriage education programs have insufficient time and 
funding to support these types of studies. Moreover, it can be 
difficult for researchers assessing abstinence-until-marriage education 
programs to convince school districts to participate in randomized 
intervention and control groups, in part because of sensitivities to 
surveying attitudes, intentions, and behaviors related to abstinence 
and sex. Similarly, experts, as well as state and HHS officials, have 
reported that it can be difficult to obtain scientifically valid 
information on biological outcomes and sexual behaviors. For example, 
experts have reported that when measuring a program's effect on 
biological outcomes--such as reducing pregnancy rates or birth rates--
it is necessary to have large sample sizes in order to determine 
whether a small change in such outcomes is the result of an abstinence-
until-marriage education program. 

Among the assessment efforts we identified are some studies that meet 
the criteria of a scientifically valid effectiveness study. However, 
results of these studies varied, and this limits the conclusions that 
can be drawn about the effectiveness of abstinence-until-marriage 
education programs. Some researchers have reported that abstinence- 
until-marriage education programs have resulted in adolescents 
reporting having less frequent sexual intercourse or fewer sexual 
partners.[Footnote 21] For example, in one study of middle school 
students, participants in an abstinence-until-marriage education 
program who had sexual intercourse during the follow-up period were 50 
percent less likely to report having two or more sexual partners when 
compared with their nonparticipant peers.[Footnote 22] In contrast, 
other studies have reported that abstinence-until-marriage education 
programs did not affect the reported frequency of sexual intercourse or 
number of sexual partners.[Footnote 23] For example, one study of 
middle school students found that participants of an abstinence-until- 
marriage program were not less likely than nonparticipants at the 1 
year follow-up to report less frequent sexual intercourse or fewer 
sexual partners.[Footnote 24] Experts with whom we spoke emphasized 
that there were still too few scientifically valid studies completed as 
of 2006 that could be used to determine conclusively which, if any, 
abstinence-until-marriage programs are effective. 

We identified two key studies that experts anticipated would meet the 
criteria of a scientifically valid effectiveness study. Experts and 
federal officials we interviewed stated that they expected the results 
of these two federally funded studies to add substantively to the body 
of research on the effectiveness of abstinence-until-marriage education 
programs. One of these key studies--the final Mathematica report, 
contracted by ASPE, on the State Program--has been completed.[Footnote 
25] In this report, the researchers found that youth who participated 
in the abstinence-until-marriage education programs were no more likely 
than control group youth to have abstained from sex, and among those 
who reported having had sex, they had similar numbers of sexual 
partners and had initiated sex at the same average age. The youth in 
abstinence-until-marriage education programs also were no more likely 
to have engaged in unprotected sex than control group youth. The second 
key study we identified is CDC's research on middle school programs, 
which is still ongoing. In addition, since October 2006, a third key 
report was released, presenting the 2007 analysis of the National 
Campaign to Prevent Teen and Unplanned Pregnancy of the available 
research on abstinence-until-marriage education programs. This report 
stated that studies of abstinence programs have not produced sufficient 
evidence of effectiveness, and that efforts should be directed toward 
further evaluation of these programs.[Footnote 26] 

Statutory Requirement to Include Information on Condom Effectiveness 
Would Apply to Certain Abstinence-until-Marriage Education Materials: 

During the course of our work on abstinence-until-marriage education, 
we identified a federal statutory provision--section 317P(c)(2) of the 
Public Health Service Act--relevant to the grants provided by HHS's 
State Program, Community-Based Program, and AFL Program.[Footnote 27] 
This provision requires that educational materials prepared by HHS's 
grantees, among others, that are specifically designed to address STDs, 
contain medically accurate information regarding the effectiveness or 
lack of effectiveness of condoms in preventing the diseases the 
materials are designed to address. 

At the time of our review, an ACF official reported that materials 
prepared by abstinence-until-marriage education grantees were not 
subject to section 317P(c)(2). However, we concluded that this 
requirement would apply to abstinence-until-marriage education 
materials prepared by and used by federal grant recipients, depending 
upon the substantive content of those materials. In other words, in 
materials specifically designed to address STDs, HHS's grantees are 
required to include information on condom effectiveness, and that 
information must be medically accurate. Therefore, we recommended in a 
letter dated October 18, 2006, that HHS reexamine its position and 
adopt measures to ensure that, where applicable, abstinence education 
materials comply with this requirement.[Footnote 28] 

In a letter to us dated January 16, 2007, ACF responded that it would 
take steps to "make it clear to grantees that when they mass produce 
materials that as a primary purpose are specifically about STDs those 
materials are required by section 317P(c)(2) of the Public Health 
Service Act to contain medically accurate information regarding the 
effectiveness or lack of effectiveness of condoms in preventing the 
sexually transmitted disease the materials are designed to address." 
The fiscal year 2007 Community-Based Program announcement states that 
mass produced materials that as their primary purpose are specifically 
about STDs are subject to this requirement. The announcement also 
states that mass produced materials are considered to be specifically 
designed to address STDs if more than 50 percent of the content is 
related to STDs. An ACF official also told us that future State and 
Community-Based Program announcements would include this 
language.[Footnote 29] 

Mr. Chairman, this completes my prepared remarks. I will be happy to 
answer questions you or other Committee Members may have. 

Contact and Acknowledgments: 

For further information regarding this testimony, please contact Marcia 
Crosse at (202) 512-7114 or [email protected]. Contact points for our 
Offices of Congressional Relations and Public Affairs may be found on 
the last page of this statement. Major contributors to this report were 
Kristi Peterson, Assistant Director; Kelly DeMots; Cathleen Hamann; 
Helen Desaulniers; and Julian Klazkin. 

[End of section]

Footnotes:

[1] GAO, Abstinence Education: Efforts to Assess the Accuracy and 
Effectiveness of Federally Funded Programs, GAO-07-87 (Washington, 
D.C.: Oct. 3, 2006). This report is available online at [hyperlink, 
http://www.gao.gov].

[2] 42 U.S.C. ï¿½ 247b-17(c)(2) (2000); see GAO, Abstinence Education: 
Applicability of Section 317P of the Public Health Service Act, B- 
308128 (Washington, D.C.: Oct. 18, 2006). This letter is available 
online at [hyperlink, http://www.gao.gov]. 

[3] The 10 states that received the largest share of funding in fiscal 
year 2005 through the State Program were Arizona, Florida, Georgia, 
Illinois, Louisiana, Michigan, New York, North Carolina, Ohio, and 
Texas.

[4] See Douglas Kirby, Emerging Answers: Research Findings on Programs 
to Reduce Teen Pregnancy (Washington, D.C.: National Campaign to 
Prevent Teen Pregnancy, 2001). The experts identifying the design 
characteristics of a scientifically valid study for the National 
Campaign to Prevent Teen Pregnancy were drawn from institutions that 
include the National Institutes of Health, the Medical Institute for 
Sexual Health, the Alan Guttmacher Institute, the Institute for 
Research and Evaluation, and various universities. See David Satcher, 
The National Consensus Process on Sexual Health and Responsible Sexual 
Behavior: Interim Report (Atlanta: Morehouse School of Medicine, 2006). 
The panel convened by former Surgeon General David Satcher included 
experts from a variety of organizations, including the Medical 
Institute for Sexual Health, the Alan Guttmacher Institute, and the 
American Academy of Pediatrics. In addition, characteristics of a 
scientifically valid study have been identified by other experts in the 
field of evaluation research. For example, see Carol H. Weiss, 
Evaluation (Upper Saddle River: Prentice Hall, 1998). 

[5] For a more detailed description of our literature review 
methodology, see [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-87]. 

[6] 42 U.S.C. ï¿½ 710(b)(2). This definition is also referred to as the A-
H definition. This statutory provision defines abstinence education for 
purposes of the State Program. Annual appropriations acts and program 
announcements have extended this definition to the Community-Based and 
AFL Programs. See, e.g., Departments of Labor, Health and Human 
Services, and Education, and Related Agencies Appropriations Act, 2006, 
Pub. L. No. 109-149, 119 Stat. 2833, 2855-56. 

[7] Funds are also provided through the State Program to the District 
of Columbia and insular areas, which include U.S. territories and 
commonwealths. In this statement, we refer to U.S. territories and 
commonwealths as "insular areas." When we refer to "states," we are 
referring to all grantees of the State Program--including states, 
insular areas, and the District of Columbia. 

[8] See 42 U.S.C. ï¿½ 300z et seq. In this statement, when we use the 
term AFL Program, we are referring only to the abstinence-until- 
marriage component of the AFL Program. The AFL Program also supports 
other projects for pregnant and parenting adolescents, their infants, 
male partners, and family members. The purpose of these projects is to 
improve the outcomes of early childbearing for teen parents, their 
infants, and their families.

[9] See [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-87]. 

[10] HHS officials told us that if ACF finds inaccurate statements 
during this more general review process or if inaccuracies are brought 
to their attention at any time during the grant period, ACF officials 
work with the grantees to take corrective action.

[11] See [hyperlink, http://www.gao.gov/cgi-bin/getrpt?GAO-07-87]. 

[12] This reporting is a part of ACF's efforts to collect evaluative 
information about these programs. These efforts include both 
performance measurement--the ongoing monitoring and reporting of 
program accomplishments toward pre-established goals--and program 
evaluation--individual systematic studies to assess how well a program 
is working. 

[13] For example, in fiscal year 2002, state grantees developed such 
measures as the percentage of teens surveyed who show an increase in 
participating in structured activities after school hours; the 
percentage of live births to women younger than 18, fathered by men age 
20 and older; the percentage of program participants proficient in 
refusal skills; the percentage of high school students who reported 
using drugs or alcohol before intercourse; and the percentage of high 
school students who had sexual intercourse for the first time before 
age 13. 

[14] The fiscal year 2006 program announcement for the Community-Based 
Program provided examples of outcome measures that grantees could use, 
including increased knowledge of the benefits of abstinence, the number 
of youths who commit to abstaining from premarital sexual activity, and 
increased knowledge of how to avoid high-risk situations and risk 
behaviors. 

[15] Data on teen birth rates and adolescents' reported sexual behavior 
are contained in the National Vital Statistics System and the Youth 
Risk Behavior Surveillance System, respectively. The former is a 
national data set of public health statistics reported by states to 
CDC, and the latter is a national data set based on nationwide surveys 
administered to high school students by CDC. 

[16] See, for example, LeCroy & Milligan Associates, Inc., Abstinence 
Only Education Program: Fifth Year Evaluation Report, a report prepared 
for the Arizona Department of Health Services (2003); Patricia Goodson 
et al., Abstinence Education Evaluation: Phase 6, a report prepared for 
the Texas Department of State Health Services (2005); MGT of America, 
Evaluation of Georgia Abstinence Education Programs Funded Under Title 
V, Section 510, a report prepared for the Georgia Department of Human 
Resources (2005); Thomas E. Smith, It's Great to Wait: An Interim 
Evaluation, a report prepared for the Florida Department of Health 
(2001). 

[17] The five abstinence-until-marriage education programs studied were 
My Choice, My Future! in Powhatan, Virginia; ReCapturing the Vision in 
Miami, Florida; Teens in Control in Clarksdale, Mississippi; Families 
United to Prevent Teen Pregnancy in Milwaukee, Wisconsin; and Heritage 
Keepers in Edgefield, South Carolina. 

[18] See Kirby. This panel included experts from NIH, the Medical 
Institute for Sexual Health, the Alan Guttmacher Institute, the 
Institute for Research and Evaluation, and various universities.

[19] See Satcher. This panel included experts from a variety of 
organizations, including the Medical Institute for Sexual Health, the 
Alan Guttmacher Institute, and the American Academy of Pediatrics. 

[20] See, for example, S. M. Fitzgerald et al., "Effectiveness of the 
Responsible Social Values Program for 6th Grade Students in One Rural 
School District," Psychological Reports, vol. 91 (2002), and J. E. 
Barnett and C. S. Hurst, "Abstinence Education for Rural Youth: An 
Evaluation of the Life's Walk Program," The Journal of School Health, 
vol. 73, no. 7 (2003). 

[21] See E. A. Borawski et al., "Effectiveness of Abstinence-only 
Intervention in Middle School Teens," American Journal of Health 
Behavior, vol. 29, no. 5 (2005). See also T. L. St. Pierre et al., "A 
27-Month Evaluation of a Sexual Activity Prevention Program in Boys & 
Girls Clubs Across the Nation," Family Relations, vol. 44, no. 1 
(1995). 

[22] See Borawski et al., "Effectiveness of Abstinence-only 
Intervention in Middle School Teens,".

[23] See N. G. Harrington et al., "Evaluation of the All Stars 
Character Education and Problem Behavior Prevention Program: Effects on 
Mediator and Outcome Variables for Middle School Students," Health 
Education & Behavior, vol. 28, no. 5 (2001). See also J. B. Jemmott 
III, L. S. Jemmott, and G. T. Fong, "Abstinence and Safer Sex HIV Risk- 
Reduction Interventions for African American Adolescents: A Randomized 
Controlled Trial," Journal of the American Medical Association, vol. 
279, no. 19 (1998). 

[24] See Harrington et al., "Evaluation of the All Stars Character 
Education and Problem Behavior Prevention Program: Effects on Mediator 
and Outcome Variables for Middle School Students." 

[25] See Trenholm at al., Impacts of Four Title V, Section 510 
Abstinence Education Programs: Final Report, a report prepared for 
ASPE, 2007. According to several scientific experts, Mathematica's 
study is an important one, in part because of its sound design: the 
study randomly assigns and compares control groups with groups 
receiving abstinence-until-marriage education and uses surveys to 
follow up with program participants for several months after their 
completion of a program.

[26] See Douglas Kirby, Emerging Answers 2007: Research Findings on 
Programs to Reduce Teen Pregnancy and Sexually Transmitted Diseases 
(Washington D.C.: National Campaign to Prevent Teen and Unplanned 
Pregnancy, 2007). 

[27] 42 U.S.C. ï¿½ 247b-17(c)(2). Section 317P(c)(2) states that "... 
educational and prevention materials prepared and printed ...for the 
public and health care providers by the Secretary (including materials 
prepared through the Food and Drug Administration, the Centers for 
Disease Control and Prevention, and the Health Resources and Services 
Administration) or by contractors, grantees, or subgrantees thereof, 
that are specifically designed to address STDs...shall contain 
medically accurate information regarding the effectiveness or lack of 
effectiveness of condoms in preventing the STD the materials are 
designed to address. Such requirement only applies to materials mass 
produced for the public and health care providers, and not to routine 
communications." 

[28] See GAO, B-308128, Oct. 18, 2006.

[29] OPA reported that, as a matter of policy, it has required since 
1993 that AFL Program materials that include information regarding STDs 
contain medically accurate information regarding the effectiveness or 
lack of effectiveness of condoms in preventing the STDs addressed in 
the materials. Further, OPA reported that, since November 2006, OPA has 
taken additional steps to inform grantees about OPA's policy and the 
need to be compliant with the requirements of Section 317P(c)(2) of the 
Public Health Service Act. 

[End of section]

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E-mail: [email protected]: 
Automated answering system: (800) 424-5454 or (202) 512-7470:

Congressional Relations:

Ralph Dawn, Managing Director, [email protected]: 
(202) 512-4400: 
U.S. Government Accountability Office: 
441 G Street NW, Room 7125: 
Washington, D.C. 20548:

Public Affairs:

Chuck Young, Managing Director, [email protected]: 
(202) 512-4800: 
U.S. Government Accountability Office: 
441 G Street NW, Room 7149: 
Washington, D.C. 20548: 
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