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Contents
CHAPTER 1: Historical Perspective and Introduction
Shifting Landscape of Reproductive Politics
The Crucial Role of Males in Pregnancy Prevention Initiatives
Programs Included in this Guide
How the Guide is Organized
CHAPTER 2: The Guys
CHAPTER 3: The Programs
Overview
Always on Saturday
Baylor Teen Health Clinic
Brothers to Brothers
Compass
Dads Make a Difference
Fifth Ward Enrichment Program, Inc.
Hablando Claro con Cariņo y Respeto
HiTOPS
Hombres Jóvenes con Palabra
It Takes Two
Male Involvement Program
Male Outreach Program
Male Youth Enhancement Program
Men's Services Program
Project Alpha
Project MISTER
The Responsive Fathers Program
Teen Parenting Skills Project
Teens on Track
Wise Guys
Young Dads Program
Young Men's Clinic
Youth Education and Development Program
CHAPTER 4: Practical Advice and Program Philosophy
Advice about Program Philosophy
Next Steps
APPENDIX ONE: Methodology
How the Programs Were Identified
How the National Survey of Adolescent Males Was Conducted
APPENDIX TWO: Contact Information for Exemplary Programs
APPENDIX THREE: List of Other Male Involvement Programs by State
APPENDIX FOUR: Examples of Materials Used by Male Involvement Programs
APPENDIX FIVE: References
List of Tables and Charts
Sexual Experience by Age: Males 15 to 19 Years Old
Males Who Have Had Intercourse by Age and Ethnicity
Likelihood of Becoming Sexually Experienced Within the Next Year, by Age
Sexual Experience, by Involvement in Problem Behaviors: Males 15 to 19 Years Old
Number of Times Had Sexual Intercourse Within the Last 12 Months, by Age: Sexually Experienced Males
Number of Female Partners in the Last 12 Months, by Ethnicity: Sexually Experienced Males
Age of Youngest Female Partner Among Males Age 16
Age of Youngest Female Partner Among Males Age 19
Age of Youngest Female Partner Among Males Ages 20 and 21
Age of Youngest Female Partner Among Males Ages 22 to 26
Consistency of Condom Use During the Last 12 Months, by Ethnicity
Contraceptive Use at Last Intercourse, by Age
Condom Use During the Last Year, by Age
Percent of 15- to 19-Year-Old Males Believing "Getting a Girl Pregnant Will Make You Feel Like a Real Man"
Attitudes Toward Condoms: Males 15 to 19 Years Old
Pregnancy and Births, by Ethnicity: Sexually Experienced Males
Sources of Contraceptive Information, by Sexual Experience: Males 15 to 19 Years Old
Involvement in Social Institutions, by Sexual Experience
Male Involvement Programs
CHAPTER 1
Historical Perspective and Introduction
Preventing teenagers from having unplanned pregnancies is an important goal that has been pursued since the 1970s, when births to teenagers were first diagnosed as a major social problem. Much has been learned about the types of interventions that work and do not work (Kirby, 1997; Moore et al., 1995; Frost and Forrest, 1995; Miller and Paikoff, 1992). A glaring gap, however, is the lack of systematic information about how males could and should participate in pregnancy prevention efforts. This guide begins to fill that void by pulling together—from data on programs around the country—what is currently known about male reproductive behavior and programs designed to influence this behavior.
The guide, funded by a grant from The California Wellness Foundation to inform its statewide Teen Pregnancy Prevention Initiative, is intended for program planners in California and throughout the country who wish to implement programs involving males in teenage pregnancy prevention. It has three main purposes:
- to dispel myths about the target population by providing a description of the male partners of potential teenage mothers,
- to identify established pregnancy prevention programs that have successfully involved males in different settings around the
country, and
- to distill practical lessons from the experiences of these exemplary programs for programs still at the fledgling stage.
In the recent groundswell of interest across the country in targeting males for teen pregnancy prevention, key policy makers have responded to the absence of prevention efforts oriented to the male partners of the teenage mothers. For example, the governor of California and the federal legislators framing the recent welfare reform legislation have called for new program initiatives involving both carrots and sticks to encourage male reproductive "responsibility." At last count 40 states were reported to have strategies to prevent unwanted or too-early fatherhood (Knitzer and Bernard, 1997). Indeed it is now generally acknowledged that teen pregnancy prevention initiatives are not likely to be successful unless they address both partners' concerns and interests.
Although consensus may have been reached about the importance of involving males in teen pregnancy prevention, little is generally known about how to reach them or how to influence their reproductive behavior. However, over the last decade knowledge has been accumulating. The National Survey of Adolescent Males (NSAM) begun in 1988 provides information about trends in young men's attitudes and behaviors that are useful for understanding the perspectives of this population (Sonenstein, Pleck, and Ku, 1989). Prior to this survey, the only national trend data on the reproductive behavior of teens were collected about females. New data from the 1995 NSAM are presented in this guide to provide a national picture of the extent of their risk for participating in pregnancies, with opportunities for influencing their behavior highlighted.
Knowledge has also been accruing about how to develop pregnancy prevention programs that involve males (Dryfoos, 1988; Levine and Pitt, 1995; Moore, Driscoll, and Ooms, 1997). A number of programs have been initiated in communities throughout the country. Their pioneering efforts could provide useful advice and counsel to new initiatives. However these prevention programs are geographically spread out, sponsored by many different organizations, and unconnected to other like efforts. This guide provides a central source of program information so that individuals interested in developing programs to help young males participate in pregnancy prevention will not need to start at ground zero.
The Shifting Landscape of Reproductive Politics
For many years reproductive policy in the United States concentrated almost singly on women. For example men made up only two percent of the clients in the federally funded Title X family planning programs in 1991 and two percent of Medicaid funded family planning in 1990 (Schulte and Sonenstein, 1995). The changed political climate has broadened the focus to acknowledge the critical role men play in human reproduction. Recently, for example, the Office of Population Affairs in the U.S. Department of Health and Human Services announced a limited male initiative, the Young Men/Family Planning Clinic Partnership Program. In this program male high school students will work in Title X family planning clinics to increase service utilization by teen males and to broaden the students' training and employment goals.
Public Health and STD Prevention
One set of pressures prodding public health and family planning providers to be more interested in the reproductive and contraceptive behavior of males is concern about the spread of HIV and other sexually transmitted diseases (STDs). The identification of new STDs that are easily transmitted, for example, has reignited the popularity of condoms as one of the effective ways to prevent transmission of STDs among sexually active populations. Since condoms are used by males, efforts to increase condom use must necessarily target them as well as their female partners. Changing the reproductive behavior of males is a crucial element of strategies to prevent the transmission of STDs.
In addition, rapid treatment of the male partners of females testing positive for bacterial STDs such as chlamydia, gonorrhea, and syphilis is a critical element in slowing the spread of these diseases and preventing reinfection. Increasingly, family planning clinics faced with many female patients testing positive for STDs have started to treat male partners. Indeed STD treatment is one of the primary reasons that family planning clinics give when asked why they have expanded their services to include males (Schulte and Sonenstein, 1995).
Child Support Policy
Another set of influences creating pressure for more intense focus on male reproductive behavior emerges from child support policy. The Child Support Enforcement Program was established in 1975 as a way of recouping from fathers some of the public funds that children on welfare (Aid to Families with Dependent Children) were receiving. Over the years the program has moved from serving just the welfare population to including within its mandate all children with noncustodial parents. In addition, as more children have been born out of wedlock the program has increasingly focused on paternity establishment to create bonds of economic responsibility between children and their fathers. While the program began as unpopular and relatively small, it has now emerged as one of the keystones of federal welfare policy. The current goals of the program include establishing paternity for all children born out of wedlock, and setting and enforcing reasonable and equitable child support orders for all children who have a parent—a father or mother—who does not live with them. Essentially, a primary goal of the program is to ensure that parents assume financial responsibility for any children that they have, whether or not these children are born within marriage.
Some have argued that requiring males to be financially responsible for their children can provide needed motivation for them to avoid unintended pregnancies and births. Since child support enforcement is far from universal at the moment, it is difficult to test this hypothesis. Less than one-third of nonmarital births are estimated to have paternity established, approximately half of custodial parents have child support orders, and only half of these orders are fully paid (U.S. House of Representatives, 1996). Major efforts are under way in many states to improve these statistics. We argue that if males are going to be held responsible for any children they produce, it is time to spend more public resources on helping them to avoid unintended pregnancies (Sonenstein and Pleck, 1995).
Statutory Rape Enforcement
A further recent development has been the call for more rigorous enforcement of statutory rape laws to reduce pregnancies and births among young female teens. Initiatives have been launched in several states including California, Delaware, Georgia, and Florida. While there is substantial state-to-state variation in definitions of statutory rape, in more than half the states the young woman must be under age 16. Many states also stipulate a minimum age difference between the partners, with 4 years the most commonly cited criterion (Donovan, 1997). Thus while statutory rape enforcement may discourage some teenage pregnancies because it results in large penalties, its target population is relatively small—adult males who have sex with very young women (Lindberg, Sonenstein, Ku, and Martinez, 1997).
The Fatherhood Movement
A final set of forces that could potentially promote greater interest in male reproductive behavior is the fatherhood movement. As the feminist movement grew in the 1960s, an initially small group of men recognized that gender roles could be as limiting for males as they were for females. Just as some women wished to participate in the male economic sphere, some men pushed for fuller participation in the female family sphere. Over the years they have been joined by an increasing number of noncustodial fathers' groups that are also interested in participating in their children's lives and have rallied for better enforcement of visitation agreements. More recently many others—both males and females—have become concerned about the increasing absence of fathers in the lives of children in female-headed families. In June 1995 President Clinton launched a government-wide initiative to strengthen the role of fathers in families. As part of this initiative the Department of Health and Human Services is spearheading an examination of its programs and data collection activities to expand and enhance activities promoting fatherhood issues. While most of this effort has focused on fathers "after the fact," after they have become fathers, there is recognition that it is also important to focus on how men become fathers. As part of the Federal Interagency Forum on Child and Family Statistics, a working group is developing recommendations about better measurement and data collection about male fertility behavior.
The time has arrived when there is now a confluence of interests supporting the crucial role of males for family and reproductive policy. It should therefore be no surprise that debates about adolescent pregnancy policy show an increasing interest in the role of males and the development of strategies that involve them in pregnancy prevention efforts.
The Crucial Role of Males in
Pregnancy Prevention Initiatives
Why males were ever excluded from the way we think about pregnancy prevention is puzzling. Sexual behavior involves two partners, and decisions to have sex and to use contraception undoubtedly reflect both partners' perspectives, whether explicitly or implicitly. Yet fertility and family are traditionally ascribed to the world of females—a perspective that has kept us from acknowledging what should have been obvious—that males must be involved in any policy solution to unintended pregnancies among teenagers.
It is well known, for instance, that adolescent boys initiate sex earlier than girls and that they tend to accumulate more sexual partners over their lifetimes. Even though males do not actually get pregnant, it does not make sense to segregate them from prevention efforts when they have sex earlier, more frequently, and with more partners than females of comparable ages.
Contrary to stereotypes about males' disregard for contraception, there is overwhelming evidence that males have played an extremely important role in providing contraceptive protection to teenage females. Even before data were collected from the males, information provided by teenage females showed that male methods of contraception were the main forms of contraception used when they first initiated sex. In 1979, for example, 70 percent of 15- to 19-year-old females reporting that they had used contraception at first intercourse reported a male method—either withdrawal or condoms (Sonenstein, 1986).
More recent evidence from the 1988 NSAM provides further justification for integrating males into pregnancy prevention initiatives. These data show that one of the biggest shifts in teenagers' reproductive behavior that we have observed in recent time is the improvement in teenage males' contraceptive behavior. Between 1979 and 1988 condom use doubled. By 1988 more than half of all sexually experienced 15- to 19-year-old males said that they had used a condom at last intercourse (Sonenstein, Pleck, and Ku, 1989), and further increases in condom use have been observed in the 1990s. This evidence comes from the reports of both male and female teenagers (Abma, Chandra, Mosher, Peterson, and Piccinino, 1997; Kann, Warren, Collins, et al., 1993 ). These shifts in male teenagers' behavior demonstrate that they can be influenced to adopt new behaviors and that programs designed to change male reproductive behavior will not necessarily fall on
deaf ears.
Most of the descriptive information about male partners in this guide comes from new data collected in the 1995 NSAM, which interviewed 1,729 males—a sample that is representative of males ages 15 to 19 living in households in the contiguous United States. Our analyses are intended to provide a nationally representative picture of the reproductive attitudes and behavior of teenage males. They show the proportions of teens engaging in behaviors that put them at risk of pregnancy, where they are getting information about protecting themselves, and where programs are likely to encounter them. Until recently such information was not collected, leaving program planners to rely on their own devices to obtain information about these important clients.
It should be noted, however, that not all the male partners of teenage girls are themselves teenagers. On average the male is 2 to
3 years older than the female, a pattern that is repeated among adults. Thus many older teen females who are 17, 18, and 19 years old are highly likely to have partners in their twenties. Analyses of birth data confirm this pattern. In 1988 two-thirds of the fathers of babies born to mothers under the age of 20 were in their twenties (Landry and Forrest, 1995; Lindberg, Sonenstein, Ku, and Martinez, 1997). Thus it is important to realize that some of the males who should be involved in teenage pregnancy prevention efforts are not teens. To the extent possible, we have attempted to integrate information into this guide about these male partners of older teenage females, and we have also looked for prevention programs that include males in their twenties. In spite of these efforts, most of the information found is about teen males. Obtaining more information about men in their early twenties is crucial for expanding prevention efforts to this population.
Programs Included in this Guide
One of the goals of this guide is to identify prevention programs that have successfully involved males using different approaches and agency settings. The first selection criterion involved the setting of the program. Because there was already an extensive literature on school-based sex education and on school-based clinics,
1 we decided not to include these types of programs in our search for promising prototypes even though most of them are coeducational and therefore involve males in some way. Because developers seeking to implement these types of programs have a number of other resources to consult, we concentrated our efforts on looking for other types of programs to increase the variety of prototypes developers can consider. We do include other school-based programs that are not explicitly sex education or school-based clinics.
The second selection criterion concerned the meaning of "involving males." 2 This was our decision rule: A crucial ingredient for programs that "involve males" is that they focus on the male role in reproduction. It is not enough that a program have participants who are males; the program content must discuss explicitly the male perspective on reproductive behaviors (sex, contraception, childbearing, and parenting). This decision is as important in defining the programs we have chosen to highlight as the decision about what types of programs to cover. Whether they are single-sex programs or include both males and females, to be included they must concentrate on reproductive issues from the male perspective.
A third criterion for selecting programs was that they acknowledge prevention of pregnancy as an explicit primary or secondary program objective. We adopted this requirement when it became clear that there are "fathers" programs helping males in their parenting roles that do not deal with the issue of pregnancy prevention. Some of these programs may indirectly lead men to be more careful about having subsequent unintended pregnancies or births. However, since programs can only be held responsible for achieving the goals that they have set for themselves, we only include programs that are trying to help men to avoid unintended pregnancies or births as an explicit goal.
A final set of criteria dealt with the selection issue of which programs can best provide advice to other programs. Since there has been an explosion of interest and support for programs involving males in teen pregnancy prevention, many programs have been implemented only recently. Many promising prototypes are almost certainly among this new generation of programs, but we decided to select those that had withstood the test of time, defined as operating for at least three years. These programs have completed their planning and implementation stages and have gained experience with program operation at scale. In addition, we decided to include only larger programs—arbitrarily defined as ones that served at least 50 males in the last year. Smaller program prototypes, however successful, are not included in this guide.
We note that the field of male involvement prevention programs has not progressed sufficiently to have developed a rigorous evaluation literature. Few of the programs covered in this guide have been formally evaluated and none have used rigorous experimental or quasi-experimental designs. The programs we have included have all been successful in recruiting male participants and keeping them engaged in program activities. In other words, male program participants have voted with their feet for these programs. Also the fact that these programs have been able to sustain themselves over time indicates that they have gained support from funders as well as participants. An important next step will be to submit some of these prototypes to more rigorous evaluation to assess their ultimate impact on unintended pregnancies and births.
We have selected 24 programs to demonstrate the variety of approaches that can be used for addressing the male role in teen pregnancy prevention. Of the programs, five are set up around clubs or youth groups, seven are primarily health focused, and seven are oriented to schools. Indeed most of the health-focused projects are in fact based in schools. Schools are overwhelmingly the most popular site for these interventions, even after the most common types of school programs, sex education and school-based clinics, have been purposely excluded. Programs oriented to sports, employment and training, and criminal justice settings are represented by single nominees. Given the numbers of teen males who have links to these settings, there appears to be a lot of room for further program development in these areas.
We were unable to locate program models fitting our criteria that are oriented to the following audiences: youth in health maintenance organizations or other managed health care, 3 Asian youth, and males in their twenties who have sex with teenagers. These are all relevant populations for teenage pregnancy prevention efforts in California as well as throughout the country.
How the Guide Is Organized
The rest of this guide is divided into three major sections and five appendices.
Chapter 2 provides a description of males who are likely to get involved in teen pregnancies and births. Using recently collected information from the 1995 National Survey of Adolescent Males we examine:
- How many males are sexually involved with teenage females and who are they?
- What is the nature of the sexual relationships males have with teenage females?
- What are teenage males doing to protect themselves and their partners from unintended pregnancy and sexually transmitted diseases?
- Where do these males get information about contraceptive protection?
- What organizations are these men involved in that could potentially be settings for pregnancy prevention programs?
Chapter 3 introduces the 24 promising prevention programs that focus on the male role in reproduction. For each of these programs we have prepared a description that covers:
- Program philosophy and history,
- What the program does,
- What kinds of males it includes,
- How the program is funded and staffed,
- What barriers it faced and overcame, and
- What lessons would be useful to other program developers.
This chapter also provides guides so that program developers can identify the programs that might be most relevant to their own circumstances. Programs are classified by their organizational settings, the ages of their participants, their annual budgets, and other special features such as cultural orientation.
Chapter 4 pulls together our observations across these programs about the common lessons that have been learned by these programs. There are practical lessons about the types of activities that attract and engage males and program materials that are popular with the programs. There are common experiences in terms of the barriers to program implementation and approaches used to overcome these hurdles. Finally we examine the elements of program philosophy shared by many of these successful programs. We conclude that careful attention to program philosophy about male development is a crucial determinant of programs' ability to attract a critical mass of male participants.
The Appendices include a wealth of information that we hope will be useful to program developers. The first appendix describes our study methodology—how we canvassed the country for teenage pregnancy prevention programs involving males and how we conducted the National Survey of Adolescent Males. We include the questions used in the National Survey of Adolescent Males so that programs wishing to assess their program participants' reproductive behavior can obtain measures that can be calibrated to national survey data. The second appendix provides contact information for the 24 programs, including notes about the willingness of program personnel to provide assistance to program developers. The third appendix lists all the programs involving males that we found by state. Many of these were too new or too small to be included in the more detailed program descriptions. The fourth appendix lists materials used by the highlighted programs, including curricula, videos, pamphlets, and activities. The fifth consists of a list of references for this guide that should be useful to programs that are just starting out.
Notes
1. See Kirby 1997 for a review of this literature.
2. This question was the subject of extensive discussion at a meeting of the guide's advisers.
3. One program in a health maintenance organization demonstrated that a half-hour slide-tape program with a personal health consultation for teen males resulted in more effective contraceptive practice one year later (Danielson et al., 1990). This program no longer exists, but a User's Guide, a complete set of program materials, and evaluation instruments are available from The Program Archive on Sexuality, Health and Adolescence (PASHA), Sociometrics Corporation, 170 State Street, Suite 260, Los Altos, CA 94022-2812, 1-800-846-3475.
CHAPTER 2
The Guys
A basic step in the development of programs is understanding the population whose behavior we wish to change. This chapter provides new information from the 1995 National Survey of Adolescent Males (NSAM) to describe the level of pregnancy risk among teenage males and to identify characteristics that could help program developers think about ways to orient pregnancy prevention efforts towards them. This information comes from interviews with 1,729 males ages 15 through 19 who were selected to represent young men in households across the United States. The picture provided is a national one. Program developers would probably like to know about the behavior of the teenage males in their own neighborhoods and communities. The questions and the methodology used in the NSAM are described in more detail in
Appendix 1 for those who wish to study their local populations more closely.
Analyses of this national sample of male teenagers show that:
Teenage males need to be reached by pregnancy prevention efforts; they appear reachable, and we know where to reach them.
- Many teenage males engage in unprotected sex.
- They express a desire to use contraceptives responsibly but do not do so consistently.
- They are connected to organizational settings in which pregnancy prevention programs could be implemented.
Teenage pregnancy prevention programs should consider expanding their efforts to include men ages 20 and 21 because many of these young adults also have teenage female partners.
How many teenage males have ever had sexual intercourse?
- In 1995, more than one-half of males 15 to 19 years old have had sexual intercourse.
- The older the teenager, the more likely he is to have had sex.
- Fewer than 30 percent of 15-year-olds have had sexual intercourse, compared to more than 80 percent of 19-year-olds.
- Half of teenage males have had sexual intercourse by the time they reach their 17th birthday. 1
- Not all young men are sexually experienced by the end of their teen years. At age 19, 15 percent of males are still virgins.
How does sexual experience vary by race and ethnicity among teenage males?
- Black teen males initiate sex earlier than Hispanic or white males. White males initiate sex later than both other groups.
- Half of black teens report having sex by age 16.
- Half of Hispanic teens report having sex by age 17.
- Half of white teens report having sex by age 18.
- By age 19, the proportion of males that are sexually experienced is similar among these groups.
- Overall, among males ages 15 to 19, 80 percent of blacks have had sexual intercourse, as compared to 61 percent of Hispanics and 50 percent of whites.
How likely is it that a teenage male virgin will start having sexual intercourse in the next year?
- One in five male virgins ages 13 to 18 will start having sexual intercourse within the next year.
- The older a male virgin, the more likely he is to become sexually experienced in the next year. The odds are:
- 1 in 10 for 14-year-olds
- 1 in 5 for 15-year-olds
- 1 in 4 for 16- and 17-year-olds
- 1 in 2 for 18-year-olds.
How is early sexual activity related to other risk taking among teenage males?
- Early sexual experience is associated with participation in other problem behaviors.
- Three-quarters of the teenage males who report using illegal drugs in the past 12 months, such as marijuana, cocaine, crack, and injection drugs, are also sexually experienced.
- Three-quarters of the teenage males with past criminal involvement, including ever being picked up by the police, arrested, or jailed, are also sexually experienced.
- Eighty-seven percent of teenage males who are two or more years behind in school for their age are sexually experienced.
How often do sexually experienced teenage males have sex?
- Teenage males' frequency of sexual intercourse is often low.
- During the last 12 months, more than half of sexually experienced teen males have had sex fewer than 10 times.
- 10 percent did not have intercourse at all.
- 42 percent had sex fewer than 10 times.
- 25 percent had sex 10 to 49 times.
- 23 percent had sex 50 times or more.
- Teenage males have sexual intercourse more frequently as they get older.
- Yet even at ages 18 and 19, fewer than one-third of sexually experienced males had sex 50 or more times in the last 12 months.
- Other national data show that teen males have sex less frequently than unmarried adult males. 2
- Young males' sexual activity tends to be episodic, and they are often sexually inactive for several months at a time. 3
How many female partners do teenage males have in a year?
- Most teenage men's sexual relationships are monogamous.
- Among sexually experienced teenage males, more than half have one partner or less in one year.
- One in four had two partners.
- One in five had three or more partners.
- Few males had five or more partners during the last year.
- On average, black males had more female partners in the last 12 months than white or Hispanic males.
- Six in ten sexually experienced black teens had more than one partner in the last year.
- Five in ten Hispanic males had multiple partners.
- Four in ten white males had multiple partners.
Whom do teenage males choose as sexual partners?
- Most sexually experienced teenage males have sexual partners close to their own age.
- The average age difference between sexually experienced
males ages 15 to 19 and their most recent female partner is less than 6 months.
- A subset of teenage males have sexual intercourse with significantly younger girls.
- Fully one-quarter of sexually active 16-year-old males report having a female partner who was age 14 or younger during the last year.
- Among sexually active males age 19, 11 percent had a female partner age 15 or younger during the last year.
- A substantial proportion of teenage males also have sexual intercourse at extremely young ages. By age 15, about one quarter of teenage males are sexually experienced.
How many adult men have sex with minor females?
- Among men ages 20 and 21, 19 percent had sex with a minor female in the last year; most of these females were age 17. 4
- Among sexually active men ages 22 to 26, about one-quarter report having engaged in sexual activity with a teenage partner during the last year. 5
- However, the majority of these female partners were not minors; most were 18 or 19 years old.
- Four percent of men ages 22 to 26 had sexual relations with minor females ages 17 or younger.
- The adult men in relationships with teenage partners are difficult to identify.
- Their employment and education characteristics are similar to those of men with adult partners.
- Drug use and criminal involvement are more common among the men having sex with minors than among those with adult partners [not shown].
How well do sexually experienced teenage males protect themselves and their partners from pregnancy and disease?
- Most sexually experienced teenage males have used condoms, but they tend to use them inconsistently.
- Ninety percent of teenage males having sex used condoms sometime during the last year [not shown].
- Less than half of teenage males used condoms 100% of the times they had sexual intercourse during the last year.
- Sexually active Hispanic males are particularly vulnerable. Fewer than one-third of Hispanic males used condoms consistently in the last year, as compared to almost half of blacks and whites.
- Pill use does not preclude condom use; one-third of sexually active teenage males who use condoms 100% of the time also report that their partner used the pill [not shown].
How does contraceptive use vary by age among sexually experienced teenage males?
- At last intercourse, teenage males are equally likely to have used an effective method of contraception, regardless of age. 6
- The type of contraception used at last intercourse differs by age.
- Condom use tends to decline with age.
- Males ages 18 and 19 are more likely to use female methods than are younger teens.
- The likelihood that a teenage male uses a condom every time he has sexual intercourse, however, tends to decline with age.
What are teenage males' attitudes about their role in preventing pregnancy?
- Teenage males express strong beliefs that preventing pregnancy is a male responsibility.
- More than 90 percent agree that male responsibilities include:
- talking about contraception before sexual intercourse,
- using contraception to protect against unwanted pregnancy, and
- taking responsibility for a child they fathered.
- Few teenage males express the belief that causing a pregnancy would make them feel like a "real man."
- Most report that they, their parents, and their friends would be upset if they made a girl pregnant [not shown]. 7
What are teenage males' attitudes about condoms?
- About half of teenage males express little embarrassment about using or buying condoms.
- About half of teenage males do not think that condoms will reduce physical sensation.
- About two-thirds express little concern about discussing condoms with a new partner or having the partner be upset about the use of condoms.
- Teenage males who are embarrassed about condoms, and who believe that condoms reduce physical pleasure, are less consistent condom users. 8
How many sexually experienced teenage males experience pregnancy and fatherhood?
- Among sexually experienced males ages 15 to 19, 14 percent have made a partner pregnant.
- Six percent of sexually experienced males in this age group have fathered a child.
- There are differences by ethnicity in the rates of pregnancy and fatherhood among sexually experienced teenage males.
- About one-fifth of black and Hispanic sexually experienced teenage males report a pregnancy, compared to one-tenth of white males.
- Just under 10 percent of black and Hispanic males report a birth, as compared to 5 percent of white males.
Where do teenage males get contraceptive information?
- Sexually experienced males are more likely than virgins to report receiving information about contraception.
- Teenage males are most likely to report having received information about contraception from television and from schools. 9
- Less than half of teenage males ever receive information about contraception from their parents or the people who raised them.
- Doctors and nurses are the least frequent sources of contraceptive information.
- During the last 12 months, only 32 percent of sexually experienced teenage males report receiving this information from doctors and nurses, but this is twice the rate reported by
virgins.
Where can programs reach teenage males?
- Teenage males have high levels of involvement in key social institutions, providing many settings in which to contact and involve them in pregnancy prevention efforts.
- Participation in sports is nearly universal among males ages 15 to 19.
- Many youths participate in clubs or youth groups, particularly those who have not yet had sexual intercourse.
- Half of sexually experienced teen males were involved with the criminal justice system.
- Most teenage males received medical care within the last 12 months. However, the majority did not talk about contraception with the medical provider.
- Almost all teenage males are involved in school or work. Sexually experienced males are more likely to be employed than virgins, in part because they are older.
Notes
1. Among young women who turned 20 in 1985-87, half engaged in sexual intercourse by the time they reached their 18th birthday. (The Alan Guttmacher Institute, 1994, Figure 12. Based on tabulations from 1988 National Survey of Family Growth).
2. Laumann, Gagnon, Michael, and Michaels, 1994, Table 3.4. Based on tabulations from the National Health and Social Life Survey.
3. In 1988, on average, sexually experienced males ages 15 to 19 did not have sexual intercourse during six of the last twelve months. Sonenstein, Pleck, and Ku, 1991.
4. Calculated by the authors from the 1991 National Survey of Men, a nationally representative survey of 20- to 39-year-old noninstitutionalized males (Tanfer, 1993.) These data are available from Sociometrics Corporation, 170 State Street, Suite 260, Los Altos, CA 94022-2812, 1-800-346-3475.
5. Data for these measures come from the 1995 National Survey of Adolescent Males (NSAM), Old Cohort. In 1988, the NSAM first interviewed a nationally-representative sample of 1,880 males ages 15 to 19. The same men were interviewed in 1991 and again in 1995, when they were ages 21 to 27. In 1995, of the 1,377 respondents reinterviewed, only 55 males in the 1995 sample were age 21, and 6 were age 27 at the time of the interview because of differences in the time of year when the 1995 interview occurred. Since these few cases are not representative of all males ages 21 or 27, we refer to this as a follow-up sample of males ages 22 to 26.
6. Effective methods of contraception included condom, the pill, Depo Provera, Norplant, female condom, cervical cap, and sterilization. Ineffective methods of contraception included douching, foam, jelly, rhythm, and withdrawal. Respondents reporting multiple methods of contraception at last intercourse were identified according to the most effective method used.
7. Among males ages 15 to 19, 94 percent thought that their parents would be upset if they got a girl pregnant, 65 percent thought that their friends would be upset, and 85 percent thought that they themselves would be upset.
8. Pleck, Sonenstein, and Ku, 1991.
9. Information from parents consists of ever receiving information on methods of birth control. Information from schools consists of ever receiving information on methods of birth control, where to obtain contraception, or how to put on a condom. Information from a doctor or nurse, and information from television, consist of receiving information on condoms or preventing pregnancy during the past 12 months.
CHAPTER 3
The Programs
The evidence from survey research suggests that many teenage males could be amenable to pregnancy prevention messages. The key is to find approaches that lead males to translate this motivation into consistent behaviors that protect them from unintended pregnancy. This chapter describes the 24 programs we identified in our systematic search for alternative approaches to involving males in teenage pregnancy prevention. Each program description provides basic information about the nature of the program, its goals and philosophy, how it was created, what resources were required, and what lessons have been learned. The individual descriptions are sufficiently detailed so that readers can consider each prototype and determine whether the circumstances surrounding its development are applicable to their own situations. For more information about particularly promising prototypes, see
Appendix 2, where we show the types of assistance that each program will provide to program developers implementing a program with a similar approach.
Overview
The following chart provides basic information for readers who want to select program models that best fit their circumstances, their audiences, and their financial resources. The information on teen males presented in
Chapter 2 indicates that many of them are involved in one or more of a variety of institutional settings that are promising places for prevention programs to attract male participants. The program descriptions are arrayed by type. The definitions we have used to array the programs follow on the next page.
- Sports: Uses sports and recreation as vehicles to bring young men together. Recreation is used to attract youth and retain them in the program. Group discussions on reproductive health and family life are coupled with recreational activities, combining education with fun.
- Club or Youth Group: Provides a place for youth to gather after school and on weekends to participate in activities, field trips, and workshops. Academic tutoring and mentoring are often incorporated. Group discussions on reproductive health, relationships, and comprehensive life skills are incorporated into the programs.
- School-based: Provides program access in a school setting, either within the context of a regular classroom period or as an after-school program. Some programs are delivered in already established classes, such as health classes. Others are delivered to particular students chosen by school counselors and teachers.
- Employment: Focuses primarily on employment assistance and job training. In addition to employment assistance, incorporates comprehensive family life education programming that includes such topics as pregnancy prevention, parenting, and relationships.
- Health Care: Provides access through health care clinics, some of which have teen-specific programs. Some programs are designed as education components to be offered within the actual clinic setting. Others are designed to provide education and community outreach outside of the clinic.
- Criminal Justice: Provides reproductive and life skills education to young people incarcerated in juvenile detention facilities.
- Community-wide: Works to involve the larger community as a whole in adolescent pregnancy prevention. Places an emphasis on involving adults in the community to act as mentors and role models. Aims to change young people's behaviors and attitudes by reshaping larger community norms.
|
Male Involvement Programs |
|
|
|
|
|
|
|
PROGRAM TYPE |
AGES |
ANNUAL BUDGET |
GENDER |
SPECIAL NOTES |
|
Sports |
|
|
|
|
|
Teens on Track |
10 to 20 |
$100,000 |
male |
Includes health |
|
Planned Parenthood of |
|
|
|
education focus. |
|
Southern New Jersey |
|
|
|
|
|
Camden, NJ |
|
|
|
|
|
|
|
|
|
|
|
Club or Youth Group |
|
|
|
|
|
Always on Saturday |
9 to 18 |
$30,000 |
male |
|
|
Hartford Action Plan |
|
per group |
|
|
|
Hartford, CT |
|
|
|
|
|
|
|
|
|
|
|
Brothers to Brother |
9 to 14 |
$30,000 |
male |
Afro-centric philosophy. |
|
Wake County Health |
|
|
|
Housing authority and after- |
|
Department |
|
|
|
school project. |
|
Raleigh, NC |
|
|
|
|
|
|
|
|
|
|
|
Fifth Ward Enrichment |
10 to 17 |
$450,000 |
male |
Afro-centric philosophy. |
|
Program, Inc. |
|
|
|
|
|
Houston, TX |
|
|
|
|
|
|
|
|
|
|
|
Male Youth Enhancement |
8 to 18 |
$125,000 |
male |
Church-based program. |
|
Project |
|
|
|
|
|
Shiloh Baptist Church |
|
|
|
|
|
Washington, DC |
|
|
|
|
|
|
|
|
|
|
|
Project Alpha |
10 to 20 |
$2,000 to |
male |
Local chapters throughout the |
|
Alpha Phi Alpha Fraternity |
|
$5,000 |
|
country coordinate events |
|
San Jose, CA |
|
per event. |
|
for young men. |
|
|
|
|
|
|
|
School-based |
|
|
|
|
|
Compass |
10 to 19 |
$37,000 |
male |
|
|
Adolescent Pregnancy |
|
|
and |
|
|
Prevention, Inc. |
|
|
coed |
|
|
Fort Worth, TX |
|
|
|
|
|
|
|
|
|
|
|
Dads Make a Difference |
13 to 21 |
$200,000 |
coed |
Peer-led education program. |
|
University of Minnesota |
|
|
|
|
|
Extension Service |
|
|
|
|
|
St. Paul, MN |
|
|
|
|
|
|
|
|
|
|
|
It Takes Two |
11 to 19 |
$132,000 |
coed |
Focus on relationships and |
|
Young Women's Resource |
|
|
|
shared responsibility. |
|
Center |
|
|
|
|
|
Des Moines, IA |
|
|
|
|
|
|
|
|
|
|
|
Project MISTER |
13 to 21 |
$100,000- |
male |
Programming in "alternative" |
|
Medina Children's Services |
|
150,000 |
|
schools targeting high-risk teens. |
|
Seattle, WA |
|
|
|
|
|
|
|
|
|
|
|
Responsive Fathers Program |
11 to 14 |
$50,000 |
male |
Program delivered in a school |
|
Philadelphia, PA |
|
|
|
assembly format. |
|
|
|
|
|
|
|
Wise Guys |
10 to 15 |
$106,000 |
male |
|
|
Family Life Council of |
|
|
|
|
|
Greater Greensboro, |
|
|
|
|
|
Greensboro, NC |
|
|
|
|
|
|
|
|
|
|
|
Youth Education and |
8 to 15 |
$216,000 |
male |
|
|
Development Program |
|
|
|
|
|
The Urban League of |
|
|
|
|
|
Eastern MA |
|
|
|
|
|
Roxbury, MA |
|
|
|
|
|
|
|
|
|
|
|
Employment |
|
|
|
|
|
Young Dads Program |
17 to 26 |
$250,000 |
male |
Targets fathers. |
|
Employment Action Center |
|
|
|
Includes criminal justice focus. |
|
Minneapolis, MN |
|
|
|
|
|
|
|
|
|
|
|
Health Care |
|
|
|
|
|
Baylor Teen Health Clinic |
|
$100,000 |
coed |
Also school-based. |
|
Baylor College of Medicine |
|
for male- |
|
|
|
Houston, TX |
|
specific |
|
|
|
|
|
components |
|
|
|
|
|
|
|
|
|
HiTOPS Inc. |
13 to 22 |
$386,000 |
coed |
Also school-based. Suburban. |
|
Princeton, NJ |
|
|
|
Peer-led education program. |
|
|
|
|
|
|
|
Male Involvement Program |
10 to 24 |
$140,000 |
male |
Also school-based. |
|
Healthy Teens Center |
|
|
|
|
|
Landover, MD |
|
|
|
|
|
|
|
|
|
|
|
Male Involvement Program |
12 to 22 + |
$75,000 |
male |
Also school-based. Suburban. |
|
Planned Parenthood of |
|
|
and |
Community focus. |
|
Nassau Co. |
|
|
coed |
|
|
Hempstead, NY |
|
|
|
|
|
|
|
|
|
|
|
Male Outreach Program |
12 to 19 |
$300,000 |
coed |
Also school-based. |
|
Valley Community Clinic |
|
|
|
|
|
N. Hollywood, CA |
|
|
|
|
|
|
|
|
|
|
|
Men's Services Program |
14 to 40 |
$400,000 |
male |
Targets fathers. |
|
Baltimore City Healthy |
|
|
|
Includes employment focus. |
|
Start, Inc. |
|
|
|
|
|
Baltimore, MD |
|
|
|
|
|
|
|
|
|
|
|
Young Men's Clinic |
15 to 28 |
$90,000 |
male |
|
|
Columbia University/ |
|
|
|
|
|
Presbyterian Hospital |
|
|
|
|
|
New York, NY |
|
|
|
|
|
|
|
|
|
|
|
Criminal Justice |
|
|
|
|
|
Teen Parenting Skills Project |
14 to 18 |
$30,000 |
coed |
Targets fathers. |
|
Bernalillo Co. Juvenile |
|
|
|
|
|
Detention Center |
|
|
|
|
|
Albuquerque, NM |
|
|
|
|
|
|
|
|
|
|
|
Community-wide |
|
|
|
|
|
Hablando Claro/Plain Talk |
all ages |
$300,000 |
coed |
Community-wide initiative. |
|
Logan Heights Family |
|
|
|
Latino focus. |
|
Health Center |
|
|
|
|
1643 Logan Avenue
San Diego, CA 92113
(619)239-0268 ext. 210 |
|
|
|
|
|
|
|
|
|
|
|
Hombres Jóvenes con Palabra |
13 to 25 |
Varies |
male |
Diverse settings. |
|
Los Angeles, CA |
|
depending |
|
Latino focus. |
|
|
|
on scope of |
|
|
|
|
|
project. |
|
|
Always on Saturday
Hartford Action Plan
Interview with Mayra Esquilin, former Project Director
Hartford, CT
Philosophy
Always on Saturday (AOS) staff realize that young men do not grow up in a vacuum. In order to promote responsible behavior, a program cannot just list all the reasons why teen males should postpone fatherhood and expect this to prevent pregnancy. Young men need to be seen as part of their larger social context and given the skills to cope and make good decisions within their daily environments. Mayra Esquilin,
AOS Project Director, believes that it is impossible to understand young people without also understanding the community systems in which they operate. Speaking to these needs, Esquilin describes
AOS as a "laboratory program"—one that continually tests different techniques and activities until it finds approaches that work best for the males within the context of their community. Not only does he want young men to avoid negative influences, but also to take full advantage of the positive "systems" in their communities. Graduating from high school is one example of how a young man can succeed within a positive community
system.
Although comprehensive in its programming, the primary objective of AOS is to provide young males with the information they need to be sexually responsible and prevent pregnancy. Esquilin takes the position that young males want to be sexually responsible, but do not have the needed information to engage in safe sexual practices. AOS's major goal is to help its participants make it through high school without fathering a baby. The program does not necessarily stress abstinence but encourages young men to delay parenthood until they are financially secure and mature enough to take care of children. While learning from positive adult role models, AOS helps young men develop their own views of sexuality.
History
With one of the highest teen pregnancy rates in the nation, 23 percent of births in Hartford occur to women under the age of 20. In response to these rates,
AOS was launched in 1986 by the Hartford Action Plan on Infant Health, Inc. The Hartford Action Plan is a private, non-profit collaboration of representatives from private agencies, community-based organizations, private corporations, foundations, health care facilities, and local government bodies. In addition to
AOS for boys and its complementary female component, the Hartford Action Plan has launched a comprehensive teen pregnancy campaign—Breaking the Cycle—in partnership with the city of Hartford and the Hartford public schools.
The Program
Always on Saturdays (AOS) is so named because it facilitates workshops and activities for its program participants every Saturday. The Hartford Action Plan currently operates three
AOS boys' programs within three low-income, minority communities in Hartford, with each group serving 20 male youth. Two other groups serve young women. The
AOS program directly provides young men with health education and reproductive health services.
AOS also works in collaboration with other agencies in Hartford to provide employment training, tutoring, and recreational activities. Each male in the program participates in four types of services that will lead them through the "Passage to Success." These four service areas include health and education, employment, special skills, and education and tutoring. The program uses small group discussion sessions, field trips, and adult mentoring to teach males about sexual responsibility and reproductive health. The male program participants are separated into two groups ages 9 to 13 and ages 14 to 18 in order to provide age-appropriate discussions of human development issues.
Small Group Sessions
AOS group discussions revolve around identifying "systems" within the community (e.g., school, government, family) and how these systems relate to issues in young people's lives. Young men are taught how to approach life using the "five keys to personal growth": feelings, problem-solving, decision-making, planning, and goal-setting. One example of this would be a discussion about the family. The young men are told to think about the types of family structures that exist both in and outside their community. They explore the pros and cons of having each type of family and their personal feelings about their own families. Finally, each male considers the type of family he would like to have in the future, and he sets goals around how to attain that type of family.
Every Saturday session includes discussions on sexual responsibility. Participants always use the five keys to personal growth to guide their thinking through each topic. Topics of discussion range from human development, contraception, HIV and sexually transmitted diseases, relationships, sexual behavior and sexual health, and violence. Experienced adult leaders facilitate these small group discussions, sharing their own personal experiences as they relate to each workshop. Esquilin believes this forum gives young men the opportunity to think in depth about issues and express their feelings in a comfortable setting.
Field Trips
AOS's field trips allow young men, as a group, to learn about issues relevant to pregnancy prevention by traveling to neighborhood sites that they might not travel to alone. Male participants go to such places as community hospitals where they try out stirrups and empathy bellies, reproductive health clinics where they are told of services, and the neighborhood pharmacy where they receive information on how to purchase and use condoms. They also go on purely recreational and cultural excursions. Esquilin feels that young men need to be aware of the recreational and cultural resources available in their community and how to use them effectively before they can become sexually responsible.
Participants
AOS is a program that primarily serves minority youth, with 51 percent of participants African-American and 49 percent Latino of either Puerto Rican, Cuban, or Mexican descent. The participants range in age from 9 to 18 with a mean age of 12.
AOS recruits young men by providing information about the program within the school system and soliciting referrals primarily through the school social workers. In addition, many of the youth served are referred to the program by collaborating agencies, such as the Hartford public libraries, the Hartford housing authority, and the YMCA.
Funding
Currently,
AOS is funded through a community development block grant from the Hartford Department of Public Health and a Weed and Seed Grant from the Hartford Housing Authority. The total annual
AOS budget is $29,609 per boys' group, which covers staff time, administrative costs, program expenses, and transportation costs. Program costs remain low because the facilitators are paid on an hourly basis and administrative costs are shared among the various programs sponsored by the Hartford Action Plan.
Staff
An exceptional aspect of
AOS is its diverse group of paid and volunteer staff. In addition to the Project Manager who provides long-term planning and the day-to-day program operations, there are three male facilitators who work on a contractual basis. The facilitators lead the small group discussions and recreational activities. Program participants over the age of 13 can opt to attend a paid peer facilitator training program. These peer facilitators teach one
AOS session each month for the younger participants and do public speaking and outreach.
Several paid consultants and volunteers aid facilitators in handling special concerns they may have regarding the participants. One local gang violence expert was able to negotiate an agreement with gang leaders to not involve AOS participants in gang activities. AOS also asks community leaders to be aware of AOS participants and alert AOS staff if they see participants involved in negative activities.
In addition to paid staff, AOS has approximately thirty adult advisers who help manage the large number of participants. Volunteers fulfill such roles as discussing their personal experiences at group meetings, teaching at field trips, employing participants as part of the employment or community service learning components, and serving as mentors for participants. The latter group of volunteers are the most involved, since they spend their free time in recreational activities with the same two or three boys for an extended period of time. The volunteers must go through a training program on "the psychology of adolescents" and on the cultural diversity of the participants. As the project director explains, "they (the participants, staff, and volunteers) are exposed to so much together that it becomes a club, almost a family."
Barriers
The males whom
AOS serves confront a lot of stereotypes, such as societal assumptions that an African-American or Latino male will inevitably become a young father and his children will be supported by welfare. These young men need to be shown that despite all of society's stereotypes, they can be sexually responsible and beat the system that perpetuates these images of them.
Tailor the program environment for the participants. Esquilin believes that when "an adult male talks, he feels from [the males'] point of view"; a gender specific program that teaches pregnancy prevention needs adult male facilitators. The male facilitators, especially those who remain in the program for a number of years, create an all-male environment that is comfortable for the young men and makes men feel as if the program is their own. Esquilin believes that the educators also need to be of the same ethnicity and from the same community as the participants. A facilitator from the same neighborhood as the participant can "walk the streets, know what is going on with [the participant], and find him if he has to." A person who understands the culture of the community is also more likely to understand a participant's concerns and can help the participant acquire necessary resources in the neighborhood. Finally, the program must be community-based so that the participants can utilize the neighborhood's resources and feel comfortable with their surroundings.
A pregnancy prevention program should be offered consistently over a long period of time. A program should have a long-standing reputation in the community that allows community members to feel that "the program is committed to the people and that the people helped build it." An effective pregnancy prevention program should be a comprehensive program that uses all of the services a community has to offer, including social services, health services, volunteers, and the schools.
In a budget crisis, the staff should eliminate services that other community agencies can provide and focus on the central program components. When the monetary problems are resolved, the staff can expand its services and continue growing without having deprived program participants of any fundamental services.
Baylor Teen Health Clinic
Baylor College of Medicine
Interview with Theresa johnson, Clinic Coordinator
Houston, TX
Philosophy
The Baylor Teen Health Clinic seeks to provide teens with both clinical services and health education at no cost. Quality is a central priority to the program staff, whose goal it is to provide care that is equal to or higher in quality than the private sector. In providing these quality services for teens, Baylor Teen Health Clinic incorporates educational programming that is fun and relevant to the concerns of adolescents, with additional programming designed specifically to encourage male involvement.
History
The Baylor Teen Health Clinic was started in the late 1960s as a comprehensive maternity program for pregnant teenagers. At its inception, the program consisted of one clinic site in a county public hospital. Recognizing that the needs of young women and their partners went well beyond prenatal and postpartum services, the clinic applied for Title X funds in order to expand services to include family planning. It was not until the clinic successfully obtained Title X funding in the early 1970s that it began to provide services to males. Since the late 1980s, the program has grown to seven sites, two in county hospitals, four in Harris County community facilities, and one in a high school. As it has grown, Baylor Teen Health Clinic has continued to serve a larger number and greater proportion of male clients.
The Program
Clinic Services
Teens in a clinic waiting room are somewhat a captive audience, and the Baylor Teen Health Clinic uses this to its advantage. While waiting rooms in most clinics are filled with bored clients anxiously checking the time and listlessly looking through magazines, the Baylor Teen Health Clinic waiting room is busy with interactive educational activities. These interactive sessions, facilitated by health educators, are usually in the form of games, such as "The Wheel of Misfortune" and "Condom Bingo." There is also a condom club in which participants receive prizes, such as earrings, beauty and health aids, and school supplies, each time they return without having contracted a STD or without getting pregnant. Baylor Teen Health Clinic acquires these incentive gifts by participating in the United Way, "gifts in kind" program, through which companies donate products to the United Way, and programs are then able to purchase items at a reduced cost.
Clinic services at the seven sites include prenatal care, postpartum care, family planning, STD testing and treatment, HIV testing and counseling, school physicals, work physicals, sports physicals, and immunizations. Additional services for males include screening for testicular cancer and instruction for testicular self-exam. Sport and work physicals have been an especially great draw for male clients since initiated in 1977. Intensive case management, social work services, and counseling are also offered.
Community Outreach and Education
Specifically for males, the Baylor Teen Health Clinic sponsors "For Males Only," a series of conferences targeting young men in the community. These conferences are held on Saturdays with workshops in the morning and a basketball tournament in the afternoon. Each conference has an overarching theme that conference workshops expand upon, such as teenage pregnancy, life skills, drugs and alcohol, and sexuality. Approximately 40 individual at-risk males are recruited to attend each conference; the first two conferences drew about 75 percent of the targeted population. Participants are recruited by male outreach workers primarily from housing projects, juvenile probation centers, and schools. Speakers from various community organizations and from the broader community are invited to present workshops at the "For Males Only" conferences.
The goals of the "For Males Only" program are to prevent unplanned pregnancies, reduce drop-out rates, improve academic performance, expand knowledge of community services and resources, and improve employment skills. Funding for the conferences and transportation for the participants are contributed by local companies.
Baylor Teen Health Clinic educators also provide group education to adolescents at schools, churches, and community centers. Two of the male health educators work primarily with young African American males in the community. Each of these educators provides weekly or biweekly visits to approximately 10 to 12 schools each year, with presentation topics depending on the students' needs. Topics are generally related to such issues as gang violence, STDs and HIV, sexuality, birth control, establishing paternity, and dating. In all of their community and school-based work, the health educators inform the teenagers about available clinic locations and services and encourage males to access these services.
Participants
The Baylor Teen Health Clinic program targets adolescent males and females who reside primarily in inner-city Houston. On an annual basis, approximately 12,000 adolescent visits are made to the seven Baylor Teen Health Clinic locations. Approximately 20 percent of these visits are made by males, the majority having been referred to the clinic by a partner who tested positive for a STD.
Female clients have always been encouraged to bring their partners in for services. Initially, the clinic provided services to partners only if they were less than 20 years old. This precluded many males from receiving services because some of the adolescent female clients had partners who were not teenagers themselves. Beginning in the late 1980s, Baylor Teen Health Clinic began to see male partners regardless of their age. As a result, the clinics have seen an increase in the number of males served and have also noted a lower chlamydia reinfection rate in their female clients.
The majority of the males seen tend to be very low-income, without health insurance and dependent on the teen health clinic for all of their health care needs. Currently, about 65 percent of clients are African-American, 20 percent are Latino, and the remainder are white. Aside from partner treatments, word of mouth through partners or friends remains the most effective way of bringing adolescent males in for clinic services. The male health educators who facilitate the "For Males Only" conferences have been instrumental in making young men aware of clinic services and locations by fostering a sense of trust between the males and clinic staff.
The Baylor Teen Health Clinic has built up an extensive referral network over the last 25 years that has been helpful in recruiting males for family planning services. Other local providers often refer teens, both male and female, to the Baylor Teen Health Clinic for reproductive health services. At the same time, this referral network serves as a resource for clients whose needs cannot be met at the Teen Clinic.
Funding
Baylor Teen Health Clinic is able to provide all services free of charge through the use of Title V, Title X, Title XX, and Medicaid funding. Only 1 percent of their clients are not eligible for family planning services covered under one of these sources. The costs for this 1 percent are absorbed into the overall clinic budget, which totals about $2 million per year. Medical services other than family planning, and non-medical services, such as outreach and education, are covered by a variety of funding sources. The program has a contract with the Texas Department of Health to provide Maternal and Child Health services under Title V, as well as a contract with the State Department of Human Services for a teen parent initiative. Both the Texas Department of Health and the Houston City Health Department provide funds for STD and HIV testing and education. A Harris County Community Development grant and the March of Dimes cover the cost of two male outreach workers. Additional funding is provided by the United Way, and the local Junior League provides volunteers and donations. Johnson states that the cost of running the male components of the Baylor Teen Health Clinic specifically is $100,000 annually.
Staff
Three of the clinics employ 12 to 15 staff each and the remaining three smaller sites require only a few staff members per clinic. Almost all staff and the majority of clients at the Baylor Teen Health Clinic are women, which may cause the male clients to shy away. The male health educators have been integral in making the clinic welcoming and comfortable for males.
Barriers
The predominance of women in the clinic can create a barrier to providing services to males. Males will often perceive this to mean that the clinic is only for females. The "For Males Only" conferences, the presence of the male outreach workers in the clinic, and the efforts of the male health educators help to get the message across to males that the clinic has a lot to offer them.
The process of just getting to the clinic is a barrier for many clients. Although the clinic will give out bus tokens to those who request them, clients may have to take two or three buses to get to a clinic location. Many clients are discouraged by the long bus rides, and the effort involved in negotiating the Houston public transportation system.
Finally, the clinic staff believe that males are not as familiar with the health care system as are females. They are not accustomed to seeking out preventive services, only going to a doctor's office when they are sick or injured. Therefore, extra effort must be put into motivating males to come in for reproductive health care and encouraging female clients to bring their partners in for services.
Generate a broad funding base. Baylor Teen Health Clinic draws on federal, state, local, and private money to help sustain services to males through periods of cutbacks and retrenchments. Staff are continually in search of new sources of funding in order to ensure against financial hardship and having to cut services.
Develop a large referral network. This aids in both bringing male clients into the Baylor program and making it easier to send clients to other agencies when their needs cannot be met at the Teen Clinic.
Hire male health educators. Male educators have more luck in reaching teen males, providing them with needed information, and bringing them into the clinic sites for services.
Serve partners of female clients regardless of age. Staff believe that this policy has greatly reduced the incidence of chlamydia reinfection among Baylor Teen Health Clinic's female clients.
Expand services to include primary care. Primary care services often bring young men through the door. When males come in for a physical or health screening, they can be provided with contraceptive information that they may not get otherwise.
Males want more than just condoms in order to be responsible. Many conference attendees reported that a job was their number one priority. The conferences expose the males to the work environment; however, the health education staff hopes to expand services in this area.
Brothers to Brother
Wake County Department of Health
Interview with Delmonte Jefferson, Project Coordinator
Raleigh, NC
Philosophy
The Brothers to Brother program, sponsored by the Wake County Health Department in North Carolina, is based in a belief that building a strong foundation of values, goals, and cultural esteem among young men will lead to declines in unintended pregnancy, substance use, and crime. The program seeks to "foster resiliency in young African American males" that will enable them to make positive decisions and demonstrate responsible sexual behavior. The program Brothers to Brother uses peer mentors in providing role-modeling for young African-American males, guiding them toward a positive sense of self and a positive approach to life. Project Coordinator Delmonte Jefferson believes that the program fosters personal growth in young men through which they learn to respect themselves, their peers, and adults.
History
The Brothers to Brother program was launched in 1991 in Wake County in response to what Jefferson describes as an "alarming adolescent pregnancy rate." At the time, the pregnancy rate in Wake County was 80.2 pregnancies per 1,000 females between the ages of 15 and 19. To address this problem, the North Carolina Department of Environment, Health, and Natural Resources awarded the Wake County Health Department a $70,000, five-year grant to produce a male-involvement adolescent-pregnancy-prevention program. According to Jefferson, Wake County has seen a decline in pregnancy rates over the life of the program to 68.5 pregnancies per 1,000 females ages 15 to 19 in 1994. Jefferson believes this progress is due to strong collaborative efforts among agencies within the county.
The Program
The Brothers to Brother program works with young men in housing authority projects (65 percent) and after-school programs at the middle schools (35 percent). The program is taught through an original family life education curriculum that addresses 10 topics of personal development covering issues surrounding self-esteem and goals, sexuality, and relationships. Young African-American male high school and college students act as peer mentors in facilitating the group discussions.
Although not all of the sessions deal with issues of pregnancy prevention directly, Jefferson states that the concepts introduced in the lessons build upon each other, helping the young men to make wiser decisions in all areas of their lives. For example, the presentation on cultural esteem does not directly discuss pregnancy prevention; however, cultural esteem is tied into a positive self-image that, in turn, leads to more responsible decision-making behaviors, including those regarding sexuality. Throughout the first four sessions, participants focus on goals and values and work to develop a stronger sense of personal identity and pride. With this foundation, they can begin to see options outside of sexual involvement, substance abuse, and violence. The group then tackles these behavioral issues more directly. The young men often take field trips that relate to the different lessons, such as a visit to a cultural museum, an African-American-owned business, or the Health Department facilities. In addition, participants are rewarded for their involvement with cultural incentives such as Kente pens, folders, T-shirts, and notebooks or dog tags that picture the Brothers to Brother logo.
Although the curriculum is only five weeks long, Jefferson stresses the importance of not abandoning the young men after these initial five weeks. In order to foster the skills that the participants have learned throughout the curriculum sessions, the mentors continue to meet with the young men once every two weeks over the next six months. Through these meetings, the mentors provide the young men with new information, take them on field trips, and monitor their progress. At the end of this six months, peer mentors continue to follow up with the males every three months. Jefferson says, however, that these more periodic follow-ups last for only about seven or eight months because many of the participants relocate and become difficult to find.
The Brothers to Brother program makes concerted efforts to involve the participants' parents in the program. During the fifth and eighth weeks of the family life education sessions, the project holds a Parents' Day during which participants and parents gather to share information that the young men have learned in Brothers to Brother. To convey their new knowledge, participants often prepare verbal presentations or posters. The program also holds a graduation ceremony. In addition, Broth
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