Multi-Dimensional Public Health Perspective And Teen Health-Risk Behavaiors in Abstinence-Based Education: Primary, Secondary and Tertiary Prevention

Background: Abstinence-based education programs (for example, 3-10 classroom hours, speaker-assemblies, teen-group performances, teen-parent and abstinence clubs, parent education, web and media campaigns) are public health prevention programs addressing the adolescent epidemics of STDs and pregnancy. "Abstinence-Only" education can be replaced by a public health "abstinence-based teen risk-behavior prevention" education paradigm. Purpose: Process and outcome utilization data on (a) program/curriculum fidelity, (b) educator assessment and (c) student/parent evaluations in federally funded abstinence-based school-focused programs are examined. The aim is to demonstrate how a public health perspective using the primary, secondary, tertiary health prevention model with different subgroups of adolescents ages 12-18 engaged in priority high risk teen behaviors (for example, alcohol and other drug use, sexual behaviors) broadens the curriculum and guides evaluation. Procedures: Presented are activity tracking data, student and teacher assessments, and before/after student questionnaire results (15,000+ students, grades 6-12) in several federally funded programs that focus on abstinence-until-marriage as the organizing learning objective. Pre-post 32 to 52 item questionnaires with comparison groups are analyzed using multivariate modeling to test hypotheses derived from descriptive and univariate analyses (with epidemiologic concepts such as odds ratio, relative benefit increase, number needed to teach [treat]). Findings indicate statistically significant differences by grade, gender, race/ethnicity, extent of parent communication, and among students who are and are not sexually active using mean composite scores and subscores for knowledge, opinions, skills, behavioral intentions and sexual activity. Conclusion. The public health primary-secondary-tertiary prevention paradigm is a useful framework to structure abstinence-based instruction and examine its effectiveness on multiple priority teen health-risk behaviors.