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Generation Sex (continued)

By Mary Beth Regan

Helping Teens

Building on such findings, Bloomberg School researchers are designing and putting into place intervention strategies in Baltimore that they hope to duplicate around the globe. They are in the right city: While Baltimore has seen dramatic declines in teen births, down from rates as high as 191.3 per 1,000 births in the 1960s, the city still remains on par with less developed countries. In 2006, for example, the incidence of adolescent births in the city to girls ages 15 to 19 was 66.9 per 1,000 live births, or about the same rate as in Paraguay.

Since 2006, Clea McNeely, DrPH, and Beth Marshall, MPH '03, have been evaluating a promising program called the Turning the Corner Achievement Program, targeted at middle school students. Working with the Eddie C. and C. Sylvia Brown Family Foundation and the Living Classrooms Program, McNeely, a PFRH assistant professor, and Marshall, a senior research program coordinator, have augmented middle school classrooms at a local charter school with "fellows" (college graduates or mid-career professionals) who work with students' families and provide academic enrichment and after-school activities.

Preliminary data indicate these charter school students, with additional attention and mentoring from fellows, perceive themselves to be in a better situation than students in other schools. Interestingly, this perception may translate into less risk-seeking behavior, Marshall says. Fewer students engaged in early sexual initiation or sexual intercourse, preliminary data show, when compared to similar students in other schools. One explanation: These students experience the protective measures of strong adults, schools and communities. "They start to expand their opportunities and possibilities," she says.

Another group of teens appearing to fare well are those serving on the School's Center for Adolescent Health's Youth Advisory Committee (YAC). These high school students from schools across Baltimore meet weekly to discuss issues and participate in enrichment activities aimed at bringing the perspective of youth to the community, policymakers and researchers. Two recent graduates—Ikia Means and Quinta Ocain, both 18 and from East Baltimore—are linked by determination, good choices and hope for the future. Both are determined to defy the statistics that mark their home turf. Means wants to be a doctor; Ocain wants to become a sports medicine therapist. Both say they want to take their message of making good choices to others.

"Some kids just aren't getting enough attention," says Means, who doesn't speak often to her own mother, but who was raised by a loving grandmother. "Most of them find love in someone of the opposite sex. They just get caught up in each other. ... And it's because they aren't getting enough attention from their parents. They are going to do whatever they are into—computers, or driving motorcycles, or drugs or having sex."

Means is now working for the Annie E. Casey Foundation, a Baltimore-based non-profit dedicated to families and children—a plum job she credits to her involvement in the Youth Advisory Committee. "The program opened doors for me," she says. "The YAC director was like a best friend. ... She was a mentor. We talked about everything."

Means and Ocain say younger teens need to know that pregnancy is not fun and that it could hamper a girl's ability to go to school or get a job. "College is a permanent fixture now. You have to go," says Ocain, who plans to transfer from community college to Morgan State University, where she will study on scholarship. " ... 'Cause these days, a McDonald's job? Nobody can live off that really."

The two young women recently helped Bloomberg School researchers and city health officials with material for a program called CONTAC-U (Connecting with Teens About Contraceptive Use), which will use a 21st-century approach to retaining clients at a clinic in West Baltimore. The clinic, on an empty lot next to boarded-up buildings, provides information and contraception to young people. The only problem: Many of them walk through the door once, but then never return. Preliminary data show that over one year, the clinic retains only half its initial visitors.

What's the best way to keep them connected, keep them contracepting and keep them coming back? Kathleen M. Cardona, DrPH '05, MPH '97, has designed a hip, teen-friendly approach. Beginning this spring, she and her team hope to enroll as many as 500 girls in a program that will use cell phone messages, text messages, email and the Web to communicate with them. For example, young women who choose to take birth control pills may receive daily inspirational text messages, with a gentle reminder to take them. "We need to meet teens where they are," says Cardona, an assistant scientist with the Center for Adolescent Health. "Kids aren't going to come into a clinic and pick up brochures to get their information these days."

Media expert Dina L.G. Borzekowski, EdD, EdM, MA, agrees. Teens spend many hours each day in front of screens, she says, and it's critical to meet them on their home turf if you want to give them good information. Borzekowski, a Health, Behavior and Society assistant professor who works in the U.S., Africa and Asia, says she sees huge possibilities for such an intervention strategy around the globe—especially in China and Africa, where many teens have Internet access or cell phones.

Researchers find encouragement in the latest trends as they piece together new insights into adolescent sexual behavior and design intervention strategies that are having an impact. "The kids seem to be moving in the right direction," Sonenstein says.

Blum agrees. "For every failed program there are successful, evidence-based programs that work. We have a lot left to learn, but now it's a matter of political will," he says. "We need to stop investing in programs that have been shown to fail and start investing in those evidence-based programs that work."

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