Does condom availability make a difference? An evaluation of Philadelphia's health resource centers.

In 1992, nine Philadelphia high schools opened drop-in centers where students could receive reproductive health information, condoms and general health referrals. Analyses of survey data collected in 1991 and 1993 suggest that the presence of the condom availability program did not increase the level of sexual activity among students in these schools and may have contributed to safer sex practices. The proportion of students who had used a condom at last intercourse increased from 52% to 58%; although the change was not statistically significant, it exceeded the increase in a group of comparison schools. Changes in the proportions of students who had ever had intercourse, who had had sex in the previous four weeks, who had used a condom at last intercourse and who had recently had unprotected sex were greatest in schools with higher levels of program usage; however, only the decline in recent unprotected intercourse among students in high-use schools (from 14% to 6%) approached statistical significance.

The impact of an increase in family planning services on the teenage population of Philadelphia.

In an assessment conducted 30 months after a Philadelphia-area project increased the resources that community family planning agencies devoted to teenage services, teenagers in targeted communities showed no generalized improvement in rates of pregnancy and childbearing, in knowledge or use of clinic services, or in attitudes toward contraception compared with those of teenagers in the entire city. Samples of adolescents aged 14-18 from the clinics' catchment areas and from the entire city were interviewed in mid-1988, when the project's activities began, and 2.5 years later. The results suggest that while community family planning clinics may provide effective services to the teenagers who seek them out, they may not be the most effective strategy for decreasing rates of pregnancy and childbearing in the overall teenage population.

PIP: An evaluation of community family planning services with adolescent services in Philadelphia, Pennsylvania, was conducted in 1988 and 1991. The new services aimed to increase the number of adolescent clients and to initiate adolescent educational outreach. 10,000 new patients were seen at clinics. The RESPECT program cost $2.5 million. The sample in Wave I (mid-1988) included 1256 teenager interviews and 966 parent interviews. In Wave II in 1991, 20% of teenagers interviewed in Wave I were interviewed and others added to yield 1181 teenage interviews and 1007 parent interviews. The total sample for analysis was 1961 teenagers. Age, race, and gender were different in the two waves. The results indicated that the desired effects of the RESPECT project were not observed over the time period. For example, the proportion of teenagers who had ever been to a clinic declined in the catchment area from 25% to 18%, while the city sample remained the same at 17-18%. The number of students in the catchment area who believed that school-based clinics should be established was greater than in the city sample. Knowledge of free contraception increased. The proportion sexually active remained stable, but the proportion having had sex in the prior 4 weeks had declined in both city and catchment samples. Differences in contraceptive use were apparent but were not statistically significant. The likelihood of teenage pregnancy increased slightly in both samples, which was consistent with national trends. Reported fertility was stable at 3% in catchment areas and increased from 2% to 4% in the city sample. Controlling for maternal age at first birth and marital status did not substantially change results. Pregnancy became greater in catchment areas. The conclusion was that the RESPECT project did not have a measurable impact on behavior, attitudes, and knowledge among the target population, but probably served the needs of teenaged users quite well. Teenaged clinics did not contribute to increased sexual activity. Research limitations included the small city sample, which could have distorted significant differences, the city-wide mass media campaign, and potential effects outside the target populations. The results may have been due to the limited scope of the clinics, too short a time frame, or the difficulties inherent in motivating teenagers. Future actions might focus on intensive public health campaigns, school-based health services, and population-level evaluations of teenage programs.

Longitudinal studies of effects of divorce on children in Great Britain and the United States.

National, longitudinal surveys from Great Britain and the United States were used to investigate the effects of divorce on children. In both studies, a subsample of children who were in two-parent families during the initial interview (at age 7 in the British data and at ages 7 to 11 in the U.S. data) were followed through the next interview (at age 11 and ages 11 to 16, respectively). At both time points in the British data, parents and teachers independently rated the children's behavior problems, and the children were given reading and mathematics achievement tests. At both time points in the U.S. data, parents rated the children's behavior problems. Children whose parents divorced or separated between the two time points were compared to children whose families remained intact. For boys, the apparent effect of separation or divorce on behavior problems and achievement at the later time point was sharply reduced by considering behavior problems, achievement levels, and family difficulties that were present at the earlier time point, before any of the families had broken up. For girls, the reduction in the apparent effect of divorce occurred to a lesser but still noticeable extent once preexisting conditions were considered.