Impacts of a School-Wide, Peer-Led Approach to Sexuality Education: A Matched Comparison Group Design.

BACKGROUND: Teen Prevention Education Program (PEP) is a school-wide, peer-led comprehensive sexuality education program currently implemented in more than 50 schools across 2 states. Many teen pregnancy prevention researchers and practitioners view peer-led programs as a promising approach for reducing teen pregnancy and associated sexual risk behaviors. However, prior research on the effectiveness of these programs indicates mixed results. METHODS: We randomly assigned schools to implement Teen PEP immediately (intervention group) or on a delayed schedule (comparison group) and used propensity score matching to improve the comparability of the study groups. We surveyed students at baseline and about 6 months after the program ended. RESULTS: Teen PEP did not significantly impact rates of sexual activity or unprotected sex; however, the program led to improvements in exposure to information about sexual health topics and knowledge of preventing pregnancy and transmission of sexually transmitted infections. CONCLUSIONS: Teen PEP succeeded in accomplishing some of its most proximal goals, increasing students' access to information and knowledge. However, we found little evidence that the program affects sexual risk-taking within 6 months of its conclusion. Future research will examine the program's longer-term impacts on sexual risk behaviors.

Enrollment and Disenrollment Experiences of Families Covered by CHIP.

OBJECTIVE: To understand why families enroll in and disenroll from Children's Health Insurance Program (CHIP), their experience with the CHIP application and renewal process, and the insurance coverage of their children after disenrolling. METHODS: We conducted a large household telephone survey in 2012 of CHIP enrollees and disenrollees in 10 states. We used survey responses to assess the perceptions and experiences of families with the CHIP application and renewal process. In addition, we combined the survey data with CHIP/Medicaid administrative data to analyze coverage outcomes of children after disenrolling. RESULTS: A large majority of recent CHIP enrollees had positive impressions of the application process; 89% found the process very or somewhat easy, and 90% of those receiving assistance found it very helpful. Families had similarly favorable impressions of the renewal process, including those recently disenrolling from CHIP. After disenrolling, children were far more likely to gain Medicaid coverage (49%) than private insurance (18%), while a sizable percentage were uninsured (32%). The likelihood of becoming uninsured was especially high among 18- and 19-year-olds (62%), who lost CHIP coverage due to their age. CONCLUSIONS: Satisfaction with the CHIP application and renewal process is high among those with recent coverage, consistent with efforts by many states to simplify these processes for families. Medicaid is a critical source of coverage for those leaving CHIP, a role that may only increase as states expanding Medicaid through the Affordable Care Act create a new coverage option for older teens losing CHIP eligibility.

Programs to reduce teen pregnancy, sexually transmitted infections, and associated sexual risk behaviors: a systematic review.

PURPOSE: This systematic review provides a comprehensive, updated assessment of programs with evidence of effectiveness in reducing teen pregnancy, sexually transmitted infections (STIs), or associated sexual risk behaviors. METHODS: The review was conducted in four steps. First, multiple literature search strategies were used to identify relevant studies released from 1989 through January 2011. Second, identified studies were screened against prespecified eligibility criteria. Third, studies were assessed by teams of two trained reviewers for the quality and execution of their research designs. Fourth, for studies that passed the quality assessment, the review team extracted and analyzed information on the research design, study sample, evaluation setting, and program impacts. RESULTS: A total of 88 studies met the review criteria for study quality and were included in the data extraction and analysis. The studies examined a range of programs delivered in diverse settings. Most studies had mixed-gender and predominately African-American research samples (70% and 51%, respectively). Randomized controlled trials accounted for the large majority (87%) of included studies. Most studies (76%) included multiple follow-ups, with sample sizes ranging from 62 to 5,244. Analysis of the study impact findings identified 31 programs with evidence of effectiveness. CONCLUSIONS: Research conducted since the late 1980s has identified more than two dozen teen pregnancy and STI prevention programs with evidence of effectiveness. Key strengths of this research are the large number of randomized controlled trials, the common use of multiple follow-up periods, and attention to a broad range of programs delivered in diverse settings. Two main gaps are a lack of replication studies and the need for more research on Latino youth and other high-risk populations. In addressing these gaps, researchers must overcome common limitations in study design, analysis, and reporting that have negatively affected prior research.

The impact of new health insurance coverage on undocumented and other low-income children: lessons from three California counties.

Three California counties (Los Angeles, San Mateo, and Santa Clara) expanded health insurance coverage for undocumented children and some higher income children not covered by Medi-Cal (Medicaid) or Healthy Families (SCHIP). This paper presents findings from evaluations of all three programs. Results consistently showed that health insurance enrollment increased access to and use of medical and dental care, and reduced unmet need for those services. After one year of enrollment the programs also improved the health status of children, including reducing the percentage of children who missed school due to health.

Impacts of abstinence education on teen sexual activity, risk of pregnancy, and risk of sexually transmitted diseases.

This paper examines the impacts of four abstinence-only education programs on adolescent sexual activity and risks of pregnancy and sexually transmitted diseases (STDs). Based on an experimental design, the impact analysis uses survey data collected in 2005 and early 2006 from more than 2,000 teens who had been randomly assigned to either a program group that was eligible to participate in one of the four programs or a control group that was not. The findings show no significant impact on teen sexual activity, no differences in rates of unprotected sex, and some impacts on knowledge of STDs and perceived effectiveness of condoms and birth control pills

The effect of new insurance coverage on the health status of low-income children in Santa Clara County.

OBJECTIVE: To examine whether providing health insurance coverage to undocumented children affects the health of those children. DATA SOURCES/STUDY SETTING: The data come from a survey of 1235 parents of enrollees in the new insurance program ("Healthy Kids") in Santa Clara County, California. The survey was conducted from August 2003 to July 2004. STUDY DESIGN: Cross-sectional study using a group of children insured for one year as the study group (N=626) and a group of newly insured children as the comparison group (N=609). Regression analysis is used to adjust for differences in the groups according to a range of characteristics. DATA COLLECTION: Parents were interviewed by telephone in either English or Spanish (most responded in Spanish). The response rate was 89 percent. PRINCIPAL FINDINGS: The study group-who were children continuously insured by Healthy Kids for one year-were significantly less likely to be in fair/poor health and to have functional impairments than the comparison group of newly insured children (15.9 percent versus 28.5 percent and 4.5 percent versus 8.4 percent, respectively). Impacts were largest among children who enrolled for a specific medical reason (such as an illness or injury); indeed, the impact on functional limitations was evident only for this subgroup. The study group also had fewer missed school days than the comparison group, but the difference was significant only among children who did not enroll for a medical reason. CONCLUSIONS: Health insurance coverage of undocumented children in Santa Clara County was associated with significant improvements in children's health status. The size of this association could be overstated, since the comparison sample included some children who enrolled because of an illness or other temporary health problem that would have improved even without insurance coverage. However, even after limiting the study sample to children who did not enroll for a medical reason, a significant association remained between children's reported health and their health coverage. We thus cautiously conclude that Healthy Kids had a favorable impact on children's health.

Risk selection among SSI enrollees in TennCare.

The issue of risk selection is especially important for states that enroll blind and disabled beneficiaries of Supplemental Security Income (SSI) in Medicaid managed care. SSI beneficiaries have persistent needs for care, have a wide variety of chronic conditions, and often need atypical and complex services. Risk selection occurs when the health care needs of beneficiaries enrolled in a specific plan differ systematically from the needs of the overall beneficiary population and payments do not reflect those needs. We assess the extent of risk selection among managed care plans for SSI beneficiaries over the first three years of Tennessee's Medicaid managed care program, TennCare. Using claims data containing fee-for-service expenditures prior to enrollment in managed care, we find substantial evidence of persistent risk selection among plans. Results are robust to most alternative measures of risk selection for most plans.

Disparities in state health coverage: A matter of policy or fortune?

The paper explores the reasons why states differ in their Medicaid coverage of the at-risk population, focusing in particular on the large disparities in Medicaid spending associated with these differences.Two distinct sources for these disparities in spending are examined. First, they may be the result of two factors largely beyond state control: differences in state wealth (or "fiscal capacity"), and differences in the generosity of federal funding. Second, they may be the result of differences in state "fiscal effort," as measured by the ratio of state Medicaid spending to capacity.