The proposal seeks support for the completion of an ongoing controlled field test to evaluate the effectiveness of a public health-based sex educational outreach program designed to increase teenagers' contraceptive and pregnancy-avoidance preceptions, lead to increased fertility control behaviors and, ultimately, help reduce pregnancy rates among females and responsibility for pregnancies among males. The study examines relationships among pre-intervention motivation for fertility control, the experimental or comparison educational outreach programs, post-intervention motivations, and fertility control behaviors and incidence of pregnancy or responsibility for pregnancy of participants one year after the outreach program is completed. The Health Belief Model (HBM) is being used as a conceptual framework for trying to understand and change teenagers' motivations, intentions and behaviors. The HBM states that the probability that an individual will undertake a particular preventive health action as a means of avoiding a specific condition or problem is linked to a number of personal perceptions, including his/her perceived susceptibility to the conditiion; the perceived seriousness of developing the condition; and the ratio of the perceived benefits to the perceived barriers to undertaking the recommended prevention action. The experimental intervention was designed to increase each teenager's perceptions that she could become pregnant or that he could cause a sexual partner to become pregnant; to increase each teenager's perceptions of the serious consequences and implications of maternity or paternity; to decrease the subjects' perceptions of the individual, dyadic, social, economic and logistical barriers to using effective contraception consistently; and to increase perceptions of the health and interpersonal benefits of protected intercourse or abstinence. Hypotheses derived from the HBM will be tested in a pretest-posttest, experimental-comparison group prospective study design. Recruited teenagers will be exposed to a 12-15 hour HBM-based small group discussion outreach program or a comparison outreach program run by one of several federally-funded participating family planning services agencies. Each teenager who participates is interviewed prior to the intervention program, immediately after completing the educational outreach program and 12 months after the program. Changes in participants' sexual and contraceptive knowledge, attitudes, motivation and behaviors resulting from the interventions are assessed and related to incidence of pregnancy or paternity of at follow-up.
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