Reducing pregnancy and health risk behaviours in teenagersBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2054 (Published 09 July 2009) Cite this as: BMJ 2009;339:b2054
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Your recently published editorial by Douglas Kirby (July 9, 2009) leaves the unfortunate and false impression that the study by Wiggins et al., on a youth development program in England was a replication of the Children’s Aid Society/Carrera model program. Although the Wiggins et al., article carefully points out many differences between the program they evaluated and a CAS/Carrera program, Kirby’s editorial sweeps together very different programs and then questions the utility of a multi-component approach to preventing teen pregnancy. This does a disservice to such approaches overall and to the CAS/Carrera program, in particular.
In fact, there has been only one faithful replication of the CAS/Carrera program, studied through a three-year random assignment design in which an 80% follow-up rate in the program and control groups was maintained, using an attempt- to-treat model. This replication is the one that produced a substantial reduction in teen pregnancy among girls and several positive results among boys.
The article by Wiggins, et al., is careful to point out that while the program they evaluated was “informed” by the CAS/Carrera model, “it intentionally differed from the outset…” In fact, Wiggins et al., say clearly that the program in England did not faithfully replicate the CAS/Carrera model on a variety of dimensions. Here is an abbreviated list of some of the dimensions on which the programs differ:
1. The U.K. program duration was one year, not three years as in the New York CAS/Carrera replication.
2. Carrera programs operate 15 hours per week, with summer and some Saturday activities for 45-48 weeks for three years. The program studied by Wiggins, et al.operated for 6-10 hours per week for one year.
3. All CAS/Carrera programs offer condoms on site, but only some of the Wiggins et al. programs did so.
4. CAS/Carrera programs have a medical component, wherein all young people enrolled receive full physical exams, including attention to various risks and issues in the area of sexual health. At the program evaluated by Wiggins et al., “All sites aimed to refer participants to sexual health services when necessary, but…only six did so…”
5. The sexual health education in sanctioned CAS/Carrera sites is comprehensive and delivered weekly by trained sexuality educators, has a curriculum, and monitors the ongoing learning of young people through extensive testing. Wiggins et al. wrote about the program they evaluated: “Education about sex and drugs was delivered to different extents and in varying styles across sites. This was generally delivered by youth workers and aimed to enable participants to make informed decisions to delay sex.”
6. In addition, the recruitment strategies of the two programs were different. The U.K. program recruited young people thought to be at high risk of pregnancy, drug use, or exclusion from school while the New York Carrera programs recruited young people from deprived areas.
7. Finally, the CAS/Carrera programs include extensive training of staff and a clearly articulated philosophy about how young people should be taught, supported, disciplined and viewed. It is not at all clear that the U.K. program replicated these critical components.
The other two studies that Kirby mentions also were not faithful replications of the CAS/Carrera model. Indicting an entire approach to teen pregnancy prevention by grouping these studies is misleading, at best.
Susan Philliber, Ph.D.
Philliber Research Associates
Competing interests: No competing interests