The Adolescent Family Life Comprehensive Abstinence Program (AFL-CAP)

Intisar Shah, CAP Project Director: To Our Children’s Future With Health, Inc.
Jennifer Thompson, Ph. D., Branch Associates, Inc., Pennsylvania

Introduction

The Adolescent Family Life Comprehensive Abstinence Program (AFL-CAP) is a multi-tiered prevention demonstration project designed to provide and evaluate innovative abstinence education services to youth ages 12-18 and their parents.  The program is administered by To Our Children’s Future With Health, (TOCFWH) Inc., a non-profit, community-based agency in Philadelphia. 

The proposed initiative will be delivered to families in low-income housing developments primarily in Philadelphia and in other cities in Pennsylvania, New Jersey, Delaware and Maryland.  All areas are predominantly African-American, with high levels of health disparities and poverty, especially among children and youth, high levels of unemployment and high rates of teen pregnancy, substance abuse and violence.

In this study, housing development sites will receive “Primary” or “Enrichment” abstinence programming.  Both groups of youth will receive an intervention which includes: (1) the 20-hour “Discovering Dignity” curriculum, © 2007 TOCFWH, Inc.,delivered to two specific age groups 12-14 and 15-18, one hour weekly over the course of twenty weeks; (2) five hours in a Parent/Youth Drop In Center supporting the abstinence curriculum with the provision of information presented via pamphlets, web-linking, videos, group discussion, games and music CDs.  Youth and their parents will also participate in “messaging” activities that include performing plays/ skits, creating newsletters, public service announcement (PSA) and designing their own abstinence based t-shirt logos.  In addition to these two components, youth residing at the enrichment sites will participate in a minimum of ten hours of community service.  Prior to placement in community service activities, TOCFWH will ensure that the youth are prepared for the experience by providing them with an extensive ten-hour orientation.

Youth recruited by TOCFWH will ultimately self-select to participate in the program, and sites will be randomly assigned to the primary or enrichment group. The purpose of the evaluation is to determine whether participation in community service enhances the following outcomes of the intervention: (1) improved communication between youth with their parents; (2) increased understanding of the benefits of abstaining from sex; (3) likelihood that participants will refrain from sex; (4) participants improvement of confidence, leadership and decision-making skills; and (5) probability youth will abstain from unhealthy behaviors such as cigarettes, alcohol and drug-use.  It is hypothesized that while participants in the primary program will improve on these measures from the beginning to the end of the program and following the program, participants in the enrichment program will improve to an even greater extent.  Previous research has found that youth involved in their communities are more likely to refrain from sexual activity and other anti-social behaviors.

Methods

Branch Associates, the independent evaluator, will conduct process and outcome evaluations to determine whether and how community service is a worthwhile addition to the abstinence education model.

 Sites and Participants

Program sites will be matched in pairs based on geographic location and other demographic characteristics. A randomized process will then determine which site of each pair will be a primary site and which will be an enriched site. In this way, while the sites are randomized, the participants are not. Significant differences between the two groups of participants are not anticipated at baseline; however, if differences do exist, they will be controlled for in the statistical analyses.

Program participants will be recruited within the housing communities with the assistance of the housing developer. All program participants will be eligible to participate in the evaluation project activities, dependent upon active youth assent and active parental consent. Parents and youth will receive monetary incentives and family trips for their participation in the program and its evaluation.

Data collection

A process evaluation will begin in spring of 2009 at the first four program sites. Branch Associates will conduct interviews with program staff and focus groups with youth and their parents. In addition, they will observe program activities. The process evaluation will focus on fidelity to the curriculum, details of program activities and program participation rates. Noted differences between the “primary” and “enriched” sites will be highlighted.

The remaining evaluation activities will primarily consist of data collection via confidential survey questionnaires. Youth will participate at baseline (before program participation), at the end of the program, one year after the program ends, and two years after the program ends. Over the course of five years, four cohorts of youth program participants will take part in the longitudinal program evaluation. Program staff will maintain extensive and up-to-date contact information for youth and their parents; it is expected that this contact information will assist with participant retention in the program and its evaluation.

Measures

Primarily, the constructs will be assessed using the Core Questionnaire for the Adolescent Family Live Prevention Programs. Measures will be added to assess other factors not covered by the Core Questionnaire. Whenever possible, these measures will be drawn from existing sources and have good reliability and validity with low-income populations of youth.

Analyses

Qualitative analyses to examine commonalities and differences across sites and between primary and enrichment sites will be conducted using data collected from the process evaluation.  Using statistical software, analyses of survey data will include descriptive statistics such as frequencies and means and the creation of scales, such as youth self-confidence.  Significance tests (t-tests, chi-square) will test differences at baseline between the primary and enriched groups.  Subsequent analyses with post-program and follow-up survey data will utilize regression and HLM techniques to control for individual and program site differences and to test the independent effect of community service on a variety of youth outcomes described in the introduction.

Anticipated Results

Statistical analyses of survey data will test the hypothesis – whether youth participants at the enrichment sites demonstrate more positive changes and outcomes than youth participants at the primary sites.  The analyses will examine changes from pre-test to post-test, and one to two years after the program ends to see if changes persist over the long-term.  The analyses will also examine how varying levels of program participation may influence outcomes, as well as participant characteristics (race/ethnicity, gender, age).  The program may have larger effects for particular groups of youth.

Discussion

The results of the evaluation will indicate whether the enriched abstinence program, compared with the primary program, leads to better youth outcomes. A couple potential limitations, however, will need to be considered. First, how similar the paired housing complexes are to each other will likely affect how well the “primary” site participants serve as a comparison group. Second, a successful evaluation will also depend on effective recruitment and retention of youth in the program and the ability to follow-up with youth after the program ends.

Implications

This evaluation will provide information on the value-added of an enriched abstinence program for inner-city youth living in housing complexes. It will identify whether integrating abstinence education programs with community service yields more positive results than an abstinence program alone among this high-risk population. The process study will help to identify what aspects of the enriched program may provide the most benefit to youth.

Contact Information

Contact Person: Dana Twyman
Telephone:  215 475-2196
E-mail address:  dtwyman@tocfwh.org