PREP Performance Measures 2017–2021: Interactive Brief

PREP Performance Measures 2017–2021: Interactive Brief

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Introduction

The proportion of teenagers engaging in sex has declined in recent decades, and rates of teen births in the United States have reached a historic low, but risky sexual activity, teen pregnancies, and sexually transmitted infections (STIs) remain a concern. Nationally, 38 percent of high school—age youth have had sex, and some of these youth engage in behaviors that increase their risk of pregnancy and STIs (Centers for Disease Control and Prevention 2020). For example, 46 percent of sexually active teens did not use a condom when they most recently had sex, and 9 percent reported more than four sexual partners. Youth account for the largest percentage of STIs by age group; more than half of all STI cases reported were for youth between the ages of 15 and 24 (Centers for Disease Control and Prevention 2022). Unplanned pregnancies and STIs pose negative consequences for the teenagers who experience them.

To help reduce teen pregnancies and STIs, Congress authorized the Personal Responsibility Education Program (PREP). The Family and Youth Services Bureau (FYSB) within the Administration for Children and Families (ACF) of the U.S. Department of Health and Human Services (HHS) administers PREP.

FYSB and the Office of Planning, Research, and Evaluation within ACF contracted with Mathematica to conduct the Performance Measures and Adulthood Preparation Subjects study. As part of the study, this brief uses grantee-submitted data on performance measures to describe PREP programs that operated from 2017 to 2021.1 This digital brief is based on Hulsey et al. 2022, a report sponsored by the Office of Planning, Research, and Evaluation.

1 A previous study reported performance measures findings from earlier years (Murphy et al. 2021). A digital brief of those findings can be accessed at: https://www.prepeval.com/reports/PREP_Reaching/index.html#reference-link-1

Overview of PREP and Performance Measures

PREP operates through four different funding streams: State PREP, Tribal PREP, Competitive PREP, and the Personal Responsibility Education Innovative Strategies (PREIS) program to provide programming on teen pregnancy prevention and adulthood preparation.

  • State PREP: Funding awarded to states and territories through formula grants
  • Competitive PREP: Funding awarded through a competitive process to local organizations and entities in the states and territories that did not accept State PREP funding
  • Tribal PREP: Funding awarded through a competitive process to tribes and tribal entities
  • Personal Responsibility Education Innovative Strategies (PREIS): Funding awarded through a competitive process to local entities and organizations implementing and evaluating innovative strategies

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Per the legislation authorizing PREP, ACF shared requirements and expectations for providing programming.

  • Emphasis on evidence-based programming (PREP) or innovative strategies (PREIS)

    State PREP, Tribal PREP, and Competitive PREP grantees must “replicate evidence-based effective programs or substantially incorporate elements of effective programs that have been proven on the basis of rigorous scientific research to change behavior, which means delaying sexual activity, increasing condom or contraceptive use for sexually active youth, or reducing pregnancy among youth” (U.S. House of Representatives 2010). In contrast, PREIS grantees are expected to focus on innovative strategies that support specific, underserved populations.

  • Incorporation of adulthood preparation subjects

    The legislation requires grantees to incorporate activities from at least three of the following six adulthood preparation subjects: (1) healthy relationships, (2) adolescent development, (3) healthy life skills, (4) parent-child communication, (5) educational and career success, and (6) financial literacy.

  • Emphasis on abstinence and contraception

    Grantees must emphasize both abstinence and contraception as ways to prevent pregnancy and STIs.

  • Focus on high-risk youth populations

    FYSB expects grantees to serve youth ages 10 to 19, or pregnant and parenting women younger than 21. From these eligible youth, grantees are “encouraged to serve youth populations who are the most high-risk or vulnerable for pregnancies or otherwise have special circumstances” (U.S. House of Representatives 2010). These high-risk and vulnerable populations include, but are not limited to, youth living in geographic areas with high teen birth rates, youth in adjudication systems, youth in foster care, and runaway and homeless youth.

Data on PREP performance measures are reported at three levels: (1) grantee, (2) provider, and (3) program. Some measures are collected from individual youth participants but are combined to the program level before submitting to ACF. Grantees submit performance measures to ACF through a web-based system with some measures submitted annually and others biannually.

There are three categories of PREP performance measures:

  1. Structure, cost, and support for program implementation:     These measures focus on grant and program operations, including staffing, resource allocation, the intended number of program hours, program model, and selected APSs. These measures are submitted annually, and the reference period for these measures each year was October 1 to September 30.
  2. Attendance, reach, and dosage:     These measures include the number of youth served overall and the setting in which they were served, the extent to which youth attended most of the intended program hours, and whether more than 50 percent of youth served were from one of several highly vulnerable populations. These measures were submitted annually through 2018—2019 and biannually beginning in program year 2019—2020. The data collection period for these measures typically followed a program year, rather than a grant year, although the months during which data were collected fluctuated over time.1
  3. Participants’ characteristics, behaviors, program experiences, and perceptions of effects:     Programs reported aggregate youth-level measures that capture information on the demographic characteristics of youth participants, their sexual risk behaviors before the start of programming, their experiences in PREP, and their perceptions of program effects on their preparation for adulthood and future sexual risk behaviors.2 These measures were collected though participant entry and exit surveys and were submitted annually through 2018—2019 and biannually beginning in 2019— 2020. The data collection period for these measures typically followed a program year, although the months during which the data were collected shifted over time.3

1 In program year 2017—2018, the data collection period was January to July, in program year 2018—2019 the period was August to July, in program year 2019—2020 the period was August to June, and in program year 2020—2020 the period was July to August.
2 Items on participants’ behaviors and perceptions of program effects were added to the surveys beginning in September 2020.
3 No data were collected for these measures in program year 2017—2018. In program year 2018—2019 the data collection period was August to July, in program year 2019—2020 the data collection period was August to June, and in program year 2020—2020 the data collection period was July to August.

 

PREP Program Implementation and Outcomes

This brief uses PREP performance measures data to discuss trends over time for the following research questions: How did grantees operate PREP programs? What were the characteristics of PREP programs? What were the characteristics of youth participants? What were youth perceptions of program effects and experiences?

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Grant operations | Program characteristics | Youth characteristics | Youth perceptions of program effects and experiences

 

Grant operations

From grant years 2017—2018 to 2020—2021, PREP continued to operate at a large scale through many grantees and providers. In the four-year reporting period, there were 94 unique grantees and each year between 386 and 426 providers implemented between 457 and 504 programs.1 PREP served more than 380,000 youth across the four years.

PREP scale

The graphic displays the number of grantees, providers, programs, and participants for each grant year. 

Pre scale showing 94 total grantees, 386-426 providers each year, 457-504 programs each year, and 389,252 total youth participated

1 Program providers are agencies or organizations that provide direct programming to youth through one or more program models. Grantees can serve as their own providers or can fund subrecipients to serve as providers.

The average funding amounts for PREP awards ranged from $701,882 to $763,906 across years and varied by funding stream. Funding allocations remained about the same during the four-year period, with a majority of PREP grant funds used for direct service. An average of more than 12 percent of PREP funding was used for training and TA each year, about 10 percent was allocated for evaluation and research, and about 20 percent for administrative support.

 

Program characteristics

The grants required State PREP, Competitive PREP, and Tribal PREP grantees to use curricula that is evidence-based or substantially incorporates elements of evidence-based programs. PREIS grantees were expected to focus on implementing and evaluating innovative strategies that support specific, underserved populations. From reporting periods 2017—2018 to 2020—2021, the four most common curricula remained the same: Making Proud Choices!, Teen Outreach Program, Be Proud! Be Responsible!, and Reducing the Risk. Each of these four curricula was reported by at least 8 percent of providers each year.

The most prevalent program models, however, varied across funding streams. Making Proud Choices!, Teen Outreach Program, and Be Proud! Be Responsible! were consistently among the most common program models among State PREP and Competitive PREP providers. Heritage Keepers Abstinence Education was increasingly popular among Competitive PREP providers, but this program model was only implemented by one grantee with multiple providers.2 Many Tribal PREP program models are culturally specific to the populations they serve. Native Youth Leadership, Circle of Life, Get Real (Middle School) and Discovery Dating were each reported by at least 8 percent of Tribal PREP providers each year. PREIS program models vary the most widely of all funding streams, and most program models implemented by PREIS grantees were implemented by only one provider each.

2 The PREP programs that implemented Heritage Keepers also incorporated information on contraceptives into their program model to meet PREP requirements.

As required, nearly all programs reported covering at least three adulthood preparation subjects (APS). Most PREP programs focused on the same subjects: healthy relationships, healthy life skills, and adolescent development. Most APS content was covered as part of the adolescent pregnancy prevention curriculum; however, some programs used original content that a provider or partner developed.

For most years, the majority youth received programming in schools during the school day. From 2017—2018 to 2019—2020, 75—81 percent of youth each year were served in schools, during school time. When the COVID-19 pandemic began in spring 2020, some programs transitioned to virtual settings, and this shift intensified in 2020—2021, when 61 percent of youth participated virtually and just 34 percent were in person in school.

Participants received a high percentage of intended program hours. Overall, about 74—79 percent of youth each year completed at least 75 percent of the intended programming.

 

Youth characteristics

Across the years, PREP programs served diverse groups of youth that varied in sex, age, and racial and ethnic composition. Each year, 52 percent of participants were female. Programs primarily served participants ages 13 to 16; 67—70 percent of participants were in this age range each year. Tribal PREP programs served younger youth (23—28 percent of youth each year were ages 10 to 12), whereas PREIS programs served older youth (18—28 percent of youth each year were age 17 or older).

The largest racial group served overall was White (49—50 percent each year). About one-third of PREP participants were Hispanic or Latino (29—36 percent each year), and one-third were African American or Black (26—35 percent each year). Because Tribal PREP was designed to engage Native American youth in programming, Tribal PREP programs served mostly American Indian or Alaska Native youth (71—84 percent each year). PREIS programs served a higher percentage Hispanic or Latino youth (34—62 percent).

Each year, the vast majority of youth reported usually speaking English when at home or with their family (80—84 percent). About one-fifth of youth reported speaking Spanish (19—23 percent each year). No other single language was reported by more than 3 percent of youth in any year.

 

A small percentage of youth reported living in vulnerable situations. Each year, 5—7 percent were in foster care, 3 percent were in adjudication systems, and 2 percent were homeless or runaway youth.

 

Only high school—age and older participants in State PREP and Competitive PREP programs during the 2020—2021 reporting period reported on sexual behaviors before the start of the program.

Thirty-one percent of high school—age and older participants had ever had sexual intercourse before entering the PREP program. This is lower than the national average of high school students who had ever had sex in 2019 (38 percent) (Centers for Disease Control and Prevention 2020).3

Before their enrollment in PREP programs, sexually experienced youth engaged in behaviors that increased their risk of pregnancy or STIs. Among youth who had ever had sex, 61 percent reported they had had sex in the three months before starting the program, and 17 percent reported two or more sexual partners in that period. Of those recently sexually active, 50 percent reported using a condom all or most of the time, and 45 percent reported using birth control other than condoms all or most of the time.

High school-age or older youth sexual behaviors at entry

The graphic displays the reported sexual behaviors of high school-age or older youth before the start of the program in 2020-2021. 

69% never had sex, 31% ever had sex, 61% had sex in the past three months (of those 50% used a condom and 45% used birth control

 

3 The high school—age youth that PREP served were younger than the youth reporting nationally

 

Youth perceptions of program effects and experiences

Only State PREP and Competitive PREP programs reported perceptions of program effects and only for the 2020—2021 reporting period. At program exit, many participants reported that participating in PREP had made them much more or somewhat more likely to engage in behaviors reflecting preparation for adulthood. More than three-quarters said they were much or somewhat more likely to better understand what makes a relationship healthy (77 percent), and almost three-quarters were more likely to be respectful of others (73 percent), to resist or say no to pressure to participate in sexual acts (72 percent), and to make plans to reach their goals (72 percent).

At program exit, more than half (56 percent) of high school—age and older youth planned to abstain from sexual intercourse for at least the next three months as a result of participating in PREP. Among those who did not plan to abstain, the majority reported they were much more or somewhat more likely to use a condom (66 percent) and/or birth control other than condoms (59 percent) during sex in the next three months because they had participated in PREP.

Across funding streams, youth reported positive experiences in their PREP programs. Most youth participants reported that their PREP programs were helpful and engaging. Each year, nearly all youth felt respected as people and reported the material presented was clear most or all of the time.

Citations and References

Suggested citation

Murphy, Lauren, and Lara Hulsey. “PREP Performance Measures 2017—2021: Interactive Brief.” OPRE Report #2023-028. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services, 2023.

References

Centers for Disease Control and Prevention. “2019 Youth Risk Behavior Survey [YRBS].” October 27, 2020. Available at https://www.cdc.gov/healthyyouth/data/yrbs/ . Accessed June 2022.

Centers for Disease Control and Prevention. “National Overview of STDs, 2020.” April 12, 2022. Available at https://www.cdc.gov/std/statistics/2020/overview.htm#National . Accessed May 2022.

Hulsey, Lara, Diletta Mittone, Katie Hunter, Mindy Scott, Asari Offiong, and Lauren Murphy. (2023). PREP Performance Measures 2017—2021, OPRE Report # 2023-027, Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services.

Murphy, Lauren, Lara Hulsey, and Susan Zief. “PREP Performance Measures Final Report.” OPRE Report #2021-12. Washington, DC: Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services, 2021.

U.S. House of Representatives. “Patient Protection and Affordable Care Act.” Public Law 111—148. May 2010. Available at http://housedocs.house.gov/energycommerce/ppacacon.pdf.  (PDF)