Reaching Far and Wide to Bring Impactful Experiences to Youth
Rates of teenagers’ sexual initiation have declined in recent decades in the United States, but teen pregnancies and sexually transmitted infections (STIs) continue to pose a problem. Nationally, 40 percent of high-school-age youth have ever had sex, and some of these youth engage in behaviors that increase their risk of pregnancy and STIs. For example, 46 percent of sexually active teens did not use a condom at their most recent sexual intercourse, and 10 percent had more than four sexual partners. Teens account for nearly half of the 20 million new incidences of STIs each year, and nearly 200,000 babies are born to teen mothers each year. Pregnancies and STIs have negative consequences not only for the teens who experience them, but also for society, including billions of dollars in health care and taxpayer costs.
The Personal Responsibility
Education Program
40%
high school aged youth have had sex
46%
of sexually active youth did not use a condom during their most recent sexual intercourse
10%
of sexually active youth had more than four sexual partners
10 million
new incidences of STIs are accounted to teens each year
200,000
babies are born to teen mothers each year
Overall
State
Tribal
Competitive
PREP Funding Streams
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 of the U.S. Department of Health and Human Services administers PREP. FYSB funds formula and competitive grants to U.S. states, territories, tribes, and local organizations to provide programming on teen pregnancy prevention and adulthood preparation.
The map indicates the state or territory in which the grantee is located, but does not indicate programming locations.
Territories are not shown on the map. Four territories (Federated State of Micronesia, Palau, Puerto Rico, and Virgin Island) received State PREP grants, American Samoa received a Competitive PREP grant, and Guam and Northern Marina Island received Competitive PREP grants in some years and State PREP grants in other years.
PREP Requirements + Expectations
Emphasis on evidence-based programming
Incorporation of adulthood preparation subjects
Coverage of abstinence and contraception
Focus on high-risk youth populations
PREP Program Implementation + Outcomes
PREP operated at a large scale through many grantees and program providers that implemented programming. From 2013 to 2017, PREP grantees served more than 400,000 youth through nearly 500 programs and 400 program providers.
PREP grants operated through two different structures to provide programming to youth: (1) grantees could act as program providers serving youth directly, or (2) they could pass funds to subawardees to act as program providers. Grantees also had the option to structure their programs to combine these two approaches. Funding subawardees to serve as the sole program providers was the most common approach across PREP, and this structure became more common over time (increasing from 48 to 70 percent of grantees).
One circle represents 100 units
Four evidence-based curricula were most common
Per the grant requirements, the curricula used by grantees had to be evidence-based or substantially incorporate elements of evidence-based programs. From reporting periods 2013–2014 to 2016–2017, 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 accounted for more than 10 percent of all PREP programs implemented each year, representing a total of 57 percent of all PREP programs. The most common program models reported by Tribal PREP programs differed from other funding streams; Becoming a Responsible Teen, Draw the Line/Respect the Line, It’s Your Game: Keep it Real, and Making Proud Choices! were each reported by at least 10 percent of Tribal PREP programs each year.
Most common curricula implemented
As required, nearly all programs reported covering at least three adulthood preparation subjects, most PREP programs focused on the same subjects: relationship skills, healthy life skills, and adolescent development. Although most programs (55 to 64 percent) implemented these three each year, some programs (6 to 7 percent each year) went beyond the requirement and implemented all six subjects.
Source: Measures of structure and support for implementation data from 2013–2014, 2014–2015, 2015–2016, and 2016–2017 State, Tribal, and Competitive PREP grantees.
Note: Adulthood preparation topics are not mutually exclusive; programs could implement more than three subjects.
Adulthood preparation subjects (APSs) implemented
Grantees primarily offered programming through schools
Most PREP programs served youth during school. Programs operating in school during the school day served the majority of youth nationwide (76 to 79 percent each year). These programs tended to be larger than those implemented outside of school time, serving an average of 322 to 369 youth per program each year, compared to 69 to 83 youth per program each year for programs operating outside of school time.
Source: Measures of structure and support for implementation data from 2013–2014, 2014–2015, 2015–2016, and 2016–2017 State, Tribal, and Competitive PREP grantees.
Percentage of youth served in each setting
Percentage of youth in out-of-school-time programs who completed at least 75 percent of the intended dosage
PREP Programs Served a Diverse Group of Youth, Including Those Most Vulnerable for Early and Risky Sexual Activity
Across all PREP programs, 45 to 51 percent of youth served identified as white, 34 to 42 percent identified as African American or black, and 32 to 39 percent identified as Hispanic or Latino.
Source: Exit survey data from 2013–2014, 2014–2015, 2015–2016, and 2016–2017 State, Tribal, and Competitive PREP grantees.
Note: Youth could select more than one racial/ethnic category, so percentages can sum to more than 100 percent.
Race and ethnicity of youth
Programs primarily served participants ages 13 to 16 (69 to 72 percent each year).
Source: Exit survey data from 2013–2014, 2014–2015, 2015–2016, and 2016–2017 State, Tribal, and Competitive PREP grantees.
Note: Percentages might not sum to 100 percent due to rounding.
Age distribution of youth
Tribal PREP programs mostly served American Indian or Alaska Native youth (72 to 74 percent each year). In addition, the youth Tribal PREP programs served were younger—about one-third each year were ages 10 to 12.
The percentage of youth who identified as LGBTQ or were undecided increased from 10 percent to 14 percent from 2012 to 2017. This is similar to national trends: from 2015 to 2017, high school aged youth who identified as LGBTQ increased from 11 percent to 14 percent.
Source: Exit survey data from 2013–2014, 2014–2015, 2015–2016, and 2016–2017 State, Tribal, and Competitive PREP grantees.
Note: Percentages might not sum to 100 percent due to rounding.
Youth who identify as LGBTQ
Grantees are encouraged to serve youth populations that are the most high-risk or vulnerable for pregnancies or otherwise have special circumstances. These high-risk and vulnerable populations include youth residing in geographic areas with high teen birth rates, adjudicated youth (that is, youth who were found guilty of a delinquent act by the juvenile court), youth in foster care, and runaway and homeless youth.
From 2013 to 2017, PREP grantees served adjudicated youth and youth in foster care more so than other vulnerable populations.
One circle represents 100 units
Highly vulnerable populations served
PREP Programs Served a Diverse Group of Youth, Including Those Most Vulnerable for Early and Risky Sexual Activity
Sexual activity rates among high-school-age youth participating in PREP programs were near national levels of sexual activity. Between 2013 and 2017, the number of youth who had had sex prior to engaging in PREP programming decreased (from 44 percent to 36 percent). Nationally, the number of high school students also decreased (from 47 percent to 40 percent). Sexually experienced youth engaged in behaviors that increased the risk of pregnancy or STIs before their enrollment in PREP programs. Among youth who had ever had sex, about two-thirds (65 to 70 percent of youth each year) indicated that they were recently sexually active, with about one in five (20 to 23 percent) reporting having more than one partner. Before beginning their PREP program, the percentage of youth who reported never using a condom during recent sexual activity increased from 27 to 35 percent.
Source: Entry survey data from 2013–2014, 2014–2015, 2015–2016, and 2016–2017 State, Tribal, and Competitive PREP grantees. 2013, 2015, and 2017 Youth Risk Behavior Survey, now called the Youth Risk Behavior Surveillance. Available at http://www.cdc.gov/yrbs.
Note: Only youth in grade 9 or higher in school settings or ages 14 and older in a community setting responded to the item.
Percentage of high school-age youth who had ever had sex compared to national averages
Attendance at PREP Programs Was High, and Youth Perceived the Programs as Interesting and Effective
Youth received a high percentage of intended program hours. About three-quarters (70 to 76 percent each year) of youth in programs operating outside of school time received at least 75 percent of the intendent program dosage. About 70 percent of youth each year reported being interested in the content, and 87 percent reported feeling respected in the program. Each year, 53 to 57 percent of youth who participated in PREP programming reported that being in the program made them more likely to abstain from sexual intercourse in the following six months. Also, a large proportion of youth reported that participation in the program increased the likelihood they would use a condom (77 percent each year) or other birth control (70 percent) if they had sex.
Likelihood of abstinence, condom and birth control use
Youth reported that their participation in PREP improved their behaviors aligned with adulthood preparation, such as being respectful toward others and resisting or saying no to peer pressure.
Preparation for adulthood
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