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The Answer Blog

Archive for October, 2009

Kudos to Carrera and His “Top Tier” Teen Pregnancy Prevention Program

October 18, 2009

I recently went to New York City to celebrate an old friend and the successful adolescent pregnancy program that he created and has faithfully administered for 25 years. I joined about 150 people at the Harvard Club in to applaud Dr. Michael Carrera and celebrate his outstanding  Children’s Aid Society Carrera Adolescent Pregnancy Prevention Program, which he developed at The Children’s Aid Society in New York City. The Program’s goal is to help young people growing up in poverty improve their life’s chances and avoid the rough seas of teen pregnancy.

The Carrera Program has nine sites in Manhattan and replications in Georgia, Washington, D.C., Maryland, Michigan, and Ohio. Recently, it was  designated a “Top Tier Youth Program” by The Coalition for Evidence-Based Policy’s Top Tier Evidence Initiative initiated by Congress.

This designation is very meaningful. The Carrera Program is only one of two national programs to receive it. As a result, it stands to receive a sizable infusion of federal funds set aside to help communities lower their stubbornly high rates of adolescent pregnancy. The Carrera Program has a seven-year plan to quadruple the number of young people it serves every year. Presently 3,000 youth are enrolled in the Program. Replications in local, community-based organizations that will accept the entire program’s concept and hands-on supervision from Dr. Carrera are presently planned in New Jersey and Connecticut with others across the nation to follow.

Dr. Carrera always refers to his work as “a long-term, above-the-waist approach that is guided by the principle that youth are ‘at promise’ not at risk.’”

The program works with boys and girls beginning at the age of 11, six days a week, 50 weeks a year, and follows them through high school and beyond. It helps them avoid too-early pregnancy by offering them after-school, weekend, and summer activities based on seven fundamental components: general education; employment and the opportunity to open a bank account; lifetime sports, including golf, tennis, swimming, squash, and bowling; comprehensive, no-cost medical and dental services; mental health services; self expression, including dance, drama, music, and writing; and family life and sex education! (He believes that when young people can see little hope for themselves in the future, sex education cannot do the job alone.)

Until its recent designation as “Top Tier” that will make it eligible for federal funding, Dr. Carrera has raised only private money from foundations and individuals to support his program. Thousands of young people and their families have participated in the program during its 25 years of existence. It costs less than $10 a day per student and reduces pregnancies by 50 percent in the communities served.

About 70 percent of program participants enter college and have found employment in education, law, medicine, media, science, engineering, and social work. As the program expands to serve more students, Dr. Carrera believes the costs will further decrease.

Guests at the 25th anniversary celebration received a booklet that detailed the high rates (and high costs) of unplanned teen pregnancy: “One hundred teens get pregnant every hour of every day in America. Fifty adolescents give birth and twenty-five adolescents have a pregnancy termination every hour of every day. The taxpayer cost of teen pregnancies, including public assistance, housing, food stamps, health care and other factors, is nearly seven billion dollars annually.”

Recently, for one brief evening, Dr. Carrera set aside his passion and let he and his accomplishments be celebrated. The crowd applauded and cheered for several hours. The speakers of the evening were numerous and included Jane Fonda, actress, author, and founder of the Georgia Campaign for Adolescent Pregnancy Prevention, which has adopted his approach. When it was Dr. Carrera’s turn to speak, he characteristically thanked everybody else for his Program’s accomplishments.

I first encountered Michael Carrera, the original energizer bunny, when he was teaching sex education to his daughter’s class at a private co-educational school, the Lenox School, in New York City.  His energy was unbelievable as was his comfort in talking about sex and answering any question that any student tossed at him.

Years went by but I kept following his accomplishments. He became chair of the Board of SIECUS, the Sexuality Information and Education Council of the United States, the major national organization committed to promoting sexual health in the nation, and wrote a coffee-table-sized book called Sex: The Facts, the Acts and the Feelings. He was a popular speaker at sex education conferences, and I always gravitated to his sessions hoping to pick up ideas for improving my teaching. After noticing me in the audience for perhaps the third, or possibly fourth time, he turned to me and said somewhat sharply, “You’ve heard everything I have to say. Now go and do something to help young people.”

Over the past 25 years, Dr. Carrera has certainly done just that.

It’s All about Prevention: A Call for a National Health Education Test

October 5, 2009

I believe that strengthening school health and sex education programs should play a role in health care reform. A big national effort to prevent health problems like obesity, sexually transmitted diseases, unplanned pregnancy, smoking, and drug use among young people could do much to lower the ever-climbing costs of health care in America. To do this, we have to increase the emphasis on health education in our public schools. Presently it is a stepchild in the national curriculum.

The Senate Finance Committee should consider adding an amendment to the health care bill now under debate that would include an appropriation for the development of a national health education test for teens. Let’s call it, the National Health Education and Literacy Test. The ultimate goal would be for all students to pass the test sometime during high school in order to graduate.

Why does health education remain on the margins of the school curriculum, particularly when it has such potential for lifelong learning? I’ve always thought that the main reason why the subject resides in a sort of limbo is because students’ knowledge about health – as indicated in a standardized test – is not a requirement for acceptance to a university or college.

No state requires its students to pass a health education test in order to graduate high school. No student has ever been rejected from a college or university because he or she lacks knowledge about health issues.

If only Harvard would require all entering freshman to demonstrate basic health knowledge by passing a health literacy test, things might change — dramatically.

Suddenly, the school’s health education curriculum would come under close scrutiny; teachers would receive increased training; and kids would realize that health class really counts.

Health education would be moved from the back to near the front of the high school curriculum line. It would gain in stature. I am not guaranteeing that better health education and a health literacy test would result in 100-percent behavioral change, but sound knowledge is the first step in the process.

I decided to find out more about the possibility of developing a nationally standardized test in health education. A health educator referred me to Nancy Hudson, a senior associate at the Council of Chief State School Officers, in Washington, D.C.  She works for the Health Education Assessment Project (HEAP), whose mission is “to develop effective standards-based health education resources … to improve health literacy through improved instruction.”

When I asked Hudson about the availability of a national health literacy test, she e-mailed that “there is no national test, but we do have the technology to produce one through the Health Education Assessment Project.”

Her reply to my next question about the cost of creating such a test didn’t surprise me:

“Unfortunately, we do not have the funding or the staff to make this a reality,” she said and added, “We have over 1,900 assessment items to work with in constructing a test. We have the ability to develop and field-test new items; we would need to do that. We would need to construct the test instrument and test the instrument for validity and reliability.

“We would have to work to get national commitment, which would be a challenge in this environment (of skepticism about testing from some advocacy groups).”

Since I happen to live down the road from the Educational Testing Service – the national nonprofit institution known famously worldwide as the developer of the SAT (Scholastic Aptitude Test) and other educational products – I decided to gather more information about the cost of developing a national test.

I carried my search to Tom Ewing, ETS’s Director of External Relations. He lead me through the steps of developing and piloting a health education test specifically for New Jersey high school students rather than conjecturing about developing a national test. His bottom line is that it would take $250,000 and 18 months to develop a standardized health education/literacy test for New Jersey public school students and that it could be done with the necessary funding.

Knowing that 1,900 test items exist for a national health education test and that the cost for one state to create and pilot such an instrument would be around $250,000, let me suggest an amendment for consideration by senators who are marking up several health care reform bills.

It would set aside an appropriation of a million dollars to create a national health education test and pilot test it in four states in different parts of the country. The results of the pilot could be a wake-up call about what our young people know and do not know about health issues and the work that lies ahead to help them gain knowledge to prevent medical problems as they age.

My next step is to e-mail this column to New Jersey Senators Robert Menendez and Frank Lautenberg. If you think developing a National Health Education and Literacy Test is a good idea and should be incorporated into health care reform, let them know. You can reach them through their websites, and

In the meantime, Harvard, it’s up to you.