Research indicates that sexual attitudes and beliefs are formed before age 12 and that many youth 12 and younger view abstinence as an appropriate pregnancy prevention method. Given this research, youth between the ages of 9 and 14 were chosen as the primary target audience of the "Not Me, Not Now" program.

Once this age group was determined, a multi-year plan was then created to identify messages, themes, and channels of communication. The "Not Me, Not Now" program involved the community’s youth by creating a youth advisory panel and inviting teens to audition for print, radio and television advertisements.

Program messages addressed the following five themes:

1. raising awareness of the program
   
   
2. communicating the consequences of teen pregnancy
   
   
3. helping youth handle peer pressure
   
   
4. promoting parent-child communication around sexuality; and
   
   
5. promoting sexual abstinence among youth.

The youths' involvement helped to shape the tone and language of these messages.

A mass communication design was utilized to deliver the messages and included the following components:

• Radio and television spots — Two television ads and two to four radio spots were created each year of the program. The program aimed to expose 95% of the target audience to a minimum of six ads per year.
  
  
• Billboards and posters — Approximately 5,000 posters were distributed throughout the community each year. To strengthen messages across media channels, the faces and text on the posters were consistent with those in the radio and television spots.
  
  
• Parent-education materials — More than 50,000 information packets were distributed to parents to assist them in discussing sexuality with their children.
  
  
• Educational series — A school-based educational series already in use in the community in 1994 was adapted to incorporate the "Not Me, Not Now" messages. This series was delivered to 500 to 1,000 middle-school students per year from 1995-1999. Educator forums served two purposes: they helped to train local teachers and also gave teachers a way to provide feedback on the program.
  
  
• Interactive web site — Launched in 1997, the web site contained games and information on the various components of the program. The web site received more than 130,000 hits in the first three months.
  
  
• Community events — "Not Me, Not Now" sponsored a variety of youth-oriented events such as a summer movie series, tickets to baseball games, and skating parties.

The "Not Me, Not Now" impact evaluation measured the following:

• Impact on beliefs and program awareness — A survey was administered at six middle schools in 1994 (prior to program onset), 1995, and 1997. The survey was delivered so that no student would be tested twice. It contained items addressing program awareness and knowledge of its messages, attitudes towards teen pregnancy and abstinence, and intended future sexual behaviors.
  
  
• Impact on self-reported behaviors — The Monroe County Youth Risk Behavior Survey (YRBS) was used to determine the program’s impact on self-reported behaviors. It was administered in 1992, 1995, and 1997 to students age 14 to 18 years. The 1997 YRBS should have picked up some of the students who completed the middle-school survey in 1994.
  
  
• Impact on adolescent pregnancy rates — Changes in adolescent pregnancy rates from 1993 to 1996 were determined by statistics from the New York State Department of Health. The rates for Monroe County adolescents were then compared with rates from four other areas within the state.

Items from the Middle School Survey measured determinants of adolescent pregnancy according to the five program themes: parent-child communication, program awareness, consequences of teen pregnancy, peer pressure, and abstinence.

While statistically significant changes were not seen for the parent-child communication theme, a slight increase was seen in the likelihood that respondents would talk with an adult caregiver about sexuality issues. Statistically significant changes were seen for the remaining four themes:

• Program Awareness
  The majority of students — 95% — reported seeing at least one ad for the "Not Me, Not Now" program, and 71% could correctly recall the tag line.
  
  
• Consequences of Teen Pregnancy
  When asked if they could "handle the consequences of intercourse," 34% of students responded affirmatively in 1994 compared with only 22% in 1997.
  
  
• Peer Pressure
  The percentage of students reporting that they would "have intercourse with the person" if pressured by a partner to have sex, decreased from 21% in 1994 to 16% in 1997.
  
  
• Abstinence
  When asked, "At what point in life is it okay for people to start having sex," the frequency of the response "until they can support a baby" increased from 22% in 1994 to 27% in 1995.

Key results from the Monroe County behavior survey and the New York State Department of Health that possibly support the efficacy of "Not Me, Not Now" include:

• The percentage of students who self-reported having intercourse by age 15 dropped from 46.6% in 1992 to 31.6% in 1997.
  
  
• The adolescent pregnancy rate for Monroe County dropped from 63.4% in 1993 to 49.5% in 1996. By comparison, Monroe’s rate was higher than two surrounding counties in 1993 and lower than both counties in 1996.

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The impact evaluation of the "Not Me, Not Now" program demonstrated statistically significant, consistent changes on measures of program awareness, beliefs and attitudes, self-reported behaviors, and pregnancy rates. Alternate explanations for these outcomes might be:

• As both the middle school survey and the YRBS relied on self-reports, it is possible that the results were biased due to the social desirability of particular responses. However, it is unlikely that this factor alone accounted for the observed changes.
  
  
• Other interventions introduced in the community during the same time period could have influenced these findings. However, none of these interventions were targeted specifically to young adolescents, so they would not be expected to have a primary impact on this audience.
  
  
• A national trend of declining teen pregnancy rates and a later onset of sexual intercourse was occurring during the same time period, making it more difficult to assess the overall impact of the "Not Me, Not Now" program.

Limited resources for this impact evaluation made it difficult to collect stronger evidence that this program alone led to the decline in adolescent pregnancy rates. Due to the high level of awareness of the program and its consistently measured outcomes, it is likely that the "Not Me, Not Now" program had some independent effect on the change in attitudes, beliefs and behaviors of its target audience.

"Not Me, Not Now" is one of the only abstinence-oriented programs to be formally evaluated. Rigorous evaluations of other such programs would lead to a clearer understanding of the effect of abstinence-based curricula on teen pregnancy rates and adolescent attitudes and behaviors.

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• The mass-communications approach of the "Not Me, Not Now" program demonstrates how the power of media can be utilized to disseminate public health messages in the community.
  
  
• "Not Me, Not Now" intentionally sought to include youth through the use of a youth advisory panel and local youth in the program's print, radio and television ads. This may be a powerful design tactic for youth-oriented health education programs.
  
  
• The ecological approach taken by "Not Me, Not Now" included youth, community leaders, media, teachers, and parents. Such an approach places responsibility for youth sexuality on the entire community, rather than on youth alone.

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