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A Brief History of Federal Funding for More Comprehensive Approaches to Sex Education FY10

 
 
A Brief History of Federal Funding for
Sex Education and Related Programs
 
Sex education, particularly in America’s public schools, has long been a political issue. As concerns over unintended teen pregnancy and HIV/AIDS rose in the 1970s and 1980s, respectively, states increasingly began to pass policies requiring HIV/AIDS education, at times, though not always, in conjunction with broader sex education classes. The federal government also began funding for teen pregnancy-, HIV-, and STD-prevention activities—such as those funded through the Centers for Disease Control and Prevention (CDC). Despite the interconnectivity of the topics, these funding streams were always separated and the government had never dedicated funding specifically to more comprehensive approaches to sex education.
 
Over the last ten years, an overwhelming body of evidence has emerged showing that more comprehensive approaches to sex education are effective in changing behavior and that broad support for these programs exists from medical and public health organizations as well as the majority of Americans, including parents and young people.[1] Still, prior to Fiscal Year 2010, the federal government had not dedicated funding for comprehensive sex education. As a result, federally funded programs provided piecemeal sex education that did not address all the information that young people needed to make healthy life choices, have healthy relationships, delay sexual activity if they chose to do so, and protect themselves from unintended pregnancy, HIV, and other STDs when they do become sexually active. 
 
Meanwhile, beginning in 1981 during the Reagan Administration, conservative policymakers inthe federal government began pouring tax-payer money into abstinence-only-until-marriage programs. Funding for these programs continues to this day, despite an overwhelming body of research proving they are ineffective and that this federal expenditure has failed to achieve its stated goals. Funding for these unproven programs grew exponentially from 1996 until 2009, particularly during the years of the George W. Bush Administration, and to date Congress has funneled over one-and-a-half billion tax-payer dollars into abstinence-only-until-marriage programs.
 
However, as questions about the merits and efficacy of abstinence-only-until-marriage programs grew, the federal government began to modify their support for these programs. After nearly thirty years of strong support from the federal government for abstinence-only-until-marriage programs, the Obama administration and Congress ushered in a new era of sex education in the United States, eliminating two-thirds of federal funding for ineffective abstinence-only-until-marriage programs and providing funding for initiatives that support evidence-based teen pregnancy prevention and more comprehensive approaches to sex education totaling nearly $190 million. The White House began to heed the evidence and the urgings of the nation’s leading medical and public health organizations and came out in support of programs that are more comprehensive in scope, have demonstrated their effectiveness, and are age-appropriate and medically accurate. It has also signaled the importance of addressing the inter-related health needs of adolescents by establishing the Office of Adolescent Health, charged with coordinating all activities within the U.S. Department of Health and Human Services that relate to adolescent “disease prevention, health promotion, preventive health services, and health information and education.”
 
New federal initiatives that are finally providing more comprehensive approaches to sex education and programs dedicated to the prevention of unintended pregnancy, HIV, and STDs continue; however, federal funding for sex education remains a political issue and these new initiatives have been under attack since their creation, despite the fact that there are still far too few young people receiving the information and education they need to make responsible decisions and lead safe and healthy lives.
 
 
THE FEDERAL GOVERNMENT CHANGES COURSE
For Fiscal Years 2010 and 2011, President Obama and Congress not only eliminated funding for two-thirds of previously existing abstinence-only-until-marriage programs, including the Community-Based Abstinence Education grant program and the abstinence-only funding granted as part of to the Adolescent Family Life Act,[2] but also provided nearly $190 million in new funding for two new sex education initiatives to support both evidence-based programs and innovative approaches to prevent unintended teen pregnancy and STDs, including HIV. In addition, the federal government protected funding for HIV/STD Prevention Education at the Centers for Disease Control and Prevention’s (CDC’s) Division of Adolescent and School Health.
                                                                                                
The President’s Teen Pregnancy Prevention Initiative
In December 2009, President Barack Obama signed the Consolidated Appropriations Act of 2010, which included $110 million for the President’s Teen Pregnancy Prevention Initiative (TPPI). This created the first federal funding stream that could be utilized for more comprehensive approaches to sex education.
 
The $110 million appropriated through this discretionary funding stream was slated for “competitive contracts and grants to public and private entities to fund medically accurate and age appropriate programs that reduce teen pregnancy.”[3] At least $75 million was available for “replicating programs that have been proven effective through rigorous evaluation to reduce teenage pregnancy, behavioral risk factors underlying teenage pregnancy, or other associated risk factors.”[4] In addition, at least $25 million was required to be available for “research and demonstration grants to develop, replicate, refine, and test additional models and innovative strategies for preventing teenage pregnancy.”[5] Finally, $4.5 million was allocated for program evaluation, including longitudinal evaluations, of teenage pregnancy prevention approaches. Upon passage of the funding, Congress indicated that it intended for “a wide range of evidence-based programs to be eligible for the $75 million available for evidence-based programs.”[6] Legislators also affirmed “programs funded under this initiative will stress the value of abstinence and provide age-appropriate information to youth that is scientifically and medically accurate.”[7]
 
These funds are under the jurisdiction the newly established Office of Adolescent Health (OAH) within the Office of the Secretary of Health and Human Services (HHS), which works in cooperation with the Administration for Children and Families (ACF), the Centers for Disease Control and Prevention (CDC), and other relevant HHS agencies on implementing the initiative. The Office of Adolescent Health was first funded in Fiscal Year 2010 is charged with coordinating all activities within HHS that related to adolescent “disease prevention, health promotion, preventive health services, and health information and education,” including program design, support, and evaluation, trend monitoring, adolescent health research projects, and training for health providers who work with adolescents.[8]
While pleased with the creation of a discretionary funding stream that would allow funding for more comprehensive approaches to sex education, advocates for comprehensive sexuality education were disappointed that the funding focused very specifically on teen pregnancy prevention and did not explicitly address the equally important health issues of STDs, including HIV. By narrowly focusing the program and not requiring discussion of both abstinence and contraception, the Obama administration and Congress missed an opportunity to provide true, comprehensive sexuality education that promotes healthy behaviors and relationships for all young people, including lesbian, gay, bisexual, and transgender (LGBT) youth.
 
On April 1, 2010, OAH released the Funding Opportunity Announcement (FOA) for Tier 1 of the TPPI funding, $75 million to be awarded to organizations intending to replicate evidence-based programs proven effective after rigorous evaluation. Grants were to be awarded in amounts ranging from $400,000 to $4 million, with the largest grants intended for programs to be “implemented in multiple sites in a targeted geographic area.”[9] Projects were expected to target individuals ages 19 and under (at the time of initial enrollment in the program) and the FOA specifically included pre-teens as a possible target population. The grants allowed applicants to replicate programs from a list of teen pregnancy prevention or youth development programs with proven effectiveness, as determined by Mathematica Policy Research, Inc. In order to compile the list of effective programs, Mathematica reviewed over 190 program evaluations and research articles and identified 28 programs that met its strict criteria.[10] While programs had to be proven effective in “reduc[ing] teenage pregnancy, behavioral risks underlying teenage pregnancy, or other associated risk factors” in order to qualify for Tier 1 TPPI funding, many of the 28 programs that met the strict criteria were originally designed as HIV- or STD-prevention programs, while several others are broad youth development programs.[11] Of the 28 programs selected, 23 include sexuality education as one component.
 
On April 8, 2010, OAH released the FOA for the Tier 2 funding for innovative approaches and promising models. This funding included $25 million in TPPI funding and $10 million from the Personal Responsibility Education Program (PREP), which was a component of health care legislation and is administered by ACF. Tier 2 funding was to be awarded to programs that intend to “develop, replicate, refine, and test additional models and innovative strategies for preventing teenage pregnancy.”[12] Grant amounts ranged from $400,000 to $1 million. 
 
For both Tier 1 and Tier 2 funding, a wide range of applicants were eligible, including non-profit organizations, for-profit organizations, universities, hospitals, community-based organizations, faith-based organizations, American Indian/Alaskan Native tribal governments or organizations, and state and local governments, including school districts and departments of education and health.
 
The TPPI Tier 2 grant program also supports communitywide initiatives to reduce rates of teenage pregnancy and births in communities with the highest rates. The program awards grants to national organizations as well as state- and community-based organizations. Funded national partners provide training and technical assistance to local grantees. The Centers for Disease Control and Prevention (CDC) administers this communitywide initiatives grant program in partnership with OAH.
 
For Fiscal Year 2010, the first year of funding for the program, the President’s Teen Pregnancy Prevention Initiative received $110 million. Over 1,000 applications were submitted for funding; however, OAH was able to fund only just over 100 grantees with available resources. Grants for all tiers of funding were announced on September 30, 2010. For Fiscal Year 2010, a total of $75 million in grant awards were made to 75 grantees in 32 States and Washington, D.C. for Tier 1. $15 million of Tier 2 funding was awarded to 19 grantees in 14 states for Tier 2, totaling $15 million. The remaining $9 million from Tier 2 funding was awarded by the CDC in partnership with OAH for the community-wide teenage pregnancy prevention programs. Eight state and local organizations are funded to demonstrate the effectiveness of innovative, multi-component, community-wide initiatives and five national organizations are funded to provide assistance and support to the community grantees. Finally, $10 million was utilized for research, evaluation, and technical assistance.
 
The President requested an increase of $19.2 million for the Teen Pregnancy Prevention Initiative in his Fiscal Year 2011 budget request, for a total of $133.7 million. After a lengthy budget battle, during which the Republican-controlled House of Representatives completely eliminated funding for TPPI,[13] the Initiative was funded at $105 million for Fiscal Year 2011 representing a $5 million cut. For Fiscal Year 2012, the President requested an increase of $5 million, for a total of $110 million, in order to bring it back to its original funding level.
 
Personal Responsibility Education Program
Following months of negotiations and partisan bickering, President Obama signed health care reform legislation, the Patient Protection and Affordable Care Act (P.L. 111-148), into law on March 23, 2010. Among its many provisions, the legislation created the Personal Responsibility Education Program (PREP), which, among other things, provides young people with medically accurate and age-appropriate sex education in order to help them reduce their risk of unintended pregnancy, HIV/AIDS, and other STDs through evidence-based and innovative programs. Programs funded by PREP would also foster development of life skills so that young people can make responsible decisions and lead safe and healthy lives. The program was offered as an amendment to the Senate health care reform legislation (Service Membership Home Ownership Tax Act of 2009) by Senator Max Baucus (D-MT). The amendment passed in the Finance Committee 14–9 with bipartisan support and was included in the final health care reform legislation signed by President Obama.
 
The program totals $75 million per year in mandatory funding for the period 2010–2014 and is administered by the ACF. Just over $55 million of the program is dedicated to state grants, while the remaining $20 million is dedicated for grants for innovative approaches ($10 million), funding for tribes and tribal organizations ($3.5 million), and research, training, and technical assistance ($6.5 million).  
 
Under the state-grant program, each state is allocated a minimum of $250,000. Additional funding levels for each state are determined by a federal formula related to the number of low-income individuals in that state. States are able to decide if the state agency granted the funds will expend the money, if they will sub-grant the funding to state or local entities, or a combination of both. Written into the state-grant program is a trigger provision which directs that if a state did not submit an application for Fiscal Years 2010 or 2011, it will become ineligible to apply for funding in subsequent years, and the federal Secretary of Health and Human Services will be able to award three-year grants to community-based and faith-based organizations and local entities in that state using the allotted funds for Fiscal Years 2012–2014. Eligible applicants are the 50 United States, the District of Columbia, Puerto Rico, Virgin Islands, and the other outer U.S. Territories.
 
Under the state-grant portion of PREP, states are required to fund programs that include a core sex education component that teaches youth about “both abstinence and contraception for the prevention of pregnancy and [STDs], including HIV/AIDS.”[14] In addition, PREP-funded programs need to address at least three of the “adulthood preparation subjects” enumerated in the bill: healthy relationships, such as positive self-esteem and relationship dynamics, friendships, dating, romantic involvement, marriage, and family interactions; adolescent development, such as the promotion of healthy attitudes and values regarding growth and development, body image, and racial and ethnic diversity; financial literacy (self explanatory); educational and career success, for employment preparation, job seeking, independent living, financial self-sufficiency, and workplace productivity; and, healthy life skills, such as goal-setting, decision-making, negotiation, communication and interpersonal skills, and stress management. PREP-funded programs are also required to address the needs of both youth who choose not be sexually active and those that are currently sexually active by placing “substantial emphasis” on both abstinence and contraception for the prevention of pregnancy and STDs. They must also include information to educate youth who are sexually active “regarding responsible sexual behavior with respect to both abstinence and the use of contraception.”[15]
 
Funded programs are required to 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, including delaying sexual activity, increasing condom or contraceptive use for sexually active youth, or reducing pregnancy among youth.”[16] Programs are also required to be “medically accurate and complete,” provide age-appropriate information and activities, and be carried out in “the cultural context that is most appropriate for individuals in the particular population group to which they are directed.”[17]
 
The Funding Opportunity Announcement for the PREP state-grant program was released on July 30, 2010. An overwhelming majority of states applied for the PREP funds, including states that have staunchly supported an abstinence-only-until-marriage approach in the past. For Fiscal Year 2010, the first year funding was available, 43 states and the District of Columbia, the Federated States of Micronesia, and Puerto Rico applied for PREP’s state-grant funding. For Fiscal Year 2011, two additional states, Nevada and Hawaii, applied for PREP state-grant funding and were retroactively provided with Fiscal Year 2010 funding. While Florida had originally applied for PREP funding for Fiscal Year 2010, in 2011 Governor Rick Scott decided to reject all funding from the Affordable Care Act. Florida subsequently returned the Fiscal Year 2010 funds it had received and did not apply for Fiscal Year 2011 funds. (However, Florida did accept Fiscal Years 2010 and 2011 funding for the Title V abstinence-only program despite the fact the program was also funded through the Affordable Care Act).
 
In addition to the funding for state grants, PREP also includes three other funded sections. The first is $10 million to award grants for innovative youth pregnancy prevention strategies and to target services to high-risk, vulnerable, and culturally under-represented youth populations, including youth in foster care, homeless youth, youth with HIV/AIDS, pregnant women who are under 21 years of age and their partners, mothers who are under 21 years of age and their partners, and youth residing in areas with high birth rates for young parents. Because the President’s Teen Pregnancy Prevention Initiative (TPPI) also included funding for innovative approaches and promising models, ACF and OAH joined together to issue a joint Funding Opportunity Announcement (FOA) for this funding.
 
Personal Responsibility Education Innovative Strategies (PREIS) grantees were announced on September 30, 2010. In Fiscal Year 2010, the PREIS Program provides a total of $10 million in funding directly to 13 grantees in 12 states. All awards are five-year grants. Funded programs are designed to support research and demonstration projects to develop, replicate, refine, and test innovative models for preventing unintended teen pregnancy. ACF is administering the PREIS grant program in collaboration with OAH.
 
In addition, approximately $3.5 million of annual PREP funds are reserved for grants to “Indian tribes and tribal organizations” so that the specific prevention needs of Native American and Indian communities can be addressed. At the time of the drafting of this edition of the SIECUS State Profiles, the Funding Opportunity Announcement for Fiscal Years 2010 and 2011 for the tribes and tribal organizations was in clearance process and had yet to be released.
 
Finally, approximately $6.5 million of PREP funds are reserved for research, training, and technical assistance. This includes the dissemination of research and information regarding effective and promising practices; providing consultation and resources on a broad array of teen pregnancy prevention strategies, including abstinence and contraception; and developing resources and materials to support the activities of recipients of grants and other state, tribal, and community organizations working to reduce teen pregnancy. This funding is to be either provided directly or through a competitive grants process and requires the Secretary of HHS to collaborate with a variety of entities that have expertise in the prevention of pregnancy and STDs, including HIV, developing healthy relationships, ensuring financial literacy, and other topics addressed in the PREP. The Secretary of HHS is to evaluate funded programs carried out by the states, and any organization or entity awarded a grant must agree to participate in a rigorous federal evaluation.
 
 
ADDITIONAL FEDERAL FUNDING FOR SEX EDUCATION INFRASTRUCTURE
In addition to the TPPI and PREP funding streams, the federal government also designates funding through the CDC to help build the infrastructure for HIV/STD prevention and sex education in states and cities across the country. Created in 1988, CDC’s Division of Adolescent and School Health (DASH) is a unique source of support for HIV prevention efforts in our nation’s schools. Funded at $40 million in Fiscal Year 2011, DASH’s HIV/STD-prevention education work provides funding and technical assistance to HIV/STD prevention programs in 49 states, the District of Columbia, 16 large urban school districts, six territories, and one tribal government. The funding and training resources go directly to state and local education agencies (SEAs and LEAs) to help schools implement effective HIV-prevention programs that are based on the best science available. DASH-funded SEAs and LEAs are required to collaborate closely with public health departments to improve program effectiveness, increase efficiency, and reduce redundancy. DASH also funds a network of nongovernmental organizations to provide national-level support for HIV prevention efforts in education agencies and other agencies that serve youth at risk for HIV infection.
 
 

[2]Congress also allowed the third funding stream, the Title V abstinence-only-until-marriage program, to expire on June 30, 2009. Unfortunately, in March of 2010 it was resurrected as part of the Patient Protection and Affordable Care Act. For more information about federal funding for abstinence-only-until-marriage programs, see SIECUS’ A History of Federal Funding for Abstinence-Only-Until-Marriage Program.
[3]Consolidated Appropriations Act, 2010, Pub. L. No. 111–117, 123 Stat. 3253, accessed 8 June 2010, <http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_public_laws&docid=f:publ117.111.pdf>. 
[4]Ibid.
[5]Ibid.
[6]U.S. Congress, Departmentsof Transportation and Housing and Urban Development, and Related Agencies Appropriations Act, 2010 (111 H. Rpt. 366), accessed 8 June 2010, <http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_reports&docid=f:hr366.111.pdf>, 1043. 
[7]Ibid.
7 Preventive Health Amendments of 1992, Pub. L. No. 102–515, accessed 8 June 2010.
[9]U.S. Department of Human Services, Office of Adolescent Health, “Teenage Pregnancy Prevention: Replication of Evidence-based Programs,” Funding Opportunity Announcement and Application Instructions released 1 April 2010, accessed 8 June 2010, <https://www.grantsolutions.gov/gs/servlet/document.DownloadPdfPublicServlet?document_id=142579>, 9. 
[10]See “Overview of the Teen Pregnancy Prevention Research Evidence Review,” U.S. Department of Human Services, Office of Adolescent Health, accessed 8 June 2010, <http://www.hhs.gov/ophs/oah/prevention/research/index.html>.
[11]“Teenage Pregnancy Prevention: Replication of Evidence-based Programs,” 3. 
[12]U.S. Department of Human Services, Office of Adolescent Health, “Teenage Pregnancy Prevention (TPP): Research and Demonstration Programs and Personal Responsibility Education Program (PREP),” Funding Opportunity Announcement and Application Instructions released 8 April 2010, accessed 8 June 2010, <https://www.grantsolutions.gov/gs/servlet/document.DownloadPdfPublicServlet?document_id=142823>, 4. 
[13]SIECUS, “Eleventh-Hour Deal on Federal Budget Avoids Government Shutdown,” April 2011, accessed 14 September 2011, <http://siecus.org/index.cfm?fuseaction=Feature.showFeature&featureid=2000&pageid=483&parentid=478>.
[14]Patient Protection and Affordable Care Act, Pub. L. No. 111–148.                 
[15]Ibid.
[16]Ibid.
[17]Ibid.
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