Beginning this school year, a five-year, $375 million grant is being divided among 28 programs that have been proven to lower the pregnancy rate among participants, no matter their focus. Many programs distribute condoms, but about half also aim to boost teens' academics, get them involved in extracurricular activities and even improve their parents' job status.
Advocates believe this "above the waist" approach gives kids the tools to help them succeed in school and make better life decisions, especially about sex.
"There's a growing realization that we have to talk to young people about relationships. It's not just body parts," said Bill Albert, the chief program officer for The National Campaign to Prevent Teen and Unplanned Pregnancy. "It's saying, 'What are your goals?' and helping young people understand what they need to do to get there."
That theory, which has become popular in the safe-sex community in the past decade, will replace the abstinence-centered talks funded by a Republican Congress in the late 1990s and later under President George W. Bush to the tune of $1.5 billion.
Critics contend there is little proof those programs lowered the teen pregnancy rate or that participants were less likely to have sex. In 2007, Mathematica Policy Research, an independent government contractor, released a study showing students in abstinence-only programs are no more likely to abstain from sex, delay having sex or have fewer partners than students who received no sex education at all.
The teen birth rate rose from 2005 to 2007 after years of a steady decline, then dipped again in 2008, according to the Centers for Disease Control and Prevention.
Valerie Huber, executive director of the National Abstinence Education Association, worries the new sex education message focuses on reducing teen pregnancy, not avoiding the risks of unprotected sex altogether. Huber considers only one of the 28 approved Department of Health and Human Services programs to be abstinence-centered.
Her agency estimates 169 abstinence programs serving 1 million teens nationwide will lose millions in funding. Those programs have received about $100 million a year in direct funds since 2005.
Larry McAdoo, executive director of an abstinence program losing funding in Mississippi, said teens there "will be left without any resources to counter the sexual messages with which they are continually bombarded."
Abstinence programs will still receive a $50 million annual federal grant that requires states to match $3 for every $4, and about 30 states have applied for that money. The $375 million HHS grant does not require states to provide matching funds.
Almost all U.S. teens have had formal sex education, but only about two-thirds have been taught birth control methods, according to a CDC report released Sept. 15.
Many parents mistakenly believe kids are getting comprehensive sex education at school. Curriculum varies among school districts, but students get a very limited amount of sex ed in school, Albert said.
Communities seeking different or additional instruction for their kids will choose from the 28 programs that were approved for funding by HHS following evaluations by Mathematica Policy Research that deemed them effective.
To qualify, programs had to be supported by at least one study showing a positive, statistically significant effect on at least one of the following categories: sexual activity, contraceptive use, sexually transmitted infections, pregnancy or births.
Birth control is distributed as part of the Carrera Adolescent Pregnancy Prevention Program, one of the approaches that are getting HHS funding. But students also get art and music classes, science field trips, homework tutoring, mental health counseling and free medical and dental care. They're also required to get summer jobs, open a bank account, save 10 percent of their wages and learn how to balance a checkbook.
Even parents many who were teen mothers get help through the program, including high school-equivalency classes, resume writing tips and mortgage advice.
"You're illuminating pathways for them ... to link the (sex) education with all the other things that make a young person whole, it sticks better," said the program's founder, Michael Carrera, an adjunct professor at The Mount Sinai Medical Center in New York.
He said that early in his career, "I didn't understand that when young people came into my workshops they brought all their issues, not just their sexuality."
Carrera's methods are taught to 2,500 children in blighted neighborhoods in Washington, D.C.; New York; Flint, Mich.; and Toledo, Ohio. Thirty-five organizations around the country applied for the HHS grant to replicate Carrera's model, which could reach an additional 3,500 kids if all the applications are approved.
Sixteen-year-old Leticia Vargas was reluctant to attend a Planned Parenthood program in Lake Worth, Fla., that replicates Carerra's model, but her mom insisted. Hearing about sex was awkward at first, she said, but the program has changed her thinking.
"I've seen a lot of girls get pregnant at an early age and I don't want to go through that," said Vargas, who wants to be a paramedic or cosmetologist so she can help her mom pay the bills. The program's tutors have helped her boost her grades from Cs and Ds to As and Bs.
Experts say Carrera's program won't be the norm under the Obama administration. The five- to six-day-a-week, nearly year-round approach follows children from age 11 through high school graduation and costs $3,500 per student per year.
But about half the HHS programs focus on more than just sex to attack teen pregnancy.
The nine-month Teen Outreach Program spends less than 15 percent of its curriculum on sex education, even though that's its chief goal. Instead, it encourages teens in 30 states to identify a problem in the community and spend at least 20 hours trying to fix it.
Those problem-solving skills and leadership roles give kids a sense of who they are and what they want, leading to better decision-making overall, the theory holds. Participants have a 53 percent lower risk of pregnancy and a 60 percent lower risk of school course failure, according to the program.
Nearly 150 organizations, including several churches, applied to replicate Teen Outreach, which has been taught to 20,000 kids from St. Louis to Indian reservations in New Mexico. It could grow to reach 160,000 with the new HHS grant if all the organizations that applied for it receive it.
Another, the Adult Identity Mentoring program, lasts only 10 weeks. Students fill out job resumes and create mock business cards, helping tie them to their adult identities, and discuss what present behaviors could affect their adult lives.