- High rates and high costs of adolescent pregnancy and school dropout have resulted in the development of many prevention programs; however, little is known about the long-range effectiveness of efforts. Empirical research is needed to document behavioral outcomes over extended periods of time. I interviewed eight young white women who were my students in a dropout and pregnancy prevention program in the 1980s. Retrospective qualitative interviews were used to encourage them to talk about how their experiences in the program impacted education, pregnancy, employment, and relationships. Participants' health risk behaviors (HRBs), both past and present, were also reported. This study provides greater understanding of the major factors that contributed to each adolescent's high-risk status. The participants identified these five program processes the greatest impact: (1) boosting self-esteem, (2) accessing resources, (3) supporting group members, (4) volunteering to help in the community, and (5) applying education. The key finding of this study is: Caring is essential for the survival of these young
women. The "Upward Spiral of Caring" is a model that portrays the stages that the
participants described as they became involved in the program. Unconditional acceptance led to a sense of belonging. Volunteering gave them opportunities to experience accomplishment and recognition. Each person learned to care for herself, others, and the community, working together to boost self-esteem. In turn, positive self-esteem positively impacted individuals' actions, such as school attendance and academic achievement. The program had two goals: to increase graduation and decrease pregnancy. Of the eight participants, seven earned a high school diploma or GED and none became pregnant while enrolled in the program. Today, all have experienced serious illness and/or injury. Half have psychological problems, and half have made suicide attempts. Seven used alcohol and/or drugs excessively as adolescents, and now those who use alcohol do so responsibly, except for one who continues to have all six HRBs. The contribution of this study was to place marginalized young women at the center of inquiry. This study is an unique combination of critical inquiry, grounded theory, qualitative case study methodology, and a health education perspective.
Recommendations for program development and future research were made.