Review articlesSchool-based teenage pregnancy prevention programs: A systematic review of randomized controlled trials
Section snippets
Methods
We identified studies of secondary-school-based pregnancy prevention programs in the United States by searching PubMed, Cochrane Registry, CINAHL, Biosis, and Embase for the medical subject heading keywords “teen pregnancy,” “teen abstinence,” “teen pregnancy prevention programs,” and “teen HIV prevention” from January 1, 1980 to September 1, 2002. We included programs with a focus on human immunodeficiency virus (HIV) prevention because these programs aim to reduce risky sexual behavior and
Summary of programs
Our search identified 19 randomized controlled trials of school-based teen pregnancy prevention programs in the United States from 1980 to 2002, of which three studies were excluded because they did not assess a relevant outcome variable [13], [14], [15]. Of the 16 remaining studies, three were found to examine abstinence-only programs, 12 evaluated abstinence-plus programs, and one study compared an abstinence-only with an abstinence-plus program. This last study compared three groups: an
Contraceptive knowledge and use
Contraceptive knowledge and use were measured by self-reported outcomes examining contraceptives in general and condom use specifically. None of the abstinence-only studies evaluated knowledge of contraception, and the one study that asked about birth control use found no difference between groups [19]. Four of the five abstinence-plus programs that evaluated students’ knowledge of contraceptives found an improvement in the intervention group compared with the control group at follow-up [22],
Discussion
Although teenage pregnancy in the United States has declined over the last decade, it remains a public health problem. The results of this systematic review show that some abstinence-only and abstinence-plus programs can change teens’ sexual behaviors, although the effects are relatively modest and may last only short term. Delay in initiation of sexual activity was shown in one abstinence-only program and two abstinence-plus programs. None of the programs resulted in decreased numbers of
Conclusion
Nationwide, over half of teens aged 15 to 19 are sexually active [40]. Most of the decline in the teenage pregnancy rate over the past decade can be attributed to increased contraceptive use, with a small contribution from decreased sexual activity [41]. To reduce the rates of teen pregnancy, programs must either improve teenage contraceptive behaviors, reduce teens’ sexual activity, or both. The variability in study populations, interventions, and outcomes of existing school-based trials of
Acknowledgments
We thank Drs. Anne Davis, Leslie Miller, Susan Reed, Roger Rosenblatt, and Devika Singh for their comments on the manuscript.
References (41)
- et al.
An evaluation of a school-based AIDS/HIV education program for high school students
J Adolesc Health
(1992) - et al.
Postponing sexual intercourse among urban junior high school students—a randomized controlled evaluation
J Adolesc Health
(2000) Abstinence-based programs for prevention of adolescent pregnancies
J Adolesc Health
(2000)- et al.
Self-reported health concerns sexual behaviors in adolescents with cervical dysplasia
J Adolesc Health
(1991) - et al.
Health education programs to prevent teen pregnancy
J Adolesc Health
(2001) Teen pregnancy preventiondo any programs work?
Annu Rev Public Health
(1999)- et al.
Adolescent pregnancy and childbearinglevels and trends in developed countries
Fam Plann Perspect
(2000) - et al.
Sexual and fertility behaviors of American females aged 15–19 years1985, 1990, and 1995
Am J Public Health
(2000) - et al.
Teenage abortion and pregnancy statistics by state, 1996
Fam Plann Perspect
(2000) - et al.
Pregnancies averted among US teenagers by the use of contraceptives
Fam Plann Perspect
(1999)