School-based teenage pregnancy prevention programs: A systematic review of randomized controlled trials

doi:10.1016/j.jadohealth.2003.11.097

Journal of Adolescent Health

Volume 36, Issue 1, January 2005, Pages 72-81

https://doi.org/10.1016/j.jadohealth.2003.11.097 Get rights and content

Abstract

We compared school-based abstinence-only programs with those including contraceptive information (abstinence-plus) to determine which has the greatest impact on teen pregnancy. The United States has one of the highest rates of teen pregnancy in the industrialized world. Programs aimed at reducing the rate of teen pregnancy include a myriad of approaches including encouraging abstinence, providing education about birth control, promoting community service activities, and teaching skills to cope with peer pressure. We systematically reviewed all published randomized controlled trials of secondary-school-based teen pregnancy prevention programs in the United States that used sexual behavior, contraceptive knowledge, contraceptive use, and pregnancy rates as outcomes.

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.

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Review articlesSchool-based teenage pregnancy prevention programs: A systematic review of randomized controlled trials

Abstract

Section snippets

Methods

Summary of programs

Contraceptive knowledge and use

Discussion

Conclusion

Acknowledgments

J Adolesc Health

J Adolesc Health

J Adolesc Health

J Adolesc Health

J Adolesc Health

Teen pregnancy preventiondo any programs work?

Annu Rev Public Health

Adolescent pregnancy and childbearinglevels and trends in developed countries

Fam Plann Perspect

Sexual and fertility behaviors of American females aged 15–19 years1985, 1990, and 1995

Am J Public Health

Teenage abortion and pregnancy statistics by state, 1996

Fam Plann Perspect

Pregnancies averted among US teenagers by the use of contraceptives

Fam Plann Perspect

Why is teenage pregnancy declining? The roles of abstinence, sexual activity and contraceptive use

State-level policies on sexuality, STD education, issues in brief

Abstinence promotion and the provision of information about contraception in public school district sexuality education policies

Fam Plann Perspect

Changing emphasis in sexuality education in US public secondary schools, 1988–1999

Fam Plann Perspect

Sex education in America, a series of national surveys of students, parents, teachers and principals

Guide to Clinical Preventive Services, 2nd edition

The NIH condom reportthe glass is 90% full

Fam Plann Perspect

Development and evaluation of a sexual decision-making and social skills programthe choice is yours—preventing HIV/STDs″

Health Educ Behav

Infant simulator lifespace interventionpilot investigation of an adolescent pregnancy prevention program

Child Adolesc Social Work J

Abstinence and safer sex HIV risk-reduction interventions for African-American adolescents

JAMA

Review articles
School-based teenage pregnancy prevention programs: A systematic review of randomized controlled trials