A Systematic Review and Meta-Analysis of Interventions to Prevent Adolescent Pregnancy, HIV, and Other Sexually Transmitted Infections: Comprehensive Risk Reduction and Abstinence Education

Background: Teen pregnancy, HIV, and sexually transmitted infection (STI) rates are higher in the United States than in other developed countries.

Objectives: To evaluate the evidence on effectiveness of group-based behavioral interventions delivered to adolescents to promote behaviors that protect against or reduce the risk of pregnancy, HIV, and STIs when using a(n) 1) CRR strategy, 2) AE strategy.

Methods: Using methods developed for the Guide to Community Preventive Services (Community Guide), a systematic search for evidence published in the period January 1988–August 2007 was conducted. Qualifying intervention studies were evaluated, and data from these studies were used to conduct a meta-analysis. The results were translated into conclusions on effectiveness according to Community Guide rules of evidence.

Results: Our review identified 62 studies and 83 study arms that used a CRR strategy and 21 studies and 23 study arms that used an AE strategy. The effect estimates indicate that CRR interventions are effective in reducing sexual activity (OR=0.84, 95% CI 0.75, 0.95) and sexual risk behaviors, and provide some direct evidence of a reduction in STIs. The effect estimates for AE interventions differed substantially by study design, making the interpretation of the effectiveness of these interventions ambiguous. For the sexual activity outcome, the OR was 0.94 (95% CI 0.81, 1.10) for RCTs and 0.66 (95% CI 0.54, 0.81) for non-RCTs.

Conclusions: Sufficient scientific evidence indicates that group-based CRR interventions delivered to adolescents are effective in promoting behaviors that protect against or reduce the risk of pregnancy, HIV, and other STIs. There is insufficient scientific evidence to determine the effectiveness of AE interventions.

Implications for Programs, Policy, and/or Research: The Task Force on Community Preventive Services recommends CRR interventions for adolescents and more research is needed to adequately assess the overall public health impact of AE.