HIV, Other STIs, and Teen Pregnancy: Youth Development Behavioral Interventions to Reduce Sexual Risk Behaviors in Adolescents Coordinated with Community Service

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Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) recommends youth development focused behavioral interventions coordinated with community service on the basis of sufficient evidence that these combined approaches are effective in reducing sexual risk behaviors in participating adolescents.

All of the interventions evaluated in this review included sexual behavior or risk reduction content as part of the behavioral intervention, although the emphasis on this component varied. The CPST acknowledges that this review, focused on the subset of intervention studies that evaluated change in sexual risk behavior outcomes, does not provide a complete, systematic assessment of all of the evidence regarding overall effectiveness of these combined approaches.

The CPSTF has related findings for youth development interventions coordinated with the following:

Intervention

Youth development behavioral interventions employ a holistic approach to adolescent health and wellness, and may or may not include components that are focused directly on pregnancy and STI prevention. These interventions emphasize:
  • Social, emotional, or cognitive competence training that promotes pro-social norms
  • Improved decision making
  • Self-determination
  • Improved communication skills
  • Positive bonding experiences between youth and their peers or non-parental role models

Community service may involve scheduled activities in one or more community settings such as nursing homes, hospitals, and homeless shelters. This experience provides extended opportunities for adolescents to interact with adults in the community and have a sense of membership in a group with explicit rules and responsibilities.

CPSTF Finding and Rationale Statement

Read the CPSTF finding.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 9 studies (search period 1980-2008). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing HIV, other STIs, and teen pregnancy.

Summary of Results

Nine studies qualified for the review.
  • The included studies targeted recruited adolescents (ages 10 19 years).
  • Rate of pregnancy: median relative decrease of 39% (interquartile interval: -59% to -9%) over a median of 9 months of observation (6 studies)
  • Self-reported sexual activity among study participants: reductions in favor of the intervention (3 studies)
  • Use of birth control or condom use: inconsistent results (3 studies)
  • Initiation of sexual intercourse: inconsistent results (3 studies)
  • Further research is required to assess the effectiveness of these interventions on use of birth control, use of condoms and on initiation of sexual intercourse.

Summary of Economic Evidence

Two studies qualified for the economic review that applied youth development and community service as part of multicomponent strategies. Monetary values are reported in 2007 U.S. dollars.
  • Both studies assessed the economic impact of pregnancies prevented due to the interventions.
  • Based on the evidence from these two studies, the interventions appear to be cost beneficial with net benefits ranging from $204 to $1053 per person per year.
    • Program costs ranged from $699 to $839 per person per year.
    • Benefits from pregnancies prevented ranged from $903 to $1891 per person per year.

Applicability

These interventions were effective in rural, suburban, and urban U.S. communities for disadvantaged participants (students of low economic status, from racial or ethnic minorities, or from schools with low graduation rates or test scores).

Evidence Gaps

Content is in development.

Study Characteristics

  • All interventions included in this review had some sexual risk reduction content.
  • To be included in the review, studies had to include sexual risk behavior outcomes.
  • Among included studies, the content and delivery differed, but most studies used interactive group sessions held in school or community settings.

Analytic Framework

Effectiveness Review

Analytic Framework

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

Effectiveness Review

Summary Evidence Table – Effectiveness Review
Contains evidence from reviews of< youth development behavioral interventions to prevent or reduce the risk of adolescent pregnancy, HIV, or other STIs when coordinated with community service, with work or vocational training, or with sports or club participation.

Economic Review

Summary Evidence Table – Economic Review

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Allen JP, Philliber S, Herrling S, Kuperminc G. Preventing teen pregnancy and academic failure: experimental evaluation of a developmentally based approach. Child Dev /em>1997;64(4):729-42.

Bayne-Smith MA. Teen Incentives Program: evaluation of a health promotion model for adolescent pregnancy prevention. J Health Educ 1994;25(1):24-9.

Coyle KK, Kirby DB, Robin LE, Banspach SW, Baumler E, Glassman JR. All4You! A randomized trial of an HIV, other STDs, and pregnancy prevention intervention for alternative school students. AIDS education and prevention: official publication of the International Society for AIDS Education 2006;18:187-203.

East P, Kiernan E, Chavez G. An evaluation of California’s Adolescent Sibling Pregnancy Prevention Program. Perspect Sex Reprod Health 2003;35(2):62-70.

Hahn A, Leavitt T, Aaron P. Extending the time of learning. In: Besharov DJ, editor. America’s Disconnected Youth: Toward a Preventive Strategy. Washington (DC): CWLA Press and American Enterprise Institute for Public Policy Research;1994. p. 233-66.

Melchior, A. Summary report: national evaluation of Learn and Serve American school and community based programs. Brandeis University: Center for Human Resources 1999.

O’Donnell L, Stueve A, O’Donnell C, et al. Long-term reductions in sexual initiation and sexual activity among urban middle schoolers in the reach for health service learning program. J Adolesc Health 2002;31(1):93-100.

O’Donnell L, Stueve A, San DA et al. The effectiveness of the Reach for Health Community Youth Service learning program in reducing early and unprotected sex among urban middle school students. Am J Public Health 1999;89(2):176-81.

Philliber S, Allen JP. Life options and community service: teen outreach program. In: Miller BC, Card JJ, editors. Preventing Adolescent Pregnancy: Model Programs and evaluations. Newbury Park: Sage Publications; 1992. p. 139-55.

Schirm A, Rodriguez-Planas N, Maxfield M, Tuttle C. The Quantum Opportunity Program Demonstration: Short-Term Impacts. Washington (DC): Mathematica Policy Research, Inc.; Aug 2003.

Economic Review

Aos S, Lieb R, Mayfield J, Miller M, Pennucci A. Benefits and Costs of Prevention and Early Intervention Programs for Youth. Washington State Institute for Public Policy; Olympia (WA): 2004.

Key JD, Gebregziabher MG, Marsh LD, O’Rourke KM. Effectiveness of an intensive, school-based intervention for teen mothers. J Adolesc Health 2008;42(4):394-400.

Search Strategies

The following outlines the search strategy for reviews of youth development behavioral interventions to prevent or reduce the risk of adolescent pregnancy, HIV, or other STIs when coordinated with community service, with work or vocational training, or with sports or club participation.

To establish the evidence base the team searched eleven computerized databases from 1980 through 2008: CINAHL; MEDLINE; PsycINFO; PubMed (PubMed includes a bit more than just MEDLINE); Sociological Abstracts; Web of Science Science Citation Index; Web of Science Social Science Citation Index; ERIC (education literature); POPLINE (reproductive literature from Johns Hopkins); NTIS (National Technical Information Service) source for locating US, Federal publications (including agency reports); GPO (Government Printing Office) source for locating US, Federal publications (including agencies reports). Medical subject headings (MeSH) searched (including all subheadings) are shown below. The team also scanned bibliographies from key articles and solicited other citations from other team members and subject-matter experts. Conference abstracts were not included because, according to Community Guide criteria, they generally do not provide enough information to assess study validity and to address the research questions.

The search identified over 5000 citations whose titles and abstracts were screened for potential relevance to interventions and outcomes of interest; of these, 64 articles were retrieved for full-text review.

Search terms: used in eleven electronic databases to find studies for inclusion in the systematic reviews of youth development behavioral interventions coordinated with pro-social activities.

Population Groups (Adolescents): adolescent; adolescent health services; adolescent behavior; adolescent; adolescents; adolescence; teen; teens; teenager; teenagers; youth; young; student; students; school; college; undergraduate

Type of Study/Intervention/Program: primary prevention; program evaluation; impact studies; impact study; social change; empirical research; outcome assessment; outcome studies; outcome study; follow-up studies; intervention; education; preventive; prevention; preventing; evaluation; evaluating; promotion; program; outcome; outcomes; initiative; design; life options; youth community service; service learning; life skills; social development; youth development; youth adult partnerships; skill building

Outcomes: sexual behavior; risk-taking; risk reduction behavior; contraception behavior; Acquired Immunodeficiency Syndrome; HIV infections; Sexually Transmitted Diseases; pregnancy in adolescence; sexual abstinence; (postpone or postponing or delay or delaying) and (sex or sexual or sexuality or intercourse); sexual activity; sexual acts; protected sex; sexual involvement; repeated childbearing; repeat pregnancies; parenting; cohabitation; mothers; fertility control

Considerations for Implementation

Content is in development.

Crosswalks

Healthy People 2030

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.