HIV, Other STIs, and Teen Pregnancy: Youth Development Behavioral Interventions to Reduce Sexual Risk Behaviors in Adolescents Coordinated with Community Service
Summary of CPSTF Finding
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:
- Work or vocational training (insufficient evidence)
- Sports or club participation (insufficient evidence)
- Social, emotional, or cognitive competence training that promotes pro-social norms
- Improved decision making
- 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
About The Systematic Review
Summary of Results
- 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
- 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.
- 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.
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
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.
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.
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.
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
Healthy People 2030
Healthy People 2030 includes the following objectives related to this CPSTF recommendation.