HIV, Other STIs, and Teen Pregnancy: Youth Development Behavioral Interventions to Reduce Sexual Risk Behaviors in Adolescents Coordinated with – Work or Vocational Training

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Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to support youth development behavioral interventions coordinated with employment or vocational training to reduce sexual risk behaviors among adolescents. Evidence is considered insufficient because effect estimates were small and inconsistent across the body of evidence.

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 CPSTF 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

Work or vocational training experience includes opportunities in business; health; auto mechanics and repair; heavy equipment operation; or paid work at day camps, child care centers, and parks and recreation programs. This experience provides opportunities for adolescents to interact with adults in the work place and aims to assist them in forming a positive adult identity, as well as a sense of responsibility, dependability, and punctuality.

CPSTF Finding and Rationale Statement

Read the CPSTF finding [PDF 133 KB.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 5 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

Five studies qualified for the review.
  • The included studies targeted recruited adolescents (ages 10 19 years), had some sexual risk reduction content, and had to include sexual risk behavior outcomes.
  • Self-reported pregnancy: median decrease of 0.8% (interquartile interval:-42% to 4%) among program participants (5 studies)
  • Self-reported sexual risk behaviors: mixed results (4 studies)
  • Five additional studies examined the relationship between work intensity and problem behaviors. In general, problem behaviors were associated with working more than 20 hours per week, which suggests that students who maintain higher intensity work schedules (i.e. more than half-time) during school are more likely to experience problems with emotional distress, substance abuse, and sexual risk behaviors.

Summary of Economic Evidence

An economic review of this intervention was not conducted because CPSTF did not have enough information to determine if the intervention works.

Applicability

Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

No content is available for this section.

Study Characteristics

No content is available for this section.

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.

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

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.

Schochet PZ, Burghardt J, Glazerman S. 2000. National Job Corps Study: the short-term impacts of Job Corps on participants’ employment and related outcomes. Mathematica Policy Research, Inc.

Walker G & Villela-Velez F. Anatomy of a Demonstration. The Summer Training and Education Program (STEP) from Pilot through Replication and Postprogram Impacts. 1992. Public/Private Ventures.

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

CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.