An evidence-based approach to teen pregnancy prevention

We’ve all heard stories about critical turning points in adolescents’ lives: an inspirational mentor that helped a young man make a daunting decision, or a conversation that inspired a young woman’s career goals. But how can we ensure that these positive changes happen for more youth? And how can we be confident that our efforts to improve young peoples’ lives are actually working?

That’s where program evaluation comes in. Rigorous and systematic assessment of social programs can help identify which approaches promote the healthy development of youth—and under what circumstances.

The need for such assessment is particularly urgent in the field of teen pregnancy prevention. Although U.S. teen birth rates have declined by 61 percent in the last two decades, they are still higher than rates in many other industrialized countries, especially among Hispanic and black youth. Research also tells us that most teen births are unintended. This is cause for concern, since teen parents tend to face more challenges than other teens, as do their children. For example, teen parents are less likely to finish high school and more likely to rely on public assistance[i], especially soon after birth, than their counterparts who delay childbearing.

While this is not every teen parent’s story, it is true for many. In order to reduce teen pregnancy, sexually transmitted infections, and sexual risk behaviors, we have to identify which practices help teen pregnancy prevention programs work for diverse groups of youth.

Coming Soon: New Evaluations of Evidence-Based Teen Pregnancy Prevention Programs

A wide range of programs aim to help reduce teen pregnancy. Only some of these are evidence-based—that is, they’ve been shown to have a positive impact on preventing teen pregnancy or risky sexual behavior in at least one prior evaluation.

Through its national Teen Pregnancy Prevention (TPP) program, the Office of Adolescent Health (OAH) has brought evidence-based TPP approaches to service providers around the country since 2010. They also fund the development and evaluation of new and innovative approaches to prevent teen pregnancy. This is one of the first federal efforts to rigorously evaluate evidence-based teen pregnancy-prevention programs, and findings from these evaluations will be released in the coming months.

In anticipation of these results, what’s important to keep in mind?

As with any intervention, it is challenging work to implement teen pregnancy prevention programs and then assess whether they work. Although designers take pains when creating these programs, real-world implementation, with real people, always presents complications, and may change how the programs are ultimately delivered. When reviewing evaluation findings, it is important to keep the following considerations in mind.

Communities and context

Communities with high teen birth rates tend to be poor and have large numbers of racial and ethnic minorities. Many TPP programs are targeted to vulnerable teens; however, the very disadvantages many of these teens face often influence their ability to participate in a teen pregnancy prevention program. For example, vulnerable youth often lack reliable transportation and are therefore more likely to miss program sessions. Some programs are held in school settings for improved accessibility, but low-income students are also less likely to attend school. For these and other reasons, they may not attend enough sessions of the program to assess whether it works or not. These types of complications can bias, or limit, the observed impacts of a program.

Furthermore, the needs of many teens vary depending on a range of factors, including where they live. Programs that were originally designed for urban teens, for example, may not fully address the needs of rural teens. Evaluation can play a critical role in determining which aspects of programs are effective for all teens and which should be adapted for teens in different contexts.

Staying true to the program

Anyone who implements TPP programs is expected to deliver the program with fidelity. This means all core components of the curriculum must be delivered as originally specified or with approved adaptations. In some cases, however, real-world obstacles can unexpectedly disrupt the implementation of the program. For those school-based TPP programs, many issues—from problem student behavior to weather-related cancelations—can reduce the number of program sessions completed or limit the content covered. These changes to the program can influence evaluation results, in many cases reducing the observed impact.

Thinking about the control group

To assess or evaluate whether a program works, researchers compare the outcomes of two different groups of people—in this case, randomly selected participants in the TPP program (the “treatment” group) are compared to those who aren’t selected to participate (the “control” group). However, youth in the control group can take part in any number of other programs, including those already offered in the community and schools. Youth in the control group may therefore learn material that is similar to the content in the TPP program, and evaluation results for TPP programs could show limited observed impacts as a result.

Rigorous evaluation of teen pregnancy prevention programs is an essential investment in adolescent well-being because it provides the key information needed to improve the quality and effectiveness of these programs. Despite real-world challenges, OAH’s upcoming findings will provide a wealth of information on what works—and who it works for—that in turn will inform evidence-based policy initiatives and improve the lives of young people.

[i] Hoffman, S. D., & Maynard, R. A. (Eds.). (2008). Kids having kids: economic costs and social consequences of teen pregnancy (2nd ed.). Washington, DC: Urban Institute Press.