Publication

What Works for Adolescent Sexual and Reproductive Health: Lessons from Experimental Evaluations of Programs and Interventions

Overview

The United States continues to have one of the highest teen birth rates in the developed world,1 and adolescent rates of sexually transmitted infections (STIs) are also high.2 These factors highlight the need to identify effective evidence based programs to improve adolescent reproductive health. This brief synthesizes findings from 118 experimental evaluations of 100 program models. These were evaluations measuring reproductive health of youth and adolescents to determine how frequently these programs work to improve behavioral sexual outcomes such as sexual initiation and activity, number of sexual partners, anal/oral sex, sex under the influence of drugs/alcohol, condom and contraceptive use, sexually transmitted infections (STIs), and pregnancies or births. These programs used a range of program approaches and served a variety of populations in many different settings.

Key Findings

This review identified 56 program evaluations that found positive impacts on sexual behaviors for at least one outcome, including programs that incorporated a variety of approaches, settings, and durations. Our review highlights a number of key findings:

  • Programs that focus on improving parent-youth relationships, particularly communication about sexual behavior and romantic relationships, were frequently found to be effective at reducing teen pregnancy and key determinants.
  • Several implementation components were frequently found to be effective, including programs that incorporate service learning/community service components, those that involve homework (for example, teen conversations with parents), and programs that describe themselves as being culturally-tailored or designed for a specific population, particularly for African American and Latino populations.
  • For every type of program intervention—including comprehensive sex education, abstinence education, youth development, clinic-based approaches, and even early childhood education approaches—some programs were identified as effective.
  • A few implementation components were not frequently found to be effective, including programs that were only delivered didactically (i.e., they did not include any interactive activities, such as role-playing, games, or group discussions), and programs that incorporated job or education preparation components.

Background

The 2013 birth rate of 26.5 per 1,000 teens ages 15 to 19 is 44 percent lower than the 2000 rate, and is the lowest recorded U.S. teen birth rate.3 However, U.S. teen birth rates remain higher than other developed countries’;1 an estimated one in nine teens will have a birth before they reach age 20, and these percentages are even higher among racial and ethnic minorities.4 In particular, black and Hispanic teens have birth rates that are double the rates of whites in the U.S., although many of these differences reflect socio-economic disadvantage among these populations.4 Also, a substantial proportion of teen births (17 percent in 2013) are the teen parents’ second or higher-order births,4 which are linked to greater disadvantage among teen parents and their children.5 Teen childbearing is linked to a host of negative outcomes among teen mothers, their children, and society as a whole. Although many teen parents were disadvantaged before they got pregnant, researchers have found that early parenthood is associated with decreased maternal educational attainment and increased poverty,6 and poorer academic and behavioral well-being among children.7 In fact, recent research has found intergenerational trends in early childbearing, suggesting that improvements in the current generation are linked to greater economic well-being of the next generation in adulthood.8 These factors highlight the need to identify effective evidence-based programs to improve adolescent reproductive health. Key proximal determinants of teen pregnancy and/or STIs include the timing and frequency of sexual activity, the number of sexual partners, and the consistency of use of condoms and other effective methods of contraception. Accordingly, this study highlights programs that have been found to have impacts on not only teen births and STIs, but also key sexual and contraceptive determinants.

About The Study

This brief synthesizes lessons learned from 118 evaluations of reproductive health programs located in Child Trends’ database of social interventions designed for children and youth—LINKS (Lifecourse Interventions to Nurture Kids Successfully). Evaluations were selected if they were implemented primarily with youth under the age of 18, did not target expectant/pregnant and parenting adolescents, and assessed impacts on pregnancies, births, STIs, or the reproductive health behaviors that lead to these outcomes. Although psychosocial outcomes (such as attitudes or intentions) are also important predictors of teen births and STIs, they were not included in this synthesis because of space limitations. The goal was to examine whether and how programs affect outcomes for youth and adolescents, so no limit was placed on the type, structure, frequency, and duration of the programs. Therefore, this synthesis includes programs designed for and specifically targeting reproductive health outcomes, and those which were not aimed at impacting reproductive health outcomes but measured at least one of the following outcomes:

  • Sexual Initiation – the percentage of teens who ever had sex;
  • Frequency or Recency of Sex – how often or how recently youth had had sex; number of sexual partners;
  • Anal/Oral Sex –  the initiation or frequency of anal or oral sex, or number of anal or oral sex partners;
  • Sex Under the Influence of Drugs or Alcohol;
  • Condom Use –  including recent use and consistency;
  • Contraceptive Use – including any use, hormonal method use, use of long-acting reversible methods (LARCs), such as IUDs and implants;
  • Contracting STIs; or
  • Pregnancy or Birth

This review does not focus on the magnitude of the impacts found, but rather the number of statistically significant impacts on measures of reproductive health outcomes. The impacts of the programs reviewed for this brief are reported in the following categories:

The impacts of the programs reviewed for this brief are reported in the following categories:

  • Found to Work: Programs in this category have positive and statistically significant impacts on the majority of measures assessed within each outcome. This would include, for example, a program that found an impact on frequency of condom use and condom use at first sex, but did not find an impact on condom use at last sex. Additionally, programs were considered to have worked if the impact was delayed, such as a program that found no impact on pregnancy at post-test but a positive impact at follow-up.
  • Mixed Findings: Programs in this category have varied impacts on particular outcomes, either at different times, for different subgroups, or on different measures. For example, a program that results in significant reductions in initiation of sex at posttest but has no impact at follow-up would receive a “mixed” coding. A program that works for one subgroup of participants but not for another subgroup (when impacts on the full sample were unreported), would also receive a “mixed” coding. A program that had a positive impact on chlamydia rates, but no impact on gonorrhea rates would receive a “mixed” STI coding.
  • Not Found to Work: Programs in this category have non-significant, marginally significant, or negative impacts on the majority of measures assessed. Note that some programs in this category may have found positive impacts, but they were not found for the majority of subgroups, followups, or measures of the same outcome.

Findings

A wide variety of programs have found impacts on reproductive health outcomes. Our last synthesis9 in 2008 included only about 50 program evaluations that had been implemented and rigorously evaluated. Over the last six years, the number of programs eligible for this synthesis has doubled. This synthesis includes 118 program evaluations of 100 program models. Sixteen of these program models have had one or more replications, including one that was replicated in a setting and population similar to that of the original program implementation, and 15 that differed from the original implementation based on population, setting, or program components.a Due to this variability, we examined each replication as though it were a separate program. To differentiate between these implementations, we included each implementation’s publication year. Because of the wide variety of programs, settings, and target populations, we provide information about each program in Table 1. Overall, 40 of the 118 rigorous evaluations were found to work on at least one reproductive health outcome, and another 16 evaluations had mixed findings. With respect to the specific outcomes:

  • Nine of 52 evaluations worked for initiation of sex, and six had mixed findings;
  • Three of seven evaluations worked for anal/oral sex;
  • Two of 14 evaluations worked for sex under the influence of drugs/alcohol;
  • 17 of 79 evaluations worked for condom use, and eight had mixed findings;
  • Four of 32 evaluations worked for contraceptive use, and five had mixed findings;
  • Four of 24 evaluations worked for contracting STIs, and one had mixed findings; and
  • Eight of 40 evaluations worked for pregnancies or births, and three had mixed findings.

Overall, we found one or more programs with positive impacts for all age groups and race/ ethnicities. Effective programs varied in duration and contact hours, although some program approaches favored certain lengths (discussed in more detail below). Almost all programs incorporated some type of psychosocial skill-building into the program (such as negotiation and refusal skills or healthy relationship skills), while about half of the programs included behavioral skill-building (such as condom-use skills). Some programs were effective for just one gender,b while others worked for both.

Based on the review of reproductive health programs (Table 1), some general statements are possible.

Found to Work

Several types of programs and implementation approaches were generally, though not always, found to work to reduce teen pregnancy or key determinants.

Parent-youth relationship programs. Parent-youth relationship programs are focused on improving parent-youth relationships, particularly communication about sexual behavior and romantic relationships. These programs varied in their implementation approaches; some focused on both parents and teens (for example, in a clinic or home setting), some only had parent participants, and others had only youth participants (who, for example, completed a series of homework assignments with their parents). These programs were generally implemented with younger youth (ages 13 or younger), and many were home-based. Of the 11 parent-youth relationship program evaluations, eight programs worked for at least one outcome and one had mixed findings.c Of the 10 parent-youth program evaluations that measured at least one sexual activity outcome (initiation, frequency, partners, anal or oral sex, or sex under the influence), three worked for at least one outcome and one was mixed – finding impacts for some but not all subpopulations, follow-ups, or measures of the same outcome.d Five of six that measured condom use worked.e The one evaluation that measured pregnancies/births worked.f

In addition to parent-youth relationship programs, 30 additional programs included a parent/family component. These programs incorporated families into the program through a variety of methods – including a parent meeting or training, homework for youth to complete with their families, and providing parents services or referrals to services in the community – but did not make the parent-youth relationship the main focus of the program. Most of these programs took a comprehensive sex education or risk-reduction approach. Ten of these programs worked for at least one reproductive health outcome and four had mixed findings.g

Service learning/community service component. Eleven programs incorporated a service learning or community service component, although the length of time committed to service varied from one visit to a full year. Most programs with a service learning component took a youth development approach or a comprehensive sex education approach, and most were implemented in a school setting. Almost all programs with a service learning component were longer in duration, lasting more than six months and including 20 or more contact hours. Overall, six of the 11 program evaluations worked for at least one outcome.h Of the six program evaluations that measured sexual activity, two worked for at least one outcome.i Two of six that measured condom use worked.j Two of six that measured contraceptive use worked.k Three of seven that measured pregnancies/births worked.l

Homework component. A wide variety of program approaches incorporated homework assignments into the program, and many of these programs also included a family/parent component. Eleven out of 20 programs with a homework component worked, and two had mixed findings for at least one reproductive health outcome.m Of the 17 that measured at least one sexual activity outcome, five worked for at least one of these outcomes.n Of the 12 that measured condom use, five worked and one was mixed.o Of the eight that measured contraceptive use, two worked and two were mixed.p Two of five that measured pregnancies/births worked, and two were mixed.q

Culturally-tailored programs. Twenty-eight programs described themselves as “culturally-tailored,” meaning they were adapted or designed for a specific population. Many of these programs described themselves as incorporating aspects of Latino or African American culture through activities such as role playing, videos, group discussions, or interactive exercises. Several program approaches—including comprehensive sex education, parent-youth relationship, and clinic-based programs—included programs that were described as culturally-tailored. Fifteen of these 28 programs worked for at least one outcome and two had mixed findings.r Of the 27 culturally-tailored programs that measured at least one sexual activity outcome, 11 worked for at least one outcome and one was mixed.s Of the 22 that measured condom use, 10 worked and two were mixed.t Only one program measured contraceptive use, and it did not work. Of two programs that measured pregnancies/births, one was mixed.u

Mixed Findings

Several types of programs and implementation approaches were found to have mixed findings with regard to reducing teen pregnancy or key determinants.

Early childhood programs. While only two programs implemented in early childhood were included in this synthesis, one of these programs worked for reducing teen pregnancies or births. One was a high-quality childcare and preschool program for high-risk children; children were followed until age 21 and the program had an impact on reduced teen pregnancy.v The second—a home-visiting-based program to promote the well-being of first-time, low-income mothers and their children— did not find impacts for the full sample of children, at 15-year follow-up, on initiation of sex, number of partners, or pregnancy.w

Clinic-based programs. Several programs that incorporated a clinic-based approach found impacts on sexual and reproductive health outcomes. Clinic-based programs were designed for implementation in a clinic or were implemented by clinic staff or physicians. Many of these programs targeted adolescents seeking contraceptive services. Nearly all of the clinic-based programs were implemented with older youth ages 14 to 18, and most contained a one-on-one component; fewer were group-based. Clinic-based programs tended to have shorter durations; nearly all lasted less than three months and had less than 10 contact hours with participants. Six out of 14 clinic-based programs worked for at least one outcome, and three had mixed findings.x Of the 11 evaluations that measured at least one sexual activity outcome, two worked for at least one outcome and two were mixed.y Of the 12 that measured condom use, three worked and three were mixed.z Both program evaluations that measured contraceptive use worked.aa One of the two that measured pregnancies/births worked.bb

In addition to clinic-based programs, 13 additional programs implemented a comprehensive sex education, parent-youth relationship, or youth development program in a clinic setting. These programs weren’t specifically designed as clinicbased interventions but were sometimes implemented in a clinic setting. Of these 13 programs, seven worked for at least one outcome and three had mixed findings.cc

Comprehensive sex education programs. A wide variety of comprehensive sex education programs were included in this synthesis; a program was considered to be comprehensive if its key focus was on improving reproductive health outcomes (e.g., preventing pregnancy, increasing STI/HIV knowledge). In general, comprehensive sex education programs promoted abstinence and contraception. Many of the comprehensive sex education programs in this synthesis were administered in a school-based setting, although several took place in community-based organizations. Thirteen of the 47 programs worked for at least one reproductive health outcome and eight had mixed findings—working for one but not all sub-populations, follow-ups, or measures of the same outcome.dd Of the 44 evaluations that measured at least one sexual activity outcome, 11 were of programs that worked for at least one outcome, and four were mixed.ee Overall, comprehensive sex education programs were more likely than other program types to measure anal/oral sex and sex under the influence (see below). Of the 40 that measured condom use, nine worked and five were mixed.ff Of the 17 that measured contraceptive use, one worked and three were mixed.gg One of the eight that measured pregnancies/births had mixed findings.hh

Youth development programs. Several programs in this synthesis focused on youth development, school achievement, or health outcomes (many in combination with reproductive health outcomes), or were designed to increase pro-social behavior such as cooperation and sharing. Youth development programs were longer in duration than other program approaches. Notably, all of the youth development programs that reported program duration lasted more than six months and included more than 20 contact hours. Several of these programs were multi-year intensive programs implemented, at least in part, in schools, and many programs included a job or education-preparation component. Overall, seven of the 17 youth development programs worked for at least one outcome and one had mixed findings.ii It is important to note, however, that seven of the nine programs that did not work for any reproductive health outcome only measured pregnancies/births.jj In fact, only three of the fourteen program evaluations that measured pregnancies/births worked and two were mixed.kk Four out of seven programs that measured at least one sexual activity outcome worked for at least one.ll None of the three program evaluations that measured condom use worked. One out of five worked and two were mixed for contraceptive use.mm

Abstinence education programs. Abstinence-based or abstinence-focused education programs are programs that promote abstinence above all other approaches. Four out of 14 programs worked for at least one outcome and one had mixed findings.nn This is an improvement on our previous synthesis, in which we found that no abstinence programs worked for any outcome.9 More specifically, three out of 13 abstinence education program evaluations that measured at least one sexual activity outcome9 worked for at least one outcome and one was mixed.oo One out of seven programs worked for pregnancies/births.pp None of the abstinence programs that measured condom use (eight), contraceptive use (six), or STIs (five) worked.

Programs with a booster component. Several programs included a booster component—that is, holding one or more additional sessions or meetings by phone or in person with participants after the conclusion of the main program. Booster components were most likely to be an additional program session; however, some programs also incorporated booster phone calls, continued individual services for up to a year, or implemented multiple booster activities including group sessions, newsletters, and individual counseling. Six of the 13 programs with a booster component worked for at least one outcome, and two had mixed findings.qq,rr Three out of 10 program evaluations that measured at least one sexual activity outcome were found to work for at least one of these outcomes, and two were mixed.ss Three out of nine worked and one was mixed for condom use,tt and one out of three was mixed for contraceptive use.uu Two of three programs worked for reducing pregnancies or births.vv

Goal setting. Many programs incorporated goal setting into their implementation, either through homework assignments or group discussions and worksheets, or by encouraging future thinking. A total of 28 programs had participants set goals, and while these programs spanned all program approaches, many of these programs took an abstinence-based, comprehensive sex education, or risk-reduction approach. These programs spanned all settings, ages, and durations. Ten of the 28 programs worked for at least one outcome and four had mixed findings.ww Five out of 23 program evaluations that measured at least one sexual activity outcome worked for at least one and two were mixed.xx Two out of 14 worked and four were mixed for condom use,yy and one out of nine was mixed for contraceptive use.zz One out of eight worked for pregnancies/births.aaa

Programs that incorporated technology. Many of the programs in this synthesis incorporated technology into the program in some way (49 in total). However, almost all of these programs included some video watching, but no other use of technology. A few programs were completely video-based or nearly completely video-based, but may have paired it with another approach, such as counseling. Another small set of programs incorporated technology more fully, as an internet-based intervention. Fifteen of 49 programs with a technology component worked for at least one outcome, and nine were mixed.bbb Of the 46 programs that measured at least one sexual activity outcome, nine worked for at least one of these outcomes and five were mixed.ccc Ten out of 38 programs worked and six were mixed for condom use.ddd One out of 14 programs that measured contraceptive use worked and two were mixed.eee One out of ten programs worked for pregnancies/births.fff

Female-only programs. A few programs in this synthesis were implemented with all-female populations. These programs used a variety of program approaches, but the majority were clinicbased or comprehensive sex education programs. Of the 16 programs that were implemented only with females, eight worked for at least one outcome and three were mixed.ggg Four of the 11 programs that measured at least one sexual activity outcome worked for at least one outcome and one was mixed.hhh Five out of 12 programs worked and two were mixed for condom use.iii One out of three programs worked for contraceptive use.jjj Of the seven female-only programs that measured pregnancies and births, three worked and one was mixed.kkk For comparison, the vast majority of programs were implemented with mixed-gender groups (90 total), and 28 of these worked, 12 were mixed. The remaining nine programs were implemented with male-only populations, and only three of these worked for at least one outcome.lll

Did Not Work

Several types of programs and implementation approaches were not frequently found to be effective at reducing teen pregnancy or key determinants.

Risk-reduction programs. Some programs in this synthesis focused on reducing risky behaviors (such as school dropout, violence, and substance use), but did not focus on reproductive health. Many of the participants in these programs were in juvenile justice, foster care, or residential facilities, and several programs included a job/education preparation component. Overall, only one of the 13 risk-reduction programs worked for at least one reproductive health outcome and two had mixed findings.mmm However, many of these program evaluations did not measure multiple outcomes; 11 of the risk-reduction programs measured a single outcome (five of which only measured pregnancies/births). Two out of the seven program evaluations that measured at least one sexual activity outcome were mixed.nnn The one program evaluation that measured condoms did not work, and neither of the two that measured contraception worked. One of six that measured pregnancies/births worked.ooo

Didactic-only programs. Didactic programs were programs that did not include any interactive activities, such as role-playing, games, or group discussions. These programs were often lecture-based, and the majority were implemented in a school setting. Only three of the 17 didactic programs had mixed findings (none worked).ppp Of the nine that measured at least one sexual activity outcome, two had mixed findings.qqq One of four was mixed for contraceptive use.rrr None of the nine programs that measured condom use, or the seven that measured pregnancy/births, worked. In comparison, 28 of the 68 programs that included interactive activities worked and 11 were mixed for at least one outcome.sss

Job/education preparation component. Many programs incorporated a job or education preparation component, frequently providing tutoring or homework assistance or helping youth find job placements. Several of these programs primarily focused on preparing the participants for getting their GED, returning to school, finding a job, or enlisting in the military, and did not include a reproductive health component. Nearly all of these programs took a risk-reduction or a youth development approach and were long-term, lasting over six months. Overall, only two of the 24 programs with a job/education preparation component worked for at least one outcome, and two had mixed findings.ttt Only one of 12 programs that measured at least one sexual activity outcome worked for at least one of these outcomes, and one was mixed.uuu None of the four programs measuring condom use or the six programs measuring contraception worked, though two were mixed for contraception use.vvv Only one of the 20 programs that measured pregnancies or births worked, and two were mixed.www

Discussion/Needed Research

The number of rigorously-evaluated sexual and reproductive health programs has been expanding, and this review identified almost twice as many evaluations as a previous review in 2008.9 Our tables include 56 programs that were found to work or had a mixed impact on at least one reproductive health outcome or behavior. Of the program approaches reviewed in this study, parent-youth relationship education programs were most frequently found to work (eight out of 11 worked, and one was mixed). The effectiveness of these programs, combined with the positive impact of many programs that incorporate homework components, supports research highlighting the role of parents in adolescent reproductive health behaviors and outcomes.10 Most other approaches were in the “mixed” category (including early childhood programs, clinic-based programs, comprehensive sex education, youth development and abstinence education programs). These findings highlight the fact that there are many types of effective program approaches to improve sexual and reproductive health outcomes among adolescents. The high number of culturally-tailored programs that were found to work helps confirm the need to include activities and scenarios that are relevant to a wide variety of adolescents and keep them engaged in programs. Evaluation findings from those programs that included service learning components confirm previous studies that have found links between community volunteering and program engagement.11

Despite the large sample size and number of findings, our review also highlighted several outcomes and populations that need additional research.

Evaluations of contraceptive use. There has been an increased program and health focus on providing teens with hormonal methods of contraception (such as the pill), long-acting methods (IUDs and implants), and dual methods (combining hormonal methods and condoms to prevent pregnancy and STIs) – and an accompanying interest in programs that have found impacts on these outcomes. However, more than twice as many program evaluations in this synthesis measured condom use (70) as measured contraceptive use (32). Further, among those program evaluations that measured contraceptive use, only five measured hormonal methods (two worked and one had mixed findings),xxx five measured dual method use (one worked and one was mixed),yyy and no programs measured LARC use. The remaining programs only assessed program impacts on a broad measure of any contraceptive use, which does not differentiate between methods.

Evaluations of programs addressing oral or anal sex. Unprotected oral sex and anal sex can lead to STIs,12 yet limited information is available about program approaches that have found impacts on these outcomes. Only seven program evaluations in this synthesis measured anal or oral sex outcomes, three of which worked.zzz Most of these seven programs used a comprehensive sex education approach, and they were primarily implemented in schools. All three of the programs that worked for anal or oral sex were comprehensive sex education programs in a school setting.

Evaluations of programs for older teens and young adults. For many reasons, this synthesis was restricted to programs that were primarily implemented with youth under the age of 18. However, most teen births are to older teens ages 18 to 19.4 Therefore, it would be helpful to identify programs that work for older teens in a future synthesis, potentially extended to include young adults ages 20 to 24, who have the highest rates of unintended pregnancy.13

Evaluations of programs implemented in rural areas. Recent research has highlighted especially high rates of teen pregnancy in rural areas.14 However, we identified few sexual and reproductive health programs that were evaluated in rural communities. Only nine were implemented (at least in part) in rural areas, and only one of these had mixed findings (none worked).aaaa In contrast, 52 were implemented in urban areas, four were implemented in the suburbs, and 56 did not provide information on urbanicity.

Better understanding of implementation quality. Within each type of program approach, we found similar program components incorporated by those programs that worked and those that did not work. Future research should better assess how each program incorporates common implementation components (such as goal setting or technology) and what other aspects of program implementation may contribute to whether programs are effective (such as staffing and youth engagement).

Replications. The best test of an evidence-based program is to assess impacts across replicated evaluation studies. Although this review identified many evaluations of programs that measured impacts on sexual and reproductive health, only 16 of the 99 programs reviewed had one or more replications. Many of those replications occurred with a different target population or setting, making it difficult to assess results when impacts differ across evaluations.

Including outcomes beyond teen pregnancies or births. Several program evaluations measured only a single reproductive health outcome; this was often a measure of teen pregnancies or births. However, very few school-age teens have a pregnancy or birth,4 so many of these evaluations do not have adequate statistical power to measure program impacts on teen pregnancies or births. Youth development programs and risk-reduction programs (many of which did not include reproductive health as a major part of the programming) were most likely to include only a measure of teen pregnancy or births. Future evaluations of these program types should also measure other reproductive health outcomes with higher incidences, such as contraceptive use and sexual risk behaviors.

Future research on these populations and outcomes can help expand the stock of evidencebased reproductive health programs. Evidence suggests that a wide variety of programs can contribute to declines in teen births/STIs and the key determinants; therefore with the expansion of these programs we should see improvements in teen birth and STI rates.

Table

giant table

Footnotes

© Child Trends 2014. May be reprinted with citation.

The support of The Alexander and Margaret Stuart Trust, the JPB Foundation, and the Edna McConnell Clark Foundation is gratefully acknowledged.

Child Trends is a nonprofit, nonpartisan research center that studies children at all stages of development. Our mission is to improve outcomes for children by providing research, data, and analysis to the people and institutions whose decisions and actions affect children. For additional information, including publications available to download, visit our website at childtrends.org.


a All Stars, was combined in our coding because the two implementations were true replications. Note that we include five evaluations of Be Proud! Be Responsible!; for all other programs we only include one replication.

b For example, Aban Aya Project found a positive impact on recent sexual intercourse for males, but no impact on females; Children’s Aid Society (CAS)-Careera Program 2002 found a positive impact on dual method use for females, but no impact for males.

c Worked: Familias Unidas 2009; Familias Unidas 2012; Familias Unidas + Parent-Preadolescent Training for HIV Prevention (PATH); Families Talking Together; Keepin’ it R.E.A.L; Project TALC; REAL Men; STRIVE (Support to Reunite, Involve and Value Each Other); Mixed: New Beginnings

d Worked: Familias Unidas 2012; Families Talking Together; STRIVE Mixed: New Beginnings

e Familias Unidas 2009; Familias Unidas 2012; Familias Unidas + PATH; Keepin’ it R.E.A.L.; REAL Men

f Project TALC

g Worked: Carolina Abecedarian; CAS-Carrera 2002; Get Real; HIV Prevention for Adolescent in Low-Income Housing Developments; It’s Your Game: Keep it Real 2010; MTFC; Positive Action Program; Prime Time; Safer Choices 1999, 2001b; TeenSTAR 2005b; Mixed: Aban Aya Youth Project; CAS-Carrera 2001; Focus on Youth Plus imPACT 2003; It’s Your Game: Keep it Real 2012, 2014

h Keepin’ it R.E.A.L.; Prime Time; Quantum Opportunities Program 1994; Reach for Health Service Learning Project; TOP 1992; TOP 1997

i Worked: Prime Time; Reach for Health Service Learning Project

j Keepin’ it R.E.A.L.; Prime Time

k Prime Time; TOP 1992

l Quantum Opportunities Program 1994; TOP 1992; TOP 1997

m Worked: Carolina Abecedarian; CAS-Carrera 2002; Families Talking Together; Horizons; It’s Your Game: Keep it Real 2010; Keepin’ it R.E.A.L.; Prime Time; REAL Men; Safer Choices 1999, 2001b; TeenSTAR 2005a; TeenSTAR 2005b; Mixed: CAS-Carrera 2001; It’s Your Game: Keep it Real 2012, 2014

n Worked: CAS-Carrera 2002; Families Talking Together; It’s Your Game: Keep it Real 2010; Prime Time; TeenSTAR 2005b

o Worked: Horizons; Keepin’ it R.E.A.L.; Prime Time; REAL Men; Safer Choices 1999, 2001; Mixed: It’s Your Game: Keep it Real 2012, 2014

p Worked: Prime Time; Safer Choices 1999, 2001; Mixed: CAS-Carrera 2001; CAS-Carrera 2002

q Worked: Carolina Abcedarian; TeenSTAR 2005a; Mixed: CAS-Carrera 2001; CAS-Carrera 2002

r Worked: Be Proud! Be Responsible! 1992; Be Proud! Be Responsible! 1999; Be Proud! Be Responsible! 2010; BART; ¡Cuídate!; Familias Unidas 2009; Familias Unidas 2012; Familias Unidas + PATH; Families Talking Together; Get Real; Horizons; Making a Difference 2010; Reach for Health Service Learning Program; SiHLE; Sisters Saving Sisters; Mixed: Aban Aya Youth Project; Project RESPECT 2007

s Worked: BART; Be Proud! Be Responsible! 1992; Be Proud! Be Responsible! 1999; ¡Cuídate!; Familias Unidas 2012; Families Talking Together; Get Real; Making a Difference 2010; Reach for Health Service Learning Program; SiHLE; Sisters Saving Sisters; Mixed: Aban Aya Youth Project;

t Worked: Be Proud! Be Responsible! 1992; Be Proud! Be Responsible! 1999; Be Proud! Be Responsible! 2010; BART; Familias Unidas 2009; Familias Unidas 2012; Familias Unidas + PATH; Horizons; SiHLE; Sisters Saving Sisters; Mixed: ¡Cuídate!; Project RESPECT 2007

u SiHLE

v Carolina Abecedarian Program

w Nurse-Family Partnership; note only the evaluation of the children 15-year outcomes was eligible for our synthesis. Also, note that impacts on subsequent births were found for the mothers.

x Worked: Horizons; Prime Time; Project IMAGE; Project RESPECT 1998; Reproductive Health Counseling for Young Men; Health Improvement Project (HIP) for Teens; Mixed: Health Belief Model Intervention to Increase Condom Use Among High Risk Female Adolescents; Project RESPECT 2007; What Could You Do?

y Worked: Prime Time; HIP for Teens; Mixed: Project RESPECT 2007; What Could You Do?

z Worked: Horizons; Prime Time; HIP for Teens; Mixed: Health Belief Model Intervention to Increase Condom Use Among High Risk Female Adolescents; Project RESPECT 1998; Project RESPECT 2007

aa Prime Time; Reproductive Health Counseling for Young Men

bb HIP for Teens

cc Worked: Becoming a Responsible Teen (BART); Children’s Aid Society (CAS)-Carrera Program 2002; Families Talking Together; Project TALC; Sistering, Informing, Healing, Loving, and Empowering (SiHLE); Sisters Saving Sisters; Washington State Client-Center Pregnancy Prevention Programs; Mixed: CAS-Carrera Program 2001; New Beginnings; Teen Talk

dd Worked: Assisting in Rehabilitating Kids (ARK); Be Proud! Be Responsible! 1992; Be Proud! Be Responsible! 1999; Be Proud! Be Responsible! 2010; BART; ¡Cuídate!; Get Real; HIV Prevention for Adolescents in Low-Income Housing Developments; It’s Your Game: Keep it Real 2010; Promoting Health Among Teens (PHAT)- Comprehensive Abstinence and Safer Sex Intervention; Safer Choices 1999, 2001b; SiHLE; Sisters Saving Sisters; Mixed: Draw the Line/Respect the Line; Focus on Youth 1996a, 1996b;Focus on Youth plus imPACT 2003; HIV Infection Prevention in Mexican Schools; It’s Your Game: Keep it Real 2012, 2014; PSI 2000; SHARP (Sexual Health and Adolescent Risk Prevention) ; Teen Talk

ee Worked: ARK; Be Proud! Be Responsible! 1992; Be Proud! Be Responsible! 1999; BART; ¡Cuídate!; Get Real; HIV Prevention for Adolescents in Low-Income Housing Developments; It’s Your Game: Keep it Real 2010; PHAT- Comprehensive Abstinence and Safer Sex Intervention; SiHLE; Sisters Saving Sisters; Mixed: Draw the Line/Respect the Line; Focus on Youth plus imPACT 2003; PSI 2000; Teen Talk

ff Worked: ARK; Be Proud! Be Responsible! 1992; Be Proud! Be Responsible! 1999; Be Proud! Be Responsible! 2010; BART; HIV Prevention for Adolescents in Low-Income Housing Developments; Safer Choices 1999, 2001b; SiHLE; Sisters Saving Sisters; Mixed: ¡Cuídate!; Focus on Youth 1996a, 1996b; Focus on Youth plus imPACT 2003; It’s Your Game: Keep it Real 2012, 2014; SHARP

gg Worked: Safer Choices 1999, 2001; Mixed: Focus on Youth 1996a, 1996b; HIV Infection Prevention in Mexican Schools; PSI 2000

hh SiHLE

ii Worked: CAS-Carrera 2002; Positive Action Program; Quantum Opportunities Program 1994; Reach for Health Service Learning Program; Teen Outreach Program (TOP) 1992; TOP 1997; Washington State Client-Centered Pregnancy Prevention Programs; Mixed: CAS-Carrera 2001

jj Did not work: Early Intervention Program; Flowers with Care; Job Corps; JOBSTART; Student Training and Reentry (STAR); Twelve Together; Up with Literacy

kk Worked: Quantum Opportunities Program 1994; TOP 1992; TOP 1997; Mixed: CAS-Carrera 2001; CAS-Carrera 2002

ll Worked: CAS-Carrera 2002; Positive Action Program; Reach for Health Service Learning Program; Washington State ClientCentered Pregnancy Prevention Programs

mm Worked: TOP 1992; Mixed: CAS-Carrera 2001; CAS-Carrera 2002

nn Worked: Making a Difference 2010; Positive Prevention; TeenSTAR 2005a; TeenSTAR 2005b; Mixed: Choosing the Best

oo Worked: Making a Difference 2010; Positive Prevention; TeenSTAR 2005b; Mixed: Choosing the Best

pp TeenSTAR 2005a

qq Worked: Familias Unidas 2009; Families Talking Together; Horizons; Making a Difference 2010; MTFC; HIP for Teens; Mixed: Focus on Youth plus imPACT 2003; Postponing Sexual Involvement (PSI) 2000

rr However, one of these programs, Focus on Youth plus imPACT 2003, did not have a positive impact after the booster session was held. The evaluation found positive impacts on condom use and frequency of sex at the six-month follow-up and no impact at the 12-month follow-up; the booster session was held at seven months. Additionally, the 2010 evaluation of Making a Difference and Making Proud Choices randomly assigned a booster to some participants; analyses of the booster were performed to determine its effectiveness. The evaluation found that the booster enhanced the efficacy of Making a Difference in reducing multiple partners compared with the control group, but did not enhance efficacy of other outcomes. The booster did not enhance the efficacy of Making Proud Choices for any outcomes.

ss Worked: Families Talking Together; Making a Difference! 2010; HIP for Teens; Mixed: Focus on Youth plus imPACT 2003; PSI 2000

tt Worked: Familias Unidas 2009; Horizons; HIP for Teens; Mixed: Focus on Youth plus imPACT 2003

uu PSI 2000

vv MTFC; HIP for Teens

ww Worked: Keepin’ it R.E.A.L.; Making a Difference 2010; Positive Action Program; Positive Prevention; Project IMAGE; Project RESPECT 1998; Project TALC; Reach for Health Service Learning Program; REAL Men; Washington State Client-Center Pregnancy Prevention Programs; Mixed: Focus on Youth 1996a, 1996b; Project AIM (Adult Identity Mentoring); Project RESPECT 2007; SHARP

xx Worked: Making a Difference 2010; Positive Action Program; Positive Prevention; Reach for Health Service Learning Program; Washington State Client-Centered Pregnancy Prevention Programs; Mixed: Project AIM; Project RESPECT 1998

yy Worked: Keepin’ it R.E.A.L.; REAL Men; Mixed: Focus on Youth 1996a, 1996b; Project RESPECT 1998; Project RESPECT 2007; SHARP

zz Focus on Youth 1996a, 1996b

aaa Project TALC

bbb Worked: ARK; Be Proud! Be Responsible! 1992; Be Proud! Be Responsible! 1999; Be Proud! Be Responsible! 2010; BART; ¡Cuídate!; HIV Prevention for Adolescents in Low-Income Housing Developments; Horizons; It’s Your Game: Keep it Real 2010; Keepin’ it R.E.A.L.; Making a Difference! 2010; Quantum Opportunities Program 1994; REAL Men; Reproductive Health Counseling for Young Men; Sisters Saving Sisters; Mixed: Focus on Youth 1996a, 1996b; Focus on Youth plus imPACT 2003; It’s Your Game: Keep it Real 2012, 2014; New Beginnings; PSI 2000; Project RESPECT 2007; SHARP; Teen Talk; What Could You Do?

ccc Worked: ARK; Be Proud! Be Responsible! 1992; Be Proud! Be Responsible! 1999; BART; ¡Cuídate!; HIV Prevention for Adolescents in Low-Income Housing Developments; It’s Your Game: Keep it Real 2010; Making a Difference! 2010; Sisters Saving Sisters; Mixed: Focus on Youth plus imPACT 2003; New Beginnings; PSI 2000; Teen Talk; What Could You Do?

ddd Worked: ARK; Be Proud! Be Responsible! 1992; Be Proud! Be Responsible! 1999; Be Proud! Be Responsible! 2010; BART; HIV Prevention for Adolescents in Low-Income Housing Developments; Horizons; Keepin’ it R.E.A.L.; REAL Men; Sisters Saving Sisters; Mixed: ¡Cuídate!; Focus on Youth 1996a, 1996b; Focus on Youth plus imPACT 2003; It’s Your Game: Keep it Real 2012, 2014; Project RESPECT 2007; SHARP

eee Worked: Reproductive Health Counseling for Young Men; Mixed: Focus on Youth 1996a, 1996b; PSI 2000;

fff Quantum Opportunities Program 1994

ggg Worked: Horizons; MTFC; Prime Time; Project IMAGE; HIP for Teens; SiHLE; Sisters Saving Sisters; TeenSTAR 2005a; Mixed: Health Belief Model Intervention to Increase Condom Use Among High Risk Female Adolescents; Project RESPECT 2007; What Could You Do?

hhh Worked: Prime Time; SiHLE; Sisters Saving Sisters; HIP for Teens; Mixed: What Could You Do?

iii Worked: Horizons; Prime Time; HIP for Teens; SiHLE; Sisters Saving Sisters; Mixed: Health Belief Model Intervention to Increase Condom Use Among High Risk Female Adolescents; Project RESPECT 2007

jjj Prime Time

kkk Worked: MTFC; HIP for Teens; TeenSTAR 2005a; Mixed: SiHLE

lll Be Proud! Be Responsible! 1992; REAL Men; Reproductive Health Counseling for Young Men

mmm Worked: MTFC; Mixed: Aban Aya Youth Project; Project AIM

nnn Aban Aya Youth Project; Project AIM

ooo MTFC

ppp Aban Aya Youth Project; Choosing the Best; HIV Infection Prevention in Mexican Schools

qqq Aban Aya Youth Project; Choosing the Best

rrr HIV Infection Prevention in Mexican Schools

sss Worked: Be Proud! Be Responsible! 1992; Be Proud! Be Responsible! 1999; Be Proud! Be Responsible! 2010; BART; CAS-Carrera 2002; ¡Cuídate!; Familias Unidas 2009; Familias Unidas 2012; Familias Unidas + PATH; Horizons; It’s Your Game: Keep it Real 2010; Keepin’ it R.E.A.L.; Making a Difference! 2010; Positive Action Program; Positive Prevention; Project RESPECT 1998; PHATComprehensive Abstinence and Safer Sex Intervention; Reach for Health Service Learning Program; REAL Men; Safer Choices 1999, 2001b; HIP for Teens; SiHLE; Sisters Saving Sisters; STRIVE; TOP 1992; TOP 1997; TeenSTAR 2005a; TeenSTAR 2005b; Mixed: Carrera 2001; Draw the Line/Respect the Line; Focus on Youth 1996a, 1996b; Focus on Youth plus imPACT 2003; Health Belief Model Intervention; It’s Your Game: Keep it Real 2012, 2014; New Beginnings; PSI 2000; Project RESPECT 2007; SHARP; Teen Talk

ttt Worked: CAS-Carrera 2002; Quantum Opportunities Program 1994; Mixed: CAS-Carrera 2001; Project AIM

uuu Worked: CAS-Carrera 2002 Mixed: Project AIM

vvv CAS-Carrera 2001; CAS-Carrera 2002

www Worked: Quantum Opportunities Program 1994; Mixed: CAS-Carrera 2001; CAS-Carrera 2002

xxx Worked: CAS-Carrera 2001; Reproductive Health Counseling for Young Men; Mixed: Prime Time

yyy Worked: Prime Time ; Mixed: CAS-Carrera 2002

zzz Be Proud! Be Responsible! 1992; Be Proud! Be Responsible! 1999;It’s Your Game: Keep it Real 2010;

aaaa Choosing the Best

Citations

1 United Nations. (2013). 2012 Demographic yearbook. New York, New York. Retrieved September 18, 2014, from http://unstats.un.org/unsd/demographic/products/dyb/dybsets/2012.pdf

2 Centers for Disease Control. (2014). Sexually transmitted disease surveillance, 2012. Atlanta, Georgia: Division of STD Prevention. Retrieved September 18, 2014, from http://www.cdc.gov/std/stats12/Surv2012.pdf

3 Martin, J. A., Hamilton, B. E., & Osterman, M. J. K. (2014). Births in the United States, 2013. Hyattsville, MD: Centers for Disease Control. Retrieved December 5, 2014, from http://www.cdc.gov/nchs/data/databriefs/db175.pdf

4 Hamilton, B. E., Martin, J. A., Osterman, M. J. K., & Curtin, S. C. (2014). Births: Preliminary data for 2013. Hyattsville, MD: National Center for Health Statistics. Retrieved August 20, 2014, from http://www.cdc.gov/nchs/ data/nvsr/nvsr63/nvsr63_02.pdf

5 Klerman, J. A. (2004). Another chance: preventing additional births to teen mothers. Washington, DC: The National Campaign to Prevent Teen Pregnancy.

6 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.

7 Martinez, G., Copen, C. E., & Abma, J. C. (2011). Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2006-2010 National Survey of Family Growth. Washington, DC: National Center for Health Statistics. Retrieved August 6, 2014, from http://www.cdc.gov/nchs/data/series/sr_23/sr23_031.pdf

8 Moore, K., Sacks, V., Manlove, J., & Sawhill, I. (2014). “What if” you earned a diploma and delayed parenthood? Bethesda, MD: Child Trends. Retrieved August 20, 2014, from https://www.childtrends.org/wp-content/ uploads/2014/12/2014-27SocialGenomeDelayChildbearing.pdf

9 Ball, V., & Moore, K. (2008). What works for adolescent reproductive health: Lessons from experimental evaluations of programs and interventions. Washington, DC: Child Trends. Retrieved September 19, 2014, from https://www.childtrends.org/?publications=what-works-for-adolescent-reproductive-health-lessons-fromexperimental-evaluations-of-programs-and-interventions-2

10 Kirby, D., & Lepore, G. (2007). Sexual risk and protective factors: factors affecting teen sexual behaviors, pregnancy, childbearing, and sexually transmitted disease. Washington, DC: The National Campagin to Prevent Teen and Unplanned Pregnancy, ETR Associates.

11 Kirby, D. (2007). Emerging Answers 2007: research findings on programs to reduce teen pregnancy and sexually transmitted diseases. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy. Retrieved September 12, 2013, from http://www.thenationalcampaign.org/EA2007/EA2007_full.pdf

12 Centers for Disease Control and Prevention. (2010). Sexually transmitted diseases treatment guidelines, 2010. Washington, DC: Morbidity and Mortality Weekly Report. Vol. 59 No. RR-12. Retrieved June 17, 2013, from http:// www.cdc.gov/std/treatment/2010/STD-Treatment-2010-RR5912.pdf

13 Finer, L. B., & Zolna, M. R. (2011). Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception, 84(5), 478-485.

14 National Campaign to Prevent Teen and Unplanned Pregnancy. (2013). Teen childbearing in rural America. Retrieved October 3, 2014, from https://thenationalcampaign.org/sites/default/files/resource-primary-download/ ss47_teenchildbearinginruralamerica.pdf

Authors