Guide to community preventive services
The Effectiveness of Group-Based Comprehensive Risk-Reduction and Abstinence Education Interventions to Prevent or Reduce the Risk of Adolescent Pregnancy, Human Immunodeficiency Virus, and Sexually Transmitted Infections: Two Systematic Reviews for the Guide to Community Preventive Services

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Context

Adolescent pregnancy, HIV, and other sexually transmitted infections (STIs) are major public health problems in the U.S. Implementing group-based interventions that address the sexual behavior of adolescents may reduce the incidence of pregnancy, HIV, and other STIs in this group.

Evidence acquisition

Methods for conducting systematic reviews from the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of two strategies for group-based behavioral interventions for adolescents: (1) comprehensive risk reduction and (2) abstinence education on preventing pregnancy, HIV, and other STIs. Effectiveness of these interventions was determined by reductions in sexual risk behaviors, pregnancy, HIV, and other STIs and increases in protective sexual behaviors. The literature search identified 6579 citations for comprehensive risk reduction and abstinence education. Of these, 66 studies of comprehensive risk reduction and 23 studies of abstinence education assessed the effects of group-based interventions that address the sexual behavior of adolescents, and were included in the respective reviews.

Evidence synthesis

Meta-analyses were conducted for each strategy on the seven key outcomes identified by the coordination team—current sexual activity; frequency of sexual activity; number of sex partners; frequency of unprotected sexual activity; use of protection (condoms and/or hormonal contraception); pregnancy; and STIs. The results of these meta-analyses for comprehensive risk reduction showed favorable effects for all of the outcomes reviewed. For abstinence education, the meta-analysis showed a small number of studies, with inconsistent findings across studies that varied by study design and follow-up time, leading to considerable uncertainty around effect estimates.

Conclusions

Based on these findings, group-based comprehensive risk reduction was found to be an effective strategy to reduce adolescent pregnancy, HIV, and STIs. No conclusions could be drawn on the effectiveness of group-based abstinence education.

Section snippets

Context

This paper presents the results of systematic reviews of effectiveness in preventing pregnancy, HIV, and other sexually transmitted infections (STI) of two group-based behavioral interventions for adolescents: (1) comprehensive risk reduction and (2) abstinence education. Intervention effectiveness was assessed on sexual behaviors (such as delayed initiation of intercourse, or use of condoms by sexually active adolescents) and biologic outcomes (including incidence of pregnancy and STIs). The

Background

Adolescent pregnancy, HIV, and other STIs are major public health problems in the U.S. The national teen birth rate (among women aged 15–19 years) decreased 37% (from 61.8 to 39.1 births per 1000) from 1991 to 2009.3 Between 2008 and 2009 among non-Hispanic white teens there was a decrease in birth rate from 26.7 to 25.6 births per 1000 teenagers; among non-Hispanic black teens from 62.9 to 59.0 births per 1000 teenagers; and among Hispanic teens from 77.4 to 70.1 births per 1000 teenagers.3, 4

Recommendations from Other Advisory Groups

Several other groups have made recommendations on the use of sex education for adolescents. The American Academy of Pediatrics25 recommends that pediatricians “encourage sexual abstinence as part of comprehensive sexuality education and services offered to their adolescent patients.” The American Academy of Family Physicians26 has similar recommendations, which promote an evidence-based comprehensive approach to sex education to prevent adolescent pregnancy and STI transmission. Specifically,

Evidence Acquisition

The general methods for conducting a Community Guide systematic review are described elsewhere.28, 29 Specific methods used for this review are described in depth in the accompanying article.30 Oversight for all stages of the systematic review was provided by a Coordination Team (the team) of 20 members—including systematic review methodologists and individuals with relevant research, policy, and programmatic expertise in comprehensive risk-reduction and abstinence education interventions and

Effectiveness

The review identified 66 studies34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96 (88 study arms) that used a comprehensive risk-reduction strategy, including one paper64 that provided information on two studies and another paper55 that provided information on three studies. Of these 66 studies,

Discussion

These two reviews summarize the evidence for Task Force conclusions on comprehensive risk-reduction and abstinence education interventions delivered to adolescents to prevent or reduce the risk of pregnancy, HIV, and other STIs.

Conclusion

The value of these reviews is that they looked systematically and thoroughly across the entire identified body of evidence for trends, and the conclusions reached considered both the overall effects in the two reviews and extensive secondary analyses. They also serve as the foundation for the recommendations made by the Task Force on comprehensive risk-reduction and abstinence education interventions delivered to adolescents.1 Findings from the comprehensive risk-reduction review showed these

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    The names and affiliations of Task Force members are listed at www.thecommmunityguide.org/about/task-force-members.html.

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