Programs to improve adolescent sexual and reproductive health in the US: a review of the evidence

Adolescent Health, Medicine and Therapeutics Dovepress open access to scientific and medical research Review Adolescent Health, Medicine and Therapeutics downloaded from https://www.dovepress.com/ For personal use only. Open Access Full Text Article Programs to improve adolescent sexual and reproductive health in the US: a review of the evidence This article was published in the following Dove Press journal: Adolescent Health, Medicine and Therapeutics 7 April 2015 Number of times this article has been viewed Jennifer Manlove Heather Fish Kristin Anderson Moore Child Trends, Bethesda, MD, USA Background: US adolescents have high rates of teen pregnancy, childbearing, and sexually transmitted infections (STIs), highlighting the need to identify and implement effective programs that will help improve teen sexual and reproductive health. Materials and methods: This review identified 103 random-assignment evaluations of 85 programs that incorporated intent-to-treat analyses and assessed impacts on pregnancy, childbearing, STIs, and their key determinants – sexual activity, number of sexual partners, condom use, and other contraceptive use – among teens. This review describes the evidence base for five broad program approaches, including abstinence education, comprehensive sex education, clinic-based programs, youth development programs, and parent–youth relationship programs. We also describe programs with impacts on key outcomes, including pregnancy/childbearing, STIs, and those that found impacts on both sexual activity and contraceptive use. Results: Our review identified 52 effective programs: 38 with consistent impacts on reproductive health outcomes, and 14 with mixed findings (across subpopulations, follow-ups, or multiple measures of a single outcome). We found that a variety of program approaches produced impacts on sexual and reproductive health outcomes. Parent–youth relationship programs and clinicbased program evaluations more frequently showed impacts than other program approaches, although we also identified a number of abstinence-education, comprehensive sex education, and youth-development programs with impacts on sexual and reproductive health outcomes. Overall, we identified nine program evaluations with impacts on teen pregnancies or births, five with impacts on reducing STIs, and 15 with impacts on both delaying/reducing sexual activity and increasing contraceptive use (including condom use). Conclusion: Future efforts should conduct replications of existing program evaluations, identify implementation components linked to impacts, rigorously evaluate programs that appear promising, and expand the evidence base on programs that impact hormonal and long-acting contraceptive method use. Keywords: reproductive health, evidence-based programs, teen pregnancy, adolescence Introduction Correspondence: Jennifer Manlove Child Trends, 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814, USA Email US teen-birth rates have declined across several decades, and the 2013 birth rate of 26.5 births per 1,000 teens ages 15–19 years was the lowest recorded birth rate.1 However, US teen-birth rates remain higher than those in other developed countries, and are 1.5 times the rate in the UK, more than two times the rate in Canada, and more than five times the rate in Sweden.2 Currently, an estimated one in nine teens in the US will have a birth before they reach age 20 years (Child Trends, unpublished data, 2014). Notably, the majority of teen births (77%) are unintended, including 58% that occurred sooner than the teen planned and 19% that were unwanted.3 Teen-birth rates are especially high among 47 submit your manuscript | www.dovepress.com Adolescent Health, Medicine and Therapeutics 2015:6 47–79 Dovepress © 2015 Manlove et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php http://dx.doi.org/10.2147/AHMT.S48054 Dovepress Manlove et al racial and ethnic (Child Trends, unpublished data, 2014); black and Hispanic teens have birth rates that are double the rate of whites in the US, although many of these differences reflect the socioeconomic disadvantage of these populations.4 Teen childbearing is linked to a host of negative outcomes among teen parents, their children, and society as a whole. Despite the fact that many teen parents were disadvantaged before they became parents, researchers have found associations between early parenthood and lower educational attainment and higher poverty rates among mothers5 and poorer academic and behavioral well-being among their children.6 Moreover, some research has found links between delaying childbearing in one generation (with an accompanying increase in educational attainment) and greater economic well-being of the next generation.7 Also, a substantial proportion of teen births (17% in 2013) are higher-order births,8 which are linked to even greater disadvantage among teen parents and their children.9 Moreover, teen childbearing costs US taxpayers billions of dollars through public assistance payments and through social services, such as health care and child welfare.10 US adolescents also have high rates of sexually transmitted infections (STIs). Almost half of the 20 million STIs that are reported in the US each year occur in adolescents and young adults.11 One study of sexually active teen females (ages 14–19 years) found that almost four in ten had at least one of five common STIs.12 STIs are an ongoing threat to adolescent health and well-being, and if left untreated they can lead to infertility, pregnancy complications, organ damage, and even death.13 These factors highlight the need to identify a variety of effective evidence-based programs that have found impacts on improving adolescent reproductive health through rigorous evaluations. Key determinants of teen pregnancy and/or STIs include the timing and frequency of sexual activity, the number of sexual partners, and the consistent use of condoms and other effective methods of contraception. Almost half of high school teens have ever had sexual intercourse, including nearly two-thirds of 12th graders.14 Teens who are younger at first sex are less likely to use contraception, and are at a greater subsequent risk of a teen birth or STI.6 Although many US teens report using contraception at last sex (86% of 15- to 19-year-old females and 93% of 15- to 19-year-old males in 2006–2010), less than half of female teens use hormo (...truncated)