Preventing HIV/AIDS, other STIs and Pregnancy: Group-Based Abstinence Education Interventions for Adolescents
Task Force Finding and Rationale Statement
Definition
Abstinence Education (AE) interventions promote abstinence from sexual activity (either delayed initiation or abstinence until marriage) and mention condoms or other birth control methods only to highlight their failure rates if at all. These interventions usually include messages about the psychological and health benefits of abstinence, and most adhere to eight federal guidelines required to obtain federal funding (the Federal A-H guidelines). This review evaluated AE interventions delivered in school or community settings to groups of adolescents (10–19 years old). These interventions could also include other components, such as media campaigns and community service events.
Task Force Finding
The Community Preventive Services Task Force finds insufficient evidence to determine the effectiveness of group-based abstinence education interventions delivered to adolescents to prevent pregnancy, HIV and other sexually transmitted infections (STIs). Evidence was considered insufficient because of inconsistent results across studies.
Rationale
Our review identified 21 studies and 23 study arms that used an abstinence education (AE) strategy. The summary statistics for each outcome are listed in the table below.
Meta-Analysis Results: Abstinence Education |
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Outcomes a |
# of observations |
OR |
95% CI |
Estimated RR |
Sexual Activity b |
23 |
0.81 |
0.70, 0.94 |
0.84 |
Frequency of Sexual Activity b |
5 |
0.77 |
0.57, 1.04 |
c |
Number of Partners |
10 |
0.96 |
0.83, 1.11 |
0.96 |
Unprotected Sexual Activity |
5 |
1.07 |
0.86, 1.33 |
1.06 |
Protection d |
19 |
1.06 |
0.96, 1.17 |
1.06 |
Condom Use d |
10 |
1.04 |
0.91, 1.19 |
1.03 |
Oral Contraceptive Use d |
9 |
1.08 |
0.94, 1.24 |
1.05 |
Sexually Transmitted Infections b |
9 |
1.08 |
0.90, 1.29 |
1.08 |
Pregnancy b |
10 |
1.15 e |
1.00, 1.32 |
1.15 |
HIV b |
0 |
-- |
-- |
-- |
a All of these outcomes were self-reported, with the exception of STIs, which were either self reported or clinically documented. |
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Twenty-one studies were included in the body of evidence for the AE strategy. The effect estimates differed substantially by study design. For the self-reported sexual activity outcome, which was the only one with a sufficient number of controlled before- after (CBA) studies to directly compare randomized controlled trials (RCTs) versus CBA studies, the effect estimate was 0.94 (95% CI 0.81, 1.10) for RCTs and 0.66 for CBAs (95% CI 0.54, 0.81), and this difference was statistically significant (p=.007). For the remaining outcomes of interest, the body of evidence was primarily from RCTs and showed no clear evidence of benefits or harms. Because RCTs and CBAs systematically differed in several respects in addition to study design (e.g., follow-up time, multiple studies conducted by same researchers), it is hard to determine the explanation for the observed differences by study design. As a result, it is difficult to ascertain the public health benefits or harms of abstinence education.
Review completed: June 2009
- Page last reviewed: March 11, 2013
- Page last updated: March 11, 2013
- Content source: The Guide to Community Preventive Services
