Prevention of HIV/AIDS, other STIs and Pregnancy: Abstinence Education Interventions
Task Force Findings and Rationale Statement
Definition
Abstinence Education (AE) promotes abstinence from sexual activity (either delayed initiation or abstinence until marriage) and mentions condoms or other birth control methods only to highlight their failure rates if at all. These interventions generally include messages regarding 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 to 19 years old). These interventions could also include other components, such as media campaigns and community service events.
Finding
The Task Force concludes that there is insufficient evidence to determine the effectiveness of group-based abstinence education delivered to adolescents to prevent pregnancy, HIV and other sexually transmitted infections (STIs). Evidence was considered insufficient due to 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 Used 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.
- Page last reviewed: March 9, 2010
- Page last updated: March 9, 2010
- Content source: The Guide to Community Preventive Services
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