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Preventing HIV/AIDS, Other STIs, and Teen 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 could also include other components, such as media campaigns and community service events.

This review evaluated AE interventions delivered in school or community settings to groups of adolescents (10–19 years old), and most adhered to eight federal guidelines that were required to obtain federal funding (the Federal A-H guidelines).

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

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.
b These outcomes reflect primary intended outcomes.
c Unable to calculate
d Odds ratio (OR)>1.0 indicate beneficial effects.
e Secondary analyses suggest that this is an unreliable effect estimate.
CI = Confidence Interval
RR = Relative Risk

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