Preventing HIV/AIDS, other STIs and Pregnancy: Group-Based Abstinence Education Interventions for Adolescents

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.

Summary of Task Force Recommendations & Findings

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 is considered insufficient because of inconsistent results across studies.

Task Force Finding and Rationale Statement

About the Intervention

Interventions may be:

• Targeted to adolescents
  • Girls only
  • Boys only
  • Girls and boys together
• Delivered in group settings in schools or communities
• Led by adult or peer educators
• Implemented as single or multicomponent programs
• Tailored to groups or individuals

Content of these interventions may address prevention of:

• HIV and STIs
• Pregnancy

Results from the Systematic Review

Twenty-one studies with 23 study arms qualified for analysis in this review. The meta-analyses found the following results for primary outcomes:

• Sexual activity: decrease of approximately 16% (odds ratio [OR]=0.81, 95% confidence interval [CI] 0.70, 0.94; 21 study arms)
  • This decrease is statistically significant, however, effect estimates differed by study design with larger effects for nonrandomized controlled trials compared to randomized controlled trials.
  • Studies with both designs had problems such as differences in follow-up time and multiple studies conducted by the same investigators.
• Frequency of sex OR=0.77, 95% CI 0.57, 1.04 ( 5 study arms)
  • This result, although in the favorable direction (decrease in frequency), is statistically nonsignificant. Also, effect estimates differed by study design with larger effects for nonrandomized controlled trials compared to randomized controlled trials.
• STIs: increase of approximately 8% that was  statistically nonsignificant (OR=1.08, 95% CI 0.90, 1.29; 9 study arms)
• Pregnancy: increase of approximately 12% (OR=1.15, 1.00, 1.32; 10 study arms)
  • Although this increase is statistically significant, sensitivity analyses suggest that the effect estimate is unreliable.
• AE had no meaningful effect on any of the following secondary outcomes:
  • Number of sexual partners
  • Use of protection
  • Unprotected sexual activity 
• In two of the studies, at least one relevant outcome was reported that could not be included in the meta-analysis because of too little information to calculate an odds ratio. The results for these studies were consistent with the results of the meta-analysis.

These reviews were based on a systematic review of all available studies, conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to adolescent sexual behavior.

Economic Review

An economic review of this intervention was not conducted because the Task Force found insufficient evidence to determine its effectiveness.

Supporting Materials

• Evidence Gaps
• Summary Evidence Table [PDF - 106KB]
• Included Studies
• Search Strategy

Publications

Chin HB, Sipe TA, Elder RW, Mercer SL, Chattopadhyay SK, Jacob V, Wethington HR, Kirby D, Elliston DB, Griffith M, Chuke SO, Briss SC, Ericksen I, Galbraith JS, Herbst JH, Johnson RL, Kraft JM, Noar SM, Romero LM, Santelli J, Community Preventive Services Task Force. 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. Am J Prev Med 2012;42(3):272-94.

Sipe TA, Chin HB, Elder RW, Mercer SL, Chattopadhyay SK, Jacob V, Community Preventive Services Task Force. Methods for conducting Community Guide systematic reviews of evidence on effectiveness and economic efficiency of group-based behavioral interventions to prevent adolescent pregnancy, Human Immunodeficiency Virus, and other sexually transmitted infections: comprehensive risk reduction and abstinence education. Am J Prev Med 2012;42(3):295-303.

Community Preventive Services Task Force. Recommendations for group-based behavioral interventions to prevent adolescent pregnancy, Human Immunodeficiency Virus, and other sexually transmitted infections: comprehensive risk reduction and abstinence education. Am J Prev Med 2012;42(3):304-7.

Barbot O. Getting our heads out of the sand: using evidence to make systemwide changes. Am J Prev Med 2012;42(3):311-12.

Weed SE. Sex education programs for schools still in question: a commentary on meta-analysis. Am J Prev Med 2012;42(3):313-15.

Wiley DC. Using science to improve the sexual health of America’s youth. Am J Prev Med 2012;42(3):308-10.

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Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Preventing HIV/AIDS, other STIs and pregnancy: group-based abstinence education interventions for adolescents. www.thecommunityguide.org/hiv/abstinence_ed.html. Last updated: MM/DD/YYYY.

Review completed: June 2009