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Preventing HIV/AIDS, Other STIs, and Teen Pregnancy: Group-Based Comprehensive Risk Reduction Interventions for Adolescents

Comprehensive risk reduction (CRR) interventions promote behaviors that prevent or reduce the risk of pregnancy, HIV, and other sexually transmitted infections (STIs). These interventions may:

  • Suggest a hierarchy of recommended behaviors that identifies abstinence as the best, or preferred method but also provides information about sexual risk reduction strategies
  • Promote abstinence and sexual risk reduction without placing one approach above another
  • Promote sexual risk reduction strategies, primarily or solely

This review evaluated CRR interventions delivered in school or community settings to groups of adolescents (10–19 years old). These interventions may also include other components such as condom distribution and STI testing.

Summary of Task Force Recommendations and Findings

The Community Preventive Services Task Force recommends group-based comprehensive risk reduction (CRR) interventions delivered to adolescents to promote behaviors that prevent or reduce the risk of pregnancy, HIV, and other sexually transmitted infections (STIs). The recommendation is based on sufficient evidence of effectiveness in:

  • Reducing a number of self-reported risk behaviors, including:
    • Engagement in any sexual activity
    • Frequency of sexual activity
    • Number of partners, and
    • Frequency of unprotected sexual activity
  • Increasing the self-reported use of protection against pregnancy and STIs
  • Reducing the incidence of self-reported or clinically-documented sexually transmitted infections

There is limited direct evidence of effectiveness, however, for reducing pregnancy and HIV.

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

Sixty-two studies with 83 study arms qualified for this review.

  • Results from meta-analyses show that effects were favorable and statistically significant for the following outcomes.
    • Sexual activity: decrease of approximately 12% (54 study arms)
    • Frequency of sexual activity: odds ratio (OR) = 0.81, 95% confidence interval (CI) 0.72, 0.90 (14 study arms)
    • Number of partners: decrease of approximately 14% (OR = 0.83, 95% CI 0.74, 0.93; 27 study arms)
    • Unprotected sexual activity: decrease of approximately 25% (OR = 0.70, 95% CI 0.60, 0.82; 28 study arms)
    • STIs: decrease of approximately 31% (OR = 0.65, 95% CI 0.47, 0.90; 8 study arms)
    • Use of protection (including use of condoms, oral contraceptives or both): increase of approximately 13% (OR = 1.39, 95% CI 1.19, 1.62; 50 study arms)
      • Condom use: increase of approximately 12% (OR = 1.45, 95% CI 1.20, 1.74; 44 study arms)
  • Results from meta-analyses were also favorable but statistically nonsignificant for the following outcomes.
    • Oral contraceptives: increase of approximately 22% (OR=1.29, 95% CI 0.89, 1.85; 10 study arms)
    • Dual use (use of both condoms and oral contraceptives): increase of approximately 17% (OR=1.21, 95% CI 0.70, 2.12; 4 study arms)
    • Pregnancy: decrease of approximately 11% (OR=0.88, 95% CI 0.60, 1.30; 11 study arms)
  • The review team also examined consistent condom use, a subgroup of the condom use outcome. The results were in the favorable direction, though statistically nonsignificant.
    • Consistent condom use: OR=1.24, 95% CI 0.96, 1.62 (19 study arms)
  • In 17 of the studies, at least one relevant outcome was reported that could not be included in the meta-analyses because of too little information to calculate an odds ratio. The results for these studies were consistent with the results of the meta-analyses.
  • Results suggest that CRR interventions are applicable to:
    • Youth ranging from 10-19 years of age
    • Male only, female only and coed groups
    • Majority African-American, majority White, majority Hispanic and mixed race samples
    • Both virgin and nonvirgin populations
    • School and community settings
  • Two notable results related to gender and setting:
    • Interventions may be somewhat more effective for boys than girls.
    • Interventions that evaluated STIs were mostly implemented in community settings with adolescents at high-risk for STIs.

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

Monetary values are reported in 2008 U.S. dollars.

Ten studies qualified for the economic review, including 8 economic evaluations of individual programs.

  • Program costs ranged from $66 to $10,024 per person per year (6 studies).
    • The wide range in costs is the result of variation in program content, number of participants, program duration, and type of program setting.
    • The highest cost programs tended to be multifaceted youth development interventions.
    • The lowest cost programs were school-based and curriculum-based education or involved a large number of participants.
  • The benefit over cost ratio ranged from 2.7 to 3.7. This means that every dollar invested in the CRR programs yielded between $2.70-$3.70 in returns based on savings in healthcare costs related to pregnancies, HIV, and STIs and improvement in income associated with higher educational attainment (2 cost-benefit studies).
    • A separate cost-benefit study that looked at the most expensive program found that the cost of the program exceeded the economic benefits of pregnancy prevention.
  • The net cost per quality adjusted life year (QALY) ranged from $9,000 to $76,000 (2 cost-utility studies).
  • CRR interventions resulted in healthcare savings from prevented pregnancies and STIs that ranged from $5.80 per participant per year for those aged 13-14 years to $338 per participant per year for those aged 18-19 years (1 dissertation).
    • Avoided pregnancies made up 80% of these savings for those aged 13-14 years and more than 95% for those aged 18-19 years.
  • Only 1 of 7 pregnancy prevention programs was found to be cost saving in the state of Washington. This is based on a review of programs requested by the state legislature.

Supporting Materials

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. Adobe PDF File [PDF - 886 kB] 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. Adobe PDF File [PDF - 253 kB] 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. Adobe PDF File [PDF - 77 kB] Am J Prev Med 2012;42(3):304-7.

Barbot O. Getting our heads out of the sand: using evidence to make systemwide changes. Adobe PDF File [PDF - 52 kB] Am J Prev Med 2012;42(3):311-12.

Weed SE. Sex education programs for schools still in question: a commentary on meta-analysis. Adobe PDF File [PDF - 64 kB] Am J Prev Med 2012;42(3):313-15.

Wiley DC. Using science to improve the sexual health of America's youth. Adobe PDF File [PDF - 64 kB] Am J Prev Med 2012;42(3):308-10.

Read other Community Guide publications about Preventing HIV/AIDS, Other STIs, and Teen Pregnancy in our library.




Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

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 teen pregnancy: group-based comprehensive risk reduction interventions for adolescents. www.thecommunityguide.org/hiv/riskreduction.html. Last updated: MM/DD/YYYY.

Review completed: June 2009