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

Summary of CPSTF Finding

The Community Preventive Services Task Force (CPSTF) 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.


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.

CPSTF Finding and Rationale Statement

Read the full CPSTF Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

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About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 62 studies with 83 study arms (search period 1988 – August 2007). The systematic review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to preventing HIV, other STIs, and teen pregnancy.

Summary of Results

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.
  • Interventions may be somewhat more effective for boys than girls.

Summary of Economic Evidence

Ten studies qualified for the economic review, including 8 economic evaluations of individual programs. Monetary values are reported in 2008 U.S. dollars.
  • 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.


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

Evidence Gaps

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

The following outlines evidence gaps for these group-based behavioral interventions to prevent or reduce the risk of adolescent pregnancy, HIV or other STIs: comprehensive risk reduction, and abstinence education interventions.

Across both reviews, there was no consistent evidence of differential effects on outcomes for any of the 12 critical moderator variables (gender, virginity status, age, race/ethnicity, setting, dosage, focus, deliverer, multicomponent, targeting, study design, and comparison group type). Also, the majority of the studies examined interventions delivered to coed groups and results were not reported by gender. This limits the ability to determine differential effectiveness by gender for comprehensive risk-reduction and abstinence education interventions. This limitation extends to the evaluation of the effectiveness of parental participation as well, since it was an uncommon component in these reviews and often had low participation rates.

More consistent reporting of moderator variables by study authors is needed to clarify which of these (or other characteristics) may maximize the effectiveness of adolescent sexual behavior interventions. In addition, common measures of sexual behavior and standard intervals for follow-up assessments of these outcomes would allow for more comparability across studies and lead to a better determination of the overall public health impact of these interventions.

In terms of economic efficiency, future research is needed to examine how cost benefit or cost-effectiveness estimates vary depending on age, gender, and risk status of participants. For programs with objectives beyond pregnancy and STI prevention, future research needs to evaluate the full impact of such programs from a societal perspective, including non-health outcomes such as improved employment potential, and higher future earnings of program participants. Finally, for school-based programs, additional research needs to address the impact on school resources where the facilities, staff, or time from the school systems may be used for these programs.

Study Characteristics

Interventions that evaluated STIs were mostly implemented in community settings with adolescents at high-risk for STIs.

Interventions included in this review were:

  • 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 addressed prevention of:

  • HIV and STIs
  • Pregnancy


Chin HB, Sipe TA, Elder RW, et al. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, HIV, and sexually transmitted infections: two systematic reviews for the Guide to Community Prevent. American Journal of Preventive Medicine. 2012;42(3):272-94.

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. American Journal of Preventive Medicine. 2012;42(3):304-7.

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. American Journal of Preventive Medicine. 2012;42(3):295-303.

Barbot O. Getting our heads out of the sand: using evidence to make systemwide changes. American Journal of Preventive Medicine. 2012;42(3):311-12.

Weed SE. Sex education programs for schools still in question: a commentary on meta-analysis. American Journal of Preventive Medicine. 2012;42(3):313-15.

Wiley DC. Using science to improve the sexual health of America’s youth. American Journal of Preventive Medicine. 2012;42(3):308-10.

Analytic Framework

Effectiveness Review

Analytic Framework see Figure 1 on page 276

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

Summary Evidence Table

Effectiveness Review

Summary Evidence Table Effectiveness Review

Economic Review

Summary Evidence Table Economic Review see Table 4 on page 282

Included Studies

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Aarons SJ, Jenkins RR, Raine TR et al. Postponing Sexual Intercourse among Urban Junior High School Students-A Randomized Controlled Evaluation. Journal of Adolescent Health 2000;27(4):236-47.

Aten MJ, Siegel DM, Enaharo M, Auinger P. Keeping middle school students abstinent: outcomes of a primary prevention intervention. J Adolesc Health 2002;31(1):70-8.

Barth RP, Fetro JV, Leland N, Volkan K. Preventing adolescent pregnancy with social and cognitive skills. Journal of Adolescent Research 1992;7(2):208-32.

Booth RE, Zhang Y, Kwiatkowski CF. The challenge of changing drug and sex risk behaviors of runaway and homeless adolescents. Child Abuse Negl 1999;23(12):1295-306.

Boyer CB, Shafer MA, Tschann JM. Evaluation of a knowledge- and cognitive-behavioral skills-building intervention to prevent STDs and HIV infection in high school students. Adolescence 1997;32(125):25-42.

Coyle K, Basen-Engquist K, Kirby D et al. Safer choices: reducing teen pregnancy, HIV, and STDs. Public Health Rep 2001;116(Suppl 1):82-93.

Coyle KK, Kirby DB, Marin BV, Gomez CA, Gregorich SE. Draw the line/respect the line: a randomized trial of a middle school intervention to reduce sexual risk behaviors. Am J Public Health 2004;94(5):843-51.

Coyle KK, Kirby DB, Robin LE, Banspach SW, Baumler E, Glassman JR. All4You! A randomized trial of an HIV, other STDs, and pregnancy prevention intervention for alternative school students. AIDS Educ Prev 2006;18(3):187-203.

DiClemente RJ, Wingood GM, Harrington KF et al. Efficacy of an HIV prevention intervention for African American adolescent girls: a randomized controlled trial. JAMA 2004;292(2):171-9.

DiIorio C, Resnicow K, McCarty F et al. Keepin’ it R.E.A.L.!: results of a mother-adolescent HIV prevention program. Nurs Res 2006;55(1):43-51.

DiIorio C, McCarty F, Resnicow K, Lehr S, Denzmore P. REAL men: a group-randomized trial of an HIV prevention intervention for adolescent boys. Am J Public Health 2007;97(6):1084-9.

Ferguson SL. Peer counseling in a culturally specific adolescent pregnancy prevention program. Journal of Health Care for the Poor and Underserved 1998;9(3):322-40.

Fisher JD, Fisher WA, Bryan AD, Misovich SJ. Information-motivation-behavioral skills model-based HIV risk behavior change intervention for inner-city high school youth. Health Psychology 2002;21(2):177-86.

Flay BR, Graumlich S, Segawa E, Burns JL, Holliday MY. Effects of 2 prevention programs on high-risk behaviors among African American youth: a randomized trial. Arch Pediatr Adolesc Med 2004;158(4):377-84.

Gillmore MR, Morrison DM, Richey CA, Balassone ML, Gutierrez L, Farris M. Effects of a skill-based intervention to encourage condom use among high risk heterosexually active adolescents. AIDS Educ Prev 1997;9(Suppl 1):22-43.

Hubbard BM, Giese ML, Rainey J. A replication study of Reducing the Risk, a theory-based sexuality curriculum for adolescents. J Sch Health 1998;68(6):243-7.

Jemmott JB, III, Jemmott LS, Fong GT. Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: a randomized controlled trial. JAMA 1998;279(19):1529-36.

Jemmott JB, III, Jemmott LS, Braverman PK, Fong GT. HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial. Arch Pediatr Adolesc Med 2005;159(5):440-9.

Jemmott JB, Jemmott LS, Fong GT. Reductions in HIV risk-associated sexual behaviors among Black male adolescents: Effects of an AIDS prevention intervention. American Journal of Public Health 1992;82(3):372-7.

Jemmott JB, III, Jemmott LS, Fong GT, McCaffree K. Reducing HIV risk-associated sexual behavior among African American adolescents: Testing the generality of intervention effects.American Journal of Community Psychology 1999;27(2):161-87.

Kennedy MG, Mizuno Y, Hoffman R, Baume C, Strand J. The effect of tailoring a model HIV prevention program for local adolescent target audiences. AIDS Education and Prevention 2000;12(3):225-38.

Kirby D, Korpi M, Adivi C, Weissman J. An impact evaluation of project SNAPP: An AIDS and pregnancy prevention middle school program. AIDS Education and Prevention 1997;9(1, Suppl):44-61.

Koniak-Griffin D, Lesser J, Nyamathi A, Uman G, Stein JA, Cumberland WG. Project CHARM: An HIV prevention program for adolescent mothers. Family & Community Health 2003;26(2):94-107.

LaChausse RG. Evaluation of the Positive Prevention HIV/STD Curriculum. American Journal of Health Education 2006;37(4):203-9.

Li X, Stanton B, Feigelman S, Galbraith J. Unprotected sex among African-American adolescents: a three-year study. J Natl Med Assoc 2002;94(9):789-96.

Lieberman LD, Gray H, Wier M, Fiorentino R, Maloney P. Long-term outcomes of an abstinence-based, small-group pregnancy prevention program in New York City schools. Fam Plann Perspect 2000;32(5):237-45.

Lightfoot M, Comulada WS, Stover G. Computerized HIV preventive intervention for adolescents: indications of efficacy. Am J Public Health 2007;97(6):1027-30.

Magura S, Kang SY, Shapiro JL. Outcomes of intensive AIDS education for male adolescent drug users in jail. Journal of Adolescent Health 1994;15(6):457-63.

Main DS, Iverson DC, McGloin J, Banspach SW. Preventing HIV infection among adolescents: Evaluation of a school-based education program. Preventive Medicine: An International Journal Devoted to Practice and Theory 1994;23(4):409-17.

McBride D, Gienapp A. Using randomized designs to evaluate client-centered programs to prevent adolescent pregnancy. Fam Plann Perspect 2000;32(5):227-35.

McGraw SA, Smith KW, Crawford SL, Costa LA, McKinlay JB, Bullock K. The Effectiveness of Poder Latino: A Community-Based HIV Prevention Program for Inner-City Latino Youth. New England Research Institutes; 2002.

Moberg D, Piper DL. The Healthy for Life Project: Sexual risk behavior outcomes. AIDS Education and Prevention 1998;10(2):128-48.

Morrison-Beedy D, Carey MP, Kowalski J, Tu X. Group-based HIV risk reduction intervention for adolescent girls: evidence of feasibility and efficacy. Res Nurs Health 2005;28(1):3-15.

Morrison DM, Hoppe MJ, Wells EA et al. Replicating a teen HIV/STD preventive intervention in a multicultural city. AIDS Educ Prev 2007;19(3):258-73.

O’Donnell L, Stueve A, Doval AS et al. The effectiveness of the reach for health community youth service learning program in reducing early and unprotected sex among urban middle school students. American Journal of Public Health 1999;89(2):176-81.

Paine-Andrews A, Harris KJ, Fisher JL et al. Effects of a replication of a multicomponent model for preventing adolescent pregnancy in three Kansas communities. Fam Plann Perspect 1999;31(4):182-9.

Pearlman DN, Camberg L, Wallace LJ, Symons P, Finison L. Tapping youth as agents for change: Evaluation of a peer leadership HIV/AIDS intervention. Journal of Adolescent Health 2002;31(1):31-9.

Philliber S, Allen J. Life Options and Community Service: Teen Outreach Program. Preventing Adolescent Pregnancy: Model Programs and Evaluations 1992;140:139-55.

Philliber S, Kaye JW, Herrling S, West E. Preventing pregnancy and improving health care access among teenagers: an evaluation of the children’s aid society-carrera program.Perspect Sex Reprod Health 2002;34(5):244-51.

Rotheram-Borus MJ, Koopman C, Haignere C, Davies M. Reducing HIV sexual risk behaviors among runaway adolescents. JAMA 1991;266(9):1237-41.

Rotheram-Borus MJ, Gwadz M, Fernandez MI, Srinivasan S. Timing of HIV interventions on reductions in sexual risk among adolescents. Am J Community Psychol 1998;26(1):73-96.

Rotheram-Borus MJ, Stein JA, Lester P. Adolescent adjustment over six years in HIV-affected families. J Adolesc Health 2006;39(2):174-82.

Rotheram-Borus MJ, Song J, Gwadz M, Lee M, Van Rossem R, Koopman C. Reductions in HIV risk among runaway youth. Prevention Science 2003;4(3):173-87.

Siegel DM, Aten MJ, Enaharo M. Long-term effects of a middle school- and high school-based human immunodeficiency virus sexual risk prevention intervention. Arch Pediatr Adolesc Med 2001;155(10):1117-26.

Sikkema KJ, Anderson ES, Kelly JA et al. Outcomes of a randomized, controlled community-level HIV prevention intervention for adolescents in low-income housing developments. AIDS 2005;19(14):1509-16.

Slonim-Nevo V, Auslander WF, Ozawa MN, Jung KG. The long-term impact of AIDS-preventive interventions for delinquent and abused adolescents. Adolescence 1996;31(122):409-21.

Smith MA. Teen Incentives Program: evaluation of a health promotion model for adolescent pregnancy prevention. J Health Educ 1994;25(1):24-9.

Smith MU, Dane FC, Archer ME, Devereaux RS, Katner HP. Students together against negative decisions (STAND): evaluation of a school-based sexual risk reduction intervention in the rural south. AIDS Educ Prev 2000;12(1):49-70.

Smith P, Weinman M, Parrilli J. The role of condom motivation education in the reduction of new and reinfection rates of sexually transmitted diseases among inner-city female adolescents. Patient Education and Counseling 1997;31(1):77-81.

St Lawrence JS, Brasfield TL, Jefferson KW, Alleyne E, O’Bannon RE, III, Shirley A. Cognitive-behavioral intervention to reduce African American adolescents’ risk for HIV infection. J Consult Clin Psychol 1995;63(2):221-37.

St Lawrence JS, Jefferson KW, Alleyne E, Brasfield TL. Comparison of education versus behavioral skills training interventions in lowering sexual HIV-risk behavior of substance-dependent adolescents. J Consult Clin Psychol 1995;63(1):154-7.

St Lawrence JS, Crosby RA, Brasfield TL, O’Bannon RE, III. Reducing HIV and STD Risk Behavior of Substance Dependent Adolescents: A Randomized Controlled Trial. Journal of Counseling and Clinical Psychology 2002;70(4):1010-21.

St.Lawrence JS, Crosby RA, Belcher L, Yazdani N, Brasfield TL. Sexual Risk Reduction and Anger Management Interventions for Incarcerated Male Adolescents: A Randomized Control Trial of Two Interventions. Journal of Sex Education and Therapy 1999;24(1&2):9-17.

Stanton B, Cole M, Galbraith J et al. Randomized trial of a parent intervention: parents can make a difference in long-term adolescent risk behaviors, perceptions, and knowledge. Arch Pediatr Adolesc Med 2004;158(10):947-55.

Stanton B, Guo J, Cottrell L et al. The complex business of adapting effective interventions to new populations: an urban to rural transfer. J Adolesc Health 2005;37(2):163.

Villarruel AM, Jemmott JB, III, Jemmott LS. A randomized controlled trial testing an HIV prevention intervention for Latino youth. Arch Pediatr Adolesc Med 2006;160(8):772-7.

Walter HJ, Vaughan RD. AIDS risk reduction among a multiethnic sample of urban high school students. JAMA 1993;270(6):725-30.

Weeks K, Levy SR, Gordon AK, Handler A, Perhats C, Flay BR. Does Parental Involvement Make a Difference? The Impact of Parent Interactive Activities on Students in a School-Based AIDS Prevention Program. AIDS Education & Prevention 1997;9(Suppl A):90-106.

Zimmerman RS, Cupp PK, Hansen GL, Donohew L, Roberto AJ, Dekhtyar O. The Effects of a School-Based HIV and Pregnancy Prevention Program in Rural Kentucky. Unpublished Work.

Economic Review

Aos S, Lieb R, Mayf eld J, Miller M, Pennucci A. Benef ts and costs of prevention and early intervention programs for youth. Olympia (WA): Washington State Institute for Public Policy, 2004.

Hahn A, Leavitt T, Aaron P. Evaluation of the Quantum Opportunities Program (QOP): did the program work? A report on the postsecondary outcomes and cost-effectiveness of the QOP Program (1989-1993). Waltham (MA): Brandeis University, 1994.

Kennedy MG, Mizuno Y, Seals BF, Myllyluoma J, Weeks-Norton K. Increasing condom use among adolescents with coalition-based social marketing. AIDS 2000;14(12):1809.

Olaiya ST. Medical cost savings attributable to comprehensive sex education programs that delay coitus and increase condom use among adolescents in the U.S. [dissertation]. Columbus (OH): Ohio State University, 2006.

Philliber S, Kaye JW, Herrling S, West E. Preventing pregnancy and improving health care access among teenagers: an evaluation of the Children’s Aid Society-Carrera Program. Perspect Sex Reprod Health 2002;34(5):244 51.

Pinkerton SD, Holtgrave DR, Jemmott JB III. Economic evaluation of HIV risk reduction intervention in African-American male adolescents. J Acquir Immune Def c Syndr 2000;25(2):164 72.

Rosenthal MS, Ross JS, Bilodeau RA, Richter RS, Palley JE, Bradley EH. Economic evaluation of a comprehensive teenage pregnancy prevention program: pilot program. Am J Prev Med 2009;37(6S1):S2807.

Tao G, Remafedi G. Economic evaluation of an HIV prevention intervention for gay and bisexual male adolescents. J Acquir Immune Def c Syndr Hum Retrovirol 1998;17(1):83 90.

Wang LY, Davis M, Robin L, Collins J, Coyle K, Baumler E. Economic evaluation of Safer Choices: a school-based human immunodef ciency virus, other sexually transmitted diseases, and pregnancy prevention program. Arch Pediatr Adolesc Med 2000;154(10):1017 24.

Zabin LS, Hirsch MB, Streett R, et al. The Baltimore Pregnancy Prevention Program for Urban Teenagers: I.Howdid it work? Fam Plann Perspect 1988;20(4):182 7.

Additional Materials

Implementation Resources

Teen Pregnancy Prevention Evidence Review
The U.S. Department of Health and Human Services sponsors systematic reviews of the teen pregnancy prevention research literature to identify programs with evidence of effectiveness in reducing teen pregnancy, sexually transmitted infections and HIV, and associated sexual risk behaviors. Identified programs reflect a variety of approaches in the field.

Search Strategies

The following outlines the search strategy for these group-based behavioral interventions to prevent or reduce the risk of adolescent pregnancy, HIV, or other STIs: comprehensive risk reduction, and abstinence education interventions.

With the assistance of a CDC librarian, the team searched for published studies in the following databases: CINAHL, MEDLINE, PsycINFO, PubMed, Sociological Abstracts, Web of Science, ERIC, POPLINE, NTIS, EPO, CRISP, and the online Cochrane Controlled Trials Register. In addition, we also reviewed references listed in all retrieved articles, published and unpublished reports provided by team members and elsewhere, and references from a search of an electronic database continuously updated and maintained by Prevention Research Synthesis (PRS) in the Division of HIV and AIDS Prevention at CDC.

The teams considered studies for inclusion if they were:

  • Published between 1988 and 2007
  • Published in English
  • Studies conducted in the United States


Portions of the search terms below in parentheses indicate allowances for variation of a keyword, such as the singular and plural versions.

  1. Adolescent(s)
  2. Teenager(s)
  3. Teen(s)
  4. Youth
  5. Young
  6. Student(s)
  7. School
  8. College
  9. Undergraduate
  10. (1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9)
  11. Human Immunodeficiency Virus
  12. HIV
  13. Acquired Immunodeficiency Syndrome or AIDS
  14. AIDS
  15. Sexually Transmitted Diseases
  16. STD
  17. STI
  18. (11 or 12 or 13 or 14 or 15 or 16 or 17 and prevent(ion/ing)
  19. Sex(ual) Behavior(s)
  20. (Sex(ual)) Risk(y) Behavior(s)
  21. Sex(ual) Risk Reduction
  22. Sex(ual) Risk Taking
  23. Sex(ual) Risk Avoidance
  24. Teen/adolescent/teenage pregnancy
  25. Unwanted pregnancy
  26. Unintended pregnancy
  27. Abstinence
  28. Postpon(ing) sex/intercourse
  29. Delay(ing) sex/intercourse
  30. Sexual Activity
  31. Sexual Acts
  32. Protected Sex
  33. Sexual Involvement
  34. Repeated Childbearing
  35. Repeat Pregnancies
  36. Parenting
  37. Cohabitation
  38. Mothers
  39. Fertility Control
  40. (18 through 39OR’d together)
  41. Program evaluation
  42. Outcome stud(ies)
  43. Primary Prevention
  44. Impact stu(dies)
  45. Follow-up stud(ies)
  46. Intervention
  47. Education
  48. Preventive/ion
  49. Evaluation/ing
  50. Program
  51. Promotion
  52. Outcome(s)
  53. Initiative
  54. Design
  55. (41through 54OR’d together)
  56. 10 and 40 and 55

Excluded Terms

Finally, to focus the search results to US-based studies, the following search terms/geographic locations were EXCLUDED:

  • Africa
  • Atlantic Islands
  • Australia
  • Britain/ish
  • Canada
  • Canad(ian)
  • Caribbean Region
  • Central Region
  • Central America
  • England
  • Europe
  • Greenland
  • Indian Ocean Islands
  • Latin America
  • Mexico
  • Oceania
  • Pacific Islands (not Hawaii)
  • South America

Note: This strategy was used rather than the INCLUSION of US-based studies because not all US-based studies are explicitly indexed as such; some allow for the assumption of a US-based study unless otherwise indicated.

Considerations for Implementation

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

Barriers to intervention implementation can be organized into three categories:

  • Restrictions on intervention activities (e.g., community demands about intervention content)
  • Funding requirements (e.g., federal requirements associated with federal funding)
  • Participation challenges (e.g., low involvement from parents or adolescents, especially in voluntary programs)