HIV, Other STIs, and Teen Pregnancy: Youth Development Behavioral Interventions to Reduce Sexual Risk Behaviors in Adolescents Coordinated with Community Service

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends youth development focused behavioral interventions coordinated with community service on the basis of sufficient evidence that these combined approaches are effective in reducing sexual risk behaviors in participating adolescents.

All of the interventions evaluated in this review included sexual behavior or risk reduction content as part of the behavioral intervention, although the emphasis on this component varied. The CPST acknowledges that this review, focused on the subset of intervention studies that evaluated change in sexual risk behavior outcomes, does not provide a complete, systematic assessment of all of the evidence regarding overall effectiveness of these combined approaches.

The CPSTF has related findings for youth development interventions coordinated with the following:

The full CPSTF Finding and Rationale Statement and supporting documents for HIV, Other STIs, and Teen Pregnancy: Youth Development Behavioral Interventions to Reduce Sexual Risk Behaviors in Adolescents Coordinated with Community Service are available in The Community Guide Collection on CDC Stacks.

Intervention

Youth development behavioral interventions employ a holistic approach to adolescent health and wellness, and may or may not include components that are focused directly on pregnancy and STI prevention. These interventions emphasize:

  • Social, emotional, or cognitive competence training that promotes pro-social norms
  • Improved decision making
  • Self-determination
  • Improved communication skills
  • Positive bonding experiences between youth and their peers or non-parental role models

Community service may involve scheduled activities in one or more community settings such as nursing homes, hospitals, and homeless shelters. This experience provides extended opportunities for adolescents to interact with adults in the community and have a sense of membership in a group with explicit rules and responsibilities.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 9 studies (search period 1980-2008). 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.

Study Characteristics

  • All interventions included in this review had some sexual risk reduction content.
  • To be included in the review, studies had to include sexual risk behavior outcomes.
  • Among included studies, the content and delivery differed, but most studies used interactive group sessions held in school or community settings.

Summary of Results

Nine studies qualified for the review.

  • The included studies targeted recruited adolescents (ages 10-19 years).
  • Rate of pregnancy: median relative decrease of 39% (interquartile interval: -59% to -9%) over a median of 9 months of observation (6 studies)
  • Self-reported sexual activity among study participants: reductions in favor of the intervention (3 studies)
  • Use of birth control or condom use: inconsistent results (3 studies)
  • Initiation of sexual intercourse: inconsistent results (3 studies)
  • Further research is required to assess the effectiveness of these interventions on use of birth control, use of condoms and on initiation of sexual intercourse.

Summary of Economic Evidence

Two studies qualified for the economic review that applied youth development and community service as part of multicomponent strategies. Monetary values are reported in 2007 U.S. dollars.

  • Both studies assessed the economic impact of pregnancies prevented due to the interventions.
  • Based on the evidence from these two studies, the interventions appear to be cost beneficial with net benefits ranging from $204 to $1053 per person per year.
    • Program costs ranged from $699 to $839 per person per year.
    • Benefits from pregnancies prevented ranged from $903 to $1891 per person per year.

Applicability

These interventions were effective in rural, suburban, and urban U.S. communities for disadvantaged participants (students of low economic status, from racial or ethnic minorities, or from schools with low graduation rates or test scores).

Evidence Gaps

Evidence gaps for HIV, Other STIs, and Teen Pregnancy: Youth Development Behavioral Interventions to Reduce Sexual Risk Behaviors in Adolescents Coordinated with Community Service are available in The Community Guide Collection on CDC Stacks.

Implementation Considerations and Resources

Considerations for Implementation for HIV, Other STIs, and Teen Pregnancy: Youth Development Behavioral Interventions to Reduce Sexual Risk Behaviors in Adolescents Coordinated with Community Service are available in The Community Guide Collection on CDC Stacks.

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.