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Summary of Evaluated Programs Effective at Changing Behavior

Since 2010, the HHS Office of Adolescent Health (OAH) has funded rigorous evaluation studies to assess the impact of a variety of program approaches to prevent teen pregnancy. These studies help build a body of evidence about when, where, and with whom specific programs are most effective. The results from the first five years of funding show many programs had impacts on teens' knowledge, attitudes and intentions. The programs described below were found effective at changing the behavior of program participants.

The OAH Teen Pregnancy Prevention (TPP) Program evaluated two types of grant programs and found:

Completed full reports are available. Additional findings will be released in the fall 2016 American Journal of Public Health.

New and Innovative Approaches that Showed Behavioral Impact

AIM 4 Teen Moms (Project AIM Adaptation)

AIM 4 Teen Moms* is a positive youth development program for new teen mothers. The program was adapted from an existing evidence-based teen pregnancy prevention program called Project AIM, which features a classroom-based youth development curriculum for middle school students. The adapted AIM 4 Teen Moms program provides nine sessions spread over a 12-week period, seven one-hour home visits, and two 90-minute group sessions that take place in community-based locations. AIM 4 Teen Moms was evaluated in a randomized controlled trial involving 800 low-income, newly parenting adolescent mothers in Los Angeles County. Participants were female and identified as Latina, black, white and other ethnicities; among the treatment group, 84.1% were Latina. The study found that about nine months after the end of the program, teen mothers participating in the intervention were significantly less likely than those in the study control group to report having had sex without using an effective contraceptive method in the past three months. This program was added to the HHS Evidence Review of Teen Pregnancy Prevention Programs in June 2016.

Crossroads (Be Proud! Be Responsible! Adaptation).

Crossroads is designed to affect knowledge, beliefs, and intentions related to condom use and sexual behaviors such as initiation and frequency of intercourse. This program was adapted from Be Proud! Be Responsible! for students at risk of dropping out of school. Planned adaptations included integrating the curriculum throughout a three-day off-campus event, and emphasizing the concept that HIV/AIDS prevention will have the added benefit of preventing other STIs and unplanned pregnancies. Adaptations to the curriculum included presentation of some activities in a large- rather than small-group format, omitting warm-up activities to ease the flow of the program, and modifying terminology to include STI/pregnancy prevention in addition to HIV to be more relevant to the population. The three-day Crossroads program was offered to 17- to 19-year-olds as a supplement to the standard dropout prevention program. Participants included male and female and white, black, Hispanic, and other race/ethnicity or multiracial adolescents. More specifically, 34% were black, 35% Hispanic, and 10% white. Compared with youth who received only the standard dropout prevention program, program participants were less likely to have vaginal intercourse without a condom 6 months after the intervention. The final report was not completed in time for the last call for studies for the HHS Evidence Review of Teen Pregnancy Prevention Programs and will be submitted for inclusion during its next call for studies.

Healthy Futures

Healthy Futures is a school-based, sex education program for middle school students. The three-year program features a relationship education curriculum, Nu-CULTURE, which is delivered in 24 lessons—eight lessons per year delivered to students in 6th, 7th, and 8th grades. At each grade level, the program also provides access to virtual classrooms, after school and summer programs, and a website and workshops designed for parents. In a cluster randomized controlled trial involving 2,346 students from 15 middle schools in three cities in northeastern Massachusetts,researchers found that at the end of 8th grade, female adolescents in the schools that delivered the intervention were significantly less likely to report they had ever had vaginal sex than their peers in schools without the program. Participants included male and female students, and Hispanic and non-Hispanic white, Asian, black, and other ethnicities. Among the treatment group, 40% of participants were Hispanic and 33% were white. This program was added to the HHS Evidence Review of Teen Pregnancy Prevention Programs in June 2016.

Love Notes

Love Notes is a healthy relationship education curriculum with 13 one-hour sessions. The program is focused on educating youth about healthy relationships and reducing dating violence and the incidence of unprotected sex. The Love Notes program was evaluated in a cluster randomized trial involving 933 adolescents recruited from community-based organizations serving youth in low-income areas of Louisville, KY. Participants included male and female and black, white, Hispanic and Asian adolescents; 86% of the treatment group was black. The study found that six months after the program ended, adolescents who were offered the Love Notes program were significantly less likely than youth in the study control group to report ever having had sex, ever having been pregnant, having had sex in the last three months, and having had sex without a condom or without birth control in the last three months. This program was added to the HHS Evidence Review of Teen Pregnancy Prevention Programs in June 2016.

Positive Potential Be The Exception (Sixth Grade)

Positive Potential Be The Exception (Positive Potential) is a school-based, youth development program primarily for adolescents attending middle school in rural communities. The Positive Potential program is provided as a supplemental program to the health and physical education curricula adolescents receive as part of their middle school education. The program offers five 45- to 50-minute classroom sessions on consecutive days during the 6th grade and one class assembly at the end of 6th grade. The Positive Potential program was evaluated in a randomized controlled trial involving 1,438 students in 14 public middle and elementary schools with 6th grade in northwestern Indiana. Participants included male and female students and white non-Hispanic and Hispanic adolescents; 85% of the treatment group was white non-Hispanic. The study found that in schools that delivered the program both the full sample of students and the subgroup of males were significantly less likely to have had sexual intercourse (ever and in the last three months) at the beginning of the 7th grade. This program was added to the HHS Evidence Review of Teen Pregnancy Prevention Programs in June 2016.

Positive Prevention PLUS

Positive Prevention PLUS is a school-based, sex education program for high school students. The Positive Prevention PLUS program consists of eleven 45-minute lessons provided during the school day in science, health, or physical education classes. Positive Prevention PLUS was evaluated in a randomized controlled trial involving 3,490 students attending 9th grade in 21 public high schools in southern California. Participants included male and female students, and black, white, Hispanic, Native American, Asian/Pacific Islander, multiple races and other ethnicity adolescents. Among the treatment group, 74% were Hispanic and 60% multiple races. The study found that six months after the end of the program, students in the schools that offered the program were significantly less likely to initiate sexual activity and to have had sex in the last three months without using birth control. This program was added to the HHS Evidence Review of Teen Pregnancy Prevention Programs in June 2016.

Reducing the Risk Adaptation

This adaptation of the Reducing the Risk (RtR) program took the 16-lesson RtR, which is a sex education program for high-school students, added five sexual health videos and delivered the program over 15 hours on two consecutive Saturdays in a community setting versus once a week in school. The program was evaluated in a cluster randomized controlled trial involving 939 students who were offered an adapted version of the RtR curriculum in community-based organizations located in Louisville, KY. Participants included male and female and white, black, Hispanic, and Asian adolescents; 88% of treatment group was black. The study found that three months after the program ended, adolescents who received the adaptation of RTR were significantly less likely to report ever having had sex or having been pregnant in the last three months. In addition, six months after the program ended, adolescents who received the adaptation of RTR were significantly less likely to report having had sex without birth control in the last three months. This program was added to the HHS Evidence Review of Teen Pregnancy Prevention Programs in June 2016.

Teen Options to Prevent Pregnancy (T.O.P.P.)

T.O.P.P.* is a clinic-based intervention for pregnant and parenting adolescent females. The T.O.P.P. program is delivered individually to program participants through telephone calls by trained nurse educators over an 18-month period. The program focuses on promoting healthy birth spacing and use of effective contraception, and it provides direct access to contraceptive services through a program clinic and access to a program social worker. The program was evaluated in a randomized controlled trial involving 493 low-income expectant or newly parenting adolescent women in the Columbus, Ohio area. Participants included non-Hispanic white, non-Hispanic black, Hispanic, and other race/ethnicity or multiracial adolescents; 44% of treatment group was white and 38% was black.The evaluation found that six months after study enrollment adolescents participating in the intervention were significantly less likely to report having had sex without using any effective birth control method in the past three months. This program was added to the HHS Evidence Review of Teen Pregnancy Prevention Programs in June 2016.

Replications of Evidenced-based Programs that Showed Behavioral Impact

Children's Aid Society-Carrera Program

The Children's Aid Society-Carrera Program is a comprehensive, multi-component youth development program for middle and high school students. The efficacy of the program was first established in a 2002 study involving 484 adolescents recruited from community-based agencies in New York City. That study found that three years after study enrollment, female adolescents participating in the program were less likely to be pregnant or report being sexually active than comparison group youth receiving each agency's regular youth programs, such recreational activities, homework help, or arts and crafts. In a more recent study funded by OAH, researchers evaluated the Carrera program using a quasi-experimental design involving 204 sixth and seventh grade students in Georgia. Participants included male and female students and black, white, Hispanic, American Indian or Alaskan Native, Asian, and other ethnicity adolescents; 92% of treatment group was black. In this study, researchers found that 12 months after study enrollment, adolescents participating in the Carrera program were less likely than those in the study comparison group to report having initiated sexual activity.

Reducing the Risk (RtR)

RtR is a 16-lesson sex education program for primarily high-school-aged students. The efficacy of the program was first established in a 1991 study involving 758 high-school students in northern California. That study found that female adolescents participating in the program who were sexually inexperienced at baseline were significantly less likely to report having had unprotected sex than a comparison group of similar youth not receiving the program. In a new OAH-funded study completed in 2015, researchers conducted a cluster randomized trial involving 2,689 students in 150 classrooms in public middle, junior high, and high school in three study sites located in Missouri, Texas, and California, respectively. Participants included male and female students, and black, white, Hispanic, and other ethnicity adolescents; 44% were Hispanic and 36% black. The study found that in the Missouri site, significantly fewer students in the group that received RTR than in the control group engaged in sexual intercourse in the last 90 days

Safer Sex

Safer Sex is an individual clinic-based intervention for female adolescents and young adults that is delivered one-on-one through a 30- to 50-minute session with a health educator, followed by three 10- to 30-minute follow-up sessions over the following six months. The efficacy of the program was first established in a 2001 study involving women younger than 24 who sought treatment for cervicitis or pelvic inflammatory disease at an urban children's hospital adolescent clinic and who were not pregnant at the time of the visit.

In a new OAH-funded study completed in 2015, researchers conducted a randomized controlled trial involving 1,809 young women who sought treatment in one of three study sites (health clinics) in Florida, Minnesota, and Tennessee. Among participants, 36% were black, 33% were white, and 18% were Hispanic. The study pooled the data across the three study sites and reported that nine months after baseline, young women who received Safer Sex were less likely to report having sexual intercourse without birth control in the last 90 days than young women assigned to the control condition. In addition, nine months after baseline, the study reports that among the subgroup of young women who were sexually inexperienced at baseline, those who received Safer Sex were less likely to report having initiated sexual activity or having had more than one lifetime sexual partner. The study also examined program impacts by study site, and found that in the Minnesota site, significantly fewer adolescents in the treatment group than in the control group reported engaging in oral sex compared in the last 90 days.

Teen Outreach Program (TOP®)

TOP® is a youth development program that incorporates weekly curriculum-guided lessons, community service learning, and positive adult guidance and support. TOP is provided in school, after-school, and community settings to adolescents 12 to 17 years old. The efficacy of this program was first established in a 1997 study involving 695 high school students attending grades 9 to 12 in high schools in 25 cities across the United States. The study found that female adolescents participating in the program were significantly less likely to report a pregnancy during the academic year of the program.

In seven recent OAH-funded studies, researchers examined the effectiveness of TOP through randomized trials. In one of the studies, a cluster-randomized trial involving 2,058 students in grades 9 to 12 in 26 high schools in Florida, researchers found that immediately after the intervention ended, students in the schools that provided TOP were less likely to report ever having sex or ever getting pregnant (or getting someone pregnant) than students in schools assigned to the control condition. Ten months after the intervention ended, the study authors found that the favorable impacts on ever having sex and pregnancy did not persist. Participants in this study were male and female, and white non-Hispanic, black non-Hispanic, Hispanic/Latino, and other non-Hispanic; 64% of treatment group was white non-Hispanic and 20% was Hispanic/Latino.


* Program implementation was supported by ACF's Family and Youth Services Bureau. OAH funded and oversaw evaluation studies.

Content created by Office of Adolescent Health
Content last reviewed on February 24, 2017