Adolescent Pregnancy Prevention: Meta-Analysis of Federally Funded Program Evaluations

• Published in: American journal of public health (1971) 2019-04, Vol.109 (4), p.e1-e8
• Main Authors: Juras, Randall, Tanner-Smith, Emily, Kelsey, Meredith, Lipsey, Mark, Layzer, Jean
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent Health; Adolescents; Aggregate data; AJPH Open-Themed Research; Boys; Criteria; Data collection; Data processing; Demographics; Demography; Design; Ethnicity; Experimental research; Federal agencies; Female; Gender; Girls; Health care policy; Health Risk Behaviors; Humans; Meta-analysis; Minority & ethnic groups; Outreach services; Pregnancy; Pregnancy in Adolescence - prevention & control; Prevention; Prevention programs; Program Evaluation; Program implementation; Public health; Quasi-experimental methods; Race; Regression analysis; Research design; Risk behavior; Risk taking; Rural areas; Search strategies; Sexual Behavior; Sexual Health; Small groups; Statistical analysis; Statistical significance; Statistics; Systematic review; Teenage pregnancy; Teenagers
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2018.304925

Beginning in 2010, the US Department of Health and Human Services (HHS) funded more than 40 evaluations of adolescent pregnancy prevention interventions. The government's emphasis on rigor and transparency, along with a requirement that grantees collect standardized behavioral outcomes, ensured that findings could be meaningfully compared across evaluations. We used random and mixed-effects meta-analysis to analyze the findings generated by these evaluations to learn whether program elements, program implementation features, and participant demographics were associated with effects on adolescent sexual risk behavior. We screened all 43 independent evaluation reports, some of which included multiple studies, funded by HHS and completed before October 1, 2016. HHS released, and our team considered, all such studies regardless of favorability or statistical significance. Of these studies, we included those that used a randomized or high-quality quasi-experimental research design. We excluded studies that did not use statistical matching or provide pretest equivalence data on a measure of sexual behavior or a close proxy. We also excluded studies that compared 2 pregnancy prevention interventions without a control group. A total of 44 studies from 39 reports, comprising 51 150 youths, met the inclusion criteria. Two researchers extracted data from each study by using standard systematic reviewing and meta-analysis procedures. In addition, study authors provided individual participant data for a subset of 34 studies. We used mixed-effects meta-regressions with aggregate data to examine whether program or participant characteristics were associated with program effects on adolescent sexual risk behaviors and consequences. To examine whether individual-level participant characteristics such as age, gender, and race/ethnicity were associated with program effects, we used a 1-stage meta-regression approach combining participant-level data (48 635 youths) with aggregate data from the 10 studies for which participant-level data were not available. Across all 44 studies, we found small but statistically insignificant mean effects favoring the programs and little variability around those means. Only 2 program characteristics showed statistically reliable relationships with program effects. First, gender-specific (girl-only) programs yielded a statistically significant average effect size (P