Meta-analysis of Federally Funded Adolescent Pregnancy Prevention Program Evaluations

Beginning in 2010, the U.S. Department of Health and Human Services (HHS) sponsored numerous studies testing the effectiveness of Adolescent Pregnancy Prevention programs on youths' risky sexual behaviors. This article presents results from a meta-analysis of such studies completed between 2015 and 2019 and provided to us by HHS. Studies were eligible for inclusion if they used an experimental/quasi-experimental design, included a comparison condition, assigned at least 10 study participants to each condition, and measured and reported at least one outcome related to sexual behavior or consequences. Data were extracted using a standardized coding protocol and outcomes were coded as, or transformed to, log odds ratio effect sizes for analysis and then transformed to odds ratio effect sizes for presentation in the text. All outcomes were coded such that log odds ratios greater than zero (odds ratios greater than 1) indicate beneficial effects (e.g., reductions in risky sexual behavior). A total of 52 studies met the inclusion criteria. Across 7 outcome types, pooled effects were generally small, the direction of effects was mixed, and none achieved statistical significance: recent pregnancy (OR = 1.30, 95% CI [1.00, 1.68]), ever had sex (OR = 1.07, 95% CI [0.99, 1.15]), recent sexual activity (OR = 0.95, 95% CI [0.84, 1.09]), recent unprotected sexual activity (OR = 1.05, 95% CI [0.96, 1.16]), ever pregnant (OR = 1.21, 95% CI [0.51, 2.89]), number of sexual partners (OR = 1.08, 95% CI = [0.28, 4.22]), and proportion of recent sexual experiences that were unprotected (OR = 0.74, 95% CI = [0.43, 1.31]). Moderator analyses pooling across all 7 outcome types indicated minor differences in program effectiveness between program settings, with those delivered in classroom settings being the least effective (b =  - 0.17, 95% CI [- 0.33, - 0.01]). These findings do not lend meaningful support for the overall effectiveness of this group of pregnancy prevention programs. However, because the meta-analysis sample only included programs recently funded by HHS, these findings may have limited generalizability to programs funded by other entities or implemented in other countries.