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U.S. Department of Health and Human Services

Office of the Assistant Secretary for Planning and Evaluation

http://tppevidencereview.aspe.hhs.gov 

Updated Findings from the HHS Teen Pregnancy Prevention Evidence 

Review: January 2011 Through April 2013

July, 2014 

By Brian Goesling, Joanne Lee, Julieta Lugo-Gil, and Timothy Novak 

Mathematica Policy Research

Since 2009, the U.S. Department of Health and Human Services (HHS) has sponsored an 

ongoing systematic review of the teen pregnancy prevention research literature to help identify 

programs with evidence of effectiveness in reducing teen pregnancy, sexually transmitted 

infections (STIs), and associated sexual risk behaviors. Mathematica Policy Research and Child 

Trends conduct the Teen Pregnancy Prevention (TPP) Evidence Review, with support from the 

Office of the Assistant Secretary for Planning and Evaluation (ASPE), Office of Adolescent 

Health (OAH), and the Family and Youth Services Bureau (FYSB) within the Administration for 

Children and Families (ACF). 

As of spring 2012, the review team had identified 31 programs meeting the review criteria for 

evidence of effectiveness. These criteria require programs to show evidence of a favorable, 

statistically significant program impact on at least one sexual behavior or reproductive health 

outcome of interest (sexual activity, contraceptive use, STIs, pregnancy, or birth). In addition, 

the supporting research studies must meet established criteria for the quality and execution of 

their research designs. To identify the 31 programs meeting these criteria, the review team 

identified and assessed about 200 studies released from 1989 through January 2011.1

 

1 Goesling, B., Colman, S., Trenholm, C., Terzian, M., & Moore, K. (2014). Programs to reduce teen pregnancy, 

sexually transmitted infections, and associated sexual risk behaviors: A systematic review. Journal of Adolescent 

Health, 54(5), 499-507.

The review team has updated the findings for this review to cover more recent research

published or released from January 2011 to April 2013. As part of this update, the review team 

identified four new programs meeting the review criteria for evidence of effectiveness:

1. Health Improvement Program for Teens (HIP Teens) 

2. Project IMAGE

3. STRIVE (Support to Reunite, Involve and Value Each Other) 

4. Families Talking Together (FTT)

Taken together, these programs serve diverse target populations and reflect a range of 

programmatic approaches, from HIV and STI prevention to family-based interventions. 
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U.S. Department of Health and Human Services

Office of the Assistant Secretary for Planning and Evaluation

http://tppevidencereview.aspe.hhs.gov 

Additional details on the four programs and supporting research studies are provided later in this 

document. 

The recent update to the review findings also sought to identify and assess any newly available 

evidence for previously reviewed programs. To date, most teen pregnancy prevention programs 

have been evaluated only once. However, as part of the review update, the review team identified 

two programs that now have more than one supporting research study available: 

1. All4You! 

2. It’s Your Game...Keep It Real (IYG)

Additional details on these two programs and the newly available research studies are provided 

later in this document.

With these updates, the review team has now identified a total 35 programs meeting the review 

criteria for evidence of program effectiveness—31 programs from earlier rounds of the review 

and the 4 newly identified programs. In addition, the review team has now identified a total of 3 

programs with more than one supporting research study available that shows evidence of 

favorable effects—one program from earlier rounds of the review (Be Proud! Be Responsible!) 

and the two newly identified programs (All4You! and IYG). 

The remainder of this document provides a more detailed description of the procedures the 

review team used to update the review findings. 

Literature Search and Study Screening

In February 2013, the review team released a public call for studies requesting new research 

released from January 2011 through April 2013. The team also identified studies through a 

comprehensive literature search, which involved searching the websites of relevant federal 

agencies and research and policy organizations, conducting keyword searches of electronic 

databases, and hand-searching relevant journals and professional conference proceedings.

The call for studies and literature search identified 97 new studies. Of these, 64 were screened 

out because they did not meet the review eligibility criteria. The remaining 33 studies met the 

review eligibility criteria and were assessed for study quality.

Assessment of Individual Studies

Teams of two trained reviewers assessed all 33 studies that met the review eligibility criteria for 

the quality and execution of their research designs. As a part of this assessment, the reviewers

assigned each study a final quality rating of high, moderate, or low according to the risk of bias 
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U.S. Department of Health and Human Services

Office of the Assistant Secretary for Planning and Evaluation

http://tppevidencereview.aspe.hhs.gov 

2 Of 

the 33 studies assessed, 11 (33 percent) met the review criteria for a high quality rating, 6 studies 

(18 percent) met the criteria for a moderate quality rating, and 16 (48 percent) were assigned a 

low rating.

in the study’s impact estimates. The review protocol describes these ratings in greater detail.

 

2 Mathematica Policy Research. Identifying programs that impact teen pregnancy, sexually transmitted infections, 

and associated sexual risk behaviors: Review protocol, version 3.0. Princeton, NJ: Mathematica Policy Research. 

Available at: http://tppevidencereview.aspe.hhs.gov. 3 Guilamo-Ramos, V., Bouris, A., Jaccard, J., Gonzalez, B., McCoy, W., & Aranda, D. (2011). A parent-based 

intervention to reduce sexual risk behavior in early adolescence: Building alliances between physicians, social 

workers, and parents. Journal of Adolescent Health, 48(2), 159-163. 4 Morrison-Beedy, D., Jones, S. H., Xia, Y., Tu, X., Crean, H. F., & Carey, M. P. (2013). Reducing sexual risk 

behavior in adolescent girls: Results from a randomized controlled trial. Journal of Adolescent Health, 52(3), 314-

321.

Programs with Evidence of Effectiveness

For the 17 studies that passed the quality assessment with a rating of either high or moderate

(11 and 6 studies, respectively), the review team extracted information on the program tested, 

evaluation setting, study sample, and research design. The review team also extracted detailed 

information on the program impact estimates. On the basis of this information, the review team 

identified programs with evidence of effectiveness, defined as having a statistically significant 

favorable impact (and no adverse effects) on at least one of the following outcome measures: 

sexual activity, contraceptive use or consistency of use, STIs, or pregnancy or birth. 

A total of four new programs met this criterion for evidence of effectiveness:

1. Families Talking Together (FTT). FTT is a parent-based program intended to reduce 

sexual risk behavior in early adolescents by intervening with the adolescent’s mother. In 

a randomized controlled trial involving 264 African American or Latino adolescents and 

their mothers, researchers found that adolescents whose mothers participated in the 

program were significantly less likely to report having had vaginal intercourse and 

reported significantly lower frequency of sexual intercourse in the past 30 days.3 The 

study found no statistically significant program impacts on the prevalence of oral sex.

The study met the review criteria for a high quality rating.

2. HIP Teens. HIP Teens is a four-session sexual risk-reduction intervention for lowincome, urban, sexually active adolescent females. In a randomized controlled trial 

involving 639 predominately African American female adolescents in an urban area of 

upstate New York, researchers found that adolescents participating in the program were 

significantly less likely to report having had sexual intercourse and unprotected sex in the 

past three months. Adolescents participating in the program also reported significantly 

lower frequency of sexual intercourse and fewer sexual partners.4 The study met the 

review criteria for a high quality rating.
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U.S. Department of Health and Human Services

Office of the Assistant Secretary for Planning and Evaluation

http://tppevidencereview.aspe.hhs.gov 

3. Project IMAGE. Project IMAGE is a cognitive behavioral intervention intended to 

reduce subsequent STI infection among ethnic minority adolescent women with a history 

of sexual or physical abuse and STI infection. In a randomized controlled trial involving 

409 African or Mexican American female adolescents ages 14 to 18, researchers found 

that adolescents participating in the program were significantly less likely to have had a 

new STI infection.5 The study met the review criteria for a moderate quality rating.

 

5 Champion, J. D., & Collins, J. L. (2012). Comparison of a theory-based (AIDS risk reduction model) cognitive 

behavioral intervention versus enhanced counseling for abused ethnic minority adolescent women on infection with 

sexually transmitted infection: Results of a randomized controlled trial. International Journal of Nursing Studies, 

49(2), 138-150. 6 Milburn, N. G., Iribarren, F. J., Rice, E., Lightfoot, M., Solorio, R., Rotheram-Borus, M., Desmond, K., Lee, A., 

Alexander, K., Maresca, K., Eastmen, K., Arnold, E. M., & Duan, N. (2012). A family intervention to reduce sexual 

risk behavior, substance use, and delinquency among newly homeless youth. Journal of Adolescent Health, 50(4), 

358-364.

7 Coyle, K. K., Kirby, D. B., Robin, L. E., Banspach, S. W., Baumler, E., & Glassman, J. R. (2006). All4You! A 

randomized trial of an HIV, other STDs, and pregnancy prevention intervention for alternative school students. 

AIDS Education and Prevention, 18(3), 187–203.

4. STRIVE. STRIVE is a five-session family-based intervention intended to reduce sexual 

risk behaviors, substance use, and delinquency among youth who have recently run away 

from home. In a randomized controlled trial involving 151 newly homeless youth in Los 

Angeles and San Bernardino counties, California, researchers found that adolescents 

participating in the program reported significantly fewer sexual partners than 

nonparticipants.6 The study found no statistically significant program impacts on rates of 

recent sexual activity, the frequency of sexual activity, or rates of unprotected sex. The 

study met the review criteria for a high quality rating.

Through this update to the review, the review team also identified additional evidence of 

program effectiveness for two programs highlighted in previous rounds of the review: 

1. All4You! All4You! is a skills-based HIV, STI, and pregnancy prevention program for 

alternative high school students. The efficacy of the program was first established in a 

2006 study involving 998 students in alternative high schools in four large urban counties 

in Northern California.7 In a more recent study, researchers conducted a multi-armed 

randomized controlled trial of All4You! involving 652 students from 11 continuation 

high schools in Northern California. The study found that students participating in a 

curriculum-only version of the program reported significantly lower rates of sex without 

a condom in the past three months. The study found no statistically significant impacts on 

this measure for two other treatment groups, and no statistically significant impacts on 

the number of sexual partners, frequency of sexual intercourse, or sexual initiation for 

any of the groups. The study met the review criteria for a moderate quality rating.
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U.S. Department of Health and Human Services

Office of the Assistant Secretary for Planning and Evaluation

http://tppevidencereview.aspe.hhs.gov 

2. It’s Your Game...Keep It Real (IYG). IYG is a 24-lesson school-based program for 

middle school students. The efficacy of the program was first established in a 2010 study 

involving 3,007 7th-grade students in Southeast Texas.8

 In a more recent study, 

researchers conducted a cluster randomized trial involving 1,258 students from 15 urban 

middle schools in a large south-central U.S. school district. The study findings for the 

9th-grade follow-up show that students participating in the standard risk reduction 

version of the intervention were significantly less likely to initiate sexual activity or 

report having unprotected sex, and reported significantly lower frequency of vaginal and 

anal sex in the past three months. The study found no statistically significant program 

impacts on the number of sexual partners. The study met the review criteria for a 

moderate quality rating.

 

8 Tortolero, S. R., Markham, C. M., Fleschler Peskin, M., Shegog, R., Addy, R. C., Escobar-Chavez, S. L., & 

Baumler, E. (2010). It’s Your Game: Keep It Real: Delaying sexual behavior with an effective middle school 

program. Journal of Adolescent Health, 46(2), 169–179. 9 http://tppevidencereview.aspe.hhs.gov

More detailed information on these programs and the supporting research evidence is available 

on the project website.9

 The website also provides more detailed information on the review 

process and standards, and a complete listing all studies included in this update to the review.