Nationally, teen birth rates have declined steadily in the last several years. From 1991 to 1997, the number of teens having engaged in sexual activity has also decreased; for sexually active teens, the rate of condom use has increased. However, the teen birth rate in the United States is high at about 54 per 1,000 girls aged 15 to 19. Teen birth rates vary greatly by state, ranging in 1996 from 30 per 1,000 girls aged 15 to 19 in Vermont to 76 per 1,000 in Mississippi. Research shows that four risk factors consistently predict teen pregnancy: poverty, early school failure, early behavior problems, and family problems and dysfunction. Risk factors for teen pregnancy are common to other problem youth behavior, such as delinquency and substance abuse. Research has also identified several factors that can help protect against teen pregnancy, including positive relationships with parents and positive connections to a school community. Recent reviews of program evaluation results concluded that certain approaches are more promising than others, but too few programs have been rigorously evaluated to assess their effect on teen pregnancy. Numerous federal, state, and local agencies as well as private citizens and organizations have had a role in TPP activities. For decades, the federal government has supported efforts to prevent teen pregnancy. As part of HHS’ Healthy People 2000 initiative, each state sets goals to reduce teen pregnancy. To help meet these goals, the federal government provides funding to states and local communities for teen pregnancy prevention through a variety of grants and programs administered primarily by HHS. HHS also supports research and data collection and surveillance on the magnitude, trends, and causes of teen pregnancies and births. The 1996 welfare reform legislation also includes provisions aimed at reducing teen pregnancy. For example, the new law provides funding for abstinence-only education—sex education programs that emphasize abstinence from all sexual activity until marriage and exclude instruction on contraception—and allows states to use their TANF block grants for other TPP activities. In addition, the legislation requires states to set goals for decreasing out-of-wedlock births and will financially reward states with bonuses for the largest decreases in all out-of-wedlock births. The legislation also requires teen parents receiving assistance to stay in school and live at home or in another approved setting. States must also indicate how they intend to address the problem of statutory rape, and the government is required to study the link between teen pregnancy and statutory rape. Finally, the new law requires HHS to develop a national strategy to prevent out-of-wedlock teen pregnancy. States in our review have designed strategies for reducing teen pregnancy and have implemented and overseen programs that support their strategies. Generally, state health departments lead state TPP efforts. However, because of the crosscutting nature of teen pregnancy prevention, coordination is necessary with other state agencies whose programs and activities can affect efforts to prevent teen pregnancy, such as departments of social services, justice, and education. Governors’ offices, special commissions, and task forces can also play a central role in designing and implementing strategies and programs at the state level. States generally administer statewide programs, but most of the responsibility for implementing programs is delegated to local communities. States also encourage building coalitions among community groups and organizations involved in teen pregnancy prevention. State strategies must operate within the context of statutes, local policies, and other activities in the state. At the local level, public institutions, like schools and health departments as well as community-based and other organizations, often implement TPP programs or otherwise influence how TPP programs are implemented. Finally, some private organizations at the national, state, or local level may support public efforts or, in some cases, run independent initiatives. In their efforts to address the problem of teen pregnancy, the states that we visited developed prevention strategies with multiple components that included a variety of programs and services. But in all cases, a key objective of these states’ strategies was to target high-risk groups, such as teens living under impoverished conditions. Within the context of their broad strategies, states generally gave localities the flexibility to administer programs to meet local needs and preferences. States identified the federal government as a major contributor of funds that support their TPP strategies. Since the early 1980s, the TPP strategies in the eight states that we visited have evolved from focusing on services for teen parents to an array of programs with increased emphasis on prevention, while still providing programs and services for pregnant and parenting teens. The TPP strategies of all the states we visited contained six basic components: sex education, family planning services, teen subsequent pregnancy prevention programs, male involvement, comprehensive youth development, and public awareness. (See table 1.) Although each state generally had all of these components in their TPP strategies, the emphasis placed on the components and the types of services and programs included in their strategies varied. Two of these components—male involvement and youth development—are beginning to play prominent roles in states’ TPP strategies. Traditionally, pregnancy prevention efforts almost exclusively targeted young women. More recently, strategies have begun to focus on young men’s role in decisions to have sex and to use contraception. In 1995, 68 percent of males surveyed by the National Survey of Adolescent Males reported having had intercourse by age 18. The survey also observed that one of the biggest shifts in teen reproductive behavior is the improvement in teenage males’ use of contraception. These shifts suggest that male teens can be encouraged to delay sex or use contraception if they have begun having sex. All the states we visited included a male involvement component in their TPP strategies in an effort to change male behavior and produce more promising results. For example, California’s male involvement program—a 3-year, $8 million grant program established in 1995—funds 23 projects across the state to improve teen males’ motivation for being sexually responsible through peer education, mentoring, youth conferences, and other activities. California also supports prevention and parenting programs for incarcerated young men and has increased enforcement of statutory rape laws to increase the prosecution and conviction of adult men who have unlawful sex with minors. In addition, one of the state’s public awareness campaigns specifically targets males. Georgia’s male involvement effort aims to establish community-based programs that focus on male responsibility for pregnancy prevention, responsible fatherhood, and motivation for academic achievement and economic self-sufficiency. In 1996, Georgia used $265,500 from the Medicaid Indigent Care Trust Fund (ICTF) to sponsor 17 projects across the state. Grant recipients included health departments, community centers, and various chapters of Alpha Phi Alpha Fraternity, Inc. In 1997, Georgia used $200,000 from ICTF to award 23 grants that focused specifically on pregnancy prevention programs from a male perspective. All of the states we visited also included youth development—another nontraditional component—in their TPP strategies. Although many of these programs do not focus specifically on teen pregnancy prevention, states and some experts believe they can reduce teen pregnancy by improving teens’ belief in their future and improving their education and career opportunities. Youth development activities often include mentoring, after-school homework assistance and tutoring, peer leadership, self-esteem building, social and recreational activities, and sex education. For example, Illinois’ Teen REACH (Responsibility, Education, Achievement, Caring, and Hope)—an $8.4-million annual after-school program—aims to decrease teen pregnancies, arrests, alcohol and drug use and increase school attendance and completion and work or work-related activities. The program targets girls and boys aged 10 to 17 at 41 sites across the state and will link participants to other state and community-based programs and services. Table 2 summarizes the activities and services in the various components that the eight states used to implement their TPP strategies. A key objective of all the states’ strategies is to target their TPP efforts to groups or communities at higher risk of teen pregnancy. California, for example, targeted TPP efforts to communities and neighborhoods with high rates of teen births, high poverty and unemployment rates, and low education levels. The states’ strategies also focused on meeting the needs of three different groups of teens: those who were not yet sexually active, those who were sexually active, and those who were already pregnant or were parenting. Louisiana is targeting 12 zip codes in the New Orleans area with the highest teen birth rates in the city. Oregon offers special life-skills training for teens whose parents receive public assistance because they are at increased risk of becoming teen parents. California, Illinois, and Vermont developed programs aimed at youth in foster care or with foster parents because research has shown that these youth are at a greater risk for unsafe sexual behavior and teen pregnancy. Other state strategies target high-risk groups such as incarcerated males and siblings of teen mothers. The states we visited were using different types of data to target TPP efforts to high-risk communities and youth. For example, all of the states in our review use teen birth data, frequently broken down by zip code, to identify and target high-risk areas. Illinois uses data from a sexually transmitted disease reporting project sponsored by HHS’ Centers for Disease Control and Prevention (CDC) to help target TPP initiatives. In addition, the states that participated in the federal Youth Risk Behavioral Survey (YRBS) use this data in developing their strategies and programs. For example, to improve access to and use of contraception, Oregon uses YRBS data to target sexually active teens who report not using contraception. While TPP strategies were applicable statewide, the states we visited typically gave communities flexibility in selecting and implementing programs to meet local needs and preferences. States generally offered localities a choice among certain state-approved programs or programs that used promising approaches. Communities selected programs that they found most consistent with local policy and values. According to state officials, this resulted in a mix of programs, approaches, and services that varied among communities within a state.