Multi-component interventions to prevent teen pregnancy
Multi-component interventions are broad-based programs that aim to reduce risky behaviors in young people through various combinations of education and skills building. They may take place in schools or in the community at multiple levels and activities can include classroom instruction, mentorship, service learning or volunteering, work experience and life skills, and contraceptive education or services (Campbell-Scher 2006, Cochrane-Oringanje 2016). Programs may also include efforts to create systemic change to improve delivery of sexual and reproductive health care (Rink 2022).
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
- Reduced teen pregnancy
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
- Reduced risky sexual behavior
- Increased use of contraception
What does the research say about effectiveness? -+
There is some evidence that multi-component interventions reduce teen pregnancy (Cochrane-Oringanje 2016, Campbell-Scher 2006), including programs in schools (Shackleton 2016), and reduce unprotected sexual intercourse (Campbell-Scher 2006). Programs appear to be particularly effective among female participants, but do not have a significant impact on male participants (Cochrane-Oringanje 2016, Campbell-Scher 2006). Additional evidence is needed to confirm effects.
Intensive programs designed for higher risk youth, such as populations with low incomes and from minority backgrounds, appear to be most effective (Campbell-Scher 2006). In community-wide interventions, increasing amounts of support and technical assistance provided by community-based organizations to other partners appears to increase the provision of contraceptives and the number of youth receiving interventions, particularly when working directly with school systems (House 2022). More broadly, sexual and reproductive health interventions appear to be more successful when they are multi-component, delivered at multiple levels and in multiple settings (Bowring 2017).
Implementing large community-wide initiatives can require significant training and technical assistance (Mueller 2017, House 2017). An analysis of the Pathways/Senderos Center in Connecticut suggests that multi-component interventions can be cost effective in the long run (Rosenthal 2009).
How could this strategy advance health equity? This strategy is rated potential to decrease disparities: suggested by intervention design. -+
Multi-component interventions to prevent pregnancy in youth have the potential to decrease disparities in unplanned pregnancy if they are designed for those most at risk. Many multi-component interventions are designed for populations with low incomes and from minority communities (Campbell-Scher 2006), and available evidence suggests multi-component programs in schools can reduce pregnancy in disadvantaged youth (Shackleton 2016). A small pilot study of a community-wide, culturally appropriate intervention for Native youth suggests it has the potential to increase self-efficacy and condom use, agreement with cultural attitudes toward pregnancy, and increase communication between parents and children (Rink 2021). More broadly, sexual and reproductive health interventions that are tailored and culturally appropriate appear to be more successful (Bowring 2017).
What is the relevant historical background? -+
Teen pregnancy rates have been declining in the U.S. since 1991 (CDC-Teen pregnancy) but are still higher than in the industrialized world, and racial and geographic disparities exist within the country (CDC-About teen pregnancy). In rural communities, lack of sexual and reproductive health education and services increases risks for adolescent pregnancy (Ott 2020). Birth rates remain high for young women of color (Fuller 2018, CDC-About teen pregnancy); American Indian and Alaska Native teens have the highest birth rates, and Hispanic and Black teens’ birth rates are two times higher than that of white teens (CDC-About teen pregnancy).
Teen pregnancy prevention programs are often built on Christian perspectives around when it is acceptable to have children (i.e., after marriage). Pregnancy prevention programs should consider communities' cultural attitudes and beliefs around pregnancy, particularly communities that have suffered from colonization and Christian cultural repression, such as Native communities (Rink 2021).
Equity Considerations -+
- Do adolescents in your community have access to the necessary knowledge and resources to prevent pregnancy and STI infections?
- Are existing programs culturally and linguistically appropriate, and inclusive of all gender identities and sexual orientations? Are there any systematic barriers to accessibility?
- Who can you partner with in the community to determine what type of programming may be useful and accepted?
Implementation Examples -+
Long running multi-component interventions in the U.S. include the Carrera Adolescent Pregnancy Prevention Program in New York City (Carrera) and the Pathways/Senderos Center in Connecticut (Pathways-Senderos).
Implementation Resources -+
Brindis 2017 - Brindis CD, ed. Implementing community-wide teen pregnancy prevention initiatives. Journal of Adolescent Health. 2017;60(3 Suppl):S1-S68.
CDC-Teen pregnancy tools and resources - Centers for Disease Control and Prevention (CDC). Teen pregnancy: Program tools and resources.
Citations -+
* Journal subscription may be required for access.
Bowring 2017* - Bowring AL, Wright CJC, Douglass C, Gold J, Lim MSC. Features of successful sexual health promotion programs for young people: Findings from a review of systematic reviews. Health Promotion Journal of Australia. 2017;29(1):46-57.
Campbell-Scher 2006* - Scher L, Maynard RA, Stagner M. Interventions intended to reduce pregnancy-related outcomes among adolescents. Campbell Systematic Reviews. 2006:12.
Carrera - Children’s Aid. Carrera adolescent pregnancy prevention.
CDC-About teen pregnancy - Centers for Disease Control and Prevention (CDC). About teen pregnancy.
CDC-Teen pregnancy - Centers for Disease Control and Prevention (CDC). Reproductive health: Teen pregnancy.
Cochrane-Oringanje 2016* - Oringanje C, Meremikwu MM, Eko H, et al. Interventions for preventing unintended pregnancies among adolescents. Cochrane Database of Systematic Reviews. 2016;(2):CD005215.
Fuller 2018* - Fuller TR, White CP, Chu J, et al. Social determinants and teen pregnancy prevention: Exploring the role of nontraditional partnerships. Health Promotion Practice. 2018;19(1):23-30.
House 2017 - House LD, Tevendale HD, Martinez-Garcia G. Implementing evidence-based teen pregnancy-prevention interventions in a community-wide initiative: Building capacity and reaching youth. Journal of Adolescent Health. 2017;60(3 Suppl):S18-S23.
House 2022 - House LD, Tevendale H, Brittain A, et al. Implementation of community-wide initiatives designed to reduce teen pregnancy: Measuring progress in a 5-year project in 10 communities. Sexuality Research and Social Policy. 2022;19(2):496-508.
Mueller 2017 - Mueller T, Tevendale HD, Fuller TR, et al. Teen pregnancy prevention: Implementation of a multicomponent, community-wide approach. Journal of Adolescent Health. 2017;60(3 Suppl):S9-S17.
Ott 2020* - Ott MA, Hunt AL, Katz AJ, Zaban LS. Tapping into community resiliency in rural adolescent pregnancy prevention: An implementation sciences approach. Behavioral Medicine. 2020;46(3-4):340-352.
Pathways-Senderos - Pathways-Senderos Center. Who we are.
Rink 2021 - Rink E, Anastario M, Johnson O, et al. The development and testing of a multi-level, multi-component pilot intervention to reduce sexual and reproductive health disparities in a tribal community. Journal of Ethnic and Cultural Diversity in Social Work. 2021;30(1-2):138-148.
Rink 2022 - Rink E, Firemoon P, Anastario M, et al. Rationale, design, and methods for Nen Unkumbi/Edahiyedo (“We are here now”): A multi-level randomized controlled trial to improve sexual and reproductive health outcomes in a Northern Plains American Indian reservation community. Frontiers in Public Health. 2022;10.
Rosenthal 2009* - Rosenthal MS, Ross JS, Bilodeau R, et al. Economic evaluation of a comprehensive teenage pregnancy prevention program: Pilot program. American Journal of Preventive Medicine. 2009;37(6 Suppl 1):S280-7.
Shackleton 2016* - Shackleton N, Jamal F, Viner RM, et al. School-based interventions going beyond health education to promote adolescent health: Systematic review of reviews. Journal of Adolescent Health. 2016;58(4):382-396.