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Adolescent Pregnancy Prevention: A Review of Interventions and Programs

Original article by: Katherine Nitz

Despite the recent downward trend in teen birth rates, the rate of teen births in the United States is much higher than any other industrialized nation. To shed light on this problem, Katherine Nitz provides a review of current theories of sexual behavior. She also reviews existing intervention approaches to adolescent pregnancy and childbearing (e.g., pregnancy prevention education, programs to facilitate access to contraceptive services, and community-based life option programs). Nitz concludes the article with a discussion of areas for future study.

There are numerous theories that have been used to guide the development of pregnancy prevention programs. Some are behavioral in nature (e.g., social cognitive theory), whereas others account for the role of the social environment in adolescents' behavior (e.g., ecological theory). Though these theories are useful for shaping and evaluating programs, Nitz argues that there is a need to develop and test a more comprehensive theoretical model, which accounts for the multidimensional nature of this problem.

The need for a more comprehensive theoretical model is supported, in part, by the fact that current programs have had a relatively limited impact on reducing adolescent pregnancy. For example, pregnancy prevention education programs (including abstinence-based programs) have not been very successful at reducing pregnancy rates among teens, though some programs have had a positive impact on reducing sexual risk-taking behavior (e.g., increasing condom use). The author concludes that programs that are theory-based, have specific goals, use a small group format, use peer educators, and include community-based components are most likely to be successful.

Programs that provide access to contraception also do not appear to lead to a sustained decrease in teen pregnancy rates, yet some of them have shown a positive impact on sexual behaviors (e.g., more consistent contraception use). Unfortunately, many of these studies involved weak evaluation methods, thereby limiting the conclusions about their impact. The most successful programs included components to enhance students' skills and to reduce barriers to getting contraception.

Community-based life options programs are becoming an increasingly common approach to reducing teen pregnancy. In general, these programs focus on skill building in areas that extend beyond pregnancy (e.g., academic or employment skills), which are important determinants of teen pregnancy. To date, many of the evaluations of these programs suggest they are having a positive impact on reducing teen pregnancy.

The article concludes that there have been few successful adolescent pregnancy prevention programs due to a lack of effective theories to guide the development of the these programs. Further, those programs that have been successful tend to extend beyond reproductive health to include life options, such as education and job skills training.

The author suggests the need for future research to better determine what factors predispose adolescents to teen pregnancy. She also notes that there are several other areas that hold promise in developing more effective pregnancy prevention programs (e.g., recognizing and addressing the impact of family, neighborhood, and community; involving males, family members, and peers; ensuring programs are culturally and developmentally appropriate).

Nitz, K. "Adolescent pregnancy prevention: A review of interventions and programs." Clinical Psychology Review, 1999, 19(4), 457-471.