Prevention Science

, Volume 19, Issue 4, pp 468–489 | Cite as

Effectiveness of School-Based Teen Pregnancy Prevention Programs in the USA: a Systematic Review and Meta-Analysis

  • Elliot Marseille
  • Ali Mirzazadeh
  • M. Antonia Biggs
  • Amanda P. Miller
  • Hacsi Horvath
  • Marguerita Lightfoot
  • Mohsen Malekinejad
  • James G. Kahn


School-based programs have been a mainstay of youth pregnancy prevention efforts in the USA. We conducted a systematic review and meta-analysis to assess their effectiveness. Eligible studies evaluated the effect on pregnancy rates of programs delivered in elementary, middle, or high schools in the USA and Canada, published between January 1985 and September 2016. The primary outcome was pregnancy; secondary outcomes were delay in sexual initiation, condom use, and oral contraception use. Randomized controlled trials (RCTs) and non-RCTs with comparator groups were eligible. We developed a comprehensive search strategy, applied to major bibliographic databases, article bibliographies, gray literature, and contact with authors. We calculated risk ratios (RR) with 95% confidence intervals (CI) for each outcome and pooled data in random effects meta-analysis. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess evidence quality. Ten RCTs and 11 non-RCTs conducted from 1984 to 2016 yielded 30 unique pooled comparisons for pregnancy, of which 24 were not statistically significant. Six showed statistically significant changes in pregnancy rates: two with increased risk (RR 1.30, 95% CI 1.02–1.65; and RR 1.39, 95% CI 1.10–1.75) and four with decreased risk ranging from RR 0.56, 95% CI 0.41–0.77, to RR 0.75, 95% CI 0.58–0.96. All studies were at high risk of bias, and the quality of evidence was low or very low. Identified evidence indicated no consistent difference in rates of pregnancies between intervention recipients and controls.


Adolescent Pregnancy Teen pregnancy Schools 


Funding Information

This project was completed with funding from CAPE (Consortium for Assessment of Prevention Economics), of the NCHHSTP Epidemiological and Economic Modeling Agreement (Grant No. U38PS004649), with the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Research Involving Human Participants and/or Animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

As no human subjects were involved in the research undertaken to produce this article, no informed consent was required.

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Copyright information

© Society for Prevention Research 2018

Authors and Affiliations

  1. 1.Health Strategies InternationalOaklandUSA
  2. 2.School of Medicine, Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA
  3. 3.Advancing New Standards in Reproductive Health (ANSIRH)University of CaliforniaSan FranciscoUSA
  4. 4.Philip R. Lee Institute for Health Policy StudiesUniversity of CaliforniaSan FranciscoUSA
  5. 5.Philip R. Lee Institute for Health Policy Studies, Global Health Sciences, and Global Health Economics ConsortiumUniversity of CaliforniaSan FranciscoUSA
  6. 6.School of Medicine, Department of MedicineUniversity of CaliforniaSan FranciscoUSA
  7. 7.Philip R. Lee Institute for Health Policy Studies, Global Health SciencesUniversity of CaliforniaSan FranciscoUSA

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