Academic journal article Journal of Marriage and Family

Effectiveness of Prevention Programs for Adolescent Pregnancy: A Meta-Analysis

Academic journal article Journal of Marriage and Family

Effectiveness of Prevention Programs for Adolescent Pregnancy: A Meta-Analysis

Article excerpt


JACQUEUNE CORCORAN University of Texas at Arlington* PAMELA O'DELL MEER University of Texas at Austin** LINDA Bui.'tM.AnN Texas Department of Health***

Using meta-analysis, we analyzed 32 outcome studies on the primary prevention of adolescent pregnancy and examined several moderator variables in relationship to the findings. Three outcome variables-sexual activity, contraceptive use, and pregnancy rates or childbirths-were analyzed as three separate and independent metaanalyses. Results indicate that the pregnancy prevention programs that we examined have no effect on the sexual activity of adolescents. We found sufficient evidence to support the efficacy of pregnancy prevention programs for increasing use of contraceptives. A smaller but significant amount of evidence supports program effectiveness in reducing pregnancy rates.

Key Words: adolescent pregnancy prevention, meta-analysis.

Political debates rage about the effectiveness of pregnancy prevention programs for adolescents and whether such programs should be offered (Whitehead, 1994). Several narrative or qualitative reviews have examined the findings of pregnancy prevention studies. Narrative reviews, however, have been limited by their lack of comprehensiveness in study selection (Jorgensen, Potts, & Camp, 1993) or by simply citing results of individual programs without attempting to synthesize the literature in a systematic way (Beck & Davies, 1987; Hofferth, 1991). They fail to provide systematic mechanisms for combining the results of different studies and for weighting and assessing the impact of variations in study methodology. Another failure of narrative reviews is that they are not equipped to assess the variation within studies of programs' effects on different subpopulations, such as specific gender, ethnic, and age groups. In addition, narrative reviews frequently suffer from mixed, contradictory, and inconclusive results. Meta-analysis may address these limitations because it allows studies to be systematically quantified and their results summarized as a common effect. This article reports the findings from a metaanalysis that evaluated the effectiveness of pregnancy prevention programs. We summarize narrative reviews conducted in this area, and we examine the potential of a meta-analysis to address the limitations of these narrative reviews. Finally, we present the methodology and the results of the meta-analysis, itself.


The most recent comprehensive narrative review of the literature involves school-based programs to prevent adolescent pregnancy (23 studies included) conducted by Kirby and colleagues (1994). The review narratively synthesizes research on the effectiveness of programs, identifies distinguishing characteristics of effective programs, and points out important research questions in this area. To be included in the review, a study had to be accepted for publication or published in a peer-reviewed journal. Findings, however, are inconsistent and inconclusive. For example, Kirby et al. identify three published studies on abstinence-based programs and conclude that the evidence is mixed whether they affect the initiation of sexual activity or contraceptive behavior. The national survey data examined also demonstrated an inconsistent relationship between sex education and sexual activity. The authors conclude that the mixed results from research studies make it impossible to "determine the impact of school-based or school-linked reproductive health services" (p. 356).

In a prior evaluation of school-based clinics, Kirby (1992) concluded that the reduction in birth rates initially reported for clinics in St. Paul, Minnesota, was not borne out by subsequent analyses. In a study of six school-based clinics, Kirby, Waszak, and Ziegler (1991) report that ". . simply dispensing contraceptives was not sufficient to dramatically increase contraceptive use, but more comprehensive approaches that focus on pregnancy and AIDS prevention might have a greater impact" (p. …

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