Reducing the Risk

Developers
Richard P. Barth, M.S.W., Ph.D.
Program Summary
Reducing the Risk: Building Skills to Prevent Pregnancy, STDs & HIV is a 16-session program focused on the development of attitudes and skills that will help teens prevent pregnancy and the transmission of STDs, including HIV. This approach addresses skills such as risk assessment, communication, decision-making, planning, and refusal strategies.
Intended Population
The program was designed for high school students. It was first evaluated with 14 to 17 year old White youth, and more recently has also been tested with Latino and African American youth. 
Program Setting

The program was designed to be implemented in a classroom-based school setting. It has been evaluated in community based organizations as well as classroom-based school settings.

Contact and Availability Information

Program Contact Information
Email: sales@etr.org
Phone: (800) 321-4407
Website: http://www.etr.org/ebi/programs/reducing-the-risk/

Training Contact Information 
Kelly Gainor, M.Ed.
ebptraining@etr.org
Website: http://www.etr.org/ebi/programs/reducing-the-risk/

Sample of Curriculum Available for Review Prior to Purchase
Yes
Languages Available
English, Spanish
Monitoring and Evaluation Tools
Monitoring and evaluation tools available
Yes
Monitoring and evaluation tool usage required
No
Information about available monitoring and evaluation tools (if applicable)

ETR provides a fidelity log that enables staff to evaluate if they are fully implementing the core components of the program. Pre- and post-tests are also available to assess short-term learning goals and to measure changes in knowledge from pre-instruction to post-instruction. There is an English and Spanish version of each test.

Program Core Components

Last updated in 2023

The data presented on this page reflects responses from the program’s developer or distributor to a program component checklist that asked them to report on the individual components within their TPP program. The same program component checklist was sent to the developer or distributor of every active TPP program with evidence of effectiveness. The program component table provides data on seven types of program components including content, delivery mechanism, dosage, staffing, format, environment, and intended population characteristics; whether the component was present or optional in the program; whether the component is considered to be core to the program; and the lesson number or activity where the component can be found in the program. For more details, refer to the FAQ.

Category Component Core Component Component present Notes Lesson number(s) / activities where present
Content STIs - Treatment Yes Yes (both versions) Class 12, activity 1
Content Other Yes Yes (both versions) Personalization of content is key and not really captured in definitions above. Throughout.
Content Volunteering/civic engagement No
Content Spirituality No
Content Morals/values No
Content Identity development No
Content Social support/capital No
Content Social influence/actual vs. perceived social norms Yes Yes (both versions) Class 2, activity 3
Content Social competence Yes Yes (both versions) Refusal skills lessons counted here. Clearly much broader topic. Class 3, activity 3,4; Class 4, activities 1-4; Class 5, activities 2-4; Class 6, activities 2,3; Class 15, activity 2
Content Parenting skills No
Content Normative beliefs Yes Yes (both versions) Class 2, activity 3
Content Leadership No
Content Gender roles No
Content Gender identity No
Content Cultural values No
Content Connections with trusted adults Yes Yes (both versions) Class 3, activity 2; Class 6, activity 1
Content Communication skills Yes Yes (both versions) Refusal skills lessons counted here because they teach verbal and non-verbal approaches. Class 3, activity 3,4; Class 4, activities 1-4; Class 5, activities 2-4; Class 6, activities 2,3; Class 15, activity 2
Content Child development No
Content Boundary setting/refusal skills Yes Yes (both versions) Lessons identified are where skills introduced/taught. See self-efficacy for all lessons where skills practiced and reinforced. Class 3, activity 3,4; Class 4, activities 1-4; Class 5, activities 2-4; Class 6, activities 2,3; Class 15, activity 2
Content Substance use cessation No
Content Substance use - Other drugs No
Content Substance use - Alcohol No
Content Substance use - Abstinence No
Content Brain development and substance use No
Content Vocational/skills training No
Content Supplemental academic services No
Content School engagement No
Content Graduating from high school No
Content College preparation No
Content Alternative schooling No
Content Self-regulation No
Content Self-esteem No
Content Self-efficacy/empowerment Yes Yes (both versions) All skill-focused activities are designed to reinforce self efficacy and are listed here. Class 4, activities 1, 2, 4; Class 5, activities 3,4; Class 9, activities 2,3; Class 10, activities 2, 3; Class 11, activities 1, 2; Class 13, activity 2; Class 15, activity 2; Class 16, activity 3
Content Conflict resolution/social problem solving No
Content Resilience No
Content Reproduction No
Content STIs - Prevention Yes Yes (both versions) Class 1B, activity 2; Class 6, activity 4; Class 7, activity 1; Class 8, activities 1, 4; Class 9, activity 1; Class 12, activity 1; Class 13, activity 1; Class 14, activity 1;
Content STIs - Information Yes Yes (both versions) Class 1B, activity 2; Class 12, activity 1; Class 13, activity 1
Content Sexual risk reduction Yes Yes (both versions) Every class reinforces risk reduction messages
Content Sexual risk discontinuation No
Content Sexual risk avoidance Yes Yes (both versions) Class 1A, activity 3; Class 1B, activity 4; Class 2, activities 2-4; Class 6, activity 3; Class 7, activity 1; Class 12, activity 1; Class 13, activity 2; Class 15, activity 2.
Content Sexual orientation No
Content Sexual health Yes Yes (both versions) Entire program is focused on sexual health so difficult to discern what this row is intending to capture. Throughout
Content Risk of STIs and Pregnancy Yes Yes (both versions) Class 1A, activity 1, 2, 3; Class 1B, activity 2; Class 12, activity 1; Class 13, activity 1
Content Contraception - Other Yes Yes (both versions) Class 7, activity 1; Class 8, activity 4
Content Personal vulnerability No
Content Anatomy/physiology No Includes appendix on anatomy/physiology for educators as background material
Content Contraception - Condoms Yes Yes (both versions) Class 6, activity 4; Class 7, activities 1 and 2; Class 8, activity 1, 4
Content Contraception - Long-acting reversible contraceptives Yes Yes (current version) LARCs not available at time of original study Class 7, activity 1; Class 8, activity 2, 4
Content Maternal health No
Program Objectives
The program seeks to prevent pregnancy and the transmission of STDs, including HIV. It is designed to reach these goals by teaching youth to:
  • Evaluate the risks and lasting consequences of becoming an adolescent parent or becoming infected with HIV or another STD.
  • Recognize that abstaining from sexual activity or using contraception are the only ways to avoid pregnancy, HIV, and other STDs.
  • Conclude that factual information about conception and protection is essential for avoiding teen pregnancy, HIV, and other STDs.
  • Demonstrate effective communication skills for remaining abstinent and for avoiding unprotected sexual intercourse.
Program Content

Reducing the Risk is a 16-session program focused on pregnancy and STD/HIV prevention. It is based on several interrelated theoretical models, namely Social Learning Theory, Social Inoculation Theory and Cognitive Behavior Theory.

The core content covered by the program consists of:

  • Knowledge of pregnancy risk and prevention
  • Knowledge about STD and HIV risk, prevention, transmission, treatment and consequences
  • Perception of individual risk for pregnancy, STDs, and HIV and their consequences, if teenagers engage in unprotected sex
  • Knowledge of how to be abstinent or use birth control methods effectively and how to access health care information and contraception (including condoms)
  • Effective and ineffective refusal skills
  • Social and peer norms, as well as personal attitudes, about abstinence, sex, unprotected sex, condoms, and contraception
  • Refusal and communication skills in pressure situations in order to avoid pregnancy and STDs
  • Skills to obtain health care information and contraception from a clinic and use it
  • Skills to communicate with parents or other adults about teen sexual activity and birth control

The program logic model can be found on ETR's website: http://www.etr.org/ebi/programs/reducing-the-risk/

Program Methods
Reducing the Risk is delivered through role plays, skill practice, brainstorming, mini-lecture, and worksheet activities.
Program Structure and Timeline

Reducing the Risk is delivered in sixteen 45- to 60-minute lessons, which are conducted 2 to 3 times per week. The classes must be taught in sequence. The ideal class size is between 10 and 30 youth.

Staffing
This curriculum is designed to be taught by classroom teachers or family life educators.
Staff Training

It is highly recommended that educators who plan to teach Reducing the Risk receive professional development to prepare them to effectively implement the curriculum with its intended target group.

Training on Reducing the Risk is available through ETR’s Professional Learning Services. Training options include:

  1. Three-day Training of Educators (TOE)—the learning process includes pre-work, skill-based instruction and post-training follow-up support.
  2. Four-day Training of Trainers (TOT)—available for seasoned trainers who have experience in delivering the intervention. Completion entitles participants to use ETR’s research-based training designs to conduct TOEs for their organization or designated affiliate group. TOT attendees who have completed the four-day TOT are eligible to attend a condensed TOT course on additional EBIs.
Program Materials and Resources

Core intervention materials include a teacher's guide (available in English only), student workbooks (available in English and Spanish), activity kit, and pamphlets.

An optional LGBTQ Supplement is also available. It includes a lesson that can be taught before implementing the intervention as well as suggestions for acceptable adaptations to make the program more inclusive of LGBTQ youth.

 

Additional Needs for Implementation

None specified

Fidelity
ETR provides a fidelity log, adaptation kit, a Reducing the Risk Student Knowledge Survey that can be administered as a pre-test/post-test, and a survey answer key. These materials can be found here: http://www.etr.org/ebi/programs/reducing-the-risk/.
Technical Assistance and Ongoing Support

ETR provides in-person and web- or phone-based technical assistance before, during and/or after program implementation. TA is tailored to the needs of the site and is designed to support quality assurance, trouble-shoot adaptation issues, and boost implementation.

ETR also provides evaluation support for EBI implementation. Services address process and outcome evaluation and include assistance with evaluation planning, instrument design and development, implementation fidelity, data management and analysis, performance measurement, continuous quality improvement (CQI) protocols, and effective tools and strategies for reporting results.

Allowable Adaptations

In-depth adaptation guidelines and tools are available through ETR at the following link: http://www.etr.org/ebi/programs/reducing-the-risk/.

Examples of allowable adaptations include adding processing questions; lengthening skills-based classes beyond 45-minutes without cutting the number of classes; and tailoring the content (e.g. for visual learners or particular gender or racial/ethnic groups).

 

Adaptation Guidelines or Kit
Yes
Reviewed Studies
Citation High-Quality Randomized Trial Moderate-Quality Randomized Trial Moderate-Quality Quasi-Experiment Low Study Rating Did Not Meet Eligibility Criteria

Kirby, D., Barth, R. P., Leland, N., Fetro, J. V. (1991). Reducing the Risk: Impact of a new curriculum on sexual risk-taking. Family Planning Perspectives, 23(6), 253-263.

Barth, R. P. (1992). Preventing adolescent pregnancy with social and cognitive skills. Journal of Adolescent Research, 7(2), 208-232.

Hubbard, B. M., Giese, M. L., Rainey, J. (1998). A replication study of Reducing the Risk, a theory-based sexuality curriculum for adolescents. Journal of School Health, 68(6), 243-247.

Ebreo, A., Feist-Price, S., Siewe, Y., Zimmerman, R. S. (2002). Effects of peer education on the peer educators in a school-based HIV prevention program: Where should peer education research go from here? Health Education Behavior, 29(4), 411-423.

Zimmerman, R. S., Cupp, P. K., Donohew, L., Sionean, C. K., Feist-Price, S., Helme, D. (2008). Effects of a school-based, theory-driven HIV and pregnancy prevention curriculum. Perspectives on Sexual and Reproductive Health, 40(1), 42-51.

Anderman, E. M., Lane, D. R., Zimmerman, R., Cupp, P. K., Phebus, V. (2009). Comparing the efficacy of permanent classroom teachers to temporary health educators for pregnancy and HIV prevention instruction. Health Promotion Practice, 10(4), 597-605.

Reyna, V. F., Mills, B. A. (2014). Theoretically Motivated Interventions for Reducing Sexual Risk Taking in Adolescence: A Randomized Controlled Experiment Applying Fuzzy-Trace Theory. Journal Of Experimental Psychology. General, 143(4), 1627-1648.

Abt Associates. Reducing the Risk: Interim Impact Report, Teen Pregnancy Prevention Replication Study, Report prepared for the Office of Adolescent Health and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, September 2015a.

Kelsey, M., Blocklin, M., Layzer, J., Price, C., Juras, R., Freiman, L. (201c). Replicating reducing the risk: 12-month impacts of a cluster randomized controlled trial. American Journal of Public Health, 106, S45-S52. doi:10.2105/AJPH.2016.303409

Kelsey, M., Layzer, J., Blocklin, M., Price, C., and Juras, R. "Reducing the Risk: Longer-Term Impact Report." Draft Teen Pregnancy Prevention Replication Study, Abt Associates: Cambridge, MA, November 2016d.

Study Characteristics
Citation Setting Majority Age Group Majority Racial/Ethnic Group Gender Sample Size

Kirby, D., Barth, R. P., Leland, N., Fetro, J. V. (1991). Reducing the Risk: Impact of a new curriculum on sexual risk-taking. Family Planning Perspectives, 23(6), 253-263.

Barth, R. P. (1992). Preventing adolescent pregnancy with social and cognitive skills. Journal of Adolescent Research, 7(2), 208-232.

In school: High school 14 to 17 White Youth of any gender

758

Hubbard, B. M., Giese, M. L., Rainey, J. (1998). A replication study of Reducing the Risk, a theory-based sexuality curriculum for adolescents. Journal of School Health, 68(6), 243-247.

n.a. n.a. n.a. n.a. n.a.

Ebreo, A., Feist-Price, S., Siewe, Y., Zimmerman, R. S. (2002). Effects of peer education on the peer educators in a school-based HIV prevention program: Where should peer education research go from here? Health Education Behavior, 29(4), 411-423.

n.a. n.a. n.a. n.a. n.a.

Zimmerman, R. S., Cupp, P. K., Donohew, L., Sionean, C. K., Feist-Price, S., Helme, D. (2008). Effects of a school-based, theory-driven HIV and pregnancy prevention curriculum. Perspectives on Sexual and Reproductive Health, 40(1), 42-51.

In school: High school 14 to 17 White Youth of any gender

1944

Anderman, E. M., Lane, D. R., Zimmerman, R., Cupp, P. K., Phebus, V. (2009). Comparing the efficacy of permanent classroom teachers to temporary health educators for pregnancy and HIV prevention instruction. Health Promotion Practice, 10(4), 597-605.

n.a. n.a. n.a. n.a. n.a.

Reyna, V. F., Mills, B. A. (2014). Theoretically Motivated Interventions for Reducing Sexual Risk Taking in Adolescence: A Randomized Controlled Experiment Applying Fuzzy-Trace Theory. Journal Of Experimental Psychology. General, 143(4), 1627-1648.

After school 14 to 17 White Youth of any gender

734

Abt Associates. Reducing the Risk: Interim Impact Report, Teen Pregnancy Prevention Replication Study, Report prepared for the Office of Adolescent Health and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, September 2015a.

Kelsey, M., Blocklin, M., Layzer, J., Price, C., Juras, R., Freiman, L. (201c). Replicating reducing the risk: 12-month impacts of a cluster randomized controlled trial. American Journal of Public Health, 106, S45-S52. doi:10.2105/AJPH.2016.303409

Kelsey, M., Layzer, J., Blocklin, M., Price, C., and Juras, R. "Reducing the Risk: Longer-Term Impact Report." Draft Teen Pregnancy Prevention Replication Study, Abt Associates: Cambridge, MA, November 2016d.

In school: High school 14 to 17 Hispanic or Latinx of any race Youth of any gender

2689

Study Findings

Evidence by Outcome Domain and Study

Citation Sexual Activity Number of Sexual Partners Contraceptive Use STIs or HIV Pregnancy

Kirby, D., Barth, R. P., Leland, N., Fetro, J. V. (1991). Reducing the Risk: Impact of a new curriculum on sexual risk-taking. Family Planning Perspectives, 23(6), 253-263.

Barth, R. P. (1992). Preventing adolescent pregnancy with social and cognitive skills. Journal of Adolescent Research, 7(2), 208-232.

Indeterminate evidence n.a. Potentially favorable evidence n.a. Indeterminate evidence

Hubbard, B. M., Giese, M. L., Rainey, J. (1998). A replication study of Reducing the Risk, a theory-based sexuality curriculum for adolescents. Journal of School Health, 68(6), 243-247.

n.a. n.a. n.a. n.a. n.a.

Ebreo, A., Feist-Price, S., Siewe, Y., Zimmerman, R. S. (2002). Effects of peer education on the peer educators in a school-based HIV prevention program: Where should peer education research go from here? Health Education Behavior, 29(4), 411-423.

n.a. n.a. n.a. n.a. n.a.

Zimmerman, R. S., Cupp, P. K., Donohew, L., Sionean, C. K., Feist-Price, S., Helme, D. (2008). Effects of a school-based, theory-driven HIV and pregnancy prevention curriculum. Perspectives on Sexual and Reproductive Health, 40(1), 42-51.

Potentially favorable evidence n.a. n.a. n.a. n.a.

Anderman, E. M., Lane, D. R., Zimmerman, R., Cupp, P. K., Phebus, V. (2009). Comparing the efficacy of permanent classroom teachers to temporary health educators for pregnancy and HIV prevention instruction. Health Promotion Practice, 10(4), 597-605.

n.a. n.a. n.a. n.a. n.a.

Reyna, V. F., Mills, B. A. (2014). Theoretically Motivated Interventions for Reducing Sexual Risk Taking in Adolescence: A Randomized Controlled Experiment Applying Fuzzy-Trace Theory. Journal Of Experimental Psychology. General, 143(4), 1627-1648.

Potentially favorable evidence Indeterminate evidence Indeterminate evidence n.a. n.a.

Abt Associates. Reducing the Risk: Interim Impact Report, Teen Pregnancy Prevention Replication Study, Report prepared for the Office of Adolescent Health and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, September 2015a.

Kelsey, M., Blocklin, M., Layzer, J., Price, C., Juras, R., Freiman, L. (201c). Replicating reducing the risk: 12-month impacts of a cluster randomized controlled trial. American Journal of Public Health, 106, S45-S52. doi:10.2105/AJPH.2016.303409

Kelsey, M., Layzer, J., Blocklin, M., Price, C., and Juras, R. "Reducing the Risk: Longer-Term Impact Report." Draft Teen Pregnancy Prevention Replication Study, Abt Associates: Cambridge, MA, November 2016d.

Indeterminate evidence n.a. Indeterminate evidence Indeterminate evidence Indeterminate evidence
KEY
Evidence Indication
Favorable findings
Two or more favorable impacts and no unfavorable impacts, regardless of null findings
Potentially favorable findings
At least one favorable impact and no unfavorable impacts, regardless of null findings
Indeterminate findings
Uniformly null findings
Conflicting findings
At least one favorable and at least one unfavorable impact, regardless of null findings
Potentially unfavorable findings
At least one unfavorable impact and no favorable impacts, regardless of null findings
Unfavorable findings
Two or more unfavorable impacts and no favorable impacts, regardless of null findings
Note: n.a. indicates the study did not examine any outcome measures within that particular outcome domain, or the study examined outcome measures within that domain but the findings did not meet the review evidence standards.
Detailed Findings
Citation Details

Kirby, D., Barth, R. P., Leland, N., Fetro, J. V. (1991). Reducing the Risk: Impact of a new curriculum on sexual risk-taking. Family Planning Perspectives, 23(6), 253-263.

Barth, R. P. (1992). Preventing adolescent pregnancy with social and cognitive skills. Journal of Adolescent Research, 7(2), 208-232.

"The program’s evidence of effectiveness was first established in a quasi-experimental study involving high school students from rural and urban areas of northern California. Students from about half the classrooms were assigned to an intervention group that received the program. Students from the other classrooms were assigned to a comparison group that received the usual school instruction. Surveys were administered immediately before the program (baseline), immediately after the program, and again six and 18 months after the program ended.

The study found that eighteen months after the program ended, female adolescents participating in the program who were sexually inexperienced at baseline were significantly less likely to report having had sex without using birth control. The study found no statistically significant program impacts on sexual initiation for adolescents who were sexually inexperienced at baseline, having unprotected sex or pregnancy for the full sample of study participants, or having unprotected sex for male adolescents who were sexually inexperienced at baseline. For the six month follow-up survey, the study found no statistically significant program impacts on sexual initiation, recent sexual activity, contraceptive use, or pregnancy.

The study also examined program impacts on measures of STD knowledge and self-reported condom failures. Findings for these outcomes were not considered for the review because they fell outside the scope of the review."

Hubbard, B. M., Giese, M. L., Rainey, J. (1998). A replication study of Reducing the Risk, a theory-based sexuality curriculum for adolescents. Journal of School Health, 68(6), 243-247.

This is a quasi-experimental study that received a low rating because it did not establish baseline equivalence for the final analysis sample

Ebreo, A., Feist-Price, S., Siewe, Y., Zimmerman, R. S. (2002). Effects of peer education on the peer educators in a school-based HIV prevention program: Where should peer education research go from here? Health Education Behavior, 29(4), 411-423.

This is a quasi-experimental study that received a low rating because it did not establish baseline equivalence for the final analysis sample

Zimmerman, R. S., Cupp, P. K., Donohew, L., Sionean, C. K., Feist-Price, S., Helme, D. (2008). Effects of a school-based, theory-driven HIV and pregnancy prevention curriculum. Perspectives on Sexual and Reproductive Health, 40(1), 42-51.

A subsequent study conducted by a separate group of researchers examined the effectiveness of an adapted version of the program designed to target high sensation-seeking and impulsive youth. The study used a cluster randomized trial involving ten high schools in the Louisville, KY, area and seven high schools in Cleveland, Ohio. Each school was randomly assigned to one of three groups: (1) a treatment group that received the standard version of the program, (2) a treatment group that received the adapted version of the program for high sensation-seeking and impulsive youth, or (3) a control group in which schools delivered their standard, non-skills-based HIV prevention curricula. Surveys were administered immediately before the program started at the beginning of the ninth grade (baseline), immediately after the program at the end of the ninth grade, and again a year later at the end of the tenth grade.

For the tenth grade follow-up, the study found that students in the control group were statistically significantly more likely to report having initiated sexual intercourse than students who received either the standard or adapted version of the program (odds ratio = 2.42, confidence interval = 1.54 to 3.80). The study found no statistically significant impacts when analyzing data for the standard and adapted versions of the program separately.

The study also examined program impacts on measures of condom use at last sexual encounter and frequency of condom use. Findings for these outcomes were not considered for the review because they did not meet the review evidence standards. Specifically, findings were reported only for subgroups of youth defined by sexual activity at follow-up.

Anderman, E. M., Lane, D. R., Zimmerman, R., Cupp, P. K., Phebus, V. (2009). Comparing the efficacy of permanent classroom teachers to temporary health educators for pregnancy and HIV prevention instruction. Health Promotion Practice, 10(4), 597-605.

This study did not meet the review's screening criteria

Reyna, V. F., Mills, B. A. (2014). Theoretically Motivated Interventions for Reducing Sexual Risk Taking in Adolescence: A Randomized Controlled Experiment Applying Fuzzy-Trace Theory. Journal Of Experimental Psychology. General, 143(4), 1627-1648.

A more recent study examined the effectiveness of an adapted version of the program, called RtR+, that places greater emphasis on the bottom-line or "gist" message of the program. The study used a randomized controlled trial involving high-school-aged students across three states (Arizona, New York, and Texas). Study participants were randomly assigned to one of three groups: (1) a treatment group that received the standard version of the program, (2) a treatment group that received RtR+, the adapted version of the program, or (3) a control group that received an unrelated curriculum on communication skills. Surveys were administered immediately before the program (baseline), immediately after the program, and again three, six and 12 months after the program ended. For the standard version of the program, the study replicated the favorable impact on sexual initiation found in the earlier study by Zimmerman et al. (2008). At the time of the 12-month follow-up survey, adolescents in the control group were more likely than those in the standard RtR group to report having initiated sexual intercourse, and the reported odds ratio (odds = 4.76) is larger than the odds ratio reported in the earlier study by Zimmerman et al. (odds = 2.42, confidence interval = 1.54 to 3.80). The study found no statistically significant impacts of the standard version of the program on two other measures of sexual risk behavior: (1)

Abt Associates. Reducing the Risk: Interim Impact Report, Teen Pregnancy Prevention Replication Study, Report prepared for the Office of Adolescent Health and the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, September 2015a.

Kelsey, M., Blocklin, M., Layzer, J., Price, C., Juras, R., Freiman, L. (201c). Replicating reducing the risk: 12-month impacts of a cluster randomized controlled trial. American Journal of Public Health, 106, S45-S52. doi:10.2105/AJPH.2016.303409

Kelsey, M., Layzer, J., Blocklin, M., Price, C., and Juras, R. "Reducing the Risk: Longer-Term Impact Report." Draft Teen Pregnancy Prevention Replication Study, Abt Associates: Cambridge, MA, November 2016d.

A recent study conducted by a separate group of researchers evaluated the standard version of the program when implemented on a broader scale and among a more broadly-defined target population. The study used a cluster randomized trial involving eighth to tenth grade students in 17 public schools across three states (California, Missouri, and Texas). Students were randomly assigned by classroom to either a treatment group that received the program or to a control group that received either a standardized health class (one site) or the regular school instruction. Surveys were administered before random assignment (baseline) and again 12 and 24 months after baseline.

The study findings failed to replicate the favorable impacts on sexual initiation found in prior studies of the program. In particular, 12-months after the baseline, the study found that students in the control group were no more likely than those in the treatment group to report having ever had sex (odds ratio = 0.95). At the 24-month follow-up, the study found no statistically significant program impacts on sexual initiation among the study participants who were not sexually active at baseline.

The study also found, for the full study sample and at each of the two follow-ups, no evidence of statistically significant program impacts on other measures of sexual risk behavior such as rates of sexual activity and unprotected sexual activity in the past 90 days. In addition, at the 24-month follow-up, the study found no evidence of statistically significant program impacts on being diagnosed with a STI in the last 12 months or on becoming pregnant (females) or getting someone pregnant (males).

The study also examined program impacts on measures of knowledge of pregnancy risk, knowledge of STI risk, attitudes toward protection, attitudes toward risky behavior, motivation to delay childbearing, condom negotiation and refusal skills, and intentions to become sexually active and use protection when sexually active. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

Notes

Some study entries may include more than one citation because each citation examines a different follow-up period from the same study sample, or because each citation examines a different set of outcome measures on the same study sample. A blank cell indicates the study did not examine any outcome measures within the particular outcome domain or the findings for the outcome measures within that domain did not meet the review evidence standards.

Information on evidence of effectiveness is available only for studies that received a high or moderate rating. Read the description of the review process for more information on how these programs are identified.