Teen Outreach Program (TOP)

The program's evidence of effectiveness was first established in a randomized controlled trial involving high school students in 25 school- and community-based sites across the United States. Within each study site, participants were randomly assigned, either individually or by classroom, to either a treatment group that received the program or a control group that received whatever regular curricula and programs each site provided. Surveys were administered immediately before the program started (baseline) and nine months later at the end of the program.The study found that at the time of the 9-month follow-up survey, female adolescents participating in the program were significantly less likely to report they had become pregnant during the academic year of the program (odds ratio = 0.41, confidence interval = 0.26 to 0.64). The study did not estimate program impacts on male adolescents' reports of having caused a pregnancy.The study also examined program impacts on rates of school suspension and course failure. Findings for these outcomes were not considered for the review because they fell outside the scope of the review.

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

A separate recent study evaluated the program among a younger sample of middle- and high-school students in Hennepin County, Minnesota. The study used a cluster randomized controlled trial involving 61 middle and high schools. In each participating school, students were randomly assigned by teacher to either a treatment group that received the program or a control group that provided the regular school instruction. Surveys were administered before the program started (baseline), and again three and 15 months after the program ended.

The study findings failed to replicate the favorable impact on sexual activity rates found in the separate study by Daley et al. (2015). In particular, the study found that students in the treatment group were no less likely than students in the control group to report ever having had sex (odds ratio = 1.33 for the 3-month follow-up survey, odds ratio = 3.14 for the 15-month follow-up survey). The study also examined program impacts on measures of recent sexual activity and recent unprotected sexual activity. The study found no statistically significant impacts on these outcomes for either follow-up survey. The study did not measure program impacts on pregnancy.

This study evaluated the program using a cluster randomized controlled trial that involved 5,633 students in 9th grade in 44 Chicago Public Schools. Schools were randomly assigned either to a group that implemented TOP or to a control group that did not implemented TOP but implemented their standard teen pregnancy and/or STI prevention curricula. The study collected outcome data immediately after the end of the program (about 10 months after the baseline).

The study examined program effects on having sex and having sex without using a condom in the last three months. Immediately after the end of the program, the study found no evidence of statistically significant program impacts on those outcomes.

A separate recent study evaluated the program using a cluster randomized controlled trial that involved 1,188 adolescents recruited from recreation centers in Rochester, NY. In each of three years, the study randomly assigned 11 recreation centers to either a treatment group implementing TOP or a control group implementing a workplace competencies program, creating a total of 33 analytic clusters. Surveys were administered before the program started (baseline), and again immediately after the program ended (about nine months after the baseline).

The study findings failed to replicate the favorable impact on sexual activity rates found in the earlier study by Daley et al. (2015). In particular, immediately after the program ended, the study found that adolescents in the group receiving TOP were no less likely than adolescents in the control group to report ever having sex (odds ratio = 0.68). The study also examined program impacts on sexual activity without using an effective method of birth control in the last three months. The study found no statistically significant program impacts on that outcome. The study did not measure program impacts on pregnancy.

A more recent study conducted by a separate group of researchers evaluated the program among a sample of 26 Florida high schools. The study randomly assigned schools in matched pairs to either a treatment group that offered the program during the regular school day or a control group that provided the regular school instruction. Surveys were administered before the program started (baseline), immediately after the program ended, and 10 months after the program ended.

Using data for the full sample of male and female adolescents, the study successfully replicated the favorable program impact on pregnancy reported in the earlier study by Allen et al. (1997). In particular, for the follow-up conducted at the end of the program, the study found that students in the treatment group were less likely to report ever having been pregnant (females) or gotten someone pregnant (males)(odds ratio = 0.58). The study found a similar pattern of results for the longer-term follow-up survey conducted 10 months after the program ended (odds ratio = 0.51).

The study also found a statistically significant program impact on sexual activity rates. In particular, for the follow-up conducted at the end of the program, the study found that students in the treatment group were statistically significantly less likely to report ever having had sex (odds ratio = 0.84, confidence internal = 0.78 to 0.90). The study found no statistically significant program impact on this outcome for the longer-term follow-up survey conducted 10 months after the program ended.

This study did not meet the review's eligibility criteria.

Another recent study evaluated the program among a sample of 934 middle and high school students in Kansas City, Missouri. The study used a cluster randomized controlled trial that involved the 98 classrooms of 17 teachers from 12 middle and high schools. Classrooms were randomly assigned to either a treatment group that received TOP or a control group that received the regular classroom curriculum from their existing core content class teachers. Surveys were administered before the program started (baseline), and again 12 months after the program ended.

The study findings failed to replicate the favorable impact on sexual activity rates found in the earlier study by Daley et al. (2015). In particular, 12 months after the end of the program the study found that adolescents in the group receiving TOP were no less likely than adolescents in the control group to report ever having sex (odds ratio = 0.96). The study also found no evidence of statistically significant program impacts on having sexual intercourse without using any method of birth control in the last three months. The study did not measure program impacts on pregnancy.

This study evaluated the program using a cluster randomized controlled trial that involved 8,662 adolescents attending schools in five northwestern states (Alaska, Idaho, Montana, Oregon, and Washington). Students were clustered into groups, and the types of groups included school classes, in-school clubs, pull-out, and after-school clubs. Randomization into treatment (receiving TOP) and control (not receiving TOP) conditions was done at the level of those groups of students. The study administered surveys before conducting random assignment (baseline), and again immediately and 12 months after the end of the program.

The study found evidence of mixed program effects. Immediately after the program ended, the study found a positive program impact: the subgroup of male adolescents in the schools that implemented TOP were less likely to report ever causing a pregnancy than their counterparts in schools that did not implement the program (odds ratio = 0.71). For the same time period, the study found evidence of an adverse effect: the subgroup of female adolescents in the treatment schools were more likely than those in the control schools to report having ever been pregnant (odds ratio = 1.27). The study found no significant impacts on pregnancy for the full sample immediately and 12 months after the program ended (odds ratio = 1.13 immediately after the program, odds ratio = 1.15 12 months after the program).

Immediately after the program ended, the study also examined program impacts on recent sexual activity and on having sexual intercourse without using an effective method of birth control in the last three months. The study found no statistically significant program impacts on those outcomes.

A separate recent study evaluated the program using a randomized controlled trial that involved 4,769 adolescents recruited from Community Based Organizations in Louisiana. Adolescents were randomly assigned to either a treatment group that received TOP or a control group that did not receive TOP or any other teen pregnancy prevention program. The study administered surveys before conducting random assignment (baseline), and again immediately and 12 months after the end of the program.

The study findings failed to replicate the favorable impacts on sexual activity rates and pregnancy found in the earlier studies by Daley et al. (2015) and Allen et al. (1997), respectively. In particular, the study found that immediately after the end of the program, the subgroup of adolescents in the group receiving TOP who were sexually inexperienced at baseline were no less likely than their counterparts in the control group to report they have had become sexually active (odds ratio = 1.25). Twelve months after the end of the program, the study found that adolescents in the group receiving TOP were no less likely than adolescents in the control group to report ever being pregnant (odds ratio = 0.96). Immediately and 12 months after the end of the program, the study also found no evidence of statistically significant program impacts on having sex without using an effective method of birth control in the last three months.