McBride D, Gienapp A
Washington Institute for Mental Illness Research and Training, University of Washington, Tacoma, USA.
Fam Plann Perspect. 2000 Sep-Oct;32(5):227-35.
Interventions to prevent adolescent pregnancy (primarily curriculum-based programs) have not produced convincing evidence as to their success. Moreover, many evaluation approaches have been inadequate to assess program effectiveness. Therefore, rigorous evaluation of different kinds of interventions may help identify potentially effective strategies to prevent adolescent pregnancy.
An experimental design, in which clients were randomized to treatment and control groups, was used to evaluate the effects of a "client-centered" approach to reducing pregnancy among high-risk young people in seven communities in Washington State. Four projects served 1,042 youth (clients aged 9-13), and three served 690 teenagers (primarily clients aged 14-17). Projects offered a wide variety of services tailored to individual clients' needs, including counseling, mentoring and advocacy.
On average, clients in the treatment group at youth sites received 14 hours of service, and their teenage counterparts received 27 hours; controls received only 2-5 hours of service. At one youth site, clients were less likely to intend to have intercourse after the intervention than before; at another, they became less likely to intend to use substances. Clients at one teenage project reported reduced sexual behavior and improved contraceptive use after receiving services; teenagers at another site reported reduced sexual intentions and drug use, and a greater intention to use contraceptives. The programs showed no other effects on factors that place young people at risk of becoming pregnant, including their sexual values and educational aspirations, communication with their parents (measured at youth sites only), and sexual and contraceptive behavior (assessed for teenagers only).
High-risk clients likely need considerably more intervention time and more intensive services than programs normally provide. Rigorous evaluation designs allow continued assessment that can guide program modifications to maximize effects.
预防青少年怀孕的干预措施（主要是基于课程的项目）尚未产生关于其成功的令人信服的证据。此外，许多评估方法不足以评估项目效果。因此，对不同类型干预措施进行严格评估可能有助于确定预防青少年怀孕的潜在有效策略。
采用实验设计，将服务对象随机分为治疗组和对照组，以评估“以服务对象为中心”的方法对华盛顿州七个社区高危年轻人怀孕率的影响。四个项目服务了1042名青少年（9至13岁的服务对象），三个项目服务了690名青少年（主要是14至17岁的服务对象）。这些项目提供了各种各样根据个体服务对象需求量身定制的服务，包括咨询、指导和宣传。
平均而言，青少年服务点治疗组的服务对象接受了14小时的服务，而青少年对照组接受了27小时的服务；对照组仅接受了2至5小时的服务。在一个青少年服务点，干预后服务对象发生性行为的意愿比之前降低；在另一个服务点，他们使用毒品的意愿降低。一个青少年项目的服务对象在接受服务后报告性行为减少且避孕措施使用有所改善；另一个服务点的青少年报告性意愿和毒品使用减少，且使用避孕药具的意愿增强。这些项目在使年轻人面临怀孕风险的因素方面未显示出其他影响，这些因素包括他们的性价值观和教育抱负、与父母的沟通（仅在青少年服务点进行测量）以及性和避孕行为（仅针对青少年进行评估）。
高危服务对象可能比通常项目提供的需要更多的干预时间和更密集的服务。严格的评估设计允许持续评估，从而指导项目调整以最大化效果。
