Competence as a predictor of sexual and reproductive health outcomes for youth: a systematic review.

To examine the association between "competence" and adolescent sexual and reproductive health (ASRH) outcomes. Competence refers to the development of skills to perform tasks successfully in four areas including social and behavioral, cognitive, emotional, and moral competence. We conducted a systematic review of research published from 1985 through 2007. Inclusion criteria included use of multivariate analyses, a sample size of >or=100, publication in a peer-reviewed journal, and measurement of an ASRH outcome. We coded findings as protective, risk, or no association and as longitudinal or cross-sectional. We considered the presence of two longitudinal studies with consistent findings for at least one outcome to be sufficient evidence for a risk or protective association. We identified 77 studies that examined cognitive competence, 27 studies that examined social and behavioral competence, 12 studies that examined emotional competence, and no studies that met inclusion criteria for moral competence. The evidence indicated that cognitive competence and social and behavioral competence can be protective factors for ASRH, with findings from at least two longitudinal studies demonstrating a protective association with an ASRH outcome. Findings across cognitive, social and behavioral subconstructs and ASRH outcomes were more mixed. There was insufficient evidence to draw conclusions about emotional and moral competence and ASRH. Helping adolescents to achieve cognitive, social, and behavioral competence may reduce the likelihood of sexual activity and teen pregnancy, and increase contraceptive use. Additional research is needed to examine other outcomes and the generalizability of findings.