Teen Pregnancy: Federal Prevention Programs

April 30, 2018 – September 1, 2022 R45183

Teen Pregnancy: Federal Prevention Programs September 1, 2022
Congress has an interest in preventing pregnancy among teenagers because of the long-term
consequences for the families of teen parents and society more generally. Since the 1980s,
Jessica Tollestrup
Congress has authorized—and the U.S. Department of Health and Human Services (HHS) has
Specialist in Social Policy
administered—programs with a focus on teen pregnancy prevention. This report assists Congress

in tracking developments in four teen pregnancy prevention programs that are currently funded.

Multiple HHS offices worked together to establish the Teen Pregnancy Prevention Evidence
Review process following enactment of the FY2010 omnibus appropriations. The review, which was discontinued in 2019, is
in the process of being reestablished and is intended to identify prevention models that have been shown to be effective based
on studies since approximately the late 1990s. HHS has encouraged or required grantees for some teen pregnancy prevention
programs to use these models.
The four current programs are the Teen Pregnancy Prevention (TPP) program, the Personal Responsibility Education
Program (PREP), the Title V Sexual Risk Avoidance Education program, and the General Departmental (GD) Sexual Risk
Avoidance Education program. Despite their similar names and purposes, the latter two programs have different authorizing
laws and funding mechanisms. Generally, the four programs serve vulnerable young people in schools, afterschool programs,
community centers, and other settings. Grantees include states, nonprofits, and other entities.
The TPP program was initially established and funded by the FY2010 omnibus appropriations law (P.L. 111-117).
Subsequent appropriations laws have also provided authority for the program and discretionary funding. As required in
appropriations law, the majority of TPP program grants must use evidence-based education models that have been shown to
be effective in reducing teen pregnancy and related risk behaviors. A smaller share of funds is available for research and
demonstration grants that implement innovative strategies to prevent teenage pregnancy. The Consolidated Appropriations
Act, 2022 (P.L. 117-103) provides $101 million for the program.
PREP was established under Section 513 of the Social Security Act by the Patient Protection and Affordable Care Act (ACA,
P.L. 111-148) in 2010. The program receives mandatory funding and is designed to educate adolescents on both abstinence
and contraception for preventing pregnancy and sexually transmitted infections, and on selected adult preparation subjects.
The PREP authorizing law requires most grantees to replicate evidence-based programs that are proven to change behavior
related to teen pregnancy. The Consolidated Appropriations Act, 2021 (CAA 2021, P.L. 116-260) provides $75 million
through FY2023.
The Title V Sexual Risk Avoidance Education program is authorized at Section 510 of the Social Security Act. It was
formerly known as the Title V Abstinence Education Grant program, which was authorized by the 1996 welfare reform law
(P.L. 104-193). The Bipartisan Budget Act of 2018 (P.L. 115-123) renamed the program and made other changes. The
program focuses on implementing sexual risk avoidance, meaning voluntarily refraining from sex before marriage. Grantees
may set aside some funds to conduct rigorous and evidence-based research on sexual risk avoidance. As with the PREP
program, the CAA 2021 provides $75 million through FY2023.
The GD Sexual Risk Avoidance Education program was initially established and funded by the FY2016 omnibus
appropriations law (P.L. 114-113). Subsequent appropriations laws have since provided authority for the program and
discretionary funding. Grantees are to use funding for education on voluntarily refraining from nonmarital sexual activity,
and they are encouraged to implement evidence-based approaches that teach the benefits associated with resisting risk
behaviors. P.L. 117-103 provides FY2022 funding of $35 million for the program.
Congressional Research Service

Teen Pregnancy: Federal Prevention Programs

Introduction
Teen pregnancy is a major public health issue because of its high cost for families of teenage
parents and society more broadly.1 In addition, teen pregnancy disproportionately affects certain
racial and ethnic groups and selected states and insular areas.2 The teen birth rate has been in
decline; however, given the consequences associated with teen births, Congress and the executive
branch continue to support programs that focus on delaying sexual activity and preventing
pregnancies among teenagers.3
Four current programs have an exclusive focus on teenage pregnancy prevention education:4
 the Teen Pregnancy Prevention (TPP) program, which is authorized on an annual
basis under the Departments of Labor, Health and Human Services, Education,
and related agencies (LHHS) appropriations;
 the Personal Responsibility Education Program (PREP), which is authorized
under Title V of the Social Security Act, and was most recently reauthorized
through FY2023, under Title III, Division CC of the Consolidated Appropriations
Act, 2021 (CAA 2021, P.L. 116-260);
 the Title V Sexual Risk Avoidance Education program, which is authorized under
Title V of the Social Security Act, and was most recently reauthorized through
FY2023, under Title III, Division CC of the CAA 2021;
 the Sexual Risk Avoidance Education program, which is authorized on an annual
basis under the LHHS appropriations, and is sometimes referred to as the General
Departmental (GD) Sexual Risk Avoidance Education program.
This report refers to the latter two programs as the Title V Sexual Risk Avoidance Education
program and the GD Sexual Risk Avoidance Education program, respectively, to avoid
confusion.5 The four programs are administered in the U.S. Department of Health and Human

1 The Centers for Disease Control and Prevention (CDC), the federal government’s lead public health agency, has
identified teen pregnancy as a major public health issue because of its high cost for families of teenage parents and
society more broadly. CDC highlights that the teen pregnancy rate has decreased steadily, dropping below CDC’s
target goal of 30.3 per 1,000 females aged 15 to 17 by 2015; however, CDC also raises the concern that the United
States has one of the highest rates of teen births of all industrialized countries. See U.S. Department of Health and
Human Services (HHS), CDC, Winnable Battles Final Report 2010-2015,
https://www.cdc.gov/winnablebattles/report/index.html.
2 Michelle J.K. Osterman et al., “Births: Final Data for 2020,” HHS, CDC, National Center for Health Statistics
(NCHS), National Vital Statistics Report, vol. 70, no. 17, February 7, 2022. See also, CRS Report R45184, Teen Birth
Trends: In Brief.
3 This report uses the terms youth, teenagers, teens, and adolescents interchangeably.
4 There are several other federally funded programs that have a pregnancy prevention component and thereby may use
their funds to provide pregnancy prevention information and/or contraception services to teenagers, but their focus is
not exclusively on teenagers or on educational efforts. These programs include Medicaid Family Planning (Title XIX
of the Social Security Act), Title X Family Planning, the Maternal and Child Health block grant (Title V of the Social
Security Act), the Temporary Assistance for Needy Families (TANF) block grant (Title IV-A of the Social Security
Act), and selected other programs administered by the U.S. Department of Health and Human Services (HHS).
5 Both of these programs generally require that grantees focus on teaching abstinence before marriage. The programs
can be distinguished in a few ways. The Title V Sexual Risk Avoidance Education program is authorized at Section
510 (Title V) of the Social Security Act. It was formerly known as the Title V Abstinence Education Grant program,
which was authorized by the 1996 welfare reform law (P.L. 104-193). The Bipartisan Budget Act of 2018 (BBA 2018,
P.L. 115-123) renamed the program and specified new program requirements on financial allotments, educational
elements, research and data, and evaluations. The General Departmental (GD) Sexual Risk Avoidance Education
Congressional Research Service

1

link to page 26 link to page 33 Teen Pregnancy: Federal Prevention Programs

Services (HHS). The TPP program was administered by the Office of Adolescent Health (OAH)
until it was subsumed under the Office of Population Affairs (OPA) in the Office of the Assistant
Secretary for Health (OASH) in June 2019.6 (The footnotes of the report continue to reference
publications that were authored by OAH.) The three other programs are administered by the
Family and Youth Services Bureau (FYSB) in HHS’s Administration for Children and Families
(ACF).
This report provides background on the role of Congress and the executive branch in preventing
teen pregnancy. It then focuses on the four programs, examining the types of grants they provide
as well as related funding, requirements, and research activities The table in Appendix A
summarizes key programmatic information and allows for comparisons across the programs.
Appendix B includes a table that indicates whether the states and insular areas, or entities within
those jurisdictions, receive funding under each of the four programs. The report accompanies
CRS Report R45184, Teen Birth Trends: In Brief; and CRS In Focus IF10877, Federal Teen
Pregnancy Prevention Programs.
Federal Approaches to Teen Pregnancy Prevention
The federal government has long played a role in educating teens and the public generally about
preventing pregnancy and sexually transmitted infections (STIs). This has involved public
awareness campaigns; providing public health services, including information and access to
contraceptives; publishing materials about STIs; and funding organizations to provide sexual
education. The federal approach to teen pregnancy prevention has often reflected prevailing
public views about sexuality and the role that the federal government should play in the private
lives of its citizens.7
Since the early 1980s, the federal government has supported programs that have an exclusive
focus on preventing teen pregnancy.8 Discussion about these programs has often focused on the
type of approaches to pregnancy prevention they should take. Some policymakers and other

program was established and first funded by the FY2016 omnibus appropriations laws and has since been funded by
subsequent appropriations laws. The appropriations laws have provided some detail about how the Sexual Risk
Avoidance Education program is to be carried out. Because it is funded under the General Departmental Management
account in appropriations law, HHS often refers to the program as the “General Departmental” Sexual Risk Avoidance
Education program.
6 The conference report (H.Rept. 111-366) accompanying the FY2010 appropriations law (P.L. 111-117) directed the
HHS Secretary to establish an Office of Adolescent Health (OAH) responsible for implementing and administering the
Teen Pregnancy Prevention (TPP) program. The report also directed OAH to coordinate its efforts with ACF, CDC,
and other appropriate offices and operating divisions in HHS. See also the Statement of Organization, Functions, and
Delegations of Authority filed in the Federal Register on April 12, 2019, explaining the new organizational structure
for the OPA that would include the TPP program (84 Federal Register 14951).
7 Alexandra M. Lord, Condom Nation: the U.S. Government’s Sex Education Campaign From World War I to the
Internet (Baltimore: Johns Hopkins University Press, 2010), pp. 1-24, 115-137, 162-186.
8 Three programs are no longer funded: the Adolescent Family Life (AFL) program, the Community-Based Abstinence
Education (CBAE) program, and the Competitive Abstinence-Only program. The AFL program was established in
1981 and funded through FY2001, with appropriations ranging from $1.4 million to $30.4 million annually. The
program focused on issues of adolescent sexuality, pregnancy, and parenting, and in 1998 it began incorporating
abstinence-only education. The CBAE program was supported from FY2001 through FY2009, with funding ranging
from $20 million to $108.9 million annually. The program provided competitive grants to public and private entities to
develop and implement abstinence-only education programs for adolescents aged 12 through 18 in communities
nationwide. Following CBAE, the Competitive Abstinence-Only program supported similar types of grants with an
exclusive focus on abstinence education. It was funded from FY2012 through FY2015, with appropriations of $4.7
million to $10 million annually.
Congressional Research Service

2

Teen Pregnancy: Federal Prevention Programs

stakeholders in the teen pregnancy prevention field have contended that teens should not engage
in sex before marriage to avoid unplanned pregnancies and protect against STIs. Further, they
support the idea that teenagers need to hear a single, unambiguous message that sex outside of
marriage is harmful to their physical and emotional health.9 This approach is sometimes referred
to as “abstinence-only,” and more recently as “sexual risk avoidance.”
Other stakeholders have prioritized an approach that provides broad information to teenagers to
help them make informed decisions about whether to engage in sex, and about using
contraceptives if they do.10 They contend that such an approach allows young people to make
choices regarding abstinence, gives them the information they need to set relationship limits and
resist peer pressure, and provides them with information on the use of contraceptives and the
prevention of STIs.
Congress has authorized and provided funding for programs that take one or both of these
approaches to preventing teen pregnancy. Of the current programs, the Title V Sexual Risk
Avoidance Education and the GD Sexual Risk Avoidance Education programs generally focus on
abstaining from premarital sex. The PREP program requires most grantees to place “substantial
emphasis on both abstinence and contraception for the prevention of pregnancy among youth and
sexually transmitted infections.”11 TPP grantees may use either or both approaches.12
Understanding of the public’s opinion about teen abstinence and contraception is incomplete,
largely due to contradictory results obtained from survey questionnaires fielded by different
organizations. The design of the survey questions may have contributed to this variation. Based
on one nationally representative survey in 2017 by Power to Decide, an organization focused on
preventing unplanned pregnancy, most adults believe that teens should receive more information
about abstinence and birth control, as well as protection from sexually transmitted infections.
Another nationally representative telephone survey conducted in 2019 by The Barna Group, a
research organization that focuses on providing information to spiritual influencers, affirmed
some of these findings; however, the study also indicated that respondents differed based on their
political affiliation with regard to questions on whether certain sexual education topics should be
taught.13

9 See, for example, U.S. House of Representatives, Committee on Energy and Commerce, The Policy Paper Series:
Transforming Ideas Into Solutions, vol. 1, issue 2, “A Better Approach to Teenage Pregnancy Prevention-Sexual Risk
Avoidance,” July 2012.
10 HHS, CDC, Dear Colleague Letter by Thomas R. Frieden, Director, January 14, 2011. Dr. Frieden served under the
Obama Administration from May 2009 to January 2017.
11 Section 513(b)(2)(4) of the Social Security Act.
12 Amy Feldman Farb and Amy L. Margolis, “The Teen Pregnancy Prevention Program (2010-2015): Synthesis of
Impact Findings,” American Journal of Public Health, vol. 106, no. 51 (September 2016) (hereinafter, Amy Feldman
Farb and Amy L. Margolis, “The Teen Pregnancy Prevention Program (2010-2015): Synthesis of Impact Findings”).
13 SSRS, an independent research organization, conducted the poll for Power to Decide, which generally supports
providing youth with information so they can make informed decisions about whether, when, and under what
circumstances to get pregnant and have a child (Power to Decide is formerly known as the National Campaign to
Prevent Teen and Unplanned Pregnancy). The poll involved a nationally representative telephone survey of
approximately 1,000 adults in the United States that asked, “Do you believe that teens should receive more information
about abstinence or postponing sex [8% supported this view], birth control and STI protection [10% supported this
view], or both [79% supported this view]?” See Power to Decide, “Survey Says: Support for Birth Control,” January
2017. See also Leslie Kantor, Nicole Levitz, and Amelia Holstrom, “Support for Sex Education and Teenage
Pregnancy Prevention Programmes in the USA: Results from a National Survey of Likely Voters,” Sex Education,
September 2, 2019. The Barna Group, a research organization that focuses on providing information to spiritual
influencers, conducted a poll about sex education for Ascend, an organization that supports sexual risk avoidance. The
poll involved a national representative online survey of nearly 1,300 adults that asked whether the primary message in
Congressional Research Service

3

Teen Pregnancy: Federal Prevention Programs

Shift Toward Evidence-Based Models
Two of the current teen pregnancy programs, TPP and PREP, reflect government-wide efforts
beginning in the George W. Bush Administration and extending into the Obama Administration,
to expand effective social interventions and eliminate those that are ineffective.14 The two
programs use a “tiered evidence” approach: some current grantees employ teen pregnancy
prevention models that are effective based on rigorous evaluation while other grantees develop
and rigorously evaluate new or innovative approaches to reducing teen pregnancy.
Following enactment of the FY2010 omnibus appropriations law (P.L. 111-117), multiple HHS
offices worked together to establish the Teen Pregnancy Prevention Evidence Review process.
This review was active from 2010 to 2019, and identified teen pregnancy prevention models that
were shown to be effective based on studies from the prior 30 years.15 Funding to restart the
review was set aside as part of FY2022 appropriations.16 HHS subsequently issued a call for
studies to be submitted for a systemic review being led by Mathematica.17
During the 2010-2019 period, the review team prioritized studies of programs based on whether
they—included youth ages 19 and younger and were intended to address teen pregnancy
outcomes through some combination of educational, skill-building, or psycho-social
interventions. The first review covered research released from 1989 through January 2010.
Subsequent reviews were conducted on an annual or biannual basis to incorporate recent research,
including newly available evidence for programs that were previously reviewed.
The evidence review identified studies with statistically significant impacts on at least one of five
areas: (1) sexual activity, (2) number of sexual partners, (3) contraceptive use, (4) STIs or HIV,
and (5) pregnancies. In addition, the studies had to evaluate impacts of programs using
randomized controlled trials (RCTs) and quasi-experimental impact study designs.18 For the

sex education classes should be “one that says teen sex is OK, so long as they use contraception” (29% supported this
view) or “one that uses practical skills to reinforce waiting for sex” (71% supported this view). See Barna Group,
“Should Sex Ed Teach Abstinence? Most Americans Say Yes,” September 5, 2017.
14 Evelyn M. Kappeler and Amy Feldman Farb, “Historical Context for the Creation of the Office of Adolescent Health
and the Teen Pregnancy Prevention Program,” Journal of Adolescent Health, vol. 54, no. 3 (March 2014) (hereinafter,
Evelyn M. Kappeler and Amy Feldman Farb, “Historical Context for the Creation of the Office of Adolescent Health
and the Teen Pregnancy Prevention Program”). In June 2019, the Office of Adolescent Health was subsumed under the
Office of Population Affairs (OPA). See also, Ron Haskins and Greg Margolis, Show Me the Evidence: Obama’s Fight
for Rigor and Results in Social Policy, Brookings Institution Press, Washington, DC, 2014; and Heather Fish et al.,
What Works for Adolescent Sexual and Reproductive Health: Lessons From Experimental Evaluations of Programs
and Interventions, Child Trends, publication no. 2014-64, December 2014.
15 The Teen Pregnancy Prevention Evidence Review was managed by the Assistant Secretary for Planning and
Evaluation (ASPE) in collaboration with FYSB within the Administration for Children and Families (ACF), and the
former Office of Adolescent Health (OAH) within the Office of the Assistant Secretary for Health (OASH). HHS
contracted with Mathematica Policy Research, Inc., a social policy research organization, to review studies of teen
pregnancy prevention programs. Such research was identified through a call for studies and review of journals,
conference proceedings, and websites for research and policy organizations. See Juliet Lugo-Gil et al., Updated
Findings from the HHS Teen Pregnancy Prevention Evidence Review: August 2015 through October 2016,
Mathematica Policy Research for HHS, ASPE, April 2018. The website for the evidence review notes that additional
updates are not planned for the future. See Youth.gov, “HHS Teen Pregnancy Prevention Evidence Review, Review
Process,” https://tppevidencereview.youth.gov/ReviewProtocol.aspx.
16 See page H2684 of the joint explanatory statement accompanying FY2022 LHHS appropriations (Congressional
Record, vol. 168, no. 42, book IV [March 9, 2022]).
17 HHS, HHS Teen Pregnancy Prevention (TPP) Evidence Review Call for Studies, https://youth.gov/sites/default/files/
2022-03/2022_TPPER_Call_for_Papers.pdf.
18 RCTs involve assigning individuals to two groups—an intervention group and a control group—using a random
Congressional Research Service

4

Teen Pregnancy: Federal Prevention Programs

studies that met these initial criteria, reviewers assigned each one a rating of high, moderate, or
low quality based on whether it used RCTs and quasi-experimental design, had relatively low
attrition, controlled for differences between the treatment and comparison groups, and met certain
other criteria.19
The last completed review of studies, which covered the period through October 2016, included
48 evidence-based program models. The identified programs are varied and approach the problem
from different frameworks. HHS categorized the evidence-based models based on certain key
features. For example, four of the identified models used an abstinence-only approach, other
models focused on both abstinence and contraception, and others addressed healthy relationships
and youth development. Programs differed based on their outcomes, settings (e.g., schools,
clinics, homes, after school programs), session length and duration over time, and target
population (e.g., males, females, selected racial and ethnic groups, sexually active youth, etc.).20
P.L. 111-117 also authorized the TPP program and required it to use models that are proven
effective through rigorous evaluation in reducing teen pregnancy and related outcomes. Despite
the connection to the TPP program, the review was intended to more broadly inform the teen
pregnancy prevention field.
Additional Research
HHS has taken additional steps to develop research on teen pregnancy prevention interventions.
These efforts have been funded through annual appropriations of approximately $4.5 million to
$6.8 million in each of FY2011 through FY2020 for Section 241 of the Public Health Service Act
(PHSA). Section 241 provides authority for HHS to conduct evaluations of the implementation
and effectiveness of public health programs. The funding has been used to support federal
evaluations on teen pregnancy, including evaluation of TPP grantees; technical assistance about
using rigorous program evaluation for TPP program grantees and unrelated grantees funded
through the Centers for Disease Control and Prevention (CDC); the Teen Pregnancy Prevention
Evidence Review; and measuring performance data for the TPP program and Pregnancy
Assistance Fund (PAF) grantees.21 (The PAF provided competitive funding to state and tribal
agencies to support pregnant and parenting teens and adults in school-based and community-
based settings.22)

process (e.g., a lottery) to compare outcomes across these groups. Under ideal conditions, this can help to explain
whether an intervention, like abstinence education, is effective because youth in both the program and control groups
were similar in all respects except for their access to the program. Quasi-experimental designs refer to studies that
attempt to estimate a treatment’s impact on a group of subjects, but, in contrast to RCTs, do not have random
assignment to treatment and control groups. Some quasi-experiments are controlled studies (i.e., with a control group),
but others lack a control group.
19 See Mathematica Policy Research, Identifying Programs That Impact Teen Pregnancy, Sexually Transmitted
Infections, and Associated Sexual Risk Behaviors, Review Protocol, version 5, for HHS, ASPE, April 2016.
20 HHS, OASH, OPA, “Evidence-Based Teen Pregnancy Prevention Programs at a Glance,” https://www.hhs.gov/ash/
oah/sites/default/files/ebp-chart1.pdf.
21 For an overview of how funds have been used for this purpose in recent years, see HHS, Fiscal Year 2020
Justification of Estimates for Appropriations Committees for General Departmental Management, p. 137; HHS, Fiscal
Year 2021 Justification of Estimates for Appropriations Committee for General Departmental Management, p. 126;
HHS, Fiscal Year 2022 Justification of Estimates for Appropriations Committee for General Departmental
Management, p. 154; and HHS, Fiscal Year 2023 Justification of Estimates for Appropriations Committee for General
Departmental Management, p. 146. See also Evelyn M. Kappeler and Amy Feldman Farb, “Historical Context for the
Creation of the Office of Adolescent Health and the Teen Pregnancy Prevention Program.”
22 For further information about the PAF, see CRS In Focus IF11040, The Pregnancy Assistance Fund.
Congressional Research Service

5

Teen Pregnancy: Federal Prevention Programs

Teen Pregnancy Prevention (TPP) Program
The Consolidated Appropriations Act, FY2010 (P.L. 111-117) established and provided annual
discretionary funding for the Teen Pregnancy Prevention program.23 The TPP program has been
funded via the appropriations process through FY2022. Funding has ranged from approximately
$98 million to $110 million annually. The program primarily provides funds to public and private
entities for evidence-based or promising programs that reduce teen pregnancy, including those
that focus on sexual risk avoidance and/or use of contraceptives.
Generally, the appropriations laws have stated that funding should be competitively awarded. It
has further specified that no more than 10% of TPP funding is for training and technical
assistance, outreach, and other program support. Of the remaining amount, the appropriations
laws have stated the following:
 75% is for grants to replicate programs that have been proven through rigorous
evaluation to be effective in reducing teenage pregnancy, behavioral factors
underlying teen pregnancy, or other related risk factors. HHS has referred to
these as “Tier 1” grants.
 25% is for research and demonstration grants to develop, replicate, and refine
additional models and innovative strategies for reducing teenage pregnancy. HHS
refers to these as “Tier 2” grants.
Appropriation laws have specified that funds must be used for “age appropriate” and “medically
accurate” programs that reduce teen pregnancy. HHS has expanded on these terms and has
established eligibility and other requirements via funding announcements and other
publications.24 The Office of Adolescent Health had administered the program until it was
subsumed under the Office of Population Affairs in June 2019.25
A range of public and private entities have been eligible to apply for TPP funding. Such entities
include nonprofit and for-profit organizations, universities and colleges, faith- and community-
based organizations, hospitals, and research institutions, among other entities.

23 The program had been proposed as part of President Obama’s FY2010 budget proposal to replace the abstinence
education program known as the Community-Based Abstinence Education (CBAE) program. See HHS, Fiscal Year
2010 Justification of Estimates for Appropriations Committees for Administration for Children and Families, pp. 55-56
and 74. The CBAE program was funded from FY2001 through FY2009.
24 Under the most recent funding opportunity announcement for 2020, age appropriate was defined as content
“appropriate for the general developmental and social maturity of the targeted age group. The ability to cognitively
understand a concept is not evidence that the concept is age appropriate.” For content to be medically accurate, that
“information [would] be referenced to peer reviewed publications by educational, scientific, governmental, or health
organizations.” HHS, OASH, OPA, Optimally Changing the Map for Teen Pregnancy Prevention (Tier 1), Funding
Opportunity Announcement and Application Instructions, AH-TP1-20-001, 2020. The 2015 funding opportunity
announcement defined both of these terms differently: “‘Age appropriate’ means the topics and teaching methods are
suitable to particular ages or groups of children and youth based on their cognitive, emotional, and behavioral capacity.
“Medically accurate” means information that is verified by or supported by research conducted in compliance with
accepted scientific methods and published in peer-reviewed journals, where applicable, or comprised of information
that stakeholders in the field recognize as accurate, objective, and complete.” HHS, OASH, OAH, Capacity Building to
Support Replication of Evidence-Based TPP Programs (Tier 1A), Funding Opportunity Announcement and Application
Instructions, AH-TP1-15-001, 2015.
25 The conference report (H.Rept. 111-366) accompanying the FY2010 appropriations law (P.L. 111-117) directed the
HHS Secretary to establish an Office of Adolescent Health responsible for implementing and administering the TPP
program. The report also directed OAH to coordinate its efforts with ACF, CDC, and other appropriate offices and
operating divisions in HHS.
Congressional Research Service

6

Teen Pregnancy: Federal Prevention Programs

Tier 1 Grants
The TPP grants have supported three cohorts of Tier 1 grantees. This first cohort was funded for
FY2010-FY2014,26 a second round of funding was provided for FY2015-FY2019,27 and a third
round of funding was provided for FY2019-FY2021. (In spring 2017, the program faced litigation
when HHS notified grantees that their programs would end at least two years sooner than
expected.28) A fourth round of Tier 1 funding (Optimally Changing the Map for Teen Pregnancy
Prevention) is for FY2020-FY202329 and FY2021-FY2023.30
This fourth cohort of Tier 1 grantees—supports 62 grantees in 28 states, the District of Columbia,
Puerto Rico, and the Marshall Islands. These grants seek to scale up effective programs that have
been proven through rigorous evaluation to reduce teenage pregnancy, behavioral risk factors
underlying teenage pregnancy, or other associated risk factors. Rigorous evaluation refers to
results that come from robust evaluation designs, particularly experiments or quasi-experiments.31
In general, Tier 1 grantees must implement their models consistent with the original evidence-
based model and have minimal adaptations (e.g., changing names). In addition, HHS requires Tier
1 grantees to use evidence-based approaches to reduce teenage pregnancy, behavioral risk factors
underlying teenage pregnancy, and/or associated risks.32 For instance, HHS emphasized the
importance of Tier 1 grantees in the third cohort replicating with fidelity effective programs and
supportive services that are culturally appropriate, age appropriate, medically accurate, and
trauma-informed.33

26 HHS, OASH, OAH, The Teen Pregnancy Prevention (TPP) Program: Performance in the First Five Years, April
2016.
27 In spring 2017, HHS sent notices to all 84 TPP grantees funded in the second round informing them that their
expected five-year projects would end in June or September 2018 instead of June or September 2020. In addition, five
organizations that provided technical assistance to the grantees were informed that their expected five-year grant period
ended in June 2017 instead of June 2022. This included all of the TPP grant types. In response, eight lawsuits were
filed in February and March 2018 on behalf of all the grantees except for the Tier 2C grantees (discussed later in this
report). From April to June 2018, five of the lawsuits were decided in favor of the grantees, including a class action
lawsuit that applied to the three remaining lawsuits. In September 2018, HHS discontinued funding for two of the three
Tier 2C grantees, which were not included in the original litigation. That same month, one of the Tier 2C grantees,
Promundo, filed a separate lawsuit. The court dismissed this grantee’s claim for FY2018 funding because the funding
was no longer available for obligation.
28 HHS, OASH, Office of Population Affairs (OPA), “OPA Awards $13.5 Million in Grants to Replicate Teenage
Pregnancy Programs,” July 11, 2019, https://www.hhs.gov/ash/oah/news/news-releases/2019-tpp-tier1-award-grantees/
index.html.
29 HHS, OASH, OPA, “OPA Awards $56.3 Million in Grants to Replicate Effective Teenage Pregnancy Prevention
Programs,” June 30, 2020, https://opa.hhs.gov/about/news/grant-award-announcements/opa-awards-563-million-
grants-replicate-effective-teenage.
30 HHS, OASH, OPA, “OPA Awards $12.6 Million in Grants to Replicate Effective Teenage Pregnancy Prevention
Programs,” June 28, 2021, https://opa.hhs.gov/about/news/grant-award-announcements/opa-awards-12-million-grants-
replicate-effective-teenage#:~:text=
The%20Office%20of%20Population%20Affairs,a%20two%2Dyear%20project%20period.
31 HHS, OASH, OPA, Optimally Changing the Map for Teen Pregnancy Prevention (Tier 1), Funding Opportunity
Announcement and Application Instructions, AH-TP1-20-001, 2020.
32 Ibid. Note that for the second cohort, HHS also emphasized the importance of Tier 1 grantees replicating programs
that have the strongest evidence and that have been evaluated as effective in multiple sites, in different settings, and
with different populations. (HHS, OASH, OAH, Capacity Building to Support Replication of Evidence-Based TPP
Programs (Tier 1A), Funding Opportunity Announcement and Application Instructions, AH-TP1-15-001, 2015.)
33 HHS, OASH, OPA, Optimally Changing the Map for Teen Pregnancy Prevention (Tier 1), Funding Opportunity
Announcement and Application Instructions, AH-TP1-20-001, 2020.
Congressional Research Service

7

Teen Pregnancy: Federal Prevention Programs

Grantee Profile: Hartford Teen Pregnancy Prevention Initiative (HTPPI)
The Hartford Teen Pregnancy Prevention Initiative serves the Hartford, CT area, and received a Tier 1B grant for
FY2015-FY2019. The program partnered with community, faith, education, and medical organizations to provide a
citywide network of sexual health education and clinical reproductive health services. The program offered three
sexual education curricula: the Get Real program in middle schools, the Be Proud! Be Responsible! program in high
schools, and the Making a Difference program in faith-based organizations. In fall 2019, teachers in Hartford public
schools were implementing the school-based interventions with HTPPI providing technical assistance as needed.
Source: HHS, Office of the Assistant Secretary for Health (OASH), Office of Adolescent Health (OAH), OAH
Teen Pregnancy Prevention Program: Successful Strategies, City of Hartford Teen Pregnancy Prevention (HTPPI), July 2019.
Note: This report includes examples of grantees recently funded under the four teen pregnancy prevention
programs. The grantees were selected by CRS based on information available on the HHS website or provided via
correspondence with HHS. Col ectively, the grantees described in the report are intended to represent all regions
of the country and are included for il ustrative purposes only.
Tier 2 Grants
As with Tier 1 grantees, HHS funded a cohort of Tier 2 grants with funds for FY2010-2014 and a
second cohort of grantees for FY2015-FY2019:34 Tier 2A (supporting and enabling early
innovation to advance adolescent health and prevent teen pregnancy), Tier 2B (rigorous
evaluation of new or innovative approaches to prevent teen pregnancy), and Tier 2C
(effectiveness of teen pregnancy prevention programs designed specifically for young males).
HHS subsequently provided FY2019 and FY2020 funding for Phase I Tier 2 (New and
Innovative Strategies) funding to 14 grantees in 14 states.35 These grants were to evaluate and test
innovative strategies to reduce teen pregnancy, improve adolescent health, and address youth
sexual risk holistically by focusing on protective factors for youth (e.g., positive connections to
supportive adults) and/or key elements of effective practices that are recognized to affect
adolescent risk behavior. Innovative strategies can include new or promising approaches,
curricula, or services informed by scientific theory or empirical evidence that may lead to, or
have the potential to result in, substantial reductions in teen pregnancy rates. Grantees were
required to develop strategies drawn from one of two research tools, SMARTool or TAC.36

34 HHS, OASH, OAH, Supporting and Enabling Early Innovation to Advance Adolescent Health and Prevent Teen
Pregnancy (Tier 2A), Funding Opportunity Announcement and Application Instructions, AH-TP2-15-001, 2015; HHS,
OASH, OAH, Rigorous Evaluation of New or Innovative Approaches to Prevent Teen Pregnancy Tier 2B), Funding
Opportunity Announcement and Application Instructions, AH-TP2-15-002, 2015; and HHS, CDC, Effectiveness of
Teen Pregnancy Prevention Programs Designed Specifically for Young Males [Tier 2C], Funding Opportunity
Announcement, RFA-DP-15-007, 2015.
35 HHS, OASH, OPA, Phase I New and Innovative Strategies (Tier 2) to Prevent Teenage Pregnancy and Promote
Health Adolescence, Funding Opportunity Announcement, AH-TP2-18-001, 2018. According to the funding
announcement, the objective for Phase II was to build on the results achieved in Phase I and is limited to successful
Phase I grantees.
36 SMARTool was developed by the Center for Relationship Education, a nonprofit organization, with support from the
CDC. SMARTool is a program guide for use by schools and other entities that provide sexual risk avoidance education,
and it identifies nine protective factors that help prevent sexual risk behaviors in youth. TAC is a resource for use by
schools and other entities that describes 17 elements of effective sexual risk reduction programs, which can include
sexual risk avoidance approaches or broader approaches such as the use of contraceptives. The tool was developed by
ETR Associates and the Healthy Teen Network (nonprofit organizations) with support from the CDC. David Kirby,
Lori A. Rolleri, and Mary Martha Wilson, Tool to Assess the Characteristics of Effective Sex and STD/HIV Education
Programs, ETR and Health Teen Network, 2007.
Congressional Research Service

8

Teen Pregnancy: Federal Prevention Programs

Currently, a third cohort of Tier 2 grants is funded for FY2020-FY2023: TPP Innovation and
Impact Networks (Tier 2; TPP20 Innovation Networks),37 and Phase 2 Rigorous Evaluation of
Promising TPP Interventions (Tier 2 Phase 2; TPP Rigorous Evaluation).38 Thirteen grantees
spread across nine states plus the District of Columbia under the TPP20 Innovation Network
grants are to target one of several key priority areas: juvenile justice, foster care/child welfare,
caregivers, expectant and parenting youth, youth with disabilities, youth access to and experience
with sexual health care, and youth engagement.39 Within the selected target area, a grantee is to
“explore, develop, test, refine, and evaluate many types of innovative interventions to improve
optimal health, prevent teen pregnancy, and address sexually transmitted infections/diseases.”40
The TPP Rigorous Evaluation grants were to continue the work supported by the Phase 1 Tier 2
grants, but were open to any applicant (not just those previously funded).41 The purpose of these
grants, awarded to four grantees in Maryland, Massachusetts, Pennsylvania, and Virginia, were to
“rigorously evaluate interventions that already have project merit, positive preliminary evidence,
readiness, and feasibility.”42
Evaluation Activities
HHS supported 41 program evaluations of the first cohort of TPP grants (funded for FY2010-
FY2015). This included 19 Tier 1 evaluations of 10 evidence-based models identified as part of
the Teen Pregnancy Prevention Evidence Review. The evaluations also included 22 studies of Tier
2 grantees, which were expected to implement new or innovative models to improve teen
pregnancy-related outcomes. HHS provided detailed findings from these evaluations in a special
supplement of the American Journal of Public Health in September 2016. Of the 41 evaluations,
12 showed a positive impact in at least one teen pregnancy-related outcome. Another 16 had no
impacts (one of these also had a negative impact), and 13 had inconclusive results. Some of the
evaluations were inconclusive because of high attrition, weak contrasts between the treatment and
control groups, a failure to meet HHS’s research standards, or other reasons.43
Separately, HHS conducted an evaluation to test whether three evidence-based models—
¡Cuídate!, Reducing the Risk, and Safer Sex Intervention (SSI)—that were shown to be effective
in a single study continued to have positive outcomes when replicated across nine TPP grantees in
the first cohort. The evaluation examined behavioral outcomes related to teen pregnancy
prevention. Cuídate! and SSI increased knowledge about sexual risk behavior in the short-term
but did not have lasting impacts on this measure or other sexual risk behaviors or sexual activity.
In the short term, SSI demonstrated a statistically significant impact on women’s use of birth

37 HHS, OASH, OPA, “OPA Awards $19.2 Million in Grants to Develop Innovation and Impact Networks to Prevent
Teen Pregnancy and Achieve Optimal Health,” July 14, 2020, https://opa.hhs.gov/about/news/grant-award-
announcements/opa-awards-192-million-grants-develop-innovation-and-impact.
38 HHS, OASH, OPA, “OPA Awards $3.7 Million in Grants to Conduct Evaluation of Promising Interventions to
Prevent Teen Pregnancy and Achieve Optimal Health,” July 14, 2020, https://opa.hhs.gov/about/news/grant-award-
announcements/opa-awards-37-million-grants-conduct-evaluation-promising.
39 HHS, OASH, OPA, Funding Opportunity: Tier 2 Innovation and Impact Network Grants: Achieving Optimal Health
and Preventing Teen Pregnancy in Key Priority Areas, Funding Opportunity Announcement, AH-TP2-20-002, 2020.
40 Ibid.
41 HHS, OASH, OPA, Funding Opportunity: FY2020 Teen Pregnancy Prevention (TPP) Tier 2, Phase II Rigorous
Evaluation of Promising Interventions, AH-TP2-20-001, 2020.
42 Ibid.
43 Amy Feldman Farb and Amy L. Margolis, “The Teen Pregnancy Prevention Program (2010-2015): Synthesis of
Impact Findings.”
Congressional Research Service

9

Teen Pregnancy: Federal Prevention Programs

control when they engaged in sexual intercourse. Over the longer term, SSI had a promising
impact on program participants who avoided pregnancy over 18 months after the start of the
program. SSI did not have an effect on other sexual behaviors or outcomes.44
HHS also awarded FY2017 and FY2018 funding to MITRE Corporation to test and replicate
meaningful ways to improve programs concerning teen pregnancy prevention under what is
known as the Teen Pregnancy Prevention Study.45 MITRE currently operates the Health Federally
Funded Research and Development Center (FFRDC) under contract with the Centers for
Medicare and Medicaid Services (CMS). The TPP program funds are supporting a contract with
MITRE as part of the Health FFRDC. MITRE has subcontracted with multiple entities to carry
out activities under the contract. The project has several activities underway, including revising
SMARTool (discussed previously), evaluating organizations that implement sexual risk avoidance
education curricula that align with SMARTool, and developing and testing surveys of youth with
key topics from SMARTool.46 Some TPP grantees in the first cohort were also involved in other
evaluation work, including an experimental study of innovative strategies for preventing teen
pregnancy prevention, known as the Adolescent Pregnancy Prevention Approaches (PPA) study, a
cost study of grantees implementing 10 evidence-based programs, and a study of financial
sustainability after TPP funding ended.47 Similarly, some TPP grantees in the second cohort are
involved in research studies, including the Tier 1B grantees and grantees that implemented the
Making Proud Choices! Model.48 In addition to these efforts, each grantee in both the first and
second cohorts were required to conduct their own evaluation to examine the goals of their
respective grant tiers (e.g., Tier 1, Tier 2A, and Tier 2B).49
OPA contracted with Abt Associates and its partners, Decision Information Resources and Data
Soapbox, to evaluate how the Tier 1 (Optimally Changing the Map for Teen Pregnancy
Prevention) and Tier 2 (Innovation Networks) grantees for FY2020 and FY2021 are
implementing each grant strategy and develop recommendations for additional TPP evaluation
options.50
Reproductive Health National Training Center
In 2020, HHS OPA and Office on Women’s Health (OWH) awarded a set of three cooperative
agreements to JSI Research & Training Institute, Inc. (JSI) to establish and operate a National

44 HHS, OASH, OFA, “Teen Pregnancy Prevention Replication Study,” https://www.hhs.gov/ash/oah/evaluation-and-
research/teen-pregnancy-prevention-program-evaluations/teen-pregnancy-prevention-program-replication-study/
index.html. A lawsuit has been filed for injunctive relief.
45 HHS, ACF, “HHS Announces New Efforts to Improve Teen Pregnancy Prevention & Sexual Risk Avoidance
Programs,” press release, November 3, 2017. The MITRE website for these efforts is https://teenhealthpartners.com.
46 These activities are described further at USASpending,gov, “Contract Summary, HHS, The MITRE Corporation,”
https://www.usaspending.gov/#/award/23605015.
47 HHS, OASH, OFA, “Teen Pregnancy Prevention Program Evaluations,” https://www.hhs.gov/ash/oah/evaluation-
and-research/teen-pregnancy-prevention-program-evaluations/index.html.
48 Ibid.
49 HHS, OASH, OAH, “Grantee Evaluations FY2010-2014,” https://www.hhs.gov/ash/oah/evaluation-and-research/
teen-pregnancy-prevention-program-evaluations/2010-2014-grantees/index.html; and HHS, ASH, OAH, “FY2015-
2019 OAH Teen Pregnancy Prevention Grant Program,” https://www.hhs.gov/ash/oah/evaluation-and-research/teen-
pregnancy-prevention-program-evaluations/fy-2015-2019/index.html.
50 The contract period for this evaluation is September 2021 through April 2024. (HHS, OASH, OPA, Teen Pregnancy
Prevention Tier 1 and 2 Evaluation Overview, https://opa.hhs.gov/sites/default/files/2022-04/tpp-fy2020-fy2021-
evaluation-overview_0.pdf.)
Congressional Research Service

10

Teen Pregnancy: Federal Prevention Programs

Training Center for Family Planning and Teen Pregnancy Prevention.51 The purpose of this center
was “to provide training and technical assistance to all OPA-funded Title X family planning
service delivery grantees and all OPA-funded Teen Pregnancy Prevention (TPP) grantees.”52
Priority areas for improving women’s reproductive health include “reducing maternal mortality;
increasing awareness, accessibility, and quality of preconception health; and increasing fertility
awareness and preventing infertility among the millions of women seen by Title X clinics and
TPP programs across the country each year.”53 This national training center has since been
renamed the Reproductive Health National Training Center.54
Personal Responsibility Education Program (PREP)
The Personal Responsibility Education Program is a broad approach to teen pregnancy prevention
that seeks to educate adolescents ages 10 through 19 and pregnant and parenting youth under age
21 on both abstinence and contraceptives to prevent pregnancy and STIs. The Patient Protection
and Affordable Care Act (ACA, P.L. 111-148) established PREP, appropriating $75 million
annually in mandatory spending for FY2010 through FY2014.55 PREP authorization and funding
has been extended multiple times, most recently through FY2023, under Title III, Division CC of
the CAA 2021 (P.L. 116-260).
PREP funds states and other entities to carry out sexual education programs that place
“substantial emphasis on both abstinence and contraception.” Recipients of PREP funds must
fulfill requirements outlined in the law, including that they must implement programs that
 provide youth with information on at least three of six specified adulthood
preparation subjects (healthy relationships, adolescent development, financial
literacy, parent-child communication, educational and career success, and healthy
life skills);
 are “medically-accurate and complete”;
 include activities to educate youth who are sexually active regarding responsible
sexual behavior with respect to both abstinence and the use of contraception; and
 provide age-appropriate information and activities, while ensuring these are
delivered in the most appropriate cultural context for the individuals served in the
program.56

51 According to the FOA, a maximum of $7.4 million would be available for the first 12-month budget period of a
project not to exceed five years between the three cooperative agreements funded by Title X, TPP, and OWH. (See
HHS, OASH, OPA, and Office of Women’s Health (OWH) FOA, “National Training Center for Family Planning and
Teen Pregnancy Prevention, PA-FPT-20-001 / AH-TPS-20-001 / WH-AST-20-002, p. 4.)
52 Ibid, p. 3.
53 Ibid.
54 See https://rhntc.org/about.
55 Section 513 of the Social Security Act (42 U.S.C. §513).
56 The law defines medically accurate and complete as verified or supported by research that is conducted in
compliance with accepted scientific methods and published in peer-reviewed journals, where applicable, or comprising
information that leading professional organizations and agencies with relevant expertise in the field recognize as
accurate, objective, and complete. This definition is generally consistent with the definition of “medically accurate”
used in the other three programs. The law defines “age-appropriate” as topics, messages, and teaching methods that are
suitable to particular ages of children and adolescents, based their on developing cognitive, emotional, and behavioral
capacity.
Congressional Research Service

11

Teen Pregnancy: Federal Prevention Programs

As with the TPP program, PREP uses a tiered-evidence approach. Nearly all PREP participants
are in evidence-based, effective programs that have been proven to delay sexual activity, increase
condom or contraceptive use for sexually active youth, or reduce pregnancy among youth.57 Other
grantees substantially incorporate elements of effective programs that have been proven to change
behavior. As specified in the law, grantees must serve youth who are ages 10 through 19 and are
the most high-risk or vulnerable for pregnancies or otherwise have special circumstances,
including youth who are in foster care, are homeless, live with HIV/AIDS, or reside in areas with
high birth rates for youth. The program can also serve pregnant youth or mothers under age 21.
PREP includes four types of grants: (1) State PREP grants, (2) Competitive PREP grants, (3)
Tribal PREP, and (4) Personal Responsibility Education Innovative Strategies (PREIS). Most of
the PREP appropriation is allocated to states and insular areas via the State PREP grant. Funding
for states and insular areas that did not apply for this grant is available to local entities under
Competitive PREP grants. The law specifies certain levels of funding for the other components,
including $10 million for the PREIS grants. After this set-aside, HHS must reserve 5% for grants
to Indian tribes and tribal organizations (Tribal PREP) and 10% for training, technical assistance,
and evaluation. Total FY2021 funding for the four grants was $72.4 million. Of this amount,
$43.5 million was for State PREP, $15.0 million was for Competitive PREP, $3.3 million was for
Tribal PREP, and $10.7 million was for PREIS.58
State PREP and Competitive PREP
The 50 states, District of Columbia, and insular areas are eligible for State PREP funding. Funds
are allocated by a formula that is based on the proportion of youth ages 10 through 19 in each
jurisdiction relative to other jurisdictions. State PREP funds do not require a match. A total of 51
jurisdictions applied for and received FY2021 PREP funding. This included 44 states, plus the
District of Columbia, Guam, the Northern Mariana Islands, Puerto Rico, the Republic of Palau,
the Virgin Islands, and the Federated States of Micronesia.59 States and insular areas can
administer the project directly or through sub-awards to public or private entities.
If a state or insular area did not submit an application for formula funding for FY2010 or
FY2011, it is ineligible to apply for that formula funding for FY2012-FY2023.60 Organizations in

57 HHS, ACF, FY2023 Justification of Estimates for Appropriations Committee, p. 295. A review of PREP grantees and
participants in 2013 and 2014 found that more than 95% of youth were in programs with evidence-based models. See
HHS, OPRE and FYSB, Personal Responsibility Education Program: A Snapshot of the PREP Performance Measures
Report to Congress, July 2015.
58 State Personal Responsibility Education Program (PREP) Grantees FY2020 & FY2021, August 2, 2021; Competitive
Personal Responsibility Education Program (PREP) Awards FY2021, October 7, 2021; Personal Responsibility
Education Innovative Strategies (PREIS) Program Grantees FY2021, October 6, 2021; and Tribal Personal
Responsibility Education Program (PREP) Grantees FY2021, October 6, 2021. The sum of the grants totals $72.4
million due to rounding.
59 HHS, ACF, FYSB, State Personal Responsibility Education Program (PREP) Grantees FY2020 & FY2021, August
2, 2021, https://www.acf.hhs.gov/fysb/grant-funding/state-personal-responsibility-education-program-prep-grantees-
fy2020-fy2-2021. Guam did not apply for State PREP funding for FY2010 through FY2015, and funding instead was
awarded under Competitive PREP. Guam first received State PREP funds for FY2016. Similarly, the Northern Mariana
Islands did not apply for State PREP funding for FY2010 through FY2016, and funding was provided under
Competitive PREP. The Northern Mariana Islands first received State PREP funds for FY2017. (Based on CRS
correspondence with HHS, December 2019.)
60 The law originally stated that jurisdictions that did not submit an application in FY2010 or FY2011 were ineligible to
apply for funding in FY2010 through FY2014. Amendments to the law shifted the latter years to FY2015 (P.L. 113-
93), FY2017 (P.L. 114-10), FY2019 (P.L. 115-123), November 21, 2019 (P.L. 116-59), December 20, 2019 (P.L. 116-
69), May 22, 2020 (P.L. 116-94), November 30, 2020 (P.L. 116-136), and FY2023 (P.L. 116-260).
Congressional Research Service

12

Teen Pregnancy: Federal Prevention Programs

such a state or insular area are eligible to apply competitively for funding, which is to be awarded
as a three-year grant. In practice, Competitive PREP applicants can include county or city
governments, public institutions of higher education, and for-profit and nonprofit organizations,
among other entities.61 HHS awarded Competitive PREP funding for FY2012-FY2014 to
organizations located in states that did not apply for funding in FY2010 or FY2011, and awarded
a second cohort Competitive PREP funding for FY2015-FY2020.62 In FY2021, HHS awarded
Competitive PREP funds for FY2021-FY2023 to 27 grantees in Florida, Indiana, Kansas, North
Dakota, Texas, and Virginia.63
Each State PREP and Competitive PREP applicant must include a description of its plan for using
the allotment to achieve its goals related to reducing pregnancy rates and birth rates for youth
populations.64 Applicants are required to specify the populations they will serve, and such
populations must be the most high-risk or vulnerable for pregnancies or otherwise have special
circumstances. States, insular areas, and entities that apply for State PREP or Competitive PREP
funds must replicate evidence-based teen pregnancy prevention programs or substantially
incorporate elements of effective programs.65

61 HHS, ACF, FYSB, Personal Responsibility Education Program (PREP) Competitive Grants under the Affordable
Care Act (for FY2015-FY2017), HHS-2015-ACF-ACYF-AK-0984, 2015.
62 The length of this grant period was related, in part, to a series of short-term funding extensions for PREP that were
enacted during this period. The Bipartisan Budget Act of 2018 (BBA 2018, P.L. 115-123) extended the funding period
for the grantees through FY2019. As a result, HHS did not publish funding announcements for FY2018 or FY2019 for
Competitive PREP or any other component of PREP. (Based on CRS correspondence with HHS, December 2019.)
Funding was subsequently extended, most recently through FY2023 (CAA 2021, P.L. 116-260). The FY2022 budget
request noted that the project period for 20 of the 21 Competitive PREP grantees was FY2015 through FY2020, with
the remaining grantee being extended through January 2022. HHS, ACF, FY 2022 Justification of Estimates for
Appropriations Committee, p. 286.
63 HHS, ACF, FYSB, “Competitive Personal Responsibility Education Program (PREP) Grantees FY2021,” October 7,
2021, https://www.acf.hhs.gov/fysb/grant-funding/fysb/competitive-personal-responsibility-education-program-prep-
grantees-fy2021. Note that eligible applicants were limited to local organizations and entities or consortia in the
following states and insular areas: Florida, Indiana, Kansas, North Dakota, Texas, Virginia, American Samoa, and the
Marshall Islands (HHS, ACF, FYSB, Personal Responsibility Education Program (PREP) Competitive Grants, HHS-
2021-ACF-ACYF-AK-1929, 2021).
64 HHS, OASH, OAH, and HHS, ACF, FYSB, Teenage Pregnancy Prevention (TPP): Research and Demonstration
Programs and Personal Responsibility Education Program (PREP), Funding Opportunity Announcement and
Application Instructions; HHS, ACF, FYSB, State Personal Responsibility Education Program (PREP), Funding
Opportunity Announcement and Instructions (for FY2016 and FY2017), HHS-2016-ACF-ACYF-PREP-1138, 2016;
and HHS, ACF, FYSB, Personal Responsibility Education Program (PREP) Competitive Grants, HHS-2021-ACF-
ACYF-AK-1929, 2021.
65 Previously, grantees were referred to the (now discontinued) Teen Pregnancy Prevention Evidence Review, though
they were not required to adopt the models identified in the review.
Congressional Research Service

13

Teen Pregnancy: Federal Prevention Programs

Grantee Profile: Massachusetts
The PREP program in Massachusetts serves youth ages 10 through 19 and pregnant or parenting youth up to age
21. Providers focus on populations with the greatest disparities in reproductive health outcomes in the state,
including Hispanic and Latino youth, African-American youth, gender and sexual minority youth, youth in or aging
out of foster care, youth with physical and intellectual disabilities, and pregnant or parenting youth. The program
implements the fol owing evidence-based curricula in school and community-based settings: It Pays: Partners for
Youth Success, Making Proud Choices!, Teen Outreach Program, Be Proud! Be Responsible!, and Get Real. The program
also educates its youth in three of the adulthood preparation subjects: adolescent development, financial literacy,
and healthy relationships.
Source: HHS, Administration for Children and Families (ACF), Family and Youth Services Bureau (FYSB), State
Personal Responsibility Education Program (PREP) Grantee Profiles, August 24, 2017.
Note: This report includes examples of grantees recently funded under the four teen pregnancy prevention
programs. The grantees were selected by CRS based on information available on the HHS website or provided via
correspondence with HHS. Col ectively, the grantees described in the report are intended to represent all regions
of the country and are included for il ustrative purposes only.
Tribal PREP
Tribal PREP grants are intended to support projects that educate American Indian and Alaska
Native youth ages 10 to 20 and pregnant and parenting youth under age 21 on abstinence and
contraception for the prevention of pregnancy, STIs, and HIV/AIDS. Specifically, grantees must
support the design, implementation, and sustainability of culturally and linguistically appropriate
teen pregnancy programs. Such programs must replicate evidence-based models, sustainably
incorporate elements of effective models, or include promising practices within tribal
communities.66 Indian tribes and tribal organizations, as these terms are defined in the Indian
Health Care Improvement Act, are eligible to apply for Tribal PREP funding. The first cohort of
15 grantees received funding from FY2011 through FY2015.67 The project period for the second
cohort of eight grantees was from FY2016 through FY2020.68 The project period for the third
cohort of eight grantees (in seven states) that was awarded in FY2021 is five years.69
Personal Responsibility Education Innovative Strategies (PREIS)
PREIS grants are intended to build evidence for promising teen pregnancy prevention programs
serving high-risk youth populations. The grants are awarded on a competitive basis to public and
private entities to implement and evaluate innovative youth pregnancy prevention strategies that
have not been rigorously evaluated and/or to participate in a federal evaluation of their program
strategies if selected.

66 HHS, ACF, FYSB, Tribal Personal Responsibility Education Program for Teen Pregnancy Prevention, HHS-2021-
ACF-ACYF-AT-1922, 2021.
67 HHS, ACF, FYSB, 2015 Tribal Personal Responsibility Education Grant Awards, https://www.acf.hhs.gov/fysb/
resource/2015-tribal-prep.
68 HHS, ACF, FYSB, Tribal Personal Responsibility Program (PREP) Awards FY2017, https://www.acf.hhs.gov/fysb/
tribal-prep-awards-fy2017. See also HHS, ACF, FY 2021 Justification of Estimates for Appropriations Committee, p.
281.
69 HHS, ACF, FYSB, Tribal Personal Responsibility Education Program (PREP) Grantees FY2021, October 6, 2021,
https://www.acf.hhs.gov/fysb/grant-funding/tribal-personal-responsibility-education-program-prep-grantees-fy2021.
The states are Alaska, Montana, New Mexico, Oklahoma, Oregon, South Dakota, and Wyoming.
Congressional Research Service

14

Teen Pregnancy: Federal Prevention Programs

According to the most recent program funding announcement, innovative strategies could include
those that are technology-based and/or computer-based, use social media, or are implemented in
nontraditional classroom settings. Such strategies must be targeted to high-risk, vulnerable, and
culturally under-represented youth populations.70 The law specifies that this includes youth ages
10 to 20 in or aging out of foster care; homeless youth; youth with HIV/AIDS; pregnant and
parenting women who are under age 21 and their partners; young people residing in areas with
high birth rates for youth; and victims of human trafficking. HHS also lists other selected youth
populations in the program funding announcement: youth who have been trafficked, runaway and
homeless youth, and rural youth.71 PREIS funds are awarded as five-year cooperative agreements.
The first cohort of PREIS grantees, funded for FY2011 through FY2015, included 11
organizations.72 The second cohort of grantees, funded for FY2016 through FY2020, included 13
organizations in 10 states plus the District of Columbia.73 The third cohort of grantees, funded in
FY2021 with a five-year project period, included 12 organizations in nine states plus the District
of Columbia.74
Evaluation Activities
PREP authorizing law directs HHS to evaluate PREP programs and activities.75 The PREP Multi-
Component Evaluation (2011-2021) supported the first cohort of PREP grantees. The activities of
this evaluation included (1) describing how states have designed and implemented PREP
programs, (2) collecting and analyzing performance measurement data, and (3) conducting a
random assignment evaluation of grantees that receive State PREP or Competitive PREP
funding.76 The study of the grantees overall found that the largest share of youth served by PREP
programs have been ages 13 through 16, and over one-quarter of programs served the most highly
vulnerable youth (e.g., those who were in foster care, identified as LGBTQ, were in residential
treatment for mental health issues).77 Further, youth tended to be served primarily through
schools, during school hours. About three quarters of the youth reported that participating in
PREP made them more prepared for adulthood. The random assignment evaluation involved
grantees implementing four evidence-based programs in rural Kentucky; Davenport, IA; New
York City; and San Angelo, TX. Generally, the studies found mixed results, with some positive
impacts such as an improvement in knowledge of contraception and STIs (Davenport, IA,

70 HHS, ACF, FYSB, Personal Responsibility Education Program Innovative Strategies (PREIS), HHS-2021-ACF-
ACYF-AP-1928, 2021.
71 Ibid.
72 HHS, ACF, FYSB, 2015 Personal Responsibility Education Innovative Strategies (PREIS) Grant Awards,
https://www.acf.hhs.gov/fysb/resource/2015-preis.
73 HHS, ACF, FYSB, Personal Responsibility Education Innovative Strategies (PREIS) Program Awards FY2017,
https://www.acf.hhs.gov/fysb/preis-awards-fy2017; and HHS, ACF, FY 2022 Justification of Estimates for
Appropriations Committee, p. 286.
74 HHS, ACF, FYSB, Personal Responsibility Education Innovative Strategies (PREIS) Program Grantees FY2021,
October 6, 2021, https://www.acf.hhs.gov/fysb/grant-funding/fysb/personal-responsibility-education-innovative-
strategies-preis-program.
75 Section 513(c)(2(B)(iii) of the Social Security Act.
76 HHS, ACF, OPRE, Personal Responsibility Education Program (PREP) Multi-Component Evaluation,
https://www.acf.hhs.gov/opre/project/personal-responsibility-education-program-prep-multi-component-evaluation-
2011-2021.
77 HHS, ACF, Office of Policy Research and Evaluation (OPRE), Personal Responsibility Education Program (PREP)
Evaluation: Nationwide Implementation of PREP Programs, OPRE Report Number 2018-23, April 2018.
Congressional Research Service

15

Teen Pregnancy: Federal Prevention Programs

grantee) and the reduced incidence of unprotected sex among youth who had previously had sex
(San Angelo, TX, grantee).
The PREP Studies of Performance Measures and Adulthood Preparation Subjects (2016-2024)
supports the second cohort of PREP grantees. This evaluation is composed of two key
components related to performance measures for PREP and adulthood preparation subjects
(APS). The multiple purposes of this project include revising measures used for PREP grantee
reporting of performance data, creating a performance dashboard tool, and developing APS
conceptual models. Several policy briefs and other supporting publications associated with this
project have been released as of the cover date of this report.78 In addition, grantee training
technical support for the second cohort is provided via the Promising Youth Programs Project.79
The PREP Local Evaluation Support and Dissemination (PLESD) project provides support for
grantees to conduct rigorous program evaluations and to build research and evaluation capacity.
This support for grantees is expected to extend through 2026.80
Grantee Profile: Kentucky Department of Health
The Kentucky Department of Health decreased the Reducing the Risk teen pregnancy prevention curriculum from
12 to 8 hours for students in a rural area of the state. The treatment group enrol ed in Reducing the Risk (which
stil covered the same topics, just in a shorter period) and the control group received the school’s standard health
curriculum. The adapted version reduced the likelihood of having sex without a condom among students who
were already sexually active, but it did not change the likelihood of having sex or having sex without a condom for
the overall sample.
Source: HHS, ACF, OPRE, Personal Responsibility Education Program (PREP) Evaluation: Evaluating a Teen Pregnancy
Prevention Program in Rural Kentucky, OPRE Report Number 2018-105, October 2018.
Note: This report includes examples of grantees recently funded under the four teen pregnancy prevention
programs. The grantees were selected by CRS based on information available on the HHS website or provided via
correspondence with HHS. Col ectively, the grantees described in the report are intended to represent all regions
of the country and are included for il ustrative purposes only.
Separate from these evaluation efforts, PREIS and Tribal PREP direct grantees to carry out
evaluation activities. PREIS grantees must contract with independent third-party evaluators to
conduct RCT or quasi-experimental research to determine whether grantees’ interventions led to
outcomes such as reduced pregnancies, births, and STIs. Tribal PREP grantees must partner with
a university or other organization not associated with the grantee to conduct an evaluation (known
as a “local evaluation”) that is either descriptive (without treatment and comparison groups) or
examines impacts using treatment and comparison groups. State PREP and Competitive PREP
grantees may choose to conduct such evaluations.
Title V Sexual Risk Avoidance Education Program
The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA, P.L.
104-193) established the “Separate Program for Abstinence Education” under Section 510 in Title
V. The Title V Sexual Risk Avoidance Education program is funded through mandatory spending.

78 ACF, ACF, OPRE, Personal Responsibility Education Program (PREP) Studies of Performance Measures and
Adulthood Preparation Subjects, https://www.acf.hhs.gov/opre/project/prep-studies-performance-measures-and-
adulthood-preparation-subjects-2016-2022.
79 ACF, ACF, OPRE, Promising Youth Programs Project, https://www.acf.hhs.gov/fysb/programs/adolescent-
pregnancy-prevention/evaluation/promising-youth-programs-project.
80 ABT Associates, Personal Responsibility Education Program (PREP) Local Evaluation Support and Dissemination
(PLESD), https://www.abtassociates.com/projects/providing-local-evaluation-support-to-acfs-prep-grantees.
Congressional Research Service

16

Teen Pregnancy: Federal Prevention Programs

P.L. 104-193 provided $50 million per year for five years (FY1998-FY2002). The program was
subsequently funded through June 30, 2009, by various legislative extensions. The ACA
reauthorized the program, providing $50 million for each of FY2010 through FY2014.
Multiple subsequent laws extended the
program and increased its funding. The
Title V Sexual Risk Avoidance
Protecting Access to Medicare Act of 2014
Education Topics
(P.L. 113-93) provided $50 million in
Sexual risk avoidance education must ensure that the
FY2015. Next, the Medicare Access and
“unambiguous and primary emphasis and context” for
CHIP Reauthorization Act of 2015 (P.L. 114-
each of six sexual risk avoidance topics is “a message to
10) increased funding to $75 million per year
youth that normalizes the optimal health behavior of
avoiding nonmarital sexual activity.” The sexual risk
for FY2016 and FY2017. Two additional
avoidance topics include the fol owing:
fiscal years (FY2018 and FY2019) of funding

The holistic individual and societal benefits
were enacted by the Bipartisan Budget Act of
associated with personal responsibility, self-
2018 (P.L. 115-123, BBA 2018). Following
regulation, goal setting, healthy decisionmaking, and
several temporary extensions, funding has
a focus on the future.
been most recently provided through FY2023

The advantage of refraining from nonmarital sexual
by the Consolidated Appropriations Act, 2021
activity in order to improve the future prospects
(P.L. 116-260).81
and physical and emotional health of youth.


The increased likelihood of avoiding poverty when
States are eligible to request mandatory Title
youth attain self-sufficiency and emotional maturity
V Sexual Risk Avoidance Education funds if
before engaging in sexual activity.
they submit an application for Maternal and

The foundational components of healthy
Child Health (MCH) Block Grant funds. The
relationships and their impact on the formation of
MCH Block Grant, authorized under Title V
healthy marriages and safe and stable families.
of the Social Security Act, is a flexible source

How other youth risk behaviors, such as drug and
of funds that states use to support maternal
alcohol usage, increase the risk for teen sex.
and child health programs.82 Title V Sexual

How to resist, avoid, and receive help regarding
Risk Avoidance Education funds are allocated
sexual coercion and dating violence, recognizing
that, even with consent, teen sex remains a youth
to each jurisdiction based on two factors: (1)
risk behavior.
the amount provided to the program minus
Source: Section 510(b)(3) of the Social Security Act.
any reservations (up to 20%) made by HHS
for administering it, and (2) states’ relative

81 See the Continuing Appropriations Act, 2020, and Health Extenders Act of 2019 (P.L. 116-59), which provided
$10.7 million through November 21, 2019; the Further Continuing Appropriations Act, 2020, and Further Health
Extenders Act of 2019 (P.L. 116-69), which provided $16.6 million through December 20, 2019; the Further
Consolidated Appropriations Act, 2020 (P.L. 116-94), which provided $48.3 million through May 22, 2020; the
CARES Act (P.L. 116-136), which provided $75 million through FY2020 and additional funding for October 1 through
November 30, 2020, prorated based on the amount appropriated for FY2020; the Continuing Appropriations Act, 2021
and Other Extensions Act (P.L. 116-159), which extended that funding through December 11, 2020; the Further
Continuing Appropriations Act, 2021, and Other Extensions Act (P.L. 116-215), which extended that funding through
December 18, 2020; and the Consolidated Appropriations Act, 2021 (P.L. 116-260), which extended that funding
through September 30, 2023.
82 For further information, see CRS Report R44929, Maternal and Child Health Services Block Grant: Background and
Funding. All states, the District of Columbia, and five insular areas (American Samoa, Guam, the Northern Mariana
Islands, Puerto Rico, and the U.S. Virgin Islands), and three freely associated states (Federated States of Micronesia,
Republic of the Marshall Islands, and Republic of Palau) receive MCH Block Grant funds. (See HHS, HRSA, Explore
the Title V Federal-State Partnership, https://mchb.tvisdata.hrsa.gov/.)
Congressional Research Service

17

Teen Pregnancy: Federal Prevention Programs

proportion of low-income children nationally.83 The law does not require states to provide a
match.84
HHS was authorized to competitively award FY2018 through FY2023 funds to one or more
entities within a state/insular area that had not previously applied for its share of funding. (The
law does not define the entities that would be eligible.) The HHS Secretary is required to publish
a notice to solicit grant applications for any remaining competitive funds. The solicitation must be
published within 30 days after the deadline for states to apply for MCH Services Block Grant
funds.85 Eligible states are required to apply for the Title V Sexual Risk Avoidance Education
funds no later than 120 days after the deadline closed for states to apply for MCH Services Block
Grant funds. The entity or entities would receive the amount that would have been otherwise
allotted to that state.
The 50 states, the District of Columbia, and the insular areas (Puerto Rico, U.S. Virgin Islands,
Guam, American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of
Micronesia, the Republic of the Marshall Islands, and Republic of Palau) were eligible to apply
for FY2018 through FY2023 funding. In total, 36 states plus Puerto Rico and the Federated States
of Micronesia applied for and received FY2021 funding. Another 35 grantees in 13 states plus
Guam and the U.S. Virgin Islands received new Competitive SRAE funding (in addition to
grantees already funded, for FY2021).86
The law directs states/insular areas or other entities to implement sexual risk avoidance education
that is medically accurate and complete, age-appropriate, and based on adolescent learning and
developmental theories for the age group receiving the education.87 As described in the previous
text box, sexual risk avoidance education must address six topics. According to the grant

83 Census data are not available for the Federated States of Micronesia, the Republic of the Marshall Islands, and the
Republic of Palau. Thus, the allocations for these three entities, when applicable, are based on the amounts allocated to
them by HHS in prior fiscal years. HHS, ACF, FYSB, Standing Announcement for Title V State Sexual Risk Avoidance
Education, HHS-2020-ACF-ACYF-SRAE-1848, 2020.
84 Previously, such a matching requirement was specified at Section 510(c) of the Social Security Act, which
referenced the Maternal and Child Health Block Grant at Section 503. Section 503(a) states that HHS is to fund four-
sevenths (approximately 57%) of the program activities under the MCH Services Block Grant. To receive federal
funding, a state must match every $4 in federal funds with $3 in state funds—via state dollars, local government
dollars, private dollars, or in-kind support—that will be used solely for activities specified in the law. This match
applied to the Title V Abstinence Education program. This requirement, as it temporarily applied to the Title V Sexual
Risk Avoidance Education program, was struck by the Consolidated Appropriations Act, 2018 (P.L. 115-141).
85 HHS, ACF, FYSB, Title V Competitive Sexual Risk Avoidance Education Funding Announcement, HHS-2018-ACF-
ACYF-TS-1384, 2018. See also HHS, ACF, FYSB, Title V Competitive Sexual Risk Avoidance Education, HHS-2021-
ACF-ACYF-TS-1925, 2021.
86 The 36 states that received FY2021 State SRAE funding are AL, AZ, AR, CO, FL, GA, ID, IN, IA, KY, LA, MD,
MA, MI, MN, MS, MO, MT, NE, NV, NJ, NM, NY, NC, OH, OK, OR, PA, SC, SD, TN, TX, UT, VA, WV, and WI.
For further information, see HHS, ACF, FYSB, Title V State Sexual Risk Avoidance Education (SRAE) Grantees
FY2020 & FY2021, October 6, 2021, https://www.acf.hhs.gov/fysb/grant-funding/fysb/title-v-state-sexual-risk-
avoidance-education-srae-grantees-fy2020-fy2021. The list of states that received Competitive FY2021 SRAE Funding
is available at HHS, ACF, FYSB, Title V Competitive Sexual Risk Avoidance Education (SRAE) Grantees FY2021,
https://www.acf.hhs.gov/fysb/grant-funding/title-v-competitive-sexual-risk-avoidance-education-srae-grantees-fy2021.
87 The law defines medically accurate and complete as information verified or supported by research that is conducted
in compliance with accepted scientific methods and published in peer-reviewed journals, where applicable, or
information that leading professional organizations and agencies with relevant expertise in the field recognize as
accurate, objective, and complete. This definition is generally consistent with the definition of medically accurate used
in the other three programs. The law defines age appropriate as topics, messages, and teaching methods that are
suitable to particular ages of children and adolescents, based their on developing cognitive, emotional, and behavioral
capacity.
Congressional Research Service

18

Teen Pregnancy: Federal Prevention Programs

announcements for the program, if sexual risk avoidance education includes any information
about contraception, such information must be medically accurate and ensure that students
understand that contraception reduces physical risk but does not eliminate risk. In addition, sexual
risk avoidance education may not include demonstration, simulations, or distribution of such
contraceptive devices.
Under the authorizing statute, a state or other entity that receives Title V Sexual Risk Avoidance
Education funding must, as specified by the HHS Secretary, collect information on the programs
and activities funded through their allotments and submit reports to HHS on the data collected
from such programs and activities. Recent grant announcements for the program specify that
jurisdictions must assess the success of their sexual risk avoidance education programs through at
least two outcome measures, one of which must be abstinence as a means for preventing teen
pregnancy, births, and/or STIs, among other outcomes.
Additionally, the grant announcements have previously specified that grantees must implement a
project with a “best practice and/or evidence-based approach.” The grant announcements direct
applicants to research documents, such as SMARTool and the CDC’s HECAT (Health Education
Curriculum Assessment Tool), that identify “critical elements to success in implementing
programs to positively change youth behavior.”88 As noted in the discussion of the TPP New and
Innovative Strategies (Tier 2) grant, SMARTool was developed by the Center for Relationship
Education, a nonprofit organization, in partnership with the CDC. The HECAT is an assessment
tool to help schools and other entities identify a curriculum for health education courses and
analyze the acceptability and appropriateness of the curriculum, among other objectives. This tool
addresses multiple health topics, including sexual health.89
Grantee Profile: Arizona
The Title V Abstinence Education program in Arizona is implementing the fol owing education models: Choosing
the Best, Love Notes SRA Edition, Making a Difference, Promoting Health Among Teens (PHAT)! Abstinence Only, and the
Teen Outreach Program (TOP). The target population is youth ages 11 through 19 who are in areas across the state
with high teen pregnancy rates; Hispanic, black, or American Indian youth; and youth in foster care. The program’s
services are provided by one county health department and with community-based organizations in schools and
community-based settings. Generally, the program focuses on the benefits of protective factors to support
adolescents’ decisions in refraining from nonmarital sex, including healthy relationships, setting goals, self-
regulation, and academic success. In addition to the curriculum above, the program may deliver an optional
parental education component to parents of youth aged 11 through 19.
Source: HHS, ACF, FYSB, Title V State Sexual Risk Avoidance Education (SRAE) Grantee Profiles, April 2, 2021.
Arizona Department of Health Services, Title V State Sexual Risk Avoidance Education Program State Plan, 2018.
Note: In the absence of information about Title V Sexual Risk Avoidance Education grantees on the HHS website,
this grantee was selected by CRS based on an internet search. Col ectively, the grantees described in the report
are intended to represent all regions of the country and are included for il ustrative purposes only.
Evaluation Activities
A state or other entity receiving funding under the Title V Sexual Risk Avoidance Education
program may use up to 20% of its allotment to build the evidence base for sexual risk avoidance
education by conducting or supporting research. Any such research must be rigorous, evidence-

88 Standing Announcement for Title V State Sexual Risk Avoidance Education, HHS-2020-ACF-ACYF-SRAE-1848,
2020.
89 CDC, “Health Education Curriculum Analysis Tool (HECAT),” https://www.cdc.gov/healthyyouth/HECAT/
index.htm.
Congressional Research Service

19

Teen Pregnancy: Federal Prevention Programs

based, and designed and conducted by independent researchers who have experience in
conducting and publishing research in peer-reviewed outlets.90
Separately, the law as amended by the BBA 2018, requires HHS to conduct one or more rigorous
evaluations of the education (and associated data) funded through the Title V Sexual Risk
Avoidance Education program. This evaluation is to be conducted in consultation with
“appropriate State and local agencies.” HHS is to consult with relevant stakeholders and
evaluation experts about the evaluation(s). HHS must submit a report to Congress on the results
of the evaluation(s). The report must also include a summary of the information collected and
reported by states and other entities on their Sexual Risk Avoidance Education programs and
activities.
HHS has contracted with Mathematica Policy Research, in partnership with Public Strategies, to
conduct evaluation activities under what is known as the Sexual Risk Avoidance National
Evaluation (SRANE). The evaluation is a five-year study that includes both Title V SRAE
grantees and SRAE program grantees funded under the General Departmental Management
account, and has three components:
 National Descriptive Study: This will describe SRAE grantees’ program plans
(Early Implementation Study) and examine grantees’ implementation and youth
outcomes (Nationwide Study).
 Program Components Impacts Study: This will provide an analysis of promising
program approaches and the effectiveness of SRAE program components (e.g.,
parent engagement and/or staff training strategies). It will not evaluate the
effectiveness of the full program.
 Data Capacity Building and Local Evaluation Support: This component focuses
on supporting grantees in collecting and using local data to improve their
programs and support grantee-funded evaluations.91
In addition, the Sexual Risk Avoidance Education Performance Analysis Study (2019-
2023) is intended to collect performance measures data from SRAE program participants
and providers to allow both the program office and grantees to monitor and report on
progress in implementing SRAE initiatives. Primary activities include support to grantees
to collect and submit performance measures, the development of a portal for performance
measures submission, and development of a dashboard for use by grantees and the
program office for continuous quality improvement. The contract for this evaluation was
awarded to Public Strategies.92

90 The law defines rigorous, with respect to research and evaluation, to mean using (1) established scientific methods
for ensuring the impact of an intervention or program model in changing behavior (specifically sexual activity or other
risk behaviors), or reducing pregnancy among youth; or (2) other evidence-based methodologies established by the
HHS Secretary for purposes of the Title V Sexual Risk Avoidance Education program.
91 HHS, ACF, OPRE, Sexual Risk Avoidance Education National Evaluation, 2018 – 2023, https://www.acf.hhs.gov/
opre/research/project/sexual-risk-avoidance-education-national-evaluation; and HHS, ACF, FYSB and OPRE, Looking
Back, Moving Forward: SRAE National Evaluation Frequently Asked questions, https://sraene.com/sites/default/files/
pdfs/SRAENE_FAQ.pdf. See also Katie Adamek et al., Conceptual Models to Depict the Factors that Influence the
Avoidance and Cessation of Sexual Risk Behaviors Among Youth, Mathematica Policy Research, Inc., for HHS, OPA
and OPRE, OPRE Research Brief Number 2020-02, February 2020.
92 HHS, ACF, OPRE, Sexual Risk Avoidance Education Performance Analysis Study, https://www.acf.hhs.gov/opre/
project/sexual-risk-avoidance-education-performance-analysis-study-2019-2022.
Congressional Research Service

20

Teen Pregnancy: Federal Prevention Programs

With regard to the prior Title V Abstinence Education Grant program, the Balanced Budget Act of
1997 (P.L. 105-133) directed HHS to conduct evaluation activities.93 In response, HHS undertook
a multi-year evaluation that included a study of how grantees in four states implemented
abstinence education programs and a separate study that rigorously evaluated whether grantees’
programs had impacts on teen sexual abstinence and related outcomes. The programs targeted
youth in elementary and middle school and engaged them as part of the school setting, including
in afterschool programming. Each youth participated for more than 50 hours. The study tracked
outcomes for youth four and six years after they were enrolled in it. The impact evaluation found
that youth who received abstinence education under the program did not have different outcomes
than youth in the control group. Further, it found that youth were no more likely than their peers
in the study to have abstained from sex.94
GD Sexual Risk Avoidance Education Program
As noted, federal funding has supported abstinence-only education through the Community-
Based Abstinence Education program (FY2001 through FY2009) and the Competitive
Abstinence-Only program (FY2012 through FY2015). In each of FY2016 through FY2022,
annual appropriations laws provided funding to support abstinence-only education through the
GD Sexual Risk Avoidance Education program. Funding was $5 million in FY2016, $15 million
in FY2017, $25 million in FY2018, and $35 million in FY2019 through FY2022. The
appropriations laws have specified that GD Sexual Risk Avoidance Education grants are to
 be awarded by HHS on a competitive basis;
 use medically accurate information;
 “implement an evidence-based approach integrating research findings with
practical implementation that aligns with the needs and desired outcomes for the
intended audience;” and
 “teach the benefits associated with self-regulation, success sequencing for
poverty prevention, healthy relationships, goal setting, and resisting sexual
coercion, dating violence, and other youth risk behaviors such as underage
drinking or illicit drug use without normalizing teen sexual activity.”95
The appropriations laws have provided that up to 10% of the funding for sexual risk avoidance
can be made available for technical assistance and administrative costs.
Through the grant application process for the Sexual Risk Avoidance Education program, HHS
has identified multiple types of entities that are eligible for funding, including states, territories,
and localities (county, city, township, special districts); school districts; public and state-
controlled institutions of higher education; federally recognized tribal governments; Native
American tribal organizations; public and Indian housing authorities; nonprofit organizations
other than institutions of higher education; private institutions of higher education; small

93 P.L. 105-133 did not amend Title V of the Social Security Act.
94 Barbara Devaney, The Evaluation of Abstinence Education Programs Funded Under Title V Section 510: Interim
Report, Mathematica Policy Research, Inc., for HHS, OPRE, April 2002; and Christopher Trenholm et al., Impacts of
Four Title V, Section 510 Abstinence Education Programs: Final Report, Mathematica Policy Research, Inc., for HHS,
ACF, ASPE, April 2007.
95 This text has been included in each of the omnibus appropriation laws for FY2016 through FY2020.
Congressional Research Service

21

link to page 33 Teen Pregnancy: Federal Prevention Programs

business; and for-profit organizations other than small businesses.96 HHS awarded 10 grants for
FY2015, 21 grants for FY2016, 27 grants for FY2017, 57 grants for FY2018, 22 grants for
FY2019, 51 grants for FY2020, and 31 grants for FY2021.97
As specified in the funding announcement, grantees must incorporate an evidence-based program
and/or effective strategies that have demonstrated impacts on delaying the initiation of sexual
activity. HHS advises that grantees provide data that demonstrate how the selected curriculum
and their proposals apply key program elements that have been found to be effective in promoting
positive youth behavior changes, especially delaying sexual activity, returning to a lifestyle
without sex, and refraining from nonmarital sex. The grant announcement points out that such
elements have been identified in research summary documents such as HECAT, which is
described in the Title V Sexual Risk Avoidance Education funding announcements (and discussed
previously in this report).98
Grantee Profile: Healthy Visions in Ohio
HHS awarded Sexual Risk Avoidance Education funding to Healthy Visions, a social services organization located in
Cincinnati, OH. The organization implements four curricula: Real Essentials, Choosing the Best, Love Notes, and TYRO
Rites of Passage. The program serves youth in grades 4-12 in school-based settings. The curricula focus on topics
such as risk avoidance (such as delaying sex), setting goals, healthy relationships, communication skil s, conflict
resolution, stress management, and self-respect.
Source: HHS, ACF, FYSB, General Departmental Sexual Risk Avoidance Education (SRAE) Program Grantee Profiles,
February 11, 2022; and Healthy Visions, “Quick Look,” https://healthyvisions.org/quick-look/.
Note: This report includes examples of grantees recently funded under the four teen pregnancy prevention
programs. The grantees were selected by CRS based on information available on the HHS website or provided via
correspondence with HHS. Col ectively, the grantees described in the report are intended to represent all regions
of the country and are included for il ustrative purposes only.

96 HHS, ACF, ACYF, Sexual Risk Avoidance Education Program, HHS-2021-ACF-ACYF-SR-1927, 2021.
97 HHS, FY 2021 Justification of Estimates for Appropriations Committees for the Administration for Children and
Families, p. 282; HHS, ACF, FYSB, General Departmental Sexual Risk Avoidance Education (GD SRAE) Grantees
FY2020, November 12, 2020; HHS, FY 2023 Justification of Estimates for Appropriations Committees for the
Administration for Children and Families, p. 297; and HHS, ACF, FYSB, General Departmental Sexual Risk
Avoidance Education (GD SRAE) Grantees FY2021, October 7, 2021. The 31 FY2021 grantees that received new
Sexual Risk Avoidance Education program funding are in 13 states: Arizona (four grantees), California (four grantees),
Florida (four grantees), Georgia (four grantees), Louisiana (two grantees), Michigan (one grantee), Mississippi (two
grantees), Missouri (one grantee), New Jersey (one grantee), New York (one grantee), South Dakota (one grantee),
Tennessee (one grantee), and Texas (five grantees). There were also 51 continuation awards for FY2021 in 20 states
plus the District of Columbia, American Samoa, Guam, the Northern Mariana Islands, and Puerto Rico. For more
information, see Table B-1.
98 HHS, ACF, ACYF, Sexual Risk Avoidance Education Program, HHS-2021-ACF-ACYF-SR-1927, 2021.
Congressional Research Service

22

link to page 31
Appendix A. Federal Teen Pregnancy Prevention Programs
Table A-1. Federal Teen Pregnancy Prevention Programs: Overview, Eligible Entities, and Funding
Title V Sexual Risk Avoidance
Education Program (known as
Teen Pregnancy Prevention
Personal Responsibility Education
the Title V Abstinence Education
GD Sexual Risk Avoidance
Program Feature
(TPP) Program
Program
Grant program through FY2017)
Education Program
Authorizing law (and statutory
Initial authorizing law was the
Patient Protection and Affordable Care
Personal Responsibility and Work
Initial authorizing law was the
citation, where applicable)
Consolidated Appropriations Act,
Act (ACA, P.L. 111-148), most recently
Opportunity Reconciliation Act of
Consolidated Appropriations Act,
2010 (P.L. 111-117) and authority has
reauthorized through FY2023 under
1996 (P.L. 104-193), most recently
2016 (P.L. 114-113) and authority
continued under subsequent
Title III, Division CC of the
reauthorized through FY2023 under
has continued under subsequent
appropriation laws. The most recent
Consolidated Appropriations Act, 2021
Title III, Division CC of the CAA
appropriation laws. The most
appropriations law is Division H,
(CAA 2021, P.L. 116-260).
2021.
recent appropriations law is
Consolidated Appropriations Act,

Division H, Consolidated
2022 (P.L. 117-103).
Appropriations Act, 2022 (P.L.

117-103).
HHS additionally cites its general
authority to administer the
program (42 U.S.C. §1310) in the
program funding announcement.a
Description
The program funds grantees to
The program funds states, insular areas,
The program funds states and insular
The program funds grantees to
replicate programs that have been
and other entities, under four
areas (or other entities in a
implement sexual risk avoidance
proven effective in reducing teen
components: State PREP, Competitive
jurisdiction that did not apply for
education that teaches participants
pregnancy and behavioral risk factors
PREP, Tribal PREP, and Personal
funds) to implement education
how to voluntarily refrain from
underlying teenage pregnancy (Tier 1
Responsibility Education Innovative
exclusively on sexual risk avoidance,
nonmarital sexual activity and
grants); and to develop, test, and
Strategies (PREIS). “Personal
meaning voluntarily refraining from
prevent other youth risk behaviors.
refine additional programs and
responsibility education program” refers sexual activity. Sexual risk avoidance
strategies for preventing teenage
to a program that is (1) designed to
education must ensure that the
pregnancy (Tier 2 grants).
educate adolescents on both abstinence
“unambiguous and primary emphasis

and contraception for the prevention of
and context” for each of six sexual
pregnancy and sexually transmitted
risk avoidance topics specified in the
infections (STIs), including HIV/AIDS;
law is “a message to youth that
and (2) incorporate at least three of six
normalizes the optimal health
adult preparatory subjects (healthy
behavior of avoiding nonmarital sexual
relationships, adolescent development,
activity.”
financial literacy, education and career
CRS-23

Title V Sexual Risk Avoidance
Education Program (known as
Teen Pregnancy Prevention
Personal Responsibility Education
the Title V Abstinence Education
GD Sexual Risk Avoidance
Program Feature
(TPP) Program
Program
Grant program through FY2017)
Education Program
success, parent-child communication,
and healthy life skil s).
Administering agency within the
Office of Population Affairs (OPA)
Family and Youth Services Bureau
FYSB/ACF
FYSB/ACF
U.S. Department of Health and
within the Office of the Assistant
(FYSB) within the Administration for
Human Services (HHS)
Secretary for Health (OASH).
Children and Families (ACF).
Entities eligible to apply, and
Eligible grantees are specified in the
As specified in the authorizing law,
As specified in the authorizing law, all
Eligible grantees are specified in the
how funds are awarded
program funding announcements.
funds are awarded on a formula basis to
states and insular areas that receive
program funding announcements.
Eligible entities vary depending on the
states and insular areas under the State
Maternal and Child Health (MCH)
They have included state,
grant, but generally include nonprofit
PREP program. Funds are allocated
block grant funds in FY2018 through
territorial, or county governments;
and for-profit organizations; small,
based on the proportion of children in
FY2023 are eligible to apply. HHS may city or township governments;
minority, and women-owned
each state between the ages of 10 and
competitively award FY2018 through
special district governments;
businesses; state and local
19, relative to the total number of
FY2023 funds to one or more entities
independent, regional, and local
governments; universities and
youth nationally. State PREP funds that
(not defined) within a state/insular
school districts; public and state
col eges; community- and faith-based
would have been allocated to states that area that had not previously applied
control ed institutions of higher
organizations; hospitals; federally
did not apply for them are competitively for its share of funding. The entity or
education; federally recognized
recognized or state-recognized
awarded under the Competitive PREP
entities would receive the amount
Native American tribal
American Indian and Alaska Native
program. As listed in the program
that would have been otherwise
governments; public housing
tribal governments; and other tribal
funding announcements, entities eligible
allotted to that state/insular area.
authorities/Indian housing
entities (e.g., Alaska Native health
to apply for the Competitive PREP
Allotments are based on two factors:
authorities; Native American tribal
corporations).
program and PREIS generally have
(1) the amount provided to the
organizations; nonprofit
included state, territorial, or county
organizations; private institutions
Funds are awarded on a competitive
program minus any reservations (up
governments; city or township
of higher education; for-profit
basis.
to 20%) made by HHS for
governments; special district
administering it, and (2) states’
organizations other than small
governments; independent, regional, and relative proportion of low-income
businesses; and small businesses.
local school districts; public and state
children nationally.
Funds are awarded on a
control ed institutions of higher
competitive basis.
education; federally recognized Native
American tribal governments; public
housing authorities/Indian housing
authorities; Native American tribal
organizations; nonprofit organizations;
private institutions of higher education;
for-profit organizations other than small
CRS-24

link to page 32
Title V Sexual Risk Avoidance
Education Program (known as
Teen Pregnancy Prevention
Personal Responsibility Education
the Title V Abstinence Education
GD Sexual Risk Avoidance
Program Feature
(TPP) Program
Program
Grant program through FY2017)
Education Program
businesses; local affiliates of national
organizations; and small businesses.
Also as listed in the program funding
announcement, Indian tribes and tribal
organizations, as these terms are
defined in the Indian Health Care
Improvement Act, are eligible to apply
for Tribal PREP funding.
Type of funding, year(s) of
Discretionary spending; funded
Mandatory spending; funded through
Mandatory spending; funded through
Discretionary spending; funded
funding, and funding set-asides
through appropriations law. Funding
authorizing law. Funding is authorized
authorizing law. Funding is authorized
through appropriations law.
(where applicable)
is provided for FY2022 as of the
through FY2023 as of the cover date of
through FY2023 as of the cover date
Funding is authorized for FY2022
cover date of this report. Up to 10%
this report. The law provides $10
of this report.
as of the cover date of this report.
of appropriated funds can be used for
mil ion for the PREIS grants. After this
training and technical assistance,
set-aside, HHS must reserve 5% for
outreach, and other program
grants to Indian tribes and tribal
support. Of the remaining amount,
organizations (Tribal PREP) and 10% for
75% is to be used to replicate
training, technical assistance, and
programs (Tier 1 grants) and 25% is
evaluation. Most of the remaining PREP
to be used for developing, testing,
appropriation is allocated to states and
and refining additional models (Tier 2
insular areas via State PREP (with a
grants).
minimum of $250,000 for each state
allotment). Funding for states and
insular areas that declined the State
PREP grant is available to eligible entities
under Competitive PREP.
Cost sharing
Not applicable.
Not applicable.
Not applicable.
Not applicable.
Enacted federal funding from
FY2010: $110.0 mil ion
FY2010: $75.0 mil ion
FY2010: $50.0 mil ion
FY2010: Not funded
FY2010-FY2023b
FY2011: $104.8 mil ion
FY2011: $75.0 mil ion
FY2011: $50.0 mil ion
FY2011: Not funded
FY2012: $104.8 mil ion
FY2012: $75.0 mil ion
FY2012: $50.0 mil ion
FY2012: $5.0 mil ion
FY2013: $98.3 mil ion
FY2013: $71.2 mil ion
FY2013: $47.5 mil ion
FY2013: $4.7 mil ion
FY2014: $100.8 million
FY2014: $69.6 mil ion
FY2014: $46.4 mil ion
FY2014: $5.0 mil ion
FY2015: $101.0 mil ion
FY2015: $75.0 mil ion
FY2015: $50.0 mil ion
FY2015: $5.0 mil ion
FY2016: $101.0 mil ion
FY2016: $75.0 mil ion
FY2016: $75.0 mil ion
FY2016: $10.0 mil ion
FY2017: $100.8 mil ion
FY2017: $69.8 mil ion
FY2017: $69.8 mil ion
FY2017: $15.0 mil ion
CRS-25

Title V Sexual Risk Avoidance
Education Program (known as
Teen Pregnancy Prevention
Personal Responsibility Education
the Title V Abstinence Education
GD Sexual Risk Avoidance
Program Feature
(TPP) Program
Program
Grant program through FY2017)
Education Program
FY2018: $101.0 mil ion
FY2018: $75.0 mil ion
FY2018: $75.0 mil ion
FY2018: $25.0 mil ion
FY2019: $101.0 mil ion
FY2019: $75.0 mil ion
FY2019: $75.0 mil ion
FY2019: $35.0 mil ion
FY2020: $101.0 mil ion
FY2020: $75.0 mil ion
FY2020: $75.0 mil ion
FY2020: $35.0 mil ion
FY2021: $101.0 mil ion
FY2021: $75.0 mil ion
FY2021: $75.0 mil ion
FY2021: $35.0 mil ion
FY2022: $101.0 mil ion
FY2022: $70.7 mil ion
FY2022: $70.7 mil ion
FY2022: $35.0 mil ion
FY2023: $70.7 mil ion
FY2023: $70.7 mil ion
Use of evidence-based
Per the FY2022 appropriations law
State PREP jurisdictions and
A state/insular area or other entity
Per the FY2022 appropriations law
interventions
(P.L. 117-103), “75 percent [of funds]
Competitive PREP grantees must
receiving funding under the Sexual
(P.L. 117-103), grantees must
shall be for replicating programs that
replicate evidence-based, effective
Risk Avoidance Education program
“implement an evidence-based
have been proven effective through
programs or substantially incorporate
may use up to 20% of such allotment
approach integrating research
rigorous evaluation to reduce teenage elements of effective programs that
to build the evidence base for sexual
findings with practical
pregnancy, behavioral risk factors
have been proven on the basis of
risk avoidance by conducting or
implementation that aligns with the
underlying teenage pregnancy, or
rigorous scientific research to change
supporting research. Any such
needs and desired outcomes for
other associated risk factors, and 25
behavior. The grant announcements
research must be rigorous, evidence-
the intended audience.”
percent shall be available for research
have referred applicants to the Teen
based, and designed and conducted by
and demonstration grants to develop,
Pregnancy Prevention Evidence Review
independent researchers who have
replicate, refine, and test additional
for information on such programs,
experience in conducting and
As specified in the funding
models and innovative strategies for
though other models can be
publishing research in peer-reviewed
announcements, grantees must
preventing teenage pregnancy.”
implemented that meet the requirement outlets.
incorporate an evidence-based
Previously, Tier 1 applicants have
of being rigorously evaluated.
program and/or effective strategies
As specified in the most recent
been referred in the program funding
that have demonstrated impacts on
The grant announcements have
funding announcements, grantees
announcement to the Teen Pregnancy
delaying the initiation of sexual
specified that Tribal PREP grantees are
must incorporate an evidence-based
Prevention Evidence Review for
activity. HHS advises that grantees
to replicate evidence-based effective
program and/or effective strategies
information on evidence-based
provide data that demonstrates
programs; substantially incorporate
that have demonstrated impacts on
models.
how the selected curriculum and
elements of effective programs to the
delaying the initiation of sexual
their proposals apply key program
extent possible; or include promising
activity. HHS advises that grantees
elements that have been found to
practices within the American
provide data that demonstrate how
be effective in promoting positive
Indian/Alaska Native (AI/AN)
the selected curriculum and their
youth behavior changes, especial y
communities. There are no pregnancy
proposals apply key program
delaying sexual activity, returning
prevention programs specifically for
elements that have been found to be
to a lifestyle without sex, and
AI/AN communities in the TPP Evidence effective in promoting positive youth
refraining from nonmarital sex. The
Review.
behavior changes, especial y delaying
grant announcement points out
The grant announcements have
sexual activity, returning to a lifestyle
that such elements have been
specified that PREIS grantees are to use
without sex, and refraining from
innovative strategies, with promising
nonmarital sex. The grant
CRS-26

link to page 32 link to page 32
Title V Sexual Risk Avoidance
Education Program (known as
Teen Pregnancy Prevention
Personal Responsibility Education
the Title V Abstinence Education
GD Sexual Risk Avoidance
Program Feature
(TPP) Program
Program
Grant program through FY2017)
Education Program
evidence of effectiveness or impact, but
announcement points out that such
identified in research summary
which must not have been rigorously
elements have been identified in
documents such as HECAT.c
evaluated. Therefore, the evidence-
research summary documents such as
based programs identified in the TPP
HECAT.c
Evidence Review are not eligible
interventions.
Target population
The TPP grants generally do not
The authorizing statute specifies that
Youth ages 10 through 19.
Per the program funding
specify a certain target population
jurisdictions and grantees are generally
announcement, grantees are to
(either in the authorizing statute or
to provide services to youth ages 10
target youth (defined as ages 10-
program funding announcement),
through 19, with a focus on high-risk or
19) populations that are at risk for
with the exception of the Tier 2
vulnerable youth. This includes youth in
nonmarital sexual activity and
Innovation Network grants. The
or aging out of foster care, homeless
other risk behaviors. These
Innovation Network grants are to
youth, youth with HIV/AIDS, pregnant
populations are not specifically
target one of several key priority
and parenting women under 21 years of
defined.
areas: juvenile justice, foster
age and their partners, and young
care/child welfare, caregivers,
people residing in areas with high birth
expectant and parenting youth, youth
rates for youth.
with disabilities, youth access to and
Tribal PREP grantees must serve
experience with sexual health care,
American Indian/Alaska Native (AI/AN)
and youth engagement. The other
youth age 10 through 19 or pregnant
grants focus on youth in geographic
and parenting women age 21 and under.
areas with the greatest need (Tier 1)
Per the program funding announcement,
and addressing disparities in teen
Tribal PREP grantees may serve AI/AN
pregnancy rates using innovative
youth who have the additional risk
approaches (Tier 2 Rigorous
factors previously discussed (and other
Evaluation).
risk factors such as having experienced
sex trafficking).
Number of youth participants
Grantees served 59,244 youth in
Grantees served 97,966 youth in
Grantees served 127,647 youth in
HHS estimates that approximately
(most recent fiscal year data
FY2021.
FY2020.
FY2020.
54,000 youth participated in
available)

FY2019.

CRS-27

Title V Sexual Risk Avoidance
Education Program (known as
Teen Pregnancy Prevention
Personal Responsibility Education
the Title V Abstinence Education
GD Sexual Risk Avoidance
Program Feature
(TPP) Program
Program
Grant program through FY2017)
Education Program
Setting for services (selected
Schools
Schools (in school or after school)
(Under the prior Title V Abstinence
Schools
examples)
Out-of-school programs
Community-based organizations
Education Grant program, school was
Community-based organizations
the primary setting)
Clinics
Foster care settings
Foster care organizations
Schools (in school or after school)
Juvenile justice centers
Juvenile detention centers
Juvenile detention centers
Mentoring programs
Faith-based organizations
Clinics
Homeless shelters
School rallies and assemblies
Out-of-home care (foster care)
Outpatient and residential treatment
Runaway/homeless youth centers
facilities for youth with social,
emotional, or substance abuse disorders
Other settings
Sources: Authorizing and appropriation laws (referenced in table); Congressional Research Service (CRS) correspondence with the U.S. Department of Health and
Human Services (HHS), Administration for Children and Families (ACF), Office of the Assistant Secretary for Health (OASH), Office of Population Affairs (OPA, formerly
Office of Adolescent Health, OAH) December 2019; HHS, Fiscal Year 2023 Justification of Estimates for Appropriations Committees for General Departmental Management, p.
93; and HHS, Fiscal Year 2023 Justification of Estimates for Appropriations Committee for Administration for Children and Families, pp. 300-302; and as referenced below.
Notes:
Teen Pregnancy Prevention (TPP) Program: (1) HHS, OASH, OPA, Optimally Changing the Map for Teen Pregnancy Prevention (Tier 1), Funding Opportunity
Announcement and Application Instructions, AH-TP1-20-001, 2020; (2) HHS, OASH, OPA, Funding Opportunity: Tier 2 Innovation and Impact Network Grants: Achieving
Optimal Health and Preventing Teen Pregnancy in Key Priority Areas, AH-TP2-20-002, 2020; and (3) HHS, OASH, OPA, Funding Opportunity: FY2020 Teen Pregnancy Prevention
(TPP) Tier 2, Phase II Rigorous Evaluation of Promising Interventions, AH-TP2-20-001, 2020.
Personal Responsibility Education Program (PREP): (1) HHS, ACF, FYSB, State Personal Responsibility Education Program (PREP), Funding Opportunity
Announcement and Instruction, HHS-2016-ACF-ACYF-PREP-1138, 2016; (2) HHS, ACF, FYSB, Personal Responsibility Education Program (PREP) Competitive Grants, Funding
Opportunity Announcement and Instruction, HHS-2021-ACF-ACYF-AK-1929, 2021; (3) HHS, ACF, FYSB, Tribal Personal Responsibility Education Program for Teen
Pregnancy Prevention, Funding Opportunity Announcement and Instruction, HHS-2021-ACF-ACYF-AT-1922, 2021; and (4) HHS, ACF, FYSB, Personal Responsibility
Education Program Innovative Strategies (PREIS), Funding Opportunity Announcement and Instruction, HHS-2021-ACF-ACYF-AP-1928, 2021.
Title V Sexual Risk Avoidance Education Program: (1) HHS, ACF, FYSB, Standing Announcement for Title V State Sexual Risk Avoidance Education, HHS-2020-ACF-
ACYF-SRAE-1848, 2020; and (2) HHS, ACF, FYSB, Title V Competitive Sexual Risk Avoidance Education Funding Announcement, HHS-2021-ACF-ACYF-TS-1925, 2021.
Sexual Risk Avoidance Education Program: HHS, ACF, ACYF, Sexual Risk Avoidance Education Program, Funding Opportunity Announcement, HHS-2021-ACF-
ACYF-SR-1927, 2021.
a. This law provides authority to HHS to make grants to states and other public organizations for paying part of the cost of research and demonstration projects, such
as those relating to the prevention and reduction of dependency, among other related topics.
CRS-28

b. See HHS, Fiscal Year 2023 Justification of Estimates for Appropriations Committee for Administration for Children and Families (PREP, Title V Sexual Risk
Avoidance Education program, and Sexual Risk Avoidance Education program) and HHS, Fiscal Year 2023 Justification of Estimates for Appropriations Committee
for General Departmental Management (Sexual Risk Avoidance Education program and TPP). These appropriations include sequestration for all four TPP programs
in FY2013, and sequestration for PREP and Title V SRAE (or its predecessor program, the Title V Abstinence Education Grant program) only in FY2014, FY2017,
FY2022, and FY2023. The Title V Abstinence Education Grant program is the only program to have received funding prior to FY2010. In each of FY1998 through
FY2009, the program received $50 mil ion annually.
c. The HECAT is an assessment tool to help schools and other entities identify curricula for health education courses and analyze the acceptability and appropriateness
of these curricula, among other objectives. This tool addresses multiple health topics, including sexual health. Another tool cited in prior grant announcements,
SMARTool, was developed by the Center for Relationship Education, a nonprofit organization, in partnership with the CDC. SMARTool is a program guide for use
by schools and other entities interested in sexual risk avoidance education, and it identifies nine protective factors that help prevent sexual risk behaviors in youth.

CRS-29

Teen Pregnancy: Federal Prevention Programs

Appendix B. Grantees Funded Under the Federal
Teen Pregnancy Prevention Programs, by State
Table B-1. Federal Teen Pregnancy Prevention Programs:
Grantees by Jurisdiction, FY2021
The table may omit grantees that are supported with program funding from prior years with project
periods that include FY2021.
Some TPP grantees and PREP grantees serve youth in multiple states.
Type(s) of Personal
Responsibility
GD Sexual Risk
Teen Pregnancy
Education Program
Title V Sexual Risk
Avoidance
Prevention (TPP)
(PREP)
Avoidance
Education
State or
Grantees
Grants in
Education (SRAE)
Grantees in
Insular Area
in Jurisdiction
Jurisdiction
Grant Funding
Jurisdiction
Alabama
No
State PREP
State Title V SRAE
No
Alaska
State PREP
No
No
No
Tribal PREP
Arizona
Tier 1 (FY2020-FY2023)
State PREP
State Title V SRAE
Yes
Arkansas
No
State PREP
State Title V SRAE
No
California
Tier 1 (FY2020-FY2023)
State PREP
Tier 1 (FY2021-FY2023)
Competitive Title V
Yes
PREIS
SRAE
Tier 2
Colorado
No
State PREP
State Title V SRAE
Yes
Connecticut
Competitive Title V
No
State PREP
SRAE
No
Delaware
No
State PREP
Competitive Title V
No
SRAE
District of
Tier 1 (FY2020-FY2023)
State PREP
Columbia
No
Yes
Tier 2
PREIS
Florida
Tier 1 (FY2020-FY2023)
Competitive PREP
State Title V SRAE
Tier 1 (FY2021-FY2023)
PREIS

Yes
Georgia
Tier 1 (FY2020-FY2023)
State PREP
State Title V SRAE
Yes
Tier 2
Hawaii
Competitive Title V
No
State PREP
SRAE
No
Idaho
No
State PREP
State Title V SRAE
No
Il inois
Competitive Title V
Tier 1 (FY2020-FY2023)
State PREP
SRAE
Yes
Indiana
Tier 1 (FY2020-FY2023)
Competitive PREP
State Title V SRAE
Yes
Tier 1 (FY2021-FY2023)
PREIS
Iowa
Tier 1 (FY2020-FY2023)
State PREP
State Title V SRAE
No
Kansas
No
Competitive PREP
Competitive Title V
No
SRAE
Congressional Research Service

30

Teen Pregnancy: Federal Prevention Programs

Type(s) of Personal
Responsibility
GD Sexual Risk
Teen Pregnancy
Education Program
Title V Sexual Risk
Avoidance
Prevention (TPP)
(PREP)
Avoidance
Education
State or
Grantees
Grants in
Education (SRAE)
Grantees in
Insular Area
in Jurisdiction
Jurisdiction
Grant Funding
Jurisdiction
Puerto Rico
Tier 1 (2020-2023)
State PREP
State Title V SRAE
Yes
U.S. Virgin
Islands
No
State PREP
Competitive Title V
No
SRAE
Source: Congressional Research Service (CRS), based on U.S. Department of Health and Human Services
(HHS), Office of the Assistant Secretary for Health (OASH), Office of Adolescent Health (OAH), Current Teen
Pregnancy Prevention (TPP) Program Grantees,” https://www.hhs.gov/ash/oah/grant-programs/teen-pregnancy-
prevention-program-tpp/current-grantees/index.html. See also HHS, Administration for Children and Families
(ACF), Family and Youth Services Bureau (FYSB), State Personal Responsibility Education Program (PREP) Grantees
FY2020 & FY2021, August 2, 2021; Competitive Personal Responsibility Education Program (PREP) Awards FY2021,
October 7, 2021; Personal Responsibility Education Innovative Strategies (PREIS) Program Grantees FY2021, October
6, 2021; Tribal Personal Responsibility Education Program (PREP) Grantees FY2021, October 6, 2021; Title V State
Sexual Risk Avoidance Education (SRAE) Grantees FY2020 & FY2021, October 6, 2021; Title V Competitive Sexual Risk
Avoidance Education (SRAE) Grantees FY2021, October 6, 2021; and General Departmental Sexual Risk Avoidance
Education (GD SRAE) Grantees FY2021, October 7, 2021; HHS, General Departmental Management, Fiscal Year
2023 Justification of Estimates for Appropriations Committee, p. 92; and HHS, Administration for Children and
Families, Fiscal Year 2023 Justification of Estimates for Appropriations Committee, pp. 296-297.
Notes:
Teen Pregnancy Prevention (TPP) program:

The 49 Tier 1 (2020-2023) entities that received funding are in 26 states (AZ, CA, FL, GA, IL, IN, IA, LA,
MD, MA, MI, MS, NM, NY, NC, OH, OK, OR, PA, SC, TN, TX, UT, VA, WV, and WI), plus the District of
Columbia and Puerto Rico. The 13 Tier 1 (2021-2023) grantees are in 8 states (CA, FL, IN, KY, MN, NY,
NC, and TX) plus the Marshall Islands.

The 13 Tier 2 grantees are in 9 states (CA, GA, LA, NY, OK, SC, TX, VA, and WA) plus the District of
Columbia.

The 4 Tier 2 Phase 2 grantees are in 4 states (MD, MA, PA, and VA).
Personal Responsibility Education Program (PREP): Most states, the District of Columbia, and six insular
areas—the Federated States of Micronesia, Guam, the Northern Mariana Islands, Palau, Puerto Rico, and the U.S.
Virgin Islands—received State PREP funds. Six states did not receive State PREP funds (FL, IN, KS, ND, TX, and
VA), plus American Samoa and Marshall Islands.
Entities that received FY2021 Competitive PREP grants are in FL, IN, KS, ND, TX, and VA. American Samoa and
the Marshall Islands do not have Competitive PREP grantees or State PREP grantees. Guam first received State
PREP funds for FY2016. It did not accept State PREP funding for FY2010 through FY2015, and funding instead
was awarded under Competitive PREP. Similarly, the Northern Mariana Islands first received State PREP funds
for FY2017. It did not accept State PREP funding for FY2010 through FY2016, and funding was provided under
Competitive PREP. (Based on CRS correspondence with HHS, December 2019.)
Eight tribes and tribal organizations in seven states received FY2021 Tribal PREP funds. The states are AK, MT,
NM, OK, OR, SD, and WI. Additionally, 12 entities in 9 states plus the District of Columbia received FY2021
PREIS funds. The states are CA, FL, IN, LA, MD, MI, NJ, TN, and TX.
Title V State Sexual Risk Avoidance Education program: The grantees that received FY2021 funding
under the Title V State Sexual Risk Avoidance Education program include 36 states (AL, AZ, AR, CO, FL, GA,
ID, IN, IA, KY, LA, MD, MA, MI, MN, MS, MO, MT, NE, NV, NJ, NM, NY, NC, OH, OK, OR, PA, SC, SD, TN,
TX, UT, VA, WV, and WI) plus the Federated States of Micronesia and Puerto Rico. The grantees that received
FY2021 funding under the Title V Competitive Sexual Risk Avoidance Education program include 13 states (CA,
CT, DE, HI, IL, KS, ME, NH, ND, RI, VT, WA, and WY) plus Guam and the U.S. Virgin Islands.
GD Sexual Risk Avoidance Education Program: The 82 grantees that received new or continuation Sexual
Risk Avoidance Education program funding are in 23 states (AZ, CA, CO, FL, GA, IL, IN, LA, MD, MI, MS, MO,
NJ, NY, OH, OK, OR, PA, SC, SD, TN, TX, and WV), plus the District of Columbia, American Samoa, Guam,
the Northern Mariana Islands, and Puerto Rico.
Congressional Research Service

33

Teen Pregnancy: Federal Prevention Programs

For further information about funding under each of these grants for each state and the District of Columbia, see
Power to Decide, Key Information About US States, https://powertodecide.org/what-we-do/information/resource-
library/key-information-about-us-states.

Author Information

Jessica Tollestrup

Specialist in Social Policy

Acknowledgments
This report was originally authored by Adrienne Fernandes-Alcantara, former CRS Specialist in Social
Policy. Isaac Nicchitta and Sylvia Brian, CRS Research Assistants, provided invaluable research support
and editorial comments on the report.

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan
shared staff to congressional committees and Members of Congress. It operates solely at the behest of and
under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other
than public understanding of information that has been provided by CRS to Members of Congress in
connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not
subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in
its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or
material from a third party, you may need to obtain the permission of the copyright holder if you wish to
copy or otherwise use copyrighted material.

Congressional Research Service
R45183 · VERSION 10 · UPDATED
34

Download PDF

Download EPUB

Revision History

Sep. 1, 2022

HTML · PDF

13% changed

May. 13, 2020

HTML · PDF

2% changed

Apr. 30, 2018

HTML · PDF

Metadata