摘要：We systematically reviewed peer-reviewed and gray literature on comprehensive adolescent health (CAH) programs (1998–2013), including sexual and reproductive health services. We screened 36 119 records and extracted articles using predefined criteria. We synthesized data into descriptive characteristics and assessed quality by evidence level. We extracted data on 46 programs, of which 19 were defined as comprehensive. Ten met all inclusion criteria. Most were US based; others were implemented in Egypt, Ethiopia, and Mexico. Three programs displayed rigorous evidence; 5 had strong and 2 had modest evidence. Those with rigorous or strong evidence directly or indirectly influenced adolescent sexual and reproductive health. The long-term impact of many CAH programs cannot be proven because of insufficient evaluations. Evaluation approaches that take into account the complex operating conditions of many programs are needed to better understand mechanisms behind program effects. Global evaluation research has repeatedly shown that the evidence for and effectiveness of many adolescent pregnancy prevention programs is unclear. 1,2 Kirby et al. 2,3 found that numerous pregnancy prevention programs had little effect; however, among programs that were most successful, the majority used comprehensive approaches that combined activities related to health, education, and social supports. Both in the United States and globally, interest has turned to such comprehensive (sometimes also referred to as multilevel or multicomponent) strategies for improving the sexual and reproductive health (SRH) of adolescents, in addition to overall health and developmental outcomes. In the United States, the Obama administration has identified the Harlem Children’s Zone as a prototype for its Promise Neighborhoods that aim to improve child and adolescent education and development in disadvantaged neighborhoods. 4 Internationally, the United Nations Population Fund and other organizations have worked together to scale up a comprehensive model for preventing early marriage and reducing adolescent fertility in 12 countries. 5 Comprehensive approaches move beyond sexuality education curriculums, contraceptive distribution programs, and abstinence-only programs to build a package of services and programs that target the root causes of sexual health risk and early pregnancy. Such strategies are based on an understanding of health and development in which adolescents are nested in a network of contexts (peers, community, health services, schools, families), suggesting that comprehensive approaches hold the greatest promise. However, little is known about the range, scope, or common activities of such programs and whether such strategies can successfully improve adolescent SRH. In this article, we explore what is known about the elements of and evidence base for comprehensive adolescent health programs that encompass SRH and other health services, educational services, and social support services. The objectives of the systematic review were to (1) describe the characteristics of evaluated comprehensive adolescent health programs, as defined in this article, (2) provide an assessment of the quality of and evidence for comprehensive adolescent health programs, and (3) identify the common elements of the strongest evaluated comprehensive adolescent health programs that show successful outcomes.
