Objective: In this study, we isolated primary messaging strategies of sexuality education curricula to improve tailored delivery of group-based interventions. Specifically, our aim was to define single-message programs (eg, messaging about avoiding sexual risk or messaging about reducing sexual risk) and multiple-message programs (eg, avoiding sexual risk and reducing sexual risk), and to investigate their comparative effectiveness. Methods: We used a descriptive approach with publicly available data from US Department of Health and Human Services-funded teen pregnancy prevention programs to categorize 16 different curricula as single-message or multiple-message. We coded primary messages using a curriculum mapping rubric and scoring that was evaluated by a panel of experts for content validity. Forest plots compared behavioral outcomes. Results: Scores for primary messages achieved inter-rater reliability of 91%-100%; curricula were scored on 20 items within each category to calculate mean scores. Spearman correlations for items ranged from .43 to .93. Conclusions: No outcome differences were observed between single- or multi-message programs. Effective delivery of primary messaging may rely more on identifying moderators of classroom climate typically underrepresented in evaluations of school-based programs.

Objective: Teen pregnancy and sexually transmitted infection (STI) prevention are top public health goals. Despite decades of research, programs to prevent adverse sexual health outcomes among adolescents show limited effectiveness in broad dissemination. In the current study, we aimed to identify understudied factors that may impact effectiveness of teen pregnancy and STI prevention (TPP) programs, with goals of informing innovation in program development and outlining future research priorities. Methods: A panel of experts in TPP programs generated a list of understudied constructs in evaluation research, distilled to 3 considerations regarding messaging: single versus multiple messages, adverse effects of safety messages, and sociocultural context. We conducted an exploratory search of published literature in health promotion fields targeted toward messaging strategies, and we synthesized information from relevant empirical and review papers. Results: Limited evidence was found suggesting multiple messages or adverse message impacts are likely to impair TPP program effectiveness overall, although both may emerge in certain contexts and populations. In contrast, considerable evidence highlighted the importance of cultural context and individual differences. Conclusions: Effective TPP program messaging should be consistent, tailored, and systemic. Future research should evaluate these messaging strategies to determine whether they may enhance program impacts.