The Impact of State Policy on Adverse Teen Sexual Health Outcomes in the United States: A Scoping Review

Introduction Adolescent sexually transmitted infections (STIs) and unintended birth are critical public health issues, with a need for continued prevention and an essential focus on health equity. This scoping review systematically examines the existing literature on the impact of state policies in the USA on both teen pregnancy/birth and STIs, including the impact of policy on racial disparities. Methods A comprehensive scoping review approach was used to systematically identify relevant studies. Articles were assessed by three reviewers for relevance based on predetermined inclusion criteria. Results Thirty-two peer-reviewed articles met all inclusion criteria. Years of publication ranged from 1986 to 2022. Broadly, policies evaluated can be grouped into seven categories: abortion access/restrictions; sex education; welfare reform and public assistance policies; family planning expenditures; contraception access/restrictions; state public education expenditures; and child support enforcement. Nine articles discussed multiple policies and their association with the selected outcomes. Conclusions State policies supporting family planning, including contraceptive access, were consistently associated with lower rates of teen pregnancy/birth. Evidence related to abortion, sex education, and public assistance policies was inconclusive. Few studies examined state policy’s impact on STIs, or the association with minority health disparities, illustrating critical gaps in the literature. Policy Implications Evidence on policy effectiveness is a vital tool in health promotion and may be particularly influential in promoting improved health behaviors and outcomes among adolescents. Collectively, this study offers a comprehensive summary of existing evidence on the association between state-level policies and adolescent sexual health outcomes, highlighting essential areas for future research in policy and adolescent sexual health.