Systematic review

[Full title: Systematic review: risk sexual behavior, sexually transmitted infections, and adolescent pregnancy prevention interventions]

[Find the meaning and references behind the names: Low, Asia, Nancy]

JOURNAL OF PUBLIC HEALTH IN AFRICA 00: JPHIA 2672, 0000 Abstract. In many countries, there is a high number of teenage pregnancies, Sexually Transmitted Infections (STIs), and unsafe sexual behavior, so there is a need for adolescent health intervention programs to change behavior. The effectiveness of comprehensive interventions in various contexts to reduce teenage pregnancy, STIs, and related sexual risk behaviors is reviewed in this system‑ atic. This study aimed to identify risk sexual behavior, sexually transmitted infections, and adolescent pregnancy prevention interventions. Literature search strategy from January 2008 to December 2022 through electronic databases. Key words ‘teenage prenancy’ OR ‘teen preg‑ nancy’ OR ‘pregnancy adolescence’, AND ‘maternal education’, AND ‘randomised clinical trial’, AND ‘risk behavior’. Articles that were deemed worthy of following the PRISMA guidelines were 28 articles. Most studies looked at school‑based, individual, community, clinic, and family‑based care. Most studies were followed up after intervention at intervals from one month to seven years, and the majority of the population and sample were adolescents with ages ranging from 13 to 18 years. Implementation of research in urban, suburban, and rural areas. This program has proven successful in preventing pregnancy, contracep‑ tive use, STI and HIV, sexual behavior, dropping out of school, knowledge about pregnancy, sexuality, attitudes towards sexuality, intention to change risky sexual behavior, self‑efficacy, and increasing parent‑children. This article describes some basic trends in adolescent pregnancy preven‑ tion interventions in several countries that can be used as a reference for health programs. Unproven effectiveness can be implemented in conjunction with other interventions that have a high‑quality impact Introduction High rates of teenage pregnancy, Sexually Transmitted Infections (STIs), and related risky sexual behavior are a problem in many countries, whether in industrialized, middle or low‑income countries (1,2). Nearly 40% of students who are sexually active did not use a condom during their most recent sexual encounter, and 24% of high school students in the United States reported having four or more partners (3). This behavior increases the risk of pregnancy and STIs, including HIV. Worldwide, approximately 16 million girls aged 15‑19 years and 2 million girls younger than 15 years give birth each year (4). In addition, 50% of women aged 20‑24 years in Asia and Africa are married at the age of 18 (5). Pregnancy rates are very high, leading to dropouts, so myths and prevailing societal norms contribute to teen pregnancy overall. This is a threat to mothers and newborns because adolescents are physi‑ cally immature and do not yet have reserves of nutrients that can cause anemia (6). Health intervention programs for adolescents have concluded that health education is effective that influ‑ encing behavior, although the evidence exists mostly from quasi‑experimental studies, observational rather than random‑ ized trials (7). This systematic review is a review of various interventions in various settings carried out in various coun‑ tries for the prevention of teenage pregnancy, STIs and related risky sexual behavior. for example, comprehensive sex educa‑ tion programs (8,9). school‑based prevention programs (10‑22), youth development programs in the community (23,24), or media‑based approaches (25‑29). Each intervention has a slightly different approach, although the study design is the same, namely using different randomized trials with several existing review results, most of the reviews used quasi‑exper‑ imental and observational studies. This demands a rigorous review to more clearly explain the effects of these interven‑ tions so that policy makers and practitioners need practical guidance in identifying intervention programs that need to be considered in wider dissemination to reduce teenage preg‑ nancy, STIs, or sexual behavior Systematic review: risk sexual behavior, sexually transmitted infections, and adolescent pregnancy prevention interventions ELVIERA GAMELIA 1 , ANIES 2 , BAGOES WIDJANARKO 1 and ZAHROH SHALUHIYAH 1 1 Faculty of Public Health, Universitas Diponegoro, Semarang; 2 Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia Received XXXXX; Accepted XXXXX DOI: 10.4081/jphia.2023.2672 Correspondence to: Elviera Gamelia, Faculty of Public Health, Diponegoro University, Semarang, Central Java, Indonesia E‑mail: elviera.gamelia@unsoed.ac.id Key words: teenage pregnancy, randomized trial, risk behavior, sexually transmitted infections, adolescent pregnancy prevention interventions, systematic review REVIEW

[Find the meaning and references behind the names: Meet, Main, Full]

GAMELIA et al : systematic review 2 Materials and methods To methodology of this review followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta‑Analyses (PRISMA). Eligibility criteria. Relevant studies, all describing programs to prevent teenage pregnancy, STIs and related risky sexual behavior. Criteria include: a. Using a randomized trial design b. One of the outputs is considered relevant to the evaluated results, namely the intervention to prevent teenage preg‑ nancy, STIs and related risky sexual behavior c. The control group for the intervention was obtained from the non‑intervention group d. This article describes interventions in all low, middle, or high‑income countries e. Research that has been published in international journals indexed by Scopus in the period January 2008 to Decem ‑ ber 2022 f. The sample in the study is teenagers g. Articles in English Information sources. The search used data from electronic databases, namely Cochrane, Medline, Elsevier, science Direct, and ProQuest, and Pubmed, in the search period published in journals for 14 years from January 2008 to December 2022 Search strategy. The strategy was developed using a combina‑ tion of vocabulary. The search strategy was developed using the keywords ‘teenage prenancy’ OR ‘teen pregnancy’ OR ‘pregnancy adolescence’ AND ‘maternal education’ AND ‘randomised clinical trial’ AND ‘risk behavior’ Fig. 1. Explains that the study process is divided into several stages a. Judging from the title and abstract even though it is against the inclusion criteria b. Duplicate articles were excluded from the study process c. Using full paper in detail to show those who meet the inclu‑ sion criteria d. Conduct a feasibility study with various data from inter‑ vention studies, grouped according to the decision‑making method derived from several articles e. After going through the process, there are 70 articles that are complete and assessed for feasibility, and 30 of them will be reviewed Data item. We extracted data on the first author, year of study, intervention location, population and sample, study method, program results findings and an assessment of the quality of the feasibility of the article. Some of these extracted data have been presented in tabular form in the ‘Results’ section Quality assessment. The assessment uses a modified version of the rating tool, which is used for the assessment, each having a high, medium, or low mean value according to the risk of bias of the study effect. The highest quality rating was provided for the randomized control trial design with no low sample size, no regrouping of samples in the intervention and control groups and no differences in timing or manner of data collection in the intervention or control groups. A cluster randomized trial should be conducted in at least two groups (schools, classrooms, districts, blocks and so on) grouped into either the intervention or control groups (30‑32) Synthesis methods. The main findings of the studies were analyzed and summarized narratively. In addition, a synthesis was provided with the information presented in the text and table to summarize and explain the characteristics and results of the included studies Results The results of the search and selection of articles in this study were carried out according to the Systematic Review stage which refers to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‑analyses) method. The chart of the article search and selection process can be seen in Fig. 1. Quality assessment is also carried out by assessing the research results and biases from the literature reviewed in this study. Quality assessment in this study is to use Critical Appraisal Tools in the form of Critical Appraisal Skills Program (CASP) Checklists. The Critical Appraisal Skills Program (CASP) includes an assessment of the types of qualitative and quantita‑ tive data consisting of 10 questions with the following scoring system: 1. High‑quality paper: >9 2. Moderate‑quality paper: score 8.5‑7.5 3. Low‑quality paper: score 7‑6.5 4. Exclude: score <6 The scientific articles in this study have the quality with the categories of High‑quality paper and Moderate‑quality paper. The results of the identification of the article's feasibility assessment are attached in the Appendix (33) Study characteristics. Identification was carried out on articles that totaled more than 12,774 original articles through an elec ‑ tronic database search of 13,438 articles (Fig. 1). Excluded that were not appropriate after reading the titles and abstracts of 12,774 articles and there were 663 article duplications, so that the articles that were assessed for eligibility were 70 articles with 28 articles meeting the inclusion criteria for review Included studies include impact for sexuality education programs defined in general terms as curriculum‑based programs that provide general information about teenage pregnancy, STI prevention, risky sexual behavior including the use of contraceptives. Other studies examine absti‑ nence‑based programs, clinic‑based programs that provide individualized services, youth development programs. Programs are mostly based in school (11‑22,34), commu ‑ nity (24), society (18,26‑28,35‑38), health care (34,39,40), and family (40‑42) or media‑based approach (26‑29). Among the programs in schools, implemented in elementary, secondary and tertiary schools. The study included samples of mixed sex (adolescent girls and boys) (11,15‑19,21,27,28,34‑36,38‑41,43), among the focus on single sex studies, namely males (12,24,26)

JOURNAL OF PUBLIC HEALTH IN AFRICA 00: JPHIA 2672, 0000 3 or only women (13,14,20,26,29,37,38,42), most focused on adolescent girls women than teenage boys. The implementa‑ tion of the intervention was found in urban areas (11‑13,15‑17, 19‑22,24,26,27,34‑44), as well as in rural areas (14,18,25,28) All distribution of the study focused on adolescents, mostly 13‑17 years of age, although the lowest age of adolescents who received the intervention was 10 years and the highest was 19 years, and the study design used was a randomized trial (Randomized Controlled Trial, Randomized Clinical Trial, Cluster‑Randomized Trial, Cluster Randomized Feasibility Trial, Double‑Blind Cluster‑RCT, Double‑Blind Randomized Combined Prevention Trial, Multicentre Individual RCT, and Pragmatic Randomized Controlled Trial) The sample size ranged from the lowest (n=107) to the largest (n=19,289). The outcomes in this study were behaviors: sexual activity (11‑16,20,26,35‑38,42,43), and contracep ‑ tive use (11,13‑16,24,35‑39,42,43), examining the impact on STI/HIV (11,13,15,20,35,36,38,43), knowledge and preventive behavior (11,17‑19,21,22,24,26‑28,34,35,38‑40,43,44), and self‑efficacy (24,29,39). Most of the study outcomes involved follow‑up more than twice, the first follow‑up was immedi ‑ ately after the intervention (26,39), 3 months (12,13,26,35,36), 6 months (11,13,29,35,39,42,43), 9 months (24,41), 12 months (17,24,37‑39), 18 months (44), 24 months (26,36,42), even 7 years (15) after the intervention ended Thirty studies included in the data extraction, the identifi ‑ cation results indicated that there were program interventions with evidence of effectiveness in reducing teenage pregnancy, STIs, or sexually‑related risk behaviors, and there were inter‑ ventions identified that did not show a statistically significant positive impact. The details of the study can be seen in Table I Discussion This systematic review provides a comprehensive, updated assessment of the program with evidence of effectiveness in reducing teenage pregnancy, the occurrence of sexually trans‑ mitted infections, and risky sexual behavior. These findings indicate that various forms of intervention can reduce the risk, both school‑based, clinic‑based, and community‑based inter‑ ventions through the support of various parties (13). Programs to prevent teenage pregnancy, STIs and risky sexual behavior that are effective are divided into basic curriculum, learning services, organizational development, parenting programs and whole community programs (7) The effect of the intervention continued to show changes in 13 of the 17 variables studied which showed higher levels of healthy sexual behavior (11). This influence is supported by the diversity of the interventions provided. Thus, the diversity of interventions carried out on adolescents also Figure 1. Article search selection.

[Find the meaning and references behind the names: Monteiro, Bertrand, Allen, Medina, Johnson, Jones, Morales]

GAMELIA et al : systematic review 4 Table I. Study characteristics No Authors/year Country Sample/population Methods Result Quality (Refs.) 1 Gómez ‑ Lugo M, Morales A, Colombia The sample is 2.047 Cluster ‑ • Decreases were found Moderate (1 1) Saavedra‑Roa A, Niebles‑Charris J, from 2.708 adolescent randomized in behavioral intentions Abello‑Luque D, Marchal‑Bertrand L, population aged 12‑19 trial to use condoms and García‑Roncallo P , García‑Montaño E, years from a total of attitudes towards HIV , Pérez‑Pedraza D, Espada JP , 13 SMA particularly in relation Vallejo‑Medina P , 2022 to HIV protective behavior when faced with barriers • There was a significant positive dif ference in the percentage of condom use during penetrative sexual intercourse (AOR=7.52; 95% CI 0.41‑16.62; P<0.05) and the number of lifetime sexual partners (AOR=1.46; 95% CI 1.02‑ 2.08; P<0.05) 2 D Morrison‑Beedy , SH Jones, Y Xia, Northeastern, The research sample is Randomized Theory‑based behavioral Moderate (13) X Tu, HF Crean, MP Carey , 2013 New York, 738 adolescent girls controlled interventions tailored to United States aged 15‑19 years who trial adolescent girls can help are sexually active and reduce sexual risk and can speak English may also reduce unwanted pregnancies 3 Stephenson J, Strange V, Allen E, England The research sample Cluster ‑ There were no significant Moderate (15) Copas A, Johnson A, Bonell C, includes 27 schools randomized dif ferences for girls or Babiker A, Oakley A, Brodala A, with 8.766 students trial boys in self‑reported first Charleston S, Flux A, Hambidge S, aged 13‑14 years unprotected sex, regretted Johnston G, Monteiro H, or suppressed sex, quality Petruckevitch A, 2008 ofcurrent sexual intercourse,diagnosed sexuallytransmitted disease, or ability to identify local sexual health services

[Find the meaning and references behind the names: Richard, Leonard, Sherif, Rex, Jung]

JOURNAL OF PUBLIC HEALTH IN AFRICA 00: JPHIA 2672, 0000 5 Table I. Continued No Authors/year Country Sample/population Methods Result Quality (Refs.) 4 Millanzi WC, Kibusi SM, Osaki KM, Tanzania The study participants Double‑ • Soft skill coefficients Moderate (35) 2022 were 660 adolescents blinded were significantly higher who were randomly clustered among adolescents in the selected from the randomized hybrid PBP and pure PBP population of school‑ controlled than in the control group aged adolescents trial • Soft skills retention rates 10‑19 years old were still significantly higher at 3 and 6 months of follow‑up compared to baseline and post‑interven‑ tion assessments 5 Parkes A, W ight D, Henderson M, London The population Double‑ • Using condoms alone has Moderate (16) Stephenson J, Strange V, 2009 includes all students blinded a lower risk than without an (9.508) from 27 clustered ef fective method (OR: 2.97, schools with a sample randomized 95% CI: 2.12‑4.15) or OC of 7.616 students controlled alone (OR: 2.44, 95% CI: trial 1.29‑4.60) • The risk of pregnancy for multiple use and emer gency contraception is not dif ferent from that of condoms alone Both ef fects are significant according to user charac‑ teristics and sexual activity 6 Richard J Haier , Sherif Karama, Prancis 400 samples from a Double‑blind • Results showed an 86% Moderate (36) Leonard Leyba, Rex E Jung, 2016 population of HIV ‑ randomized relative reduction (95% CI: negative men or trans‑ combined 40‑98) in HIV incidence gender women who prevention among participants taking have sex with men, trial tenofovir disoproxil aged 18 years, at high fumarate‑emtricitabine vs risk of contracting HIV placebo • Comprehensive PrEP can improve prevention in MSM

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GAMELIA et al : systematic review 6 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Table I. Continued No Authors/year Country Sample/population Methods Result Quality (Refs.) 7 Ladapo JA, Elliott MN, Bogart LM, California Study participants Randomized • Cost ef fectiveness was Moderate (41) Kanouse DE, Vestal KD, Klein DJ, Selatan included 535 parents controlled $7.42 per new topic Ratner JA, Schuster MA with children in grades trial covered using parent J Adolesc Health, 2013 6‑10 (approximately responses and $9.18 using 11‑16 years old) in youth responses 13 workplaces • Other efficacy results also result in a favorable cost‑ef fectiveness ratio 8 Sieving RE, McRee AL, McMorris BJ, Minnesota The sample is 253 girls Randomized There was an improvement Moderate (42) Beckman KJ, Pettingell SL, United States aged 13‑17 years who controlled in family relationships and Bearinger LH, Garwick AW , are sexually active and trial self‑efficacy to resist un‑ Oliphant JA, Plowman S, Resnick MD, meet certain risk wanted sex, and a reduction Secor ‑T urner M., 2013 criteria in the perception of the importance of having sex 9 Ekstrand M, Tydén T, Darj E, Sweden 420 Sample from a Randomized Girls in the intervention Moderate (37) Larsson M., 2013 total of 667 female controlled group reported a shorter population aged 15‑19 trial time interval (mean 15.3 h) years from unprotected inter ‑ course to intake of ECP compared to the control group (mean 25.8 h) (P=0.019), with no evidence of decreased contraceptive use or increased sexual risk 10 Letourneau EJ, McCart MR, United States 107 samples from 216 Randomized • Intervention conditions Moderate (38) Sheidow AJ, Mauro PM., 2017 male adolescent controlled did not dif fer significantly population aged 1 1‑17 trial on adolescent demographic years characteristics or baseline substance use, sexual risk, or HIV testing experience (all P‑value<0.05) • The strong ef fect of the intervention was not detected in a study setting that included a strong background intervention by juvenile drug courts

[Find the meaning and references behind the names: Lee, Nielsen, Silver, Rodriguez, Salazar, Costa, Hwang, Patel, Rico, Rivera, Susan]

JOURNAL OF PUBLIC HEALTH IN AFRICA 00: JPHIA 2672, 0000 7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Table I. Continued No Authors/year Country Sample/population Methods Result Quality (Refs.) 11 Tingey L, Chambers R, Patel H, United States 534 samples from 703 Randomized Intervention participants Moderate (24) Littlepage S, Lee S, Lee A, Susan D, adolescent population controlled had significantly more Melgar L, Slimp A, Rosenstock S. 2021 trial communication with their parents about sexual and reproductive health than control participants at 9 and 12 months (P=0.042 and P=0.001, respectively) 12 Bauman LJ, W atnick D, Silver EJ, Bronx, 397 samples from 459 Randomized Program participation and Moderate (39) Rivera A, Sclafane JH, Rodgers CRR, New York adolescent population controlled completion rates, and Leu CS. 2021) aged 12‑14 years trial sample retention did not dif fer by gender or age However , the program ef fect was slightly stronger for boys than for girls 13 Tebb KP , Rodriguez F , Pollack LM, Los Angeles 1,360 samples from Cluster ‑ Intervention participants High (26) Adams S, Rico R, Renteria R, (LA) 3,903 adolescent randomized had higher rates of initial Trieu SL, Hwang L, Brindis CD, population controlled sexual activity , more Ozer E, Puf fer M. 2021 trial recruitment visits for pregnancy testing, emer gency contraception or birth control, and lower survey follow‑up comple‑ tion rates than controls 14 Nielsen AM, De Costa A, Gemzell‑ Stockholm, 433 samples from 972 Pragmatic Consistent condom use was High (27) Danielsson K, Marrone G, Boman J, Sweden adolescent population randomized reported for 32/214 (15.0%) Salazar M, Diwan V. 2021 controlled in the intervention group trial and for 35/219 (16.0%) in the control group (OR 0.9, 95% CI 0.5 to 1.6) and no significant dif ferences in secondary outcomes were seen

[Find the meaning and references behind the names: Xie, Lisa, Hunter, Benjamin, Esther, Lewis, Elaine, Michael, Clarke]

GAMELIA et al : systematic review 8 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Table I. Continued No Authors/year Country Sample/population Methods Result Quality (Refs.) 15 Lohan M, Brennan‑W ilson A, United The sample is 8,216 Cluster ‑ Significantly more interven‑ High (17) Hunter R, Gabrio A, McDaid L, Kingdom students/66 schools randomized tion students used reliable Young H, French R, Aventin Á, from a population of trial contraception at last sex Clarke M, McDowell C, Logan D, students aged 12‑14 compared to control Toase S, O’Hare L, Bonell C, years and 803 schools students, there were no Gillespie K, Gough A, Lagdon S, significant dif ferences W arren E, Buckley K, Lewis R, between groups for sexual Adara L, McShane T, Bailey J, abstinence and no side White J. 2022 ef fects were reported 16 Lisa A. Marsch, Ph.D., New York 141 samples from 208 Randomized • Participants in the TES High (28) Honoria Guarino, Ph.D., population new patients control trial intervention achieved a Michael J. Grabinski, M.C.S.D., (aged 12‑18 years) significant increase in HIV Cassandra Syckes, M.A., entering outpatient drug knowledge, condom use Elaine T. Dillingham, B.A., Haiyi Xie, abuse adolescents in efficacy , and condom skills Ph.D., Benjamin S. Crosier , three work locations and decreased risky sexual Ph.D. 2015 behavior in participants who received an interven‑ tion delivered by a preven‑ tion specialist • Participants are given a TES score that is easier to understand 17 Esther Duflo, Pascaline Dupas, Kenya The sample consisted Cluster • Education subsidies reduce High (18) Michael Kremer 2015 of 19,289 students Randomized adolescent dropout, (9,487 girls and 9,802 trial pregnancy and marriage boys) from 328 school but not sexually transmitted populations in two infections (STIs) districts • The government's HIV curriculum, which empha‑ sizes abstinence until marriage, does not reduce pregnancy or STIs • Government subsidies and HIV curricula reduce STIs more, but reduce dropout rates and fewer pregnancies, than subsidies for education alone

[Find the meaning and references behind the names: Judith, Reshma, Murthy, Siyabonga, Sven, Sarah, Dlamini, Myra, Sally, James, Good]

JOURNAL OF PUBLIC HEALTH IN AFRICA 00: JPHIA 2672, 0000 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Table I. Continued No Authors/year Country Sample/population Methods Result Quality (Refs.) 18 Baird SJ, Garfein S, McIntosh CT , Malawi 1.289 Malawian Cluster • The cash transfer structural High (44) Ozler B 2012 women (13‑22 years) randomized intervention alone is who were never married trial sufficient to influence and enrolled in school behavior at the start of the study • In particular , young women in the intervention group were more likely to choose a younger partner and reported having less sex with that partner although the study found no ef fect on the frequency of unprotected sex • After 18 months, HIV prevalence was reduced by 64% and HVS‑2 was reduced by 76% by cash transfer , regardless of whether school attendance was required 19 Myra Taylor , Champak Jinabhai, KwaZulu‑ 818 samples are Randomized Increased good attitude, High (19) Siyabonga Dlamini, Natal, South randomly selected control trial including intention to Reshma Sathiparsad, Africa abstain from pregnancy sex Matthijs S. Eggers And Hein De Vries 2014 20 Sally A Brinkman, Sarah E Johnson, W estern The sample is 2.834 Randomized • The proportion of girls in James P Codde, Michael B Hart, Australia girls aged 13‑15 years control trial the intervention group was Judith A Straton, Murthy N Mittinty , from 66 schools higher than in controls, Sven R Silburn. 2016 recorded one birth (97 [8%] of 1267 in the intervention group vs. 67 [4%] of 1567 in the control group) and had a higher overall risk of pregnancy than the control group (relative risk 1:36 [95% CI 1 10‑1, 67], P=0 003)

[Find the meaning and references behind the names: Maria, Mike, Nepal, Molly, Thomas, Mark, Ann, Amanda, Dev, Carolina, Queen]

GAMELIA et al : systematic review 10 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Table I. Continued No Authors/year Country Sample/population Methods Result Quality (Refs.) • One abortion as the first Moderate (20) pregnancy event (1 13 [9%] vs 101 [6%]) • The intervention group outcome was obtained using a hazard ratio of 1 35 [95% CI 1 10‑1 67], P=0 016 21 Amanda E. Tanner , PhD, MPH, University of Prime Time study Uji coba • Program staf f described Moderate (34) Molly Secor ‑T urner , PhD, RN, North participants were acak Prime the dif ferent capacities of Ann Garwick, PhD, RN, LP , F AAN, Carolina at sexually active aged Time (2006‑ youth to engage with the Renee Sieving, PhD, RN, and Greensboro 13‑17 years (253) 201 1) dengan program (sociable, middle Kayci Rush, MSW , MA. 2012 desain and difficult youth) and kualitatif made specific recommen‑ dations for working with dif ferent connectors • Behaviors related to early pregnancy , building a trusting relationship is an important step towards building skills, motivation, opportunities and support for change 22 Dev Acharya, Malcolm Thomas, Nepal The research sample is Randomised • There is a lar ge number of Moderate (21) Rosemary Cann. 2017 448 students/4 schools control trial school children who report from 482 high school an increase in sexual health students aged 14‑18 knowledge in experimental years old schools • Facilitators who lead sex education programs are more ef fective in increasing sexual health knowledge about school children 23 Maria Lohan, A´ine Aventin, Queen's 630 students from 7 Cluster • An acceptable and Moderate (22) Lisa Maguire, Mike Clarke, University schools are the sample randomised ef fective intervention has Mark Linden, Lisa McDaid. 2014 Belfast with the tar get popula‑ feasibility the potential to be rolled out tion being male trial to a lar ge number of boys

[Find the meaning and references behind the names: Heather, Gina, Karin]

JOURNAL OF PUBLIC HEALTH IN AFRICA 00: JPHIA 2672, 0000 11 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Table I. Continued No Authors/year Country Sample/population Methods Result Quality (Refs.) teenagers aged 14‑16 and girls. Generalizable years findings especially with regard to gender ‑specific adolescent pregnancy interventions • School‑based RSE is an important opportunity to open up understanding of sexuality and unwanted pregnancies between boys and girls, but maximizing this opportunity requires developing acceptable and ef fective RSE resources 24 Karin K. Coyle, Ph.D., Hispanic/ 765 samples from 899 Randomized • Participants were 53% Moderate (12) Jill R. Glassman, Ph.D., Latino or student population control trial male (mean age: 16.2 years) Heather M. Franks, M.A., African‑ with the majority of youth Shannon M. Campe, Jill Denner , American Hispanic/Latino or African‑ Ph.D., and Gina M. Lepore. 2013 American (37.9 and 22.3%) • Students in HIV/STI/ pregnancy prevention curriculum conditions tended to have unprotected vaginal sex in the 3 months prior to the survey [odds ratio (OR) .58, p .04] • The program significantly reduces students' exposure to risk situations • This change was not significant in service learning alone or in the combined intervention conditions relative to controls

[Find the meaning and references behind the names: Annik, Svetlana, Kaye, Ruth, Jennifer, Oman, Roy, Green, Peter, Chris]

GAMELIA et al : systematic review 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Table I. Continued No Authors/year Country Sample/population Methods Result Quality (Refs.) 25 Jennifer Green, M.P .H., Ph.D, California, 1,036 ethnically diverse Randomized Adolescents in the PTC Moderate (43) Roy F . Oman, Ph.D, Minggen Lu, Maryland, adolescents (aged control trial intervention showed Ph.D., and Kristen D. Clements‑Nolle, and 13‑18 years) were significantly increased Ph.D. 2017 Oklahoma recruited from 44 resi‑ knowledge compared to the dential homes in three control group about anatomy states and fertility (adjusted odds ratio [AOR] 1.07, 95% confidence interval [CI] 1.03‑1.1 1), HIV and STIs (AOR 1, 03, 95% CI 1.002‑ 1.07), and methods of protection (AOR 1.06, 95% CI 1.03‑1.09), and self‑ efficacy regarding self‑ efficacy to communicate with partners (AOR 1.14, 95% CI 1.04‑1.26), plans to protect against sex and avoid unprotected sex (AOR 1.16, 95% CI 1.04‑ 1.28), and where to get a method of birth control (AOR 1.13, 95% CI 1.01‑ 1.26) 12 months after intervention 26 Chris Bonell , Ruth Maisey , England, UK The research sample is Randomized • There is no evidence of Moderate (40) Svetlana Speight , Susan Purdon, 404 girls trial dengan intervention benefits for our Peter Keogh, Ivonne W ollny , matched pair primary outcomes and Annik Sorhaindo, Kaye W ellings 2013 individual positive impact for our secondary outcomes • Outcomes: low self‑ esteem, low knowledge of sexual health, and difficulty discussing contraceptive pills

[Find the meaning and references behind the names: Narayana, Joan, Robert, Basil, Smith, Julie, Elizabeth, Safi, Pamela, Rama]

JOURNAL OF PUBLIC HEALTH IN AFRICA 00: JPHIA 2672, 0000 13 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Table I. Continued No Authors/year Country Sample/population Methods Result Quality (Refs.) • Interventions should be refined, with clearer logical models and more emphasis on sex education, and re‑ evaluated 27 Nandita Kapadia‑Kundu, India A sample of 1.200 girls Cluster • Interventions have a Moderate (14) Douglas Storey , Basil Safi, was randomly selected, randomized significant impact on more Geetali Trivedi, Rama Tupe, 1.195 eligible girls control trial than 13 preventive health G. Narayana d. 2014 were randomized to 3 behaviors groups • Approximately 65% of girls in the intervention group had adopted 13 or more health behaviors at the end‑line compared to 4.5 percent in the control group at the end‑line and 5 percent at baseline • Behavioral impacts are demonstrated in all three areas of nutrition, hygiene and reproductive health 28 Julie S. Downs, PhD , Carnegie 1.317 samples from Multicenter • Participants in the High (29) Amie M. Ashcraft, PhD, MPH , Mellon 2.814 population of individual Seventeen Days group Pamela J. Murray , MD, MHP , University , sexually active RCT reported higher gains in Elise D. Berlan, MD, Department adolescent girls aged self‑efficacy after 6 months Wändi Bruine de Bruin, PhD , of Social and 14‑19 years compared to the control Joan Eichner , MP A, MPH, Decision group in 2008 Baruch Fischhof f, PhD, Sciences, • This finding was carried Janie A. Leary , PhD, MPH , out after controlling for Robert B. McCall, PhD , baseline self‑efficacy scores Elizabeth Miller , MD, Jennifer Salaway , and other covariates PhD, Janell Smith‑Jones, PhD , Gina S. Sucato, MD, MPH. 2017

[Find the meaning and references behind the names: Real, Long]

GAMELIA et al : systematic review 14 strongly proves that the focus of the study covers a wide range of settings. Research has been carried out with programs ranging from curriculum‑based and individual sexuality education programs, to clinic‑based services, in settings ranging from schools to communities. This diversity is important because no single intervention that is successful in improving adolescent health must be comprehensive, there are variations in the various interventions imple‑ mented. It is appropriate that comprehensive Pre‑exposure Prophylaxis (PrEP) can improve prevention in MSM (36). In addition, diversity is important to meet the interests of the community, where there is no appropriate intervention model for varying populations, it must be adapted to the characteristics (school settings have different program needs with needs in the clinic and in the community). Youth interventions in rural areas will also be different from inter‑ ventions developed in urban areas. Similarly, youth in rural areas may respond differently to programs originally devel‑ oped in urban areas. For example, intervention participants reported improvements in family relationships as well as self‑efficacy for resisting unwanted sex (42). Each popula ‑ tion and setting has distinctive characteristics it is essential to have a variety of programs available for implementation, requiring research outcomes that have a broad focus. The diversity of the target population is important to determine effective interventions for all adolescents (Latin, Hispanic, African, etc.) (12,19,26) Compared with adolescents in the control group, adoles‑ cents in the Power Through Choices (PTC) intervention showed a significant increase in knowledge about anatomy and fertility (43). This shows that interventions from several programs show potentially significant effects in general, namely teenage pregnancy, STIs, and risky sexual behavior but show differences in several outcome measurement variables. Potential productive strategies have an impact on the success of interventions and improving adolescent health status (preventing teenage pregnancy, STIs, risky sexual behavior) can reduce public health problems, reduce all risk factors for adolescent health problems. The implementation of this can be seen from the medical record audit for girls recruited from clinical settings (n=322) documenting a 50% reduction in posi ‑ tive pregnancy tests at 12 months (13) The outcome of the intervention is observed within a certain period of time in accordance with the objectives of each program with an average observation of 3 months‑2 years. Long‑term research using questionnaires and observation instruments requires the use of accurate data, so it needs to be considered when analyzing data according to needs, both short‑term data and long‑term data (18). The use of i‑surveys to strengthen the evidence that interventions have short‑term (skills, attitudes, and intentions) and long‑term impacts are often better for measuring impacts on behavior or health outcomes, which take longer. Future research should more carefully consider the appropriate time for follow‑up surveys. Most current teen pregnancy and STI prevention programs are built on predictions of both the short‑term impact on sexual activity or contraceptive use and the long‑term impact on preg‑ nancy or STIs (12). However, there are studies that examine the impact on short‑term outcomes such as pregnancy and STIs. To allow broader testing of the impact of the program, researchers should consider a follow‑up schedule for example using three relatively short surveys (immediate post‑test and at 6 and 12 months post intervention), researchers can administer two surveys, one short term (6 months postprogram). and long term (18‑24 months postprogram) Quality control tools for research would be useful to avoid bias in the population: 1) Randomized designs should use objective results (accurate evidence), 2) Develop evaluation tools for randomized studies and systematic reviews taking into account the distinction between subjective and objective outcomes of assessments, 3) Program makers intervention should develop interventions that are supported by evidence from high‑quality randomized studies that show real and large effects should study the interventions and policies implemented to manage health problems, especially adoles‑ cent pregnancy prevention that have shown real effects, in addition to reviewing educational strategies used in groups social status with teenage pregnancy rates (13,14). These findings strongly suggest that the use of randomized trials is a realistic expectation, the literature on teenage pregnancy and STI prevention, and the foundation on which future research should be built Strenghs and limitations. Search strategy adapted to the research question, a large number of articles related to the topic of the research question, limited access. The relevant literature spans the disciplines of medicine, public health, demography, psychology, economics, sociology, and other social sciences, where relevant search terms may vary. Manually reviewing titles and abstracts to determine whether studies meet inclusion criteria, it is possible to skip those articles where the intervention is not explicitly identified in the title or abstract. Limiting studies to English only excluding relevant studies written in other languages. Bias can be found in the types of outcomes reported, intentional or unintentional selective reporting due to the nature of the intervention and the desire to demonstrate a positive effect. Similar forces can affect the likelihood of publication in an indexed journal. The quality and completeness of the evidence is not accessed directly by contacting the author. The studies included in this review represent only a fraction of the total global effort to reduce pregnancy over the past fourteen years, and it is likely that programs of very good quality are not within the time limit of the search Conclusions This article reviews the scope and quality of the existing literature on interventions to reduce adolescent pregnancy and risky sexual behavior. This article describes some basic trends in adolescent pregnancy prevention interventions in several countries that can be used as a reference for health programs. Adolescent pregnancy prevention interventions are directed primarily at programs that have evidence of effectiveness. Unproven effectiveness can be implemented in conjunction with other interventions that have a high‑quality impact Funding None.

[Find the meaning and references behind the names: Gavin, Martins, Ahmed, Pir, Gomez, David, Peer, Gonzalez, Chin, Harris, Jack, Wilson, Med, Alves, April, Jacob]

JOURNAL OF PUBLIC HEALTH IN AFRICA 00: JPHIA 2672, 0000 15 Availability of data and materials All data generated or analyzed during this study are included in this published article Authors' contributions EG, screening and data extraction, quality assessment; A, reviewed the systematic review; BW, corrected the manuscript of the article, corrected data analysis and interpretation; ZS, reviewed the systematic review. All the authors have read and approved the final version of the manuscript and agreed to be held accountable for all aspects of the work Conflict of interest The authors declare no potential conflict of interest Accepted: 9, May 2023; submitted: 28, April 2023 References 1. WHO. World Health Statistics. Geneva, 2008 2. Leftwich HK and Alves MVO: Adolescent pregnancy. Pediatr Clin North Am 64: 381‑388, 2017 3. Eaton DK, Kann L, Kinchen S, Shanklin S, Flint KH, Hawkins J, Harris WA, Lowry R, McManus T, Chyen D, et al : Youth risk behavior surveillance‑United States, 2011. MMWR Surveill Summ 61: 1‑162, 2012 4. Ahmed S and Hill K: Estimation de la mortalité maternelle au niveau sous‑national: Une méthode à base de modèles appliquée au Bangladesh. Bull World Health Organ 89: 12‑21, 2011 5. Kassebaum NJ, Bertozzi‑Villa A, Coggeshall MS, Shackelford KA, Steiner C, Heuton KR, Gonzalez‑Medina D, Barber R, Huynh C, Dicker D, et al : Global, regional, and national levels and causes of maternal mortality during 1990‑2013: A systematic analysis for the global burden of disease study 2013. Lancet 384: 980‑1004, 2014 6. UNFPA. Motherhood in Childhood, 2013. http://www.unfpa.org br/Arquivos/EN‑SWOP 2013‑Report‑Final.pdf 7. Fullerton D, Dickson R, Eastwood AJ and Sheldon TA: Preventing unintended teenage pregnancies and reducing their adverse effects. Qual Heal Care 6: 102‑108, 1997 8. Chin HB, Sipe TA, Elder R, Mercer SL, Chattopadhyay SK, Jacob V, Wethington HR, Kirby D, Elliston DB, Griffith M, et al : The effectiveness of group‑based comprehensive risk‑reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: Two systematic reviews for the Guide to Community Preventive Services. Am J Prev Med 42: 272‑294, 2012 9. Kohler PK, Manhart LE and Lafferty WE: Abstinence‑only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. J Adolesc Heal 42: 344‑351, 2008 10. Bennett SE and Assefi NP: School‑based teenage pregnancy prevention programs: A systematic review of randomized controlled trials. J Adolesc Heal 36: 72‑81, 2005 11. Gomez Lugo M, Morales A, Saavedra Roa A, Niebles‑Charris J, Abello‑Luque D, Marchal‑Bertrand L, García‑Roncallo P, García‑Montaño E, Pérez‑Pedraza D, Espada JP and Vallejo‑Medina P: Effects of a Sexual Risk‑reduction interven ‑ tion for teenagers: A cluster‑randomized control trial. AIDS Behav 26: 2446‑2458, 2022 12. Coyle KK, Glassman JR, Franks HM, Campe SM, Denner J and Lepore GM: Interventions to reduce sexual risk behaviors among youth in alternative schools: A randomized controlled trial. J Adolesc Heal 53: 68‑73, 2013 13. Morrison‑Beedy D, Jones SH, Xia Y, Tu X, Crean HF and Carey MP: Reducing sexual risk behavior in adolescent girls: Results from a randomized controlled trial. J Adolesc Heal 52: 314‑321, 2013 14. Kapadia‑Kundu N, Storey D, Safi B, Trivedi G, Tupe R and Narayana G: Seeds of prevention: The impact on health behav ‑ iors of young adolescent girls in Uttar Pradesh, India, a cluster randomized control trial. Soc Sci Med 120: 169‑179, 2014 15. Stephenson J, Strange V, Allen E, Copas A, Johnson A, Bonell C, Babiker A and Oakley A; RIPPLE Study Team: The long‑term effects of a peer‑led sex education programme (RIPPLE): A cluster randomised trial in schools in England. PLoS Med 5: 1579‑1590, 2008 16. Parkes A, Wight D, Henderson M, Stephenson J and Strange V: Contraceptive method at First sexual intercourse and subsequent pregnancy risk: Findings from a secondary analysis of 16‑year‑old girls from the RIPPLE and SHARE Studies. J Adolesc Heal 44: 55‑63, 2009 17. Lohan M, Brennan‑Wilson A, Hunter R, Gabrio A, McDaid L, Young H, French R, Aventin Á, Clarke M, McDowell C, et al : Effects of gender‑transformative relationships and sexuality education to reduce adolescent pregnancy (the JACK trial): A cluster‑randomised trial. Lancet Public Heal 7: e 626‑e 637, 2022 18. Ester D, Pascaine D and Kremer M: Education, HIV, and early fertility: Experimental evidence from kenya esther. Am Econ Rev 105: 2757‑2797, 2015 19. Taylora M, Jinabhai C, Dlamini S, Sathiparsad R, Eggers MS and De Vries H: Effects of a teenage pregnancy prevention program in KwaZulu‑Natal, South Africa. Health Care Women Int 35: 845‑858, 2014 20. Brinkman SA, Johnson SE, Codde JP, Hart MB, Straton JA, Mittinty MN and Silburn SR: Effi cacy of infant simulator programmes to prevent teenage pregnancy: A school‑based cluster randomised controlled trial in Western Australia. Lancet 388: 2264‑2271, 2016 21. Acharya D, Thomas M and Cann R: Evaluating school‑based sexual health education programme in Nepal: An outcome from a randomised controlled trial. Int J Educ Res 82: 147‑158, 2017 22. Lohan M, Aventin Á, Maguire L, Clarke M, Linden M and McDaid L: Feasibility trial of a film‑based educational interven ‑ tion for increasing boys' and girls' intentions to avoid teenage pregnancy: Study protocol. Int J Educ Res 68: 35‑45, 2014 23. Gavin LE, Catalano RF, David‑Ferdon C, Gloppen KM and Markham CM: A review of positive Youth development programs that promote adolescent sexual and reproductive health. J Adolesc Heal 46 (Suppl): S 75‑S 91, 2010 24. Tingey L, Chambers R, Patel H, Littlepage S, Lee S, Lee A, Susan D, Melgar L, Slimp A and Rosenstock S: Prevention of sexually transmitted diseases and pregnancy prevention among Native American Youths: A randomized controlled trial, 2016‑2018. Am J Public Health 111: 1874‑1884, 2021 25. Guse K, Levine D, Martins S, Lira A, Gaarde J, Westmorland W and Gilliam M: Interventions using new digital media to improve adolescent sexual health: A systematic review. J Adolesc Heal 51: 535‑543, 2012 26. Tebb KP, Rodriguez F, Pollack LM, Adams S, Rico R, Renteria R, Trieu SL, Hwang L, Brindis CD, Ozer E and Puffer M: Improving contraceptive use among Latina adolescents: A cluster‑random‑ ized controlled trial evaluating an mHealth application, Health‑E You/Salud iTu. Contraception 104: 246‑253, 2021 27. Nielsen AM, De Costa A, Gemzell‑Danielsson K, Marrone G, Boman J, Salazar M and Diwan V: The MOSEXY trial: Mobile phone intervention for sexual health in youth‑a pragmatic randomised controlled trial to evaluate the effect of a smartphone application on sexual health in youth in Stockholm, Sweden. Sex Transm Infect 97: 141‑146, 2021 28. Marsch LA, Guarino H, Grabinski MJ, Syckes C, Dillingham ET, Xie H and Crosier BS: Comparative effectiveness of Web‑based vs. Educator‑delivered HIV prevention for adolescent substance users: A randomized, controlled trial. J Subst Abuse Treat 59: 30‑37, 2015 29. Downs JS, Ashcraft AM, Murray PJ, Berlan ED, Bruine de Bruin W, Eichner J, Fischhoff B, Leary JM, McCall RB, Miller E, et al : Video intervention to increase perceived Self‑efficacy for condom use in a randomized controlled trial of female adolescents. J Pediatr Adolesc Gynecol 31: 291‑298, 2017 30. What Works Clearinghouse: What Works Clearinghouse Procedures and Standards Handbook Version 3.0 31. Spillane JP, Pareja AS, Dorner L, Barnes C, May H, Huff J and Camburn E: Mixing methods in randomized controlled trials (RCTs): Validation, contextualization, triangulation, and control. Educ Assessment Eval Account 22: 5‑28, 2010 32. O'Connor D, Green S and Higgins JP: Cochrane Handbook for systematic reviews of interventions. British, 2008 (Epub ahead of print) doi:10.1002/9780470712184.ch 5.

[Find the meaning and references behind the names: Suzan, Rojas, Castro, Mora]

GAMELIA et al : systematic review 16 33. Butler A, Hall H and Copnell B: A Guide to writing a qualitative systematic review protocol to enhance evidence‑based practice in nursing and health care. Worldviews Evid Based Nurs 13: 241‑249, 2016 34. Tanner AE, Secor‑Turner M, Garwick A, Sieving R and Rush K: Engaging Vulnerable adolescents in a pregnancy prevention program: Perspectives of prime time staff. J Pediatr Heal Care 26: 254‑265, 2012 35. Millanzi WC, Kibusi SM and Osaki KM: Effect of integrated reproductive health lesson materials in a problem‑based peda‑ gogy on soft skills for safe sexual behaviour among adolescents: A schoolbased randomized controlled trial in Tanzania. PLoS One 17: e 0263431, 2022 36. Sagaon Teyssier L, Suzan Monti M, Demoulin B, Capitant C, Lorente N, Préau M, Mora M, Rojas Castro D, Chidiac C, Chas J, et al : Uptake of PrEP and condom and sexual risk behavior among MSM during the ANRS IPERGAY trial. AIDS Care 28 (Suppl): S 48‑S 55, 2016 37. Ekstrand M, Tydén T, Darj E and Larsson M: Twelve‑month follow‑up of advance provision of emergency contraception among teenage girls in Sweden‑a randomized controlled trial. Ups J Med Sci 118: 271‑275, 2013 38. Letourneau EJ, McCart MR, Sheidow AJ and Mauro PM: First evaluation of a contingency management intervention addressing adolescent substance use and sexual risk behaviors: Risk reduc‑ tion therapy for adolescents. J Subst Abus 72: 56‑65, 2017 39. Bauman LJ, Watnick D, Silver EJ, Rivera A, Sclafane JH, Rodgers CRR and Leu CS: Reducing HIV/STI risk among adolescents aged 12 to 14 years: A randomized controlled trial of project prepared. Prev Sci 22: 1023‑1035, 2021 40. Bonell C, Maisey R, Speight S, Purdon S, Keogh P, Wollny I, Sorhaindo A and Wellings K: Randomized controlled trial of ‘teens and toddlers’: A teenage pregnancy prevention interven‑ tion combining youth development and voluntary service in a nursery. J Adolesc 36: 859‑870, 2013 41. Ladapo JA, Elliott MN, Bogart LM, Kanouse DE, Vestal KD, Klein DJ, Ratner JA and Schuster MA: Cost of talking parents, healthy teens: A Worksite‑based intervention to promote parent‑adolescent sexual health communication. J Adolesc Heal 53: 595‑601, 2013 42. Sieving RE, McRee AL, McMorris BJ, Beckman KJ, Pettingell SL, Bearinger LH, Garwick AW, Oliphant JA, Plowman S, Resnick MD and Secor‑Turner M: Prime time: Sexual health outcomes at 24 months for a clinic‑linked intervention to Prevent pregnancy risk behavior. JAMA Pediatr 167: 333‑340, 2013 43. Green J, Oman RF, Lu M and Clements‑Nolle KD: Long‑term improvements in knowledge and psychosocial factors of a teen pregnancy prevention intervention implemented in group homes. J Adolesc Heal 60: 698‑705, 2017 44. Baird SJ, Garfein RS, McIntosh CT and Ozler B: Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: A cluster randomised trial. Lancet 379: 1320‑1329, 2012.

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