Despite downward trends in the U.S. teen birth rate overall, the associated social and economic costs are still significant. Historically, teen pregnancy prevention policy and program adoption have been influenced by the sociopolitical environment at national, state, and local levels. Recent federal efforts have begun to re-emphasize the importance of developing and supporting evidence-based prevention efforts. Current teen pregnancy prevention approaches are reviewed with attention to the range of program philosophies, components, settings, populations served, and documented effectiveness. Promising directions in pregnancy prevention program development for adolescents are also highlighted.