In 2013, U.S. teen births accounted for 7.0% of all births and 15.4% of all nonmarital births. The birth rate for U.S. teenagers (ages 15 through 19) increased in 2006 and 2007 after a steady decline since 1991. However, in each of 2008 through 2013, the teen birth rate dropped below the 2006 teen birth rate, reversing the two-year upward trend. Although the birth rate for U.S. teens has dropped in 21 of the past 23 years, it remains higher than the teen birth rate of most industrialized nations. Preventing teen pregnancy is generally considered a priority among policy makers and the public because of its high economic, social, and health costs for teen parents and their families. The Adolescent Family Life (AFL) program, created in 1981 (Title XX of the Public Health Service Act), was the first federal program to focus on pregnancy among adolescents. It was created to support demonstration projects that provide comprehensive and innovative health, education, and social services to pregnant and parenting adolescents, their infants, male partners, and their families. From 1998 to 2009, federal teen pregnancy prevention efforts in the AFL program and in general relied heavily on using abstinence-only education as their primary tool. The appropriation for the AFL program was $16.7 million in FY2010 and $12.4 million for FY2011. The AFL program has not received any funding since FY2011. P.L. 111-117 (Consolidated Appropriations Act, 2010) included a new discretionary Teen Pregnancy Prevention (TPP) program, funded at $110 million for FY2010, which provides grants and contracts, on a competitive basis, to public and private entities to fund "medically accurate and age appropriate" programs that reduce teen pregnancy. Since FY2010, funding for the TPP program has fluctuated from a high of $109 million in FY2011 to a low of $98.4 million in FY2013 (post-sequester). P.L. 113-76 (the Consolidated Appropriations Act, 2014) provided $101 million for the TPP program (and $8.5 million for program evaluation) for FY2014. Pursuant to P.L. 113-235 (the Consolidated and Further Continuing Appropriations Act, 2015), the TPP program is funded at $101 million for FY2015 (plus $6.8 million for program evaluation). P.L. 111-148 (the Patient Protection and Affordable Care Act-ACA) established a new state formula grant program and appropriated $375 million, at $75 million per year for five years (FY2010-FY2014), to enable states to operate a new Personal Responsibility Education Program (PREP), which is a broad approach to teen pregnancy prevention that educates adolescents on both abstinence and contraception to prevent pregnancy and sexually transmitted diseases. PREP also provides youth with information on several adulthood preparation subjects (e.g., healthy relationships, adolescent development, financial literacy, parent-child communication, educational and career success, and healthy life skills). P.L. 113-93 (the Protecting Access to Medicare Act of 2014), which was enacted on April 1, 2014, extended PREP ($75 million per year) through FY2015 (i.e., September 30, 2015).