PurposeWe assessed the extent to which implementing adolescent pregnancy prevention programs in conjunction with three level implementation strategies reduces adolescent pregnancy rates at the county-level in North Carolina (NC).MethodsFixsen and colleagues' (2005) three levels of implementation were used to organize the prevention strategies: core (e.g., training, fidelity monitoring), organizational (e.g., administrative support), and external (e.g., community resources).ResultsCounties that had adolescent friendly clinic/services (external) were more likely to report lower adolescent pregnancy rates in comparison to counties that did not have access to such services.ConclusionsFindings suggest external implementation strategies are key to reducing adolescent pregnancy rates