Significant Reduction of Repeat Teen Pregnancy in a Comprehensive Young Parent Program

Omar, Hatim A.; Fowler, Amy M.; McClanahan, Kimberly K.

doi:10.1016/j.jpag.2007.08.003

Cited by 25 publications

(22 citation statements)

References 18 publications

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“…The few preliminary studies of the model have found declines in the number of repeat pregnancies and more positive outcomes in education for teen mothers and infant health. 86,87 …”

Section: Pediatric Primary Care: the Teentot Modelmentioning

confidence: 99%

Addressing the Mental Health Needs of Pregnant and Parenting Adolescents

et al. 2014

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Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of the mental health challenges associated with teen parenthood, barriers that often prevent teen mothers from seeking mental health services, and interventions for this vulnerable population that can be integrated into primary care services. Pediatricians in the primary care setting are in a unique position to address the mental health needs of adolescent parents because teens often turn to them first for assistance with emotional and behavioral concerns. Consequently, pediatricians can play a pivotal role in facilitating and encouraging teen parents’ engagement in mental health treatment.

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“…The few preliminary studies of the model have found declines in the number of repeat pregnancies and more positive outcomes in education for teen mothers and infant health. 86,87 …”

Section: Pediatric Primary Care: the Teentot Modelmentioning

confidence: 99%

Addressing the Mental Health Needs of Pregnant and Parenting Adolescents

et al. 2014

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“…Thirty-four studies 86,94,95, were used to identify risk factors in addition to the randomised trials discussed above. These 34 studies included 20 non-comparative studies, 94,95,[98][99][100][101][102][103]106,108,109,[112][113][114][115][116][117][118][119]128 seven prospective cohort studies 97,105,[120][121][122][123][124] and eight retrospective cohort studies. 86,104,107,110,111,[125][126][127] Qualitative studies…”

Section: Studies Used To Identify Risk Factorsmentioning

confidence: 99%

“…Policy documents from the UK were also used to explore elements of the theory areas under investigation, applying the criteria of relevance and rigor. Identified quantitative studies that were not synthesised in any 'pooled' analysis Twenty-one additional quantitative studies [112][113][114][115][123][124][125][126][127][128][143][144][145][146][147][148][149][150][151][152][153] were identified as included studies, but were not synthesised in any 'pooled' analysis as they did not report on or contain data relevant to the outcomes under investigation. We extracted data on other risk factors but had insufficient data to perform metaregression with any statistical integrity.…”

Section: Realist Synthesismentioning

confidence: 99%

Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement

Whitaker¹,

Hendry

Aslam

et al. 2016

Health Technol Assess

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BackgroundThe UK has one of the highest rates of teenage pregnancies in Western Europe. One-fifth of these are repeat pregnancies. Unintended conceptions can cause substantial emotional, psychological and educational harm to teenagers, often with enduring implications for life chances. Babies of teenage mothers have increased mortality and are at a significantly increased risk of poverty, educational underachievement and unemployment later in life, with associated costs to society. It is important to identify effective, cost-effective and acceptable interventions.ObjectivesTo identify who is at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what the barriers to and facilitators of the uptake of these interventions are.Data sourcesWe conducted a multistreamed, mixed-methods systematic review informed by service user and provider consultation to examine worldwide peer-reviewed evidence and UK-generated grey literature to find and evaluate interventions to reduce repeat unintended teenage pregnancies. We searched the following electronic databases: MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database), EMBASE (Excerpta Medicadatabase), British Nursing Index, Educational Resources Information Center, Sociological Abstracts, Applied Social Sciences Index and Abstracts, BiblioMap (the Evidence for Policy and Practice Information and Co-ordinating Centre register of health promotion and public health research), Social Sciences Citation Index (supported by Web of Knowledge), Research Papers in Economics, EconLit (American Economic Association’s electronic bibliography), OpenGrey, Scopus, Scirus, Social Care Online, National Research Register, National Institute for Health Research Clinical Research Network Portfolio and Index to THESES. Searches were conducted in May 2013 and updated in June 2014. In addition, we conducted a systematic search of Google (Google Inc., Mountain View, CA, USA) in January 2014. Database searches were guided by an advisory group of stakeholders.Review methodsTo address the topic’s complexities, we used a structured, innovative and iterative approach combining methods tailored to each evidence stream. Quantitative data (effectiveness, cost-effectiveness, risk factors and effect modifiers) were synthesised with reference to Cochrane guidelines for evaluating evidence on public health interventions. Qualitative evidence addressing facilitators of and barriers to the uptake of interventions, experience and acceptability of interventions was synthesised thematically. We applied the principles of realist synthesis to uncover theories and mechanisms underpinning interventions (what works, for whom and in what context). Finally, we conducted an overarching narrative of synthesis of evidence and gathered service user feedback.ResultsWe identified 8664 documents initially, and 816 in repeat searches. We filtered these to 12 randomised controlled trials (RCTs), four quasi-RCTs, 10 qualitative studies and 53 other quantitative studies published between 1996 and 2012. None of the RCTs was based in the UK. The RCTs evaluated an emergency contraception programme and psychosocial interventions. We found no evidence for effectiveness with regard to condom use, contraceptive use or rates of unprotected sex or use of birth control. Our primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control goup, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78 to 1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with a RR of 0.60 (95% CI 0.39 to 0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations, and negligible opportunities. Service user feedback suggested that there were specific motivations for many repeat conceptions, for example to replace loss or to please a partner. Realist synthesis highlighted that context, motivation, planning for the future and letting young women take control with connectedness and tailoring provide a conceptual framework for future research.LimitationsIncluded studies rarely characterised adolescent pregnancy as intended or unintended, that is interventions to reduce repeat conceptions rarely addressed whether or not pregnancies were intended. Furthermore, interventions were often not clearly defined, had multiple aims and did not indicate which elements were intended to address which aims. Nearly all of the studies were conducted in the USA and focused largely on African American or Hispanic and Latina American populations.ConclusionsWe found no evidence to indicate that existing interventions to reduce repeat teenage pregnancy were effective; however, subsequent births were reduced by home-based interventions. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce repeat teenage pregnancy in the UK.Study registrationThis study is registered as PROSPERO CRD42012003168. Cochrane registration number: i=fertility/0068.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…For instance, in a prospective clinical study of new teenage mothers, results indicated that those who chose long-term contraception (i.e., the DepoProvera/DMPA shot) were more likely to still be using contraception, and were significantly less likely to have experienced a repeat pregnancy one year after delivery, than those who chose oral contraceptives or the patch (Thurman et al 2007). As another example, the Young Parent Program provides comprehensive healthcare, continuity of care, and contraceptive counseling, along with flexible office hours, free contraceptives to teens without insurance, and regular appointment reminders (Omar et al 2008). In a retrospective study of the Young Parent Program, only 11 (\1 %) of the 1386 teenage mothers who participated in this program reported a repeat pregnancy during the 3 years after participation, a sharp contrast to other research finding rates of up to 35 % of teen mothers have a repeat pregnancy within a year of this first child's birth (Omar et al 2008).…”

Section: Clinical Medicinementioning

confidence: 99%

Multidisciplinary Approaches to Research on Bullying in Adolescence

et al. 2016

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Bullying is a significant public health problem in the United States that affects youth functioning in multiple domains. Much of the research on bullying to date has focused on children, however, leaving gaps in the literature with respect to understanding bullying among adolescents. In particular, less is known about how adolescents conceptualize bullying, what predicts and is associated with bullying involvement among adolescents, and how prevention programs might address the unique needs of middle and high school students. This special issue proposes that a multidisciplinary perspective might be particularly useful in better understanding bullying among adolescents and determining how to design more effective interventions and prevention programs for this age-group. The current article introduces the special issue by briefly discussing what is known about bullying in adolescence and considering three disciplines (computer science, big data, and virtual communities; media studies; anthropology) that are particularly well situated to move the field forward. Next, this article reviews teen pregnancy prevention efforts, as an example of another adolescent public health concern that has been addressed successfully using a multidisciplinary approach. The article concludes with an overview of the three manuscripts that are part of the special issue.

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Significant Reduction of Repeat Teen Pregnancy in a Comprehensive Young Parent Program

Cited by 25 publications

References 18 publications

Addressing the Mental Health Needs of Pregnant and Parenting Adolescents

Addressing the Mental Health Needs of Pregnant and Parenting Adolescents

Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement

Multidisciplinary Approaches to Research on Bullying in Adolescence

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