Abstract
Adolescent mothers in Washington, DC have a high rate of subsequent teen pregnancies, often within 24 months. Children of
teen mothers are at risk for adverse psychosocial outcomes. When adolescents are strongly attached to parents, schools, and
positive peers, they may be less likely to repeat a pregnancy. This study tested the efficacy of a counseling intervention
delivered by cell phone and focused on postponing subsequent teen pregnancies by strengthening healthy relationships, reproductive
practices, and positive youth assets. The objective of this study was to compare time to a repeat pregnancy between the intervention
and usual care groups, and, secondarily, to determine whether treatment intensity influenced time to subsequent conception.
Primiparous pregnant teens ages 15–19, were recruited in Washington, DC. Of 849 teens screened, 29.3% (n = 249) met inclusion criteria, consented to participate, and completed baseline measures. They were then randomized to the
intervention (N = 124) or to usual care (N = 125). Intervention group teens received cell phones for 18 months of counseling sessions, and quarterly group sessions.
Follow-up measures assessed subsequent pregnancy through 24 months post-delivery. A survival analysis compared time to subsequent
conception in the two treatment groups. Additional models examined the effect of treatment intensity. By 24 months, 31% of
the intervention and 36% of usual care group teens had a subsequent pregnancy. Group differences were not statistically significant
in intent-to-treat analysis. Because there was variability in the degree of exposure of teens to the curriculum, a survival
analysis accounting for treatment intensity was performed and a significant interaction with age was detected. Participants
who were aged 15–17 years at delivery showed a significant reduction in subsequent pregnancy with increased levels of intervention
exposure (P < 0.01), but not those ≥18 years. Adolescents ≥18 years faced considerable challenges to treatment success. Individual, social,
and contextual factors are all important to consider in the prevention of repeat teen pregnancy. Cell phone-based approaches
to counseling may not be the most ideal for addressing complex, socially-mediated behaviors such as this, except for selective
subgroups. A lack of resources within the community for older teens may interfere with program success.
teen mothers are at risk for adverse psychosocial outcomes. When adolescents are strongly attached to parents, schools, and
positive peers, they may be less likely to repeat a pregnancy. This study tested the efficacy of a counseling intervention
delivered by cell phone and focused on postponing subsequent teen pregnancies by strengthening healthy relationships, reproductive
practices, and positive youth assets. The objective of this study was to compare time to a repeat pregnancy between the intervention
and usual care groups, and, secondarily, to determine whether treatment intensity influenced time to subsequent conception.
Primiparous pregnant teens ages 15–19, were recruited in Washington, DC. Of 849 teens screened, 29.3% (n = 249) met inclusion criteria, consented to participate, and completed baseline measures. They were then randomized to the
intervention (N = 124) or to usual care (N = 125). Intervention group teens received cell phones for 18 months of counseling sessions, and quarterly group sessions.
Follow-up measures assessed subsequent pregnancy through 24 months post-delivery. A survival analysis compared time to subsequent
conception in the two treatment groups. Additional models examined the effect of treatment intensity. By 24 months, 31% of
the intervention and 36% of usual care group teens had a subsequent pregnancy. Group differences were not statistically significant
in intent-to-treat analysis. Because there was variability in the degree of exposure of teens to the curriculum, a survival
analysis accounting for treatment intensity was performed and a significant interaction with age was detected. Participants
who were aged 15–17 years at delivery showed a significant reduction in subsequent pregnancy with increased levels of intervention
exposure (P < 0.01), but not those ≥18 years. Adolescents ≥18 years faced considerable challenges to treatment success. Individual, social,
and contextual factors are all important to consider in the prevention of repeat teen pregnancy. Cell phone-based approaches
to counseling may not be the most ideal for addressing complex, socially-mediated behaviors such as this, except for selective
subgroups. A lack of resources within the community for older teens may interfere with program success.
- Content Type Journal Article
- Pages 1-12
- DOI 10.1007/s10995-011-0860-3
- Authors
- Kathy S. Katz, Department of Pediatrics/Psychiatry, Georgetown University Medical Center, 2115 Wisconsin Ave NW Suite 200, Washington, DC 20007, USA
- Margaret Rodan, George Mason University, 4400 University Dr, MS-3C4, Fairfax, VA 22030, USA
- Renee Milligan, George Mason University, 4400 University Dr, MS-3C4, Fairfax, VA 22030, USA
- Sylvia Tan, RTI International, 701 13th St NW Suite 750, Washington, DC 20005, USA
- Lauren Courtney, RTI International, 701 13th St NW Suite 750, Washington, DC 20005, USA
- Marie Gantz, RTI-International, 3040 East Cornwallis RD, Research Triangle Park, NC 27709, USA
- Susan M. Blake, Department of Prevention and Community Health, The George Washington University Medical Center, 2175 K ST NW, Suite 700, Washington, DC 20037, USA
- Lenora McClain, Department of Child and Maternal Health, Howard University Hospital, 2041 Georgia Ave NW, Room 5-H01, Washington, DC 20060, USA
- Maurice Davis, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive BLVD, Rm 7B13 J, Rockville, MD 20852, USA
- Michele Kiely, DESPR/NICHD/NIH, 6100 Executive BLVD, Rm 7B05, Rockville, MD 20852, USA
- Siva Subramanian, Department of Neonatology, Georgetown University Medical Center, 3800 Reservoir RD NW. Main 3400, Washington, DC 20007, USA
- Journal Maternal and Child Health Journal
- Online ISSN 1573-6628
- Print ISSN 1092-7875