Abstract
Introduction
A small but growing body of evidence suggests individualized support services and improved access to contraception can promote healthy birth spacing among adolescent mothers. This study examines the effectiveness of Steps to Success, a 2-year home visiting program in San Angelo, Texas, enhanced with content designed to reduce rapid repeat pregnancy among young mothers, increase fathers’ involvement, and support mothers’ education and career aspirations.
Methods
The study used a randomized controlled trial, with 594 young mothers ages 14–20 randomly assigned to either a program group that received Steps to Success or a control group that received an existing home visiting program focused only on parenting and child development. Women in both research groups completed a baseline survey upon enrolling in the study and 1- and 2-year follow-up surveys.
Results
After 2 years, participants in the Steps to Success and existing home visiting groups had similar rates of repeat pregnancy. However, women in the Steps to Success group were more likely to use long-acting reversible contraceptives (effect size = 0.18, p = 0.066), particularly younger adolescent mothers ages 14–18 (effect size = 0.34, p = 0.010). Steps to Success also decreased the incidence of unprotected sex for younger adolescent mothers (effect size = -0.25, p = 0.035). Steps to Success did not improve outcomes in other domains.
Discussion
Steps to Success improved some outcomes related to healthy birth spacing among younger adolescent mothers. Communities interested in similar programming may want to consider focusing their services on this age group.
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Data Availability
This data is available here: https://www.icpsr.umich.edu/web/ICPSR/studies/38138.
Code Availability
Analyses were conducted using RCT-YES, which is freely available at www.rct-yes.com.
Notes
Random assignment was not stratified in the first 2 months of assignment. Our main analysis treats the 40 women who enrolled during these first 2 months as if they were randomly assigned in the same manner used to assign those who were enrolled later in the study period. However, our findings are robust to treating this group as a separate (third) random assignment stratum. We discuss our sensitivity analysis below.
Our results are robust to the exclusion of these 21 mothers from the analysis.
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Acknowledgements
Many people contributed in significant ways to this study. First, we acknowledge the valued support of staff at the Administration for Children and Families, U.S. Department of Health and Human Services. We particularly thank our project monitor, Kathleen McCoy; project officer, Caryn Blitz; and former project officers, Seth Chamberlain, Clare DiSalvo, and Dirk Butler, for their oversight and guidance throughout the project. We also thank Kenyatta Parker, Kathleen McCoy, and Caryn Blitz for reviewing and providing thoughtful comments on this research. We also received support from many of our colleagues at Mathematica. We thank Melissa Thomas, Robert Sheaff, and Season Bedell for overseeing the successful survey data collection. We thank Hanley Chiang, John Deke, and Ken Fortson for expert guidance on the evaluation design and analysis methods; Morgan Kolarich for valuable programming assistance; Lauren Murphy and Adrienne Jones for assistance with processing the administrative data; and Brian Goesling for helpful comments. Finally, we express our gratitude to staff members from Healthy Families San Angelo. Without their creativity, energy, and willingness to subject their program to rigorous evaluation, this study would not have been possible. Any opinions, findings, conclusions, or recommendations expressed in this article are those of the authors and do not necessarily reflect the view of their institutions, the U.S. Department of Health and Human Services, or the U.S. government.
Funding
This research was funded by the Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services (contract number HHSP23320110011YC).
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This study was reviewed and approved by the New England Institutional Review Board (#12-352).
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All mothers ages 18 years or older, provided informed consent. For mothers younger than 18, a parent or legal guardian provided informed consent and the mother provided assent.
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Rotz, D., Shiferaw, M. & Wood, R.G. The Impact of a Home Visiting Program Enhanced to Address Repeat Adolescent Pregnancy—A Randomized Controlled Trial of Steps to Success. Matern Child Health J 26, 1453–1463 (2022). https://doi.org/10.1007/s10995-022-03413-6
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DOI: https://doi.org/10.1007/s10995-022-03413-6