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.
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Acknowledgments
This study was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Center on Minority Health and Health Disparities, National Institutes of Health (3U18HD030445, 3U18HD030447, 5U18HD31206, 3U18HD031919, and 5U18HD036104). We offer posthumous acknowledgement of the tremendous contribution of Dr Lorraine Klerman and Dr Nabil El-Khorazaty to the development of the GirlTalk study. We thank the dedicated teen counselors Julia Baidoo, Tanya Gooding, Danielle Norman, Tina Arrington, Kristine Andrews, Vernessa Perry and Misti Washington, the interviewers, and the data management staff. Collaborating researchers included Jutta Thornberry BS, Sharon Ramey, PhD, Robin Lanzi, PhD, and Davene White NNP,MPH. Also, we thank the teen participants and their families, who welcomed us into their lives in hopes of helping themselves and their children..
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Katz, K.S., Rodan, M., Milligan, R. et al. Efficacy of a Randomized Cell Phone-Based Counseling Intervention in Postponing Subsequent Pregnancy Among Teen Mothers. Matern Child Health J 15 (Suppl 1), 42–53 (2011). https://doi.org/10.1007/s10995-011-0860-3
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DOI: https://doi.org/10.1007/s10995-011-0860-3