A multifaceted 18-month program for adolescent girls at high risk for pregnancy led to more consistent use of contraception, researchers found.
Girls who participated in the program reported using condoms with their partners all or most of the time in 1.53 of the previous 6 months, compared with 0.93 months in controls, for an adjusted relative risk of 1.57 (95% CI 1.28 to 1.94), according to Renee E. Sieving, RN, PhD, of the University of Minnesota in Minneapolis, and colleagues.
They also used hormonal contraceptives more consistently, in 3.29 months compared with 2.34 months in controls (RR 1.30, 95% CI 1.06 to 1.58), and both methods of birth control for 0.65 versus 0.42 months (RR 1.36, 95% CI 1.01 to 1.85) the researchers reported online in JAMA Pediatrics.
While rates of teen pregnancy have fallen in recent years, at least 750,000 U.S. adolescents become pregnant every year, setting the stage for lifelong difficulties owing to less education and lower income for the young mothers and costing society more than $10 billion in 1 year alone.
To help at-risk adolescent girls avoid pregnancy, a program named Prime Time has been designed for use in primary care clinics with the goals of teaching teens about sexual risks, prevention of violence and aggression, and encouraging connectedness to home and school.
Each participant was assigned to a case manager, and during monthly one-on-one sessions the teen's individual needs and interests were explored and addressed. Consistency of contraceptive use and other responsible sexual behaviors were emphasized in these regular sessions, and condoms were provided.
A second component of the program involved training participants to act as educators for their peers, emphasizing relationship skills and expectations, influences on sexual activity, and understanding of contraception.
An additional aspect was encouraging the teens to develop leadership capabilities in projects directed toward community services.
The study included 253 girls ages 13 to 17 considered to be at risk for various reasons such as having undergone treatment for a sexually transmitted infection, exhibiting aggressive behavior, or school avoidance, as well as 318 controls.
The effects of the intervention were assessed during a follow-up survey 6 months after completion of the program.
At the time of follow-up there were no differences between cases and controls in the number of male sexual partners in the previous 6 months, with 1.39 for cases and 1.34 for controls.
Two-thirds of program participants reported only one sexual partner during the past 6 months, so this aspect of decreasing risk was less relevant than consistency of contraceptive use, the researchers noted.
The teens who participated in the program reported greater involvement in their families, which was thought to be a considerable benefit since many were from socioeconomically deprived families.
"Expanding opportunities that foster positive family communication and connectedness may be critical to sustaining healthy sexual behaviors, including contraceptive use, especially for youth from disadvantaged contexts," they wrote.
At follow-up, 61.5% of the intervention group were attending college or technical school, compared with 44.2% of controls.
Significantly fewer intervention group participants reported having had sex in order to acquire material possessions (6% versus 11.9%, OR 0.50, 95% CI 0.41 to 0.61), and they were more willing to refuse unwanted sex.
"Reductions in perceived importance of having sex for material reasons along with improvements in self-confidence to refuse unwanted sex may be indicators of establishing clear sexual relationship boundaries within the intervention group," observed Sieving and colleagues.
Limitations of the study included self-report of sexual behaviors and uncertainty as to how the close involvement of case managers contributed to the intervention's success.
"Results from this study suggest that involvement in a youth development intervention that combines individualized case management and youth leadership components holds great promise for preventing multiple risk behaviors among youth most vulnerable to poor health outcomes, including early pregnancy," concluded Sieving and colleagues.
The study was funded by the National Institute of Nursing Research, the CDC, and the Bureau of Health Professions at the Health Resources and Services Administration.
The lead author is principal investigator for the Prime Time study.
- Reviewed by F. Perry Wilson, MD, MSCE Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner