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Having the Best Intentions is Necessary but not Sufficient: What would Increase the Efficacy of Home Visiting for Preventing Second Teen Pregnancies?

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Abstract

Objective: Identify ways to increase the impact a well-known home-based intervention—the Nurse Family Partnership (NFP)—has on conception rates among teenage mothers. Methods: Secondary analysis of data collected on 111, 13-to-19 years old, primiparas who were visited in their homes by nurses during, and for 2 years after pregnancy. Data bearing on assistance with family and career planning were culled from the nurses’ records. These were graded on a 3-point scale. Higher scores reflected more active, therapeutic interventions. The primary outcome was repeat pregnancy. Results: The pregnancy rate at 6, 12, and 24 months was 8.3%, 18.4%, and 28.1%. Teenagers who conceived were less likely to have used contraceptives during the previous six months than those who did not. Almost everyone received the recommended number of visits. However, discussions and active interventions related to lapses in contraceptive use were only documented during 30% of visits. Those who conceived had as many visits and discussions of this type as those who did not. Nurses rarely involved boyfriends and family. Other differences between teens that did and did not conceive support the NFP theoretical framework. Conclusions: Contrary to the stated aims of the intervention, the nurses rarely documented therapeutic interventions that could make repeated childbearing fit less harmoniously into the teenagers’ lives. The best way to strengthen the impact of this program on teen pregnancy rates is to deepen the nurses’ training so that they are able to intervene actively enough to bring about behavioral change in family planning.

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References

  • American Academy of Pediatrics. (1998). The role of home-visitation programs in improving health outcomes for children and families. Pediatrics, 101, 486489.

    Google Scholar 

  • Blankson, M. L., Cliver, S. P., Goldenberg, R. L., Hickey, C. A., Jin, J., & Dubard, M.B. (1990). Health behavior and outcomes in sequential pregnancies of black and white adolescents. Journal of the American Medical Association, 296, 14011403.

    Google Scholar 

  • Blum R. W. Improving the health of youth. (1998). A community health perspective. Journal of Adolescent Health, 23, 254258.

    Google Scholar 

  • Chervin, D. D., Philliber, S., Brindis, C. D., Chadwick, A. E., Revels, M. L., Kamin, S. L., et al. (2005). Community capacity building in CDC’s Community Coalition Partnership Programs for the Prevention of Teen Pregnancy. Journal of Adolescent Health, 37, S11–S19.

    Article  PubMed  Google Scholar 

  • Darroch, J. E., Singh, S., Frost, J. J., and the Study Team. (2001). Differences in teenage pregnancy rates among five developed countries: the roles of sexual activity and contraceptive use. Family Planning Perspectives, 33, 244250.

    Google Scholar 

  • DiCenso, A., Guyatt, G. H., & Griffith, W. L. (2002). Interventions to reduce unintended pregnancies among adolescence: Systematic review of randomized controlled trials. British Journal of Medicine, 324, 14261430.

    Article  Google Scholar 

  • Duggan, A. K., McFarlane, E., Fuddy, L., Burrell, L., Higman, S. M., Windhan, A., & Sia, C. (2004). Randomized trial of a state-wide home visiting program to prevent child abuse: impact in preventing child abuse and neglect. Child Abuse and Neglect, 28, 597–622.

    Article  Google Scholar 

  • Duggan, A. K., Starfield, B., Deangelis, C. (1990). Structured encounter forms: the impact on provider performance and recording of well-child care. Pediatrics, 85, 104–113.

    CAS  PubMed  Google Scholar 

  • El-Kamary, S. S., Higman, S. M., Fuddy, L., McFarlane, E., Sia, C., & Duggan, A. K. (2004). Hawaii’s healthy start home visiting program: Determinants and impact of rapid repeat birth. Pediatrics, 114, e317.

    Article  PubMed  Google Scholar 

  • Ford, K., Sohn, W., & Lepkowski, J. (2001). Characteristics of adolescents’ sexual partners and their association with use of condoms and other contraceptive methods. Family Planning Perspectives, 33, 100105.

    Article  CAS  PubMed  Google Scholar 

  • Gallup-Black, A., & Weitzman, B. C. (2004). Teen pregnancy and urban youth: Competing truths, competency, and perceptions of the problem. Journal of Adolescent Health, 34, 366375.

    Article  PubMed  Google Scholar 

  • Geronimus, A. T. (1991). Teenage childbearing and social and reproductive disadvantage: The evolution of complex questions and the demise of simple answers. Family Relationships, 40, 463471.

    Article  Google Scholar 

  • Ginsberg, K. R., Alexander, P. M., Hunt, J., Sullivan, M., Zhao, H., & Cnaan, A. (2002). Enhancing their likelihood for a positive future: The perspective of inner-city youth. Pediatrics, 109, 11361143.

    Article  Google Scholar 

  • Gomby, D. S. Culross, P. L., & Behrman, R. E. (1999). Home visiting: recent program evaluation – analysis and recommendations. Future of Children, 9, 426.

    Article  CAS  PubMed  Google Scholar 

  • Jumping-Eagle S., Sheeder J., & Stevens-Simon, C. (2005). When are “assets” protective? Journal of Pediatric and Adolescent Gynecology, 18, 223.

    Google Scholar 

  • Kelly, L. S., Sheeder, J. L., Scott, S., & Stevens-Simon, C. (2005). Another chicken and egg dilemma: teen pregnancy, parity, and prematurity. Journal of Pediatric and Adolescent Gynecology, 18, 209.

    Google Scholar 

  • Kershaw, T. S., Niccolai, L. M., Ickovics, J. R., Lewis, J. B., Meade, C. S., & Ethier, K.A. (2003). Short and long-term impact of adolescent pregnancy on postpartum contraceptive use: Implications for prevention of repeat pregnancy. Journal of Adolescent Health, 33, 359–68.

    Article  PubMed  Google Scholar 

  • Key, J., Barbosa, G., & Owens, V. (2001). The second chance club: repeat adolescent pregnancy prevention with a school-based intervention. Journal of Adolescent Health, 28, 167169.

    Article  CAS  PubMed  Google Scholar 

  • Klerman, L.V. (2004). Another Chance: Preventing additional births to teen mothers. The National Campaign to Prevent Teen Pregnancy.

  • National Commission to Prevent Infant Mortality. (1989). Home Visiting: Opening Doors for America’s Pregnant Women and Children. Washington, DC.

  • Olds, D. L., Robinson, J. A., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R. K., et al. (2004). Effect of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial. Pediatrics, 114, 1560–1568.

    Article  PubMed  Google Scholar 

  • Olds, D. L., Robinson, J., O’Brien, R., Luckey, D. W., Pettitt, L. M., Henderson, C. R., et al. (2002). Home visiting by paraprofessional and by nurses: a randomized, controlled trial. Pediatrics, 110, 486496.

    Article  PubMed  Google Scholar 

  • Olds, D. L. (2002). Prenatal and infancy home visiting by nurses: from randomized trials to community replication. Prevention Science, 3, 153–172.

    Article  PubMed  Google Scholar 

  • Philliber, S., Kaye, J. W., Herrling, S., & West, E. (2002). Preventing pregnancy and improving health care access among teenagers: An evaluation of the Children’s Aid Society – Carrera Program. Family Planning Perspectives, 34, 244–251.

    Google Scholar 

  • Quint, J. C., Bos, J. M., & Polit, D.F. (1997). New Chance: Final report on a comprehensive program for young mothers in poverty and their children. Manpower Demonstration Research Corporation, San Francisco, California.

  • Resnick, M. D., Bearman, P. S., Blum, R. W., Bauman, K. E., Harris, K. M., Jones, J., et al. (1997). Protecting adolescents from harm. Journal of the American Medical Association, 278, 823832.

    Article  CAS  PubMed  Google Scholar 

  • Rigsby, D. C., Macones G. A., & Driscoll D. A. (1998). Risk factors for rapid repeat pregnancy among adolescent mothers: a review of the literature. Journal of Pediatric and Adolescent Gynecology, 11, 11526.

    CAS  PubMed  Google Scholar 

  • Roth J., & Brooks-Gunn, J. (1998). Promoting healthy adolescents: Synthesis of youth development program evaluations. Journal of Research in Adolescence, 8, 423459.

    Article  Google Scholar 

  • Seitz, V., & Apfel, N. H. (1993). Adolescent mothers and repeat childbearing: Effects of a school-based intervention program. American Journal of Orthopsychiatry, 63, 572581.

    CAS  PubMed  Google Scholar 

  • Shea, S., DuMouchel, W., & Bahamonde, L. (1996). A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. Journal of the American Medical Information Association, 3, 399409.

    CAS  Google Scholar 

  • Sheeder, J. L., Scott, S., & Stevens-Simon, C. (2004). The electronic report on adolescent pregnancy (ERAP). Journal of Pediatric & Adolescent Gynecology, 17, 341346.

    Article  Google Scholar 

  • Stevens-Simon, C., Beach, R., & Klerman, L. V. (2001). To be rather than not to be, that is the problem with the question. Archives of Pediatrics and Adolescent Medicine, 155, 12981300.

    CAS  PubMed  Google Scholar 

  • Stevens-Simon, C., Kelly, L., & Kulick, R. (2001). A village would be nice but it takes a long acting contraceptive to prevent repeat adolescent pregnancies. American Journal of Preventive Medicine, 21, 6065.

    Article  CAS  PubMed  Google Scholar 

  • Stevens-Simon, C., & Kelly, L. S. (1999). Effect of Norplant on repeat conceptions among adolescent mother. Family Planning Perspectives, 31, 8893.

    Article  CAS  PubMed  Google Scholar 

  • Stevens-Simon, C., & Lowy, R. (1995). Is teenage childbearing an adaptive strategy for the socioeconomically disadvantaged or a strategy for adapting to socioeconomic disadvantage? Archives of Pediatrics and Adolescent Medicine, 149, 912915.

    CAS  PubMed  Google Scholar 

  • Stevens-Simon, C., Roghmann, K. J., & McAnarney, E. R. (1990). Repeat adolescent pregnancy and low birthweight: Methods Issues. Journal of Adolescent Health Care, 11, 114118.

    Article  CAS  PubMed  Google Scholar 

  • Stevens-Simon, C. (2003). A cautionary note. Journal of Adolescent Health, 33, 322.

    Article  PubMed  Google Scholar 

  • Stevens-Simon, C. (2003). Ducks have ducks, unless. Pediatrics, 111, 446447.

    Article  PubMed  Google Scholar 

  • US Department of Health and Human Services. (2000). Healthy People 2010 Conference Edition. Vols 1 and 2; Washington, DC: US Department of Health and Human Services.

  • Zavodny, M. (2001). The effect of partners’ characteristics on teenage pregnancy and it resolution. Family Planning Perspectives, 33, 192199.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The investigators thank Dr David Olds for his helpful comments in preparing this manuscript.

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Correspondence to Jeanelle Sheeder.

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Gray, S., Sheeder, J., O’Brien, R. et al. Having the Best Intentions is Necessary but not Sufficient: What would Increase the Efficacy of Home Visiting for Preventing Second Teen Pregnancies?. Prev Sci 7, 389–395 (2006). https://doi.org/10.1007/s11121-006-0045-2

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