Objectives. We evaluated the effectiveness of care demonstration projects supported by the Title XX Adolescent Family Life (AFL) program, which serves pregnant and parenting adolescents in an effort to mitigate the risks associated with adolescent childbearing.

Methods. This cross-site evaluation involved 12 projects and 1038 adolescents who received either enhanced services funded by the AFL program or usual care. We examined the effects of enhanced services on health, educational, and child care outcomes approximately 6 months to 2 years after intake and explored moderation of program effects by time since intake and project characteristics associated with outcomes.

Results. The odds of using long-acting reversible contraception (odds ratio [OR] = 1.58) and receiving regular child care (OR = 1.50) in the past month were higher in the intervention group than in the comparison group. Odds of a repeat pregnancy were lower (OR = 0.39) among intervention group adolescents than among comparison group adolescents within 12 months of intake. Several project characteristics were associated with adolescent health outcomes.

Conclusions. These projects show promise in improving effective contraceptive use, increasing routine child care, and yielding short-term decreases in repeat pregnancy.

Enhancements to supportive services targeting pregnant and parenting adolescents can improve maternal and child outcomes, including repeat pregnancy, educational attainment, and child well-being.1,2 The disadvantages faced by adolescent mothers and their children3,4 can be mitigated by providing high-quality programs at school or home visits, case management, and mentoring.2,5,6 One such program, the Title XX Adolescent Family Life (AFL) program, was established to support demonstration projects in developing, implementing, and evaluating innovative strategies to serve pregnant and parenting adolescents, their infants, male partners, and family members. The goals of the AFL program include reducing the number of repeat adolescent pregnancies and increasing educational attainment.7 The program also targets contraceptive use and receipt of child care (Figure 1). This study involved a multisite evaluation to assess effectiveness of selected AFL care demonstration projects in achieving these goals.

Prior efforts to improve outcomes for pregnant and parenting adolescents—repeat pregnancy and birth, contraception, and educational attainment—have had mixed results. Some individual randomized controlled trials of home visiting and family support programs have found no effect on repeat pregnancy or birth,8–10 but other randomized controlled trials of motivational interviewing, home-based monitoring, and multicomponent interventions have shown promising effect.11–13 Two individual studies reported intervention group repeat birth rates (13.8% and 11%) that were about half the control group rates (25% and 24%).11,12 A meta-analysis of 16 experimental and quasi-experimental evaluations that were diverse with regard to sample and interventions found moderate effects on repeat pregnancy over approximately 18 months of follow-up that disappeared at later follow-up.1 Fewer studies have examined program effects on contraception, but 1 posttest-only quasi-experimental study of a comprehensive school-based program found higher rates among intervention than among comparison group respondents for current use of contraception (86.7% vs 77.4%) and ever use of Depo-Provera (56.9% vs 45.8%).14 For educational outcomes such as preventing dropout and increasing school attendance or graduation, a review2 and individual randomized controlled trials8,13,15 indicated that program models involving peer support groups, community-based home visiting, or comprehensive case management showed promising evidence. One individual randomized controlled trial of a home visiting program found that the odds of school continuation were 3.5 times higher among intervention than among control group respondents8; another randomized controlled trial that tested a peer support prenatal care intervention found that intervention group respondents completed 0.5 year more school by 12 months postpartum than did control group respondents.15 However, 2 home-visiting programs did not affect graduation rates in separate randomized controlled trials.9,16

Despite the emerging base of randomized controlled trials of pregnant and parenting adolescent programs, limitations such as small sample sizes and high attrition persist.1,5 These studies often examine a limited number of outcomes, and some outcomes of importance have not been investigated. For instance, no rigorous studies have evaluated program effect on long-acting contraceptive use, which is linked to reduced risk for repeat or unintended pregnancy.17,18 Receipt of regular child care, which may enable adolescent mothers to advance their education or seek employment and may improve child development, also has not been examined as a program outcome.

Limited information is also available about the project characteristics associated with program effectiveness in this population. Programs that have been successful in postponing additional births have initiated services during the prior pregnancy and continued to the end of the child’s second year.5 For example, effective home-visiting programs initiated services early and sustained the length of service delivery with specially trained nurses who followed a regular schedule and discussion protocol at each visit.19,20 More broadly, effective curriculum-based adolescent pregnancy prevention programs use activities, instructional methods, and behavioral messages that are appropriate to adolescents’ culture, developmental age, and sexual experience.21

Although local evaluations of AFL demonstration projects have yielded some evidence of individual project effectiveness,8,11,22–24 no multisite evaluations of programs for pregnant and parenting adolescents have been conducted to examine effects across program models and with diverse populations. This national cross-site evaluation provided an opportunity to understand, through rigorous evaluation, the overall effect of 12 AFL demonstration projects on repeat pregnancy, educational attainment, contraceptive use, and child care receipt, as well as project characteristics associated with effectiveness. We hypothesized that odds of repeat pregnancy and school dropout would be lower, and educational attainment and odds of using long-acting contraception and receiving regular child care would be higher, among intervention than among comparison group adolescents. Given prior evidence of diminishing program effects on repeat pregnancy over time1 and the variation in intervention duration across projects, the evaluation examined the extent to which intervention effects and effects of project characteristics varied as a function of time since intake.

Only demonstration projects with experimental (i.e., randomized controlled trial) or quasi-experimental local evaluation designs (i.e., enrolling matched groups of intervention and comparison adolescents) were included in the cross-site evaluation. Table 1 presents descriptive information about the participating projects. Twelve pregnant and parenting adolescent projects in 10 states recruited participants. Because of differences in local evaluation designs among the projects, different sampling methods were used for each project. However, sampling methods were similar at each project for intervention and comparison respondents.

Table

TABLE 1— Selected Project Characteristics: Adolescent Family Life Program, 2009

TABLE 1— Selected Project Characteristics: Adolescent Family Life Program, 2009

Grantee NameLocationApproaches UsedEvidence-Based Curricula UsedMean Dosage, h
Arlington Independent School DistrictArlington, TXHV, CM, SBNone31–50
Children’s Hospital BostonBoston, MAHV, CMAnsel Casey Life Skills; Nurturing Parenting Program5
Children’s National Medical CenterWashington, DCHV, CMNone7–13
The Children’s ShelterSan Antonio, TXHV, MT, CMNurturing Parenting Program76–100
Congreso de Latinos UnidosPhiladelphia, PAHV, CMBe Proud/Be Responsible; Partners in Parenting Education4
La Clinica de la Raza, Inc.Oakland, CACMCentering Pregnancy21–30
Metro Atlanta Youth for ChristAtlanta, GAHV, CM, SBBecoming a Responsible Teen21–30
San Mateo County Health SystemSan Mateo, CAHV, CM, SBStrengthening Multiethnic Families51–75
Truman Medical CenterKansas City, MOHV, MTNone31–50
University of Maryland, BaltimoreBaltimore, MDHV, CM, SBAdapted Three Generations Parenting Curriculum51–75
University of UtahSalt Lake City, UTHV, CMNone21–30
The Village for Families and Children, Inc.Hartford, CTHV, CM, SBCommon Sense Parenting; Parents as Teachers; 24/7 Dad7–13

Note. CM = case management; HV = home visiting; MT = mentoring; SB = school-based activities. For the purpose of this study, curricula were considered evidence-based if at least 1 evaluation study demonstrated statistically significant program effects on 1 or more outcomes.

Most of the projects indicated that adolescents were selected to participate in the project by self-referral or a referral from a school, physician, or clinic, and 80% of the projects indicated that intervention services were generally available to all adolescents in need rather than being targeted to specific subgroups. To be eligible for inclusion in the cross-site evaluation, adolescents had to be female, aged 19 years or younger at the time of baseline data collection, and able to read English or Spanish to complete the evaluation instrument and provide written consent or assent for their participation. Parents of adolescents aged 17 years or younger had to be able to speak English or Spanish to consent to their child’s participation.

Effectiveness data were collected with self-administered paper-and-pencil instruments or computer-assisted self-interviews at baseline (August 2008 to April 2010), at 6 and 12 months after birth (for adolescents pregnant at baseline, n = 569), and at 1 year after baseline (for adolescents parenting at baseline, n = 469). Privacy and data security were ensured during survey administration to maximize measurement quality.

Power analyses indicated that 700 adolescents would need to complete a survey at final follow-up to yield 0.80 power to detect a program effect on repeat pregnancy comparable in magnitude to that of previous studies (e.g., 11% in the intervention group vs 24% in the control group).12 Consent was obtained for 1157 adolescents (79% of those who received a consent form). Among the adolescents with consent, 1038 (90%) completed a baseline survey, and 794 (76% of those completing a baseline survey) participated at final follow-up. At baseline, participants were aged 12 to 19 years (mean = 17 years), average gestational age among pregnant adolescents was 22 weeks (SD = 9 weeks), and average target child age among parenting adolescents was 8.7 months (SD = 10.8 months).

Intervention and Comparison Groups

Projects are required to offer both intervention and comparison adolescents the following 10 core services directly or by referral:

    pregnancy testing and maternity counseling,

    adoption counseling and referral services,

    primary and preventive health care services (including prenatal and postnatal care),

    nutrition information and counseling,

    referral for screening and treatment of sexually transmitted infections, including HIV/AIDS,

    referral to appropriate pediatric care,

    educational services related to family life and problems associated with adolescent premarital sexual relations,

    appropriate educational and vocational services,

    mental health services, and

    counseling and referral for family planning services.25

In addition, intervention groups received a variety of enhanced services (Table 1), including home visiting (93%) and case management (86%), and a few groups received school-based activities (29%) and mentoring (21%). About 57% of the intervention groups provided child care services during project activities, which were delivered primarily in participants’ homes, in schools, and in health clinics. Intervention groups received a median of 21 to 30 hours of project activities, and most groups received services at least once every 2 weeks. Project activities were provided to intervention group participants over a 6- to 24-month period.

Measures

Respondent outcome measures were pilot tested to assess respondent comprehension and comfort, as well as likelihood of reporting errors; measures were subsequently improved before the main study began. Repeat pregnancy was measured by asking respondents who were pregnant at baseline to indicate at follow-up whether they had been pregnant since their baseline pregnancy ended and by asking respondents who were parenting at baseline whether they had been pregnant since the baseline survey. Measures of contraception and educational attainment were adapted from the National Survey of Family Growth.26 Past-month use of long-acting, reversible contraception included use of the intrauterine device, the contraceptive implant, or injectable contraceptives to prevent pregnancy.17,18 Educational attainment was measured in 2 ways: current school status (“in school or general equivalency diploma [GED] program” or “graduated from high school or completed GED” vs “dropped out of school”) and the highest grade that respondents reported completing (8th grade or below, 9th grade, 10th grade, 11th grade, 12th grade, some college, college degree or more; this variable was treated as continuous). Respondents also indicated whether their child received any regular child care (at least once a week for a month or more) in the past 4 weeks, including day care, nursery school, playgroup, babysitter, after-school care, relative care, or some other child care plan.

Project characteristics were assessed with implementation evaluation surveys completed in December 2009 by project staff via an enclosure in the annual end-of-year grantee report template. These characteristics included whether messages about sexual behavior were tailored, whether project activities occurred at school during school hours, frequency of school-based activities, whether home visiting was provided by social workers or nurses, frequency of home visits, frequency of case manager meetings, proportion of adolescents completing the intervention, and average duration of participant receipt of project activities.

Statistical Analyses

We conducted an intent-to-treat analysis, comparing respondents originally assigned to receive intervention activities with respondents assigned to the comparison group. We first estimated multilevel regression models, to account for respondents clustered within projects and repeated observations, with treatment group predicting each outcome measure. We estimated linear regression models (SAS version 9.2 PROC MIXED; SAS Institute, Cary, NC) for continuous outcomes and logistic regression models (SAS version 9.2 PROC GLIMMIX; SAS Institute, Cary, NC) for binary outcomes. These models controlled for baseline values on the outcome under examination (if available) and baseline values for variables on which the intervention and comparison groups differed.

We also examined associations between specific project characteristics of intervention groups; long-acting, reversible contraception; and repeat pregnancy. These project characteristics were selected because descriptive analyses identified sufficient cell sizes and variation among the 12 projects to warrant testing of associations with respondent outcomes. Intervention group adolescents were coded as being exposed or not being exposed to each AFL-funded project characteristic under examination, depending on the project from which they were drawn; comparison group adolescents were included in the models and coded as not being exposed to each characteristic.

To investigate short-term compared with longer-term program effects, we then examined the extent to which group differences varied as a function of time since intake, which was dichotomized as 12 months or less versus more than 12 months. (This cutpoint was based on prior study findings1 and because 12 months was the approximate median time since intake.) We tested for moderation by adding time since intake and an interaction term between this variable and treatment group membership to the regression models. When the interaction term was significant, we examined simple effects by time since intake to examine conditional program effects.

We used multiple imputation to address missing data. Most items had less than 10% missing data. Five data sets were imputed for the intervention group, and 5 data sets were imputed for the comparison group with SAS version 9.2 PROC MI (SAS Institute, Cary, NC). To retain clustering found in the complete case data, dummy codes for project site were included in the imputation models, and auxiliary variables (e.g., demographic characteristics, parent involvement, perceived importance of graduating from high school) were included in the imputation models to improve power and reduce attrition bias.27 The intervention and comparison data sets were then merged. Imputed values for dichotomous variables were rounded to 0 or 1 based on their association with a randomly generated number between 0 and 1. Estimates from regression models were combined with SAS version 9.2 PROC MI ANALYZE (SAS Institute, Cary, NC). Imputed data for both independent and dependent variables were included in analyses, which is customary given a sufficient number of data sets.28

After we controlled for demonstration project, we found 3 statistically significant baseline differences by group assignment (Table 2). Comparison group respondents were older and more likely to be parenting (rather than pregnant) at baseline than were intervention group respondents. Comparison group respondents also had completed more education at baseline than did intervention group respondents; however, this difference was no longer significant after accounting for age differences. We controlled for respondent age and pregnant versus parenting status at baseline in all remaining analyses.

Table

TABLE 2— Baseline Characteristics of Participants in Intervention and Comparison Groups: Adolescent Family Life Program, 2008–2010

TABLE 2— Baseline Characteristics of Participants in Intervention and Comparison Groups: Adolescent Family Life Program, 2008–2010

Intervention Group (n = 509), % or Mean ±SDComparison Group (n = 529), % or Mean ±SDTotal (n = 1038), % or Mean ±SD
Race/ethnicity
 Black or African American48.544.546.4
 Hispanic or Latino43.147.945.6
 Other8.47.68.0
Parenting (vs pregnant)**42.848.645.8
> 1 prior pregnancy14.718.416.7
Dropped out of school10.513.612.1
Romantic relationship with father of the child66.769.968.4
Age,** y16.8 ±1.317.3 ±1.417.1 ±1.3
Highest grade completed**10.3 ±1.410.7 ±1.410.6 ±1.4

Note. Group comparisons controlled for demonstration project.

**Intervention and comparison groups significantly different at P < .01.

Table 3 presents differences in outcomes between the intervention and comparison groups. The odds of using long-acting, reversible contraception and receiving regular child care in the past month were higher at follow-up in the intervention group than in the comparison group. Intervention and comparison groups were similar on repeat pregnancy, school dropout, and highest grade completed.

Table

TABLE 3— Tests of Differences Between Intervention and Comparison Groups at Follow-Up: Adolescent Family Life Program, 2009–2011

TABLE 3— Tests of Differences Between Intervention and Comparison Groups at Follow-Up: Adolescent Family Life Program, 2009–2011

Intervention Group, % or Mean ±SDComparison Group, % or Mean ±SDOR (95% CI) or b (SE)
Repeat pregnancy14.814.40.97 (0.62, 1.52)
 Within 12 mo of intake9.819.50.39* (0.16, 0.98)
 After 12 mo from intake16.412.81.39 (0.84, 2.30)
Used long-acting, reversible contraception in past mo39.231.61.58** (1.16, 2.14)
Received regular child care in past mo70.457.81.50** (1.12, 2.01)
Dropped out of school12.816.41.08 (0.63, 1.83)
Highest grade completed11.1 ±1.511.4 ±1.50.05 (0.07)

Note. CI = confidence interval; OR = odds ratio. Percentages and means are not adjusted for covariates that were included in the regression models.

*P < .05; **P < .01.

Moderation results indicated a statistically significant interaction between group membership and time since intake predicting repeat pregnancy (P < .01). Follow-up analyses conditioned on time since intake indicated that the odds of experiencing a repeat pregnancy within 12 months of intake were lower among intervention than among comparison group respondents. The odds of repeat pregnancy were similar for the intervention and comparison groups after 12 months from intake. No moderating influence of time since intake was found for any other outcomes.

As shown in Table 4, tailoring messages to the culture of adolescents or higher frequency of home visits was associated with reduced odds of repeat pregnancy within 12 months of intake and increased odds of past-month long-acting, reversible contraception use. Project activities at school during school hours, higher frequency of school-based activities, home visiting by a social worker, higher frequency of case manager meetings, and a higher proportion of adolescents completing the intervention were associated with higher odds of long-acting, reversible contraception use. We did not find evidence of association with outcomes for tailoring messages to the age or sexual experience of adolescents, for home visiting by nurses, or for longer duration of participant receipt of project activities.

Table

TABLE 4— Associations Between Project Characteristics and Adolescent Outcomes: Adolescent Family Life Program, 2009

TABLE 4— Associations Between Project Characteristics and Adolescent Outcomes: Adolescent Family Life Program, 2009

Implementation CharacteristicRepeat Pregnancy Within 12 Months of Intake, OR (95% CI)Repeat Pregnancy After 12 Months From Intake, OR (95% CI)Past-Month Long-Acting, Reversible Contraception Use, OR (95% CI)
Tailoring messages to adolescent
 Culture0.34 (0.12, 0.93)NS1.88 (1.34, 2.64)
 AgeNSNSNS
 Sexual experienceNSNSNS
Project activities at school during school hoursNSNS1.93 (1.25, 2.95)
Frequency of school-based activitiesNSNS1.15 (1.04, 1.26)
Home visiting by a
 Social workerNSNS1.67 (1.03, 2.71)
 NurseNSNSNS
Frequency of home visits0.73 (0.55, 0.97)NS1.12 (1.01, 1.24)
Frequency of meetings with case managerNSNS1.12 (1.04, 1.20)
Higher proportion of adolescents complete interventionNSNS1.19 (1.06, 1.34)
Longer duration of participant receipt of project activitiesNSNSNS

Note. CI = confidence interval; NS = not significant; OR = odds ratio.

This study found that participation in AFL demonstration projects was associated with increased use of reliable, effective contraception; increased use of regular child care; and short-term decreases in repeat pregnancy. This research advances the evaluation of programs for pregnant and parenting adolescents by involving projects across the United States that use a variety of approaches and by examining multiple outcomes. With a few exceptions, sample size was larger in this study than in recent randomized controlled trials included in a previous meta-analysis (in which number of participants ranged from 88 to 704).1 Attrition was also lower in this study (24%) than in many of the meta-analysis studies (26%–76%). Furthermore, this was the first study to report program effects on long-acting, reversible contraception and use of routine child care for parenting adolescents.

Adolescent mothers who elect to use long-acting, reversible contraception are less likely to experience subsequent pregnancy and birth than are those who use other contraceptive methods.17,29 The proportion of comparison group adolescent mothers who reported past-month use of long-acting, reversible contraception in this study was higher than the proportion of sexually active adolescents who reported ever using long-acting, reversible contraception in the National Survey of Family Growth (21.3%), but adolescent pregnancy and childbearing may be associated with greater use of long-acting, reversible contraception.18 Adolescents in the intervention group reported even higher rates of long-acting, reversible contraception use. Long-acting, reversible contraception is considered optimal because it does not require frequent action on the part of the user, and it is not user- or coitus-dependent. Child care was offered by many AFL projects during project activities as a recruitment strategy, but the projects increased receipt of regular child care across different sources, enabling pursuit of adolescents’ educational goals and potentially providing opportunities for socialization and school preparedness among their children. Adolescent mothers who are working or going to school are often eligible for child care assistance, although this varies from state to state; projects increased receipt of regular child care over and above assistance available to comparison group adolescents. It is important to note that this study was not able to assess the quality of child care that was received, which may have implications for child development; this is an important direction for future research.

Within 12 months of intake, participation in AFL projects was associated with decreased repeat pregnancy. Adolescent mothers are far more likely than their peers to become pregnant; nearly one fourth of adolescent mothers go on to have a second birth before they reach age 20 years.5 Few interventions have been able to document decreases in repeat pregnancy among this high-risk population.11–13 Our findings are consistent with a meta-analysis of programs for pregnant and parenting adolescents that found some short-term decreases in repeat pregnancy that did not persist over time.1 The reasons for a nonsignificant longer-term program effect on repeat pregnancy were not addressed in this study. It is possible that projects with a longer follow-up, either by design or because of difficulties locating respondents, also had weaker program effects.

Most of the intervention groups reported that participants received project activities for between 6 and 18 months, and approximately 50% of the groups reported that only about one half or fewer participants completed the intervention in its entirety. Determining whether the transience of this high-risk study population and the challenges faced by projects in following up with program dropouts accounted for differential effects over time should be addressed in future studies of interventions targeting pregnant and parenting adolescents. Longer involvement in a program by adolescent mothers may help postpone additional births, and participant involvement in an intervention for 2 years postpartum has been associated with long-term success.5 Although we did not find that duration of project involvement or proportion of adolescents completing the intervention was associated with repeat pregnancy (proportion completing was associated with long-acting, reversible contraception use), a restricted range on these variables may have made it difficult to detect significant associations. Identifying strategies for retaining pregnant and parenting adolescent program participants—particularly those from high-risk families and neighborhoods who are more likely to have adverse outcomes—is another future challenge for interventions.

We found no program effects on educational attainment, operationalized as school dropout and highest grade completed. This may be because of the small normative changes in these measures from baseline to follow-up. Future studies would benefit from more fine-grained assessment of educational attainment (for instance, asking whether respondents have completed additional months rather than years of schooling; asking for more detail about dropout and subsequent re-enrollment) and may need to assess these outcomes over a longer duration.

Understanding which project characteristics are most effective, which we began to do in this study, is important to inform future programs for pregnant and parenting adolescents. Our results showed that addressing adolescents’ culture, involving home visits by social workers, using school-based activities, and having frequent contact with adolescents are important program components. These findings add to previous reviews suggesting that individualized attention over a significant duration, well-trained staff, promotion of effective contraception, and provision of child care may be important for program success with this population.5 In contrast with other research, we did not find that home visiting by nurses was associated with program effectiveness.19,20

This study had several limitations. First, although 11 of 12 projects used randomization, baseline differences were found between intervention and comparison groups; we controlled for these differences analytically, but it is not clear how these differences may have affected the results. Second, the intervention approaches were highly localized, and projects with the strongest local evaluation designs were selected for this study rather than using a random sample of AFL projects; consequently, the findings are not generalizable to AFL projects overall. Third, self-report data were used in this study, but medical and school records may have provided more accurate data for some outcomes, such as long-acting, reversible contraception use and highest grade completed. Fourth, the study had a limited follow-up period when compared with other studies and what is recommended for outcomes such as repeat pregnancy.1,5 Finally, we did not statistically adjust for multiple hypothesis testing, although we found more significant associations than would have been expected by chance given a significance level of P < .05. Our intent-to-treat analytic approach also yielded conservative estimates because some intervention group respondents received little treatment, and some comparison group respondents received AFL-funded services.

Subsequent pregnancies to adolescent mothers have significant consequences that may be even more detrimental than those of a first pregnancy5 and are costly to society.3 Because of the public health effect of repeat adolescent pregnancy and the special disadvantages of adolescent parents and their children, it is important to build an evidence base for secondary adolescent pregnancy prevention programs. This study provided preliminary evidence for the projects examined. Much remains to be learned about the ingredients needed for long-term program effects on repeat pregnancy and how to improve educational outcomes.

Acknowledgments

This publication was made possible by the US Department of Health and Human Services, Office of Population Affairs (contract HHSP233200800292G).

The authors thank Jeffrey Novey for assistance with editing and Christina LaChance for review of the article.

Note. The statements and opinions expressed are solely the responsibility of the authors and do not necessarily represent the official views of the US Department of Health and Human Services.

Human Participant Protection

All research presented in this article was approved by the RTI International institutional review board as well as the local institutional review boards governing the participating grantee projects.

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Marni L. Kan, PhD, Olivia Silber Ashley, DrPH, Kathryn L. LeTourneau, MSW, MSPH, Julia Cassie Williams, BA, Sarah B. Jones, MPH, Joel Hampton, MS, and Alicia Richmond Scott, MSWMarni L. Kan, Olivia Silber Ashley, Kathryn L. LeTourneau, Julia Cassie Williams, and Sarah B. Jones are with Risk Behavior and Family Research, RTI International, Research Triangle Park, NC. Joel Hampton is with Program Evaluation and Outcome Measurement, RTI International. At the time of the research, Alicia Richmond Scott was with the Office of Adolescent Pregnancy Programs, Office of Population Affairs, Department of Health and Human Services, Rockville, MD. “The Adolescent Family Life Program: A Multisite Evaluation of Federally Funded Projects Serving Pregnant and Parenting Adolescents”, American Journal of Public Health 102, no. 10 (October 1, 2012): pp. 1872-1878.

https://doi.org/10.2105/AJPH.2012.300836

PMID: 22897549