AMCHP 2005 Conference

1. AMCHP 2005 Conference Another Chance: Preventing Additional Births to Teen MothersCindy Costello, National Campaign to Prevent Teen Pregnancyand Pat Paluzzi, Healthy Teen Network

2. About the National Campaign About Healthy Teen Network Teen pregnancy in the U.S.: Good and bad news Major findings and implications from a publication on subsequent births to teen mothers produced through a CDC-funded cooperative agreement AMCHP 2005 Conference This Presentation Covers 4 Areas:

3. AMCHP 2005 Conference The National Campaign to Prevent Teen Pregnancy Campaign’s mission is to improve the well-being of children, youth, and families by preventing teen pregnancy. Our goalis to reduce the rate of teen pregnancy in the United States by one-third between 1996 and 2005. It looks like the nation will meet this goal.

4. AMCHP 2005 Conference Our Strategy… Research Influence cultural values and messages Unusual Partners NCPTP Teen Voices Strengthen state & local programs Tolerance & Bipartisanship

5. Our Mission:To provide general leadership, education, training, information, advocacy, resources, and support to individuals and organizations in the field of adolescent pregnancy, parenting, and prevention. Our Vision: All adolescents will make responsible decisions about sexuality, pregnancy, and parenting. AMCHP 2005 Conference Healthy Teen Network (formerly NOAPPP)

6. AMCHP 2005 Conference Strategic Approaches

7. Cooperative Agreement funded by the Centers for Disease Control and Prevention (CDC). Goal: To enhance the ability of state and local organizations to incorporate science-based approaches into their teen pregnancy prevention efforts. AMCHP 2005 Conference CDC Cooperative Agreement

8. AMCHP 2005 Conference Putting What Works To Work Produce high-quality, research-based, user-friendly materials. Use these materials to encourage states, communities, and national organizations to incorporate solid research into their work. Go beyond the traditional partners and reach out to media executives, state legislators, funders and other opinion leaders.

9. General Membership: Objective: To improve knowledge and attitudes regarding SBP. Activities: SBP focus in all member supports and materials. State and Local Coalitions: Objective: To promote SBP through coalition capacity building. Activities: Training with ETR Associates-- Logic Models; Evaluation 101; Using Data to Improve Program, and Evaluating the Effectiveness of Your Coalition– and leadership support and networking opportunities. AMCHP 2005 Conference HTN’s CDC-Funded Work

10. Teen Pregnancy in the United States: Good News and Bad News AMCHP 2005 Conference

11. Teen Pregnancy Rates, 1972-2000 (number of pregnancies per 1,000 girls aged 15-19) After increasing 23 percent between 1972 and 1990 (including 10 percent between 1987 and 1990), the teen pregnancy rate for girls aged 15-19 decreased 28 percent between 1990 and 2000 to a record low. Henshaw, S. (2003). U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24. New York: The Alan Guttmacher Institute.

12. Teen Birth Rates, 1940-2003 (number of births per 1,000 girls aged 15-19) From 1940 to 1957, the teen birth rate increased 78% to a record high. The birth rate dropped fairly steadily from the end of the 1950s through the mid-1980s, but then increased 23% between 1986 and 1991. Between 1991 and 2003, the teen birth rate decreased 32.5% to a record low of 41.7 in 2003. Henshaw, S. (2003). U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24. New York: The Alan Guttmacher Institute.

13. Since 1991: Teen pregnancy rates have declined 28%, from 115.3 per 1000, to 83.6 per 1000 in 2000. Teen birth rates declined 31%, from 61.8 births per 1000, to a record low of 41.7 per 1000 in 2003. AMCHP 2005 Conference More Good News… Note: changes over 1991-2003 from the YRBS, high school students in grades 9-12. Source: http://www.cdc.gov/mmwr/PDF/wk/mm5138.pdf

14. AMCHP 2005 Conference A Mixed Picture… Teen birth rates, and rates of decline, vary substantially among the largest racial/ethnic subgroups. Between 1991 and 2002, teen birth rates declined 42% for African-Americans, 36%, for Native Americans, 34% for non-Hispanic Whites, 33% for Asian/Pacific Islanders, and 20% for Hispanics. The decline for all teens was 30%.

15. Between 1991 and 2003: The percentage of teens who ever had sex declined from 54% to 47%. 57% of Latino teens report they’ve ever had sexual intercourse vs. 47% overall. The percentage of teens with four or more partners declined from 19% to 14%. The percentage of teens that used condoms increased from 46% to 63%. AMCHP 2005 Conference A Mixed Picture… Note: changes over 1991-2003 from the YRBS, high school students in grades 9-12. Source: http://www.cdc.gov/mmwr/PDF/wk/mm5138.pdf

16. AMCHP 2005 Conference Some Bad News… • The U.S. still has the highest rate of teen pregnancy in the industrialized world. • 34% of teen girls become pregnant at least once before age 20. • Recent data show an increase in the percent of high school girls who have had sex (2001 – 2003). Source: National Campaign to Prevent Teen Pregnancy, Fact Sheet “How is the 34% Statistic Calculated?”, February 2004.

17. AMCHP 2005 Conference Another Chance: Preventing Additional Births in Teen Mothers Background Information

18. Overall teen birth rates are down, but additional births to teen mothers are still disturbingly common. In 2002, there were nearly 89,000 such births, representing 21% of all teen births. Nearly 1/4 of teen mothers have a second birth before age 20. AMCHP 2005 Conference Why Care about Subsequent Births?

19. Reasons for second births are less apparent than reasons for first births. Causes of first births presumably do not apply to women who are already teen mothers. AMCHP 2005 Conference Reasons for Additional Births

20. Some research has shown that girls with a higher risk for closely-spaced second births include: Teenage mothers 16 years and younger African-American and Hispanic/Latina teen mothers Girls with lower educational expectations Girls who drop out of school before or after first birth AMCHP 2005 Conference Risk Factors

21. Some research has shown that girls with a higher risk for closely-spaced second births include: Teen mothers who had a desire to have their first child. Teen mothers who live with a boyfriend, spouse, or other adult vs. living with parent or alone. AMCHP 2005 Conference Other Risk Factors

22. Teen mothers who have closely-spaced second births are: More likely to initiate pre-natal care late Less likely to complete school Less likely to have a job AMCHP 2005 Conference Consequences: Teen Mothers

23. 5 year-old children of teen mothers who avoided a second birth are: Better prepared for school Better behaved More outgoing and happy AMCHP 2005 Conference Consequences: Children

24. From Pittsfield, MA First child at 16; second at 19 Planned first pregnancy No long term plans, no role models Wanted to gain popularity Wanted to “keep” her boyfriend AMCHP 2005 Conference Case Study: Shayla

25. “I definitely think my environment influenced me to get pregnant. When you’re around people that are constantly doing something…you’re gonna pick that up. If I had hung out with people that were more school-oriented or more focused on the bigger picture, then I don’t think I would have gotten pregnant.” Shayla, Age 16 AMCHP 2005 Conference Case Study: Shayla

26. AMCHP 2005 Conference MCH Impact of Teen Births Teen mothers less likely to have adequate PNC—initiate even later with 2nd and 3rd pregnancies. Teen mothers more likely to have LBW infants—with greater risk for infant mortality—findings less clear for subsequent births among teens Teen mothers more likely to smoke during pregnancy, have inadequate diet and weight gain.

27. AMCHP 2005 Conference MCH Impact of Teen Births –cont’d More emergency medical visits among children of teen parents. More developmental delays among children of teen parents. Pregnant teens at great risk for intimate partner violence and even death—two studies of autopsy reports show increase in pregnancy among murdered teens.

28. AMCHP 2005 Conference Another Chance: Preventing Additional Births in Teen Mothers Program Findings

29. AMCHP 2005 Conference Inclusion Criteria for Klerman Study Program focused on pregnant or parenting teens; Was conducted in the US; Used an experimental or quasi-experimental design for evaluation; Had a sample size of at least 50 in each group; and Teen mothers were followed for at least 12 months post partum.

30. AMCHP 2005 Conference Results Caveats • Many differences occurred leaving comparison difficult: • Participant differences such as age or pregnancy number; • Program differences such as length of stay; length of follow-up; care for teens with first or >2nd pregnancy; • Evaluation differences such as outcomes measured; quasi-experimental design; loss to follow-up • Inadequate description of many programs

31. AMCHP 2005 Conference Findings • 19 programs of 6 different types included • Multi-site (6)-emphasis on education and employment-self sufficiency • Project Redirection • Parents Too Soon (2) • Teenage Parent Welfare Demonstration • New Chance • Early Head Start • Conclusion: Marginal differences in repeat pregnancy rates-most successful program had more emphasis on CSE and family planning

32. AMCHP 2005 Conference Findings-cont’d • Medical Settings (4)-emphasis on prenatal, postpartum and child care with family planning education and/or services • Comprehensive Adolescent Program in Queens Hospital • Teen Mother and Child Program • Teen Baby Clinic • West Dallas Youth Clinic • Conclusions: Two marginally successful, one clearly statistically better and one without difference. One with clear differences had heavy emphasis on family planning.

33. AMCHP 2005 Conference Findings-cont’d • School-based (3)-two were alternative schools and one a program within a school-emphasis on education plus medical and support needs • Polly T. McCabe Center • Special School Program • Second Chance Club • Conclusions: two out of three had statistically significant differences in repeat pregnancy rates.

34. AMCHP 2005 Conference Findings-cont’d • Home Visiting (3)-Combined education and support—followed curricula • Nurse-Family Partnership (Olds Model) • Nurse Visiting Program in Memphis • Teenage Parent Home Visitor Services Demonstration • Conclusions: Nurse-based program successful at 24, 36 and 45 months but not 12. Demonstration project not successful.

35. Contraceptive-Based (2)-participants self-selected to receive Norplant Colorado Medicaid program Colorado Adolescent Maternity Program Conclusions: Statistically significant differences in teen birth rates at 12 and 24 months. AMCHP 2005 Conference Findings-cont’d

36. Dollar a Day Program (1)-combined a financial incentive of $1.00 for each non-pregnant day with education and support though weekly meetings-not successful LEAP focuses on education and employment-not successful Cal-Learn emphasizes education and employment-not successful Second Chance Homes focuses on education-not yet evaluated but repeat pregnancy prevention not suggested at this time. AMCHP 2005 Conference Findings-cont’d

37. BCHD-two case management models, one for primary prevention and one for secondary—quantitative assessment up to 6 months showed success with primary prevention. Qualitative assessment of both=not successful. Most significant features-case managers personally made the biggest difference, connecting with teens, and stated focus on educational attainment and not pregnancy prevention-succeeded with education and not pregnancy prevention AMCHP 2005 Conference Other Example not in Klerman

38. Effective Characteristics Close and sustained relationships-home-based programs seem to foster this effective personnel-staff matter emphasis on family planning-education and access to services a must AMCHP 2005 Conference The Bottom Line

39. Essential components of home visiting programs Staff that closely resembles clients vs. nurses Emphasis on education/employment vs. pregnancy prevention AMCHP 2005 Conference Issues to Resolve

40. We need more and better evaluations-including qualitative data to enrich our conversation We need to consider cost/benefit of types of programs We need to delve into what makes program staff work? We need to ensure that access to contraceptive education and services is maintained. AMCHP 2005 Conference Next Steps

41. Visit www.teenpregnancy.org www.healthyteennetwork.org AMCHP 2005 Conference For more information: Thank You!