Effectiveness of an Intensive, School-Based Intervention for Teen Mothers
Received 30 January 2007; accepted 4 September 2007. published online 13 February 2008.
Abstract
Purpose
This study evaluated the effectiveness of a secondary teen pregnancy prevention intervention that includes school-based social work services coordinated with comprehensive health care for teen mothers and their children.
Methods
A prospective cohort study compared subsequent births to teen mothers followed for at least 24 months or until age 20 years (whichever was longer) compared with matched subjects from state data. Analyses were based on intent to treat and included χ2, survival, and cost–benefit analysis.
Results
Subjects included 63 girls (97% eligible, 99% African-American, mean age 16 years). A propensity-matched comparison group (n = 252) did not differ from subjects. Participation in program components was good: (1) group meetings: 76%; (2) case management: 95%; (3) coordinated medical care: 63%. The majority of subjects used contraception (93%), with greater use of medroxyprogesterone associated with participation in coordinated medical care (80% vs. 50%, p = .0145). Subsequent births were more common in the comparison group (33%) than among subjects (17%) (p = .001), and survival curves were significantly different (p = .007) (hazard ratio = 2.5). There was a trend toward fewer births with increased participation in medical care (p = .08) and case management (p = .08) but not with group meetings. Cost savings were calculated as $19,097 per birth avoided or $5,055 per month.
Conclusions
The intervention was effective in reducing subsequent births to teens; however selection bias of school enrollment cannot be excluded by this study. The cost savings of delayed births outweigh the expenses of this intensive model
aDepartment of Pediatrics, The Medical University of South Carolina, Charleston South Carolina
bDepartment of Biostatistics, Bioinformatics, and Epidemiology, The Medical University of South Carolina, Charleston South Carolina
cThe Lawton and Rhea Chiles Center for Healthy Mothers and Babies, University of South Florida, Tampa, Florida
Address correspondence to: Janice D. Key, M.D., The Medical University of South Carolina, Department of Pediatrics, 135 Rutledge Avenue, PO Box 250561, Charleston, SC 29425.
ABSTRACT