A primary care intervention involving case support and peer leadership significantly increased contraception use among teenagers at high-risk for pregnancy, US research shows.
Additionally, girls reported feeling more connected to their families, had improved confidence to refuse sex, and reported reduced perceptions of the importance of sex.
The study, reported in JAMA Pediatrics, included 253 sexually active girls aged 13 to 17 years who were deemed at risk for pregnancy.
Overall, 126 girls were assigned to the "Prime Time" intervention group, which involved monthly one-to-one visits with a case manager over 18 months focusing on healthy relationships, responsible sexual behaviors, and positive family and school involvement. The girls also took part in a peer education group, in which they were incentivized to connect with girls outside of the group and teach them about healthy relationships and contraception. They also worked on a group project to develop their social, emotional, and leadership skills.
A survey completed after 2 years by 99.3% of participants showed that girls in the intervention group reported more consistent condom use with their most recent partner, more consistent hormonal contraception use, and more consistent dual-method use, compared with girls in the control group. The number of male sexual partners in the prior 6 months did not differ between the groups.
Girls in the intervention group also reported significantly higher levels of family connectedness, said that it was less important to have sex with their partner in exchange for material things, and reported greater confidence in refusing sex than their control group counterparts.
The authors also note high levels of engagement in the intervention, with 88.4% of participants actively involved in case management and 66.9% actively involved in peer education groups.
Renee Sieving (University of Minnesota, Minneapolis) and colleagues say their findings support growing evidence that youth development approaches could be used to tackle the USA's teenage pregnancy problem. Currently, there are more than 750,000 pregnancies per year among women aged 15-19 years in the country, leading to 400,000 births.
The authors explain that girls who become mothers at a young age achieve a lower educational status, report lower overall well-being of their children, and are at greater risk for poverty. Black and Hispanic teenage girls are particularly at risk, and made up 54% of participants in the study.
Sieving and colleagues conclude: "Together with previous findings demonstrating reductions in sexual risk behaviors, relational aggression, and violence victimization among Prime Time participants, results from this study suggests 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."
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