Teen Options to Prevent Pregnancy

Updated: Jan 12, 2018
Evidence Rating:
Near Top Tier

Highlights

  • Program:

    An 18-month program for low-income adolescent mothers, delivered by nurse educators and a social worker, that aims to reduce rapid repeat pregnancy and promote healthy birth spacing.

  • Evaluation Methods:

    A well-conducted randomized controlled trial (RCT) with a sample of 598 mothers, ages 10 to 19.

  • Key Findings:

    For the full sample, the program reduced the rate of repeat pregnancy during the 20 months after random assignment by about half (21 percent of the treatment group became pregnant versus 39 percent of the control group). Based on state birth records obtained for the subsample of mothers ages 18 or 19 at the start of the study, the program reduced the rate of new births during the 30 months after random assignment by about one-third (24 percent of the treatment group gave birth versus 36 percent for the control group). Both effects were statistically significant.

  • Other:

    The study’s main limitation is that it was conducted within a single health system in Ohio; thus, a replication RCT in a different site would be desirable to confirm the results and establish that they generalize to other settings.

The Teen Options to Prevent Pregnancy (TOPP) program was developed by OhioHealth, a large faith-based health system in Columbus, Ohio, and enrolled adolescent mothers from seven outpatient clinics and five hospital postpartum units serving seven counties in Central Ohio. TOPP’s main goal is to reduce rapid repeat pregnancy and promote healthy birth spacing among adolescent mothers. The program, delivered by nurse educators and a social worker over an 18-month period, includes the following recommended components:

  • Monthly one-on-one motivational interviewing sessions delivered by a nurse educator by telephone to help the young mothers identify a birth control plan that meets their needs;
  • Free transportation to a local health care provider or a TOPP clinic to receive contraceptive services (e.g., LARCs);
  • At least one in-person visit from the nurse educator in the young mother’s home or a community setting; and
  • Access to a program social worker who, based on an initial psychosocial assessment of the participating mother and subsequent identification of service needs by the nurse educators, could refer her to appropriate support services.

The program developers emphasize two aspects of program implementation as essential to successful delivery of the above components: (i) initial training and rigorous ongoing coaching of the nurse educators in motivational interviewing, and (ii) the nurses’ discussion of both contraceptive and non-contraceptive topics with the adolescent mothers. The study reports do not provide information on the program’s cost.

To see our full evidence summary:
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References

Jack Stevens, Robyn Lutz, Ngozi Osuagwu, Dana Rotz, and Brian Goesling, “A randomized trial of motivational interviewing and facilitated contraceptive access to prevent rapid repeat pregnancy among adolescent mothers,” American Journal of Obstetrics and Gynecology, vol. 217, no. 4, October 2017, pp. 423.e1-423.e9.

Dana Rotz, Dara Lee Luca, Brian Goesling, Elizabeth Cook, Kelly Murphy, and Jack Stevens, Final Impacts of the Teen Options to Prevent Pregnancy Program. Mathematica Policy Research, July 2016.

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