文章基本信息

标题：Preventing Pregnancy in High School Students: Observations From a 3-Year Longitudinal, Quasi-Experimental Study
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作者：Jonathan Gelfond ; Nicole Dierschke ; Diana Lowe 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2016
卷号：106
期号：Suppl 1
页码：S97-S102
DOI：10.2105/AJPH.2016.303379
语种：English
出版社：American Public Health Association
摘要：Objectives. To assess whether a sexual health education intervention reduces pregnancy rates in high school students. Methods. We performed a secondary analysis of a 3-year quasi-experimental study performed in South Texas from 2011 to 2015 in which 1437 students without a history of pregnancy at baseline were surveyed each fall and spring. Potentially confounding risk factors considered included sexual behaviors, intentions, and demographics. The outcome measure was self-reported pregnancy status for male and female students. We performed analyses for male and female students using separate discrete time-to-event models. Results. We found no difference in pregnancy rates between intervention and comparison students within the first 3 years of high school. Female and male students in the intervention groups had pregnancy hazard ratios of, respectively, 1.62 (95% CI = 0.9, 2.61; P = .1) and 0.78 (95% CI = 0.44, 1.48; P = .4) relative to the comparison groups. Conclusions. The educational intervention had no impact on the pregnancy rate. Social media tools in pregnancy prevention programs should be adaptive to new technologies and rapidly changing adolescent preferences for these services. Although adolescent pregnancy rates have declined over the past 2 decades, 1 the United States has the highest rate of pregnancy among adolescents aged 15 to 19 years compared with other Western industrialized countries. 2 Pregnancy rates vary across the United States, and adolescents living in the southern United States have the highest rates. Texas consistently has one of the highest rates in the nation, at 41 births per 1000 female adolescents aged 15 to 19 years, ranking fifth in the nation in adolescent birth rate in 2013. 3 Almost 4 in 5 pregnancies (77%) among adolescents aged 15 to 19 years are unintended, 4 and the adverse behaviors and outcomes associated with unintended pregnancy are both immediate and long term, including adverse birth outcomes, poor health during childhood, and poor mother–child relationship. 5–9 Pregnancy also increases the risk of dropping out of high school. According to a 2012 report, just 40% of high-school-aged adolescents who become pregnant are expected to graduate, and only 2% complete college before age 30 years. 10 In addition, relative to mothers in their 20s, adolescent mothers have greater morbidity and mortality, and they account for 13% of pregnancy-related deaths. 11 A recent study assessing factors associated with pregnancy likelihood reported that older adolescents, as well as Black, Hispanic, or mixed-race young women, are at highest risk for becoming pregnant. 12 In 2011, Texas had the second highest Hispanic population in the nation, 13 and it had the third highest Black or mixed-race population in the United States in 2010. 14 However, pregnancy risk extends beyond certain demographic profiles. Adolescents have a higher prevalence of risky behaviors and experiences before pregnancy than older adults, 15–18 increasing their risk of becoming pregnant. Finally, there are significant financial implications when adolescents become pregnant that place a substantial burden on taxpayers. Adolescent pregnancy costs $9.4 billion nationally every year, and in 2010 adolescent pregnancy cost Texas taxpayers $1.1 billion. 19 Therefore, preventing adolescent pregnancy might contribute to declining rates of poverty and child abuse, reduce the rate of low-birth-weight infants, improve high school graduation rates, and improve economic productivity through a prepared workforce. 20