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A REVIEW OF TEEN-TOT PROGRAMS: COMPREHENSIVE CLINICAL CARE FOR YOUNG PARENTS AND THEIR CHILDREN.

ABSTRACT

Comprehensive clinical programs for teenage mothers and their children, also known as teen-tot programs, have been a promising intervention to improve outcomes of teenage childbearing and parenting. However, much remains unknown regarding the efficacy of such programs. We reviewed four published evaluations of programs that provided medical care, counseling, contraception, guidance for parenting, and assistance with staying in school. The evaluations reported moderate success in preventing repeat pregnancies, helping teen mothers continue their education, and improving teen and infant health over 6 to 18 months. However, the evaluations had limitations that may have reduced or accentuated observed effectiveness. Teen-tot programs will continue to face the challenges of sustaining adequate long-term interventions and evaluations, and reducing the high attrition rate among program participants. It is concluded that increased support and funding for teen-tot programs and more complete evaluations are warranted.

Teenage childbearing poses risks for teenage mothers, such as higher risk of inadequate education and living in poverty, and their infants, including poor birth outcomes and long-term learning and behavior problems (Card & Wise, 1978; Furstenberg, Brooks-Gunn, & Morgan, 1987; Baldwin & Cain, 1990; Fraser, Brockert, & Ward, 1995; Jekel, Harrison, Bancroft, Tyler, & Kierman, 1975). Furthermore, repeat pregnancy rates among teenage mothers of low socioeconomic status may be as high as 39% within one year of delivery (Linares, Leadbeater, Jaffe, Kato, & Diaz, 1992) and 50% within two years of delivery (Polit & Kahn, 1986). Each additional childbirth increases the chance that a teenage parent and her children will live in poverty for a longer period of time by postponing the teenager's return to school or reducing her ability to find employment (Furstenberg et al., 1987). Despite the declining rate of repeat births to teenagers, in 1998, nearly 110,000 births (22% of all births to teenagers) occurred among teenage rs who were already mothers (Ventura, Martin, Curtin, Mathews & Park, 2000).

Teen-tot programs were established to prevent poor outcomes for teenage parents and their children. These comprehensive clinic-based programs serve teenage mothers and their infants in a single setting and typically offer health care, family planning, counseling, encouragement for teenage mothers to continue their education, assistance with obtaining services, and social support. By providing "one-stop shopping" for this high-risk population, the teen-tot model is designed to remove barriers to receiving care that exist in traditional care models, such as transportation difficulties, lack of continuity of care, and lack of case management. A central goal is to prevent rapid repeat pregnancy by simplifying access to contraception, discouraging school dropout, and encouraging the pursuit of careers that provide economic security. In addition, components of these programs are designed to improve infant and teen health and parenting practices.

Concern has been raised about the inadequate evaluation of programs for teenage mothers (Stahler & DuCette, 1991; Stahler, DuCette, & McBride, 1989). Previously published reviews of teenage parent program evaluations have not specifically focused on postnatal clinic-based interventions targeted at both mother and child (Scholl, Hediger, & Belsky, 1989; O'Sullivan, 1991). We sought to review the experience of teen-tot programs in meeting the goals of improving outcomes and preventing repeat pregnancies.

METHOD

Published medical literature was systematically searched via computerized databases. Medline, Popline, and Health Star were searched from January 1980 to August 2000 using the terms "pregnancy in adolescence," "parents," and "program evaluation." The Psych Info database was searched using the terms "adolescent mothers," "adolescent pregnancy," and "program evaluation." Two investigators independently reviewed the results of each search to identify articles that were potentially eligible for inclusion. In addition, bibliographies of articles identified through the search were examined for additional eligible articles. Initial criteria included a title and abstract, if available, that described a comprehensive program for pregnant and/or parenting teenagers and their children.

Potentially eligible articles were reviewed in entirety by three investigators to determine which described a comprehensive clinical teen-tot program, that is, a program including clinical health supervision, family planning, and support for teen parents, such as assistance with staying in school or obtaining community services. Each article describing a comprehensive teen-tot program was rated in four areas: (1) statement of goals used to develop the program, (2) statement of the intervention content (i.e., the parameters, intensity, and target of the intervention, as well as the staff involved in conducting the intervention), (3) description of study design: size and characteristics of the target group and the comparison group (randomized, matched, or convenience), program duration, and data collection procedures and intervals, and (4) program impact evaluation: use of reliable outcome measures and appropriate impact analyses, including statistical significance (Bauman, Drotar, Leventhal, Perrin, & Pless, 1 997; personal communication, L. J. Bauman).

RESULTS

The literature search identified 46 articles describing interventions that met initial criteria for closer review. Most of these articles were excluded because they did not clearly describe a clinical component or described outcomes in descriptive terms only. Four studies met eligibility criteria: the Teen-Tot Clinic (TTC) (Nelson, Key, Fletcher, Kirkpatrick, & Feinstein, 1982), the Queens Hospital Center (QHC) (Rabin, Seltzer, & Pollack, 1991), the Teen Mother and Child Program (TMCP) (Elster, Lamb, Tavare, & Ralston, 1987), and the Special Care Program (SCP) (O'Sullivan & Jacobsen, 1992) (see Table 1). The SCP evaluation did not describe on-site clinical services for the adolescent participants, but is included in this review because it is the only example we found of a randomized study.

All four programs were conducted in hospital clinics or academic centers in urban areas. Participants were recruited from hospital clinics (TTC, SCP), prenatal adolescent programs (QHC), or were self-referred (TMCP). TTC, SCP, and QHC drew participants from socioeconomically disadvantaged minority groups, while the participants in TMCP were predominantly white and 35% came from higher socioeconomic groups. Control groups were created through randomization (SCP), by matching characteristics of a group of mothers who delivered one year earlier with those of the participants (TTC), or by drawing a convenience sample of teenagers concurrently receiving care in traditional programs (TMCP, QHC).

Each program limited duration of participation either by infant or maternal age. Evaluators of the TTC and QHC did not provide data for average duration of program participation or attrition rate. TMCP reported a high attrition rate, with complete data available for 42% of participants and 49% of controls at the 26-month postpartum evaluation. SCP also reported a high attrition rate: at 18 months, 40% of participants and 18% of controls were still attending the well-baby clinic. However, 91% of the original participants and controls were interviewed at 18 months. None of the four evaluations provided data on attendance for individual program components.

Outcome data were gathered at varying intervals (TTC, TMCP, and QHC) or at the conclusion of the intervention (SCP). Sources of outcome data included chart reviews (TTC, QHC, TMCP, and SCP), interviews of participants and controls (TTC, TMCP, SCP), developmental and maternal knowledge test scores (TMCP), assessment of home environment (TMCP), and school attendance records (SCP).

We analyzed the efficacy of these programs in meeting three goals they had in common: (1) preventing repeat pregnancies and school drop-out, (2) improving infant and teen health outcomes, and (3) improving the adequacy of teenagers in the parental/caretaking role. All four programs reported decreased repeat pregnancy rates among participants compared to controls between 12 and 26 months postpartum (for TMCP, the difference between participants and controls did not reach a level of statistical significance). Outcomes for maternal school attendance varied. TTC and QHC reported that participants were significantly more likely to be attending school, and QHC reported significantly greater rates of employment among participants compared to controls. However, TTC reported outcomes at 6 months postpartum, a relatively short interval for evaluation, and QHC failed to specify a time period at all. There was no difference in school attendance between participants and controls in the TMCP or SCP.

In general, reported infant health outcomes were favorable. Higher rates of clinic attendance (QHC, SCP), immunization completion (TTC, TMCP, SCP), adequate weight- and height-for-age (TTC), and lower rates of injury and illness (QHC) were reported for participants compared to controls. However, TMCP reported minimal impact on infant growth, development, and medical outcomes among participants. Only QHC reported maternal health outcomes; maternal morbidity was significantly lower among program participants. None of the evaluators of the four programs specified whether record-keeping for clinic attendance, immunizations, or hospitalizations was uniform between participant and control sites. Some programs did not report data necessary to adequately evaluate outcomes. For example, TTC and TMCP did not report rates of clinic attendance for participants and controls.

Only TMCP reported outcomes for interventions designed to improve caretaking skills. The evaluators measured the use of preventive health behaviors such as using car seats. There were no significant differences between participants and controls at either 12 or 26 months into the intervention. Unfortunately, no program reported outcomes for interventions designed to improve parenting practices.

While there was no statistically significant difference between many outcomes for participants and controls in the TMCP, a composite score was calculated for 10 outcomes. The score was significantly better for participants compared to controls at both the 12- and 26-month evaluations. The score was also robust: mothers with a low (better) score at 12 months also had a low score at 26 months. The authors concluded that a broad range of events should be studied when evaluating programs for teenage parents.

DISCUSSION

It is disappointing but not surprising that only four studies met inclusion criteria for this review. Although many programs for teenage parents and their children exist, few are truly comprehensive, and fewer still are evaluated. In 1976, the National Alliance Concerned with School-Age Parents listed 1,132 programs for sexually active and parenting teenagers, of which only 54 offered comprehensive medical and social services (Weatherley, Perlman, Levine, & Klerman, 1986). Comprehensive programs may be rare because they face major constraints, including inadequate financial support, insufficient health and social welfare infrastructure, and negative public attitudes toward the target population (Weatherley et al., 1986). The inadequate assessment of comprehensive programs for pregnant and parenting adolescents has been widely acknowledged, and attributed in part to the precedent set by the legislative limit on resources for evaluation of federally funded programs (Stahler & DuCette 1991; Stahler et al., 1989; O'Sullivan, 1991). Although the federal legislation of the early 1980s called for program evaluation, a maximum of 5% of the total program budget can be used for evaluation under Title XX (Stahler et al., 1989). Another barrier to rigorous evaluation might be the perception of program managers that allocating resources for evaluation siphons them away from participants.

The four studies we identified were able to conduct fairly rigorous evaluations given the constraints. And on the surface, the evaluations suggest that comprehensive programs are more successful than traditional health care in addressing some of the risks teenage mothers and their children face. One of the most important successes is postponing repeat pregnancies, because studies have shown an association between short interpregnancy intervals and poor birth outcomes (Khoshnood, Lee, Wall, Hseih, & Mittendorf, 1998; Rawlings, Rawlings, & Read, 1995) and higher risk of poor birth outcomes for second births to teenage mothers compared to alder mothers (Santelli & Jacobsen, 1990; Akinbami, Schoendorf, & Kiely, 2000). Of the four programs that reported various outcomes for infant health, three found a positive impact. In contrast, the results for other important outcomes, such as parenting skills, mastering knowledge of child development, and outcomes for child development, were disappointing. The achievements o f these programs are theoretically the result of providing "one-stop shopping" and fostering greater communication and trust between teen parents and health care workers. By removing barriers both to access to services and to bonding with providers, greater compliance with contraception and clinic visits can be realized, and greater efficacy from health education, anticipatory guidance, and counseling can be achieved.

Unfortunately, in addition to having only four evaluations on which to base conclusions about the efficacy of teen-tot programs, there are also shortcomings in these evaluations that make it difficult to judge how well program goals were met. For example, reported immunization rates are dependent on numerous factors in addition to clinic attendance and patient compliance, such as provider behavior and record keeping (Morrow, Crews, Caretta, Altaye, Finch, & Shin, 2000; Taylor, Darden, Slora, Hasemeier, Asmussen, & Wasserman, 1997). Furthermore, the knowledge that immunization completion rate would be evaluated might have changed the behavior of the health providers in the evaluated teen-tot programs. Thus, it is unclear if higher immunization rates in teen-tot programs can be attributed to specific interventions or are due to biases introduced by the study design. Another example is inadequate longitudinal assessment of teenage mothers' education. Evaluating long-term outcomes such as school completion and e mployment, rather than rates of school enrollment, is necessary to fully analyze the success of education interventions. School enrollment in the short term is important since teenagers who obtain additional schooling after a first birth may be less likely to have a closely spaced second birth (Kalmuss & Brickner Namerow, 1994). However, a review of community programs found that immediate gains in education among teenage participants were short-lived (Carson Jones, 1991). Since teenage mothers are more likely than their childless peers to have poor academic records even before becoming pregnant (Card & Wise, 1978; Brooks-Gunn & Chase Landsdale, 1991), it is important to determine which interventions are most effective in helping teenage mothers obtain an adequate education.

In addition to these issues, these studies also have more general limitations that might have introduced bias into the findings. The randomized study design, which is optimal because it minimizes systematic differences in baseline characteristics between participant and control groups, is rare among published evaluations. Just as devoting funds to evaluation might be seen as depriving participants of services they might otherwise receive, randomly enrolling eligible teenage mothers in a control arm of a study might be seen as denying benefits to those in need. Given the difficulties in creating sustainable programs for teenage mothers and their children, it might be too optimistic to expect randomized studies to be undertaken. As seen with one of the included studies (TTC), it is possible to minimize differences between participants and controls by matching characteristics of controls otherwise ineligible for participation with those of participants.

Probably more vital to minimizing bias in a study is minimizing attrition rates. The teenagers who drop out of a study are likely to have different characteristics than those who remain, and these characteristics may affect the risk of repeat pregnancy or compliance with prenatal care and well-child visits. High attrition also hampers program sustainability and statistical power of evaluation. Not only should programs strive to minimize attrition, but, in order to assess bias, it is also necessary to evaluate outcomes and background characteristics among controls and participants who drop out of the program. However, drop-outs are notoriously hard to follow (Stahler et al., 1989). Funds devoted to such efforts should be included in both intervention and evaluation budgets (e.g., staff and resources to track participants and controls, home visits, reminder post cards and phone calls, and financial incentives). O'Sullivan and Jacobsen (1992) have provided an analysis of SCP outcomes among drop-outs from both t he participant and control groups. This analysis revealed important information; for example, there were significantly increased immunization rates and decreased inappropriate emergency room visits among participants remailing in the program but not among drop-outs, and differences in repeat pregnancy timing and frequency between drop-outs and participants.

Misclassifying participants might have led to biases through measurement error. As acknowledged by Elster et al. (1987), most programs are unable to quantify the individual services a participant receives. Classifying a teen as a participant assumes she has attended all program components and thus is in a position to benefit. Including teens with poor attendance as participants will underestimate program impact. A related problem arises from failing to measure participation in each separate program component--it is unclear which elements of the program are related to the observed effects. For example, it is not possible to determine if an impact on pregnancy rates is primarily related to attendance at family planning sessions, clinic attendance in which contraceptive measures are prescribed, encouragement to continue with school, or to a combination of these interventions. And while the use of a composite score in the evaluation by Elster et al. (1987) may be useful in detecting small impact in many areas, th is approach compounds the problem of linking observed impacts to specific interventions.

A source of bias common among programs located in resource-rich areas is the difficulty of isolating a true "no treatment" control group. When the provision of a wide array of community and public services to control groups occurs, the observed difference in impact between control and intervention groups is diminished (Stahler & DuCette, 1991). In general, authors were careful to specify that they were comparing comprehensive delivery of services to traditional delivery of services rather than to absence of services. O'Sullivan and Jacobsen (SCP) (1992) delineated what services the control group received within their program, but, like the other studies, did not specify if controls had received additional outside services. To conduct a comparative study of impact or cost-effectiveness, it is necessary to know the alternative services provided, their impact, and the costs involved.

Many of the above limitations are likely to lead to an underestimation of the true benefit of teen-tot programs. Publication bias may lead to an overestimation of the positive impact of teen-tot programs. Studies that demonstrate positive impact are more likely to be published than those showing little or no impact. As a result of this bias and other numerous obstacles to conducting adequate evaluations, we have limited evidence upon which to judge the performance of teen-tot programs. A more representative picture of the experience of teen-tot programs could be obtained by adopting multi-site evaluations, as proposed by Stabler and DuCette (1991). Several programs could de vote time and effort to collecting outcome data from participants and to documenting services actually received. Recruitment of matched controls and analysis of program outcomes could be undertaken by a third party with a full-time qualified staff and a separate budget (see Stabler & DuCette, 1991, for a discussion of third-party evaluatio n).

CONCLUSIONS

Although rates of teenage childbearing have been decreasing in recent years, the risks faced by teenage mothers and their children in a new era of welfare reform increases the urgency of implementing effective interventions among this still large and vulnerable group. Given the positive outcomes for teenage mothers and their children that have been observed, and also the substantial limitations that hamper efforts to conduct rigorous program evaluations, continued support and funding for teen-tot interventions and evaluation are warranted. Specifically, questions remain about the efficacy of separate program components, sustainability of benefits in the long run, the success of programs in resource-poor areas, and how to best address the high attrition rates that teen-tot programs face. The challenge to adequately evaluate programs for pregnant and parenting teens that was raised over a decade ago still remains.

This work was started while Lara J. Akinbami was a pediatric resident at Children's National Medical Center, Washington, D.C.

Tina L. Cheng, Department of General Pediatrics and Adolescent Medicine, Children's National Medical Center, Washington, D.C., and George Washington University School of Medicine and Public Health, Washington, D.C.

Dana Kornfeld, Department of General Pediatrics and Adolescent Medicine, Children's National Medical Center, Washington, D.C.

Reprint requests to Lara J. Akinbami, National Center for Health Statistics, 6525 Belcrest Road, Room 790, Hyattsville, Maryland 20782.

REFERENCES

Akinbami, L. J., Schoendorf, K. C., & Kiely, J. L. (2000). Risk of preterm birth in multiparous teenagers. Archives of Pediatrics and Adolescent Medicine, 154, 1101-1107.

Baldwin, W., & Cain, V. S. (1990). The children of teenage parents. Family Planning Perspectives, 12(1), 34-43.

Bauman, L. J., Drotar, D., Leventhal, J. M., Perrin, E. C., & Pless, I. B. (1997). A review of psychosocial interventions for children with chronic health conditions. Pediatrics, 100(2), 244-251.

Brooks-Gunn, J., & Chase Lansdale, P. L. (1991). Children having children: Effects on the family system. Pediatric Annals, 20(9), 467-481.

Card, J. J., & Wise, L. L. (1978). Teenage mothers and teenage fathers: The impact of early childbearing on the parent's personal and professional lives. Family Planning Perspectives, 10(4), 199-205.

Corson Jones, L. (1991). Community-based tertiary prevention with the adolescent parent and child. Birth Defects, 27(1), 57-71.

Elster, A. B., Lamb, M. E., Tavare, J., & Ralston, C. W. (1987). The meareal and psychosocial impact of comprehensive care on adolescent pregnancy and parenthood. Journal of the American Medical Association, 258(9), 1187-1192.

Fraser, A. M., Brockert, J. E., & Ward, R. H. (1995). Association of young maternal age with adverse reproductive outcomes. New England Journal of Medicine, 332(17), 1113-1117.

Furstenberg, F. F., Brooks-Gunn, J., & Morgan, S. P. (1987). Adolescent mothers and their children in later life. Family Planning Perspectives, 19(4), 142-151.

Jekel, J. F., Harrison, J. T., Bancroft, D. R. E., Tyler, N. C., & Kierman, L. V. (1975). A comparison of the health of index and subsequent babies born to school age mothers. American Journal of Public Health, 65(4), 370-374.

Kalmuss, D. S., & Brickner Namerow, P. (1994). Subsequent childbearing among teenage mothers: The determinants of a closely spaced second birth. Family Planning Perspectives, 26(4), 149-153, 159.

Khoshnood, B., Lee, K., Wall, S., Hseih, H., & Mittendorf, R. (1998). Short interpregnancy intervals and the risk of adverse birth outcomes among five racial/ethnic groups in the United States. American Journal of Epidemiology, 148, 798-805.

Linares, L. O., Leadbeater, B. L., Jaffe, L., Kato, P. M., & Diaz, A. (1992). Predictors of repeat pregnancy outcome among Black and Puerto Rican adolescent mothers. Journal of Developmental and Behavioral Pediatrics, 13(2), 89-94.

Morrow, A. L., Crews, R. C., Caretta, H. J., Altaye, M, Finch, A. B., & Sinn, J. S. (2000). Effect of method of defining active patient population on measured immunization rates in predominantly Medicaid and non-Medicaid practices. Pediatrics, 106(1), 171-176.

Nelson, K G., Key, D., Fletcher, J. K, Kirkpatrick, E., & Feinstein, R. (1982). The teen-tot clinic: An alternative to traditional care for infants of teenage mothers. Journal of Adolescent Health, 3, 19-23.

O'Sullivan, A. L. (1991). Tertiary prevention with adolescent mothers: Rehabilitation after the first pregnancy. Birth Defects, 27(1), 57-71.

O'Sullivan, A. L., & Jacobsen, B. S. (1992). A randomized trial of a health care program for first-time adolescent mothers and their infants. Nursing Research, 41(4), 210-215.

Polit, D. F., & Kahn, J. R. (1986). Early subsequent pregnancy among economically disadvantaged teenage mothers. American Journal of Public Health, 76, 167-171.

Rabin, J. M., Seltzer, V., & Pollack, S. (1991). The long-term benefits of a comprehensive teenage pregnancy program. Clinical Pediatrics, 30(5), 305-309.

Rawlings, J. S., Rawlings, V. B., & Read, J. A. (1995). Prevalence of low birth weight and preterm delivery in relation to the interval between pregnancies among white and black women. New England Journal of Medicine, 332, 69-74.

Santelli, J. S., & Jacobsen, M. S. (1990). Birth weight outcomes for repeat teenage pregnancy. Journal of Adolescent Health Care, 160, 240-247.

Scholl, T. O., Hediger, M. L., & Belsky, D. H. (1994). Prenatal care and maternal health during adolescent pregnancy: A review and metanalysis. Journal of Adolescent Health, 15, 444-456.

Stabler, G. J., & DuCette, J. P. (1991). Evaluating adolescent pregnancy programs: Rethinking our priorities. Family Planning Perspectives, 23(3), 129-133.

Stabler, G. J., DuCette, J. P., & McBride, D. (1989). The evaluation component in adolescent pregnancy care projects: Is it adequate? Family Planning Perspectives, 21(3), 123-126.

Taylor, J. A., Darden, P. M., Slora, E., Hasemeier, C. M., Asmussen, L., & Wasserman, R. (1997). The influence of provider behavior, parental characteristics, and a public policy initiative on the immunization status of children followed by private pediatricians: A study from Pediatric Research in Office Setting. Pediatrics, 99(2), 209-215.

Ventura, S. J., Martin, J. A., Curtin, S. C., Mathews, T. J., & Park, M. M. (2000). Births: Final data for 1998 (National Vital Statistics Reports, Vol. 48, No. 3). Hyattsville, MD: National Center for Health Statistics.

Weatherley, R. A., Perlman, S. B., Levine, M. H., & Klerman, L. V. (1986). Comprehensive programs for pregnant teenagers and teenage parents: How successful have they been? Family Planning Perspectives, 18(2), 73-78.
Table 1:
Teen-Tot Program Characteristics
Interventions and Outcomes
PROGRAM INTERVENTION
TEEN-TOT CLINIC. Nelson, Key, 1. Well-child health visits,
Fletcher, Kirkpatrick & developmental assessment,
Feinstein (1982) nutrition counseling, WIC,
 referral to community
 services.
* Duration: 18 mos postpartum. 2. Group sessions on child
 development ad parenting
 skills.
* Participants (n=35): age 3. Contraceptive counseling
[less than] 17 yrs, race 91% and services.
black. Referred from urban
hospitals.
* Control group (n=70) matched 4. Assistance with education,
for maternal and child employment, living
characteristics. Received care arrangements, goals and
at public clinics. relationships.
QUEENS HOSPITAL CENTER. 1. 24-hour "on call" system,
Rabin, Seltzer, & Pollack each teen-infant pair assigned
(1991) to one interdisciplinary team.
* Duration until mother 20 yrs 2. Family life education
old. program with bi-weekly classes
 for participants, their
 partners and families.
* Participants (n=498): age 3. Comprehensive services
[less than] 20 yrs, race not available on-site (mental
specified. Recruited from health center, WIC, housing
clinical adolescent program. office, high school equivale-
 ncy program, day care center).
* Control group (n=91): from
adult obstetric clinic.
Received care in pediatric and
adult family planning clinic.
PROGRAM EVALUATED OUTCOMES
TEEN-TOT CLINIC. Nelson, Key, 1. 91% VS. 46% controls fully
Fletcher, Kirkpatrick & immunized (6 mos). [*] 97% vs.
Feinstein (1982) 83% controls between 5th-95th
 growth percentiles
 (6 mos). [*]
* Duration: 18 mos postpartum. [2. None reported]
* Participants (n=35): age 3. Contraceptive use (6 mos):
[less than] 17 yrs, race 91% 91% vs. 63% controls. [*]
black. Referred from urban Repeat pregnancy (18 mos): 16%
hospitals. vs. 38% controls. [*]
* Control group (n=70) matched 4. School enrollment (6 mos):
for maternal and child 86% vs. 66% controls. [*]
characteristics. Received care
at public clinics.
QUEENS HOSPITAL CENTER. 1. Clinic attendance: 75% vs.
Rabin, Beltzer, & Pollack 18% of controls. [*] Maternal
(1991) morbidity [+] and infant
 morbidity [++] lower among
 participants. [*]
* Duration until mother 20 yrs 2. Contraceptive use: 85%
old. participants vs. 22% of
 controls. [*] Repeat
 pregnancy: 9% participants
 vs. 70% controls. [*]
* Participants (n=498): age 3. School attendance: 77%
[less than] 20 yrs, race not participants vs. 38%
specified. Recruited from controls. [*] School
clinical adolescent program. completion: 95% participants
 graduated from high school.
 Employment: 48% participants
 vs. 22% controls [*]
* Control group (n=91): from
adult obstetric clinic.
Received care in pediatric and
adult family planning clinic.
PROGRAM STRENGTHS AND
 WEAKNESSES
TEEN-TOT CLINIC. Nelson, Key, [up arrow] Matched control
Fletcher, Kirkpatrick & group. No difference between
Feinstein (1982) participant and control group
 characteristics.
* Duration: 18 mos postpartum. [down arrow] No analysis of
 attrition.
* Participants (n=35): age [down arrow] Many outcomes
[less than] 17 yrs, race 91% reported only at 6 mos.
black. Referred from urban
hospitals.
* Control group (n=70) matched [down arrow] Small number of
for maternal and child participants.
characteristics. Received care
at public clinics.
QUEENS HOSPITAL CENTER. [up arrow] No difference
Rabin, Beltzer, & Pollack between participant and
(1991) control group characteristics.
* Duration until mother 20 yrs [down arrow] Length of
old. participation not specified.
* Participants (n=498): age [down arrow] No discussion of
[less than] 20 yrs, race not attrition or drop-out
specified. Recruited from characteristics.
clinical adolescent program.
* Control group (n=91): from [down arrow] Intervals of
adult obstetric clinic. outcome evaluation not
Received care in pediatric and specified
adult family planning clinic.
TEEN MOTHER AND CHILD 1. Prenatal care, education,
PROGRAM Elster, Lamb, psychosocial and nutritional
Tavare & Ralston (1987) assessments.
 2. Health care for infants and
* Duration: 2 yrs postpartum. teen mothers. Staff on call.
* Participants (n = 125): Age WIC referral.
[less than] 18 yrs, race 3. Individual counseling about
[greater than]80% white, 35% financial management, school
from high socioeconomic group. and work. Referrals for
Self-referral, community vocational training,
referral. education.
* Control group (n = 135): 4. Contraceptive education.
Recruited from WIC site. 5. Infant health and
Received care from community development education.
providers. 6. Counseling on parenting,
 interpersonal relationships
 and stress. Outreach to
 fathers.
SPECIAL CARE PROGRAM. 1. Well-baby visits.
O'Sullivan & Jacobsen (1992) Participants received
 reminders if appointment
 missed.
* Duration: 18 mos. 2. Social worker reviewed
* Participants (n=120): Age family planning methods, made
[less than] 18 yrs, race 100% referrals to birth control
black. Recruited from urban clinic.
teaching hospital. 3. Health care provider asked
* Random assignment to control about mother's plan to return
group (n=123). Received to school.
routine care. 4. Health teaching in the
 waiting room. Infant care and
 appropriate ER use education.
TEEN MOTHER AND CHILD 1 Participants had more
PROGRAM Elster, Lamb, prenatal visits. [*] No
Tavare & Ralston (1987) difference in preterm or low
 birthweight.
 2-6. Participants had better
* Duration: 2 yrs postpartum. composite score at 12 and 26
* Participants (n = 125): Age mos postpartum [*] (repeat
[less than] 18 yrs, race pregnancy, school/job
[greater than]80% white, 35% attendance, receipt of
from high socioeconomic group. entitlements, ER visits,
Self-referral, community hospitalizations,
referral. immunizations, maternal
* Control group (n = 135): preventive health efforts,
Recruited from WIC site. child developmental
Received care from community knowledge and General Well-
providers. Being Schedule scores).
 Greater immunization
 completion among
 participants. [*] No
 significant difference in
 infant growth and development
 or repeat pregnancy rates.
SPECIAL CARE PROGRAM. 1. Clinic attendance (18 mos):
O'Sullivan & Jacobsen (1992) 40% vs. 22% of controls.
 Immunizations (18 mos): 33%
 vs. 18% of controls. [*]
* Duration: 18 mos. 2. Repeat pregnancy (18 mos):
* Participants (n=120): Age 12% vs. 28% of controls. [*]
[less than] 18 yrs, race 100% 3. Return to school:
black. Recruited from urban [greater than]50% of both
teaching hospital. participants and controls (no
* Random assignment to control significant statistical
group (n=123). Received difference).
routine care. 4. ER use: 75% vs. 85% for
 controls (no significant
 statistical difference).
TEEN MOTHER AND CHILD [leftright arrow] Participants
PROGRAM Elster, Lamb, more likely to
Tavare & Ralston (1987) have higher income, attend
 school, graduate, or be
 working at time of
* Duration: 2 yrs postpartum. enrollment. Multiple
* Participants (n = 125): Age regression used to control
[less than] 18 yrs, race for difference.
[greater than]80% white, 35% [down arrow] High attrition
from high socioeconomic group. rate.
Self-referral, community
referral.
* Control group (n = 135):
Recruited from WIC site.
Received care from community
providers.
SPECIAL CARE PROGRAM. [up arrow] Randomized study.
O'Sullivan & Jacobsen (1992) [up arrow] Outcomes analyzed
 among drop-outs.
 [leftright arrow]High
* Duration: 18 mos. attrition rate but 91%
* Participants (n=120): Age of original participants
[less than] 18 yrs, race 100% and controls interviewed at
black. Recruited from urban 18 mos.
teaching hospital.
* Random assignment to control
group (n=123). Received
routine care.
(*)Statistically significant difference using chi-square test (95%
confidence level).
(+)Disease state of pelvic organs, upper-respiratory, hematologic
or gastrointestinal systems requiring multiple doctor visits or
hospitalizations.
(++)Includes maternal morbidity definition plus any accident in a child
under 2 years of age.
ER: emergency room
WIC: Women Infant Children program
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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Article Details
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Author:Akinbami, Lara J.; Cheng, Tina L.; Kornfeld, Dana
Publication:Adolescence
Geographic Code:1USA
Date:Jun 22, 2001
Words:5123
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