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Objective: In this research, a randomized controlled trial (RCT) tested the efficacy of two teen pregnancy prevention (TPP) curricula, Reducing the Risk and Love Notes, compared with a group of adolescents in a control condition, on primary pregnancy prevention among youth at high‐risk for teen pregnancy. A secondary purpose was to examine two potential mediators, negative beliefs about teen pregnancy and intentions to follow the sequence of completing education, marrying or establishing a committed relationship, and then having children. Background: Teen pregnancy rates for racial/ethnic minority youth in the United States are disproportionately high compared with White youth. Given the positive view of children in these populations and the drive for youth to form peer relationships and explore their sexuality, meeting these cultural and developmental needs within TPP may be critical. Methods: The study examined the number of reported pregnancies across the first year after the interventions from a three‐arm, cluster RCT engaging 1,448 youth living in poverty between the ages of 14 and 19 years in 23 community‐based organizations in a southeastern U.S. city. Results: At the 1‐year follow‐up, youth in Love Notes report significantly fewer pregnancies compared with the control condition (18 pregnancies, 3.51%), F(2, 1,309) = 4.17, p =.02, d = 0.11. There was no significant difference between Reducing the Risk (31 pregnancies, 6.14%) and the control condition (27 pregnancies, 6.49%) in number of pregnancies. Less favorable attitudes about having a child as a teenager and other attitudes were associated with predicted outcomes. Conclusions: This study provides additional evidence for the efficacy of Love Notes, which embeds sex education into a larger curriculum on life planning and healthy relationship formation and maintenance. Implications. TPP approaches need to add content on planning and relationships to comprehensive sexual education. [ABSTRACT FROM AUTHOR]

Background: Teenage pregnancies cause serious health, social and economic consequences including death among adolescent girls worldwide. It is estimated that in 2019 about 55% of unintended pregnancies among adolescent girls aged 15–19 years ended up in abortions, which are often unsafe in developing countries. Little was known about the magnitude of teenage pregnancy and its associated factors in Dodoma Tanzania. Therefore, the study aimed at establishing the magnitude and factors associated with teenage pregnancies among adolescents in Dodoma Region Tanzania. Method: It was a community-based analytical cross-sectional study that included 539 adolescent girls aged 15 to 19 years old. A multistage sampling technique was used to recruit study participants. An interviewer-administered structured questionnaire was used to collect data. Data were analyzed by using SPSS v23. Descriptive statistics were used to describe the distribution of the entire study variable while the inferential statistics helped to establish factors associated with teenage pregnancy among adolescent girls and the level of significance was set at two sides of less than 0.05. Results: The magnitude of teenage pregnancy in Dodoma was 29%. After controlling for possible confounders, factors associated with teenage pregnancy were; urban residence [AOR: 3.02, 95%CI: (1.60–5.68), p = 0.001], low mothers' education status [AOR: 3.46, 95%CI: (1.47–8.11), p = 0.004]; Poor knowledge on sexual and reproductive health [AOR: 2.09, 95%CI: (1.2–3.63), p = 0.009]; Low family economic status [AOR: 3.83, 95%CI: (1.77–8.30), p = 0.001]; Peer group [AOR: 2.92, 95%CI: (1.33–6.40), p = 0.007]; Early marriage [AOR: 2.58, 95%CI: (1.57–4.26), p < 0.0001]; and Sexual abuse [AOR: 13.56, 95%CI: (7.98–23.06), p < 0.0001]. Conclusion: This study found a high magnitude of teenage pregnancy among youth in Dodoma. Teenagers who were more likely to teenage pregnancy were those with limited knowledge about sexual and reproductive health living in urban, from families with low economic status, their mothers had a low level of education, from a culture that encourage early marriages, with the influence of peer and who experienced sexual abuse. An innovative intervention study to come up with a cost-effective strategy to address the challenge of teenage pregnancy in Dodoma is highly recommended. Plain English summary: The study is reporting the status of teenage pregnancy among adolescents aged 15–19 years in the Dodoma Region. Dodoma Region is the capital city of Tanzania and it is among the fastest-growing city of Tanzania. The region has the highest population of youth in Tanzania. In addition, the study is reporting on factors associated with teenage pregnancy. A range of factors that have been reported by previous studies was assessed in this study to test whether they are significant factors in this population. These factors were sociodemographic factors (age, sex, marital status, education, occupation), social factors (Peer pressure, sexual abuse), familial factors (Household socio-economic status, domestic violence, marital status,), behavioral factors (like age at first sexual intercourse, early marriage, and contraceptive use, perception on teenage pregnancy, family income, peer pressure, and casual sex) and knowledge on sexual and reproductive health. The findings from this study are key to the development of a focused intervention study that will work out the strategies to be used to solve the problem of teenage pregnancies in Dodoma Region Tanzania. [ABSTRACT FROM AUTHOR]

This article focuses on examining the implementation of evidence-based teen pregnancy prevention programming in a select school district. Results are presented based on the following implementation drivers: (1) actions taken by leadership to make decisions, provide guidance, and support how the school site and community-based organizations are functioning in support of implementation; (2) actions taken to ensure competent staff delivery of the curricula; and (3) actions taken to create and sustain a hospitable context in order to implement the interventions at the school site. The need for adolescent sexual health education is evident in this geographic location where Hispanic or Latino teens consistently have higher birth rates among race and ethnicities that are routinely reported. For 2018, when this project started, those rates were 40 births per 1,000 females aged 15 to 19 years. For 2018, the birth rates for African Americans was 31 and for Whites was 17 per 1,000 females aged 15 to 19 years. The project goals were to reduce teen birth rates by (1) providing evidence-based teen pregnancy prevention curricula to youth aged 11 to 19 years over the course of the 5-year project period, (2) training school staff and community members in the curricula, and (3) generating community support of youth access to reproductive health care and education. Despite a funding interruption to implementation of the project and the impact of COVD-19, educational programming was provided to 9,616 youth. The article details the key implementation strategies and solutions so that other practitioners can consider application of these implementation drivers in their own adolescent health education programming. [ABSTRACT FROM AUTHOR]

RE-AIM is an implementation science framework that provides a structure to promote data collection and analysis in the domains of R each, E fficacy/ E ffectiveness, A doption, I mplementation, and M aintenance. The RE-AIM approach promotes more data collection and reporting than typical evaluations so potential adopters can determine the potential program fit for their setting. RE-AIM has been used to evaluate a variety of programs; however, there are few resources that provide strategies for conducting a RE-AIM evaluation in the school setting. The purpose of this article is to inform future studies by elucidating experiences conducting a large, complex, multisite, longitudinal RE-AIM evaluation in schools in partnership with the state's Departments of Education and Health, and to share strategies for overcoming obstacles. With the long-term goal of facilitating the translation of school-based intervention research into practice, we provide key considerations and recommend strategies for school-based RE-AIM evaluation success. [ABSTRACT FROM AUTHOR]

Background: Teenage pregnancy is known to have physical, emotional, and psychosocial effects. Because of these risks, family planning and contraception messages have been disseminated in various forms of media, but their association with teenage pregnancy has not been studied previously in the Philippines. This study aims to examine the association between exposure to various family planning and contraception messages disseminated in various media channels and pregnancy among Filipino women aged 15–19. The study also intended to examine interactions between the different media channels where these family planning and contraception messages are being disseminated on their effect on teenage pregnancy. Methods: We used data from the individual recode of the 2017 Philippine National Demographic and Health Survey. We used logistic regression for survey data to study the association between exposure to family planning and contraception messages and teenage pregnancy. Results: Out of 5120 respondents, 44% of respondents have accessed information on contraception from the internet, 25% have heard information about contraception through the radio, 55% of respondents have heard about contraception via television, 15% have read about contraception in the newspapers and magazines, and only 6% have received information on contraception via short messaging service (SMS). There were 420 (8.56%) who have ever been pregnant. After adjusting for confounding variables, those who were exposed to family planning/contraceptive messages via the internet (aOR: 0.90; 95% CI: 0.59, 1.35) and newspapers/magazines (aOR: 0.78; 95% CI: 0.44, 1.41) have lower odds of teenage pregnancy, but no strong evidence of their effectiveness. On the other hand, exposure to family planning messages through the radio (aOR: 1.06; 95% CI: 0.71, 1.59), television (aOR: 1.09; 95% CI: 0.72, 1.65), and short messaging service (aOR: 1.29; 95% CI: 0.51, 3.22) marginally increase the risk of teenage pregnancy. We did not find any pairwise interactions between the different exposure variables. Conclusions: Our results highlight the need to improve the content and key messages of contraceptive and family planning messages in the Philippines, especially those that are broadcasted online and in print media. There is also a need to increase the reach of these different family planning and contraception messages, especially by utilizing social media and other print and online media platforms commonly used by the youth. Plain language summary: Adolescent pregnancy is associated with adverse health, psychosocial, and economic outcomes. As of 2017, the proportion of women aged 15–19 who have begun childbearing in the Philippines is 9%. To counter this, the Philippine government and its partners in the private sector disseminate family planning and contraception information to the general population. Thus, we studied the effect of being exposed to these family planning and contraception information in different forms of media and their effect of teenage pregnancy. We analysed the 2017 Philippine National Demographic and Health Survey. After controlling for the effect of other variables, we found that these family planning and contraception information had little effect on teenage pregnancy in the country. These findings highlight the need to improve the content and key messages of contraceptive and family planning messages, and improve their coverage in the general population. [ABSTRACT FROM AUTHOR]

Background: An understanding of the psychosocial support challenges and opportunities in the context of teenage pregnancy is important for developing appropriate interventions for pregnant and parenting girls. This qualitative study was conducted in Homa Bay County, Kenya, to examine the experience of teenage pregnancy and the resultant psychosocial support needs from the perspectives of both pregnant/parenting girls and their own parents, who are typically expected to provide various forms of support. Methods: The study used a descriptive case study design, drawing on counseling case notes documented by psychologists who held counseling sessions with 20 pregnant or parenting girls and 6 of their parents as part of a psychosocial support intervention. The counseling case notes formed a qualitative data set, which was analyzed thematically. Results: Emerging master themes were related to pregnant and parenting girls' experience of sexual violence and adverse childbirth outcomes; psychological trauma confronted by girls and their parents alike; parental need for support in communicating with pregnant/parenting girls about sex and sexuality; and the availability of family support as a resource for teenage mothers. Conclusion: Pregnant and parenting teenage girls require a range of psychosocial support responses that recognize the realities of sexual violence and other challenges in the lives of the girls themselves, as well as in the lives of their parents and caregivers. While parents and other caregivers can serve as an important resource for supporting affected girls, they often need assistance as well, in order to support pregnant/parenting girls effectively. These realities need to be taken into account to maximize the effectiveness of health and development programs for pregnant and parenting girls. Furthermore, emerging themes from actual counseling sessions with affected girls and parents can provide important insights into the potential psychosocial support needs of the broader population of pregnant and parenting girls. Plain language summary: This study looked into the lives of pregnant and parenting girls in Kenya by examining case notes that were written up by psychologists during the counseling sessions they held with 20 different teenage girls who were pregnant, or already had children, and 6 of their parents. The case notes provided an understanding of the kind of support pregnant and parenting girls need, including mental health care to deal with the trauma of sexual violence (and other issues) that some had experienced. It also helped put a spotlight on the traumas that parents of affected girls face after a teenage pregnancy occurs. These issues need to be addressed in order to ensure that health and development professionals who work with pregnant and parenting girls are as helpful to them as possible. [ABSTRACT FROM AUTHOR]

There is a long history of regarding marginalised groups as unfit to parent and of eugenic policies targeting those with 'undesirable' bodily conditions or behaviours. This is part of a broader pattern of stratified reproduction – structural conditions that enable or discourage certain groups from reproducing – that often brings about and exacerbates injustices. This paper critically assesses the US and UK social and medical literature on applying pressure to marginalised groups, or those who have behaved 'irresponsibly', to use long-acting reversible contraception (LARC). Targeting young people for LARC fails to recognise that social inequality is the context for teenage pregnancy, not the result of it. Provider pressure on women of colour to use LARC is linked to institutional racism, whilst policy for those with physical and intellectual disabilities is shaped by disability discrimination. Other groups to be targeted include so-called 'welfare mothers', substance users, those who have had children put into care and offenders. Particularly controversial are cases in which LARC has been ordered by courts. LARC policy incorporating these kind of discriminatory practices needs to stop; future policy should focus on person-centred care that bolsters reproductive justice. [ABSTRACT FROM AUTHOR]

Teen birth is a contributor to significant challenges, including poverty, foster care, increased medical expenses, and high school dropout. Although teen birth rates have declined, disparities persist by state. Oklahoma's teen birth rate is fifth highest in the nation. Recognizing population-level change is not possible through the work of any single organization, Thrive is the convening leader of a multipartner collaboration called the Central Oklahoma Teen Pregnancy Prevention Collaboration. This collaboration utilizes the Collective Impact framework to bring organizations together to address teen pregnancy. The purpose of this article is to detail the consulting phase of the Collective Impact Community Engagement Toolkit, welcoming feedback from community members regarding programs. Method. Researchers conducted a mixed-methods needs assessment, including interviews and surveys with community-based organization staff, faith members, and caregivers. Data were analyzed using SPSS 26 and NVIVO 12 Pro. Results. A total of 350 surveys and 25 interviews were included in the analysis. Looking across all three populations, participants wanted to learn most about parent-child communication, communication skills with partners, and sexually transmitted infections/sexually transmitted diseases. Participants wanted topics delivered through educational programs, handouts/brochures, group settings, and websites. Common barriers were needing additional training/information, limited time, and lack of approval/support from others. Conclusions. This community needs assessment provided valuable information regarding needs of community-based organization staff, faith members, and parents related to adolescent sexual health. By including the community in needs assessments and using multiple tools, researchers/practitioners are able to see which strategies are best for gathering rich feedback and planning sustainable programs. [ABSTRACT FROM AUTHOR]

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Ethiopia has the second-largest youth population in Africa with about 37.4 million people aged 10–24 years. To meet the needs of this population group, adolescent, and youth health (AYH) programs, including those focused on sexual and reproductive health (SRH) and youth development, have gained traction in Ethiopia in the last two decades, especially following the 2005 election in Ethiopia. However, adolescents and youths in Ethiopia continue to face a high burden of morbidity and mortality from multiple factors including, teenage pregnancy, unplanned pregnancy, compromised nutrition, HIV and STIs, unsafe abortion, early and child marriage, and unmet needs for family planning. To date, adolescents and youth-related interventions in Ethiopia are fragmented under various ministries, uncoordinated, underfunded, project-oriented, lack effective policy implementation, and lack meaningful participation of young people. Addressing adolescents and youth health and development issues require evidence-based, well-tailored, at scale, intensified, coordinated, and holistic national responses. Therefore, there is a need to advocate for a realization of robust government commitment to ensure a multi-sectoral, coordinated, at scale, and well-funded national response to address the multifaceted needs of young people in Ethiopia including their sexual and reproductive health. An example to emulate is the HIV/AIDS response in Ethiopia, which was led by a national council chaired by the President of the Federal Democratic Republic of Ethiopia and spearheaded by a secretariat leveraging resources and implementing a multisectoral national plan down to the kebele level. [ABSTRACT FROM AUTHOR]

High levels of adolescent pregnancy and child marriage rates in low- and middle-income countries is an issue of concern to many stakeholders, including in Zambia where almost one-third of women give birth before age 18. The aim of this paper is to explore and analyse social norms concerning adolescents' sexual behaviour within the context of an intervention trial in rural communities in southern Zambia. It is based on a qualitative study applying individual interviews, focus group discussions and participatory research methods. We apply the distinction between injunctive and descriptive norms to demonstrate that adolescent girls are caught between conflicting norms. Injunctive norms express that premarital sex, contraceptive use, and discussions about sex between adults and youths are socially condemned. At the same time poor girls are reported to feel pressure towards having sexual relations for the economic benefits such relations can bring, and this practice is considered so common that it amounts to a descriptive norm. Norms and structural conditions combine to create a disabling and disempowering environment for adolescent sexual and reproductive health, which limits girls' agency and exposes them to unwanted pregnancies. [ABSTRACT FROM AUTHOR]

Objective: A literature review was conducted to analyze the impact of COVID-19 on documented preexisting determinants of adolescent pregnancy in sub-Saharan Africa such as poverty, inequitable gender norms, low access to education, and reproductive health services. Methods: The terms "sub-Saharan Africa," "Gender Norms," "Poverty," and "Adolescent Pregnancy" were used to search the literature for preexisting determinants of adolescent pregnancy in academic and grey literature. "COVID-19" was added to investigate the potential consequences of the pandemic. The literature revealed similar experiences in adolescent girls during the Ebola outbreak, which lead to the analysis of government and healthcare official responses to previous epidemics. Results: The literature review revealed that the relationship between identified micro (inequitable gender norms, transactional sex, sexual and gender-based violence, early marriage, and menstruation) and macro (poverty, education, and healthcare) factors contributing to adolescent pregnancy were exacerbated by the COVID-19 pandemic. Conclusion: Three realistic targets including, expanding and communicating available reproductive health resources, prioritizing the role of women in the economy, and ensuring return to school should be included as part of current COVID-19 mitigation programs. Additionally, these interventions should be incorporated in future public health preparedness plans to reduce the risk of adolescent pregnancy during public health emergencies. [ABSTRACT FROM AUTHOR]

Introduction: A small but growing body of evidence suggests individualized support services and improved access to contraception can promote healthy birth spacing among adolescent mothers. This study examines the effectiveness of Steps to Success, a 2-year home visiting program in San Angelo, Texas, enhanced with content designed to reduce rapid repeat pregnancy among young mothers, increase fathers' involvement, and support mothers' education and career aspirations. Methods: The study used a randomized controlled trial, with 594 young mothers ages 14–20 randomly assigned to either a program group that received Steps to Success or a control group that received an existing home visiting program focused only on parenting and child development. Women in both research groups completed a baseline survey upon enrolling in the study and 1- and 2-year follow-up surveys. Results: After 2 years, participants in the Steps to Success and existing home visiting groups had similar rates of repeat pregnancy. However, women in the Steps to Success group were more likely to use long-acting reversible contraceptives (effect size = 0.18, p = 0.066), particularly younger adolescent mothers ages 14–18 (effect size = 0.34, p = 0.010). Steps to Success also decreased the incidence of unprotected sex for younger adolescent mothers (effect size = -0.25, p = 0.035). Steps to Success did not improve outcomes in other domains. Discussion: Steps to Success improved some outcomes related to healthy birth spacing among younger adolescent mothers. Communities interested in similar programming may want to consider focusing their services on this age group. [ABSTRACT FROM AUTHOR]

This cross-sectional study sought to identify factors associated with sexual intentions among a sample of 252 African American high school adolescents who participated in a teen pregnancy prevention program in a large urban city. Participants completed surveys that included measures of youth assets and knowledge of HIV-related sexual risk behaviors. A series of data analyses included descriptive statistical analyses, t-tests, chi-square, and ordinal regression. Study results demonstrate that older age, male gender, and lower levels of youth assets predicted intentions to have sex in the future. Findings also suggest youth assets may serve as a protective factor against the transmission of HIV for African American adolescents in the context of theory regarding intentions to have sex. Surprisingly, more accurate knowledge about HIV-related sexual risk behaviors was associated with intentions to engage in sexual intercourse within the next six months, calling into question subjects' confidence in or perceived self-efficacy about safely engaging in sexual activity. [ABSTRACT FROM AUTHOR]

Background: In teen pregnancy prevention (TPP) evidence-based program replication, fidelity toolkits (FTKs) provide structure to ensure that essential curricular components are delivered as intended. Objective: The purpose of this project was to extend quality improvement efforts (Flinders, 2017) through analysis of FTKs from four years of TPP implementation. Methods: An evidence-based TPP program was delivered to females, 15–19 years of age (n = 1,658) from four suburban Ohio counties. Fidelity rates were calculated by agency staff and undergraduate nursing students. Grounded theory was used to identify themes from the narrative sections of the FTKs. Plan-Do-Study-Act methodology (Agency for Healthcare Research and Quality, 2008) guided this quality improvement work. Results: Staff fidelity was reported as 98.38%. Student fidelity was reported at 99.05%. Key themes, identified as a result of the qualitative analysis, were categorized as participant factors, site factors, or presenter factors. Conclusions: Toolkits created an effective safeguard to ensure the replication of the evidence-based TPP program, with fidelity. Implications for Nursing: Undergraduate students are capable of implementing evidence-based programming, with fidelity, to meet the educational needs of their communities. Analysis of narrative comments from toolkits can influence FTK revisions to improve program delivery. [ABSTRACT FROM AUTHOR]

Zambia, like other low- and middle-income countries, faces numerous adolescent sexual and reproductive health challenges such as teenage pregnancies. This study aimed at understanding teachers' and community health workers' (CHWs) implementation of comprehensive sexuality education (CSE) as part of a comprehensive support package for adolescent girls to prevent early childbearing. Data collected using in-depth interviews [n = 28] with teachers [n = 15] and community health workers [n = 13] were analysed using thematic analysis. The teachers and CHWs reported that the use of participatory approaches and collaboration between them in implementing CSE enabled them to increase girls' and boys' participation youth clubs. However, some teachers and CHWs experienced practical challenges with the manuals because some concepts were difficult to understand and translate into local language. The participants perceived that the youth club increased knowledge on CSE, assertiveness and self-esteem among the learners. Training and providing a detailed teaching manual with participatory approaches for delivering CSE, and collaborative teaching enabled teachers and CHWs to easily communicate sensitive SRH topics to the learners. However, for the adoption of CSE to be even more successful, piloting of the curriculum with local facilitators and translating the manuals into the local languages before they are implemented, is recommended. [ABSTRACT FROM AUTHOR]

Background: Interventions to prepare for a healthy pregnancy from an early age can ensure the health of both mother and child. This study aims to compare the factors associated with healthy pregnancy preparation behavior (HPPB) among male and female adolescents. Methods: A total of 690 Korean adolescents participated in this cross-sectional study from July 11 to August 24, 2018. Determinants of the likelihood of engaging in HPPB were described using hierarchical regression about the importance of and confidence in HPPB, the gender equality related to pregnancy and birth, and the health belief model (HBM) constructs about HPPB. Results: Smoking experience (β = − 0.18, p < 0.001 for boys, β = − 0.25, p < 0.001 for girls), and HBM constructs were identified as factors correlated with HPPB in both genders. The significant factors in boys were perceived susceptibility (β = − 0.13, p = 0.005), perceived severity (β = 0.12, p = 0.015), perceived benefits (β = 0.23, p < 0.001), and perceived barriers (β = − 0.18, p < 0.001), whereas the corresponding factors in girls were perceived severity (β = 0.20, p = 0.001), and perceived barriers (β = − 0.23, p < 0.001). The importance of HPPB was identified as a factor only among girls (β = 0.19, p = 0.005), while confidence in HPPB (β = 0.12, p = 0.401), gender equality related to pregnancy and childbirth (β = − 0.20, p = 0.001 for women's responsibility variable, β = 0.14, p = 0.018 for men's responsibility variable), and alcohol (β = − 0.10, p = 0.022) were factors identified only among boys. Conclusions: The gender differences in opinions on HPPB identified in this study can help nurses and community health care professionals recognize issues for which they can develop and implement preventive interventions. For healthy pregnancy preparation, interventions based on HBM constructs and smoking should be presented for both male and female adolescents. Imparting education to females on the importance of HPPB and to males on confidence in HPPB, gender equality related to pregnancy and childbirth, and alcohol consumption, should be emphasized. In addition, as perceived susceptibility may be low in a disease prevention model using the health belief model, it is necessary to prioritize increasing the perceived susceptibility of school-age children as an intervention. Plain Language Summary: In the context of pregnancy preparation, attention has recently shifted from the period just before pregnancy to the early years, or even throughout one's life. The World Health Organization identifies adolescents as requiring specific attention. Adolescents' health behaviors can impact their adulthood years and have significant repercussions on the health of the future generation. In addition, recent studies consistently report that the preparedness of both men and women is essential to pregnancy preparation. Therefore, it is now time to present a new strategy by identifying and grasping the different factors that influence the two genders. This study can raise awareness of healthy pregnancy preparation behavior from adolescence onwards of both genders. There were differences in factors affecting HPPB by gender. For healthy pregnancy preparation, interventions based on HBM constructs and smoking should be presented for both male and female adolescents. Imparting education to females on the importance of HPPB (β = 0.19, p = 0.005) and males on confidence in HPPB (β = 0.12, p = 0.401), gender equality related to pregnancy and childbirth (β = − 0.20, p = 0.001 for women's responsibility variable, β = 0.14, p = 0.018 for men's responsibility variable), and alcohol consumption (β = − 0.10, p = 0.022) should be emphasized; and effective healthy pregnancy preventive strategies should be developed based on these findings. Interventions to prepare for a healthy pregnancy from an early age can ensure the health of both mother and child. [ABSTRACT FROM AUTHOR]

Background: The current diverse health care environment makes it vital for nursing students to have multicultural respect and understanding. Collaborative action research can be used to engage students in the learning process. Method: Action research addressing adolescent pregnancy in rural Paraguay involved nursing students in the research process and care delivery. Results: Two groups of nursing students participated in two or more cycles of action research. The first cycle included identifying the problem, research development, data gathering, and interpreting results. Contributing factors to adolescent pregnancy and potential solutions were discovered. Teaching reproductive education informed the second cycle of the action research. Students created reproductive education modules and taught them to more than 700 adolescents in Paraguay. Conclusion: Action research provided a collaborative and engaging method to teach undergraduate nursing students about both global health advocacy and the research process. The cyclic nature of action research provides an excellent way to involve subsequent student groups. [J Nurs Educ. 2022;61(4):193–196.] [ABSTRACT FROM AUTHOR]

Background: Improving access to adolescent contraception information and services is essential to reduce unplanned adolescent pregnancies and maternal mortality in Uganda and Kenya, and attain the SDGs on health and gender equality. This research studies to what degree national laws and policies for adolescent contraception in Uganda and Kenya are consistent with WHO standards and human rights law. Methods: This is a comparative content analysis of law and policy documents in force between 2010 and 2018 governing adolescent (age 10–19 years) contraception. Between and within country differences were analysed using WHO's guidelines "Ensuring human rights in the provision of contraceptive information and services". Results: Of the 93 laws and policies screened, 26 documents were included (13 policies in Uganda, 13 policies in Kenya). Ugandan policies include a median of 1 WHO recommendation for adolescent contraception per policy (range 0–4) that most frequently concerns contraception accessibility. Ugandan policies have 6/9 WHO recommendations (14/24 sub-recommendations) and miss entirely WHO's recommendations for adolescent contraception availability, quality, and accountability. On the other hand, most Kenyan policies consistently address multiple WHO recommendations (median 2 recommendations/policy, range 0–6), most frequently for contraception availability and accessibility for adolescents. Kenyan policies cover 8/9 WHO recommendations (16/24 sub-recommendations) except for accountability. Conclusions: The current policy landscapes for adolescent contraception in Uganda and Kenya include important references to human rights and evidence-based practice (in WHO's recommendations); however, there is still room for improvement. Aligning national laws and policies with WHO's recommendations on contraceptive information and services for adolescents may support interventions to improve health outcomes, provided these frameworks are effectively implemented. Plain language summary: The unmet need for contraception among adolescents is high in Uganda and Kenya, and has many negative consequences, including unwanted pregnancy, exposure to unsafe abortion, and maternal morbidity and mortality. National laws and policies play an important role in determining adolescents' access to contraception. For example, national laws and policies can shape the government programs that provide (or withhold) contraception, and the social norms influencing adolescents' access to contraception. Therefore, this research compares national laws and policies that determine access to contraception services and information for adolescents in Uganda and Kenya with WHO's recommendations for access to contraception. This is an analysis of the content of Ugandan and Kenyan laws and policies in force between 2010 and 2018. The content of these documents was analyzed using WHO's nine recommendations for how contraception information and services should be provided: non-discrimination, availability, accessibility, acceptability, quality, informed decision-making, confidentiality, participation, accountability. Ninety-three documents were screened and 26 documents were included in the analysis: 13 policies from Uganda and 13 policies from Kenya. On average, Ugandan policies include one WHO recommendation for adolescent contraception per policy and Kenyan policies include two WHO recommendations. This recommendation most frequently mentioned in all policies is the accessibility of contraception (for example, for adolescents living remotely, integrated in adolescent HIV or pre-/post-natal care, etc.). Together, all Ugandan policies mentioned 6/9 WHO recommendations whereas all Kenyan policies cover 8/9 WHO recommendations. In conclusion, Ugandan and Kenyan policies are consistent with many of WHO's recommendations for access to contraception, however, there is still room for improvement. [ABSTRACT FROM AUTHOR]

American Indian (AI) youth are at increased risk for poor reproductive health outcomes. Parental communication and monitoring are established predictors of sexual risk-taking among adolescents. No program evaluations of sexual risk avoidance programs have focused exclusively on AI youth and parents. This study assesses the impact of the Respecting the Circle of Life (RCL) Teenage Pregnancy Prevention program on parent–youth communication and parental monitoring through a randomized controlled trial with AI youth ages 11–19 and their trusted adults (parents/caregivers) (N  = 518). RCL consists of 8-peer group and one parent–youth session. Trusted adult participants completed the Parental Monitoring Scale and the Parent Adolescent Communication Scale at baseline and 3 and 9 months post-intervention via self-report. Intervention impact was evaluated using linear regression models, which included an indicator for study group. At 3 months post, trusted adults in the intervention reported significantly higher levels of sexual health communication (P  = 0.042) and spoke to their child more often about how to get condoms (P  = 0.001), get birth control (P  = 0.014) and protect themselves from human immunodeficiency virus (P  = 0.005) compared with trusted adults in the control condition. Program impact varied by age and sex. This study adds to literature and extends findings on RCL impact. [ABSTRACT FROM AUTHOR]

Background: Adolescent pregnancy carries both health and economic risks for the pregnant girl and resulting baby, and it is common in Zambia. Providing alternative methods of preventing early pregnancy than abstinence is regarded as culturally and religiously unacceptable in most parts of the country. The community dialogue approach is being tested to address norms and beliefs around early pregnancy, marriage and school dropout, and is based on Paulo Freire's transformative communication approach. The objective of this paper was to understand parents' perspectives on the application of the community dialogue approach in addressing adolescents' early pregnancy and school dropout in a cluster randomized controlled trial in rural Zambia. Methods/design: This was a case study design. We nested the study in the community dialogue intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Dialogue meetings were held and economic support was provided for a period of 27 months from September 2016 until November 2018. We held focus group discussions in November 2018 with guardians/parents in six schools in Chibombo District of Central Province. All the discussions were audio recorded and transcribed verbatim. Thematic analysis was used to analyze the data. Results: The guardians/parents perceived the community dialogue to be a relevant approach for addressing social and cultural norms regarding early pregnancy, marriage and school dropout. It was embraced for its value in initiating individual and collective change. The facilitators' interactive approach and dialogue in the community meetings coupled with the use of films and role plays with the parents, lead to active participation and open discussions about sexual and reproductive health (SRH) topics during the community dialogue meetings. Group interactions and sharing of experiences helped parents clarify their SRH values and subsequently made them feel able to communicate about SRH issues with their children. However, cultural and religious beliefs among the parents regarding some topics, like the use of condoms and contraceptives, complicated the delivery of reproductive health messages from the parents to their children. Conclusion: The study indicated that the community dialogue was appreciated by the parents and helped in addressing cultural barriers to discussing SRH issues between generations. Plain language summary: Adolescent pregnancy carries health and economic risks for the pregnant girl and her baby. However, many adolescent girls in Zambia become pregnant and this is partly due to social norms around fertility and marriage. Community dialogue meetings may be useful in order to discuss norms and beliefs around early pregnancy, marriage and school dropout and encourage reflection around cultural practices in the communities. A cluster randomized controlled trial in rural Zambia tested the effects of organizing community dialogue meetings and providing economic support for families with adolescent girls for a period of 27 months, from 2016 to 2018. The objective of this case study was to understand parents' perspectives on the use of the community dialogue approach. Focus group discussions were held in November 2018 with guardians/parents in six schools in Chibombo District of Central Province. The guardians/parents perceived the community dialogue to be a relevant approach for addressing social and cultural norms regarding early pregnancy, marriage and school dropout. The facilitators' interactive approach in the community meetings coupled with the use of films and role plays, lead to active participation and open discussions about sexual and reproductive health topics during the community dialogue meetings. Group interactions and sharing of experiences made the guardians feel able to communicate about sexual and reproductive health issues with their children. However, cultural and religious beliefs among the parents regarding the use of condoms and contraceptives made it difficult for them to touch upon this topic. [ABSTRACT FROM AUTHOR]

Background: Teen pregnancy prevention in the United States has traditionally focused on the development, testing, and subsequent implementation of a set of evidence-based programs (EBPs), recommended nationally. However, these existing EBPs often do not prioritize the most at-risk or vulnerable populations. Methods: The Innovative Teen Pregnancy Prevention Programs (iTP3) project was funded to facilitate the development of new, innovative programs to reach disparate populations. Through a mixed methods design, iTP3 evaluated the process and resulting innovative programs from five iterative cohorts of funded organizations, referred to as Innovators. iTP3 utilized both a traditional funding model with more traditional methods of capacity building assistance, but transitioned over time to a design-focused funding model in which organizations and individuals developed innovative programs through an intensive human centered design process. Results: Evaluation results showed that the resulting portfolio of programs had differences in the types of programs resulting from the differing funding models. Notable differences among programs from the two funding models include program length, along with personnel, time, and resources needed to develop and manage. Conclusion: Both traditional and design funding models led to innovative programs, with notable differences in the development process and resulting programs. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Provision of reproductive health preventive services to adolescents is critical given their high rates of sexually transmitted infections and unintended pregnancies. Pediatricians are well positioned to provide these services but often face barriers. With this project, we aimed to build quality improvement (QI) capacity within pediatric practices to improve adherence to national guidelines for adolescent reproductive health preventive services. METHODS: In 2016, an accountable care organization overseeing health care delivery for low-income children in the Midwestern United States used practice facilitation, a proven approach to improve health care quality, to support pediatric practices in implementing reproductive health QI projects. Interested practices pursued projects aimed at providing (1) sexual risk reduction and contraceptive counseling (reproductive health assessments [RHAs]) or (2) etonogestrel implants. QI specialists helped practices build key driver diagrams and implement interventions. Outcome measures included the proportion of well-care visits with RHAs completed and number of etonogestrel insertions performed monthly. RESULTS: Between November 1, 2016, and December 31, 2019, 6 practices serving >7000 adolescents pursued QI projects. Among practices focused on RHAs, the proportion ofwell-care visitswith completed RHAs permonth increased from0% to 65.8%(P< .001)within 18months. Among practices focused on etonogestrel implant insertions, overall insertions permonth increased from 0 to 8.5 (P< .001). CONCLUSIONS: Practice facilitation is an effective way to increase adherence to national guidelines for adolescent reproductive health preventive services within primary care practices. Success was driven by practice-specific customization of interventions and ongoing, hands-on support. [ABSTRACT FROM AUTHOR]

Background: Rates of unplanned adolescent pregnancy and unsafe induced abortions are very high in Sub-Saharan African countries including Tanzania. Despite their availability and accessibility, modern family planning methods are reported to be critically underutilized by adolescents. This study is part of a broader study that aims to develop a curriculum that will be used in training health professionals by investigating the sexual health training needs of health providers and students in Tanzania. Aim: This study describes the perceptions of health professionals and students on the provision of contraceptives to adolescents. Methods: Qualitative formative assessment type of research was conducted using 18 focus groups stratified among health professionals and students (midwives, nurses, and medical doctors). Study participants were presented with the theoretical scenario of a 14-year-old girl who sought contraceptive services at a family planning clinic. This theoretical scenario was used to determine how health professionals and students would handle the case. Thematic analysis guided the examination and determination of data results. Results: Three main themes emerged from the data, including (1) knowledge about the provision of contraceptives to adolescents, (2) perception of the adolescents' right to contraceptive use, and (3) barriers to the provision of contraceptives to adolescents. Participants stated that having a baseline knowledge of contraceptive services for adolescents and their rights to contraceptives would trigger their decision on offering the contraceptive. On the other hand, being unaware of the reproductive health rights for adolescents, judgmental behavior of providers, as well as religious and cultural dynamics were all found to be major barriers for providers to offer contraceptive services to the 14-year-old adolescent girl in the theoretical scenario. Conclusion: These findings support the need for comprehensive sexual health education in Tanzanian health professional training programs. Plain language summary: In Tanzania, adolescent pregnancies are culturally unwanted, abortion remains illegal and yet the utilization of family planning services among adolescents is still low. The community myths and misconceptions about the side effects of contraceptives, healthcare providers' attitudes, and barriers within the healthcare system hinder adolescents' utilization of family planning services. The effective use of family planning methods will prevent the use of unsafe induced abortions and hence reduce morbidity and mortality among young women. This will be possible only if healthcare providers are equipped with the knowledge and skills to address these sexual and reproductive health challenges among adolescents in Tanzania. Therefore, in this study, we decided to explore the perceptions of health professionals and students on the provision of contraception to adolescents. We conducted 18 focus groups stratified among health professionals and students (midwives, nurses, medical doctors). Participants were supplied with a theoretical scenario wherein a 14-year-old girl presented to a family planning clinic seeking contraceptive services to determine how health professionals and students would handle the case. We found that the decision of providers with regards to offering contraception is highly dependent on having a baseline knowledge of the rights and contraceptive services available to adolescents. Some barriers identified as reasons for providers not to offer contraceptive services include a lack of awareness of the reproductive health rights for adolescents, judgmental behavior (implicit and explicit biases among providers), as well as religious and cultural dynamics. Participants also acknowledged that the presence of guidelines and proper training among providers might avoid the infringement of adolescents' rights to sexual and reproductive health services. In conclusion, these findings support the need for comprehensive sexual health education in Tanzanian health professional training programs. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Latinx adolescents are at increased risk of teen pregnancy. This study evaluates the impact of Re:MIX, a comprehensive sexuality education program cofacilitated by professional health educators paired with young parent educators implemented with primarily Latinx youth in Texas. METHODS: A cluster randomized trial was conducted with students in grades 8‐10 in 57 classrooms across three schools. Students completed baseline, post‐test, and long‐term follow‐up surveys to determine the impact of the program on behavioral outcomes—sexual experience and unprotected sex—and on mediating factors including intentions, attitudes, knowledge, and self‐efficacy related to sexual activity and contraception. RESULTS: Re:MIX was implemented with fidelity and educators were well‐received. At post‐test, compared to control students, Re:MIX students were more likely to intend to use hormonal or long‐acting contraceptive methods if they had sex, had greater reproductive health knowledge, had more confidence in their ability to ask for and give consent, and were more likely to know where to obtain contraception. Most findings were sustained at the long‐term follow‐up, but there were no impacts on behaviors. CONCLUSIONS: The implementation and impact findings highlight the promising approach of pairing young parent educators with experienced health educators for teen pregnancy prevention among Latinx students. [ABSTRACT FROM AUTHOR]

Native American youth endure a complex interplay of factors that portend greater risk-taking behaviors and contribute to marked health disparities experienced in adolescence. The Asdzáán Be'eená ("Female Pathways" in Navajo) program was developed as a primary prevention program to prevent substance use and teen pregnancy among Navajo girls. The Asdzáán Be'eená program consists of 11 lessons delivered to dyads of girls ages 8 to 11 years and their female caregivers. Feasibility, acceptability, and preliminary impact on risk and protective factors were assessed through a pre-/post study design. Data were collected from girls and their female caregivers at baseline, immediate, and 3 months postprogram completion. Forty-seven dyads enrolled in the study, and 36 completed the 3-month evaluation. At 3 months postprogram, girls reported significant increases in self-esteem, self-efficacy, parent-child relationship, social support, cultural, and sexual health knowledge. Caregivers reported increased family engagement in Navajo culture and parent-child communication and improved child functioning (fewer internalizing and externalizing behaviors). Findings suggest Asdzáán Be'eená has potential to break the cycle of substance use and teen pregnancy in Native communities by improving protective and reducing risk factors associated with these adverse health outcomes. Additional rigorous efficacy trials are necessary to establish program effectiveness. [ABSTRACT FROM AUTHOR]

Although US teenage birth rates substantially decreased over the past two decades, it still remains the highest in the developed world. More innovative, community-wide initiatives are needed to combat the issue. In Oklahoma County, Oklahoma, the Central Oklahoma Teen Pregnancy Prevention Collaboration is utilizing the collective impact model to convene multiple organizations with the goal of making systems-level changes related to teenage pregnancy within the community. This study used an interorganizational network analysis to evaluate the current strength of relationships between organizations in the Collaboration. An interorganizational network survey assessed collaborative relationships (e.g. information sharing and joint planning) within the network. Using R software, network diagrams were developed to depict partner relationships, and network measures, including node-, group- and network-level measures, were calculated. The network depiction (n  = 23) revealed that the network core was composed of organizations from multiple sectors, and the backbone organization served as the most central organization for most centrality measures. This study provides insight into how organizational relationships can be assessed in order to increase community capacity to address teenage pregnancy. Continuous monitoring of the strength of relationships is important to ensure success in achieving goals as well as collective impact. [ABSTRACT FROM AUTHOR]

Background: The inclusion of protective factors ("assets") are increasingly supported in developing culturally grounded interventions for American Indian (AI) populations. This study sought to explore AI women's cultural assets, perspectives, and teachings to inform the development of a culturally grounded, intergenerational intervention to prevent substance abuse and teenage pregnancy among AI females.Methods: Adult self-identified AI women (N = 201) who reside on the Navajo Nation completed a cross-sectional survey between May and October 2018. The 21-question survey explored health communication around the transition to womanhood, cultural assets, perceptions of mother-daughter reproductive health communication, and intervention health topics. Univariate descriptive analyses, chi squared, and fisher's exact tests were conducted.Results: Respondents ranged in age from 18 to 82 years, with a mean age of 44 ± 15.5 years. Women self-identified as mothers (95; 48%), aunts (59; 30%), older sisters (55; 28%), grandmothers (37; 19%), and/or all of the aforementioned (50; 25%). 66% (N = 95) of women admired their mother/grandmother most during puberty; 29% (N = 58) of women were 10-11 years old when someone first spoke to them about menarche; and 86% (N=172) felt their culture was a source of strength. 70% (N = 139) would have liked to learn more about reproductive health when they were a teenager; 67% (N = 134) felt Diné mothers are able to provide reproductive health education; 51% (N = 101) reported having a rite of passage event, with younger women desiring an event significantly more than older women. Responses also indicate a disruption of cultural practices due to government assimilation policies, as well as the support of male relatives during puberty.Conclusions: Results informed intervention content and delivery, including target age group, expanded caregiver eligibility criteria, lesson delivery structure and format, and protective cultural teachings. Other implications include the development of a complementary fatherhood and/or family-based intervention to prevent Native girls' substance use and teen pregnancy. [ABSTRACT FROM AUTHOR]

Background: Early sexual initiation is associated with higher risk for sexually transmitted infection, teen pregnancy, domestic violence and substance use in later adolescence and early adulthood. Native American adolescents are more likely to have early sexual initiation compared to other racial/ethnic groups. Few programs designed with and for Native adolescents to delay sexual initiation and substance use have been tested through rigorous evaluations. This is the protocol for the randomized controlled trial of the Asdzáán Be'eena' program, a teen pregnancy and substance use prevention program for young Native girls and their female caregivers.Methods: N = 410 female adolescents ages 10-14 and their female caregivers will be enrolled in the study and randomized to the intervention or control arm. The intervention consists of the 11-session Asdzáán Be'eena' program. The control arm consists of mailed non-monetary incentives. All participants will complete evaluations at baseline and 3 follow-up timepoints (immediate, 6 and 12 months post intervention). Evaluations include measures to assess protective factors associated with delayed sexual initiation and substance use.Discussion: This is one of the first rigorous evaluations of a gender-specific, culturally tailored teen pregnancy and substance use primary prevention program for Native girls and their female caregivers. If proven efficacious, Native communities will have a culturally appropriate program for promoting protective factors associated with delayed substance use and sexual risk taking.Trial Registration: NCT04863729 ; April 27, 2021. [ABSTRACT FROM AUTHOR]

Safer sex provision, including contraception information and services, should be made available to adolescents regardless of their marital status in strategies to reduce the incidence of unintended teenage pregnancies and the spread of STIs. In Malaysia, this information is still not being delivered formally to adolescents even though unintended teenage pregnancies and the practice of "baby dumping" are serious public health issues. The aims of this article are to describe the Malaysian context in terms of the need for comprehensive sexual and reproductive health information and treatment for unmarried adolescents. The article presents the key aspects of Malaysian society and the potential influence on the provision and delivery of sexual and reproductive health information and treatment to unmarried Malaysian adolescents that can be a reference for healthcare professionals especially school health nurses. The article also describes the establishment of sheltered homes, baby hatches and unregulated adoption processes as the initiatives being taken to address the issue of unintended teenage pregnancies. This article suggests that the policy and laws that require parental consent for accessing the services need to be reviewed and revised to ensure that specific services are available to adolescents in a safe environment that maintains confidentiality. [ABSTRACT FROM AUTHOR]

Background: Missouri Personal Responsibility Education Program (PREP) provides sexual health education programs to youth with goals of reducing unintended teen pregnancies. Theories of change provide that youth improve their sexual health knowledge, intentions, attitudes, and behaviors as a result of program implementation. Program evaluations are needed to assess the degree to which PREP programs are meeting their goals of improving youth outcomes. Objective: The purpose of this study is to examine youth sexual intentions to use a condom, engage in sexual behavior, and abstain from sex as a result of Missouri PREP program implementation. We evaluate the effectiveness of the Missouri program in modifying youth intentions toward healthier planned behaviors. Method: All programs required youth to take pre- and post-program surveys. For this study, we evaluate a sample of 1335 youth's pre- and post-survey intentions related to condom use, sex, and abstention. We utilize t-tests as well as a lagged logistic regression approach to account for youth's respective pre-intentions. Results: Youth's scores on intentions, knowledge, and attitudes rise from pre- to post-survey. Knowledge gains are salient while attitudes remain relatively high and stable. Intentions to use condoms differ from those in intentions to have or abstain from sex. Program change in intentions to use a condom are highest among the three intention outcomes. Conclusions: Missouri PREP saw improvements in knowledge, attitudes, and intentions as a result of program implementation. Findings suggest that the Missouri PREP program is effective at positively influencing youth intentions to engage in risky or sexual behavior. [ABSTRACT FROM AUTHOR]

Background: Despite global and regional policies that promote the reduction of adolescent fertility through ending early marriages and reducing early child-bearing, adolescent fertility remains high in most sub-Saharan countries. This study aimed to explore the competing discourses that shape adolescent fertility control in Zambia. Methods: A qualitative case study design was adopted, involving 33 individual interviews and 9 focus group discussions with adolescents and other key-informants such as parents, teachers and policymakers. Thematic and critical discourse analysis were used to analyze the data. Results: Adolescents' age significantly reduced their access to Sexual and Reproductive Health, SRH services. Also, adolescent fertility discussions were influenced by marital norms and Christian beliefs, as well as health and rights values. While early marriage or child-bearing was discouraged, married adolescents and adolescents who had given birth before faced fewer challenges when accessing SRH information and services compared to their unmarried or nulliparous counterparts. Besides, the major influencers such as parents, teachers and health workers were also conflicted about how to package SRH information to young people, due to their varying roles in the community. Conclusion: The pluralistic view of adolescent fertility is fueled by "multiple consciousnesses". This is evidenced by the divergent discourses that shape adolescent fertility control in Zambia, compounded by the disempowered position of adolescents in their communities. We assert that the competing moral worlds, correct in their own right, viewed within the historical and social context unearth significant barriers to the success of interventions targeted towards adolescents' fertility control in Zambia, thereby propagating the growing problem of high adolescent fertility. This suggests proactive consideration of these discourses when designing and implementing adolescent fertility interventions. [ABSTRACT FROM AUTHOR]

Introduction: Long-acting reversible contraception (LARC) methods are safe for adolescents and provide the greatest assurance against rapid repeated pregnancy when inserted during the immediate postpartum (IPP) and immediate post-abortion (IPA) period. Despite increasing enthusiasm for IPP/IPA LARC insertion, adolescents' preferences and experiences have seldom been examined. The objective of this review was to examine the attitudes of adolescents (aged 10-19 years) towards IPP/IPA LARC, their experiences and perceptions around having an LARC device fitted IPP/IPA and the factors involved in decision-making to use, not use or discontinue IPP/IPA LARC.Material and Methods: In January 2021, we searched seven bibliographic databases for original research articles published in English, from the year 2000. Studies of any design focused on IPP/IPA LARC were eligible for inclusion. Three of the authors assessed articles for eligibility and extracted data relevant to the outcomes of the review. Joanna Briggs Institute Critical Appraisal Tools were used to assess methodological quality. Key themes emerging from the data were synthesized and reported narratively.Results: We identified 10 relevant articles, four of which were entirely adolescent-focused. Only three addressed IPA LARC. IPP availability was important for ensuring access to LARC postpartum. Attitudes towards LARC IPP were associated with adolescents' sociodemographic characteristics and positive perceptions related to the long duration of action. Determinants of discontinuation and nonuse included poor-quality contraceptive counseling, intolerable side effects and subsequent distress, misconceptions about LARC safety IPP and the influence of partners and community on autonomy. No factors involved in IPA LARC decision-making were available. Limited evidence demonstrated that adolescents may favor contraceptive implants over intrauterine devices, and in certain contexts may face greater barriers to IPA LARC access than adult women do.Conclusions: Immediate insertion of LARC postpartum appears acceptable to adolescents who do not experience side effects and those with the opportunity to make autonomous contraception decisions. This important topic has been addressed in few studies involving an entirely adolescent population. Very limited evidence is available on IPA LARC. Further research on adolescents' lived experiences of IPP/IPA LARC access and use is necessary to inform the provision of person-centered care when assisting adolescents' contraceptive choice following pregnancy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although lesbian, gay, bisexual and other sexual minority (LGB1) girls are more likely than heterosexual girls to be pregnant during adolescence, relevant pregnancy prevention programming is lacking. METHODS: A national randomized controlled trial was conducted with 948 14- to 18-year-old cisgender LGB1 girls assigned to either Girl2Girl or an attention-matched control group. Participants were recruited on social media between January 2017 and January 2018 and enrolled over the telephone. Between 5 and 10 text messages were sent daily for 7 weeks. Both experimental arms ended with a 1-week booster delivered 12 weeks subsequently. RESULTS: A total of 799 (84%) participants completed the intervention end survey. Participants were, on average, 16.1 years of age (SD: 1.2 years). Forty-three percent were minority race; 24% were Hispanic ethnicity. Fifteen percent lived in a rural area and 29% came from a lowincome household. Girl2Girl was associated with significantly higher rates of condomprotected sex (adjusted odds ratio [aOR] = 1.48, P, .001), current use of birth control other than condoms (aOR = 1.60, P = .02), and intentions to use birth control among those not currently on birth control (aOR = 1.93, P = .001). Differences in pregnancy were clinically but not statistically significant (aOR = 0.43, P = .23). Abstinence (aOR = 0.82, P = .34), intentions to be abstinent (aOR = 0.95, P = .77), and intentions to use condoms (aOR = 1.09, P = .59) were similar by study arm. CONCLUSIONS: Girl2Girl appears to be associated with increases in pregnancy preventive behaviors for LGB1 girls, at least in the short-term. Comprehensive text messaging--based interventions could be used more widely to promote adolescent sexual health behaviors across the United States. [ABSTRACT FROM AUTHOR]

The objective of this overview was to identify and evaluate the effectiveness of sex education interventions aimed at reducing sexual risk behaviors in adolescents. A search was conducted of systematic reviews in English, Spanish and Portuguese from 1946 until July 2018 in the following databases: MEDLINE (Ovid), EMBASE, Scopus, PsyArticles, Cochrane Central Register of Controlled Trials, LILACS and additional resources. The extraction and analysis of data was synthesized in a narrative mode describing intervention, population, and key outcomes such as decreased risky sexual behavior, decreases in sexually transmitted infections, and adolescent pregnancy. There were 2289 potentially relevant studies, of which 31 systematic reviews related to adolescent interventions were included. It was demonstrated that interventions involve parents and the community as participants, are based on audiovisual media and school workshops, and their emphasis is on information and training in school. Different reviews framed in methods of psychosocial intervention based on community groups and the home as a fundamental axis were reported. Finally, a large amount of scientific evidence related to the subject was identified. New directions are presented for interventions in sexual education for adolescents based on the combination of actions and techniques, the implementation of digital technology, and socio-cultural and contextual adaptations. [ABSTRACT FROM AUTHOR]

BACKGROUND Teen pregnancy continues to burden families, communities, and society. Programs continue to educate and impower youth and young adults to make positive behavioral decisions. METHODS: We evaluated a program aimed at high‐risk youth in after‐school programs. The goal of the program was to instill a sense of community and empathy, as well as sexual health decision‐making. The evaluation was a multiyear evaluation from external evaluators. RESULTS: There were statistically significant changes in empathy toward others in the community and a feeling of safety at school. Other positive changes noted were that students felt empowered to use condoms, other barriers, or birth control in the future when having sexual relations. The program noted a positive direction in students feeling they develop plans or goals and stick to them. CONCLUSIONS: These programs serve to instill a sense of empowerment, community, and responsibility in students. Evaluation data can serve as a metric of the merit of these programs and the impact on school health programs and communities. [ABSTRACT FROM AUTHOR]

This paper explores the use of withdrawal as a harm reduction approach to adolescent pregnancy prevention and its association with condom use. Data come from a baseline survey of a randomised controlled trial to test the effectiveness of FLASH, a sexual health education curriculum. Study participants completed electronic self-report surveys in health classes in their first or second year of high school (age range 14.1–17.9, mean 15.3 years). One-hundred and ninety-one students (12% of full sample) reported engaging in vaginal intercourse in the 3 months prior to the survey; of these, 66.0% reported using withdrawal as a birth control method, without significant differences by race, gender, region or birth control beliefs. Withdrawal was often used in combination with condoms (55.5%), periodic abstinence (40.0%) and birth control pills (13.4%). The effectiveness of withdrawal and its prevalence suggest an opportunity to reflect on how withdrawal is taught – moving from avoiding its use to a harm reduction approach to help sexually active youth avoid risk, reduce risk and reduce potential harm associated with sexual behaviours. Rather than focusing on withdrawal as risky, youth-serving professionals should acknowledge young people's efforts to prevent pregnancy and recognise the social and relational contexts of contraceptive choices. [ABSTRACT FROM AUTHOR]

Despite a national decline in teenage pregnancy rates, Arkansas continues to have one of the highest rates in the USA. More teenagers in the state reported not using any method of contraception (20%) compared to the USA (13.8%). National-level research suggests that misinformation and lack of awareness about contraception is prevalent. This study examines awareness, knowledge and attitudes towards contraception among Arkansas teenagers and parents. Between July-November 2018, twelve focus groups – 6 with teenagers (n = 40) and 6 with parents (n = 28) – were conducted around the state. Parent participants were uncertain about their teenagers' access to and knowledge of contraception, had many concerns about their teenagers using contraception and spoke about teaching their kids about contraception in a future sense ('would' and 'should'). Although parents preferred abstinence for their teenagers, they preferred contraception use to teenage pregnancy. Teenage participants had limited knowledge/awareness of methods of contraception beyond condoms and birth control pills. They saw contraception as ineffective, were concerned about side effects and experienced difficulty accessing contraception. This study provides insight into current knowledge and attitudes towards contraception among teenagers and parents in Arkansas, as well as recommendations for designing educational campaigns centred around awareness, empowerment and inclusion. [ABSTRACT FROM AUTHOR]

This study explores the role of faith leaders and congregations in preventing teen pregnancy and enhancing overall health. Seventeen faith-based leaders responded to an invitation to participate. Participants were recruited from two counties within Oklahoma, based on desired community characteristics. Findings were directly related to: (1) the vulnerability of rural communities to negative health outcomes; (2) resiliency of rural faith communities to address health issues; and (3) the adaptive capacity of rural faith leaders and their communities to decrease teen pregnancy and maximize community health. Culturally relevant public health programming is necessary to engage this at risk population; however, it requires engaging faith leaders in efforts to build congregation-based and community-based capacity. [ABSTRACT FROM AUTHOR]

BACKGROUND Positive youth development emphasizes that adaptive features of adolescence may contribute to teenage pregnancy prevention. METHODS: Using data from approximately 1300 seventh‐ninth graders, we describe positive youth development assets (external and internal) and their association with sexual risk taking. School‐, sex‐, and race/ethnicity‐stratified logistic or linear models assessed associations between developmental assets and 6 outcomes (continuous attitudes about teenage sex and marriage, abstinence intentions, and nonsexual risk‐taking behavior; dichotomous high risk‐dating behavior, friends' sexual activity, and prior sexual activity). RESULTS: Associations between developmental assets and youth sexual behavior differed by school, sex, and race/ethnicity. White female respondents showed the most consistent associations between higher amounts of each of the positive youth development assets and attitudes and behaviors conducive to delaying sexual activity while black youth showed the fewest associations. CONCLUSION: These results contribute to the positive youth development literature by identifying that relationships between assets and adolescent risk differs by race and sex. [ABSTRACT FROM AUTHOR]

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Teenage pregnancy is a cause and consequence of inequality, limiting the life chances of young parents and their children. It is an issue of global concern, with many countries developing programmes of prevention. This review focuses on the experience of the England strategy, launched in 1999 to address the historically high rates. It is one of the few examples of a successful long term, multi-agency programme, led by national government and locally delivered which, between 1998 and 2018, reduced the under-18 conception rate by 64%. It sets out the case for helping young people delay early pregnancy, the international evidence for prevention, how evidence is translated into a 'whole system' approach and the priorities for further reducing inequalities. Questions are included to encourage both investigation into local programmes on teenage pregnancy prevention, and reflection on individual practice. The review concludes with summarizing the next steps for England and the lessons that can be shared more widely. [ABSTRACT FROM AUTHOR]

Introduction: This is a brief report of a systematic review and meta-analysis which examined the effectiveness of early childhood educational programs for preventing teenage pregnancy by synthesizing randomized control trials.Methods: The search terms included 'children', 'early childhood intervention', and 'teen pregnancy'. Databases, bibliographies, grey literature, and policy reports were searched in February and March 2018 and included studies with interventions implemented with participants from birth to 5 years old.Results: Only four randomized control trials were eligible for inclusion. Individually, only two of the studies reported a significant effect of early childhood education. There was a significant effect for the primary outcome of teenage pregnancy prevention in the meta-analysis (RR 0.70, 95% CI 0.54-0.89). However, the evidence was very weak. The meta-analysis results were weighted heavily by one study. Additionally, the included studies were conducted decades ago, lacked rigor, and varied considerably by curriculum, enrollment age, length, and intensity.Conclusions: Given the few number of studies, and issues with rigor and heterogeneity, it is unclear whether the results of this review represent a true effect of the intervention. Importantly, this review highlights the paucity of randomized control trials examining the effectiveness of early childhood education for preventing teenage pregnancy. Future studies need to be designed to address the methodological challenges noted here to determine what facets of early childhood education most effectively prevent teenage pregnancy. Randomized control trials, while challenging to implement, are best suited to determine the true causal effect of early childhood education for preventing teenage pregnancy. [ABSTRACT FROM AUTHOR]

Subsequent teenage births may present various challenges for teenage parents and their children. Evaluation of efforts to prevent subsequent teenage pregnancy and increase use of long-acting reversible contraception (LARC) have lacked investigation of the mechanisms—particularly, goal orientation and social supports—through which these efforts may be effective. Data were from a multisite evaluation of the Title XX Adolescent Family Life program, which involved 12 demonstration projects comparing enhanced and core services to pregnant and parenting teenagers. Data from 857 female teenagers at baseline and follow-up were used in analyses. Multivariate regression models examined associations between independent variables (study condition and effective project characteristics) and mediators (orientation toward goals and social supports) and between mediators and outcomes (subsequent pregnancy and use of LARC). Structural equation models tested mediation pathways. The program and selected project characteristics significantly predicted decreased coresidence with parents, and support from the child's father was associated with higher LARC use. However, neither orientation toward goals nor social supports mediated program effects on LARC use or subsequent pregnancy. Programs to prevent subsequent teenage pregnancy may encourage teenagers' independence from families of origin and should consider promoting supportive relationships with the child's father. [ABSTRACT FROM AUTHOR]

Objective Access to effective contraceptives, including emergency contraception (EC), is critical to reducing unintended adolescent pregnancy. This study evaluates the accessibility of Ln-EC (levonorgestrel EC) for adolescents in Quebec community pharmacies. Methods We conducted an anonymous self-administered electronic survey of Quebec community pharmacists between June 1, 2016 and October 31, 2016. Pharmacists were asked about the availability of Ln-EC in their pharmacy, whether they prescribed Ln-EC, and their experience with adolescents who requested Ln-EC. Results Five hundred and ninety-one pharmacists responded, with representation from across the province. Ninety-five per cent had Ln-EC in stock. Most pharmacists (90%) reported being comfortable prescribing Ln-EC, though they were less comfortable prescribing to adolescents than to adults (*P<0.001). Pharmacists also reported that cost and confidentiality are barriers to accessing Ln-EC for some adolescents. Conclusions This study indicates that availability and pharmacist comfort are not likely to be barriers to Ln-EC use for adolescents. On the other hand, cost and/or confidentiality do represent a barrier for some adolescents. This study lays the groundwork for a national study examining the accessibility of EC for adolescents. [ABSTRACT FROM AUTHOR]

South Carolina ranks 16th in the USA for highest rates of teenage pregnancy. The South Carolina Comprehensive Health Education Act (CHEA) does not require medically accurate, unbiased, culturally appropriate materials, and varies greatly in compliance and implementation. This study aimed to better understand parents' perspectives in one county in South Carolina regarding reproductive and sexual health education. A total of 484 parents responded to a qualitative questionnaire, collectively representing 798 students. Researchers conducted a thematic analysis to organise the data. Main themes identified include comprehensive reproductive and sexual health education as a duty; dispelling themyth of abstinence-only education; and the value of comprehensive reproductive and sexual health education. Parents described teaching reproductive sexual health education in public schools as a 'duty.' Furthermore, parents rejected the idea that abstinence- only education is effective and believed reproductive and sexual health education should be taught without the influence of religion. Parents valued inclusive reproductive and sexual health education, covering a robust set of topics. Findings from the study provide evidence for the need to update current reproductive and sexual health education materials and legislation to meet parental demands and reduce youth sexual and reproductive health disparities. [ABSTRACT FROM AUTHOR]

The article focuses on Teen Pregnancy in which Teen patients are at increased risk of medical adverse outcomes, including preeclampsia, preterm birth, intrauterine fetal growth retardation, and infant death. It mentions that clinicians also should have an increased concern for sexual abuse or sex trafficking, with a study showing that two-thirds of adolescents who became pregnant had been sexually abused.

Unintended teen pregnancy continues to be a problem in the United States which has the highest rate of adolescent pregnancy among developed nations. Long-acting reversible contraception (LARC) has much higher continuation rates compared with moderately effective reversible contraception; however, moderately effective reversible contraception is more commonly used by adolescents. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend LARC as first-line contraception for adolescents. Clinicians providing contraception to adolescents should be knowledgeable of LARC indications, side effects, initiation guidelines, management of adverse reactions, and adolescent specific issues regarding LARC counseling, initiation, and continuation. [ABSTRACT FROM AUTHOR]