Lewin Amy, Mitchell Stephanie, Beers Lee, Schmitz Kristine, Boudreaux Michel
Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland.
Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland.
J Adolesc Health. 2016 Aug;59(2):171-6. doi: 10.1016/j.jadohealth.2016.04.007.
The Generations program, a patient-centered medical home, providing primary medical care, social work, and mental health services to teen mothers and their children, offers a promising approach to pregnancy prevention for teen mothers. This study tested whether the Generations intervention was associated with improved rates of contraceptive and condom use among participants 12 months after program entry.
This study compared teen mothers enrolled in Generations to those receiving standard community-based pediatric primary care over 12 months. Participants included African-American mothers ages 19 and younger, with infants under 6 months, living in Washington DC. A total of 83% of the baseline sample (150 mother-child dyads) was retained at follow-up.
Generations participants had over three times the odds of contraceptive use, with an odds ratio (OR) of 3.35, and twice the odds of condom use (OR = 2.29) after 12 months, compared to participants receiving standard pediatric care. The odds remained comparable and significant when adjusting for differences in baseline use. Once additional covariates were entered into the model, the association was reduced to OR = 2.59 because being in a relationship with the baby's father was significantly associated with reduced contraceptive use. The same pattern was evident for condom use. Mothers in Generations had steady use of contraceptives over time, but there was a decline in use among comparison mothers, indicating that Generations prevented contraceptive discontinuation.
Findings from this study suggest that the Generations program is an effective intervention for improving contraceptive use among teen mothers, a group at especially high risk for pregnancy.
“代际项目”是一个以患者为中心的医疗之家，为青少年母亲及其子女提供初级医疗护理、社会工作和心理健康服务，为预防青少年母亲怀孕提供了一种有前景的方法。本研究测试了“代际干预”是否与项目开始12个月后参与者中避孕药具和避孕套使用率的提高有关。
本研究将参加“代际项目”的青少年母亲与在12个月内接受基于社区的标准儿科初级护理的青少年母亲进行了比较。参与者包括居住在华盛顿特区的19岁及以下的非裔美国母亲及其6个月以下的婴儿。随访时保留了基线样本的83%（150对母婴）。
与接受标准儿科护理的参与者相比，参加“代际项目”的参与者在12个月后使用避孕药具的几率高出三倍多，优势比（OR）为3.35，使用避孕套的几率高出两倍（OR = 2.29）。在调整基线使用差异后，几率仍然相当且显著。一旦将其他协变量纳入模型，该关联降至OR = 2.59，因为与婴儿父亲有关系与避孕药具使用减少显著相关。避孕套使用情况也呈现相同模式。参加“代际项目”的母亲随着时间推移持续使用避孕药具，但对照母亲的使用率有所下降，这表明“代际项目”防止了避孕药具停用。
本研究结果表明，“代际项目”是一种有效的干预措施，可提高青少年母亲（这一怀孕风险特别高的群体）的避孕药具使用率。
