House L Duane, Tevendale Heather, Brittain Anna, Burley Kim, Fuller Taleria R, Mueller Trish, Romero Lisa, Venugopalan Bala, Koumans Emilia H
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Insignia Federal Group, Atlanta, GA, USA.
Sex Res Social Policy. 2022;19(2):496-508. doi: 10.1007/s13178-021-00565-y.
Community-wide initiatives (CWI) to prevent teen pregnancy were implemented in 10 communities in the USA. The CWI supported the implementation of evidence-based teen pregnancy interventions (EBIs) and implementation of best practices for adolescent reproductive health care. Implementation was supported through mobilizing communities, educating stakeholders, and strategies to promote health equity.
We assessed indicators of progress of the CWI for the following five project components (data collected from 2010 to 2015): community mobilization, stakeholder education, working with diverse communities, evidence-based interventions, and increasing access to clinical services and the potential contributions of training and technical assistance.
Communities engaged multiple stakeholder groups to contribute to planning, community outreach and education, and partnership development and used multiple dissemination methods to share information on adolescent reproductive health needs and teen pregnancy prevention strategies. The amount of training and technical assistance from state- and community-based organizations was associated with increased numbers of youth receiving EBIs and increased provision of contraceptives. The number of health centers implementing best practices for adolescent reproductive health services increased; conducting sexual health assessments, offering hormonal contraception or IUD, and offering quick start of IUDs were associated with increases in long-acting reversible contraception utilization.
These findings demonstrate that scaled prevention efforts can occur with adequate support including training and technical assistance and community awareness and engagement in the process.
The findings raise important questions for understanding what factors contribute to successful community-wide implementation of EBIs and health center best practices for contraceptive access and whether these lead to reductions in teen pregnancies in highly impacted communities.
美国10个社区实施了全社区范围的青少年怀孕预防倡议（CWI）。CWI支持实施基于证据的青少年怀孕干预措施（EBIs）以及青少年生殖健康护理最佳实践的实施。通过动员社区、教育利益相关者以及促进健康公平的策略来支持实施工作。
我们评估了CWI在以下五个项目组成部分（2010年至2015年收集的数据）的进展指标：社区动员、利益相关者教育、与不同社区合作、基于证据的干预措施以及增加临床服务的可及性，以及培训和技术援助的潜在贡献。
各社区让多个利益相关者群体参与规划、社区外展和教育以及伙伴关系发展，并使用多种传播方法来分享有关青少年生殖健康需求和青少年怀孕预防策略的信息。来自州和社区组织的培训和技术援助数量与接受EBIs的青年人数增加以及避孕药具供应增加相关。实施青少年生殖健康服务最佳实践的健康中心数量增加；进行性健康评估、提供激素避孕或宫内节育器（IUD）以及提供IUD快速启动服务与长效可逆避孕方法的使用增加相关。
这些发现表明，在包括培训和技术援助以及社区意识和参与过程的充分支持下，可以开展大规模的预防工作。
这些发现提出了重要问题，即了解哪些因素有助于在全社区成功实施EBIs以及健康中心在避孕可及性方面的最佳实践，以及这些是否会导致受影响严重社区的青少年怀孕率下降。
