Article Figures & Data
Figures
- Figure 1.
Participant flow through intervention and study.
CAMI = computer-assisted motivational intervention; CAMI+ = CAMI plus a multicomponent home-based intervention; SIDS = sudden infant death syndrome.
- Figure 2.
Effects of CAMI on the risk of subsequent birth intent-to-treat model.
CAMI = computer-assisted motivational intervention; CAMI+ = CAMI plus a multicomponent home-based intervention; UCC=usual-care control.
Tables
Characteristic Overall n=235 CAMI+ n=80 CAMI-Only n=87 UCC n=68 PValue CAMI = computer-assisted motivational intervention; CAMI+ = CAMI plus multicomponent home-based intervention; DMCI = Decision-Making-Competency Inventory; STD=sexually transmitted disease; UCC=usual-care control. a Range from 12 to 19 years. b Range from 14 to 39 years. c Oral contraceptive pills, patch, ring, medroxyprogesterone depot. d Range from 55.0 to 113.0; higher scores are more favorable (greater competency, greater self-efficacy). Demographic and education variables Maternal age,a mean, (SD), y 17.0±1.2 17.2±1.1 17.0±1.2 16.9±1.4 .24 African American, % 97 99 95 99 .39 Medicaid insurance, % 86 80 89 90 .18 Continuous health insurance, past 12 months, % 61 53 66 63 .25 Dropped out of school, % 42 39 43 46 .69 Relationships and support Lives with her mother, % 61 63 63 57 .73 Age of baby’s father,b mean (SD), y 19.8±3.2 20.4±3.4 19.3±2.6 19.7±3.6 .11 Age difference between teen mother and baby’s father, mean (SD), y 2.7±3.0 3.2±3.2 2.3±2.4 2.8±3.4 .21 Married (n = 2), living together, going with baby’s father, % 74 78 72 72 .66 Social support satisfaction score, mean (SD) 15.6 (2.9) 16.0 (2.4) 15.0 (3.1) 15.8 (3.0) .07 Pregnancy history Age at first pregnancy, mean, (SD), y 14.3±1.4 14.4±1.4 14.2±1.5 14.3±1.5 .60 Prior pregnancy, % 31 38 30 24 .19 Prior birth, % 11 16 5 13 .04 Prior abortion, % 14 14 18 7 .14 Prior miscarriage/stillbirth, % 12 14 12 10 .85 Mental health and violence exposure Depressive symptoms (CES-D ≥24), % 32 25 38 32 .20 Maternal substance use Tobacco use in past 30 days, % 8 5 13 4 .11 Alcohol use in past 30 days, % 3 0 7 3 .04 Marijuana use in past 30 days, % 3 3 5 0 .25 Sexually transmitted infection history, contraceptive practices and plans, decision making Ever diagnosed with a sexually transmitted infection, % 37 23 41 49 .003 Any condom use in the past 12 months, % 81 83 78 82 .76 Always uses a condom for STD protection, % 22 21 24 19 .76 Plans to use condom at next intercourse, % 76 78 69 82 .14 Plans to use hormonal contraceptionc after delivery, % 6 65 53 75 .02 DMCI score,d mean (SD) 86.2±11.0 86.4±11.3 85.9±10.0 86.3±11.9 .96 Wants another child within 2 years, % 3 5 4 2 .54 Characteristic Overall n=235 Repeat Birth n=43 No Repeat Birth n=192 PValue CES-D = Center for Epidemiologic Studies Depression Scale; DMCI = Decision-Making-Competency Inventory; STD = sexually transmitted disease. a Range = 12 to 19 years. b Range = 14 to 39 years. c Oral contraceptive pills, patch, ring, medroxyprogesterone depot. d Range from 55.0 to 113.0; higher scores are more favorable (greater competency, greater self-efficacy) Demographic and education variables Maternal age,a mean (SD), y 17.0±1.2 17.1±1.0 17.0±1.3 0.59 African American, % 97 98 97 1.00 Medicaid insurance, % 86 88 85 0.81 Continuous health insurance in past 12 mo, % 61 47 64 0.04 Dropped out of school, % 42 47 41 0.61 Relationships and support Lives with her mother, % 61 65 60 0.61 Age of baby’s father,b mean (SD), y 19.8±3.2 19.6±2.9 19.9±3.3 0.59 Age difference between teen mother and baby’s father, mean (SD), y 2.7 ± 3.0 2.4 ± 2.7 2.8 ± 3.1 0.44 Married (n = 2), living together, going with baby’s father, % 74 81 72 0.25 Social support satisfaction score, mean (SD) 15.6 (2.9) 15.7 ± 2.9 15.6 ± 2.9 0.98 Pregnancy history Age at first pregnancy, mean (SD), y 14.3±1.4 16.0±1.3 15.9±1.4 0.85 Prior pregnancy, % 31 23 32 0.28 Prior birth, % 11 12 11 1.00 Prior abortion, % 14 2 16 0.01 Prior miscarriage/stillbirth, % 12 4 12 0.61 Mental health and violence exposure Depressive symptoms (CES-D ≥24), % 32 33 32 1.00 Maternal substance use Tobacco use in past 30 days, % 8 2 9 0.21 Alcohol use in past 30 days, % 3 0 4 0.36 Marijuana use in past 30 days, % 3 0 3 0.60 Sexually transmitted infection history, contraceptive practices and plans, and decision making Ever diagnosed with a sexually transmitted infection, % 37 332 38 0.60 Any condom use in the past 12 months, % 81 79 81 0.83 Always uses a condom for STD protection, % 22 28 20 0.31 Plans to use condom at next intercourse, % 76 65 78 0.08 Plans to use hormonal contraceptionc after delivery, % 6 56 65 0.29 DMCI score,d mean (SD) 86.2±11.0 87.6±11.5 85.8±10.9 0.34 Wants another child within 2 years, % 3 2 4 1.00 Group Hazard Ratioa 95% CI CAMI=computer-assisted motivational intervention; CAMI+=CAMI plus a multicomponent home-based intervention; CACE = complier average causal effect; CI=confidence interval; ref = reference group. Note: Model adjusted for significant baseline differences between intervention and control groups. a P <.05. Control ref – CAMI+ 0.40a 0.16–0.98 CAMI−only 0.19a 0.05–0.69
Supplemental Appendix and Table
Supplemental Appendix. Construction of Complier Average Causal Effect (CACE) Model; Supplemental Table 1. Group Differences in Baseline Characteristics of Adherent (Received 2 or more CAMI sessions) and Nonadherent Intervention Participants
Files in this Data Supplement:
- Supplemental data: Appendix & Table - PDF file, 2 pages, 164 KB
The Article in Brief
Motivational Intervention to Reduce Rapid Subsequent Birth to Adolescent Mothers: A Community-Based Randomized Trial
Beth Barnet, and colleagues
Background Almost one-quarter of adolescent mothers give birth to another child within 2 years of having a baby. Repeat births in adolescents have been shown to increase risks of poorer medical, educational, economic, and developmental outcomes. This study evaluates the effectiveness of a program that combines computerized information, individual counseling by community members, and home visits. Some participants received additional services, such as parenting training. The goal of the program was to prevent rapid repeat births in low-income African-American adolescent mothers.
What This Study Found The program was effective in reducing subsequent birth within 24 months in teen mothers. The group that received additional services, including parenting training, had a 44% reduction in repeat births. Mothers in this group who reported continuous insurance coverage had the greatest reduction in the risk of repeat births.
Implications
- Receipt of at least two computer-assisted motivational intervention sessions reduces the risk of rapid subsequent birth to low-income, African American adolescent mothers.
- The approach used in this study can be effective in reducing repeat births, but its impact may be affected by participants' insurance coverage.
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