Transcript Illinois Subsequent Pregnancy Project: Latina Program

™
ISPP
Contraceptive Knowledge and Use of
Contraception Among Adolescent Mothers
Participating in the Illinois Subsequent
Pregnancy Program
Pat W. Mosena, Ph.D.,
Holly S. Ruch-Ross, Sc.D. and
Suzanne G. McLone, M.P.H.
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ISPP
The Illinois Subsequent Pregnancy Program

A community-based program to delay second pregnancies among
adolescent mothers.

Begun as pilot project in Chicago 1990, implemented statewide
1994 –2007.

Supported by Illinois Department of Human Services
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Program Goals:
1. Delay a second pregnancy
2. Use contraception correctly and consistently
3. Remain in and graduate from high school

There have been 3,000 participants in 30 communities
 3% had second pregnancy,
 85% graduated/remained in school
Illinois Subsequent Pregnancy Program
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ISPP
Methods
Program Data
 Four Years of Program Data: 2003 to 2006
 Participant Characteristics Collected and Reported by ISPP Home Visitor
 Self-Reported Participant Questionnaires
Measures
 Contraceptive Knowledge : Percent correct of questions asked (16 to 21 questions,
updated yearly to reflect new contraceptive choices and to drop outdated methods)
 Contraceptive Behavior (yes/no responses):
1. Anything Last Sex: The last time you had sex, did [you] do anything to keep from
getting pregnant?
2. Condom Last Sex : The last time you had sex, did your partner use a condom?
Illinois Subsequent Pregnancy Program
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ISPP
Methods
Data Collection
 Self-administered participant questionnaires completed during group meeting
 Three time points:
1. Baseline
 Contraceptive Knowledge Score
 Contraceptive Behavior
2. Posttest (1 Month)
 Contraceptive Knowledge Score
 Contraceptive Behavior
3. Follow Up (6 Months)
 Contraceptive Behavior
Illinois Subsequent Pregnancy Program
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ISPP
Questionnaire Completion:
Baseline, 1 Month and 6 Months
Questionnaire Completion (N=239)
Baseline and Posttest (1 Month) Only
Baseline , Posttest (1 Months) and Follow Up (6 Months)
n
98
141
%
41.0
59.0
 There are no significant differences between the sample subsets with completed
questionnaires at baseline and posttest (1 month) only (n=98) versus those with
completed questionnaires at baseline, posttest (1 month) and follow up (6 months)
(n=141) for the following variables:




Age of mother at intake
Participant status at intake (parenting vs. pregnant)
Contraception Knowledge Scores (Baseline or Posttest)
Contraceptive Behavior: Anything Last Sex, Condom Last Sex (Baseline or Posttest)
 The sample subsets did differ significantly on the following variable:
 Ethnicity:
 African Americans were more likely to have a follow up questionnaire on file
 Mexican Americans were less likely to have a follow up questionnaire on file
Illinois Subsequent Pregnancy Program
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ISPP
Participant Characteristics, N=239
Participant Ethnicity
Other
(Including MultiEthnicities)
5%
African American
60.7%
Puerto Rican
3.2%
Mexican
American
23.9%
Caucasian, Not
Hispanic
5.4%
Illinois Subsequent Pregnancy Program
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ISPP
Participant Characteristics, N=239
Participant Status at Intake
Pregnant,
48.3%
Parenting,
51.7%
Participant Age (Years)
14 and
younger,
11.5%
18 and
older,
8.3%
15 to 17,
80.3%
Illinois Subsequent Pregnancy Program
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ISPP
Participant Responses on Questionnaires, N=239
Contraceptive Knowledge Score, Baseline (% Correct)
Mean: 46.2
Range: 10.0 to 100.0
Contraceptive Knowledge Score, Posttest (1 Month)
(% Correct)
Mean: 73.2
Range: 15.0 to 100.0
Change in Contraceptive Knowledge Score, Posttest
(1 Month )
Mean: 27.1
Range: -24.0 to 76.0
Contraceptive Behavior
Used Contraception Last Sex
Yes
n
Baseline
57.0%
228
Posttest,
1 Month
64.9%
225
Follow Up,
6 Months
81.4%
129
Yes
54.8%
61.4%
74.0%
228
223
127
Used a Condom Last Sex
n
Illinois Subsequent Pregnancy Program
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ISPP
Change in Contraceptive Knowledge Score,
Baseline to Posttest (1 Month) (N=239)
t = -19.66
p <0.001
Paired sample t-test statistic used
Illinois Subsequent Pregnancy Program
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ISPP
Changes in Contraceptive Behavior,
Baseline to Posttest (1 Month) (N=239)
McNemar 2 test statistic used
2 = 97.26
2 = 5.354
p =0.002
p =0.002
Illinois Subsequent Pregnancy Program
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ISPP
Changes in Contraceptive Behavior,
Baseline to Follow Up (6 Months) (n=141)
McNemar 2 test statistic used
2 = 96.80
2 = 5.354
p =0.017
p =0.002
Illinois Subsequent Pregnancy Program
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ISPP
Bivariate Analyses: Changes in Contraceptive Knowledge
Scores and Reported Contraceptive Behavior at
Posttest (1 Month) and Follow Up (6 Months)
Percent with a POSITIVE
Change in Score 1
Mean Change of
Score 2
Used Contraception , Any Method, at Last Sex
87.0 %
26.9
Did NOT Use Contraception at Last Sex
78.5 %
26.1
89.1 % *
29.4
77.9 %
23.6
87.6 % *
28.6
Did NOT Use Contraception at Last Sex
66.7 %
19.6
Used a Condom Last Sex
85.1 %
28.1
Did NOT use a Condom Last Sex
81.8 %
22.3
Posttest (1 Month)
Used a Condom Last Sex
Did NOT use a Condom Last Sex
Follow Up (6 Months)
Used Contraception , Any Method, at Last Sex
Significance levels: * p<0.05
1 Fisher’s Exact 2 test statistic used
2 Independent sample t-test statistic used
Illinois Subsequent Pregnancy Program
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ISPP
Logistic Regression Models: Contraceptive Behavior at
Posttest (1 Month) and Follow Up (6 Months)
Standardized  Coefficients
Anything Last
Sex, 1 Month
Anything Last
Sex, 6 Months
Condom Last Sex,
1 Month
Condom Last
Sex, 6 Months
70.79***
4.78*
36.33***
2.12
Participant Aged 14 and Younger
4.72
4.07
10.42*
4.82
Participant Aged 15 to 17
6.17
6.85*
2.75
3.43
Ethnicity (African American)
1.90
0.36
1.77
0.95
Ethnicity (Caucasian)
13.66
0.23
4.75
1.23
Ethnicity (Mexican American)
1.76
0.31
1.16
0.53
Ethnicity (Puerto Rican)
22.41
2E+008
16.47*
6E+008
Pregnant at Intake
0.89
0.43
0.69
0.71
Score at Baseline
1.00
1.00
1.00
0.99
Positive Change in Score (Yes)
1.83
5.46*
1.23
0.81
Adjusted (Nagelkerke) R2
0.64
0.33
0.58
0.14
115.16***
26.49**
103.31***
10.90
189
114
189
110
Dependent Variables:
Independent Variables:
Any Method/Condom Use at Baseline
2 for Model (df=10)
n
Significance levels: *** p<0.001; **p<0.01; * p<0.05; all two-tailed tests.
Illinois Subsequent Pregnancy Program
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ISPP
Key Findings
 From Baseline to Posttest (1 Month)
 Reported contraceptive use increased among participants in the
Subsequent Pregnancy Project:
 Participants increased their use of contraception (any method) at last sexual
intercourse
 Participants increased their use of a condom at last sexual intercourse
 Contraceptive Knowledge increased among program participants
 From Baseline to Follow Up (6 Months)
 Reported contraceptive use increased among participants in the
Subsequent Pregnancy Project:
 Participants increased their use of contraception (any method) at last sexual
intercourse
 Participants increased their use of a condom at last sexual intercourse
 A positive change in Contraceptive Knowledge score is independently
associated with use of contraception (any method) at last sexual
intercourse
Illinois Subsequent Pregnancy Program
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ISPP
Conclusions
 These findings support the expected changes in contraceptive behavior
among adolescent mothers participating in ISPP. After 6 months of program
participation, there was in increase in the proportion of young mothers who:
 Used a method of contraception at last sexual intercourse
 Used a condom at last sexual intercourse
 The ISPP Program Model has been shown to consistently increase
contraceptive use, across time and diverse populations of adolescents:
1. In participants’ self-report (i.e. current analysis)
2. Home Visitors’ report at the end of the program year
3. Very low subsequent pregnancy rates for program participants (3%)
 Using Contraceptive Knowledge in an effort to assess a mechanism for
behavior change among ISPP participants, we found:
 An increase in Contraceptive Knowledge at 1 month shows a positive association
with contraceptive use at 6 months, controlling for other factors