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Queens Hospital Center's Comprehensive Adolescent Program for Teenage Mothers and Their Children Print
Programs that Work to Prevent Subsequent Pregnancy among Adolescent Mothers

Program Components

  • Hospital-based, comprehensive program offering medical, psychosocial, educational, and family planning support
  • Interdisciplinary team of obstetrician-gynecologist, pediatrician, social worker, and health educator assigned to each teenage mother and her infant
  • Physician or practitioner on call 24 hours a day
  • Reproductive health and family life education program with ongoing bi-weekly classes for the teen mother, her partner, and her family
  • Multi-service center, offering mental health care, WIC (nutritional supplemental program for women, infants, and children), housing office, high school equivalency program, day care center, and adult and pediatric clinic

For Use With

  • Economically disadvantaged, pregnant and parenting adolescents and their infants

Evaluation Methodology

  • Quasi-experimental evaluation design, with treatment and comparison conditions of adolescents and their newborns, enrolled prior to delivery, and receiving care at Queens Hospital Center
  • Pregnant adolescents receiving prenatal care in the comprehensive adolescent program (treatment group n=498) or in the adult obstetric clinic (comparison group n=91)
  • Baseline data collected at enrollment, with follow-up to age 20 or 1989, whichever came first
  • Data collected retrospectively from inpatient and outpatient charts prior to July 1985 and prospectively from July 1985 through 1989, or until adolescent mothers reached age 20

Evaluation Findings

  • Reduced incidence of repeat pregnancy
  • Increased use of contraception
  • Reduced incidence of maternal morbidity
  • Reduced incidence of infant injury and illness
  • Increased educational attainment among young mothers
  • Increased employment outcomes among young mothers

Program Description

This comprehensive program is designed with the belief that teenage pregnancy is only a symptom of an underlying problem which may be amenable to change. The basic philosophy of the program is that pregnant adolescents need comprehensive services to address complex issues and needs. The program stresses early intervention to: 1) reduce repeat pregnancy; 2) improve school completion among adolescent mothers; and 3) improve health outcomes among adolescent mothers and their children. To accomplish these goals, the program assigns each adolescent mother and her newborn to an interdisciplinary team, consisting of obstetrician-gynecologist, pediatrician, social worker, and health educator. The teen and her infant remain under the care of the assigned team until the adolescent mother reaches age 20.2

The Queens Hospital Center’s comprehensive adolescent program also offers the young mothers 24-hour access to physicians and nurse practitioners. It also offers reproductive and family life education, consisting of ongoing bi-weekly classes for the adolescent, her partner, and her family. Located within a multi-service center, the program also offers referral for mental health care, WIC (nutritional supplemental program for women, infants, and children), a housing office, a high school equivalency program, a day care center, and adult and pediatric clinics.2

Evaluation Methodology

The study evaluated the impact of the comprehensive program on maternal and infant health and on subsequent reproductive and life choices of the adolescent mothers. The treatment group consisted of 498 adolescents and their newborns, enrolled prior to delivery, who received care at Queens Hospital Center’s comprehensive adolescent program. Participants included those in the program from its inception in 1982 until 1989, when the study ended. The study followed the mothers until they reached age 20 or until 1989, whichever came first. The comparison group consisted of 91 adolescents and their newborns who received prenatal care at Queens Hospital Center’s adult obstetric and gynecologic and pediatric clinics from 1980 to 1982 and who continued to receive care with their children at the hospital’s adult family planning and pediatrics clinics until they reached age 20 or until 1989, whichever came first.2

All participants were under age 20 at delivery; mean age at delivery for both groups was 17. All retrospective data were abstracted from the outpatient and inpatient medical charts prior to July 1985; data were prospectively collected from July 1985 and onward. At delivery, there were no differences between the two adolescent groups in terms of age, socioeconomic status, completed years of school, prior poor obstetrical outcome (stillbirth, fetal death, or neonatal death), or employment status as head of the household. Standards of medical care were identical at both clinics. Adolescent mothers were excluded from the study if they had pre-existing hypertension, diabetes, cardiac or renal disease, diseases of the endocrine or neurologic systems, multiple gestations, or known or subsequently documented drug use.2

Outcomes
  • Behaviors—
    • Increased contraceptive use—Adolescents in the treatment program were significantly more likely to use contraceptives and to use them regularly than were adolescents in the comparison group (85 versus 22 percent, respectively; P≤.0001). By 1989, over 96 percent of adolescents in the treatment group reported regular contraceptive use.2
    • Improved attendance at gynecologic and pediatric clinics— Seventy-five percent of adolescents in the treatment group regularly completed their gynecologic and pediatric appointments, versus 18 percent of adolescent mothers in the comparison group (P≤.0001).2
Long-Term Outcomes
  • Decreased incidence of pregnancy—Fewer adolescents in the treatment group than in the comparison group became pregnant again during their remaining teenage years—nine percent of treatment adolescents versus 70 percent of comparison group adolescents. Across all the years of the program, repeat pregnancy among adolescents in the treatment group declined significantly with each successive year. For all the years of the program, repeat pregnancy, whether ending in live birth or termination, declined significantly with each successive year (P≤.0001).2
  • Decreased incidence of maternal morbidity—Eighteen percent of adolescents in the treatment group suffered subsequent maternal morbidity (prolonged disease of the pelvic organs or of upper respiratory, circulatory, or gastro-intestinal systems, requiring multiple physician visits or hospitalization). By contrast, 36 percent of adolescent mothers in the comparison group suffered subsequent maternal morbidity, a difference that was statistically significant (P≤.0001).2
  • Decreased incidence of infant morbidity—Morbidity was significantly lower among infants in the treatment group versus the control group (P≤.001). Infant morbidity included any accident or injury in a child under age two that required multiple physician visits or hospitalization.2
  • Increased educational attainment—More adolescents in the treatment program than in the comparison group attended school regularly (77 versus 38 percent, respectively; P≤.0001). By 1989, over 95 percent of treatment group adolescents who had regularly attended school had also graduated from high school, earned a high school equivalency diploma, or were within six months of graduating from one of these programs. The differences between treatment and comparison groups in adolescents’ educational attainments were statistically significant.2
  • Improved employment status—More adolescents in the treatment program than in the comparison group sought and maintained employment (48 versus 22 percent, respectively; P≤.0001). Again, the difference was statistically significant.2

For More Information, Contact

  • Sociometrics, Program Archive on Sexuality, Health & Adolescence Phone, 1.800.846.3475; Fax, 1.650.949.3299; E-mail, This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; Web, http://www.socio.com

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