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Mohamed S, Chipeta MG, Kamninga T, Nthakomwa L, Chifungo C, Mzembe T, Vellemu R, Chikwapulo V, Peterson M, Abdullahi L, Musau K, Wazny K, Zulu E, Madise N. Interventions to prevent unintended pregnancies among adolescents: a rapid overview of systematic reviews. Syst Rev 2023; 12:198. [PMID: 37858208 PMCID: PMC10585784 DOI: 10.1186/s13643-023-02361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Risks associated with unintended pregnancy include unsafe abortions, poor maternal health-seeking behaviour, poor mental health, and potentially, maternal and infant deaths. Adolescent girls with unintended pregnancies are particularly vulnerable as they are at higher risk of eclampsia, premature onset of labour, and increased neonatal morbidity and mortality. Unintended pregnancy, with the right combination of interventions, can be avoided. Evidence-based decision-making and the need for a robust appraisal of the evidence have resulted in many systematic reviews. This review of systematic reviews focuses on adolescent pregnancy prevention and will seek to facilitate evidence-based decision-making. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR 2 criteria. We identified three systematic reviews from low- and middle-income countries and high-income counties and included all socioeconomic groups. We used vote counting and individual narrative review summaries to present the results. Overall, skill-building, peer-led and abstinence programmes were generally effective. Interventions focused on information only, counselling and interactive sessions provided mixed results.In contrast, exposure to parenting and delaying sexual debut interventions were generally ineffective. Adolescent pregnancy prevention interventions that deploy school-based primary prevention strategies, i.e. strategies that prevent unintended pregnancies in the first place, may effectively reduce teenage pregnancy rates, improve contraceptive use, attitudes and knowledge, and delay sexual debut. However, the included studies have methodological issues, and our ability to generalise the result is limited.
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Affiliation(s)
- Sahra Mohamed
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Michael G Chipeta
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi.
| | | | - Lomuthando Nthakomwa
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Chimwemwe Chifungo
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Themba Mzembe
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Ruth Vellemu
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Victor Chikwapulo
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Maame Peterson
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Leyla Abdullahi
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Kelvin Musau
- The Children's Investment Fund Foundation, Nairobi, Kenya
| | - Kerri Wazny
- The Children's Investment Fund Foundation, London, UK
| | - Eliya Zulu
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Nyovani Madise
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
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Pike C, Coakley C, Ahmed N, Lee D, Little F, Padian N, Bekker LG. Goals for girls: a cluster-randomized trial to investigate a school-based sexual health programme amongst female learners in South Africa. HEALTH EDUCATION RESEARCH 2023; 38:375-391. [PMID: 37405698 PMCID: PMC10516375 DOI: 10.1093/her/cyad025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
The delivery of comprehensive sexuality education to adolescents at school is recognized as a long-term strategy to support adolescent health. Suboptimal sexual and reproductive health (SRH) outcomes among South African adolescents necessitate the ongoing development and optimization of SRH education and promotion models. We conducted a cluster-randomized controlled trial amongst secondary schools (n = 38) in Cape Town, South Africa, to evaluate a sport-based, near-peer-led SRH curriculum, SKILLZ, amongst female learners (n = 2791). Biomedical (sexually transmitted infections [STIs], human immunodeficiency virus [HIV] and pregnancy) and socio-behavioural (social support, gender norms and self-concept) outcomes were assessed pre and post intervention. Attendance at SKILLZ was low and intervention participants did not show an improvement in SRH outcomes, with HIV and pregnancy incidence remaining stable and STI prevalence remaining high and increasing in both control and intervention arms. Although evidence of positive socio-behavioural measures was present at baseline, participants with high attendance showed further improvement in positive gender norms. SKILLZ did not demonstrate the capacity to significantly impact clinical SRH outcomes. Modest improvements in outcomes amongst high attenders suggest that the impact may be possible with improved attendance; however, in the absence of optimal attendance, alternative intervention strategies may be required to improve SRH outcomes amongst adolescents.
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Affiliation(s)
- C Pike
- Desmond Tutu HIV Centre, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - C Coakley
- Desmond Tutu HIV Centre, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- Centre for Social Science Research, Faculty of Humanities, University of Cape Town, Cape Town 7701, South Africa
| | - N Ahmed
- Desmond Tutu HIV Centre, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
- Mortimer Market Centre, Central North West London NHS Trust, Off Caper Street, London WC1E 6 JB, UK
| | - D Lee
- Grassroot Soccer, 35 Jamieson Street, Cape Town 7784, South Africa
| | - F Little
- Department of Statistical Sciences, University of Cape Town, Private Bag X3, Rhodes Gift, Cape Town 7707, South Africa
| | - N Padian
- Grassroot Soccer, 35 Jamieson Street, Cape Town 7784, South Africa
- School of Medicine University of California San Francisco, San Francisco, CA 94143, USA
| | - L G Bekker
- Desmond Tutu HIV Centre, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
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Cunha-Oliveira A, Menino E, Santos D, Cardoso D, Neves M, Martins MJ, Gonçalves AM, Dias C, Gonçalves ML, Santos R, Sambango A, Rodrigues R. Prevention of risky sexual behavior in primary healthcare: a best practice implementation project. JBI Evid Implement 2023:02205615-990000000-00059. [PMID: 37477193 DOI: 10.1097/xeb.0000000000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES Sexually transmitted infections are a public health problem affecting 45% of adolescents and young adults worldwide. The evidence suggests that primary care settings are uniquely positioned to provide an opportunity for these preventive interventions. The aim of this project is to improve nurses' interventions for preventing risky sexual behaviors in adolescents attending nursing consultations in a primary healthcare unit. METHODS An audit and feedback were conducted by the JBI Model and Implementation Framework. Five audit criteria representing best practice recommendations for preventing risky sexual behaviors in adolescents were used. Barriers to compliance with the best practices were identified, and strategies were adopted to overcome them. A follow-up audit was conducted using the same approach as the baseline audit. RESULTS Compliance rates improved in four criteria from baseline audit to follow-up audit. CONCLUSION Through auditing and feedback, evidence-based interventions were implemented to prevent sexual risk behavior in adolescents in primary care settings. Further best practice implementation projects should be conducted to improve adolescent health outcomes.
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Affiliation(s)
- Aliete Cunha-Oliveira
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC)
- Nursing School of Coimbra
| | - Eva Menino
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC)
- Nursing School of Coimbra
| | - Diana Santos
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC)
- Nursing School of Coimbra
- Centro Hospitalar e Universitário de Coimbra, EPE
| | - Daniela Cardoso
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC)
- Nursing School of Coimbra
- Portugal Centre for Evidence-Based Practice: A JBI Centre of Excellence, Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra
| | - Marília Neves
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC)
- Nursing School of Coimbra
| | - Maria J Martins
- Unidade de Cuidados de Saúde Personalizados da Lousã, Lousã, Portugal
| | - Ana M Gonçalves
- Unidade de Cuidados de Saúde Personalizados da Lousã, Lousã, Portugal
| | - Clara Dias
- Unidade de Cuidados de Saúde Personalizados da Lousã, Lousã, Portugal
| | - Maria L Gonçalves
- Unidade de Cuidados de Saúde Personalizados da Lousã, Lousã, Portugal
| | - Rita Santos
- Unidade de Cuidados de Saúde Personalizados da Lousã, Lousã, Portugal
| | - Arão Sambango
- Unidade de Cuidados de Saúde Personalizados da Lousã, Lousã, Portugal
| | - Rogério Rodrigues
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC)
- Nursing School of Coimbra
- Centro Hospitalar e Universitário de Coimbra, EPE
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Lohan M, Brennan-Wilson A, Hunter R, Gabrio A, McDaid L, Young H, French R, Aventin Á, Clarke M, McDowell C, Logan D, Toase S, O’Hare L, Bonell C, Gillespie K, Gough A, Lagdon S, Warren E, Buckley K, Lewis R, Adara L, McShane T, Bailey J, White J. Effects of gender-transformative relationships and sexuality education to reduce adolescent pregnancy (the JACK trial): a cluster-randomised trial. THE LANCET PUBLIC HEALTH 2022; 7:e626-e637. [DOI: 10.1016/s2468-2667(22)00117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
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Ayelotan M, Adebayo AM, Omokhodion F. Perception and intention to use reproductive life plan among female final year undergraduates of the University of Ibadan, Nigeria. J OBSTET GYNAECOL 2022; 42:2449-2455. [PMID: 35666950 DOI: 10.1080/01443615.2022.2070839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A descriptive cross-sectional study was conducted to assess perception (of) and intention to use reproductive life plan among 500 female final year undergraduates of the University of Ibadan, Nigeria. Only 22% of the respondents were aware of RLP and 63% had good perception of RLP. Most (85.1%) had the intention to plan their pregnancy and 64.5% intended to use RLP as a tool for planning pregnancy. More respondents (85.8%) who were aware of family planning methods had intention to plan their pregnancy compared to those that were not (61.5%; p = .015). Similarly, 65.8% of respondents who were aware of family planning methods had intention to use RLP compared to 23.1% of those who were not (p = .002). Respondents' awareness of the concept of RLP was poor and majority agreed to use RLP as a tool for planning pregnancy. Awareness of family planning methods was associated with intention to use RLP.Impact StatementWhat is already known on this subject? Reproductive life plan (RLP) is a tool for setting goals in terms of childbearing. It outlines personal goals about pregnancy which includes having the desired number of children, avoiding unintended pregnancies and avoiding ill health that may threaten reproduction. RLP is a useful tool in preconception and the tool can adequately prepare young unmarried girls for motherhood, thus reducing the high rate of unintended pregnancy which remains a public health and social challenge especially in low income settings including Nigeria.What do the results of this study add? This study has been able to bridge an existing gap in knowledge because no study has been conducted to assess the perception of RLP and intention to use it as a preconception tool in Nigeria. The results provided new information on the perception and intention to use reproductive life plan among female final year undergraduate students of University of Ibadan, Nigeria.What are the implications of these findings for clinical practice and/or further research? The use of RLP serves as health promotion strategy to improve the health of each woman prior to conception by planning their pregnancies, identifying risk factors, providing education and stabilising medical conditions so as to optimise maternal and foetal outcomes.
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Affiliation(s)
- Mayowa Ayelotan
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | | | - Folashade Omokhodion
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
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Sullivan EE, Love HL, Fisher RL, Schlitt JJ, Cook EL, Soleimanpour S. Access to Contraceptives in School-Based Health Centers: Progress and Opportunities. Am J Prev Med 2022; 62:350-359. [PMID: 34922786 DOI: 10.1016/j.amepre.2021.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The U.S. has a higher adolescent pregnancy rate than other industrialized countries. School-based health centers can improve access to contraceptives among youth, which can prevent unplanned pregnancies. This cross-sectional study examines the characteristics and predictors of contraceptive provision at school-based health centers in 2016-2017 and changes in and barriers to provision between 2001 and 2017. METHODS In 2020-2021, the authors conducted analyses of the National School-Based Health Care Census data collected from 2001 to 2017. The primary outcome of interest was whether adolescent-serving school-based health centers dispense contraceptives, and a secondary outcome of interest was the policies that prohibit school-based health centers from dispensing contraceptives. A multivariate regression analysis examined the associations between contraceptive provision and various covariates, including geographic region, years of operation, and provider team composition. RESULTS Less than half of adolescent-serving school-based health centers reported providing contraceptives on site. Those that provided contraceptives were more likely located in the Western and Northeastern regions of the U.S., older in terms of years of operation, and staffed by a wide variety of health provider types. Among school-based health centers that experienced policy barriers to providing access to contraceptive methods, most attributed the source to the school or school district where the school-based health center was located. CONCLUSIONS School-based health centers are an evidence-based model for providing contraceptives to adolescents but not enough are providing direct access. Understanding the predictors, characteristics, and barriers influencing the provision of contraceptives at school-based health centers may help to expand the number doing so.
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Affiliation(s)
- Erin E Sullivan
- Research and Evaluation, School-Based Health Alliance, Washington, District of Columbia.
| | - Hayley L Love
- Research and Evaluation, School-Based Health Alliance, Washington, District of Columbia
| | - Rebecca L Fisher
- New York City Department of Health and Mental Hygiene, Office of School Health & Bureau of Maternal, Infant, and Reproductive Health, New York, New York
| | - John J Schlitt
- Research and Evaluation, School-Based Health Alliance, Washington, District of Columbia
| | - Elizabeth L Cook
- Reproductive Health and Family Formation, Child Trends, Bethesda, Maryland
| | - Samira Soleimanpour
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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Ponsford R, Meiksin R, Allen E, Melendez-Torres GJ, Morris S, Mercer C, Campbell R, Young H, Lohan M, Coyle K, Bonell C. The Positive Choices trial: study protocol for a Phase-III RCT trial of a whole-school social marketing intervention to promote sexual health and reduce health inequalities. Trials 2021; 22:818. [PMID: 34789322 PMCID: PMC8596352 DOI: 10.1186/s13063-021-05793-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Background Positive Choices is a whole-school social marketing intervention to promote sexual health among secondary school students. Intervention comprises school health promotion council involving staff and students coordinating delivery; student survey to inform local tailoring; teacher-delivered classroom curriculum; student-run campaigns; parent information; and review of sexual/reproductive health services to inform improvements. This trial builds on an optimisation/pilot RCT study which met progression criteria, plus findings from another pilot RCT of the Project Respect school-based intervention to prevent dating and relationship violence which concluded such work should be integrated within Positive Choices. Young people carry a disproportionate burden of adverse sexual health; most do not report competence at first sex. Relationships and sex education in schools can contribute to promoting sexual health but effects are small, inconsistent and not sustained. Such work needs to be supplemented by ‘whole-school’ (e.g. student campaigns, sexual health services) and ‘social marketing’ (harnessing commercial marketing to social ends) approaches for which there is good review-level evidence but not from the UK. Methods We will conduct a cluster RCT across 50 schools (minimum 6440, maximum 8500 students) allocated 1:1 to intervention/control assessing outcomes at 33 months. Our primary outcome is non-competent first sex. Secondary outcomes are non-competent last sex, age at sexual debut, non-use of contraception at first and last sex among those reporting heterosexual intercourse, number of sexual partners, dating and relationship violence, sexually transmitted infections, and pregnancy and unintended pregnancy for girls and initiation of pregnancy for boys. We will recruit 50 school and undertake baseline surveys by March 2022; implement the intervention over the 2022–2024 school years and conduct the economic and process evaluations by July 2024; undertake follow-up surveys by December 2024; complete analyses, all patient and policy involvement and draft the study report by March 2025; and engage in knowledge exchange from December 2024. Discussion This trial is one of a growing number focused on whole-school approaches to public health in schools. The key scientific output will be evidence about the effectiveness, costs and potential scalability and transferability of Positive Choices. Trial registration ISRCTN No: ISRCTN16723909. Trial registration summary: Date:. Funded by: National Institute for Health Research Public Health Research Programme (NIHR131487). Sponsor: LSHTM. Public/scientific contact: Chris Bonell. Public title: Positive Choices trial. Scientific title: Phase-III RCT of Positive Choices: a whole-school social marketing intervention to promote sexual health and reduce health inequalities. Countries of recruitment: UK. Intervention: Positive Choices. Inclusion criteria: Students in year 8 (age 12–13 years) at baseline deemed competent by schools to participate in secondary schools excluding pupil referral units, schools for those with special educational needs and disabilities, and schools with ‘inadequate’ Ofsted inspections. Study type: interventional study with superiority phase III cluster RCT design. Enrollment: 1/9/21-31/3/22. Sample size: 50 schools and 6440–8500 students. Recruitment status: pending. Primary outcome: binary measure of non-competent first sex. Secondary outcomes: non-competent last sex; age at sexual debut; non-use of contraception at first and last sex; number of sexual partners; dating and relationship violence (DRV) victimisation; sexually transmitted infections; pregnancy and unintended pregnancy for girls and initiation of pregnancy for boys using adapted versions of the RIPPLE measures. Ethics review: LSHTM research ethics committee (reference 26411). Completion data: 1/3/25. Sharing statement: Data will be made available after the main trial analyses have been completed on reasonable request from researchers with ethics approval and a clear protocol. Amendments to the protocol will be communicated to the investigators, sponsor, funder, research ethics committee, trial registration and the journal publishing the protocol. Amendments affecting participants’ experience of the intervention or important amendments affecting the overall design and conduct of the trial will be communicated to participants.
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Affiliation(s)
- Ruth Ponsford
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Rebecca Meiksin
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Elizabeth Allen
- London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
| | - G J Melendez-Torres
- University of Exeter College of Medicine and Health, South Cloisters, St Luke's Campus, Heavitree Road, EX1 2, Exeter, LU, UK
| | - Steve Morris
- Department of Public Health & Primary Care, Cambridge University, Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN, UK
| | - Catherine Mercer
- UCL Institute for Global Health, 3rd Floor Mortimer Market Centre, off Capper Street, WC1E 6JB, London, UK
| | - Rona Campbell
- University of Bristol, 1-5 Whiteladies Road, Clifton, Bristol, BS8 1NU, UK
| | - Honor Young
- DECIPHer, Cardiff School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Maria Lohan
- School of Nursing and Midwifery, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
| | - Karin Coyle
- , 5619 Scotts Valley Drive, Suite 140, Scotts Valley, CA, 95066, Scotts Valley, USA
| | - Chris Bonell
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
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Macounová P, Tomášková H, Šnajdrová A, Stanovská M, Polochová M, Tomášek I, Maďar R. Education of Adolescents in the Prevention of HIV/AIDS in the Czech Republic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116148. [PMID: 34200215 PMCID: PMC8201296 DOI: 10.3390/ijerph18116148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/25/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022]
Abstract
The number of HIV-positive people in the Czech Republic has trebled over the last decade. An educational programme aimed at the prevention of HIV and STDs in adolescents between 13 and 19 years of age is underway in the Moravian-Silesian Region in the Czech Republic. All schools in the region have been offered the chance to participate in the programme (on a voluntary basis). The programme consists of an educational lecture and a game with interactive elements; the students perform various tasks in groups. An anonymous paired questionnaire (input/output) was used to assess the efficacy of the programme. In order to evaluate the programme efficacy, descriptive statistics, non-parametric Wilcoxon paired test at the level of significance of 5%, and a model of logistic regression for a dichotomous variable were used. A total of 1210 students took part in the programme. The students’ knowledge improved, on average, by 15.5%. The highest efficacy was observed in the age group of 13–14-year-olds, where the improvement reached 17.9%. The educational programme was effective in raising awareness about STDs. Due to the observed increase in knowledge especially among the youngest participants (13–14 years old), we recommend aiming further interventions at the youngest age groups.
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Affiliation(s)
- Petra Macounová
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, 709 00 Ostrava, Czech Republic; (P.M.); (M.S.); (M.P.); (R.M.)
| | - Hana Tomášková
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, 709 00 Ostrava, Czech Republic; (P.M.); (M.S.); (M.P.); (R.M.)
- Public Health Institute Ostrava, 702 00 Ostrava, Czech Republic; (A.Š.); (I.T.)
- Correspondence: ; Tel.: +420-553-461-788
| | - Anna Šnajdrová
- Public Health Institute Ostrava, 702 00 Ostrava, Czech Republic; (A.Š.); (I.T.)
| | - Markéta Stanovská
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, 709 00 Ostrava, Czech Republic; (P.M.); (M.S.); (M.P.); (R.M.)
| | - Martina Polochová
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, 709 00 Ostrava, Czech Republic; (P.M.); (M.S.); (M.P.); (R.M.)
| | - Ivan Tomášek
- Public Health Institute Ostrava, 702 00 Ostrava, Czech Republic; (A.Š.); (I.T.)
| | - Rastislav Maďar
- Department of Epidemiology and Public Health, Faculty of Medicine, University of Ostrava, 709 00 Ostrava, Czech Republic; (P.M.); (M.S.); (M.P.); (R.M.)
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Lassi ZS, Kedzior SGE, Tariq W, Jadoon Y, Das JK, Bhutta ZA. Effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low- and middle-income countries: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1156. [PMID: 37131925 PMCID: PMC8356350 DOI: 10.1002/cl2.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background The preconception period is an ideal time to introduce interventions relating to nutrition and other lifestyle factors to ensure good pregnancy preparedness, and to promote health of mothers and babies. In adolescents, malnutrition and early pregnancy are the common challenges, particularly among those who live in low- and middle-income countries (LMIC) where 99% of all maternal and newborn deaths occur. These girls receive little or no attention until their first pregnancy and often the interventions after pregnancy are too late to revert any detrimental health risks that may have occurred due to malnutrition and early pregnancy. Objectives To synthesise the evidence of the effectiveness of preconception care interventions relating to delayed age at first pregnancy, optimising inter-pregnancy intervals, periconception folic acid, and periconception iron-folic acid supplementation on maternal, pregnancy, birth and child outcomes. Search Methods Numerous electronic databases (e.g., CINAHL, ERIC) and databases of selected development agencies or research firms were systematically searched for all available years up to July 2019. In addition, we searched the reference lists of relevant articles and reviews, and asked experts in the area about ongoing and unpublished studies. Selection Criteria Primary studies, including large-scale programme evaluations that assessed the effectiveness of interventions using randomised controlled trials (RCTs) or quasi-experimental designs (natural experiments, controlled before-after studies, regression discontinuity designs, interrupted time series [ITS]), that targeted women of reproductive age (i.e., 10-49 years) during the pre- and periconceptional period in LMICs were included. Interventions were compared against no intervention, standard of care or placebo. Data Collection and Analysis Two or more review authors independently reviewed searches, selected studies for inclusion or exclusion, extracted data and assessed risk of bias. We used random-effects model to conduct meta-analyses, given the diverse contexts, participants, and interventions, and separate meta-analyses for the same outcome was performed with different study designs (ITS, RCTs and controlled before after studies). For each comparison, the findings were descriptively summarised in text which included detailing the contextual factors (e.g., setting) to assess their impact on the implementation and effectiveness of each intervention. Main Results We included a total of 43 studies; two of these were included in both delaying pregnancy and optimising interpregnancy intervals resulting in 26 studies for delaying the age at first pregnancy (14 RCTs, 12 quasi-experimental), four for optimising interpregnancy intervals (one RCT, three quasi-experimental), five on periconceptional folic acid supplementation (two RCTs, three quasi-experimental), and 10 on periconceptional iron-folic acid supplementation (nine RCTs, one quasi-experimental). Geographically, studies were predominantly conducted across Africa and Asia, with few studies from North and Central America and took place in a combination of settings including community, schools and clinical. The education on sexual health and contraception interventions to delay the age at first pregnancy may make little or no difference on risk of unintended pregnancy (risk ratio [RR], 0.42; 95% confidence internal [CI], 0.07-3.26; two studies, =490; random-effect; χ 2 p .009; I 2 = 85%; low certainty of evidence using GRADE assessment), however, it significantly improved the use of condom (ever) (RR, 1.54; 95% CI, 1.08-2.20; six studies, n = 1604; random-effect, heterogeneity: χ 2 p .004; I 2 = 71%). Education on sexual health and and provision of contraceptive along with involvement of male partneron optimising interpregnancy intervals probably makes little or no difference on the risk of unintended pregnancies when compared to education on sexual health only (RR, 0.32; 95% CI, 0.01-7.45; one study, n = 45; moderate certainty of evidence using GRADE assessments). However, education on sexual health and contraception intervention alone or with provision of contraceptive showed a significant improvement in the uptake of contraceptive method. We are uncertain whether periconceptional folic acid supplementation reduces the incidence of neural tube defects (NTDs) (RR, 0.53; 95% CI, 0.41-0.77; two studies, n = 248,056; random-effect; heterogeneity: χ 2 p .36; I 2 = 0%; very low certainty of evidence using GRADE assessment). We are uncertain whether preconception iron-folic acid supplementation reduces anaemia (RR, 0.66; 95% CI, 0.53-0.81; six studies; n = 3430, random-effect; heterogeneity: χ 2 p < .001; I 2 = 88%; very low certainty of evidence using GRADE assessment) even when supplemented weekly (RR, 0.70; 95% CI, 0.55-0.88; six studies; n = 2661; random-effect; heterogeneity: χ 2 p < .001; I 2 = 88%; very low certainty of evidence using GRADE assessments),and in school set-ups (RR, 0.66; 95% CI, 0.51-0.86; four studies; n = 3005; random-effect; heterogeneity: χ 2 p < .0001; I 2 = 87%; very low certainty of evidence using GRADE assessment). Data on adverse effects were reported on in five studies for iron-folic acid, with the main complaint relating to gastrointestinal side effects. The quality of evidence across the interventions of interest was variable (ranging from very low to moderate) which may be attributed to the different study designs included in this review. Concerning risk of bias, the most common concerns were related to blinding of participants and personnel (performance bias) and whether there were similar baseline characteristic across intervention and comparison groups. Authors' Conclusions There is evidence that education on sexual health and contraception interventions can improve contraceptive use and knowledge related to sexual health, this review also provides further support for the use of folic acid in pregnancy to reduce NTDs, and notes that weekly regimes of IFA are most effective in reducing anaemia. However the certainty of the evidence was very low and therefore more robust trials and research is required, including ensuring consistency for reporting unplanned pregnancies, and further studies to determine which intervention settings (school, community, clinic) are most effective. Although this review demonstrates promising findings, more robust evidence from RCTs are required from LMICs to further support the evidence.
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Affiliation(s)
- Zohra S. Lassi
- Robinson Research InstituteUniversity of AdelaideAdelaideAustralia
| | - Sophie G. E. Kedzior
- Faculty of Health and Medical Sciences, Robinson Research InstituteUniversity of AdelaideAdelaideAustralia
| | | | - Yamna Jadoon
- Department of PaediatricsAga Khan University HospitalKarachiPakistan
| | - Jai K. Das
- Division of Women and Child HealthAga Khan University HospitalKarachiPakistan
| | - Zulfiqar A. Bhutta
- Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoCanada
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Ponsford R, Meiksin R, Bragg S, Crichton J, Emmerson L, Tancred T, Tilouche N, Morgan G, Gee P, Young H, Hadley A, Campbell R, Bonell C. Co-production of two whole-school sexual health interventions for English secondary schools: positive choices and project respect. Pilot Feasibility Stud 2021; 7:50. [PMID: 33597013 PMCID: PMC7888187 DOI: 10.1186/s40814-020-00752-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/16/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Whole-school interventions represent promising approaches to promoting adolescent sexual health, but they have not been rigorously trialled in the UK and it is unclear if such interventions are feasible for delivery in English secondary schools. The importance of involving intended beneficiaries, implementers and other key stakeholders in the co-production of such complex interventions prior to costly implementation and evaluation studies is widely recognised. However, practical accounts of such processes remain scarce. We report on co-production with specialist providers, students, school staff, and other practice and policy professionals of two new whole-school sexual heath interventions for implementation in English secondary schools. METHODS Formative qualitative inquiry involving 75 students aged 13-15 and 23 school staff. A group of young people trained to advise on public health research were consulted on three occasions. Twenty-three practitioners and policy-makers shared their views at a stakeholder event. Detailed written summaries of workshops and events were prepared and key themes identified to inform the design of each intervention. RESULTS Data confirmed acceptability of addressing unintended teenage pregnancy, sexual health and dating and relationships violence via multi-component whole-school interventions and of curriculum delivery by teachers (providing appropriate teacher selection). The need to enable flexibility for the timetabling of lessons and mode of parent communication; ensure content reflected the reality of young people's lives; and develop prescriptive teaching materials and robust school engagement strategies to reflect shrinking capacity for schools to implement public-health interventions were also highlighted and informed intervention refinements. Our research further points to some of the challenges and tensions involved in co-production where stakeholder capacity may be limited or their input may conflict with the logic of interventions or what is practicable within the constraints of a trial. CONCLUSIONS Multi-component, whole-school approaches to addressing sexual health that involve teacher delivered curriculum may be feasible for implementation in English secondary schools. They must be adaptable to individual school settings; involve careful teacher selection; limit additional burden on staff; and accurately reflect the realities of young people's lives. Co-production can reduce research waste and may be particularly useful for developing complex interventions, like whole-school sexual health interventions, that must be adaptable to varying institutional contexts and address needs that change rapidly. When co-producing, potential limitations in relation to the representativeness of participants, the 'depth' of engagement necessary as well as the burden on participants and how they will be recompensed must be carefully considered. Having well-defined, transparent procedures for incorporating stakeholder input from the outset are also essential. Formal feasibility testing of both co-produced interventions in English secondary schools via cluster RCT is warranted. TRIAL REGISTRATION Project Respect: ISRCTN12524938 . Positive Choices: ISRCTN65324176.
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Affiliation(s)
- Ruth Ponsford
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Rebecca Meiksin
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sara Bragg
- Centre for Sociology of Education and Equity, UCL Institute of Education, 20 Bedford Way, London, WC1H 0AL, UK
| | - Joanna Crichton
- Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Lucy Emmerson
- Sex Education Forum, National Children's Bureau, 23 Mentmore Terrace, London, E8 3PN, UK
| | - Tara Tancred
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Nerissa Tilouche
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Gemma Morgan
- Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Pete Gee
- School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Honor Young
- School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Alison Hadley
- Teenage Pregnancy Knowledge Exchange, University of Bedfordshire, University Square, Luton, LU1 3JU, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Chris Bonell
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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11
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Rheumatology-led pregnancy clinic: men perspective. Clin Rheumatol 2021; 40:3067-3077. [PMID: 33449229 PMCID: PMC8289755 DOI: 10.1007/s10067-020-05551-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 10/26/2022]
Abstract
The birth of reproductive rheumatology as a subject of interest in rheumatology has led to improvement of clinical care for patients living with autoimmune rheumatic diseases and paved the way towards setting a specialized pregnancy service within the standard rheumatology practice. In contrast to women, where there has been wealth of literature regarding pregnancy, lactation, and birth outcomes, there is not as much focusing on male sexual health and outcomes among inflammatory arthritis patients. Challenges such as decrease ability to conceive, impaired fertility, erectile dysfunction, and other sexual problems have been raised by male patients living with autoimmune rheumatic diseases. This broad scope gives the reproductive health concept in men another expansion with views to include sexual health problems screening among men attending the standard outpatient rheumatology clinics. This article adds to the paucity of real-life experience and aims at discussing the sexual health from the men perspective and provides a practical approach towards screening, and assessment of men living with autoimmune diseases in standard day to day practice.
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12
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Stephenson J, Bailey JV, Blandford A, Brima N, Copas A, D'Souza P, Gubijev A, Hunter R, Shawe J, Rait G, Oliver S. An interactive website to aid young women's choice of contraception: feasibility and efficacy RCT. Health Technol Assess 2020; 24:1-44. [PMID: 33164729 DOI: 10.3310/hta24560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Effective use of contraception can reduce numbers of unintended pregnancies, but misunderstandings and concerns about contraception abound. Increasingly, women seek health-care information online. OBJECTIVES To develop an interactive website to aid informed choice of contraceptive method, including long-acting reversible contraception (Phase I), and test its effectiveness in a parallel, single-blind randomised trial (Phase II). Approval came from London - Camden & King's Cross Research Ethics Committee (reference 17/LO/0112). SETTING AND PARTICIPANTS For both phases, women aged 15-30 years were recruited from general practice, sexual health services, maternity services, community pharmacies and an abortion service. DESIGN In Phase I, we conducted three systematic literature reviews, a review of YouTube (YouTube, LLC, San Bruno, CA, USA) videos about contraception, and focus groups and interviews with young women to explore barriers to and concerns and misperceptions about contraception. We then iteratively co-designed an interactive website, Contraception Choices [URL: www.contraceptionchoices.org (accessed June 2020)], with young women and a software company. In Phase II, we evaluated the website through a randomised trial that began as a feasibility trial. Early demand for Contraception Choices stimulated a design change from a feasibility to an efficacy trial, with follow-up for clinical outcomes at 3 and 6 months. A randomisation list was incorporated into the trial software program to allocate participants to the intervention (website) or control group (standard care). INTERVENTION Contraception Choices is a co-designed, evidence-based, interactive website to aid informed choice of contraception. It provides information about different methods, addresses common concerns and offers tailored contraceptive options in response to individual preferences. MAIN OUTCOME MEASURES Qualitative - participant views and experience of the intervention, assessed through qualitative interviews. Quantitative primary outcomes - follow-up rate at 6 months in the initial feasibility trial, using a long-acting reversible contraception method, and satisfaction with contraceptive method at 6 months in the efficacy trial. RESULTS A total of 927 women were randomised online to the website (n = 464) or control group (n = 463), of whom 739 (80%) provided follow-up data at 6 months [786 women (85%) provided data at 3 and/or 6 months that were included in the analysis of primary outcomes]. There was little difference between groups in the proportion using long-acting reversible contraception at 6 months [30.4% intervention vs. 31.0% control, adjusted odds ratio after imputation 0.87 (95% confidence interval 0.60 to 1.27)] or in satisfaction with contraceptive method [proportion being 'satisfied' or 'very satisfied', 82.6% intervention vs. 82.1% control, adjusted odds ratio 0.93 (95% confidence interval 0.69 to 1.25)]. Qualitative evaluation indicated highly positive views about the website and increased knowledge of contraceptive methods that could dispel misperceptions. Women appreciated having information tailored to their specific needs and felt better prepared before consultations. LIMITATIONS We did not include intermediate measures, such as knowledge of contraceptive methods, intention to change method or confidence in discussing contraception with a health-care professional, which may have indicated other benefits of using the website. In future, the website should be studied in different settings (e.g. schools and in routine practice) to see whether or not it improves the quality or efficiency of contraceptive consultations. CONCLUSIONS Our systematic review indicated wide-ranging influences on women's use of contraception globally. The website, Contraception Choices, was very popular with young women and contraception service providers. It was not associated with statistically significant differences in use of long-acting reversible contraception or satisfaction with contraceptive method at 6 months. TRIAL REGISTRATION Current Controlled Trials ISRCTN13247829. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 56. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Judith Stephenson
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Julia V Bailey
- Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | - Ann Blandford
- UCL Interaction Centre (UCLIC), University College London, London, UK
| | - Nataliya Brima
- Institute for Global Health, University College London, London, UK
| | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Preethy D'Souza
- Department of Social Science, UCL Institute of Education, University College London, London, UK
| | - Anasztazia Gubijev
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | | | - Jill Shawe
- Institute of Health and Community, University of Plymouth, Plymouth, UK
| | - Greta Rait
- PRIMENT Clinical Trials Unit, Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | - Sandy Oliver
- Department of Social Science, UCL Institute of Education, University College London, London, UK.,Africa Centre for Evidence, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
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13
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Campero L, Cruz-Jiménez L, Estrada F, Suárez-López L, de Castro F, Villalobos A. “I Matter, I Learn, I Decide”: An Impact Evaluation on Knowledge, Attitudes, and Rights to Prevent Adolescent Pregnancy. J Prim Prev 2020; 42:343-361. [DOI: 10.1007/s10935-020-00609-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2020] [Indexed: 11/29/2022]
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14
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15
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Lee RMK, How CH, Rajasegaran K. Sexual matters among teenagers. Singapore Med J 2020; 60:439-445. [PMID: 31570948 DOI: 10.11622/smedj.2019112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the complex developmental period of puberty, adolescents experience biophysical changes and adapt to societal and cultural expectations of adulthood. Development of their sexuality is an important biopsychosocial change during this period that, when neglected, may result in unmet sexual and reproductive health needs. Patterns of behaviour in adolescence have repercussions across the lifespan. HEADSSS (home, education/employment/eating, activities, drugs, sexuality, sleep, suicide/depression and safety) is a systematic clinical screening tool for use with adolescents. Adolescents may view risk-seeking lifestyle patterns as appropriate behaviours, and physicians can help them recognise the risks and develop less harmful alternatives and strategies. Personal biases should not affect healthcare providers' duty to respect the rights of adolescents and ability to provide developmentally appropriate care. Healthcare professionals should be familiar with the relevant legal statutes in Singapore and refer suspected sexual abuse or violence, risk of self-harm, teenage pregnancy, newly diagnosed sexual transmitted infections or multiple risk-seeking behaviours for further evaluation and help.
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Affiliation(s)
- Richard Meng Kam Lee
- Woodlands Polyclinic, National Healthcare Group Polyclinics, Singapore.,Family Medicine Development, National Healthcare Group Polyclinics, Singapore
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore.,Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Kumudhini Rajasegaran
- Adolescent Medicine Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
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16
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Lassi ZS, Kedzior SGE, Tariq W, Jadoon Y, Das JK, Bhutta ZA. Effects of Preconception Care and Periconception Interventions on Maternal Nutritional Status and Birth Outcomes in Low- and Middle-Income Countries: A Systematic Review. Nutrients 2020; 12:E606. [PMID: 32110886 PMCID: PMC7146400 DOI: 10.3390/nu12030606] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
Abstract
Pregnancy in adolescence and malnutrition are common challenges in low- and middle-income countries (LMICs), and are associated with many complications and comorbidities. The preconception period is an ideal period for intervention as a preventative tactic for teenage pregnancy, and to increase micronutrient supplementation prior to conception. Over twenty databases and websites were searched and 45 randomized controlled trials (RCTs) or quasi-experimental interventions with intent to delay the age at first pregnancy (n = 26), to optimize inter-pregnancy intervals (n = 4), and supplementation of folic acid (n = 5) or a combination of iron and folic acid (n = 10) during the periconception period were included. The review found that educational interventions to delay the age at first pregnancy and optimizing inter-pregnancy intervals significantly improved the uptake of contraception use (RR = 1.71, 95% CI = 1.42-2.05; two studies, n = 911; I2 = 0%) and (RR = 2.25, 95% CI = 1.29-3.93; one study, n = 338), respectively. For periconceptional folic acid supplementation, the incidence of neural tube defects were reduced (RR = 0.53; 95% CI = 0.41-0.77; two studies, n = 248,056; I2 = 0%), and iron-folic acid supplementation improved the rates of anemia (RR = 0.66, 95% CI = 0.53-0.81; six studies; n = 3430, I2 = 88%), particularly when supplemented weekly and in a school setting. Notwithstanding the findings, more robust RCTs are required from LMICs to further support the evidence.
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Affiliation(s)
- Zohra S. Lassi
- Robinson Research Institute, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide 5005, Australia;
| | - Sophie G. E. Kedzior
- Robinson Research Institute, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide 5005, Australia;
| | - Wajeeha Tariq
- Department of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan; (W.T.); (Y.J.); (J.K.D.); (Z.A.B.)
| | - Yamna Jadoon
- Department of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan; (W.T.); (Y.J.); (J.K.D.); (Z.A.B.)
| | - Jai K. Das
- Department of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan; (W.T.); (Y.J.); (J.K.D.); (Z.A.B.)
| | - Zulfiqar A. Bhutta
- Department of Pediatrics, the Aga Khan University, Karachi 74800, Pakistan; (W.T.); (Y.J.); (J.K.D.); (Z.A.B.)
- Centre for Global Child Health, the SickKids Hospital, Toronto, ON M5G 0A4, Canada
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17
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Stephenson J, Bailey JV, Gubijev A, D'Souza P, Oliver S, Blandford A, Hunter R, Shawe J, Rait G, Brima N, Copas A. An interactive website for informed contraception choice: randomised evaluation of Contraception Choices. Digit Health 2020; 6:2055207620936435. [PMID: 32704380 PMCID: PMC7359649 DOI: 10.1177/2055207620936435] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 06/01/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Improving use of effective contraception to prevent unintended pregnancy is a global priority, but misperceptions and concerns about contraception are common. Our objective was to evaluate an interactive website to aid informed choice of contraception. METHODS The Contraception Choices website is an interactive digital intervention which offers tailored advice to aid contraception decision-making (www.contraceptionchoices.org). In a parallel single-blind trial, we randomised 927 women aged 15-30 years from six clinic settings to access the intervention website (n = 464) or to a waiting-list control group (n = 463). The study was initially a feasibility trial, evolving into an evaluation of efficacy, with two primary outcomes at six months: long-acting reversible contraception (LARC) use, and satisfaction with contraceptive method. Secondary outcomes included self-reported pregnancy and sexually transmitted infection diagnoses. Free-text comments on the 3 and 6 month outcome surveys were analysed thematically. FINDINGS There was no significant difference between intervention and control groups in the proportion of women using LARC [30.4% intervention versus 31.0% control; adjusted odds ratio 0.87 (95% confidence interval 0.60 to 1.28)]; satisfaction with contraceptive method [82.6% versus 82.1%; adjusted ordinal odds ratio 0.93 (95% CI 0.69 to 1.25)]; self-reported pregnancy [3.3% versus 4.1%; adjusted odds ratio 0.90 (95% CI 0.45 to 1.79)] nor sexually transmitted infection [5.3% versus 4.7%; adjusted odds ratio 0.72 (95% CI 0.55 to 2.36)]. Highly positive free-text comments from intervention participants indicated that the website facilitates contraception choice and can help women feel better prepared before consultation with healthcare providers. INTERPRETATION The Contraception Choices website was popular for its design, trustworthy information and decision aids but it was not associated with significant differences in use of LARC or satisfaction with contraceptive method. An interactive website can aid contraception choice, but interventions that address factors beyond women's control, such as access to services, and partner, family or community influences are needed to complement this approach. RESEARCH IN CONTEXT Preventing unintended pregnancy through effective use of contraception is essential for women's health, but choosing between different contraceptive methods can be challenging, and the opportunity for adequate discussion during routine consultations is often constrained. EVIDENCE BEFORE THIS STUDY We conducted two systematic literature reviews: 1) Factors influencing contraception choice, uptake and use: a meta-synthesis of systematic reviews; and 2) Effectiveness of interactive digital interventions (IDI) for contraception choice, uptake and use. For the first review we searched PubMed, CDSR, Epistemonikos, DoPHER, DARE, NHS Economic Evaluation Database, Campbell Library, NIHR Health Technology Assessment, and Health Evidence Canada databases for systematic reviews which addressed contraceptive choice, uptake or use, from 2000 to 2017. PROSPERO registration number: CRD42017081521 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=81521. We synthesised the findings of 18 systematic reviews of mostly moderate or high quality. They highlighted the importance of women's knowledge, beliefs, perceptions of side effects and health risks, as well as relationship status, social network, economic and healthcare factors on contraception choice and use. For the second review, we searched 23 electronic databases, trials registers and reference lists for randomised controlled trials of IDI for contraception, including CENTRAL, MEDLINE, EMBASE, CINAHL, ERIC, ASSIA and PsycINFO, from start date to June 2017. PROSPERO registration number: CRD42017081636. We found only five randomised trials of IDI, all from the USA. Risk of bias prevented synthesis of results. www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=81636. ADDED VALUE OF THIS STUDY Women's common concerns about contraception - fear of hormones, weight gain, cancer, infertility, mood changes, breaks from contraception and changes in bleeding patterns - underpinned development of a new interactive website (www.contraceptionchoices.org). Contraception Choices addresses women's concerns through succinct text; Q and A format (Frequently Asked Questions, Did you Know?; videos of women and health professionals); an effectiveness infographic, and an interactive decision aid (What's right for me?).In an online randomised trial with 927 women attending clinics, we found no association of the Contraception Choices intervention with the primary outcomes - satisfaction with contraceptive method and uptake of long-acting reversible methods at 6 months. Nor did we find an association with secondary adverse outcomes - sexually transmitted infections or pregnancy. Comments from women indicated that the website can meet young women's need for information on the benefits and drawbacks of contraception, help them to make informed decisions, and feel better prepared before healthcare consultations. Contraception Choices is now available on the NHS website: www.nhs.uk/conditions/contraception/which-method-suits-me. IMPLICATIONS OF ALL THE AVAILABLE EVIDENCE Interactive digital interventions (websites) can aid contraception choice, but other intervention research is needed to address wider influences on unintended pregnancy, including partner views, friends, family, the media, wider society and experiences with healthcare professionals. Future research could examine the impact of the website in different settings, e.g. schools or different countries. We hypothesise that use of the website during contraceptive consultations might improve the efficiency or quality of consultation, for both patients and healthcare providers. Appropriate methodology and time-scale for evaluating digital health interventions remains a key question.
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Affiliation(s)
- Judith Stephenson
- UCL Elizabeth Garrett Anderson
Institute for Women’s Health,
University
College London, UK
| | - Julia V Bailey
- eHealth Unit, Research Department of
Primary Care and Population Health,
University
College London, UK
| | - Ana Gubijev
- UCL Elizabeth Garrett Anderson
Institute for Women’s Health,
University
College London, UK
| | - Preethy D'Souza
- Department of Social Science, UCL
Institute of Education,
University
College London, UK
| | - Sandy Oliver
- Department of Social Science, UCL
Institute of Education,
University
College London, UK
- Africa Centre for Evidence, Faculty
of Humanities, University of Johannesburg, South Africa
| | - Ann Blandford
- UCL Interaction Centre (UCLIC),
University
College London, UK
| | - Rachael Hunter
- Priment Clinical Trial Unit,
Research Department of Primary Care & Population Health, UCL, Royal Free
Campus, UK
| | - Jill Shawe
- Institute of Health and Community,
University of Plymouth, UK
| | - Greta Rait
- Priment Clinical Trial Unit,
Research Department of Primary Care & Population Health, UCL, Royal Free
Campus, UK
| | - Nataliya Brima
- Institute for Global Health,
University
College London, UK
| | - Andrew Copas
- Institute for Global Health,
University
College London, UK
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18
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Trends of Contraceptive Choices Among Young Women in Inner City Houston. J Pediatr Adolesc Gynecol 2019; 32:487-490. [PMID: 31125608 PMCID: PMC7370865 DOI: 10.1016/j.jpag.2019.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/05/2019] [Accepted: 05/02/2019] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVE Although long-acting reversible contraceptives (LARC) such as intrauterine devices and subdermal implants remain the most effective methods of contraception for teenagers, most adolescents continue to use less reliable methods. The purpose of this study was to determine: (1) the distribution of contraceptive type according to age of the patients in our clinic system (Baylor Teen Health Clinic); and (2) the differences in this distribution over the past decade. DESIGN This study was a comprehensive chart review of at least 15,500 charts for the years 2005 to 2014. SETTING Baylor Teen Health Clinic. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES Charts of patients less than 25 years of age who attended one of the 9 Baylor Teen Health Clinics were reviewed. Contraceptive uptake by age and year was the main outcome measured. RESULTS The percentage of women younger than age 25 years who used LARC increased for all age groups from 2005 to 2014, with the greatest increase for women 20-24 years old (<1% to 9%). The percentage of women using no method decreased for all age groups from 2005 to 2014 with the greatest decrease for women 15-19 years old (9% to 5%). The percentage of women using less effective methods decreased for teenagers younger than 18 years old, but increased for women 20-24 years old and remained the same for women 18-19 years old. Use of pills/patches/rings decreased for all age groups and use of hormonal injections increased for all age groups, with the greatest increase for teenagers younger than 15 years of age (35% to 68%). Our clinic population has a greater proportion of teenagers and young women using LARC than the national average, possibly because of the increased access to LARC when these women enter our clinic system. Nevertheless, less than 10% of all age groups studied used LARC, with the proportion being lowest in teenagers younger than 18 years. CONCLUSION More efforts need to be placed on determining the reasons for low LARC uptake despite greatest efficacy in this young, vulnerable population.
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Yakubu I, Garmaroudi G, Sadeghi R, Tol A, Yekaninejad MS, Yidana A. Assessing the impact of an educational intervention program on sexual abstinence based on the health belief model amongst adolescent girls in Northern Ghana, a cluster randomised control trial. Reprod Health 2019; 16:124. [PMID: 31416450 PMCID: PMC6694566 DOI: 10.1186/s12978-019-0784-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/29/2019] [Indexed: 12/28/2022] Open
Abstract
Background Adolescent pregnancy is a worldwide problem because of its health, social, economic and political repercussions on the globe. Even though the rates of adolescent pregnancy have declined over the decade, there is still unacceptably high rates especially in lower and middle-income countries including Ghana. Although the problem has been widely investigated, there is little information on the effectiveness of different methods to improve adolescent sexual abstinence based on theoretical models. This study is aimed to assess an educational intervention program on sexual abstinence based on the Health Belief Model (HBM) among adolescent girls in Northern Ghana. Methods A cluster randomized control trial was conducted in Ghana from April to August 2018. Participants within the ages of 13–19 years were enrolled voluntarily from six randomly selected Senior High Schools (3 for intervention and 3 for control). A total of 363 adolescent were enrolled. A self-structured questionnaire was administered to both groups of participants at baseline and endpoint of the study. Control participants received their normal classes whiles the intervention group additionally received comprehensive sexuality education for 1 month. Qualified midwives conducted the health education program. At least two sessions were conducted for each participating class weekly. The lessons focused on perceived susceptibility, perceived severity of adolescent pregnancy, perceived benefits, perceived barriers to adolescent pregnancy prevention, personal and family values, perceived self-efficacy and knowledge of contraceptives. Educational strategies such as discussions, demonstrations, role-play and problem solving techniques were used to deliver the lessons. Sexual abstinence was the outcome variable of the study and it was measured after 3 months of the intervention. Binary logistic regression was used to assess the impact of the intervention on sexual abstinence practice. Results At baseline, there was no difference between control and intervention groups. The mean score of Knowledge and attitude for control were (58.17 and 139.42) and intervention (60.49 and 141.36) respectively. Abstinence practice was 69.4% for control and 71.6% in the intervention group. However, after the intervention, the mean score of knowledge and attitude for control were (87.58 and 194.12) respectively. Sexual abstinence in the control was 84.4% and intervention was 97.3% respectively. The educational interventions resulted in a significant difference in sexual abstinence between intervention and control groups (OR = 13.89, 95% Confidence Interval (2.46–78.18, P < 0.003). Conclusion Educational intervention, which was guided by HBM, significantly improved sexual abstinence and the knowledge of adolescents on pregnancy prevention among the intervention group. Provision of comprehensive sex education guided by behavioural theories to adolescents at Senior High Schools in Ghana is recommended. Trial registration This trial was retrospectively registered in Protocol Registration and Results System (PRS) with trial number NCT03384251.
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Affiliation(s)
- Ibrahim Yakubu
- Department of Health Education And Promotion, School of Public Health Tehran University of Medical Sciences, Tehran, Iran. .,Department of Nursing, Nursing and Midwifery Training College, Gushegu, Ghana.
| | - Gholamreza Garmaroudi
- Department of Health Education And Promotion, School of Public Health Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Sadeghi
- Department of Health Education And Promotion, School of Public Health Tehran University of Medical Sciences, Tehran, Iran
| | - Azar Tol
- Department of Health Education And Promotion, School of Public Health Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health Tehran University of Medical Sciences, Tehran, Iran
| | - Adadow Yidana
- Department of Community Health and Family Medicine, School of Medicine, University for Development Studies, Tamale, Ghana
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Lassi ZS, Kedzior SG, Das JK, Bhutta ZA. PROTOCOL: Effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low‐ and middle‐income countries: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1007. [PMCID: PMC6988117 DOI: 10.1002/cl2.1007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Zohra S. Lassi
- Robinson Research Institute, Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Sophie G.E. Kedzior
- Robinson Research Institute, Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Jai K. Das
- Department of PediatricsAga Khan UniversityKarachiSindhPakistan
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Young H, Turney C, White J, Lewis R, Bonell C. Formative mixed-method multicase study research to inform the development of a safer sex and healthy relationships intervention in further education (FE) settings: the SaFE Project. BMJ Open 2019; 9:e024692. [PMID: 31289053 PMCID: PMC6629453 DOI: 10.1136/bmjopen-2018-024692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 03/06/2019] [Accepted: 06/12/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Sexual health includes pleasurable, safe, sexual experiences free from coercion, discrimination and violence. In the UK, many young people's experiences fall short of this definition. This study aimed to inform the development of a safer sex and healthy relationships intervention for those aged 16-19 years studying in further education (FE) settings. DESIGN A formative mixed-method multicase study explored if and how to implement four components within a single intervention. SETTING Six FE settings in England and Wales and one sexual health charity participated between October and July 2015. PARTICIPANTS Focus groups with 134 FE students and 44 FE staff, and interviews with 11 FE managers and 12 sexual health charity staff, first explored whether four candidate intervention components were acceptable and could have sustained implementation. An e-survey with 2105 students and 163 staff then examined potential uptake and acceptability of components shortlisted in the first stage. Stakeholder consultation was then used to refine the intervention. INTERVENTION Informed by a review of evidence of effective interventions delivered in other settings, four candidate intervention components were identified which could promote safer sex and healthy relationships among those aged 16-19 years: 1) student-led sexual health action groups; 2) on-site sexual health and relationships services; 3) staff safeguarding training about sexual health and relationships and 4) sex and relationships education. RESULTS On-site sexual health and relationships services and staff safeguarding training about sexual health and relationships were key gaps in current FE provision and welcomed by staff, students and health professionals. Sex and relationships education and student-led sexual health action groups were not considered acceptable. CONCLUSIONS The SaFE intervention, comprising on-site sexual health and relationships services and staff safeguarding training in FE settings, may have potential promoting sexual health among FE students. Further optimisation and refinement with key stakeholders is required before piloting via cluster randomised controlled trial.
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Affiliation(s)
- Honor Young
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Catherine Turney
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - James White
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
| | - Ruth Lewis
- Institute of Health and Wellbeing, MRC Social and Public Health Sciences Unit, Glasgow, UK
| | - Christopher Bonell
- London School of Hygiene and Tropical Medicine, Public Health and Policy, London, UK
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Muchabaiwa L, Mbonigaba J. Impact of the adolescent and youth sexual and reproductive health strategy on service utilisation and health outcomes in Zimbabwe. PLoS One 2019; 14:e0218588. [PMID: 31237891 PMCID: PMC6592535 DOI: 10.1371/journal.pone.0218588] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 06/06/2019] [Indexed: 11/18/2022] Open
Abstract
Poor reproductive health among youth and adolescents threatens their future health and economic wellbeing in Zimbabwe amidst a high HIV/AIDS prevalence. This study evaluates the impact of a multi-pronged adolescent sexual and reproductive health (ASRH) strategy implemented by government of Zimbabwe between 2010 and 2015 to improve ASRH in terms of the uptake of condoms and HIV testing as well as outcomes in terms of sexually transmitted infection (STI) prevalence and HIV prevalence. We combine the difference in difference and propensity score matching methods to analyse repeated Zimbabwe demographic health survey cross-sectional datasets. Young people aged 15–19 years at baseline in 2010, who were exposed for the entire five-year strategy are designated as the treatment group and young adults aged 25–29 at baseline as the control. We find that the ASRH strategy increased HIV testing amongst youth by 36.6 percent, whilst treatment of STIs also increased by 30.4 percent. We also find that the HIV prevalence trajectory was reduced by 0.7 percent. We do not find evidence of impact on condom use and STI prevalence. The findings also suggest that although HIV testing increased for all socio-economic groups that were investigated, the effect was not the same. Lastly, we do not find evidence supporting that more resources translate to better ASRH outcomes. We recommend designing future ASRH strategies in a way that differentiates service delivery for youths in HIV hotspots, rural areas and out of school. We also recommend improving the strategy’s coordination and monitoring, as well as aligning and enforcing government policies that promote sexual and reproductive health rights.
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Affiliation(s)
- Lazarus Muchabaiwa
- Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
- Economics Department, Bindura University of Science Education, Bindura, Zimbabwe
- * E-mail:
| | - Josue Mbonigaba
- Economics Department, School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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23
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Mirzazadeh A, Biggs MA, Viitanen A, Horvath H, Wang LY, Dunville R, Barrios LC, Kahn JG, Marseille E. Do School-Based Programs Prevent HIV and Other Sexually Transmitted Infections in Adolescents? A Systematic Review and Meta-analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:490-506. [PMID: 28786046 DOI: 10.1007/s11121-017-0830-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We systematically reviewed the literature to assess the effectiveness of school-based programs to prevent HIV and other sexually transmitted infections (STI) among adolescents in the USA. We searched six databases including PubMed for studies published through May 2017. Eligible studies included youth ages 10-19 years and assessed any school-based programs in the USA that reported changes in HIV/STI incidence or testing. We used Cochrane tool to assess the risk of bias and GRADE to determine the evidence quality for each outcome. Three RCTs and six non-RCTs, describing seven interventions, met study inclusion criteria. No study reported changes in HIV incidence or prevalence. One comprehensive intervention, assessed in a non-RCT and delivered to pre-teens, reduced STI incidence into adulthood (RR 0.36, 95% CI 0.23-0.56). A non-RCT examining chlamydia and gonorrhea incidence before and after a condom availability program found a significant effect at the city level among young men 3 years later (RR 0.43, 95% CI 0.23-0.80). The remaining four interventions found no effect. The effect on STI prevalence was also not significant (pooled RR 0.83 from two non-RCTs, RR 0.70 from one RCT). Only one non-RCT showed an increase in HIV testing (RR 3.19, 95% CI 1.24-8.24). The quality of evidence for all outcomes was very low. Studies, including the RCTs, were of low methodological quality and had mixed findings, thus offering no persuasive evidence for the effectiveness of school-based programs. The most effective intervention spanned 6 years, was a social development-based intervention with multiple components, rather than a sex education program, and started in first grade.
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Affiliation(s)
- Ali Mirzazadeh
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. .,Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | - M Antonia Biggs
- Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
| | - Amanda Viitanen
- Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Hacsi Horvath
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Li Yan Wang
- Division of Adolescent and School Health, U.S. Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, 30329, USA
| | - Richard Dunville
- Division of Adolescent and School Health, U.S. Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, 30329, USA
| | - Lisa C Barrios
- Division of Adolescent and School Health, U.S. Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, 30329, USA
| | - James G Kahn
- Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,Global Health Economics Consortium, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
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Lohan M, Aventin Á, Clarke M, Curran RM, Maguire L, Hunter R, McDowell C, McDaid L, Young H, White J, Fletcher A, French R, Bonell C, Bailey JV, O'Hare L. JACK trial protocol: a phase III multicentre cluster randomised controlled trial of a school-based relationship and sexuality education intervention focusing on young male perspectives. BMJ Open 2018; 8:e022128. [PMID: 30056390 PMCID: PMC6067362 DOI: 10.1136/bmjopen-2018-022128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/04/2018] [Accepted: 06/06/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Teenage pregnancy remains a worldwide health concern which is an outcome of, and contributor to, health inequalities. The need for gender-aware interventions with a focus on males in addressing teenage pregnancy has been highlighted as a global health need by WHO and identified in systematic reviews of (relationship and sexuality education (RSE)). This study aims to test the effectiveness of an interactive film-based RSE intervention, which draws explicit attention to the role of males in preventing an unintended pregnancy by reducing unprotected heterosexual teenage sex among males and females under age 16 years. METHODS AND ANALYSIS A phase III cluster randomised trial with embedded process and economic evaluations. If I Were Jack encompasses a culturally sensitive interactive film, classroom materials, a teacher-trainer session and parent animations and will be delivered to replace some of the usual RSE for the target age group in schools in the intervention group. Schools in the control group will not receive the intervention and will continue with usual RSE. Participants will not be blinded to allocation. Schools are the unit of randomisation stratified per country and socioeconomic status. We aim to recruit 66 UK schools (24 in Northern Ireland; 14 in each of England, Scotland and Wales), including approximately 7900 pupils. A questionnaire will be administered at baseline and at 12-14 months postintervention. The primary outcome is reported unprotected sex, a surrogate measure associated with unintended teenage pregnancy. Secondary outcomes include knowledge, attitudes, skills and intentions relating to avoiding teenage pregnancy in addition to frequency of engagement in sexual intercourse, contraception use and diagnosis of sexually transmitted infections. ETHICS AND DISSEMINATION Ethical approval was obtained from Queen's University Belfast. Results will be published in peer-reviewed journals and disseminated to stakeholders. Funding is from the National Institute for Health Research. TRIAL REGISTRATION NUMBER ISRCTN99459996.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Rhonda M Curran
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Lisa Maguire
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, London, UK
| | | | - Lisa McDaid
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Honor Young
- The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - James White
- The Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | | | - Rebecca French
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Christopher Bonell
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Julia V Bailey
- Department of Primary Care and Population Health, University College London
| | - Liam O'Hare
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, UK
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Shahraki-Sanavi F, Rakhshani F, Ansari-Moghaddam A, Mohammadi M, Feizabad AK. Prevalence of health-risk behaviors among teen girls in Southeastern Iran. Electron Physician 2018; 10:6988-6996. [PMID: 30034668 PMCID: PMC6049972 DOI: 10.19082/6988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 09/26/2017] [Indexed: 12/02/2022] Open
Abstract
Background Investigating female adolescents’ health status is essential because of their two-fold role within the health of the community and the impending generations’ health. Objective The present study aimed to determine the prevalence of health-risk behaviors among teen girls in Southeastern Iran. Methods This cross-sectional study was carried out on a sample of 457 tenth grade female adolescents in four public high schools in Zahedan in Southeastern Iran, in 2015. First, high schools were randomly selected; then, all students in Grade 10 were enrolled in the study through a census. Data were collected using a self-reported questionnaire of the health-risk behaviors with the content validity ratio (CVR) of 0.80, the content validity index (CVI) of 0.88 and Cronbach’s α score of 0.71. The Results were analyzed using ANOVA test with SPSS-15. Results The highest prevalence rate of health-risk behaviors of students included: failing to drink natural fruit juice (53.1%), failing to wear a seat belt (43.0%), sitting in a car while the driver is sending message or emails (43.0%), failing to drink milk daily (36.0%), lack of minimum daily physical activity 37.0%, and watching TV more than 3 hours a day (35.0%). On average, the number of health-risk behaviors among under study students was 1.47. Additionally, the ANOVA showed a statistically significant difference in the average number of health-risk behaviors of adolescents in families with high economic status, those who never talked with their parents or those who had physical relations with the opposite sex (p<0.001). Conclusion It is suggested that attention be paid to emphasizing the pattern of healthy eating, increasing physical activity, and reducing unsafe behaviors in adolescents; moreover, behavioral consultation should be given regarding relationships with the opposite sex. Furthermore, more attention must be paid to the familiar behavior patterns and the relationships in school health programs.
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Affiliation(s)
- Fariba Shahraki-Sanavi
- PhD Student of Health Education & Promotion, Health Promotion Research Center, Public Health Department, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Fatemeh Rakhshani
- Professor of Health Education, Safety Promotion and Injury Prevention Research Center (SPIPRC), School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Ansari-Moghaddam
- Professor of Epidemiology, Health Promotion Research Center, Epidemiology & Biostatistics Department, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mahdi Mohammadi
- Associate Professor of Statistic, Health Promotion Research Center, Epidemiology & Biostatistics Department, Zahedan University of Medical Sciences, Zahedan, Iran
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Young H, Long SJ, Hallingberg B, Fletcher A, Hewitt G, Murphy S, Moore GF. School practices important for students' sexual health: analysis of the school health research network survey in Wales. Eur J Public Health 2018; 28:309-314. [PMID: 29161403 DOI: 10.1093/eurpub/ckx203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background This study investigates how the sexual health outcomes of a representative sample of students aged 15-16 in Wales vary according to the person delivering Sex and Relationships Education (SRE) in schools, students' access to on-site sexual health services and access to free condoms. Methods Cross-sectional, self-report survey data were collected from students who participated in the 2015/16 School Health Research Network questionnaire in Wales. Data were analyzed from 59 schools, totalling 3781 students aged 15-16 (M = 15.7; SD = 0.3) who responded to questions about ever having had sex; age of sexual initiation and condom use at last intercourse. School level data were also collected, examining who delivers school SRE, provision of on-site, school 'drop-in' sexual health services and provision of free condoms for students. Binary and linear multi-level analyses explored the relationship between school level predictors and sexual health outcomes. Results Compared to teachers, other modes of SRE delivery were associated with better sexual health outcomes, including remaining sexually inactive, later age of first intercourse and condom use. Providing on-site sexual health services did not significantly reduce the odds of having ever had sex or delaying first intercourse; but was associated with increased condom use. On-site condom provision was associated with lower condom use. Conclusions SRE delivery by educators other than teachers is optimum to young people's sexual health outcomes. Further funding and coordination of on-site sexual health advice services are required. Longitudinal research is needed to identify the temporal sequence of sexual health practices and outcomes.
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Affiliation(s)
- Honor Young
- Department of Social Sciences, DECIPHer, UKCRC Centre of Excellence, Cardiff University, Cardiff, UK
| | - Sara Jayne Long
- Department of Social Sciences, DECIPHer, UKCRC Centre of Excellence, Cardiff University, Cardiff, UK
| | - Britt Hallingberg
- Department of Social Sciences, DECIPHer, UKCRC Centre of Excellence, Cardiff University, Cardiff, UK
| | - Adam Fletcher
- Department of Social Sciences, Y Lab, Cardiff University, Cardiff, UK
| | - Gillian Hewitt
- Department of Social Sciences, DECIPHer, UKCRC Centre of Excellence, Cardiff University, Cardiff, UK
| | - Simon Murphy
- Department of Social Sciences, DECIPHer, UKCRC Centre of Excellence, Cardiff University, Cardiff, UK
| | - Graham F Moore
- Department of Social Sciences, DECIPHer, UKCRC Centre of Excellence, Cardiff University, Cardiff, UK
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Chimah UC, Lawoyin TO, Ilika AL, Nnebue CC. Contraceptive knowledge and practice among senior secondary schools students in military barracks in Nigeria. Niger J Clin Pract 2018; 19:182-8. [PMID: 26856278 DOI: 10.4103/1119-3077.175970] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Many adolescents lack adequate health education coupled with low contraceptive use. As a result of this, they may experience the negative health consequences of early, unprotected sexual activity as well as its social and economic implications. OBJECTIVE To determine the level of knowledge of contraceptives and its use among senior secondary schools students in Ojo military barracks, Lagos. METHODOLOGY A cross-sectional study of 400 senior secondary schools students in Ojo military barracks, Lagos, selected using the multistage sampling technique was done. Data were collected using pretested, self-administered structured questionnaires. The data were analyzed using Statistical Package for Social Sciences version 17 (International Business Machine USA). Tests for statistical significance were carried out using Chi-square tests for proportions. P < 0.05 was considered significant. RESULTS The response rate was 100%. Majority of them 391 (97.8%), were in the adolescent age group (10-19 years). The mean age was 15 ± 2.4 for males and 15 ± 2.2 for the females. Two hundred and seventy (67.5%) of them had correct knowledge of the use of condoms while 48 (31.1%) of the sexually active respondents have ever used any form of contraceptive with no statistically significant difference between the male and female respondents (P = 0.338). The most common barrier to contraceptive methods as reported by 131 (85.1%) of respondents was their being too embarrassed to source for the commodities. CONCLUSIONS There was a fairly high level of knowledge and relatively low use of contraceptives. We recommend that efforts should be intensified to promote the safe sexual practice and contraceptive use in this age group.
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Affiliation(s)
| | | | | | - C C Nnebue
- Department of HIV Care; Department of Community Medicine, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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Bowring AL, Wright CJC, Douglass C, Gold J, Lim MSC. Features of successful sexual health promotion programs for young people: findings from a review of systematic reviews. Health Promot J Austr 2018; 29:46-57. [PMID: 29700941 DOI: 10.1002/hpja.3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/22/2017] [Indexed: 11/11/2022] Open
Abstract
ISSUE ADDRESSED Young people have a high burden of sexual and reproductive health (SRH) problems, and it is important to reach this group through health promotion initiatives. We conducted a systematic review of reviews to identify successful elements of health promotion programs for improving SRH of young people. METHODS We identified and collated systematic reviews published in 2005-2015 which focused on young people (10-24 years), reported on SRH outcomes (pregnancy, sexually transmissible infections, condoms/contraceptive use, risky sexual behaviour, sexual healthcare access or intimate partner violence), and included primary studies predominantly conducted in high-income countries. This report focuses on features of successful SRH programs identified in the interpretation and discussion of included systematic reviews. RESULTS We identified 66 systematic reviews, of which 37 reported on program features which were anecdotally or statistically associated with improved program effectiveness and success. Common features of effective interventions were: longer term or repeated implementation; multi-setting and multi-component; parental involvement; culturally/gender/age appropriate; and inclusion of skills-building. SO WHAT?: There is marked consistency of features improving SRH program effectiveness for young people despite the wide variation in interventions reviewed. There is a need to better implement this knowledge in future programs, and our findings provide useful guidance for optimising the design of SRH interventions for young people.
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Affiliation(s)
| | - Cassandra J C Wright
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Caitlin Douglass
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Judy Gold
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Megan S C Lim
- Burnet Institute, Melbourne, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Tancred T, Fletcher A, Melendez-Torres GJ, Thomas J, Campbell R, Bonell C. Integrating Health Education in Academic Lessons: Is This the Future of Health Education in Schools? THE JOURNAL OF SCHOOL HEALTH 2017; 87:807-810. [PMID: 29023837 DOI: 10.1111/josh.12554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 02/21/2017] [Accepted: 02/23/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Tara Tancred
- London School of Hygiene and Tropical Medicine, 219, 15-17 Tavistock Place, London WC1H 9SH, UK
| | - Adam Fletcher
- Cardiff University, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, CF10 3WT, UK
| | | | - James Thomas
- UCL Institute of Education, 18 Woburn Square, London WC1H 0NR, UK
| | - Rona Campbell
- School of Social and Community Medicine, University of Bristol, Office 4.06, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Chris Bonell
- London School of Hygiene and Tropical Medicine, 218, 15-17 Tavistock Place, London WC1H 9SH, UK
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Whitaker R, Hendry M, Aslam R, Booth A, Carter B, Charles JM, Craine N, Tudor Edwards R, Noyes J, Ives Ntambwe L, Pasterfield D, Rycroft-Malone J, Williams N. Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement. Health Technol Assess 2016; 20:1-214. [PMID: 26931051 DOI: 10.3310/hta20160] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The UK has one of the highest rates of teenage pregnancies in Western Europe. One-fifth of these are repeat pregnancies. Unintended conceptions can cause substantial emotional, psychological and educational harm to teenagers, often with enduring implications for life chances. Babies of teenage mothers have increased mortality and are at a significantly increased risk of poverty, educational underachievement and unemployment later in life, with associated costs to society. It is important to identify effective, cost-effective and acceptable interventions. OBJECTIVES To identify who is at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what the barriers to and facilitators of the uptake of these interventions are. DATA SOURCES We conducted a multistreamed, mixed-methods systematic review informed by service user and provider consultation to examine worldwide peer-reviewed evidence and UK-generated grey literature to find and evaluate interventions to reduce repeat unintended teenage pregnancies. We searched the following electronic databases: MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database), EMBASE (Excerpta Medica database), British Nursing Index, Educational Resources Information Center, Sociological Abstracts, Applied Social Sciences Index and Abstracts, BiblioMap (the Evidence for Policy and Practice Information and Co-ordinating Centre register of health promotion and public health research), Social Sciences Citation Index (supported by Web of Knowledge), Research Papers in Economics, EconLit (American Economic Association's electronic bibliography), OpenGrey, Scopus, Scirus, Social Care Online, National Research Register, National Institute for Health Research Clinical Research Network Portfolio and Index to THESES. Searches were conducted in May 2013 and updated in June 2014. In addition, we conducted a systematic search of Google (Google Inc., Mountain View, CA, USA) in January 2014. Database searches were guided by an advisory group of stakeholders. REVIEW METHODS To address the topic's complexities, we used a structured, innovative and iterative approach combining methods tailored to each evidence stream. Quantitative data (effectiveness, cost-effectiveness, risk factors and effect modifiers) were synthesised with reference to Cochrane guidelines for evaluating evidence on public health interventions. Qualitative evidence addressing facilitators of and barriers to the uptake of interventions, experience and acceptability of interventions was synthesised thematically. We applied the principles of realist synthesis to uncover theories and mechanisms underpinning interventions (what works, for whom and in what context). Finally, we conducted an overarching narrative of synthesis of evidence and gathered service user feedback. RESULTS We identified 8664 documents initially, and 816 in repeat searches. We filtered these to 12 randomised controlled trials (RCTs), four quasi-RCTs, 10 qualitative studies and 53 other quantitative studies published between 1996 and 2012. None of the RCTs was based in the UK. The RCTs evaluated an emergency contraception programme and psychosocial interventions. We found no evidence for effectiveness with regard to condom use, contraceptive use or rates of unprotected sex or use of birth control. Our primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control goup, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78 to 1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with a RR of 0.60 (95% CI 0.39 to 0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations, and negligible opportunities. Service user feedback suggested that there were specific motivations for many repeat conceptions, for example to replace loss or to please a partner. Realist synthesis highlighted that context, motivation, planning for the future and letting young women take control with connectedness and tailoring provide a conceptual framework for future research. LIMITATIONS Included studies rarely characterised adolescent pregnancy as intended or unintended, that is interventions to reduce repeat conceptions rarely addressed whether or not pregnancies were intended. Furthermore, interventions were often not clearly defined, had multiple aims and did not indicate which elements were intended to address which aims. Nearly all of the studies were conducted in the USA and focused largely on African American or Hispanic and Latina American populations. CONCLUSIONS We found no evidence to indicate that existing interventions to reduce repeat teenage pregnancy were effective; however, subsequent births were reduced by home-based interventions. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce repeat teenage pregnancy in the UK. STUDY REGISTRATION This study is registered as PROSPERO CRD42012003168. Cochrane registration number: i=fertility/0068. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Maggie Hendry
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Rabeea'h Aslam
- Liverpool Review and Implementation Group, University of Liverpool, Liverpool, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ben Carter
- Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | - Joanna M Charles
- Centre for Health Economics and Medicines Evaluation, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Noel Craine
- Microbiology Department, Public Health Wales, Ysbyty Gwynedd, Bangor, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, UK
| | | | - Diana Pasterfield
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | | | - Nefyn Williams
- North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK.,North Wales Organisation for Randomised Trials in Health (& Social Care), School of Healthcare Sciences, Bangor University, Bangor, UK
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Denford S, Abraham C, Campbell R, Busse H. A comprehensive review of reviews of school-based interventions to improve sexual-health. Health Psychol Rev 2016; 11:33-52. [PMID: 27677440 DOI: 10.1080/17437199.2016.1240625] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To systematically review systematic reviews of school-based sexual-health and relationship Education (SHRE) programmes and, thereby, identify interventions and intervention components that promote reductions in risky sexual behaviour among young people. METHODS Electronic bibliographies were searched systematically to identify systematic reviews of school-based interventions targeting sexual-health. Results were summarised using a narrative synthesis. RESULTS Thirty-seven systematic reviews (summarising 224 primary randomised controlled trials) met our inclusion and quality assessment criteria. In general, these reviews analysed distinct sets of primary studies, and no comprehensive review of available primary studies was identified. Interventions were categorised into five types that segment this review literature. Unfortunately, many reviews reported weak and inconsistent evidence of behaviour change. Nonetheless, integration of review findings generated a list of 32 design, content and implementation characteristics that may enhance effectiveness of school-based, sexual-health interventions. Abstinence-only interventions were found to be ineffective in promoting positive changes in sexual behaviour. By contrast, comprehensive interventions, those specifically targeting HIV prevention, and school-based clinics were found to be effective in improving knowledge and changing attitudes, behaviours and health-relevant outcomes. CONCLUSIONS School-based interventions targeting risky sexual behaviour can be effective. Particular design, content and implementation characteristics appear to be associated with greater effectiveness. We recommend consideration of these characteristics by designers of school-based sexual-health interventions.
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Affiliation(s)
- Sarah Denford
- a Psychology Applied to Health Group, Institute of Health Research , University of Exeter Medical School , Exeter , UK
| | - Charles Abraham
- a Psychology Applied to Health Group, Institute of Health Research , University of Exeter Medical School , Exeter , UK
| | - Rona Campbell
- b School of Social and Community Medicine , University of Bristol , Bristol , UK
| | - Heide Busse
- b School of Social and Community Medicine , University of Bristol , Bristol , UK
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Berglund A, Lindmark G. Preconception health and care (PHC)-a strategy for improved maternal and child health. Ups J Med Sci 2016; 121:216-221. [PMID: 27320774 PMCID: PMC5098484 DOI: 10.1080/03009734.2016.1191564] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/11/2016] [Accepted: 05/16/2016] [Indexed: 11/06/2022] Open
Abstract
Maternal health status before pregnancy is a decisive factor for pregnancy outcomes and for risk for maternal and infant complications. Still, maternity care does not start until the pregnancy is established and in most low-income settings not until more than half of the pregnancy has passed, which often is too late to impact outcomes. In Western societies preconception care (PCC) is widely recognized as a way to optimize women's health through biomedical and behavioural changes prior to conception with the aim of improving pregnancy outcomes. But the content of PCC is inconsistent and limited to single interventions or preconception counselling to women with chronic illnesses. It has been suggested that PCC should be extended to preconception health and care (PHC), including interventions prior to pregnancy in order to optimize women's health in general, and thereby subsequent pregnancy outcomes, the well-being of the family, and the health of the future child. With this definition, almost every activity that can improve the health of girls and women can be included in the concept. In the World Health Report of 2005 a longitudinal approach to women's wellness and reproductive health was highlighted, and the World Health Organization has proposed a more comprehensive maternal and child health care, also including psychosocial issues and intimate partner violence. The present article gives an overview of the recent literature and discusses contents and delivery of PCC/PHC in Western as well as low-income countries. The article puts special emphasis on why violence against women is an issue for PHC.
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Affiliation(s)
- Anna Berglund
- National Centre for Knowledge on Men’s Violence against Women, Uppsala University, Uppsala, Sweden
| | - Gunilla Lindmark
- International Maternal and Child Health, Uppsala University, Uppsala, Sweden
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Salam RA, Faqqah A, Sajjad N, Lassi ZS, Das JK, Kaufman M, Bhutta ZA. Improving Adolescent Sexual and Reproductive Health: A Systematic Review of Potential Interventions. J Adolesc Health 2016; 59:S11-S28. [PMID: 27664592 PMCID: PMC5026684 DOI: 10.1016/j.jadohealth.2016.05.022] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/14/2016] [Accepted: 06/24/2016] [Indexed: 01/08/2023]
Abstract
Adolescents have special sexual and reproductive health needs (whether or not they are sexually active or married). This review assesses the impact of interventions to improve adolescent sexual and reproductive health (including the interventions to prevent female genital mutilation/cutting [FGM/C]) and to prevent intimate violence. Our review findings suggest that sexual and reproductive health education, counseling, and contraceptive provision are effective in increasing sexual knowledge, contraceptive use, and decreasing adolescent pregnancy. Among interventions to prevent FGM/C, community mobilization and female empowerment strategies have the potential to raise awareness of the adverse health consequences of FGM/C and reduce its prevalence; however, there is a need to conduct methodologically rigorous intervention evaluations. There was limited and inconclusive evidence for the effectiveness of interventions to prevent intimate partner violence. Further studies with rigorous designs, longer term follow-up, and standardized and validated measurement instruments are required to maximize comparability of results. Future efforts should be directed toward scaling-up evidence-based interventions to improve adolescent sexual and reproductive health in low- and middle-income countries, sustain the impacts over time, and ensure equitable outcomes.
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Affiliation(s)
- Rehana A Salam
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anadil Faqqah
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Nida Sajjad
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zohra S Lassi
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Miriam Kaufman
- Division of Adolescent Medicine, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan.
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Charles JM, Rycroft-Malone J, Aslam R, Hendry M, Pasterfield D, Whitaker R. Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances. BMC Pregnancy Childbirth 2016; 16:271. [PMID: 27644695 PMCID: PMC5029024 DOI: 10.1186/s12884-016-1066-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has demonstrated emotional, psychological and educational harm to young mothers following unintended conceptions. The UK has one of the highest rates of pregnancies in adolescence in Western Europe with a high proportion of these being repeat pregnancies, making it a topic of interest for public health policy makers, and health and social care practitioners. As part of a wider mixed-methods systematic review, realist principles were applied to synthesise evidence about interventions aiming to reduce repeat pregnancies in adolescence. METHODS A multi-streamed, mixed-methods systematic review was conducted searching 11 major electronic databases and 9 additional databases from 1995 onwards, using key terms such as pregnancy, teen or adolescent. The principles of realist synthesis were applied to all included literature to uncover theories about what works, for whom, how and in what context. Initial theory areas were developed through evidence scoping, group discussion by the authors and stakeholder engagement to uncover context + mechanism = outcome (CMO) configurations and related narratives. RESULTS The searches identified 8,664 documents initially, and 403 in repeat searches, filtering to 81 included studies, including qualitative studies, randomised controlled trials, quantitative studies and grey literature. Three CMO configurations were developed. The individual experiences of young mothers' triggered self-efficacy, notions of perceived risks, susceptibility and benefits of pregnancy, resulting in the adolescent taking control of their fertility and sexual encounters. The choice between motherhood and other goals triggered notions of motivations, resulting in the adolescent managing their expectations of motherhood and controlling their fertility and sexual encounters. Barriers and facilitators to accessing services triggered notions of connectedness and self-determination; resulting in interventions that are tailored so they are relevant to young persons, and improve access to services and engagement with the issue of pregnancy in adolescence. CONCLUSIONS Pregnancy in adolescence is a complex issue with many factors to consider. The conceptual platform described here could help guide policy makers and professionals towards a number of areas that need to be attended to in order to increase the likelihood of an intervention working to prevent rapid repeat pregnancy in adolescence. TRIAL REGISTRATION PROSPERO CRD42012003168.
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Affiliation(s)
- Joanna M. Charles
- Centre for Health Economics & Medicines Evaluation, Ardudwy, Normal Site, Bangor University, Bangor, Gwynedd LL57 2PZ UK
| | - Jo Rycroft-Malone
- School of Healthcare Sciences, Fron Heulog, Bangor University, Bangor, Gwynedd LL57 2EF UK
| | - Rabeea’h Aslam
- Liverpool Review and Implementation Group, University of Liverpool, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Maggie Hendry
- North Wales Centre for Primary Care Research, Gwenfro Units 4-8, Wrexham Technology Park, Wrexham, UK
| | - Diana Pasterfield
- North Wales Centre for Primary Care Research, Gwenfro Units 4-8, Wrexham Technology Park, Wrexham, UK
| | - Rhiannon Whitaker
- Whitaker Research Ltd. Cae Ffos, Treborth Road, Bangor, Gwynedd LL57 2RJ UK
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Ngui EM, Greer DM, Bridgewater FD, Salm Ward TC, Cisler RA. Trends and Progress in Reducing Teen Birth Rates and the Persisting Challenge of Eliminating Racial/Ethnic Disparities. J Racial Ethn Health Disparities 2016; 4:615-622. [PMID: 27440119 DOI: 10.1007/s40615-016-0265-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/14/2016] [Accepted: 07/05/2016] [Indexed: 01/12/2023]
Abstract
PURPOSE We examined progress made by the Milwaukee community toward achieving the Milwaukee Teen Pregnancy Prevention Initiative's aggressive 2008 goal of reducing the teen birth rate to 30 live births/1000 females aged 15-17 years by 2015. We further examined differential teen birth rates in disparate racial and ethnic groups. METHOD We analyzed teen birth count data from the Wisconsin Interactive Statistics on Health system and demographic data from the US Census Bureau. We computed annual 2003-2014 teen birth rates for the city and four racial/ethnic groups within the city (white non-Hispanic, black non-Hispanic, Hispanic/Latina, Asian non-Hispanic). To compare birth rates from before (2003-2008) and after (2009-2014) goal setting, we used a single-system design to employ two time series analysis approaches, celeration line, and three standard deviation (3SD) bands. RESULTS Milwaukee's teen birth rate dropped 54 % from 54.3 in 2003 to 23.7 births/1000 females in 2014, surpassing the goal of 30 births/1000 females 3 years ahead of schedule. Rate reduction following goal setting was statistically significant, as five of the six post-goal data points were located below the celeration line and points for six consecutive years (2010-2014) fell below the 3SD band. All racial/ethnic groups demonstrated significant reductions through at least one of the two time series approaches. The gap between white and both black and Hispanic/Latina teens widened. CONCLUSION Significant reduction has occurred in the overall teen birth rate of Milwaukee. Achieving an aggressive reduction in teen births highlights the importance of collaborative community partnerships in setting and tracking public health goals.
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Affiliation(s)
- Emmanuel M Ngui
- Community and Behavioral Health Promotion, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, 1240 N. 10th Street, Milwaukee, 53201-0413, WI, USA. .,Center for Urban Population Health, Milwaukee, WI, USA.
| | - Danielle M Greer
- Center for Urban Population Health, Milwaukee, WI, USA.,Aurora Health Care, Inc., Milwaukee, WI, USA
| | - Farrin D Bridgewater
- Center for Urban Population Health, Milwaukee, WI, USA.,College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, USA
| | - Trina C Salm Ward
- Center for Urban Population Health, Milwaukee, WI, USA.,Health Promotion & Behavior, College of Public Health, The University of Georgia, Athens, GA, USA
| | - Ron A Cisler
- Community and Behavioral Health Promotion, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, 1240 N. 10th Street, Milwaukee, 53201-0413, WI, USA.,Center for Urban Population Health, Milwaukee, WI, USA.,Aurora Health Care, Inc., Milwaukee, WI, USA.,College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, USA.,School of Medicine and Public Health, University of Wisconsin, Madison, USA
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Berghs M, Atkin K, Graham H, Hatton C, Thomas C. Implications for public health research of models and theories of disability: a scoping study and evidence synthesis. PUBLIC HEALTH RESEARCH 2016. [DOI: 10.3310/phr04080] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BackgroundPublic health interventions that are effective in the general population are often assumed to apply to people with impairments. However, the evidence to support this is limited and hence there is a need for public health research to take a more explicit account of disability and the perspectives of people with impairments.Objectives(1) To examine the literature on theories and models of disability; (2) to assess whether or not, and how, intervention studies of effectiveness could incorporate more inclusive approaches that are consistent with these theories and models; and (3) to use the findings to draw out implications for improving evaluative study designs and evidence-based practice.Review methodsThe project is a scoping review of the literature. The first stage examines theories and models of disability and reflects on possible connections between theories of disability and public health paradigms. This discussion is used to develop an ethical–empirical decision aid/checklist, informed by a human rights approach to disability and ecological approaches to public health. We apply this decision aid in the second stage of the review to evaluate the extent to which the 30 generic public health reviews of interventions and the 30 disability-specific public health interventions include the diverse experiences of disability. Five deliberation panels were also organised to further refine the decision aid: one with health-care professionals and four with politically and socially active disabled people.ResultsThe evidence from the review indicated that there has been limited public health engagement with theories and models of disability. Outcome measures were often insensitive to the experiences of disability. Even when disabled people were included, studies rarely engaged with their experiences in any meaningful way. More inclusive research should reflect how people live and ‘flourish’ with disability.LimitationsThe scoping review provides a broad appraisal of a particular field. It generates ideas for future practice rather than a definite framework for action.ConclusionsOur ethical–empirical decision aid offers a critical framework with which to evaluate current research practice. It also offers a resource for promoting more ethical and evidence-based public health research that is methodologically robust while being sensitive to the experiences of disability.Future workDeveloping more inclusive research and interventions that avoid conceptualising disability as either a ‘burden’ or ‘problem’ is an important starting point. This includes exploring ways of refining and validating current common outcome measures to ensure that they capture a diverse range of disabling experiences, as well as generating evidence on meaningful ways of engaging a broad range of disabled children and adults in the research process.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Maria Berghs
- Department of Health Sciences, University of York, York, UK
| | - Karl Atkin
- Department of Health Sciences, University of York, York, UK
| | - Hilary Graham
- Department of Health Sciences, University of York, York, UK
| | - Chris Hatton
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
| | - Carol Thomas
- Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK
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Lopez LM, Grey TW, Tolley EE, Chen M. Brief educational strategies for improving contraception use in young people. Cochrane Database Syst Rev 2016; 3:CD012025. [PMID: 27027480 PMCID: PMC7081122 DOI: 10.1002/14651858.cd012025.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Global high rates of unplanned pregnancy and abortion among young women demonstrate the need for increased access to modern contraceptive services. In sub-Saharan Africa, the birth rate for those aged 15 to 19 years is 121 per 1000. In the USA, 6% of teens aged 15 to 19 years became pregnant in 2010. Most pregnancies among young women to age 25 are unintended. OBJECTIVES The aim was to identify brief educational interventions for improving contraceptive use among young people that are feasible for implementing in a clinic or similar setting with limited resources. SEARCH METHODS To 7 March 2016, we searched for studies in CENTRAL, PubMed, POPLINE, Web of Science, ClinicalTrials.gov and ICTRP. SELECTION CRITERIA We considered randomized controlled trials (RCTs) that assigned individuals or clusters as well as non-randomized studies (NRS). We included young people to age 25.The intervention had to be sufficiently brief for a clinic, i.e. one to three sessions of 15 to 60 minutes plus potential follow-up. The strategy had to emphasize one or more effective methods of contraception. Primary outcomes were pregnancy and contraceptive use. DATA COLLECTION AND ANALYSIS We assessed titles and abstracts identified during the searches. One author extracted and entered the data into Review Manager; a second author verified accuracy. We examined studies for methodological quality.For dichotomous outcomes, we calculated the Mantel-Haenszel odds ratio (OR) with 95% confidence interval (CI). For continuous variables, we computed the mean difference (MD) with 95% CI. We used adjusted measures for cluster RCTs, typically ORs, that the investigators reported. For NRS, which need to control for confounding, we also used reported adjusted measures. We did not conduct meta-analysis due to varied interventions and outcome measures. MAIN RESULTS We found 11 studies, published from 1983 to 2015, that included a total of 8338 participants. Ten were from the USA and one was from China. We focused here on intervention effects for our primary outcomes. Five studies showed some effect on contraceptive use. Of three RCTs that examined innovative counseling, one showed an intervention effect. At one year, adolescents with developmental counseling were more likely to use contraception effectively than those with standard counseling (OR 48.38, 95% CI 5.96 to 392.63).Three studies used an audiovisual tool plus counseling; two reported some effect on contraceptive use. An NRS with young men, aged 15 to 18, examined a slide-tape presentation plus reproductive health consultation. At one year, the intervention group was more likely than the standard-care group to report using an effective contraceptive and having a partner who used oral contraceptives (OCs), both at last intercourse (reported adjusted OR 1.51 and 1.66, respectively). Another study utilized a computer program for contraceptive decision-making plus standard counseling for women to age 20. At one year, fewer women in the intervention group at one site had not used OCs compared with the counseling-only group (3.4% versus 8.8%; reported P = 0.05).Three RCTs provided phone follow-up after counseling, one of which showed an effect on contraceptive use among women age 16 to 24. Women who received counseling plus phone calls to encourage contraceptive use were more likely than the counseling-only group to report consistent OC use at three months (OR 1.41, 95% CI 1.06 to 1.87) and six months (OR 1.39, 95% CI 1.03 to 1.87). Also at three months, they were more likely to report condom use at last sex (OR 1.45, 95% CI 1.03 to 2.03).Two cluster randomized trials trained providers on contraceptive methods and counseling. One trial with an intervention effect tested comprehensive contraceptive services for women to age 25, postabortion. At six months, the comprehensive-service group was more likely than the standard-care group to use an effective contraceptive (reported adjusted OR 2.03, 95% CI 1.04 to 3.98) and to use condoms consistently and correctly (reported adjusted OR 5.68, 95% CI 3.39 to 9.53). AUTHORS' CONCLUSIONS Few studies tested brief strategies for young people. We noted heterogeneity across studies in participants' ages and life situations. Of five studies with some effect, one provided moderate-quality evidence; four were older studies with low-quality evidence. More intensive strategies could be more effective, but would also be challenging for many clinics to implement.
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Affiliation(s)
- Laureen M Lopez
- FHI 360Clinical and Epidemiological Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Thomas W Grey
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Elizabeth E. Tolley
- FHI 360Social and Behavioral Health Sciences359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
| | - Mario Chen
- FHI 360Biostatistics359 Blackwell St, Suite 200DurhamNorth CarolinaUSA27701
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Cresswell JA, Schroeder R, Dennis M, Owolabi O, Vwalika B, Musheke M, Campbell O, Filippi V. Women's knowledge and attitudes surrounding abortion in Zambia: a cross-sectional survey across three provinces. BMJ Open 2016; 6:e010076. [PMID: 27000784 PMCID: PMC4809085 DOI: 10.1136/bmjopen-2015-010076] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES In Zambia, despite a relatively liberal legal framework, there remains a substantial burden of unsafe abortion. Many women do not use skilled providers in a well-equipped setting, even where these are available. The aim of this study was to describe women's knowledge of the law relating to abortion and attitudes towards abortion in Zambia. SETTING Community-based survey in Central, Copperbelt and Lusaka provinces. PARTICIPANTS 1484 women of reproductive age (15-44 years). PRIMARY AND SECONDARY OUTCOME MEASURES Correct knowledge of the legal grounds for abortion, attitudes towards abortion services and the previous abortions of friends, family or other confidants. Descriptive statistics and multivariable logistic regression were used to analyse how knowledge and attitudes varied according to sociodemographic characteristics. RESULTS Overall, just 16% (95% CI 11% to 21%) of women of reproductive age correctly identified the grounds for which abortion is legal. Only 40% (95% CI 32% to 45% of women of reproductive age knew that abortion was legally permitted in the extreme situation where the pregnancy threatens the life of the mother. Even in urban areas of Lusaka province, only 55% (95% CI 41% to 67%) of women knew that an abortion could legally take place to save the mother's life. Attitudes remain conservative. Women with correct knowledge of abortion law in Zambia tended to have more liberal attitudes towards abortion and access to safe abortion services. Neither correct knowledge of the law nor attitudes towards abortion were associated with knowing someone who previously had an induced abortion. CONCLUSIONS Poor knowledge and conservative attitudes are important obstacles to accessing safe abortion services. Changing knowledge and attitudes can be challenging for policymakers and public health practitioners alike. Zambia could draw on its previous experience in dealing with its large HIV epidemic to learn cross-cutting lessons in effective mass communication on what is a difficult and sensitive issue.
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Affiliation(s)
- Jenny A Cresswell
- MARCH Centre for Maternal, Adolescent, Reproductive and Child Health, LSHTM, London, UK
| | - Rosalyn Schroeder
- MARCH Centre for Maternal, Adolescent, Reproductive and Child Health, LSHTM, London, UK
- Bixby Center for Global Reproductive Health, University of California, San Francisco, California, USA
| | | | - Onikepe Owolabi
- MARCH Centre for Maternal, Adolescent, Reproductive and Child Health, LSHTM, London, UK
| | - Bellington Vwalika
- Department of Obstetrics and Gynaecology, University of Zambia School of Medicine, Lusaka, Zambia
| | | | - Oona Campbell
- MARCH Centre for Maternal, Adolescent, Reproductive and Child Health, LSHTM, London, UK
| | - Veronique Filippi
- MARCH Centre for Maternal, Adolescent, Reproductive and Child Health, LSHTM, London, UK
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Patel PR, Lee J, Hirth J, Berenson AB, Smith PB. Changes in the Use of Contraception at First Intercourse: A Comparison of the National Survey of Family Growth 1995 and 2006-2010 Databases. J Womens Health (Larchmt) 2016; 25:777-83. [PMID: 26919078 DOI: 10.1089/jwh.2015.5513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVE To determine trends in characteristics associated with contraceptive use at coitarche from 1995 to 2006-2010. METHODS The National Survey of Family Growth (NSFG) 1995 and 2006-2010 databases were used to abstract variables of interest. Generalized linear models (GLM) were applied to examine the association between the use of contraceptive methods at coitarche and variables abstracted for each database. RESULTS Of the 9599 women from the 1995 database included in this study, 3885 (40%) used contraception at coitarche in comparison to 4860 (82%) out of 5931 women assessed in 2006-2010. For both time periods, Hispanic women were significantly less likely to use contraception at coitarche when compared to White women. In the 1995 database, only women from families with incomes >$50,000 were more likely to use contraception at coitarche, while women from families with income > $20,000 were more likely to use contraception at coitarche in 2006-2010. There were some differences noted in the association between age at coitarche and contraception use at coitarche, but in general, women who had a higher age at coitarche were more likely to use contraception. For both time periods, women were more likely to use contraception at coitarche if they used barrier methods as their first form of contraception or if they obtained their first contraceptive method from a spouse, partner, or friend. CONCLUSIONS Our results suggest that access to contraception may be associated with use of a contraceptive method at coitarche. Innovative measures need to be investigated so that this young population has increased access to more reliable methods before their first sexual experience.
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Affiliation(s)
- Pooja R Patel
- 1 Department of Obstetrics and Gynecology, The University of Texas Medical Branch in Galveston , Galveston, Texas.,2 The Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch in Galveston , Galveston, Texas
| | - Jinhyung Lee
- 3 Department of Economics, Sungkyunkwan University , Seoul, Korea
| | - Jacqueline Hirth
- 1 Department of Obstetrics and Gynecology, The University of Texas Medical Branch in Galveston , Galveston, Texas.,2 The Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch in Galveston , Galveston, Texas
| | - Abbey B Berenson
- 1 Department of Obstetrics and Gynecology, The University of Texas Medical Branch in Galveston , Galveston, Texas.,2 The Center for Interdisciplinary Research in Women's Health, The University of Texas Medical Branch in Galveston , Galveston, Texas
| | - Peggy B Smith
- 4 Department of Obstetrics and Gynecology, Baylor College of Medicine , Houston, Texas
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Lopez LM, Grey TW, Tolley EE, Chen M. Brief educational strategies for improving contraception use in young people. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bayley JE, Brown KE. Translating group programmes into online formats: establishing the acceptability of a parents' sex and relationships communication serious game. BMC Public Health 2015; 15:1225. [PMID: 26651616 PMCID: PMC4674924 DOI: 10.1186/s12889-015-2545-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 11/30/2015] [Indexed: 12/03/2022] Open
Abstract
Background With ongoing concerns about the sexual health and wellbeing of young people, there is increasing need to innovate intervention approaches. Engaging parents as agents to support their children, alongside capitalising on increasingly sophisticated technological options could jointly enhance support. Converting existing programmes into interactive game based options has the potential to broaden learning access whilst preserving behaviour change technique fidelity. However the acceptability of this approach and viability of adapting resources in this way is yet to be established. This paper reports on the process of converting an existing group programme (“What Should We Tell the Children?”) and tests the acceptability within a community setting. Methods Translation of the original programme included selecting exercises and gathering user feedback on character and message framing preferences. For acceptability testing, parents were randomised to either the game (n = 106) or a control (non-interactive webpage) condition (n = 76). At time 1 all participants completed a survey on demographics, computer literacy and Theory of Planned Behaviour (TPB) items. Post intervention (time 2) users repeated the TPB questions in addition to acceptability items. Interviews (n = 17) were conducted 3 months post intervention to gather qualitative feedback on transfer of learning into real life. Results The process of conversion identified clear preferences for first person role play, home setting and realistic characters alongside positively phrased feedback. Evaluation results show that the game was acceptable to parents on cognitive and emotional dimensions, particularly for parents of younger children. Acceptability was not influenced by baseline demographics, computer skills or baseline TPB variables. MANOVA analysis and qualitative feedback suggest potential for effective translation of learning into real life. However attrition was more likely in the game condition, potentially due to feedback text volume. Conclusions A manualised group programme can be viably converted into a serious game format which is both cognitively and emotionally acceptable. The intervention may be more effectively targeted at parents with younger children, and further game developments must particularly address information dosing. Establishing the viability of digitally converting a group programme is a significant step forward for implementation focused research.
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Affiliation(s)
- Julie E Bayley
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
| | - Katherine E Brown
- Centre for Technology Enabled Health Research, Coventry University, Coventry, UK.
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Abstract
OBJECTIVE To describe the needs and evidence-based practice specific to care of the pregnant adolescent in Canada, including special populations. OUTCOMES Healthy pregnancies for adolescent women in Canada, with culturally sensitive and age-appropriate care to ensure the best possible outcomes for these young women and their infants and young families, and to reduce repeat pregnancy rates. EVIDENCE Published literature was retrieved through searches of PubMed and The Cochrane Library on May 23, 2012 using appropriate controlled vocabulary (e.g., Pregnancy in Adolescence) and key words (e.g., pregnancy, teen, youth). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. Results were limited to English or French language materials published in or after 1990. Searches were updated on a regular basis and incorporated in the guideline to July 6, 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, national and international medical specialty societies, and clinical practice guideline collections. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS/HARMS/COSTS: These guidelines are designed to help practitioners caring for adolescent women during pregnancy in Canada and allow them to take the best care of these young women in a manner appropriate for their age, cultural backgrounds, and risk profiles. RECOMMENDATIONS 1. Health care providers should adapt their prenatal care for adolescents and offer multidisciplinary care that is easily accessible to the adolescent early in the pregnancy, recognizing that adolescents often present to care later than their adult counterparts. A model that provides an opportunity to address all of these needs at one site may be the preferred model of care for pregnant adolescents. (II-1A) 2. Health care providers should be sensitive to the unique developmental needs of adolescents through all stages of pregnancy and during intrapartum and postpartum care. (III-B) 3. Adolescents have high-risk pregnancies and should be managed accordingly within programs that have the capacity to manage their care. The unique physical risks of adolescent pregnancy should be recognized and the care provided must address these. (II-1A) 4. Fathers and partners should be included as much as possible in pregnancy care and prenatal/infant care education. (III-B) 5. A first-trimester ultrasound is recommended not only for the usual reasons for properly dating the pregnancy, but also for assessing the increased risks of preterm birth. (I-A) 6. Counselling about all available pregnancy outcome options (abortion, adoption, and parenting) should be provided to any adolescent with a confirmed intrauterine gestation. (III-A) 7. Testing for sexually transmitted infections (STI) (II-2A) and bacterial vaginosis (III-B) should be performed routinely upon presentation for pregnancy care and again in the third trimester; STI testing should also be performed postpartum and when needed symptomatically. a. Because pregnant adolescents are inherently at increased risk for preterm labour, preterm birth, and preterm pre-labour rupture of membranes, screening and management of bacterial vaginosis is recommended. (III-B) b. After treatment for a positive test, a test of cure is needed 3 to 4 weeks after completion of treatment. Refer partner for screening and treatment. Take the opportunity to discuss condom use. (III-A) 8. Routine and repeated screening for alcohol use, substance abuse, and violence in pregnancy is recommended because of their increased rates in this population. (II-2A) 9. Routine and repeated screening for and treatment of mood disorders in pregnancy is recommended because of their increased rates in this population. The Edinburgh Postnatal Depression Scale administered in each trimester and postpartum, and more frequently if deemed necessary, is one option for such screening. (II-2A) 10. Pregnant adolescents should have a nutritional assessment, vitamins and food supplementation if needed, and access to a strategy to reduce anemia and low birth weight and to optimize weight gain in pregnancy. (II-2A) 11. Conflicting evidence supports and refutes differences in gestational hypertension in the adolescent population; therefore, the care usual for adult populations is supported for pregnant adolescents at this time. (II-2A) 12. Practitioners should consult gestational diabetes mellitus (GDM) guidelines. In theory, testing all patients is appropriate, although rates of GDM are generally lower in adolescent populations. Practitioners should be aware, however, that certain ethnic groups including Aboriginal populations are at high risk of GDM. (II-2A) 13. An ultrasound anatomical assessment at 16 to 20 weeks is recommended because of increased rates of congenital anomalies in this population. (II-2A) 14. As in other populations at risk of intrauterine growth restriction (IUGR) and low birth weight, an ultrasound to assess fetal well-being and estimated fetal weight at 32 to 34 weeks gestational age is suggested to screen for IUGR. (III-A) 15. Visits in the second or third trimester should be more frequent to address the increased risk of preterm labour and preterm birth and to assess fetal well-being. All caregivers should be aware of the signs and symptoms of preterm labour and should educate their patients to recognize them. (III-A) 16. It should be recognized that adolescents have improved vaginal delivery rates and a concomitantly lower Caesarean section rate than their adult counterparts. (II-2A) As with antenatal care, peripartum care in hospital should be multidisciplinary, involving social care, support for breastfeeding and lactation, and the involvement of children's aid services when warranted. (III-B) 17. Postpartum care should include a focus on contraceptive methods, especially long-acting reversible contraception methods, as a means to decrease the high rates of repeat pregnancy in this population; discussion of contraception should begin before delivery. (III-A) 18. Breastfeeding should be recommended and sufficient support given to this population at high risk for discontinuation. (II-2A) 19. Postpartum care programs should be available to support adolescent parents and their children, to improve the mothers' knowledge of parenting, to increase breastfeeding rates, to screen for and manage postpartum depression, to increase birth intervals, and to decrease repeated unintended pregnancy rates. (III-B) 20. Adolescent women in rural, remote, northern, and Aboriginal communities should be supported to give birth as close to home as possible. (II-2A) 21. Adolescent pregnant women who need to be evacuated from a remote community should be able to have a family member or other person accompany them to provide support and encouragement. (II-2A) 22. Culturally safe prenatal care including emotional, educational, and clinical support to assist adolescent parents in leading healthier lives should be available, especially in northern and Aboriginal communities. (II-3A) 23. Cultural beliefs around miscarriage and pregnancy issues, and special considerations in the handling of fetal remains, placental tissue, and the umbilical cord, must be respected. (III).
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Empowering adolescent girls in Sub-Saharan Africa to prevent unintended pregnancy and HIV: A critical research gap. Int J Gynaecol Obstet 2015; 132:1-3. [PMID: 26613822 DOI: 10.1016/j.ijgo.2015.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The need to prevent early pregnancy and HIV among adolescent girls in Sub-Saharan Africa has been recognized increasingly over recent years. Although extensive work has been done to determine appropriate interventions for girls in high-income countries, very little evidence is available to guide programmatic interventions in Sub-Saharan Africa. The available evidence has been equivocal regarding improved outcomes. While knowledge and self-reported behaviors frequently change with interventions, including those performed at the community level, educational programs, and direct contraceptive provision, downstream outcomes rarely reflect a significant effect of the interventions; however, provision of financial or other interventions to incentivize continued school enrollment are a promising development. We suggest directions for future research to fill this critical gap in the literature.
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Schmid R. The Cost-Effectiveness of Emergency Hormonal Contraception with Ulipristal Acetate versus Levonorgestrel for Minors in France. PLoS One 2015; 10:e0138990. [PMID: 26422259 PMCID: PMC4589416 DOI: 10.1371/journal.pone.0138990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 09/07/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of ulipristal acetate and levonorgestrel in minors in France, and analyze whether it is worthwhile to provide ulipristal acetate to minors free of charge. METHODS The cost-effectiveness of two emergency contraceptive methods was compared based on a decision-analytical model. Pregnancy rates, outcomes of unintended pregnancies, and resource utilization were derived from the literature. Resources and their costs were considered until termination or a few days after delivery. Deterministic and probabilistic sensitivity analyses were performed. RESULTS The cost of an unintended pregnancy in a French minor is estimated to be 1,630 € (range 1,330 € - 1,803 €). Almost 4 million € (3.1 € - 13.7 € million) in unintended pregnancy spending in 2010 could have been saved by the use of ulipristal acetate instead of levonorgestrel. The incremental cost of ulipristal acetate compared to levonorgestrel is 3.30 € per intake, or 418 € per pregnancy avoided (intake within 72 hours). In the intake within 24 hours subgroup, ulipristal acetate was found to be more efficacious at a lower cost compared to levonorgestrel. CONCLUSIONS Ulipristal acetate dominates levonorgestrel when taken within 24 hours after unprotected intercourse, i.e., it is more effective at a lower cost. When taken within 72 hours, ulipristal acetate is a cost- effective alternative to levonorgestrel, given that the cost of avoiding an additional pregnancy with ulipristal acetate is less than the average cost of these pregnancies. In the light of these findings, it is worthwhile to provide free access to minors.
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Nair M, Baltag V, Bose K, Boschi-Pinto C, Lambrechts T, Mathai M. Improving the Quality of Health Care Services for Adolescents, Globally: A Standards-Driven Approach. J Adolesc Health 2015; 57:288-98. [PMID: 26299556 PMCID: PMC4540599 DOI: 10.1016/j.jadohealth.2015.05.011] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/20/2015] [Accepted: 05/26/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE The World Health Organization (WHO) undertook an extensive and elaborate process to develop eight Global Standards to improve quality of health care services for adolescents. The objectives of this article are to present the Global Standards and their method of development. METHODS The Global Standards were developed through a four-stage process: (1) conducting needs assessment; (2) developing the Global Standards and their criteria; (3) expert consultations; and (4) assessing their usability. Needs assessment involved conducting a meta-review of systematic reviews and two online global surveys in 2013, one with primary health care providers and another with adolescents. The Global Standards were developed based on the needs assessment in conjunction with analysis of 26 national standards from 25 countries. The final document was reviewed by experts from the World Health Organization regional and country offices, governments, academia, nongovernmental organizations, and development partners. The standards were subsequently tested in Benin and in a regional expert consultation of Latin America and Caribbean countries for their usability. RESULTS The process resulted in the development of eight Global Standards and 79 criteria for measuring them: (1) adolescents' health literacy; (2) community support; (3) appropriate package of services; (4) providers' competencies; (5) facility characteristics; (6) equity and nondiscrimination; (7) data and quality improvement; and (8) adolescents' participation. CONCLUSIONS The eight standards are intended to act as benchmarks against which quality of health care provided to adolescents could be compared. Health care services can use the standards as part of their internal quality assurance mechanisms or as part of an external accreditation process.
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Affiliation(s)
- Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
| | - Valentina Baltag
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Krishna Bose
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Cynthia Boschi-Pinto
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Thierry Lambrechts
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Matthews Mathai
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Gonsalves L, L'Engle KL, Tamrat T, Plourde KF, Mangone ER, Agarwal S, Say L, Hindin MJ. Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) Study: formative protocol for mHealth platform development and piloting. Reprod Health 2015; 12:67. [PMID: 26248769 PMCID: PMC4527108 DOI: 10.1186/s12978-015-0059-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a high unmet need for sexual and reproductive health (SRH) information and services among youth (ages 15-24) worldwide (MacQuarrie KLD. Unmet Need for Family Planning among Young Women: Levels and Trends 2014). With the proliferation of mobile technology, and its popularity with this age group, mobile phones offer a novel and accessible platform for a discreet, on-demand service providing SRH information. The Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) formative study will inform the development of an intervention, which will use the popular channel of SMS (text messages) to deliver SRH information on-demand to youth. METHODS/DESIGN Following the development of potential SMS message content in partnership with SRH technical experts and youth, formative research activities will take place over two phases. Phase 1 will use focus group discussions (FGDs) with youth and parents/caregivers to develop and test the appropriateness and acceptability of the SMS messages. Phase 2 will consist of 'peer piloting', where youth participants will complete an SRH outcome-focused pretest, be introduced to the system and then have three weeks to interact with the system and share it with friends. Participants will then return to complete the SRH post-test and participate in an in-depth interview about their own and their peers' opinions and experiences using ARMADILLO. DISCUSSION The ARMADILLO formative stage will culminate in the finalization of country-specific ARMADILLO messaging. Reach and impact of ARMADILLO will be measured at later stages. We anticipate that the complete ARMADILLO platform will be scalable, with the potential for national-level adoption.
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Affiliation(s)
- Lianne Gonsalves
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
| | - Kelly L L'Engle
- FHI360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
| | - Tigest Tamrat
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
| | - Kate F Plourde
- FHI360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
| | - Emily R Mangone
- FHI360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA. .,Health Policy & Management, UNC Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA.
| | - Smisha Agarwal
- FHI360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA. .,Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA.
| | - Lale Say
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
| | - Michelle J Hindin
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland.
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Lassi ZS, Salam RA, Das JK, Wazny K, Bhutta ZA. An unfinished agenda on adolescent health: Opportunities for interventions. Semin Perinatol 2015; 39:353-60. [PMID: 26162972 DOI: 10.1053/j.semperi.2015.06.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Millennium Development Goal era has resulted in improvements in maternal and child health worldwide. As more children are surviving past their fifth birthday, the population of adolescents is increasing. Adolescence is a time of significant developmental transition; adolescence sets the stage for adult health through risks taken and beneficial and detrimental habits that are formed and it is thus an optimal time to target health interventions. Beginning interventions in adolescence or even earlier in childhood maximizes the impact on the individual's health in adult life. Evidence suggests that interventions to promote sexual and reproductive health, physical activity and healthy lifestyle, mental health and wellbeing, safe and hazard-free environment, improving access to nutritious and healthy foods, and minimizing exposure to substance abuse can improve health outcomes in young adolescents. School-based delivery strategies appear to be the most highly evaluated for improving adolescent health; they have been used to deliver interventions such as sexual health, substance abuse prevention, and nutritional interventions. Use of social media and information technologies, cash transfers, social protection, and micro-finance initiatives are promising strategies; however, given the lack of rigorous evaluations, there is a need for further research. Additional research is also warranted to strengthen the evidence base by establishing causality, understanding the differential impacts of adolescent health in different contexts particularly in low- and middle-income countries. In addition, research and evaluation in the domain of adolescent health must focus on how to implement interventions effectively at-scale, sustain the impacts over time and ensure equitable outcomes.
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Affiliation(s)
- Zohra S Lassi
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan
| | - Kerri Wazny
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University Karachi, Pakistan; Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Godfrey EM. Helping Clinicians Prevent Pregnancy among Sexually Active Adolescents: U.S. Medical Eligibility Criteria for Contraceptive Use and U.S. Selected Practice Recommendations for Contraceptive Use. J Pediatr Adolesc Gynecol 2015; 28:209-14. [PMID: 26026219 DOI: 10.1016/j.jpag.2014.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 08/06/2014] [Accepted: 08/13/2014] [Indexed: 11/19/2022]
Abstract
The United States has made substantial progress in reducing teenage birth rates in recent decades, but rates remain high. Teen pregnancy can increase the risk of poor health outcomes and lead to decreased educational attainment, increased poverty, and welfare use, as well as increased cost to taxpayers. One of the most effective ways to prevent teenage pregnancy is through the use of effective birth control methods. The Centers for Disease Control (CDC) and Prevention has made the prevention of teenage pregnancy 1 of its 10 winnable battles. The CDC has released 2 evidence-based clinical guideline documents regarding contraceptive use for adolescents and adults. The first guideline, US Medical Eligibility Criteria for Contraceptive Use, 2010, helps clinicians recognize when a contraceptive method may not be safe to use for a particular adolescent but also when not to withhold a contraceptive method that is safe to use. The second document, US Selected Practice Recommendations for Contraceptive Use, 2013, provides guidance for how to use contraceptive methods safely and effectively once they are deemed safe. Health care providers are encouraged to use these documents to provide safe and effective contraceptive care to patients seeking family planning, including adolescents.
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Affiliation(s)
- Emily M Godfrey
- Departments of Family Medicine and Obstetrics and Gynecology, University of Washington, Seattle, WA.
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Constantine NA, Jerman P, Berglas NF, Angulo-Olaiz F, Chou CP, Rohrbach LA. Short-term effects of a rights-based sexuality education curriculum for high-school students: a cluster-randomized trial. BMC Public Health 2015; 15:293. [PMID: 25886554 PMCID: PMC4407845 DOI: 10.1186/s12889-015-1625-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/09/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND An emerging model for sexuality education is the rights-based approach, which unifies discussions of sexuality, gender norms, and sexual rights to promote the healthy sexual development of adolescents. A rigorous evaluation of a rights-based intervention for a broad population of adolescents in the U.S. has not previously been published. This paper evaluates the immediate effects of the Sexuality Education Initiative (SEI) on hypothesized psychosocial determinants of sexual behavior. METHODS A cluster-randomized trial was conducted with ninth-grade students at 10 high schools in Los Angeles. Classrooms at each school were randomized to receive either a rights-based curriculum or basic sex education (control) curriculum. Surveys were completed by 1,750 students (N = 934 intervention, N = 816 control) at pretest and immediate posttest. Multilevel regression models examined the short-term effects of the intervention on nine psychosocial outcomes, which were hypothesized to be mediators of students' sexual behaviors. RESULTS Compared with students who received the control curriculum, students receiving the rights-based curriculum demonstrated significantly greater knowledge about sexual health and sexual health services, more positive attitudes about sexual relationship rights, greater communication about sex and relationships with parents, and greater self-efficacy to manage risky situations at immediate posttest. There were no significant differences between the two groups for two outcomes, communication with sexual partners and intentions to use condoms. CONCLUSIONS Participation in the rights-based classroom curriculum resulted in positive, statistically significant effects on seven of nine psychosocial outcomes, relative to a basic sex education curriculum. Longer-term effects on students' sexual behaviors will be tested in subsequent analyses. TRIAL REGISTRATION ClinicalTrials.gov NCT02009046.
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Affiliation(s)
- Norman A Constantine
- Center for Research on Adolescent Health and Development, Public Health Institute, 555 12th Street, 10th Floor, 94607, Oakland, CA, USA.
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, 50 University Hall, 94720, Berkeley, CA, USA.
| | - Petra Jerman
- Center for Research on Adolescent Health and Development, Public Health Institute, 555 12th Street, 10th Floor, 94607, Oakland, CA, USA.
| | - Nancy F Berglas
- Center for Research on Adolescent Health and Development, Public Health Institute, 555 12th Street, 10th Floor, 94607, Oakland, CA, USA.
| | - Francisca Angulo-Olaiz
- Center for Research on Adolescent Health and Development, Public Health Institute, 555 12th Street, 10th Floor, 94607, Oakland, CA, USA.
| | - Chih-Ping Chou
- Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, 90032, Los Angeles, CA, USA.
| | - Louise A Rohrbach
- Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, 90032, Los Angeles, CA, USA.
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