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1630737 Assignment 1: Annotated Bibliography SPH 380: WINTER 2019
I focused on teenage pregnancy, looking at risk factors and barriers to contraception, specifically looking the most effective forms of contraception available. I chose this topic because I felt uneducated on teenage pregnancy in the United States and was curious on its etiology and impact.
Bibliography 1.
Garwood SK, Gerassi LWB, Jonson-Reid M, Plax K, Drake B. More Than Poverty: The Effect of Child Abuse and Neglect on Teen Pregnancy Risk. J Adolesc Heal. 2015;57:164168. doi:10.1016/j.jadohealth.2015.05.004 This study was funded by the Centers for Disease Control and Prevention and the National Institute of Mental Health. This study was original research, using data from a larger administrative data study that held information on government service involvement and outcomes of children who grew up in poverty and were exposed to maltreatment. This study used this data to compare pregnancy rates among teenagers who grew up in poverty and teenagers who experienced child abuse and neglect in an impoverished household. It concluded that maltreatment during childhood is a significant risk factor for teenage pregnancy: A child in poverty who has experienced maltreatment has a 66% higher risk of
teenage pregnancy than a child in a financially and emotionally stable home, while a child who grew up in poverty has a 40% higher risk. Limitations of these results include a lack of account for substance abuse, mental health disorders, school performance, and whether STD contraction was due to abuse or risky sexual behavior. The data used only included Caucasian or African American women due to a small sample size for other races. Expanding the racial groups within the sample size studied would increase the integrity of these findings.
Evidence has been presented linking poverty as an etiology of teenage pregnancy, as well as teenage pregnancy being an etiology of poverty. Poverty has also been associated with higher reports of child abuse, which this study has shown is a risk factor for teenage pregnancy.
2.
Gina M. Secura, Ph.D., M.P.H., Tessa Madden, M.D. MPH, Colleen McNicholas, D.O., Jennifer Mullersman BSN, Christina M. Buckel, M.S.W., Qiuhong Zhao, M.S. and, Jeffrey F. Peipert, M.D. PD. Provision of No-Cost, Long-Acting Contraception and Teenage Pregnancy. N Engl J Med. 2014. doi:10.1056/NEJMoa1400506 This study was original research titled the Contraceptive CHOICE Project funded by the Susan Thompson Buffet Foundation and approved by the Washington University School of Medicine in St. Louis Human Research Protection Office. Following 9256 girls and women between the ages of 14 and 45, this study provided free contraception, eliminating the barrier of cost. All forms of
contraception were available, however long-acting reversible contraception (LARC) was promoted. The participants were followed and documented on whether they birthed, miscarried, or aborted a child. Among teens in the cohort between 2008 and 2013, these rates were 34.0, 19.4, and 9.7 per 1000 teens, respectively. Among the general population of US teens in 2008, these rates were 158.5, 94.0, and 41.5 per 1000, respectively. Additionally, those among the cohort who chose an LARC method continued its use longer than shorter-acting contraceptive methods. Limitations of the study included self-reported pregnancy results, consistent interviews (possibly affecting adherence), and enrollment requiring parental consent. Improvement of this study would be significant if parental consent were not required, as confidentiality is a proven barrier for many at risk teenagers. This suggests those participating in the study were likely of lower risk.
Providing free contraception eliminates a significant barrier for many girls and women. This article concludes that the effect of cost-free contraception access significantly reduces pregnancy rates; cost of contraception is an etiology for teenage pregnancy.
3.
McClellan K, Temples H, Miller L. The Latest in Teen Pregnancy Prevention: Long-Acting Reversible Contraception. J Pediatr Heal Care. 2018;32(5). doi:10.1016/j.pedhc.2018.02.009
This article is a review of the latest research on LARCs and discusses the barriers to LARC access among adolescents. The review was completed by several Nurse Practitioners who teach at Clemson University and was copyrighted by the National Association of Pediatric Nurse Practitioners. This article cites LARC methods as the best and safest option for adolescents, but it is estimated that less than 5% of adolescents use them. The reasons for this include cost, confidentiality, and a lack of pediatrician recommendation. Adolescents are more likely to choose an LARC method when recommended by their pediatrician, however only one third of pediatric providers offer this method. No limitations of data provided in their review were cited.
This article exemplifies the barriers to LARC methods, highlighting cost, confidentiality, and lack of recommendation as etiology for lack of contraception use, and therefore teenage pregnancy. This article also cites teen pregnancy as a risk factor for low education, poverty, and unemployment for the mother and child.
4.
Tavernise S. Colorado’s Effort Against Teenage Pregnancies Is a Startling Success - The New York Times. The New York Times. https://www.nytimes.com/2015/07/06/science/colorados-push-against-teenagepregnancies-is-a-startling-success.html?_r=1. Published 2015. Accessed January 23, 2019.
This New York Times article reports on teenagers in Colorado who were offered long-acting birth control. This public health implementation resulted in a 40 percent decrease in teenage birth rates and 42 percent decrease in abortion rates between 2009 and 2013. These results were especially prevalent among the most impoverished areas within the state. Half of all first births in these locations occurred before mother's turned 21 in 2009, with the age moving to 24 years old in 2014. This shift in age provides the opportunity for women to finish their education and create a foundation for themselves before bearing the financial burden of a child. This ultimately helps to break the cycle of poverty, as women are able to choose who they have children with and can become parents when they are financially, and emotionally, ready.
Poverty is an etiology of teenage pregnancy. Colorado’s implementation of LARC access for all teenagers significantly reduced their teenage pregnancy rates, most dramatically reducing pregnancy among impoverished communities. This implementation, especially in poverty ridden areas, also reduced the etiology of future teenage births. Would-have-been mothers are now less likely to continue living in poverty, which in turn reduces the exposure of unintended children to poverty and potentially unstable environments. This ultimately reduces riskfactors for future generations.
5.
Verhaeghe J. Clinical practice Contraception in adolescents. Eur J Pediatr. 2012;171:895-
899. doi:10.1007/s00431-012-1676-x In the western world, the age of menarche (first menstruation) has dropped. This drop is associated with earlier, and riskier, sexual activity. This review discusses each form of birth control and its use among adolescents, also discussing the barriers and hazards for adolescent girls. It has been observed that over 80% of adolescent girls on LARC methods continue their use, marking the highest continuation rates among available contraception. It has also been shown that when cost is removed as a barrier for LARC methods, the majority of adolescents will choose this method. Other barriers for all contraception include needing parental consent and access to refills. This review was written by a member of the Department of Obstetrics and Gynecology and Health Sciences campus of Katholieke Universiteit Leuven in Belgium. No limitations of data provided in the review were cited.
This article highlights the safety of LARCs among adolescents and the observed effectiveness of continuation, marking LARCs as the most effective option for adolescents. This analysis exemplifies that cost of LARC methods are a significant barrier, and its elimination creates the best results for teenage pregnancy rates. The use of LARC methods also eliminates the need for refills, providing better protection for many sexually active teenagers. Etiologically, parental consent and cost remain significant factors in high teenage pregnancy rates, and the recent
decrease in menarche is also a significant risk factor due to its association with riskier sexual behavior.
I focused on teenage pregnancy, looking at risk factors and barriers to contraception, specifically looking the most effective forms of contraception available. I chose this topic because I felt uneducated on teenage pregnancy in the United States and was curious on its etiology and impact.
Bibliography 1.
Garwood SK, Gerassi LWB, Jonson-Reid M, Plax K, Drake B. More Than Poverty: The Effect of Child Abuse and Neglect on Teen Pregnancy Risk. J Adolesc Heal. 2015;57:164168. doi:10.1016/j.jadohealth.2015.05.004 This study was funded by the Centers for Disease Control and Prevention and the National Institute of Mental Health. This study was original research, using data from a larger administrative data study that held information on government service involvement and outcomes of children who grew up in poverty and were exposed to maltreatment. This study used this data to compare pregnancy rates among teenagers who grew up in poverty and teenagers who experienced child abuse and neglect in an impoverished household. It concluded that maltreatment during childhood is a significant risk factor for teenage pregnancy: A child in poverty who has experienced maltreatment has a 66% higher risk of
teenage pregnancy than a child in a financially and emotionally stable home, while a child who grew up in poverty has a 40% higher risk. Limitations of these results include a lack of account for substance abuse, mental health disorders, school performance, and whether STD contraction was due to abuse or risky sexual behavior. The data used only included Caucasian or African American women due to a small sample size for other races. Expanding the racial groups within the sample size studied would increase the integrity of these findings.
Evidence has been presented linking poverty as an etiology of teenage pregnancy, as well as teenage pregnancy being an etiology of poverty. Poverty has also been associated with higher reports of child abuse, which this study has shown is a risk factor for teenage pregnancy.
2.
Gina M. Secura, Ph.D., M.P.H., Tessa Madden, M.D. MPH, Colleen McNicholas, D.O., Jennifer Mullersman BSN, Christina M. Buckel, M.S.W., Qiuhong Zhao, M.S. and, Jeffrey F. Peipert, M.D. PD. Provision of No-Cost, Long-Acting Contraception and Teenage Pregnancy. N Engl J Med. 2014. doi:10.1056/NEJMoa1400506 This study was original research titled the Contraceptive CHOICE Project funded by the Susan Thompson Buffet Foundation and approved by the Washington University School of Medicine in St. Louis Human Research Protection Office. Following 9256 girls and women between the ages of 14 and 45, this study provided free contraception, eliminating the barrier of cost. All forms of
contraception were available, however long-acting reversible contraception (LARC) was promoted. The participants were followed and documented on whether they birthed, miscarried, or aborted a child. Among teens in the cohort between 2008 and 2013, these rates were 34.0, 19.4, and 9.7 per 1000 teens, respectively. Among the general population of US teens in 2008, these rates were 158.5, 94.0, and 41.5 per 1000, respectively. Additionally, those among the cohort who chose an LARC method continued its use longer than shorter-acting contraceptive methods. Limitations of the study included self-reported pregnancy results, consistent interviews (possibly affecting adherence), and enrollment requiring parental consent. Improvement of this study would be significant if parental consent were not required, as confidentiality is a proven barrier for many at risk teenagers. This suggests those participating in the study were likely of lower risk.
Providing free contraception eliminates a significant barrier for many girls and women. This article concludes that the effect of cost-free contraception access significantly reduces pregnancy rates; cost of contraception is an etiology for teenage pregnancy.
3.
McClellan K, Temples H, Miller L. The Latest in Teen Pregnancy Prevention: Long-Acting Reversible Contraception. J Pediatr Heal Care. 2018;32(5). doi:10.1016/j.pedhc.2018.02.009
This article is a review of the latest research on LARCs and discusses the barriers to LARC access among adolescents. The review was completed by several Nurse Practitioners who teach at Clemson University and was copyrighted by the National Association of Pediatric Nurse Practitioners. This article cites LARC methods as the best and safest option for adolescents, but it is estimated that less than 5% of adolescents use them. The reasons for this include cost, confidentiality, and a lack of pediatrician recommendation. Adolescents are more likely to choose an LARC method when recommended by their pediatrician, however only one third of pediatric providers offer this method. No limitations of data provided in their review were cited.
This article exemplifies the barriers to LARC methods, highlighting cost, confidentiality, and lack of recommendation as etiology for lack of contraception use, and therefore teenage pregnancy. This article also cites teen pregnancy as a risk factor for low education, poverty, and unemployment for the mother and child.
4.
Tavernise S. Colorado’s Effort Against Teenage Pregnancies Is a Startling Success - The New York Times. The New York Times. https://www.nytimes.com/2015/07/06/science/colorados-push-against-teenagepregnancies-is-a-startling-success.html?_r=1. Published 2015. Accessed January 23, 2019.
This New York Times article reports on teenagers in Colorado who were offered long-acting birth control. This public health implementation resulted in a 40 percent decrease in teenage birth rates and 42 percent decrease in abortion rates between 2009 and 2013. These results were especially prevalent among the most impoverished areas within the state. Half of all first births in these locations occurred before mother's turned 21 in 2009, with the age moving to 24 years old in 2014. This shift in age provides the opportunity for women to finish their education and create a foundation for themselves before bearing the financial burden of a child. This ultimately helps to break the cycle of poverty, as women are able to choose who they have children with and can become parents when they are financially, and emotionally, ready.
Poverty is an etiology of teenage pregnancy. Colorado’s implementation of LARC access for all teenagers significantly reduced their teenage pregnancy rates, most dramatically reducing pregnancy among impoverished communities. This implementation, especially in poverty ridden areas, also reduced the etiology of future teenage births. Would-have-been mothers are now less likely to continue living in poverty, which in turn reduces the exposure of unintended children to poverty and potentially unstable environments. This ultimately reduces riskfactors for future generations.
5.
Verhaeghe J. Clinical practice Contraception in adolescents. Eur J Pediatr. 2012;171:895-
899. doi:10.1007/s00431-012-1676-x In the western world, the age of menarche (first menstruation) has dropped. This drop is associated with earlier, and riskier, sexual activity. This review discusses each form of birth control and its use among adolescents, also discussing the barriers and hazards for adolescent girls. It has been observed that over 80% of adolescent girls on LARC methods continue their use, marking the highest continuation rates among available contraception. It has also been shown that when cost is removed as a barrier for LARC methods, the majority of adolescents will choose this method. Other barriers for all contraception include needing parental consent and access to refills. This review was written by a member of the Department of Obstetrics and Gynecology and Health Sciences campus of Katholieke Universiteit Leuven in Belgium. No limitations of data provided in the review were cited.
This article highlights the safety of LARCs among adolescents and the observed effectiveness of continuation, marking LARCs as the most effective option for adolescents. This analysis exemplifies that cost of LARC methods are a significant barrier, and its elimination creates the best results for teenage pregnancy rates. The use of LARC methods also eliminates the need for refills, providing better protection for many sexually active teenagers. Etiologically, parental consent and cost remain significant factors in high teenage pregnancy rates, and the recent
decrease in menarche is also a significant risk factor due to its association with riskier sexual behavior.
