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Biomedical subjects

C Stevens-Simon

Publications and source records attributed to C Stevens-Simon.

At least 37 records · Page 2Linked to original sources
PubMed1997

The effect of monetary incentives and peer support groups on repeat adolescent pregnancies. A randomized trial of the Dollar-a-Day Program.

OBJECTIVES: To test the hypotheses that (1) a monetary incentive promotes peer-support group participation; and (2) peer-support group participation decreases repeat adolescent pregnancies. DESIGN: Two-year, prospective, randomized controlled trial. SETTING: Denver, Colo. PARTICIPANTS: A total of 286 primiparous girls younger than 18 years, whose infants were younger than 5 months. INTERVENTION: Participants were randomized to 4 interventions: monetary incentive and peer-support group, peer-support group only, monetary incentive only, or no intervention. MAIN OUTCOME MEASURES: Consistency of participation in planned intervention and repeat pregnancy. RESULTS: Participation in interventions was generally low. Hypothesis 1 was supported: 58% of those offered a monetary incentive participated in the peer-support groups, compared with 9% of those who were not offered the incentive. Hypothesis 2 was rejected: the peer-support group experience failed to prevent repeat pregnancies. The incidence of second pregnancies at 6 months (9%, 22/248), at 12 months (20%, 49/248), at 18 months (29%, 72/248), and at 24 months (39%, 97/248) following delivery did not vary significantly in relation to intervention strategy. Background sociodemographic characteristics significantly affected the timing of subsequent conceptions but not intervention participation. CONCLUSION: A monetary incentive draws adolescent mothers to sites where they can discuss the costs and benefits of contraception and conception with knowledgeable adults and supportive peers. These discussions do not prevent repeat pregnancies. Further studies are needed to determine if an intervention that produces substantive changes in the daily living environment will eliminate the sexual practices that are responsible for the high rate of repeat pregnancy in this population.

Adolescent↗
PubMed1996

Pattern of prenatal care and infant immunization status in a comprehensive adolescent-oriented maternity program.

OBJECTIVE: To examine the relationship between patterns of prenatal care utilization and the subsequent pattern of preventive infant health care utilization among patients in a comprehensive, multidisciplinary, adolescent-oriented maternity program. METHODS: We hypothesized that the mothers of incompletely immunized 8-month-olds were less compliant with their own prenatal care appointments than were mothers of fully immunized 8-month-olds. We retrospectively reviewed the medical records of 150 consecutively delivered infants and their adolescent mothers. Data concerning the pattern of prenatal and postnatal use of preventive health care services and potentially confounding maternal characteristics were collected. RESULTS: Of the 150 infants aged 8 months, 22 (14.7%) were incompletely immunized. Mothers of completely and incompletely immunized infants did not differ in age, school enrollment status, or compliance with prenatal appointments. However, the latter group initiated prenatal care later, obtained fewer prenatal visits, returned later for postpartum care, and were more likely to be black and to report inadequate family support after delivery. Three of the 5 characteristics entered a logistic regression function that predicted the risk of incomplete immunizations at 8 months of age: third-trimester initiation of prenatal care (odds ratio, 4.05; 95% confidence interval, 1.19-13.7), inadequate family support (odds ratio, 3.42; 95% confidence interval, 1.17-10.0), and black race (odds ratio, 3.14; 95% confidence interval, 1.19-8.69). The total model chi 2 was 15.8 (P < .001). CONCLUSIONS: Among patients in a comprehensive adolescent-oriented maternity program, the timing of the first prenatal visit helps to identify infants who are at increased risk for incomplete primary immunization status. Our findings favor preferential allocation of scarce, costly outreach services to infants born to adolescent mothers who enter prenatal care during the third trimester.

Adolescent↗
PubMed1996

Absence of negative attitudes toward childbearing among pregnant teenagers. A risk factor for a rapid repeat pregnancy?

OBJECTIVE: To test the hypothesis that adolescent mothers who conceive again during the first postpartum year express more positive attitudes toward childbearing while pregnant than do adolescent mothers who postpone further childbearing. METHOD: Prospective, cross-sectional, population-based survey. DESIGN: A racially diverse group of 200 consecutively enrolled, poor, pregnant 13- to 18-year-old patients in an adolescent-oriented maternity program were interviewed to determine why they had not used contraceptives prior to the index conception. The study participants were followed up prospectively for the first postpartum year. The data analysis included t tests, chi 2 tests, analysis of variance, and logistic regressions. RESULTS: The repeat pregnancy rate was 11.5% during the first postpartum year. As hypothesized, those who became pregnant again were more likely to have expressed positive attitudes toward childbearing during the index pregnancy (60.9% vs 39.6%; P = .05; odds ratio = 2.38; 95% confidence interval, 0.96-5.90). In addition, those who conceived again were more likely to have had a prior miscarriage, dropped out of school, abused illicit substances, moved away from home, and reported inadequate family support during the index pregnancy, and were less likely to plan to use levonorgestrel (Norplant) following delivery. The best model for predicting repeat pregnancy included education status, postpartum plans for Norplant use, and miscarriage history. Having a positive attitude toward childbearing during pregnancy was not included in the final model because it did not contribute to the model or affect any of the other parameters in the model. CONCLUSIONS: The sexually active teenaged mother who does not use contraception poses a perplexing diagnostic dilemma. The differential diagnosis is a long, complex one that includes ambivalent feelings about postponing future childbearing. This study demonstrates an indirect association between positive attitudes toward childbearing during pregnancy and repeat adolescent pregnancy. Our finding that this association operates through common linkages between maternal educational and contraceptive plans and both positive attitudes toward childbearing and repeat adolescent pregnancy suggests that interventions specifically targeting these underlying causes could reduce the unsafe sexual practices that persist among the participants in comprehensive adolescent-oriented maternity programs.

Adolescent↗
PubMed1996

Why pregnant adolescents say they did not use contraceptives prior to conception.

OBJECTIVE: In this study we attempted to learn why childbearing adolescents failed to use contraceptives prior to conception. We hypothesized that among adolescents who elect to bear their children, positive and/or ambivalent feelings about having a baby are the most frequently cited reasons for not having used contraceptives. STUDY DESIGN: This is a cross-sectional, clinic-based survey of a racially and ethnically diverse group of 200 consecutively enrolled, poor, pregnant, 13-18-year-old patients in an adolescent-oriented maternity program. The participants completed a self-administered questionnaire which elicited information about environmental and personal risk factors for inconsistent use of contraceptives and information about the reasons they had not used contraceptives consistently prior to conception. Student's t-tests, Chi-square, and logistic regression analyses were used. RESULTS: The most frequently cited reasons for not using contraceptives prior to conception were: "I didn't mind getting pregnant" (20%) and "I wanted to get pregnant" (17.5%), followed by "I was using birth control but it didn't work (broke)" (12%), "I thought there was something wrong with me and I couldn't get pregnant" (9%) and "I just didn't get around to it" (9%). Teenagers who cited positive and/or ambivalent attitudes toward childbearing as their primary reason for not using contraceptives at the time of conception did not differ from others with regard to age, Medicaid status, gravidity, parity, frequency of living with parents, partner's age, depressive symptoms, or perceived family support. They were, however, more likely to have known the father of the baby for more than 6 months at the time of conception [odds ratio (OR) 2.53; 95% confidence interval (CI) 1.22-5.26) and to have dropped out of school (OR) 2.15; 95% CI 1.10-4.26]. CONCLUSIONS: The study hypothesis was supported. The absence of negative attitudes toward having babies rather than negative attitudes toward contraceptives is the most commonly cited reason for nonuse of contraceptives among childbearing adolescents. The results of this study may enable health care and social service providers to design more effective programs for preventing first and subsequent adolescent pregnancies.

Adolescent↗
PubMed1995

Gravid students. Characteristics of nongravid classmates who react with positive and negative feelings about conception.

OBJECTIVE: To determine whether gravid classmates affect nongravid students' feelings about conception. METHOD: Cross-sectional survey of a school-based clinic population. We asked 130 nulliparous high school students who were seeking routine health care at an urban school-based clinic to complete an anonymous questionnaire concerning risk factors for and attitudes about teen pregnancy. RESULTS: The respondents were grouped according to the effect that contact with gravid classmates had on their desire for conception: increased desire (n = 13), no change in desire (n = 59), and decreased desire (n = 49). The analysis disclosed no significant group differences for age (mean +/- SD, 16.3 +/- 1.2 years), sex (65% female), welfare use (20%), or living situation (85% lived with a parent). The increased-desire group had significantly more sociodemographic risk factors for teen pregnancy than did the groups with no change and decreased desire. The group with increased desire was significantly more likely than the other two groups to be failing in school (54% vs 44% and 12.2%; P < .001), to have low education goals (15.4% vs 3.4% and 0%; P = .02), to be unhappy with their family support (69.2% vs 27.1% and 29.8%; P = .01), to be concerned about sterility (30.8% vs 8.6% and 6.1%; P = .03), not to be using contraceptives (77% vs 35.6% and 30.6%; P < .01), to want a pregnancy within 2 years (61.5% vs 25.4% and 12.2%; P < .001), and to have a sexual partner who wanted a pregnancy within 2 years (61.5% vs 13.6% and 8.2%; P < .0001). CONCLUSIONS: Our findings support the study hypothesis that that never-pregnant students in the increased-desire group had more sociodemographic risk factors for teen pregnancy than did students in the groups with no change or decreased desire. The results of this study may help to ally concerns about the adverse effect that the increased prevalence of gravid students in American schools might have on the childbearing attitudes of never-pregnant students.

Adolescent↗
PubMed1995

Teenage childbearing. An adaptive strategy for the socioeconomically disadvantaged or a strategy for adapting to socioeconomic disadvantage?

OBJECTIVE: To examine the relation between childbearing and educational and vocational achievements of American females high school students. DATA SOURCE: Articles published in English during the past decade about the educational, vocational, and socioeconomic sequelae of childbearing among female high school students. DATA SELECTION: Articles that did not contain data about the relation between adolescent childbearing and educational and vocational achievement were excluded. DATA SYNTHESIS: Most females who begin childbearing during adolescence obtain less schooling and poorer-paying jobs than do females who postpone childbearing. The reasons for this are elusive. Differences in the family and cultural backgrounds of early (high school-age) and later (18 years and older) childbearers explain some but not all of the association between early childbearing and educational and vocational underachievement. The effect of childbearing preferences on the educational and vocational achievements of teenagers has not been studied adequately. Lack of concrete information could result in underestimation of the effect of early childbearing on the socioeconomic well-being of young Americans, and create the impression that adolescent pregnancy is an adaptive response to urban poverty. CONCLUSIONS: As much as the long-term socioeconomic sequelae of adolescent childbearing reflect factors that influence the judgments young people make about the costs and benefits of contraception and parenthood, adolescent childbearing is a means of adapting to urban poverty. Thus postponing adolescent conceptions and parenthood may have a less important effect on the socioeconomic well-being of young Americans than expected.

Adolescent↗
PubMed1995

Are adolescents who report prior sexual abuse at higher risk for pregnancy?

Adolescents who report prior sexual abuse are at increased risk for adolescent pregnancy. This may result from earlier, more frequent, less well-protected sexual activity or from a greater desire to conceive. To determine the relative contribution of these two possible explanations to the reported association between sexual abuse and adolescent pregnancy, we studied the reproductive and sexual histories of 200 sexually active 13-18 year old females in relation to self-reported sexual abuse. Anonymous questionnaires revealed that 40 (20%) of the 200 subjects reported sexual abuse. Analyses revealed no group differences in the median age of first voluntary intercourse, the frequency of sexual intercourse, or the consistency of birth control use. Compared to their nonabused peers, however, teenagers reporting abuse were more likely to be trying to conceive (35% vs. 14% p < .01), to have boyfriends pressuring them to conceive (76% vs. 44% p < .01), and to have fears about infertility (38% vs. 16% p < .01). Our findings suggest that childhood sexual abuse may increase the risk of adolescent pregnancy by fostering the desire to conceive. Further study is needed to determine why a disproportionate number of sexually abused adolescents desire pregnancy. The efficacy of adolescent pregnancy prevention programs may be improved by identifying previously abused adolescents and by designing educational interventions that specifically address their desire to conceive.

Adolescent↗
PubMed1995

Which teen mothers choose Norplant?

PURPOSE: The objective of this study was to determine if there are sociodemographic differences between adolescent mothers who choose to use Norplant after delivery and those who do not. We hypothesized that those adolescent mothers who are at highest risk for repeat adolescent pregnancy are least likely to select Norplant as a postpartum contraceptive. METHODS: We prospectively compared the prevalence of epidemiologic risk factors for repeat adolescent pregnancy in a group of 187 consecutively delivered 13-18-year-olds who were enrolled in a comprehensive, multidisciplinary, adolescent-oriented maternity program. The study subjects were interviewed at delivery; 100 subsequently had a Norplant inserted (Norplant users). Student's t-tests and chi-square analyses were used to compare Norplant users and refusers. RESULTS: We found no statistically significant differences between Norplant users and refusers with regard to: age, race, Medicaid, or marital or school status. Compared to Norplant refusers, Norplant users were less likely to be primiparous (79% compared to 90%; p = .04) and more likely to have poor school grades (20% compared to 7%; p = .001). Norplant users were more likely to state that they had had trouble remembering to use contraceptives in the past (32% compared to 14%; p = .005). CONCLUSIONS: These data do not support the study hypothesis and are encouraging because they suggest that Norplant may reduce repeat pregnancy among adolescent parents.

Adolescent↗
PubMed1995

Maternal prepregnant weight and weight gain: relationship to placental microstructure and morphometric oxygen diffusion capacity.

This study examines the effects of maternal prepregnant weight and gestational weight gain on the size, microstructure, and function of the human placenta. Standard gross, histologic, and histomorphometric techniques were used to examine placentas obtained from the deliveries of 77 poor, black 12- to 30-year-old subjects in relation to maternal prepregnant weight and the rate of maternal weight gain during gestation. The weight, volume, and fetal capillary surface area of the placenta increased significantly in relation to both maternal prepregnant weight and the rate of maternal weight gain during gestation. Prepregnant weight was a more important determinant of placental size and fetal capillary surface area than was the rate of maternal weight gain. The rate of maternal weight gain was a more important determinant of the density of fetal capillary tissues within the placenta and of placental resistance to oxygen diffusion than was prepregnant weight. Both maternal prepregnant weight and the rate of maternal weight gain during gestation relate positively to the size of the placenta, but they have different, potentially complementary effects on placental microstructure and function.

Adolescent↗
PubMed1995

Further evidence of reproductive immaturity among gynecologically young pregnant adolescents.

OBJECTIVE: To obtain further information about the reproductive maturity of adolescents who become pregnant soon after menarche. We hypothesized that the length of the follicular phase of the menstrual cycle antedating conception is related inversely to the gynecological age of the adolescent mother at conception. DESIGN: Observational clinical study. SETTING: Pregnant volunteers in a multidisciplinary adolescent-oriented maternity program. PATIENTS: Pregnant adolescents with accurate pregnancy dating. MAIN OUTCOME MEASURE: We studied the difference between the estimated date of confinement (EDC) computed from the stated last menstrual period (EDCLMP) and the EDC computed from ultrasound studies (EDCUS) in a group of 66, 12 to 19 year olds. A prolonged follicular phase was defined as EDCUS-EDCLMP > 0 and shortened follicular phase was defined as EDCUS-EDCLMP < or = 0. RESULTS: Pearson correlations revealed a statistically significant inverse relationship between gynecological age and the duration of the follicular phase antedating conception when the follicular phase was prolonged. Within this subgroup of patients EDCUS exceeded EDCLMP by 15.6 +/- 7.3 days when conception occurred within 3 years of menarche and 6.2 +/- 6.0 days when conception occurred > or = 3 years after menarche. CONCLUSIONS: Our findings support the hypothesis that some adolescents conceive before establishing a fully mature adult ovulatory pattern.

Adolescent↗
PubMed1994

Sexual abuse, adolescent pregnancy, and child abuse. A developmental approach to an intergenerational cycle.

OBJECTIVE: To elucidate the relationship between childhood sexual abuse and adolescent pregnancy. DATA SOURCE: Articles published in English during the past two decades and pertaining to the sequelae of childhood sexual abuse or the antecedents of adolescent pregnancy. STUDY SELECTION: Studies that did not contain data pertinent to the relationship between childhood sexual abuse and adolescent pregnancy were excluded. RESULTS: Studies suggest that former victims of childhood sexual abuse may be at increased risk for conception during adolescence and that adolescent pregnancies that are antedated by childhood sexual abuse are often only one manifestation of socially deviant behavior. CONCLUSIONS: Experiences associated with childhood sexual abuse may affect the incidence and the outcome of adolescent childbearing. Identification and treatment of previously abused adolescent prenatal patients may break this vicious intergenerational cycle of violence.

Adolescent↗
PubMed1994

Childhood victimization: relationship to adolescent pregnancy outcome.

Childhood sexual abuse is a common antecedents of adolescent pregnancy. We studied the pregnancies of 127 poor, black, 12- to 18-year-olds; 42 (33%) of whom reported that they had been physically or sexually abused prior to conception. We hypothesized that during pregnancy: (a) Previously abused adolescents report more stress and depression and less adequate social support than do nonabused adolescents; and (b) Previously abused adolescents obtain less prenatal care, gain less weight, engage in more substance abuse, and give birth to smaller babies than do nonabused adolescents. Consistent with the first study hypothesis, we found that abused adolescents scored significantly higher on stress and depression scales and rated their families as less supportive than did nonabused adolescents. Although there were no group differences in the rate of weight gain or the quantity of prenatal care obtained during pregnancy, abused adolescents were more likely to report substance use during pregnancy and gave birth to significantly smaller, (2,904 +/- 676 vs. 3,198 +/- 443 grams; p = .01), less mature (38.0 +/- 3.4 vs. 39.1 +/- 1.7 weeks; p = .05) infants. Our finding demonstrate the importance of asking pregnant adolescents about abuse.

Adolescent↗
PubMed1994

Incentives enhance postpartum compliance among adolescent prenatal patients.

OBJECTIVE: To test the hypothesis that incentives enhance compliance with postpartum appointments. METHOD: We studied a multiracial group of 240, poor, 12-to-19 year olds. At 34 weeks gestation consecutively enrolled patients were randomized to incentive and non-incentive groups. Patients in the incentive group were told that they would receive a Gerry "Cuddler" if they returned for an examination within 12 weeks of delivery. The groups were compared with Student's t-tests and chi-square and logistic regression analyses. RESULTS: We found no significant group differences in age, race, Medicaid status, gravidity, parity, the timing of the first prenatal visit, compliance with prenatal appointments, or well-baby care site. One hundred and seventy-five (73%) of the 240 patients returned for a postpartum examination. Patients randomized to the incentive group were significantly more likely to return for an examination within 12 weeks of delivery (82.4% vs. 65.2%, chi 2 = 9.0; p = .003). The logistic regression analysis revealed that in addition to membership in the incentive group, three characteristics were significantly associated with postpartum compliance: primiparity, compliance with prenatal care, and school enrollment. CONCLUSIONS: Among adolescents who obtained prenatal care in a multidisciplinary adolescent-oriented maternity program, the offer of an incentive significantly improved compliance with the 6-week postpartum appointment. Since other factors associated with improved postpartum compliance are less amenable to change we recommend that health care providers consider offering a postpartum incentive, especially to their multiparous adolescent patients who are not enrolled in school and/or are non-compliant with prenatal appointments.

Adolescent↗