Cost-effectiveness of a Motivational Intervention to Reduce Rapid Repeated Childbearing in High-Risk Adolescent Mothers

Barnet, Beth; Rapp, Thomas; DeVoe, Margo; Mullins, C. Daniel

doi:10.1001/archpediatrics.2010.16

Cited by 25 publications

(28 citation statements)

References 27 publications

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“…Despite the Barnet study showing no significant effectiveness on teenage conception rates (but showing some tentative effect on school dropout) the study did provide data on costs. 83 Overall, the mean cost per adolescent was US$2064, with unadjusted and adjusted ICERs per prevented birth of US$21,895 and US$17,388, respectively. The authors concluded that the costs and cost-effectiveness ratios associated with CAMI compare favourably with other effective programmes aimed at pregnancy prevention, although the evidence base is limited.…”

Section: Context and Populationmentioning

confidence: 98%

“…Using EPOC criteria, 52 we identified 13 individual RCTs 31,[78][79][80][81][82][83][84][85][86][87][88][89][90][91][92] (one study reported in three papers [82][83][84] and one in two papers 85,86 ), one cluster RCT 93 and two non-randomised trials [94][95][96] (one of which was reported in two publications 94,95 ) for potential inclusion in the meta-analysis. One of the 'trials'…”

Section: Studies Used In the Effectiveness Evaluationmentioning

confidence: 99%

“…We identified 14 RCTs that met our inclusion criteria 31,[78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93] and two studies that contained useful effectiveness evidence when EPOC criteria 52 were applied. One of the randomised trials 93 was a cluster randomised trial of poor quality and another was a large study that combined 12 smaller randomised and quasi-randomised studies on one multifactorial intervention into an RCT-style analysis.…”

Section: Studies Identifiedmentioning

confidence: 99%

“…ICERs were adjusted for age, prior birth, continuous insurance, history of sexually transmitted infection and contraceptive-use intentions during pregnancy using logistic regression analyses. Table 4 shows the unadjusted and adjusted ICERs of cost per prevented repeated birth, as calculated by Barnet et al,83 depending on the level of CAMI received.…”

Section: Cost-effectiveness Of a Psychosocial Interventionmentioning

confidence: 99%

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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

Whitaker¹,

Hendry

Aslam

et al. 2016

Health Technol Assess

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BackgroundThe 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.ObjectivesTo 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 sourcesWe 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 Medicadatabase), 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 methodsTo 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.ResultsWe 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.LimitationsIncluded 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.ConclusionsWe 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 registrationThis study is registered as PROSPERO CRD42012003168. Cochrane registration number: i=fertility/0068.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Context and Populationmentioning

confidence: 98%

Section: Studies Used In the Effectiveness Evaluationmentioning

confidence: 99%

Section: Studies Identifiedmentioning

confidence: 99%

Section: Cost-effectiveness Of a Psychosocial Interventionmentioning

confidence: 99%

See 2 more Smart Citations

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

Whitaker¹,

Hendry

Aslam

et al. 2016

Health Technol Assess

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“…30,31 Motivational interviewing can be used to address the ambivalence and discrepancies among adolescents' sexual and contraceptive behaviors, their sexual and relationship values, and future life goals. Key elements are (1) an empathetic and nonjudgmental interviewer with unconditional positive regard for the adolescent in a safe, nonthreatening environment; (2) engaging adolescents in their own behavior change; (3) asking adolescents about their goals, and helping them identify inconsistencies between their goals and current behavior; (4) "rolling with resistance," or avoiding direct confrontation when resistance is met, and waiting for adolescents to find their own answers rather than pointing them out; and (5) supporting adolescents' capacity to change.…”

Section: Counseling Using Motivational Interviewingmentioning

confidence: 99%

Contraception for Adolescents

Ott

Sucato²

2014

Pediatrics

234

133

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A working knowledge of contraception will assist the pediatrician in both sexual health promotion as well as treatment of common adolescent gynecologic problems. Best practices in adolescent anticipatory guidance and screening include a sexual health history, screening for pregnancy and sexually transmitted infections, counseling, and if indicated, providing access to contraceptives. Pediatricians’ long-term relationships with adolescents and families allow them to help promote healthy sexual decision-making, including abstinence and contraceptive use. Additionally, medical indications for contraception, such as acne, dysmenorrhea, and heavy menstrual bleeding, are frequently uncovered during adolescent visits. This technical report provides an evidence base for the accompanying policy statement and addresses key aspects of adolescent contraceptive use, including the following: (1) sexual history taking, confidentiality, and counseling; (2) adolescent data on the use and side effects of newer contraceptive methods; (3) new data on older contraceptive methods; and (4) evidence supporting the use of contraceptives in adolescent patients with complex medical conditions.

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Education for contraceptive use by women after childbirth

Lopez

Hiller

Grimes³

et al. 2012

Cochrane Database of Systematic Reviews

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Analysis 2.1. Comparison 2 Contraceptive information (one time): physician counseling versus video versus pamphlet, Outcome 1 Satisfied with 'counseling' after the session: video versus physician. . . . . . . . . . . . Analysis 2.2. Comparison 2 Contraceptive information (one time): physician counseling versus video versus pamphlet, Outcome 2 Satisfied with 'counseling' after the session: video versus written information. . . . . . . . . Analysis 3.1. Comparison 3 Contraceptive counseling (one time) versus no counseling, Outcome

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Cost-effectiveness of a Motivational Intervention to Reduce Rapid Repeated Childbearing in High-Risk Adolescent Mothers

Abstract: To determine the cost-effectiveness of an intervention that successfully reduced rapid repeated births within 2 years of an index birth to adolescent mothers.

Cited by 25 publications

References 27 publications

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

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

Contraception for Adolescents

Education for contraceptive use by women after childbirth

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