- Email: [email protected]
Engaging Teen Moms in their Goals for the Future to Reduce Rapid Repeat Pregnancies
Poster Abstracts / 60 (2017) S83eS126
vaccine rates for >/¼ 1 dose of these vaccines. Likewise, reproductive health counseling and provision of effective contraception at adolescent well visits have been found to be suboptimal. The AAP emphasizes using the menstrual cycle as an additional vital sign in the assessment of normal development and the exclusion of pathological conditions. However, it is unclear if this is assessed consistently. The AAP/Bright Futures recommends screening for sexually activity and risk assessment, the evaluation of adolescent menstrual patterns, and the administration of eligible vaccines at each preventive care visit. The aim of this research project is to assess missed opportunities in the reproductive health care of adolescent females seen in pediatric primary care settings across three closely related domains: documentation of menstrual history, documentation of sexual activity status, and HPV vaccination. Methods: A retrospective chart review identified adolescent females aged 13 to 19 years who completed a Well Adolescent Visit at one of five pediatric clinics between July 1, 2014 and July 1, 2015. A total of 124 charts were reviewed. Researchers extracted age, race/ethnicity, insurance type, language spoken, documentation of sexual activity status, contraceptive use (past, present or prescribed at visit), pregnancy history, HPV vaccination records, assessment of menses, referrals for contraception, as well as orders for testing for sexually transmitted infections (STI) and pregnancy. Basic descriptive statistics were utilized in analyzing the data. Results: The demographics of our population are as follows: 73% black, 57% English speaking, 85% Medicaid insurance, with a median age 16.7 years at time of visit. There was no documentation of sexual activity in 24.2% of patients. Older adolescents (17-19 years old) had higher rates of documentation of sexually activity (83.1%) compared to adolescents aged 13-16 (69.2%). 43.5% completed the HPV vaccination series with 3 or more doses administered at the time of the visit. Of those eligible to receive the vaccine at the time of visit, 56% received the vaccine. Menstrual cycle characteristics were recorded in 21% of the visits. Only 15.3% of our population had documentation on sexual activity, menstrual characteristics, and completed or received the HPV vaccine at the time of visit if eligible. Of patients documented as sexually active, 66.7% had documentation on condom use, 63% were tested for STIs and only 10% of sexually active teens not using hormonal contraception had an order or prescription for contraception placed at the visit. Referrals for contraception were rarely made. Conclusions: Our findings highlight deficiencies in provision of routine reproductive health care in the primary care pediatric setting. Sources of Support: Unfunded. 206. “WHEN THE RIGHT TIME IS NOT RIGHT NOW”: EXPLORING PREGNANCY AMBIVALENCE & CONTRACEPTIVE BEHAVIORS AMONG HIGHRISK YOUTHS Cameron D. Nereim, MD 1, DeAnne Turner, MPH 2, Diane Straub, MD, MPH 2, Cheryl Vamos, PhD 2, Ellen Daley, PhD 2, Nancy Romero-Daza, PhD 3, Stephanie Marhefka, PhD 2. 1
University of South Florida Morsani College of Medicine; 2University of South Florida College of Public Health; 3University of South Florida College of Arts and Sciences. Purpose: Many young women inconsistently use contraception. Some pro-contraceptive approaches assume that young women do not desire pregnancy. This study used mixed methods to examine
S111
factors affecting inconsistent contraception use among young women with unclear pregnancy intentions. Methods: Participant recruitment occurred at a family planning/ STI clinic serving people aged 13 to 25. Eligible women consented for up to three assessments: an ACASI survey, semi-structured interviews, and chart review. Semi-structured interviews were 3060 minutes, during which participants recounted personal experiences. Data were analyzed thematically. Medical record reviews were conducted approximately six months later to determine contraceptive behaviors and outcomes. Results: 101 women (ages 15 to 25; 41% Black, 39% White, and 37% Hispanic) participated in the baseline survey. When measured broadly (conflicting reports between desire to become pregnant, avoid pregnancy, and contraceptive behaviors) pregnancy ambivalence was high, affecting 93.6% of participants. Of the participants who reported a casual sex partner (n¼64), 28% reported using a hormonal or long-lasting form of birth control; 50% had used condoms at last sex. Of the participants who reported having a main sex partner (n¼94), 55% reported using a hormonal or longlasting form of birth control; 32% used condoms at last sex with this partner. Thirty women participated in the follow-up interviews to further explain the findings. Participants noted concerns regarding specific types of contraceptive methods; for example, when discussing IUDs women noted a fear of having a contraceptive method that was inside of them, some stating that it felt less safe than oral birth control pills. Some women noted a misunderstanding of regulations surrounding access to contraception, such as stating contraception could not be obtained as a minor or noting that young women were not aware of places to obtain contraception free of charge. At the time of chart review, participants indicated contraceptive behaviors consistent with being ambivalent toward pregnancy. Among participants who had any follow-up chart information available for the last 6 months (from our clinic or partner clinics; n¼85), 71% had used any hormonal or long-lasting method of birth control; 7% had used more than one method. Among participants for whom sufficient data existed to determine consistency of birth control use (n¼43), 40% indicated inconsistent use during the prior 6-months; 14% had completely stopped using birth control. Among participants with follow-up STI testing available (n¼49), 25% had acquired an STI between the first study visit and 6-month chart review. Conclusions: The young women in our sample demonstrated high rates of ambivalence about pregnancy, which was reflected in their inconsistent use of contraception, both at baseline and at follow up. Factors affecting contraceptive use are complicated, and may sometimes be rooted in misunderstandings, desire for a child, or fear. Public health professionals must be open to having frank conversations with young women, even if conversations include women openly reporting a desire to become pregnant. Sources of Support: USF Women’s Health Collaborative Grant. 207. ENGAGING TEEN MOMS IN THEIR GOALS FOR THE FUTURE TO REDUCE RAPID REPEAT PREGNANCIES Leslie F. Clark, PhD 1, Mona Desai, MPH 1, Frances Juliana Cordero, MPH 1, Pamela Drake, PhD 2, Vivian Okonta, PhD 1, Jill Glasman, PhD 2, Susan C. Potter, MS 2. 1
Children’s Hospital Los Angeles; 2ETR Associates.
S112
Poster Abstracts / 60 (2017) S83eS126
Purpose: One in five teen mothers will go on to have a subsequent birth while still in their teens. Teen mothers who have repeat births are less likely to receive prenatal care, complete school, work or maintain economic self-sufficiency, and have children who are ready for school. They are also more likely to experience preterm delivery, receive federal benefits, and have children with emotional and behavioral problems. AIM 4 Teen Moms is an adaptation of an innovative evidence based intervention (Project AIM “Adult Identity Mentoring”) to lower sexual risk among youth in poverty. This adaptation provides a targeted intervention to promote long-term contraceptive use and delay rapid repeat pregnancies among teen mothers. The project used an eight-session program targeting new teen mothers in the Los Angeles County. Seven of the sessions were delivered one-on-one and 2 of the sessions were delivered in a group setting. AIM 4 Teen Moms is based on the Theory of Possible Selves and engages teen mothers in planning for the future around a desired occupational goal (i.e. a positive possible future self). Preliminary outcome analysis examined the unprotected sex in the last 3 months and repeat pregnancies since the birth of the index child as well as the age of the teen mother as a moderator of intervention effects. Methods: A total of 949 participants took part in the AIM 4 Teen Moms (AIM4TM) program. 475 participants were part of the control group and 474 were in the treatment group that received the AIM4TM program. Three hundred and four of the AIM4TM participants completed 5 out of 8 sessions due in part to low group session attendance. Seven hundred and ninety-eight participants were included in the 12 month interim analyses; 84% of those who completed baseline. Results: The interaction of age of mother and participation in AIM4TM on unprotected sex was significant at p<.05 indicating that among respondents who were 17 years or younger when they had their first child, those in the comparison group were 1.72 times more likely than the treatment group to have unprotected sex in the last 3 months. Analyses of repeat pregnancies indicated that participants in the control condition were 1.45 (p¼.06) times more likely to have had a repeat pregnancy by the 12-month follow-up than AIM4TM participants. A significant interaction showed that among participants 17 and under, those in the intervention condition were 1.81 (p¼.01) times more likely to have had a repeat pregnancy at the 12month follow-up than participants in the control condition; among participants 18 and older the AOR was 0.78 (p¼.90). Conclusions: By fostering a positive vision of the future, AIM4TM encourages the formation of adult identities that benefit from family planning behaviors to protect against a rapid repeat pregnancy. AIM4TM addresses personal barriers to contraception use and promotes both problem-focused coping and achievement motivation. Preliminary analyses indicate that AIM4TM is a promising program to reduce rapid repeat pregnancies among adolescent mothers, especially those 17 years old and younger. Sources of Support: Funded by Administration for Children, & Families (Grant# 90AP2674). 208. THE ASSOCIATION BETWEEN ADOLESCENT MEN’S DAILY ACADEMIC BEHAVIOR, SUBSTANCE USE AND SEXUAL BEHAVIORS Brandon Sorge, PhD 1, Devon Hensel, PhD 2. 1
Indiana University Purdue University Indianapolis; 2Indiana University School of Medicine.
Purpose: Emerging literature suggests that adolescent men’s academic experiences may link to the types of emotional and behavioral outcomes they experience in their romantic/sexual relationships. The majority of existing literature, however, relies on retrospective and/or cross-sectional data, limiting understanding of how and when the association between academic and relationship-based experiences could vary over different days. Methods: Diary data were from a longitudinal cohort study of young men’s sexual health and sexual relationships (N¼72; 14 to 17 years; 60% African American). Academic behaviors were (both partner-specific, no/yes): skipped school and did homework. Substance use behaviors were (all no/yes): solo use (alcohol and/or marijuana use), any partnered use (any alcohol and/or marijuana use), smoked a cigarette. Sexual behaviors were (all partner-specific, no/yes): any kissing or hand holding, manual-genital sex (partner-specific: given or received), oral-genital sex (given or received), vaginal sex and insertive anal sex. Daily emotions were: positive mood (4-item additive index; alpha¼0.95), negative mood (4-item additive index; alpha¼0.93), feeling in love (single, 10-point item), sexual interest (single, 10-point item, relationship-satisfaction (single, 10-point item), partner support (4-item additive index; alpha¼0.95) and partner negativity (4-item index; alpha¼0.95). Chi-square assessed behavior prevalence on days when academic behaviors did and did not occur; random intercept mixed effects linear (continuous outcomes) or logistic (categorical outcomes) regression evaluated daily emotions mean differences when academic behaviors did and did not occur. All models controlled for participant age and relationship length (Stata v.13; all p<.05). Results: Participants contributed 1703 partner-specific diaries (8.5% [N¼145)] doing homework with a partner; 3.2% [N¼55] skipping school with a partner). Doing homework with a partner was associated with significantly less frequent cigarette use (Table 1: 11.95% vs. 2.76%; p<.01), solo substance use (8.54% vs. 1.38%; p<.001), kissing/hand holding (64.86% vs. 55.16%; p<.05) and manual-genital sex (23.38% vs. 9.66%; p<.05). Skipping school with a partner was associated with significantly more frequent cigarette use (0% vs. 11.51%; p<.05), solo substance use (1.96% vs. 8.12%; p<.001), kissing/hand holding (63.05% vs. 96.08%; p<.001), manual-genital and oral-genital sex (21.38% vs. 62.63%; 7.94% vs. 21.57%; both p<.001) and vaginal sex (11.14% vs. 56.86%; p<.001). Doing homework with a partner was associated with significantly higher levels of positive mood (b¼0.24; p<.05), relationship satisfaction (OR¼2.37; p<.001) and feeling in love (OR¼1.62; p<.01). Skipping school with a partner was linked to significantly lower positive mood (b¼-0.56; p<.01), relationship satisfaction (OR¼0.54; p<.001) and higher negative mood (b¼0.33; p<.05), feeling in love (OR¼2.45; p<.001), sexual interest (OR¼2.56; p<.001), partner support (b¼0.35; p<.05) and partner negativity (b¼0.43; p<.01). Conclusions: Young men’s daily partnered academic experiences intersect with his daily solo substance use behaviors, with the types of coital and non-coital behaviors he engages with a partner, and the way he feels about a partner. Sexual risk interventions may consider the larger context in which an adolescent spends time with his partner. Sources of Support: NIH U19AI43924.
vaccine rates for >/¼ 1 dose of these vaccines. Likewise, reproductive health counseling and provision of effective contraception at adolescent well visits have been found to be suboptimal. The AAP emphasizes using the menstrual cycle as an additional vital sign in the assessment of normal development and the exclusion of pathological conditions. However, it is unclear if this is assessed consistently. The AAP/Bright Futures recommends screening for sexually activity and risk assessment, the evaluation of adolescent menstrual patterns, and the administration of eligible vaccines at each preventive care visit. The aim of this research project is to assess missed opportunities in the reproductive health care of adolescent females seen in pediatric primary care settings across three closely related domains: documentation of menstrual history, documentation of sexual activity status, and HPV vaccination. Methods: A retrospective chart review identified adolescent females aged 13 to 19 years who completed a Well Adolescent Visit at one of five pediatric clinics between July 1, 2014 and July 1, 2015. A total of 124 charts were reviewed. Researchers extracted age, race/ethnicity, insurance type, language spoken, documentation of sexual activity status, contraceptive use (past, present or prescribed at visit), pregnancy history, HPV vaccination records, assessment of menses, referrals for contraception, as well as orders for testing for sexually transmitted infections (STI) and pregnancy. Basic descriptive statistics were utilized in analyzing the data. Results: The demographics of our population are as follows: 73% black, 57% English speaking, 85% Medicaid insurance, with a median age 16.7 years at time of visit. There was no documentation of sexual activity in 24.2% of patients. Older adolescents (17-19 years old) had higher rates of documentation of sexually activity (83.1%) compared to adolescents aged 13-16 (69.2%). 43.5% completed the HPV vaccination series with 3 or more doses administered at the time of the visit. Of those eligible to receive the vaccine at the time of visit, 56% received the vaccine. Menstrual cycle characteristics were recorded in 21% of the visits. Only 15.3% of our population had documentation on sexual activity, menstrual characteristics, and completed or received the HPV vaccine at the time of visit if eligible. Of patients documented as sexually active, 66.7% had documentation on condom use, 63% were tested for STIs and only 10% of sexually active teens not using hormonal contraception had an order or prescription for contraception placed at the visit. Referrals for contraception were rarely made. Conclusions: Our findings highlight deficiencies in provision of routine reproductive health care in the primary care pediatric setting. Sources of Support: Unfunded. 206. “WHEN THE RIGHT TIME IS NOT RIGHT NOW”: EXPLORING PREGNANCY AMBIVALENCE & CONTRACEPTIVE BEHAVIORS AMONG HIGHRISK YOUTHS Cameron D. Nereim, MD 1, DeAnne Turner, MPH 2, Diane Straub, MD, MPH 2, Cheryl Vamos, PhD 2, Ellen Daley, PhD 2, Nancy Romero-Daza, PhD 3, Stephanie Marhefka, PhD 2. 1
University of South Florida Morsani College of Medicine; 2University of South Florida College of Public Health; 3University of South Florida College of Arts and Sciences. Purpose: Many young women inconsistently use contraception. Some pro-contraceptive approaches assume that young women do not desire pregnancy. This study used mixed methods to examine
S111
factors affecting inconsistent contraception use among young women with unclear pregnancy intentions. Methods: Participant recruitment occurred at a family planning/ STI clinic serving people aged 13 to 25. Eligible women consented for up to three assessments: an ACASI survey, semi-structured interviews, and chart review. Semi-structured interviews were 3060 minutes, during which participants recounted personal experiences. Data were analyzed thematically. Medical record reviews were conducted approximately six months later to determine contraceptive behaviors and outcomes. Results: 101 women (ages 15 to 25; 41% Black, 39% White, and 37% Hispanic) participated in the baseline survey. When measured broadly (conflicting reports between desire to become pregnant, avoid pregnancy, and contraceptive behaviors) pregnancy ambivalence was high, affecting 93.6% of participants. Of the participants who reported a casual sex partner (n¼64), 28% reported using a hormonal or long-lasting form of birth control; 50% had used condoms at last sex. Of the participants who reported having a main sex partner (n¼94), 55% reported using a hormonal or longlasting form of birth control; 32% used condoms at last sex with this partner. Thirty women participated in the follow-up interviews to further explain the findings. Participants noted concerns regarding specific types of contraceptive methods; for example, when discussing IUDs women noted a fear of having a contraceptive method that was inside of them, some stating that it felt less safe than oral birth control pills. Some women noted a misunderstanding of regulations surrounding access to contraception, such as stating contraception could not be obtained as a minor or noting that young women were not aware of places to obtain contraception free of charge. At the time of chart review, participants indicated contraceptive behaviors consistent with being ambivalent toward pregnancy. Among participants who had any follow-up chart information available for the last 6 months (from our clinic or partner clinics; n¼85), 71% had used any hormonal or long-lasting method of birth control; 7% had used more than one method. Among participants for whom sufficient data existed to determine consistency of birth control use (n¼43), 40% indicated inconsistent use during the prior 6-months; 14% had completely stopped using birth control. Among participants with follow-up STI testing available (n¼49), 25% had acquired an STI between the first study visit and 6-month chart review. Conclusions: The young women in our sample demonstrated high rates of ambivalence about pregnancy, which was reflected in their inconsistent use of contraception, both at baseline and at follow up. Factors affecting contraceptive use are complicated, and may sometimes be rooted in misunderstandings, desire for a child, or fear. Public health professionals must be open to having frank conversations with young women, even if conversations include women openly reporting a desire to become pregnant. Sources of Support: USF Women’s Health Collaborative Grant. 207. ENGAGING TEEN MOMS IN THEIR GOALS FOR THE FUTURE TO REDUCE RAPID REPEAT PREGNANCIES Leslie F. Clark, PhD 1, Mona Desai, MPH 1, Frances Juliana Cordero, MPH 1, Pamela Drake, PhD 2, Vivian Okonta, PhD 1, Jill Glasman, PhD 2, Susan C. Potter, MS 2. 1
Children’s Hospital Los Angeles; 2ETR Associates.
S112
Poster Abstracts / 60 (2017) S83eS126
Purpose: One in five teen mothers will go on to have a subsequent birth while still in their teens. Teen mothers who have repeat births are less likely to receive prenatal care, complete school, work or maintain economic self-sufficiency, and have children who are ready for school. They are also more likely to experience preterm delivery, receive federal benefits, and have children with emotional and behavioral problems. AIM 4 Teen Moms is an adaptation of an innovative evidence based intervention (Project AIM “Adult Identity Mentoring”) to lower sexual risk among youth in poverty. This adaptation provides a targeted intervention to promote long-term contraceptive use and delay rapid repeat pregnancies among teen mothers. The project used an eight-session program targeting new teen mothers in the Los Angeles County. Seven of the sessions were delivered one-on-one and 2 of the sessions were delivered in a group setting. AIM 4 Teen Moms is based on the Theory of Possible Selves and engages teen mothers in planning for the future around a desired occupational goal (i.e. a positive possible future self). Preliminary outcome analysis examined the unprotected sex in the last 3 months and repeat pregnancies since the birth of the index child as well as the age of the teen mother as a moderator of intervention effects. Methods: A total of 949 participants took part in the AIM 4 Teen Moms (AIM4TM) program. 475 participants were part of the control group and 474 were in the treatment group that received the AIM4TM program. Three hundred and four of the AIM4TM participants completed 5 out of 8 sessions due in part to low group session attendance. Seven hundred and ninety-eight participants were included in the 12 month interim analyses; 84% of those who completed baseline. Results: The interaction of age of mother and participation in AIM4TM on unprotected sex was significant at p<.05 indicating that among respondents who were 17 years or younger when they had their first child, those in the comparison group were 1.72 times more likely than the treatment group to have unprotected sex in the last 3 months. Analyses of repeat pregnancies indicated that participants in the control condition were 1.45 (p¼.06) times more likely to have had a repeat pregnancy by the 12-month follow-up than AIM4TM participants. A significant interaction showed that among participants 17 and under, those in the intervention condition were 1.81 (p¼.01) times more likely to have had a repeat pregnancy at the 12month follow-up than participants in the control condition; among participants 18 and older the AOR was 0.78 (p¼.90). Conclusions: By fostering a positive vision of the future, AIM4TM encourages the formation of adult identities that benefit from family planning behaviors to protect against a rapid repeat pregnancy. AIM4TM addresses personal barriers to contraception use and promotes both problem-focused coping and achievement motivation. Preliminary analyses indicate that AIM4TM is a promising program to reduce rapid repeat pregnancies among adolescent mothers, especially those 17 years old and younger. Sources of Support: Funded by Administration for Children, & Families (Grant# 90AP2674). 208. THE ASSOCIATION BETWEEN ADOLESCENT MEN’S DAILY ACADEMIC BEHAVIOR, SUBSTANCE USE AND SEXUAL BEHAVIORS Brandon Sorge, PhD 1, Devon Hensel, PhD 2. 1
Indiana University Purdue University Indianapolis; 2Indiana University School of Medicine.
Purpose: Emerging literature suggests that adolescent men’s academic experiences may link to the types of emotional and behavioral outcomes they experience in their romantic/sexual relationships. The majority of existing literature, however, relies on retrospective and/or cross-sectional data, limiting understanding of how and when the association between academic and relationship-based experiences could vary over different days. Methods: Diary data were from a longitudinal cohort study of young men’s sexual health and sexual relationships (N¼72; 14 to 17 years; 60% African American). Academic behaviors were (both partner-specific, no/yes): skipped school and did homework. Substance use behaviors were (all no/yes): solo use (alcohol and/or marijuana use), any partnered use (any alcohol and/or marijuana use), smoked a cigarette. Sexual behaviors were (all partner-specific, no/yes): any kissing or hand holding, manual-genital sex (partner-specific: given or received), oral-genital sex (given or received), vaginal sex and insertive anal sex. Daily emotions were: positive mood (4-item additive index; alpha¼0.95), negative mood (4-item additive index; alpha¼0.93), feeling in love (single, 10-point item), sexual interest (single, 10-point item, relationship-satisfaction (single, 10-point item), partner support (4-item additive index; alpha¼0.95) and partner negativity (4-item index; alpha¼0.95). Chi-square assessed behavior prevalence on days when academic behaviors did and did not occur; random intercept mixed effects linear (continuous outcomes) or logistic (categorical outcomes) regression evaluated daily emotions mean differences when academic behaviors did and did not occur. All models controlled for participant age and relationship length (Stata v.13; all p<.05). Results: Participants contributed 1703 partner-specific diaries (8.5% [N¼145)] doing homework with a partner; 3.2% [N¼55] skipping school with a partner). Doing homework with a partner was associated with significantly less frequent cigarette use (Table 1: 11.95% vs. 2.76%; p<.01), solo substance use (8.54% vs. 1.38%; p<.001), kissing/hand holding (64.86% vs. 55.16%; p<.05) and manual-genital sex (23.38% vs. 9.66%; p<.05). Skipping school with a partner was associated with significantly more frequent cigarette use (0% vs. 11.51%; p<.05), solo substance use (1.96% vs. 8.12%; p<.001), kissing/hand holding (63.05% vs. 96.08%; p<.001), manual-genital and oral-genital sex (21.38% vs. 62.63%; 7.94% vs. 21.57%; both p<.001) and vaginal sex (11.14% vs. 56.86%; p<.001). Doing homework with a partner was associated with significantly higher levels of positive mood (b¼0.24; p<.05), relationship satisfaction (OR¼2.37; p<.001) and feeling in love (OR¼1.62; p<.01). Skipping school with a partner was linked to significantly lower positive mood (b¼-0.56; p<.01), relationship satisfaction (OR¼0.54; p<.001) and higher negative mood (b¼0.33; p<.05), feeling in love (OR¼2.45; p<.001), sexual interest (OR¼2.56; p<.001), partner support (b¼0.35; p<.05) and partner negativity (b¼0.43; p<.01). Conclusions: Young men’s daily partnered academic experiences intersect with his daily solo substance use behaviors, with the types of coital and non-coital behaviors he engages with a partner, and the way he feels about a partner. Sexual risk interventions may consider the larger context in which an adolescent spends time with his partner. Sources of Support: NIH U19AI43924.