Very Young Adolescent Mothers and Delay of a Second Pregnancy ISPP ™ Very Young Adolescent Mothers and Delay of a Second Pregnancy Pat W. Mosena, Ph.D., Holly S. Ruch-Ross, Sc.D. and Suzanne G. McLone, M.P.H.

The Illinois Subsequent Pregnancy Program ISPP ™ The Illinois Subsequent Pregnancy Program A community-based program to delay second pregnancies among adolescent mothers. Begun as pilot project in Chicago 1990, implemented statewide 1994 –2007. Supported by Illinois Department of Human Services Program Goals: Delay a second pregnancy Use contraception correctly and consistently Remain in and graduate from high school There have been 3,000 participants in 30 communities 3% had second pregnancy, 85% graduated/remained in school

Subsequent Pregnancy Program Model Community Area Chicago Suburbs Small Cities Community-Based Social Service Agency Public Health Departments Community Health Center Agency Type Home Visitor On-going, long-term relationship with ISPP trained Home Visitor Year 1 Advisory Group Young first-time mothers from diverse communities brought together for training and peer support provided at bimonthly Advisory Group meetings Peer Education Intensive Summer Training Eight week summer Peer Education Training. Eligibility based upon attendance at monthly Advisory Group meetings Continuing Education Training Ongoing Peer Education training through bimonthly Peer Education meetings During the second year, ISPP Peer Educators begin to work in their own communities, talking about the “why” and “how” to delay a second pregnancy Year 2 Subsequent Pregnancy Program Model

Illinois Subsequent Pregnancy Program ISPP ™

ISPP Methods ™ Illinois Subsequent Pregnancy Program Data Collection Program Years 2001 to 2006 (6 Years) Data Collected and Reported by ISPP Home Visitor Participant characteristics at intake Services received by participant during course of program year (monthly reports) Early Exit from Program* Data Self-Reported by Participant: Questionnaire Completed at Year End – Contraceptive Use Data Analysis Data Entered into Microsoft Access Data Imported into and Analyzed Using SPSS 15.0 * Based upon exit form submitted by Home Visitor and/or date of last Home Visitor contact

Participant Characteristics, N=1191 Illinois Subsequent Pregnancy Program ISPP ™ Participant Characteristics, N=1191 n % Program Year of First-Year Participation (N=1191) 2000-2001 275 23.1 2001-2002 191 16.0 2002-2003 196 16.5 2003-2004 154 12.9 2004-2005 153 12.8 2005-2006 222 18.6 Participant Ethnicity (n=1088) African American 639 58.7 Mexican/ Mexican American 71 6.5 Caucasian, Not Hispanic 268 24.6 Puerto Rican 48 4.4 Other (Includes Bi- or Multi-Ethnic) 62 5.7 Participant Status at Intake (n=1135) Parenting 582 51.3 Pregnant 553 48.7

Participant Characteristics, N=1191 Illinois Subsequent Pregnancy Program ISPP ™ Participant Characteristics, N=1191 n % Participant Lives with Parent(s) (n=1117) 838 75.0 Participant’s Mother was an Adolescent Parent (n=1086) 515 47.4 Participant’s Sibling(s) was an Adolescent Parent (n=1088) 260 23.9 Participant and/or Participant’s Parent(s) Receives: TANF/AFDC (n=1055) 302 23.1 Medicaid (n=1096) 421 58.7 Social Security/SSI (n=1055) 56 5.3 Family’s Social/Emotional Support to Participant (n=1100) Rated “Very Good”/”Consistent” by Home Visitor 815 74.1 Father of Child’s Social/Emotional Support to Participant (n=1099) 535 48.7

Participant Characteristics, N=1191 Illinois Subsequent Pregnancy Program ISPP ™ Participant Characteristics, N=1191 n % School Status at Intake (n=1102) In School 892 80.9 Not in School 210 19.1 Was Participant Using Contraception at Intake (Non-Pregnant Only)?* (n=448) Yes 283 63.2 No 165 36.8 Had Participant EVER used Contraception?* (n=775) 752 97.0 23 3.0 Had Participant EVER used a Condom?* (n=573) 494 86.2 79 13.8 * Program Year 2005-2006 not included in analysis

Participant Characteristics, N=1191 Illinois Subsequent Pregnancy Program ISPP ™ Participant Characteristics, N=1191 Mean Age of Mother at Program Intake, Years (n=1054) 16.3 (Range: 12 to 22) Mean Age of Child at Program Intake, Months (n=479) 6.2 (Range: <1 to 49)

Services Received by Participant , N=1191 Illinois Subsequent Pregnancy Program ISPP ™ Services Received by Participant , N=1191 n % Participant Received Home Visiting Services (N=1191) Yes 1153 96.8 No 38 3.2 Participant Attended Group Meetings (N=1191) 704 59.1 487 40.9 Mean Number of Home Visitor Contacts (n=1153) 26.4 (Range: 1 to 234) Mean Number of Group Meetings Attended (n=704) 11.5 (Range: 1 to 75) Did Participant Complete the Program Year? (n=1133) 760 67.1 373 32.9

Participant Outcomes at Year End, n=692* Illinois Subsequent Pregnancy Program ISPP ™ Participant Outcomes at Year End, n=692* n % Participant Either In School or Graduated/Received GED (n=647) 553 85.5 Participant Was Sexually Active in Previous Month (n=664) 475 71.5 Of those sexually active in past month: Use of Condom at Last Intercourse (n=458) 372 81.2 No Unprotected Intercourse in Last Month (n=445) 409 91.9 Used Contraception Correctly (n=428) 408 95.3 * Number of participants who completed the program year (May 1st or later) and had year-end data on file

Very Young Participants: How they Differ from Their Older Counterparts Illinois Subsequent Pregnancy Program ISPP ™ Very Young Participants: How they Differ from Their Older Counterparts Significance levels: *** p<0.001; **p<0.01; * p<0.05; all two-tailed tests. Fisher’s Exact 2 test statistic used

Very Young Participants: How they Differ from Their Older Counterparts Illinois Subsequent Pregnancy Program ISPP ™ Very Young Participants: How they Differ from Their Older Counterparts Significance levels: *** p<0.001; **p<0.01; * p<0.05; all two-tailed tests. Independent sample t-test statistic used

Illinois Subsequent Pregnancy Program ISPP ™ Bivariate Analyses: School Status and Contraceptive Behavior at Year End by Maternal Age χ2 statistic used; No significant differences by maternal age

Illinois Subsequent Pregnancy Program ISPP ™ Bivariate Analyses: School Status and Contraceptive Behavior at Year End by Number of Individual Contacts Individual Contacts Significance levels: *** p<0.001; **p<0.01; * p<0.05; all two-tailed tests. Independent sample t-test statistic used

Illinois Subsequent Pregnancy Program ISPP ™ Bivariate Analyses: School Status and Contraceptive Behavior at Year End by Number of Group Meetings Attended Group Meetings Attended Significance levels: *** p<0.001; **p<0.01; * p<0.05; all two-tailed tests. Independent sample t-test statistic used

ISPP Key Findings ™ Illinois Subsequent Pregnancy Program ISPP participants who are very young (age 14 or less) DO NOT differ from older participants (age 15 or older): On perceived risk variables at program intake On test scores (pre or post) At Year–End, ISPP participants who are very young (age 14 or less) DO NOT differ from older participants (age 15 or older) on selected outcomes: School status No unprotected sex in last month (sexually active participants) Use of a condom at last sexual intercourse Participants who are very young DO differ from older ISPP participants in the amount of services received during program year: They have MORE individual contacts from their Home Visitor They attend MORE group meetings

Illinois Subsequent Pregnancy Program ISPP ™ Conclusions ISPP Home Visitors report that younger participants, those age 14 or less when they enter the program, are more “needy”, and require more of their time and effort than older participants, those age 15 and older at program intake. Results of the current analysis demonstrate that younger ISPP participants do require more intense service delivery; they have more individual contacts with their Home Visitor and they attend more Group Meetings. However, with intense service delivery, younger ISPP participants have year-end outcomes consistent with older participants. These findings support the efficacy of the Subsequent Pregnancy Program Model in meeting the individualized needs and achieving desired outcomes among young mothers participating in ISPP.