Holly S. Ruch-Ross, Sc.D. and Suzanne G. McLone, M.P.H. ISPP ™ Contraceptive Knowledge and Use of Contraception Among Adolescent Mothers Participating in the Illinois Subsequent Pregnancy Program 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

ISPP Methods ™ Program Data Measures Illinois Subsequent Pregnancy Program ISPP ™ Methods Program Data Four Years of Program Data: 2003 to 2006 Participant Characteristics Collected and Reported by ISPP Home Visitor Self-Reported Participant Questionnaires Measures Contraceptive Knowledge : Percent correct of questions asked (16 to 21 questions, updated yearly to reflect new contraceptive choices and to drop outdated methods) Contraceptive Behavior (yes/no responses): Anything Last Sex: The last time you had sex, did [you] do anything to keep from getting pregnant? Condom Last Sex : The last time you had sex, did your partner use a condom?

ISPP Methods ™ Data Collection Illinois Subsequent Pregnancy Program Self-administered participant questionnaires completed during group meeting Three time points: Baseline Contraceptive Knowledge Score Contraceptive Behavior Posttest (1 Month) Follow Up (6 Months)

Questionnaire Completion: Baseline, 1 Month and 6 Months Illinois Subsequent Pregnancy Program ISPP ™ Questionnaire Completion: Baseline, 1 Month and 6 Months Questionnaire Completion (N=239) n % Baseline and Posttest (1 Month) Only 98 41.0 Baseline , Posttest (1 Months) and Follow Up (6 Months) 141 59.0 There are no significant differences between the sample subsets with completed questionnaires at baseline and posttest (1 month) only (n=98) versus those with completed questionnaires at baseline, posttest (1 month) and follow up (6 months) (n=141) for the following variables: Age of mother at intake Participant status at intake (parenting vs. pregnant) Contraception Knowledge Scores (Baseline or Posttest) Contraceptive Behavior: Anything Last Sex, Condom Last Sex (Baseline or Posttest) The sample subsets did differ significantly on the following variable: Ethnicity: African Americans were more likely to have a follow up questionnaire on file Mexican Americans were less likely to have a follow up questionnaire on file

Participant Characteristics, N=239 Illinois Subsequent Pregnancy Program ISPP ™ Participant Characteristics, N=239

Participant Characteristics, N=239 Illinois Subsequent Pregnancy Program ISPP ™ Participant Characteristics, N=239

Participant Responses on Questionnaires, N=239 Illinois Subsequent Pregnancy Program ISPP ™ Participant Responses on Questionnaires, N=239 Contraceptive Knowledge Score, Baseline (% Correct) Mean: 46.2 Range: 10.0 to 100.0 Contraceptive Knowledge Score, Posttest (1 Month) (% Correct) Mean: 73.2 Range: 15.0 to 100.0 Change in Contraceptive Knowledge Score, Posttest (1 Month ) Mean: 27.1 Range: -24.0 to 76.0 Contraceptive Behavior Baseline Posttest, 1 Month Follow Up, 6 Months Used Contraception Last Sex Yes 57.0% 64.9% 81.4% n 228 225 129 Used a Condom Last Sex 54.8% 61.4% 74.0% 223 127

ISPP Change in Contraceptive Knowledge Score, Illinois Subsequent Pregnancy Program ISPP ™ Change in Contraceptive Knowledge Score, Baseline to Posttest (1 Month) (N=239) t = -19.66 p <0.001 Paired sample t-test statistic used

ISPP Changes in Contraceptive Behavior, Illinois Subsequent Pregnancy Program ISPP ™ Changes in Contraceptive Behavior, Baseline to Posttest (1 Month) (N=239) 2 = 97.26 p =0.002 2 = 5.354 p =0.002 McNemar 2 test statistic used

ISPP Changes in Contraceptive Behavior, Illinois Subsequent Pregnancy Program ISPP ™ Changes in Contraceptive Behavior, Baseline to Follow Up (6 Months) (n=141) 2 = 96.80 p =0.017 2 = 5.354 p =0.002 McNemar 2 test statistic used

Percent with a POSITIVE Illinois Subsequent Pregnancy Program ISPP ™ Bivariate Analyses: Changes in Contraceptive Knowledge Scores and Reported Contraceptive Behavior at Posttest (1 Month) and Follow Up (6 Months) Percent with a POSITIVE Change in Score 1 Mean Change of Score 2 Posttest (1 Month) Used Contraception , Any Method, at Last Sex 87.0 % 26.9 Did NOT Use Contraception at Last Sex 78.5 % 26.1 Used a Condom Last Sex 89.1 % * 29.4 Did NOT use a Condom Last Sex 77.9 % 23.6 Follow Up (6 Months) 87.6 % * 28.6 66.7 % 19.6 85.1 % 28.1 81.8 % 22.3 Significance levels: * p<0.05 1 Fisher’s Exact 2 test statistic used 2 Independent sample t-test statistic used

Illinois Subsequent Pregnancy Program ISPP ™ Logistic Regression Models: Contraceptive Behavior at Posttest (1 Month) and Follow Up (6 Months) Standardized  Coefficients Dependent Variables: Anything Last Sex, 1 Month Anything Last Sex, 6 Months Condom Last Sex, 1 Month Condom Last Sex, 6 Months Any Method/Condom Use at Baseline 70.79*** 4.78* 36.33*** 2.12 Participant Aged 14 and Younger 4.72 4.07 10.42* 4.82 Participant Aged 15 to 17 6.17 6.85* 2.75 3.43 Ethnicity (African American) 1.90 0.36 1.77 0.95 Ethnicity (Caucasian) 13.66 0.23 4.75 1.23 Ethnicity (Mexican American) 1.76 0.31 1.16 0.53 Ethnicity (Puerto Rican) 22.41 2E+008 16.47* 6E+008 Pregnant at Intake 0.89 0.43 0.69 0.71 Score at Baseline 1.00 0.99 Positive Change in Score (Yes) 1.83 5.46* 0.81 Adjusted (Nagelkerke) R2 0.64 0.33 0.58 0.14 2 for Model (df=10) 115.16*** 26.49** 103.31*** 10.90 n 189 114 110 Independent Variables: Significance levels: *** p<0.001; **p<0.01; * p<0.05; all two-tailed tests.

ISPP Key Findings ™ From Baseline to Follow Up (6 Months) Illinois Subsequent Pregnancy Program ISPP ™ Key Findings From Baseline to Posttest (1 Month) Reported contraceptive use increased among participants in the Subsequent Pregnancy Project: Participants increased their use of contraception (any method) at last sexual intercourse Participants increased their use of a condom at last sexual intercourse Contraceptive Knowledge increased among program participants From Baseline to Follow Up (6 Months) A positive change in Contraceptive Knowledge score is independently associated with use of contraception (any method) at last sexual intercourse

ISPP Conclusions ™ Illinois Subsequent Pregnancy Program These findings support the expected changes in contraceptive behavior among adolescent mothers participating in ISPP. After 6 months of program participation, there was in increase in the proportion of young mothers who: Used a method of contraception at last sexual intercourse Used a condom at last sexual intercourse The ISPP Program Model has been shown to consistently increase contraceptive use, across time and diverse populations of adolescents: In participants’ self-report (i.e. current analysis) Home Visitors’ report at the end of the program year Very low subsequent pregnancy rates for program participants (3%) Using Contraceptive Knowledge in an effort to assess a mechanism for behavior change among ISPP participants, we found: An increase in Contraceptive Knowledge at 1 month shows a positive association with contraceptive use at 6 months, controlling for other factors