Original Study
Strategically Timed Preventive Education and Media Strategies Reduce Seasonal Trends in Adolescent Conception

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Abstract

Study Objective

This study sought to analyze the effect of strategically timed local preventive education on reducing teen conception rates during known seasonal peaks in March and April.

Design

All teen conceptions (age ≤ 19) from March and April 2010, 2011, and 2012 were identified using medical records data. Teen conceptions occurring in January 2010, 2011, and 2012 were also identified to control for any new trends in the community.

Setting

A city of 160,000 with 1 tertiary care centre.

Participants

Pregnant adolescents (age ≤ 19).

Interventions

During the month of February 2012, preventive education and media awareness strategies were aimed at parents, teachers, and teens.

Main Outcome Measures

Adolescent conceptions in March and April 2012.

Results

Conception rates in teens ≤18 years old were significantly reduced in March and April 2012 compared to March and April 2010 and 2011 (RR = 0.53, 95% CI = 0.32 - 0.88, P = .0132). There was an increase in conceptions in March and April 2012 compared to 2010 and 2011 among 19-year-olds (RR = 1.57, 95% CI = 0.84-2.9, P = .1500). Effect modification revealed our ≤18-year-old group and our 19-year-old group were distinct groups with different risk estimates (P = .0075).

Conclusions

Educational sessions were poorly attended and contraception clinic volume was static. We propose increased parental supervision in response to media reminders as a possible explanation for the reduction in adolescent conceptions (≤18 years old) seen in March 2012.

Introduction

Despite the overall decline in teenage pregnancy rates in industrialized nations such as Canada, the U.S., England, and Wales,1 adolescent childbearing continues to be an important health determinant for both teen mothers and their offspring. Teen conception rates in Canada (including births, miscarriages, and induced abortions) were reported to be 24.6/1000 in 2005.2 In the U.S., teenage pregnancy rates continue be more than double those of Canada despite numerous efforts to decrease the occurrence.1, 3

The adverse outcomes associated with adolescent pregnancy have been established.3 Teen mothers are more likely to attend an inadequate number of prenatal care visits4 and are less likely to take folic acid prior to their pregnancy.5 Teen mothers are also at a higher risk of gaining an inadequate amount of weight during their pregnancy4 and have lower breastfeeding initiation rates and duration.5 Adolescent mothers are more likely to develop mental health problems such as depression5, 6 and are at a higher risk of experiencing partner violence including physical and/or sexual abuse in their lifetime.5, 7 Furthermore, teenage mothers tend to have a lower socioeconomic status6, 7 and are more likely to be single parents.7

Children of adolescent mothers have been shown to have an increased risk of death during infancy, school-aged years, and adolescence, as well as an increased risk of hospitalization.8 They have also been shown to have poorer educational achievement,8, 9 lower socioeconomic outcomes,8, 9 and decreased life satisfaction.9

Seasonal trends in conception rates have been established in both adult and adolescent populations in North America.10, 11, 12, 13, 14 When investigating adolescent conception trends in a university and military town in Ontario, Canada, Turnbull et al11 identified a significant and consistent seasonal peak in adolescent conceptions (age ≤ 18) during the month of March that was not seen among adults in this community; this finding was consistent for 5 consecutive years (2004 - 2008). The aforementioned peak in adolescent conceptions was termed the “March Break Phenomenon” by local and national media who postulated that the spike in teen pregnancies could be due to a lack of supervision and an increase in risk taking behavior during Spring Break (occurring in March).

Numerous preventive education strategies have been shown to be effective in reducing adolescent conceptions in various communities.15, 16, 17, 18 Timing such strategies to reduce seasonal peaks in conception has yet to be investigated. The present study sought to analyze the effect of strategically timed local preventive education on reducing school-aged Canadian teen conceptions during the known seasonal peak in March, and identify any lingering benefit in April. This study took place in the same community described by Turnbull et al.11

Section snippets

Methods

This study was conducted in a university and military town of approximately 160,000 in Ontario, Canada (Statistics Canada, 2011). This community has 2 sister hospitals, one of which is a tertiary care centre, which share an electronic patient care system that tracks utilization data from both sites. The health care system in Canada is publicly funded including access to gynecologic, prenatal, and obstetrical care. There were no recognizable changes of access to care over the study period.

During

Results

A total of 134 adolescents (age ≤ 18) and 41 adolescents (age = 19) conceived during our study periods of interest; see Table 2, Table 3. Total annual adolescent conceptions (age ≤18) were 159 in 2010, 162 in 2011, and 137 in 2012. At least 1 visit was required to identify conceptions in this study.

As previously described, preventive education and awareness strategies aimed at parents, teachers, and teens in February 2012 consisted of a targeted media campaign, educational sessions, and

Discussion

Following the timed media awareness intervention, there was a significant decrease in March and April 2012 conceptions among teens ≤ 18 years old compared to previous years (2010, 2011) when no preventive education or media awareness strategies were offered.

Despite efforts to publicize educational sessions and the extended availability of family planning clinics, there was no increase in clinical volume in any of the walk-in contraception clinics offered in February and early March 2012.

Acknowledgments

We would like to thank data analyst David Barber and statisticians Wilma Hopman and Andrew Day for their help with this study. We would also like to thank KFLA Public Health and the Limestone District School Board.

References (18)

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The author indicates no conflict of interest.

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