National Center for Education in Maternal and Child Health
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December 23, 2004
1. Tools Designed to Help Assess MCH Program Capacity to
Support Adolescent Health
2. Brief Highlights Findings About Adolescents'
Perspectives on Relationships with Parents
3. Fact Sheets Report Trends on Sexual Activity,
Contraceptive Use, and Childbearing Among Adolescents and Women
4. Longitudinal Study Examines Adolescent Pregnancy
Intentions and Pregnancy Outcomes
5. Article Assesses Outcomes Associated with a Trial of
Labor After Cesarean Delivery
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Readers: MCH Alert will not be published for the next 2 weeks. The next
issue is scheduled for January 14, 2005. Happy holidays!
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1. TOOLS DESIGNED TO HELP ASSESS MCH PROGRAM CAPACITY TO SUPPORT
ADOLESCENT HEALTH
System Capacity for Adolescent Health: Public Health Improvement Tool
is a set of tools designed to assist states in assessing six areas of
capacity to support effective adolescent health programs. The System
Capacity project and tools are a collaborative effort of the
Association of Maternal and Child Health Programs and the State
Adolescent Health Coordinators Network (SAHCN), with support from the
Annie E. Casey Foundation. The project Web site contains an overview,
capacity assessment tools and instructions, action planning guidance,
and an online evaluation of Web resources. Information on technical
assistance and resource colleagues, a conceptual framework for
adolescent health, and related links and resources are also presented.
Forthcoming materials include a facilitator's guide, evaluation
guidance, a best practices collection form, a sample agenda, lessons
learned, and tool adaptations for local use. The Web site is available
at http://www.amchp.org/syscap/index.php.
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2. BRIEF HIGHLIGHTS FINDINGS ABOUT ADOLESCENTS' PERSPECTIVES ON
RELATIONSHIPS WITH PARENTS
Parent-Teen Relationships and Interactions: Far More Positive Than Not
brings together recent results of a nationally representative survey of
U.S. adolescents about the nature of their relationships with their
parents and findings from studies on the parent-adolescent bond. The
research brief, published by Child Trends, presents information on
adolescent perspectives based on data from interviews of the 1997
cohort from the National Longitudinal Survey of Youth (NLSY). The brief
includes a discussion of the NLSY findings, implications, and
conclusion. Findings from research examining the relationship between
five types of parent-adolescent interactions and student literacy
across 21 industrialized countries are also presented. The brief is
available at http://en.groundspring.org/EmailNow/pub.php?module=URLTracker&cmd=track&j=15973920&u=144702.
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3. FACT SHEETS REPORT TRENDS ON SEXUAL ACTIVITY, CONTRACEPTIVE USE, AND
CHILDBEARING AMONG ADOLESCENTS AND WOMEN
"There is little evidence in the report that adults as a whole are
using more effective methods [of contraception] in 2002 than they were
in 1991, but teen contraceptive use has become more effective since
1995," state the authors of Use of Contraception and Use of Family
Planning Services in the United States: 1982-2002. The fact sheet is
one of two recently released from the National Survey of Family Growth
(NSFG), a periodic nationwide survey of adolescents, women, and men
ages 15-44 on a range of behaviors including sexual activity,
contraceptive use, pregnancy, and birth. The fact sheets are based on
two NSFG reports recently published by the National Center for Health
Statistics.
Researchers conducted interviews with 12,571 adolescents, men, and
women in 2002 (N=7,543 females). The purpose of the analysis was to
describe trends and group differences in contraceptive use and use of
family planning services from 1982 through 2002.
The authors found that
- Contraceptive use is virtually universal in the United States.
- Ninety-eight percent of women have used one or more methods of
contraception, and a large majority of women have used the pill and the
male condom.
- The condom is the leading contraceptive method at first
intercourse, and its use at first intercourse has been rising steadily
over the last 20 years.
- The pill is the leading contraceptive method among young women,
and female sterilization is the leading method among women over age 35.
- There are large differences in contraceptive use by age,
education, race, marital status and other characteristics.
The second fact sheet, Teenagers in the United States: Sexual Activity,
Contraceptive Use, and Childbearing, 2002, describes sexual activity,
contraceptive use, and births among males and females ages 15-19 in
1988, 1995, and 2002.
The authors found that
- Adolescents in 2002 delayed first intercourse for longer than
adolescents in 1995.
- Adolescents in 2002 used contraceptives more often than
adolescents in 1995.
- Trends in sexual activity and contraceptive use as measured from
1995 through 2002 are consistent with the downward trend in pregnancies
and births to adolescents that has been observed since 1991.
The fact sheets, along with the full reports, are available at http://www.cdc.gov/nchs/nsfg.htm.
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4. LONGITUDINAL STUDY EXAMINES ADOLESCENT PREGNANCY INTENTIONS AND
PREGNANCY OUTCOMES
"Although both planning and likelihood have been considered means by
which pregnancy 'intentions' are measured, it is clear that they do not
represent unitary constructs to adolescent females before conception,"
state the authors of an article published in the December 2004 issue of
the Journal of Adolescent Health. Understanding adolescents' pregnancy
intentions before conception may help identify targets for intervention
to prevent adolescent pregnancy. The article describes a prospective
study of nonpregnant adolescents to estimate the value of pregnancy
intention (characterized by pregnancy plans and likelihood) in
predicting actual pregnancy.
Data were collected as part of a larger study examining perceived risk
of sexually transmitted diseases (STDs), perceived risk of pregnancy,
and sexual decision-making. Eligible participants included female
adolescents ages 14-19 who reported having had intercourse in the
preceding 3 months (N=388). Baseline interviews were used to assess
demographics, perceived risk of STDs, attitudes toward condom use,
perceived social norms regarding condom use, condom self-efficacy,
intentions to use a condom, pregnancy attitudes and intentions, oral
contraceptive attitudes, perceived risk of pregnancy, and abortion
intentions. Responses to baseline and 6-month follow-up interviews were
used to create pregnancy intention groups (planning and likely to
become pregnant, not planning but likely, not planning and not likely).
The final analysis determined whether there were significant
differences in pregnancy outcomes among the pregnancy intention groups.
The authors found that
- Adolescents' reports of their pregnancy plans and their
assessments of pregnancy likelihood differed from one another.
- Adolescents with inconsistent pregnancy intentions (i.e., not
planning but likely) indicated more positive attitudes toward pregnancy
and less contraceptive use than those who clearly indicated no
pregnancy intentions.
- Nearly a third of adolescents with inconsistent pregnancy
intentions reported positive pregnancy test results in the past 6
months.
"Despite a majority of the teens expressing no plans to become pregnant
in the next 6 months, there was tremendous variability in their
assessments of the likelihood that they would become pregnant in the
next 6 months," state the authors, suggesting that "a counseling
intervention focused on adolescents' perceptions of the life
circumstances that influence conception and contraceptive use may be
beneficial."
Rosengard C, Phipps MG, Adler NE, et al. 2004. Adolescent pregnancy
intentions and pregnancy outcomes: A longitudinal examination. Journal
of Adolescent Health 35(6):453-461.
Readers: More information is available from the MCH Library's knowledge
path, Adolescent Pregnancy Prevention, at http://www.mchlibrary.info/KnowledgePaths/kp_adolpreg.html;
annotated bibliography, Adolescent Pregnancy Prevention, at http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_adolpregprev.html&-MaxRecords=all&-DoScript=auto_search_adolpregprev&-search;
and organizations resource list, Adolescent Pregnancy and Parents, at http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_adolpregpar.html&-MaxRecords=all&-DoScript=auto_search_adolpregpar&-search.
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5. ARTICLE ASSESSES OUTCOMES ASSOCIATED WITH A TRIAL OF LABOR AFTER
CESAREAN DELIVERY
"Overall, our data suggest a risk of an adverse perinatal outcome at
term among women with a previous cesarean delivery of approximately 1
in 2000 trials of labor . . . , a risk that is quantitatively small but
greater than that associated with elective repeated cesarean delivery,"
state the authors of an article published in the December 16, 2004,
issue of The New England Journal of Medicine. In the United States, the
rate of vaginal birth after previous cesarean delivery rose from 3% in
1981 to 31% in 1998. However, an apparent increase in the frequency of
uterine rupture and concern about maternal and perinatal morbidity have
challenged the safety and appropriateness of vaginal birth after
previous cesarean delivery. The authors of this article conducted a
multicenter observational study involving women with a previous
cesarean delivery to assess the risks of uterine rupture and neonatal
and maternal morbidity associated with a trial of labor as compared
with elective repeat cesarean delivery.
The authors undertook a prospective cohort study from 1999 through 2002
of all women at 19 academic medical centers who had a previous cesarean
delivery and who had a singleton pregnancy. Maternal and perinatal
outcomes were compared between women who had a trial of labor and those
who underwent elective repeat cesarean delivery without labor or other
indications for cesarean delivery.
The authors found that
- Among the 45,988 women who had a singleton gestation and a
history of cesarean delivery, 17,898 underwent a trial of labor, and
15,801 had an elective repeat cesarean delivery without labor or other
indications for cesarean delivery.
- Uterine rupture occurred in 124 women who underwent trial of
labor (0.7%).
- Maternal endometritis and transfusion were both significantly
more common with a trial of labor than with an elective repeat cesarean
delivery.
- The frequencies of hysterectomy and maternal death were not
significantly different between the two groups.
- The frequency of antepartum stillbirth was higher among the women
who underwent a trial of labor than among those with an elective repeat
cesarean delivery.
- The frequency of hypoxic-ischemic encephalopathy was
significantly higher among the infants of women who underwent a trial
of labor than among the infants of women with an elective repeat
cesarean delivery.
The authors conclude that "we believe that these estimates of risk . .
. , along with other factors, will facilitate the counseling of women
who have to make a choice between trial of labor and elective repeated
cesarean delivery after a prior cesarean delivery."
Landon MB, Hauth JC, Leveno KJ, et al. 2004. Maternal and perinatal
outcomes associated with trial of labor after prior cesarean delivery.
The New England Journal of Medicine 351(5):2581-2589.
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MCH Alert © 2004 by
National Center for Education in Maternal and
Child Health and Georgetown University. MCH Alert is produced by
MCH Library Services at the National Center for Education in Maternal
and Child Health under its cooperative agreement (6U02 MC 00001) with
the Maternal and Child Health Bureau, Health Resources and Services
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Please contact us at the address below.
EDITORS: Jolene
Bertness, Tracy Lopez
COPYEDITOR: Ruth
Barzel
National Center for
Education in Maternal and Child Health
Georgetown University
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571272, Washington, DC 20057-1272
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