Monday, April 5, 2010
A computer-assisted, home-based intervention shown to reduce the risk of repeated births among low-income pregnant teenagers appears to do so at a reasonable cost, according to a report in the April issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
After 14 years of steady decline, U.S. teenage birth rates increased in both 2006 and 2007, according to background information in the article. “Both first and subsequent births to U.S. teenagers produce substantial detrimental health, social and economic burdens,” the authors write. “Repeated childbearing during adolescence compounds the risk of academic failure for the teenage mother and increases the public costs associated with child welfare, criminal justice system involvement and long-term poverty.”
Rapid subsequent births among teenagers occur more frequently among African American and Hispanic girls and have been difficult to prevent. Beth Barnet, M.D., of the University of Maryland School of Medicine, Baltimore, and colleagues assessed the costs associated with one intervention that, in a previous study, achieved a 45 percent reduction in repeated births within 24 months among high-risk, low-income, predominately African-American teenage mothers.
A total of 235 pregnant teenagers age 18 or younger were recruited at 24 weeks or more of gestation. The girls were randomly assigned to usual care (68) or one of two home-based interventions conducted by community outreach workers (87 received quarterly computer-assisted motivational intervention [CAMI] and 80 received the same intervention plus two additional visits by a counselor each quarter). To administer CAMI, trained counselors with laptop computers and customized software guided teens through a motivational interviewing process, an empirically validated method of behavior change.
After 24 months, teenagers receiving either intervention were significantly less likely to have another child. The average cost per teenager was $2,064, and the estimated cost-effectiveness ratio per prevented repeat birth—the cost divided by the difference in the number of repeated births between the intervention and control groups—was $21,895 before and $17,388 after adjustment for related factors. Certain personal characteristics, including age and insurance status before pregnancy, moderated this cost-effectiveness.
“Only a handful of experimentally evaluated teenage pregnancy–prevention interventions have been subject to examination of costs and benefits,” the authors write. “Our findings suggest that CAMI is at least as cost-effective as these programs and warrants replication in larger samples for consideration in that group.”
Almost one-fifth of girls give birth by age 20, and one-quarter of these teenaged mothers will give birth again within two years, the authors note. “Expenditures per teenage mother per year are estimated at $4,080 nationally (for teenagers 17 years old and younger) and $5,150 in Maryland,” the authors write. “Findings from this study provide evidence for the value of investing in evidence-based interventions, particularly for young people who are most vulnerable.” (Arch Pediatr Adolesc Med. 2010;164:370-376.)
Editor’s Note: This research was supported by a grant from the Department of Health and Human Services, Office of Population Affairs, Office of Adolescent Pregnancy Programs. Please see the article (available at www.jamamedia.org) for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.