Results Ten controlled trials and five qualitative studies were included. Controlled trials evaluated either early childhood interventions or youth development programmes. Three main themes associated with early parenthood emerged from the qualitative studies: Comparison of these factors related to teenage pregnancy with the content of the programmes used in the controlled trials indicated that both early childhood interventions and youth development programmes are appropriate strategies for reducing unintended teenage pregnancies.
The programmes aim to promote engagement with school through learning support, ameliorate unhappy childhood through guidance and social support, and raise aspirations through career development and work experience. Conclusions A small but reliable evidence base supports the effectiveness and appropriateness of early childhood interventions and youth development programmes for reducing unintended teenage pregnancy. Combining the findings from both controlled trials and qualitative studies provides a strong evidence base for informing effective public policy. Countries such as the United Kingdom and the United States have high teenage pregnancy rates relative to other countries.
Recent research evidence shows that traditional approaches to reducing teenage pregnancy rates—such as sex education and better sexual health services—are not effective on their own. The objectives of this study were to determine on the basis of evidence in qualitative and quantitative research the impact on teenage conceptions of interventions that address the social disadvantage associated with early parenthood and to assess the appropriateness of such interventions for young people in the UK.
We undertook a three part systematic review of the research evidence on social disadvantage and pregnancy in young people by using an innovative method we developed previously for integrating qualitative and quantitative research. The second part focused on qualitative research and examined intervention need and appropriateness on the basis of the perspectives and experiences of young people.
In the third part of the review, we integrated the two sets of findings to assess the extent to which existing evaluated interventions do in fact address the social disadvantage associated with early pregnancy and parenthood as determined by the needs and concerns of young people. Highly sensitive topic based search strategies were designed for each database.
We did not use study type search filters and identified controlled trials and qualitative studies using the same strategy. We included randomised and non-randomised controlled trials that evaluated interventions designed to target social disadvantage and that reported teenage conceptions or births as an outcome measure. The inclusion of trials was not restricted according to language, publication date, or country.
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We included any qualitative study published between and that focused on teenage pregnancy and social disadvantage among young people aged less than 20 years old living in the UK. Relevant interventions could be targeted at children, young people, or their families. Controlled trials of sex education or sexual health services and qualitative studies focusing solely on attitudes to and knowledge of sexual health or sex education were excluded.
We also reviewed the reference lists of all studies that met our inclusion criteria and contacted experts in the field who suggested further studies to pursue. We assessed the extent to which controlled trials had minimised bias and error in their findings by using a set of criteria developed in previous health promotion reviews.
The criteria we used to assess the methodological quality of the qualitative studies were built on those suggested in the literature on qualitative research. A final assessment sorted studies into one of three categories on the basis of quality: Was there an adequate description of the context in which the research was carried out?
Was there an adequate description of the sample and the methods by which the sample was identified and recruited? Were there attempts to establish the reliability of the data collection tools for example, by use of interview topic guides? Were there attempts to establish the validity of the data collection tools for example, with pilot interviews? Were there attempts to establish the reliability of the data analysis methods for example, by use of independent coders? Were there attempts to establish the validity of data analysis methods for example, by searching for negative cases?
Did the study use appropriate data collection methods for helping young people to express their views?
Did the study use appropriate methods for ensuring the data analysis was grounded in the views of young people? Data on the development, design, methods, and the populations involved were extracted from the qualitative studies in a standardised way by using an established tool designed for a broad range of study types. The data synthesis was conducted in three stages according to the model described by Thomas and colleagues. Our procedures for meta-analysis followed standard practice in the field 37 38 39 and were similar to those used in previous reviews by the Evidence for Policy and Practice Information Centre.
Secondly, we conducted a thematic synthesis of the findings from the qualitative studies, 41 42 following established principles developed for the analysis of qualitative data. The review team then drew out the implications for appropriate interventions suggested by each theme. Thirdly, we constructed a methodological and conceptual matrix to integrate the findings of the two syntheses. Screening of full reports against inclusion criteria, quality assessment, data extraction, and data synthesis were all carried out by pairs of reviewers working independently at first and then together.
Initial screening of titles and abstracts was done by single reviewers after a period of double screening to ensure consistency across reviewers. Ten controlled trials w1-w10 and five qualitative studies ww15 met our inclusion criteria. Six controlled trials were judged to be of sufficient methodological quality to provide reliable evidence about the impact of interventions on teenage pregnancy rates. Each of the methodologically sound controlled trials evaluated one of two intervention types: Three studies evaluated early childhood interventions that aimed to promote cognitive and social development through preschool education, parent training, and social skills training.
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A further three studies evaluated youth development programmes that aimed to promote self esteem, positive aspirations, and a sense of purpose through vocational, educational, volunteering, and life skills work. In each trial, the control group received no intervention or standard education. The four controlled trials that were deemed not to be of sufficient quality also evaluated youth development programmes in the US.
Four studies focused on, or included, the views of young parents, w11 w12 w14 w15 but only two of these studies included the views of young fathers as well as young mothers. Characteristics of the four high and medium quality qualitative studies. Of the six controlled trials deemed to be of sufficient methodological quality, four measured pregnancy rates reported by young women, w1 w2 w7 w10 three measured partner pregnancy rates reported by young men, w1 w7 w10 and two measured birth rates reported by young men and young women separately w3 or together.
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The findings of the two controlled trials that measured birth rates w3 w6 were not subject to meta-analysis, but their findings are summarised after each meta-analysis. Tests revealed no statistical heterogeneity between the studies, suggesting that it would be appropriate to pool the effect sizes. However, effect sizes for youth development interventions and early childhood education interventions were pooled separately in recognition of the differences between these two types of intervention.
The pooled effect size from the first meta-analysis showed that early childhood interventions and youth development programmes reduced teenage pregnancy rates among young women RR 0. The effect of an early childhood intervention on birth rates reported by young women was similar in the study by Campbell and colleagues w3 0. Fig 1 Forest plot showing the effect of youth development programmes and early childhood interventions on pregnancy rates reported by young women.
The pooled effect size from the second meta-analysis showed that young men who had received an early childhood or youth development intervention reported fewer partner pregnancies than those who had not, but this result was not statistically significant RR 0. Fig 2 Forest plot showing the effect of youth development programmes and early childhood interventions on pregnancy rates reported by young men.
Hahn and colleagues w6 evaluated a youth development programme and measured birth rates reported by both young women and young men. Three major themes relating to teenage pregnancy emerged from the findings of the five qualitative studies: The reasons young people gave for disliking school varied fig 3. Young parents reported unhappiness, rather than poverty in itself, as the most significant aspect of their childhood experiences that related to becoming a parent, although unhappiness went hand in hand with adversity and material disadvantage in their accounts.
Common experiences included family conflict and breakdown, sometimes caused by violence, which could lead to living in care fig 3. Young fathers reported violent fathers and a lack of suitable role models. It is important to note, however, that not all the teenage mothers who participated in these studies had grown up unhappy or experienced personal adversity.
Regardless of circumstances, some women had wanted to have a baby when they were young and looked forward to still being young when their children were older. There were differences in the expectations and aspirations of young people who had, or wanted to have, a baby early in life and young people who had or wanted to have a baby later in life. For example, mothers who had children when they were teenagers wanted to leave school as soon as possible and get a job. In contrast, those who became pregnant later in life expected to go to university and travel.
Young mothers described how having a baby was a more attractive option than entering the workforce, further education, or training.
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Young people who wanted children later in life had long term plans and a more positive outlook for the future, and they described how participating in out of school activities such as sports, music, and arts improved their self esteem and motivation. These programmes offered young people work experience in their local communities, careers advice, group work to stimulate active reflection, and discussion of future careers and employment opportunities.
Two of the three soundly evaluated youth development programmes also provided out of school sports or arts activities. This review sought to improve our understanding of the link between social disadvantage and teenage pregnancy by integrating evidence from qualitative studies and quantitative trials. The evidence from the six controlled trials we looked at showed that early childhood interventions and youth development programmes can significantly lower teenage pregnancy rates. Both types of intervention target the social determinants of early parenthood but are very different in content and timing.
Preschool education and support appear to exert a long term positive influence on the risk of teenage pregnancy, as well as on other outcomes associated with social and economic disadvantage such as unemployment and criminal behaviour. Our review of five qualitative studies of young people in the UK indicated that happiness, enjoying school, and positive expectations for the future can all help to delay early parenthood. Young people who have grown up unhappy, in poor material circumstances, do not enjoy school, and are despondent about their future may be more likely to take risks when having sex or to choose to have a baby.
The findings of our review are especially important in the light of evidence that sex education and sexual health services are not on their own effective strategies for encouraging teenagers to defer parenthood 12 ; they need to be complemented by early childhood and youth development interventions that tackle social disadvantage. However, important gaps exist in the evidence on how effectively current interventions address these themes table 5.
Our review adds to a growing body of research identifying factors that may explain the association between social disadvantage and teenage pregnancy. Dislike of school, an unhappy childhood, and a lack of opportunities for jobs and education have all emerged as explanatory factors in large scale national and international epidemiological analyses.
For example, a dislike of school was frequently the result of bullying, frustration with rules and regulations, lack of curriculum relevance, boredom, and inadequate support. As well as developing and testing interventions to modify these antecedents, future research on teenage pregnancy and social disadvantage needs to consider strategies that counter the stigmatisation and discrimination faced by young parents.
Some of the social exclusion experienced by young parents is the result of negative societal reaction. However, there is evidence to suggest that teenage parenting can under certain circumstances be a route to social inclusion rather than exclusion. Like many other systematic reviews in health promotion and public health, we found few trials conducted in the UK. Our inclusion of qualitative evidence permitted us to examine the appropriateness of interventions evaluated in US trials from the perspective of young people in the UK. The appropriateness of interventions is an important aspect of generalisability to consider.
This difference in approach may explain the difference in the findings of the two studies and highlights the need to evaluate a revised youth development programme in the UK. Including only studies that evaluated interventions relative to control conditions over the same period of time avoids missing temporal differences between groups. Such changes include the relaxing of abortion laws and the increasing acceptability of abortion over time, which may affect self reported pregnancy rates.
Why are so many of Britain's teen girls struggling with mental health problems?
The small numbers of studies we found are a limitation of the available body of research, as is the dominance of controlled trials conducted in the US although this is a common feature of many health promotion and public health reviews. Our search strategies would have under-represented non-English language studies. As with any systematic review, we cannot be certain that we identified all relevant studies; in particular we may not have identified all unpublished studies, which are more likely to report negative findings than are published studies. We are only aware of one relevant study published since the searches for this review were carried out: This review provides a small but reliable evidence base that early childhood interventions and youth development programmes are effective and appropriate strategies for reducing unintended teenage pregnancy rates.
Our findings on the effects of early childhood interventions highlight the importance of investing in early care and support in order to reduce the socioeconomic disadvantage associated with teenage pregnancy later in life. Evidence suggests that sex education and better sexual health services do not reduce teenage pregnancy rates. No systematic review has brought these quantitative trials and qualitative studies together to determine intervention effectiveness and appropriateness.
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Early childhood interventions and youth development programmes that combine individual level and structural level measures to tackle social disadvantage can lower teenage pregnancy rates. Such interventions are likely to be appropriate for children and young people in the UK because they improve enjoyment of school, raise expectations and ambitions for the future, and ameliorate the effect of an unhappy childhood in poor material circumstances. A policy move to invest in interventions that target social disadvantage should complement rather than replace high quality sex education and contraceptive services.
AF, GB, and AH conducted the searches, screened titles and full papers, assessed study quality, extracted data, and undertook the statistical and qualitative syntheses. All authors contributed to the drafting of the paper and approved the final submitted version. All authors had full access to all the data in the study, including statistical reports and tables, and can take responsibility for the integrity of the data and the accuracy of the data analysis. The review was funded by the Department of Health.
AH was funded by a senior level research scientist in evidence synthesis award from the Department of Health. The researchers operated independently from the funders and the views expressed in this paper are those of the authors and not necessarily those of the Department of Health. Technical appendix available at http: This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.
That leads to a real struggle to hope. On one hand, the defining characteristics of the iGeneration make it harder for parents and parishes to evangelize and catechize teens.
If everything is relative, how do you navigate the world? They thrive on that. Emily Stimpson is an OSV contributing editor. Confessions of a Catholic Dad Editor's Notebook. Plugging teens into the faith: A how-to guide The iGeneration is living in a culture of excess. But what they lack is what they need the most: Others prefer Generation Z, Pluralists or post-Millennials.
For the Catholic Church in particular, that last bit of news is cause for concern. Poll Question How do you encourage your teens to engage in the Faith? Answer in the comments. Nor is it youth ministers who know how to play the guitar and could moonlight as stand-up comedians.
As Protestant communities have learned, smart packaging and excellent facilities can help attract teens to youth events. But those details are the icing, not the essence of a successful youth ministry program. They are not essential to engaging the iGeneration. According to the Catholic youth ministers from around the country to whom OSV put that question, effective Catholic youth ministry requires four key components.