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Universidad de los Andes Santiago, Chile ADOLESCENT PREGNANCY PREVENTION: AN ABSTINENCE-CENTERED INTERVENTION WITH A COGNITIVE-BEHAVIOURAL PROGRAM IN A PUBLIC HIGH SCHOOL IN CHILE Dr. Carlos Cabezón G. Dept. Obstetrics and Gynecology Faculty of Medicine Universidad de los Andes

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Universidad de los Andes

Santiago, Chile

ADOLESCENT PREGNANCY PREVENTION:

AN ABSTINENCE-CENTERED INTERVENTION

WITH A COGNITIVE-BEHAVIOURAL PROGRAM

IN A PUBLIC HIGH SCHOOL IN CHILE

Dr. Carlos Cabezón G.

Dept. Obstetrics and Gynecology

Faculty of Medicine

Universidad de los Andes


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Introduction

  • Experience in one school starting in 1997

    • Liceo A 128 “Elvira Brady”

    • San Bernardo (peripheral, low income neighborhood)

    • Dept Ob/Gin Universidad de los Andes

  • Journal of Adolescent Health 36 (2005):64-69



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    Liceo A 128 “Elvira Brady” San Bernardo

    • Only Girls

    • 4 grades – high school

    • 10 classes (30 – 40 students each) per grade

    • Approx. 1,500 students

    • Age 15 – 19 years old


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    Background: Pregnancies during 1996 Liceo A 128


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    Adolescent risky behaviour: triad

    • Sexual activity (disordered)

    • Tobacco / Alcohol / Drugs

    • Violence, delinquency

    • Strongly related: focusing on sexuality can help in the other problems



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    The TeenSTAR Program(www.teenstar.org)

    • Developmental curriculum

    • Learning fertility pattern

    • Self-understanding / self-esteem

    • Responsible decision making

    • Communication skills in the area of sexual behaviour

    • Abstinence


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    TeenSTAR Program

    • One class a week through 2 semesters

    • Teachers’ training: one week workshop (40 hours)

    • Personal monitoring for students

    • Parental informed consent

    • Voluntary participation of students


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    The program: 14 units

    • Initial session

    • Differences between genders

    • Prejudices, complement

    • Anatomy and Physiology of human reproductive organs

    • Fertility awareness: observation and registration of fertility records.

    • Fertility awareness: interpretation

    • Knowing emotions and controlling behaviour


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    8. The manipulation of sexuality in media

    9. Self-assurance and maintaining decisions

    10. Marriage and family

    11. Beginning of life, value of human life

    12. Family planning methods, contraception and STD

    13. Pregnancy, delivery and breastfeeding

    14. Final session



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    Prospective, randomized, controlled

    • Three cohorts:

      • 1996 cohort (n = 425)

      • 1997 cohort (n = 423)

      • 1998 cohort (n = 411)

    • Follow up: 4 years (each cohort)

    • Outcome: pregnancies occurring during the 4 year period in each cohort


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    Randomization (1997 – 1998 cohorts)

    • 1997 cohort: 5 teachers/ 10 classes

      • 5 classes received the program (n = 210)

      • 5 classes control group (n = 213)

  • 1998 cohort: 8 teachers/ 10 classes

    • 8 classes received the program (n = 328)

    • 2 classes control group (n = 83)





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    Pregnancy rates: 1997 – 1998 cohorts


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    Teachers’ involvement



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    (1)

    • A long term cognitive-behavioural intervention proposing abstinence has been effective in prevention of unintended pregnancies among female high school students.

      • Measured outcome

      • Control group

      • Prospective intervention


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    Limitations (1)

    • No record of abortions

    • No record of STD

    • No information (facts) about sexual activity among students

      • Further investigation is being done


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    (2)

    • School teachers get involved and cooperate with this program

    • Improves educational environment


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    Limitations (2)

    • Persistence in time

    • Cost (“$ 5 vs. $ 500”)

    • Entertaining, interesting (not tedious)

    • Parental involvement (must be improved)


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    Conclusions

    • Starting point for our group

    • Further research has to be done

      • Age of sexual initiation

      • Attitude towards sexuality

      • Biological facts

      • Parents’ involvement

  • Importance of the central message proposed to adolescents



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