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An Evaluation of the Teen Clinic Program Jessica Knaster Maternal and Child Health MPH Program
Background • Rates of sexual activity among adolescents are the same in the U.S. as in Europe (AGI 1999) • Highest rates of teenage pregnancy, abortion, and STI infection in the developed world (AGI 1999) • Numerous adverse economic, social and health outcomes for teenage mothers and their babies • LBW and its sequelae, maternal mortality, infant mortality (Kotch 1997; Hoyt 2002; Henshaw 2004) • Unintended early childbearing has tremendous social and financial costs
Background • Less overall contraceptive use and less use of more effective birth control methods (AGI 2004) • 35% of the U.S. school districts that have a policy to teach sex education teach abstinence only (Landry 2003) • Clinic-based programming is often the only available source of reproductive health information.
The Teen Clinic Program • 11 sites throughout Western Washington • Special afternoon hours, teens only • No appointment needed, walk-in service • Free services for teens (19 and younger) • Birth control (no spec exam required) • Pregnancy testing • Sexually transmitted infection (STI) testing and treatment • Emergency contraception • HIV testing and counseling • Confidential • Waiting room education program
Teen Clinic Conceptual Model Program : Age-appropriate Normalizes adolescent sexual activity Information on method side effects, risks and benefits Improves quality of time with provider Use of contraception Use of more effective methods of contraception reduced method failure/ increased acceptability use of strategies to prevent STI transmission Reduce unintended adolescent pregnancy Increased self-efficacy Teen Perceptions: Care about teens Feel safe, respected, comfortable Fears, worries, concerns addressed Increased knowledge of pregnancy prevention Increased knowledge of STI prevention Reduce morbidity and mortality from STIs
Evaluation Design Anonymous survey • Pilot: Pretest posttest nonequivalent comparison group design for the measurement of self-efficacy and knowledge • Posttest only comparison group design • Comparison group= adolescents who attend same clinics during regular, non-Teen Clinic hours Anonymous semi-structured interviews with Teen Clinic patients
Methods • 5 sites, varied size, location (rural/urban) • All clients <19 who see a clinician for services during evaluation period invited • Knowledge Quiz- 7 T/F questions • Self-efficacy- 3 question scale- National Longitudinal Study of Adolescent Health • Satisfaction- 3 questions from validated PPWW tool +4 additional • Demographics-age, gender, race/ethnicity, parents’ educational attainment, school status, nulliparity, previous teen clinic, sex ed in last year
Pilot Results • n=147, 95 TC and 52 comp • Differences between TC and comparison pretest - posttest scores were not significant for either knowledge or self-efficacy- unadjusted, full model • Paired t-test was significant (p <.0001) for both knowledge and self-efficacy • Knowledge .4 point, scale 0-7 • Self-efficacy .7 point, scale 0-21
Preliminary Results Satisfaction • no significant differences between TC and comparison, unadjusted (p=.19) or full model (p=.59) race/ethnicity, parent’s educational attainment, age, school, site, previous TC • Restricted to post-pilot data, near significant (p=.1) when wait time is added to the model (n=86) • Time with clinician- p=.07 unadjusted (n=218), but not significant in full model
Preliminary Results Knowledge Quiz • Not significant in unadjusted analysis • Significant difference in full models (p=.03) both for n=219 and n=87 • Difference of .7 point on 0-7 scale
Preliminary Results Contraceptive Self-Efficacy • Approaching significance in unadjusted model (p=.1) • Not significant in full model
Limitations • Not all the data is in yet!! • Nonrandomized, posttest only design- can’t rule out differences between the groups • Measurement error from nonvalidated questions • Imperfect implementation- 5 sites Strengths • Will have large n (400+ in each group) • Powered to conduct subgroup analyses • Triangulation with qualitative data
Thank you! My thesis committee Michelle Bell David Grembowski James Pfeiffer Planned Parenthood of Western Washington Mina Halpern Funding from : Dr. & Mrs. Harry B. Knaster U.S. Dept of Education Stafford Loan Program UW President’s Advisory Committee on Women U.S. Department of Health and Human Services, Health Resources and Services Administration’s Maternal and Child Health Bureau (Title V, Social Security Act), grant #T76MC00011-21-00