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Assignment 1: Annotated Bibliography

SPH 380: WINTER 2019

I focused on teenage pregnancy, looking at risk factors and barriers to contraception,

specifically looking the most effective forms of contraception available. I chose this topic

because I felt uneducated on teenage pregnancy in the United States and was curious on its

etiology and impact.

Bibliography

1. Garwood SK, Gerassi LWB, Jonson-Reid M, Plax K, Drake B. More Than Poverty: The

Effect of Child Abuse and Neglect on Teen Pregnancy Risk. J Adolesc Heal. 2015;57:164-

168. doi:10.1016/j.jadohealth.2015.05.004

This study was funded by the Centers for Disease Control and Prevention and the

National Institute of Mental Health. This study was original research, using data

from a larger administrative data study that held information on government

service involvement and outcomes of children who grew up in poverty and were

exposed to maltreatment. This study used this data to compare pregnancy rates

among teenagers who grew up in poverty and teenagers who experienced child

abuse and neglect in an impoverished household. It concluded that

maltreatment during childhood is a significant risk factor for teenage pregnancy:

A child in poverty who has experienced maltreatment has a 66% higher risk of
 teenage pregnancy than a child in a financially and emotionally stable home,

while a child who grew up in poverty has a 40% higher risk. Limitations of these

results include a lack of account for substance abuse, mental health disorders,

school performance, and whether STD contraction was due to abuse or risky

sexual behavior. The data used only included Caucasian or African American

women due to a small sample size for other races. Expanding the racial groups

within the sample size studied would increase the integrity of these findings.

Evidence has been presented linking poverty as an etiology of teenage

pregnancy, as well as teenage pregnancy being an etiology of poverty. Poverty

has also been associated with higher reports of child abuse, which this study has

shown is a risk factor for teenage pregnancy.

2. Gina M. Secura, Ph.D., M.P.H., Tessa Madden, M.D. MPH, Colleen McNicholas, D.O.,

Jennifer Mullersman BSN, Christina M. Buckel, M.S.W., Qiuhong Zhao, M.S. and, Jeffrey

F. Peipert, M.D. PD. Provision of No-Cost, Long-Acting Contraception and Teenage

Pregnancy. N Engl J Med. 2014. doi:10.1056/NEJMoa1400506

This study was original research titled the Contraceptive CHOICE Project funded

by the Susan Thompson Buffet Foundation and approved by the Washington

University School of Medicine in St. Louis Human Research Protection Office.

Following 9256 girls and women between the ages of 14 and 45, this study

provided free contraception, eliminating the barrier of cost. All forms of

 contraception were available, however long-acting reversible contraception

(LARC) was promoted. The participants were followed and documented on

whether they birthed, miscarried, or aborted a child. Among teens in the cohort

between 2008 and 2013, these rates were 34.0, 19.4, and 9.7 per 1000 teens,

respectively. Among the general population of US teens in 2008, these rates

were 158.5, 94.0, and 41.5 per 1000, respectively. Additionally, those among the

cohort who chose an LARC method continued its use longer than shorter-acting

contraceptive methods. Limitations of the study included self-reported

pregnancy results, consistent interviews (possibly affecting adherence), and

enrollment requiring parental consent. Improvement of this study would be

significant if parental consent were not required, as confidentiality is a proven

barrier for many at risk teenagers. This suggests those participating in the study

were likely of lower risk.

Providing free contraception eliminates a significant barrier for many girls and

women. This article concludes that the effect of cost-free contraception access

significantly reduces pregnancy rates; cost of contraception is an etiology for

teenage pregnancy.

3. McClellan K, Temples H, Miller L. The Latest in Teen Pregnancy Prevention: Long-Acting

Reversible Contraception. J Pediatr Heal Care. 2018;32(5).

doi:10.1016/j.pedhc.2018.02.009
 This article is a review of the latest research on LARCs and discusses the barriers

to LARC access among adolescents. The review was completed by several Nurse

Practitioners who teach at Clemson University and was copyrighted by the

National Association of Pediatric Nurse Practitioners. This article cites LARC

methods as the best and safest option for adolescents, but it is estimated that

less than 5% of adolescents use them. The reasons for this include cost,

confidentiality, and a lack of pediatrician recommendation. Adolescents are

more likely to choose an LARC method when recommended by their

pediatrician, however only one third of pediatric providers offer this method. No

limitations of data provided in their review were cited.

This article exemplifies the barriers to LARC methods, highlighting cost,

confidentiality, and lack of recommendation as etiology for lack of contraception

use, and therefore teenage pregnancy. This article also cites teen pregnancy as a

risk factor for low education, poverty, and unemployment for the mother and

child.

4. Tavernise S. Colorado’s Effort Against Teenage Pregnancies Is a Startling Success - The

New York Times. The New York Times.

https://www.nytimes.com/2015/07/06/science/colorados-push-against-teenage-

pregnancies-is-a-startling-success.html?_r=1. Published 2015. Accessed January 23, 2019.

 This New York Times article reports on teenagers in Colorado who were offered

long-acting birth control. This public health implementation resulted in a 40

percent decrease in teenage birth rates and 42 percent decrease in abortion

rates between 2009 and 2013. These results were especially prevalent among

the most impoverished areas within the state. Half of all first births in these

locations occurred before mother's turned 21 in 2009, with the age moving to 24

years old in 2014. This shift in age provides the opportunity for women to finish

their education and create a foundation for themselves before bearing the

financial burden of a child. This ultimately helps to break the cycle of poverty, as

women are able to choose who they have children with and can become parents

when they are financially, and emotionally, ready.

Poverty is an etiology of teenage pregnancy. Colorado’s implementation of LARC

access for all teenagers significantly reduced their teenage pregnancy rates,

most dramatically reducing pregnancy among impoverished communities. This

implementation, especially in poverty ridden areas, also reduced the etiology of

future teenage births. Would-have-been mothers are now less likely to continue

living in poverty, which in turn reduces the exposure of unintended children to

poverty and potentially unstable environments. This ultimately reduces risk-

factors for future generations.

5. Verhaeghe J. Clinical practice Contraception in adolescents. Eur J Pediatr. 2012;171:895-

899. doi:10.1007/s00431-012-1676-x

In the western world, the age of menarche (first menstruation) has dropped. This

drop is associated with earlier, and riskier, sexual activity. This review discusses

each form of birth control and its use among adolescents, also discussing the

barriers and hazards for adolescent girls. It has been observed that over 80% of

adolescent girls on LARC methods continue their use, marking the highest

continuation rates among available contraception. It has also been shown that

when cost is removed as a barrier for LARC methods, the majority of adolescents

will choose this method. Other barriers for all contraception include needing

parental consent and access to refills. This review was written by a member of

the Department of Obstetrics and Gynecology and Health Sciences campus of

Katholieke Universiteit Leuven in Belgium. No limitations of data provided in the

review were cited.

This article highlights the safety of LARCs among adolescents and the observed

effectiveness of continuation, marking LARCs as the most effective option for

adolescents. This analysis exemplifies that cost of LARC methods are a significant

barrier, and its elimination creates the best results for teenage pregnancy rates.

The use of LARC methods also eliminates the need for refills, providing better

protection for many sexually active teenagers. Etiologically, parental consent and

cost remain significant factors in high teenage pregnancy rates, and the recent
decrease in menarche is also a significant risk factor due to its association with

riskier sexual behavior.