Meta-analysis of Federally Funded Adolescent Pregnancy Prevention Program Evaluations.

Beginning in 2010, the U.S. Department of Health and Human Services (HHS) sponsored numerous studies testing the effectiveness of Adolescent Pregnancy Prevention programs on youths' risky sexual behaviors. This article presents results from a meta-analysis of such studies completed between 2015 and 2019 and provided to us by HHS. Studies were eligible for inclusion if they used an experimental/quasi-experimental design, included a comparison condition, assigned at least 10 study participants to each condition, and measured and reported at least one outcome related to sexual behavior or consequences. Data were extracted using a standardized coding protocol and outcomes were coded as, or transformed to, log odds ratio effect sizes for analysis and then transformed to odds ratio effect sizes for presentation in the text. All outcomes were coded such that log odds ratios greater than zero (odds ratios greater than 1) indicate beneficial effects (e.g., reductions in risky sexual behavior). A total of 52 studies met the inclusion criteria. Across 7 outcome types, pooled effects were generally small, the direction of effects was mixed, and none achieved statistical significance: recent pregnancy (OR = 1.30, 95% CI [1.00, 1.68]), ever had sex (OR = 1.07, 95% CI [0.99, 1.15]), recent sexual activity (OR = 0.95, 95% CI [0.84, 1.09]), recent unprotected sexual activity (OR = 1.05, 95% CI [0.96, 1.16]), ever pregnant (OR = 1.21, 95% CI [0.51, 2.89]), number of sexual partners (OR = 1.08, 95% CI = [0.28, 4.22]), and proportion of recent sexual experiences that were unprotected (OR = 0.74, 95% CI = [0.43, 1.31]). Moderator analyses pooling across all 7 outcome types indicated minor differences in program effectiveness between program settings, with those delivered in classroom settings being the least effective (b = - 0.17, 95% CI [- 0.33, - 0.01]). These findings do not lend meaningful support for the overall effectiveness of this group of pregnancy prevention programs. However, because the meta-analysis sample only included programs recently funded by HHS, these findings may have limited generalizability to programs funded by other entities or implemented in other countries.

Effects of March of Dimes Supportive Pregnancy Care on Social Support and Postpartum Depression.

PURPOSE: Group prenatal care, which integrates medical care with patient education and empowerment in a group setting, has the potential to build social support among pregnant women and reduce the risk of postpartum depression (PPD). Past research on group care's effects on social support or PPD has produced inconsistent findings. Studies have tended to (1) examine direct effects on social support or PPD and (2) treat group care participation as a dichotomous variable. This study tests the hypothesis that group care has an indirect effect on PPD through its effect on social support. It uses both a dichotomous measure of group care participation and an ordinal measure of social contact with group members. METHOD: This study used survey data from 199 women at two Tennessee health care sites who participated in traditional care (TC) or Supportive Pregnancy Care (SPC), a new group program developed by March of Dimes. Path analysis was employed, estimating standardized path coefficients with propensity score weighted multilevel modeling. RESULTS: The study found no evidence of an indirect relationship between SPC and PPD symptoms when modeling the dichotomous measure. Modeling the ordinal measure revealed more favorable PPD outcomes among women reporting high group member contact (compared with TC) and adverse outcomes among women reporting low group member contact. CONCLUSION: SPC may be useful for preventing PPD symptoms among women socially engaged with other group care patients. Given the adverse effect among women who do not engage with other group members, group facilitators should encourage women to interact outside of scheduled sessions.

Effects of March of Dimes Supportive Pregnancy Care on Maternal and Infant Health Across Diverse Patient Populations: a Quasi-Experimental Multi-Site Pilot Study.

Group prenatal care may be a promising alternative to traditional one-on-one care. However, research on its effects has produced inconsistent findings and raises questions about effectiveness across different patient populations. This pilot study evaluated the effects of March of Dimes Supportive Pregnancy Care (SPC) on maternal health and behavior across six diverse healthcare sites. Analyses of a propensity score-matched medical record dataset aggregated across sites (N = 1950) indicated significant unfavorable effects on gestational age at delivery (b = - 0.34, p < .05), birthweight (b = - 94.55, p < .05), and low birthweight (OR = 1.10, p < .05). However, these findings did not hold up to sensitivity analyses. Significant favorable aggregate effects were observed for postpartum visit attendance (OR = 1.68; 95% CI [1.12, 2.53]), breastfeeding at delivery (OR = 1.84; 95% CI [1.20, 2.83]), and breastfeeding at follow-up (OR = 3.82; 95% CI [1.46, 9.97]). These findings remained largely consistent across sensitivity analyses. In addition to these aggregate effects, significant site-level effects were observed, but only for two sites. Both were racially homogenous, serving White and African American patient populations, respectively. Future research should determine whether these effects can be generalized to women receiving care in racially heterogeneous settings or whether they are limited to White and African American women receiving care in racially homogenous settings. Efforts to roll out SPC should be accompanied by a continual accrual of research assessing the effects of this program on maternal and infant health across a range of geographic settings and patient profiles.

Culturally sensitive substance use treatment for racial/ethnic minority youth: A meta-analytic review.

This systematic review and meta-analysis synthesized findings from studies examining culturally sensitive substance use treatment for racial/ethnic minority youth. An extensive literature search located eight eligible studies using experimental or quasi-experimental designs. The meta-analysis quantitatively synthesized findings comparing seven culturally sensitive treatment conditions to seven alternative conditions on samples composed of at least 90% racial/ethnic minority youth. The results from the meta-analysis indicated that culturally sensitive treatments were associated with significantly larger reductions in post-treatment substance use levels relative to their comparison conditions (g=0.37, 95% CI [0.12, 0.62], k=7, total number participants=723). The average time between pretest and posttest was 21weeks (SD=11.79). There was a statistically significant amount of heterogeneity across the seven studies (Q=26.5, p=0.00, τ2=0.08, I2=77.4%). Differential effects were not statistically significant when contrasts were active generic counterparts of treatment conditions (direct "bona fide" comparisons; g=-0.08, 95% CI [-0.51, 0.35]) and 'treatment as usual' conditions (g=0.39, 95% CI [-0.14, 0.91]). Strong conclusions from the review were hindered by the small number of available studies for synthesis, variability in comparison conditions across studies, and lack of diversity in the adolescent clients served in the studies. Nonetheless, this review suggests that culturally sensitive treatments offer promise as an effective way to address substance use among racial/ethnic minority youth.

Do brief alcohol interventions reduce tobacco use among adolescents and young adults? A systematic review and meta-analysis.

This meta-analysis synthesizes studies of brief interventions (BIs) that targeted alcohol consumption and reported both alcohol and tobacco outcomes. It examines whether BIs reduce alcohol and tobacco use for adolescents and young adults among interventions that (1) directly targeted tobacco and alcohol use, or (2) did not target tobacco use but measured it as a secondary outcome. Multiple databases and grey literature sources were searched (1980-2012) resulting in the identification of 18 randomized or controlled quasi-experimental studies (5949 participants). Analyses were conducted using random effects inverse-variance weighted three-level models. BIs were associated with a significant reduction in alcohol consumption relative to control groups [g = 0.11, 95 % CI (0.04, 0.17)] but not with a significant decrease in tobacco use [g = 0.07, 95 % CI (-0.01, 0.16)]. Directly addressing tobacco was not a significant moderator affecting tobacco use outcomes. Post-hoc exploratory analysis revealed potential questions to address with future research.

Effects of Brief Alcohol Interventions on Drinking and Driving among Youth: A Systematic Review and Meta-analysis.

OBJECTIVE: Alcohol-impaired driving persists as a major cause of traffic fatalities and injuries among young drivers. This meta-analysis examined whether brief alcohol interventions were effective in reducing driving after drinking among adolescents and young adults. METHOD: Our systematic search identified 12 experimental/quasi-experimental evaluations (16 intervention groups) that measured driving while intoxicated and related consequences and provided data for effect size calculation (N = 5,664; M age =17 years; 57% male). The studies were published between 1991 and 2011. Three-level random-effects meta-analyses using a structural equation modeling approach were used to summarize the effects of the interventions. RESULTS: Compared with controls, participants in brief alcohol interventions reported reduced drinking and driving and related consequences (g = 0.15, 95% CI [0.08, 0.21]). Supplemental analyses indicated that reductions in driving while intoxicated were positively associated with the reduced post-intervention heavy use of alcohol. These findings were not attenuated by study design or implementation factors. CONCLUSIONS: Brief alcohol interventions under 5 hours of contact may constitute a promising preventive approach targeting drinking and driving among adolescents and young adults. Reducing heavy episodic alcohol consumption appeared to be a major factor in reducing drunk-driving instances. Interpretation of the findings must be made with caution, however, given the possibility of publication bias and the small observed effect size. Future research should focus on the exact mechanisms of behavior change leading to beneficial outcomes of brief alcohol interventions and the potential effectiveness of combined brief interventions and other preventive approaches.

Effects of 21st birthday brief interventions on college student celebratory drinking: A systematic review and meta-analysis.

INTRODUCTION: College students' 21st birthday celebrations often involve consumption of extreme amounts of alcohol as well as alcohol-related risks. This systematic review aims to determine whether birthday-focused, individually-targeted, no-contact (email or letter-based) brief alcohol interventions (BAIs) reduce college students' 21st birthday celebratory drinking. METHODS: A systematic search identified 9 randomized evaluations with 10 interventions to reduce 21st birthday drinking. Quantity of alcohol consumed and estimated blood alcohol concentration (BAC) were measured. Random-effects meta-analysis was used to summarize the effects of the interventions. RESULTS: There was no evidence that birthday-focused BAIs reduce quantities of alcohol consumed during birthday celebrations (g = 0.05, 95% CI [-0.03 to 0.13]). The interventions were associated with significant reductions in estimated BAC levels (g = 0.20, 95% CI [0.07 to 0.33]), but this effect was small in absolute terms. The quality of this body of evidence was very low, as evaluated using the GRADE approach. In particular, it was limited by substantial participant attrition post-randomization due to included studies' recruitment and randomization procedures. CONCLUSIONS: There is no evidence that birthday-focused, individually-targeted BAIs reduce the quantity of alcohol consumed by students during 21st birthday celebrations, although these interventions may yield small beneficial effects on estimated BAC. Many methodological concerns were identified in included studies. This area of research would benefit from theory-based RCTs that are well-designed and executed. Future research should also investigate strategies other than birthday-focused, individually-targeted, brief interventions to curb 21st birthday celebratory drinking.

Can brief alcohol interventions for youth also address concurrent illicit drug use? results from a meta-analysis.

Brief interventions aimed at reducing alcohol use among youth may interrupt a possible developmental progression to more serious substance use if they can also affect the use of other illicit drugs. This meta-analysis examined the findings of recent research on the effects of brief alcohol interventions for adolescents and young adults on both alcohol and illicit drug use. Eligible studies were those using randomized or controlled quasi-experimental designs to examine the effects of brief alcohol interventions on illicit drug use outcomes among youth. A comprehensive literature search identified 30 eligible study samples that, on average, included participants age 17, with 57 % male participants and 56 % White youth. Three-level random-effects meta-analyses were used to estimate mean effect sizes and explore variability in effects. Overall, brief interventions targeting both alcohol and other drugs were effective in reducing both of these substances. However, the brief interventions that targeted only alcohol had no significant secondary effects on untargeted illicit drug use. The evidence from current research, therefore, shows modest beneficial effects on outcomes that are targeted by brief interventions for youth, but does not show that those effects generalize to untargeted illicit drug use outcomes.

Comparative effectiveness of group and individual prenatal care on gestational weight gain.

This study examined differences in gestational weight gain for women in CenteringPregnancy (CP) group prenatal care versus individually delivered prenatal care. We conducted a retrospective chart review and used propensity scores to form a matched sample of 393 women (76 % African-American, 13 % Latina, 11 % White; average age 22 years) receiving prenatal care at a community health center in the South. Women were matched on a wide range of demographic and medical background characteristics. Compared to the matched group of women receiving standard individual prenatal care, CP participants were less likely to have excessive gestational weight gain, regardless of their pre-pregnancy weight (b = -.99, 95 % CI [-1.92, -.06], RRR = .37). CP reduced the risk of excessive weight gain during pregnancy to 54 % of what it would have been in the standard model of prenatal care (NNT = 5). The beneficial effect of CP was largest for women who were overweight or obese prior to their pregnancy. Effects did not vary by gestational age at delivery. Post-hoc analyses provided no evidence of adverse effects on newborn birth weight outcomes. Group prenatal care had statistically and clinically significant beneficial effects on reducing excessive gestational weight gain relative to traditional individual prenatal care.

The effects of CenteringPregnancy group prenatal care on gestational age, birth weight, and fetal demise.

We examined the effects of CenteringPregnancy group prenatal care versus individually delivered prenatal care on gestational age, birth weight, and fetal demise. We conducted a retrospective chart review and used propensity score matching to form a sample of 6,155 women receiving prenatal care delivered in a group or individual format at five sites in Tennessee. Compared to the matched group of women receiving prenatal care in an individual format, women in CenteringPregnancy group prenatal care had longer weeks of gestation (b = .35, 95 % CI [.29, .41]), higher birth weight in grams (b = 28.6, 95 % CI [4.8, 52.3]), lower odds of very low birth weight (OR = .21, 95 % CI [.06, .70]), and lower odds of fetal demise (OR = .12, 95 % CI [.02, .92]). Results indicated no evidence of differences in the odds of preterm birth or low birth weight for participants in group versus individual prenatal care. CenteringPregnancy group prenatal care had statistically and clinically significant beneficial effects on very low birth weight and fetal demise outcomes relative to traditional individually delivered prenatal care. Group prenatal care had statistically significant beneficial effects on gestational age and birth weight, although the effects were relatively small in clinical magnitude.

Effects of CenteringPregnancy group prenatal care on breastfeeding outcomes.

INTRODUCTION: The purpose of this study was to examine the effects of CenteringPregnancy group prenatal care on breastfeeding outcomes, relative to traditional prenatal care delivered in an individual format. METHODS: A quasi-experimental research design was conducted with 794 women receiving prenatal care delivered in a group or individual format at 4 sites in Tennessee. Propensity scores were used to create groups of women statistically matched on background demographics and medical history. Outcomes included breastfeeding at discharge and breastfeeding at postpartum follow-up. RESULTS: Compared with the matched comparison group of women receiving prenatal care in an individual format, women in CenteringPregnancy group prenatal care had significantly higher odds of any breastfeeding at discharge (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.32-3.26; P < .001). Across the 4 sites, there were no consistent differences in the odds of any breastfeeding at follow-up or exclusive breastfeeding at discharge or postpartum follow-up. DISCUSSION: CenteringPregnancy group prenatal care may have beneficial effects on initial rates of breastfeeding relative to individually delivered care. However, there is not sufficient evidence to conclude that CenteringPregnancy group prenatal care has robust effects on exclusive breastfeeding at discharge or postpartum follow-up.