• By Laura Whybra
  • Posted on Monday 11th November, 2013

“Teens and Toddlers” pregnancy prevention trial finds few significant benefits

strong>A combination of sexual health education for girls at risk, sessions to improve their confidence and life skills and regular interaction with the toddlers at a local nursery appeared a promising formula for preventing unsafe sex and teenage pregnancies.But an evaluation of the “Teens and Toddlers” (T&T) program in England has found no benefits from the intervention in altering expectations of early parenthood or preventing unprotected sex.The T&T intervention was developed in the US by Children: Our Ultimate Investment (COUI) drawing on evidence that “youth development” approaches to increase teenagers’ social skills and awareness of their own potential may be more effective than merely focusing on their risk of early parenthood. T&T went further by adding a “voluntary service” dimension where teenage girls experience working with young children.Randomization using matched pairsIn the UK, the Department for Education commissioned a trial based on 12 schools in London, Manchester and other areas. Altogether, 449 girls aged 13-14 considered by schools to be at-risk for early pregnancy took part in the study. The girls were matched into pairs on the basis of age and sexual experience. A member of each pair was then randomly allocated to participate in the T&T program, or be part of a control group. The intervention consisted of weekly three-hour sessions over 18-20 weeks in pre-school nurseries. Each session included ‘check in’ time, where any problems were identified and discussed in a group setting, group work on a curriculum that included sessions on sexual health issues and personal development, and nursery time where the girls played with and supported a child under the age of five. Data was collected from the intervention and control groups through the use of confidential interviews and questionnaires before and after the intervention was completed, and again a year later. Although participants generally liked the program and most rated the time they spent with toddlers as highly enjoyable, the intervention did not deliver the main benefits expected that related to reducing teenage pregnancy. There was no significant difference between the T&T participants and the control group on measures of having sex without contraception or a “youth development score” based on questions about personal goals and self-efficacy.Immediately after the course, participants were significantly less likely to be scored low on self-esteem, sexual health knowledge and difficulties discussing contraception. However, after a year the only remaining significant difference was on self-esteem.Recommendations for changeThe researchers from academic institutions including NatCen Social Research acknowledge that the girls chosen by schools to take part in the study were not generally as involved in risky sexual behavior as expected. This might have reduced the chance of detecting behavioral changes – although T&T facilitators thought them similar to the teenagers that they normally worked with.Given the contrast with results from a previous, self-evaluation study that favorably compared pregnancy rates among girls who completed T&T training with national teenage pregnancy rates, the research underlines the value of conducting randomized controlled trials before jumping to conclusions about whether an intervention is effective.In this case, the researchers conclude that if the program continues to be delivered, it should be refined and re-evaluated. In particular, they recommend using existing research to devise a well conceived “logic model” that would clarify the purpose of the work with toddlers and pay more attention to delivering accurate information on sexual health.*********************ReferenceBonell, C., Maisey, R., Speight, S., Purdon, S., Keogh, P., Wollny, I., Sorhaindo, A. & Wellings, K. (2013) Randomized controlled trial of ‘teens and toddlers’: A teenage pregnancy prevention intervention combining youth development and voluntary service in a nursery. Journal of Adolescence, 36 859-870.

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