Social and Biological Transgenerational Underpinnings of Adolescent Pregnancy
Abstract
:1. Introduction
Limitations of Current Interventions
Intervention | Reference | Outcome | Developmental Period | Population | Socio- Economic Context | Level of Action | Location |
---|---|---|---|---|---|---|---|
School-Based Abstinence Only Sexual Education & School-Based Abstinence Plus Contraceptive Sexual Education (Review) | (Bennett & Assefi, 2005) [19] | Not effective Modest, short acting change to adolescents’ sexual behaviour; Programs with contraceptive information improved adolescents’ knowledge about contraceptives but did not significantly change their sexual behaviours | Adolescence | Girls and boys | Industrialised, variable SES | Individuals | USA |
Primary Prevention Sexual Education Programs Delivered at Schools, Community Centers, and Health Clinics | (DiCenso et al., 2002) [15] | Not effective Does not significantly delay initiation of sexual activity, increase contraceptive use, or prevent pregnancies | Adolescence | Girls and boys | Industrialised (trend towards low-SES) | Individuals | Canada, USA, UK, Australia, New Zealand, Europe |
School-Based Infant Simulator Program (students tasked with caring for a robotic infant) | (Brinkman et al., 2016) [20] | Not effective Compared to standard sexual education program, participants had a higher pregnancy risk, were more likely to experience birth and an induced abortion before age 20. | Adolescence (13–15 years) | Girls | Industrialised | Individuals | Australia |
School-Based Infant Simulator Program (students tasked with caring for a robotic infant) | (Herrman et al., 2011) [33] | Not effective No significant changes in adolescents’ perception of pregnancy and parenting | Adolescence (14–18 years) | Girls and boys | Industrialised | Individuals | USA |
Teens and Toddlers Intervention Program (at-risk adolescent girls enrolled in volunteer service in preschools to experience the reality of caring for children) | (Bonell et al., 2013) [22] | Not effective Did not significantly reduce rate of sexual activity without contraception or expectation of adolescent parenthood score | Adolescence (13–14 years) | Girls | Industrialised | Individuals | UK |
School-Based Peer-Led Sexual Education (standard curriculum delivered by 16–17-year-old peers) | (Stephenson et al., 2004) [16] | Positive partial results Girls reported significantly lower intercourse frequency by age 16 compared to control group (teacher-led sexual education); No difference in boys’ behaviour; No difference in self-reports of adolescent pregnancy compared to controls at follow-up (18 months post-intervention) | Adolescence (13–14 years) | Girls and boys | Industrialised | Individuals | UK |
School-Based Pregnancy Prevention Program using the I-Change Model (focused on attitude and behavioural change, teaching communication and negotiation strategies) | (Taylor et al., 2014) [18] | Positive partial results Increased report of condom use, plans to communicate with partners about pregnancy, and intentions to abstain from sex while at school; Of those who reported having had sex, no difference in self-reports of adolescent pregnancy compared to controls at follow-up (8 months post-intervention) | Adolescence (13–14 years) | Girls and boys | Developing | Individuals | South Africa |
Expanded Access to Long-Acting Reversible Contraceptives (LARCs) (provision of free LARCs, increased promotion and education for at-risk individuals) | (Lindo & Packham, 2017) [21] | Promising Reduction in adolescent pregnancies; Authors suggest this result to be partially attributable to increases in LARC uptake | Adolescence | Girls | Industrialised | Structural | USA |
Implementation Intention Setting (at-risk adolescent girls coached in contraceptive use intention-setting and communication of these intentions) | (Martin et al., 2009) [24] | Promising Significant shift from participants consulting family planning clinic for emergency contraception and pregnancy testing to consulting for contraceptive supplies only; Fewer positive pregnancy tests compared to controls at follow-up (9 months post-intervention) | Adolescence (mean 16.7 years) | Girls | Industrialised | Individuals | USA |
Parent-Based Interventions (sexual education programs including parental involvement in educating about sexual health decision-making and behaviours) | (Widman et al., 2019) [17] | Postive partial results Improved condom use and parent–child sexual communication; No impact on delaying onset of adolescent sexual activity | Adolescence (younger than 18 years) | Girls and boys | Industrialised | Family Unit | USA |
Mother–Daughter Communication Focused Intervention (multi-week sexual health education program featuring facilitated conversation between mothers and daughters) | (Powwattana et al., 2018) [34] | Promising Significant increase in frequency of discussions about sexual risk between mothers and daughters; Significant increase in perceived power in relationship control and ability to prevent sexual risk for daughters | Adolescence (12–15 years) | Girls | Developing | Family Unit | Thailand |
Early Childhood Intervention and Youth Development Programs (designed to promote school engagement and raise life aspirations via career development and work experience for youth with adverse childhoods) | (Harden et al., 2009) [25] | Promising Lower adolescent pregnancy rates among individuals who received the opportunity to participate in an intervention program | Childhood Adolescence | Girls and boys | Industrial | Individuals | UK |
Conditional Cash Transfers for Education (significant sums of money provided to adolescent girls contingent on their enrolment in and completion of education programs) | (Cortés et al., 2016) [35] | Promising Reduced adolescent pregnancy rates | Adolescence | Girls | Developing | Structural | Colombia |
2. Combining Theoretical Frameworks to Tackle Adolescent Pregnancy
2.1. Eco-Social Theory
2.2. Eco-Social Theory Meets Life History Theory and Developmental Origins of Health and Disease
3. Biological Mechanisms Linking Socio-Structural and Ecological Exposures to Reproductive Maturation
3.1. Epigenetic Mechanisms
3.2. A Role for the Stress Axis
4. Timing of Socio-Structural and Ecological Exposures
4.1. Pre-Conception
4.2. In Utero
4.3. Post-Natal
4.4. Family Dynamics
4.5. Social Dynamics
5. Discussion and Conclusions
5.1. Targeting the Root Causes of Socio-Structural Inequities
5.2. Targeting Earlier Stages of Development
5.3. Addressing Adolescent Pregnancy Involves Everyone
5.4. Socio-Structural and Ecological Variation in Attitudes towards Adolescent Pregnancy and Its Outcomes
5.5. Breaking the Transgenerational Cycle of Adolescent Pregnancy
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Rowlands, A.; Juergensen, E.C.; Prescivalli, A.P.; Salvante, K.G.; Nepomnaschy, P.A. Social and Biological Transgenerational Underpinnings of Adolescent Pregnancy. Int. J. Environ. Res. Public Health 2021, 18, 12152. https://doi.org/10.3390/ijerph182212152
Rowlands A, Juergensen EC, Prescivalli AP, Salvante KG, Nepomnaschy PA. Social and Biological Transgenerational Underpinnings of Adolescent Pregnancy. International Journal of Environmental Research and Public Health. 2021; 18(22):12152. https://doi.org/10.3390/ijerph182212152
Chicago/Turabian StyleRowlands, Amanda, Emma C. Juergensen, Ana Paula Prescivalli, Katrina G. Salvante, and Pablo A. Nepomnaschy. 2021. "Social and Biological Transgenerational Underpinnings of Adolescent Pregnancy" International Journal of Environmental Research and Public Health 18, no. 22: 12152. https://doi.org/10.3390/ijerph182212152