Purpose: Although infants born to adolescent mothers are at increased risk of preterm birth and low birth weight, little is known about factors that can affect birth outcomes in this group. Given the importance of the school context to adolescent health and development, health services and social supports that are available in-school may be important resources for pregnant teens. The purpose of this study is to investigate the associations between school-based health and supportive services and the birth outcomes of infants born to adolescent mothers. Methods: Data from the National Longitudinal Study of Adolescent Health Waves I and IV were analyzed. Adolescent mothers' first singleton live births were included if they occurred after Wave I and before the mother left high school. Live births from 402 adolescent mothers attending 104 schools were included. Birth weight and gestational age of the infants were reported by mothers at Wave IV interview. School services details came from the Wave I school administrator survey. On-site school health services included diagnostic screening (including STDs), treatment for STDs, family planning counseling, rape counseling, and prenatal/ postpartum health services. Supportive services included forcredit courses in parenting, counseling offered during pregnancy, and day care for children of enrolled students. Control variables included age at pregnancy, BMI, and parent education at the individual level, and socioeconomic disadvantage, school quality, number of past year pregnancies, enrollment options after pregnancy, public/private, and school size at the school level. We implemented multilevel OLS models with random intercepts for schools, regressing birth outcomes on school services and controlling for individual and school-level demographic traits. Results: The average birth weight of included infants was 3.28 kg, and the average gestational age was 39.5 weeks. On-site reproductive health services were offered in less than 15% of the schools: diagnostic screening (7.7%), treatment for STDs (2.9%), family planning counseling (8.7%), prenatal/postpartum health care (3.9%), and rape counseling (12.5%). Supportive services were relatively more common than reproductive health services (forcredit courses in parenting [20.2%], counseling for pregnant teens [88.5%]), except day care for children of enrolled students (4.8%). In multilevel analyses including controls, availability of family planning counseling (Est. s = .22), for-credit courses in parenting (Est. s = .23), counseling services (Est. s = .22) and day care (Est. s = .28) were all significantly (p < .05) associated with increased infant birth weight. Family planning counseling (Est. s = .90, p < .05) was also significantly associated with increased gestational age after controlling for individual and school-level characteristics. Conclusions: Family planning counseling offered on-site at schools was associated with greater birth weight and gestational age among adolescent mothers, while other supportive services were only associated with increased birth weight. Such on-site services may signal openness for a teen to discuss and receive support for reproductive health issues, and thus improve birth outcomes through the social support a pregnant teen feels. Future analyses that study mechanisms by which these services impact birth outcomes are warranted.
Madkour, A. S., Harville, E. W., & Xie, Y. (2014). School-based Health and Supportive Services for Pregnant and Parenting Teens: Associations with Birth Outcomes of Infants Born to Adolescent Mothers. Journal of Adolescent Health, 54(2), S36. https://doi.org/10.1016/j.jadohealth.2013.10.085