Replicating the Use of Motivational Interviewing and Facilitated Contraceptive Access to Reduce Repeat Adolescent Pregnancy: A Randomized Trial.

Objectives: It is important to identify programs that can work in multiple contexts to support adolescent parents in achieving their reproductive health goals. A randomized controlled trial (RCT) in Ohio in 2012 found that the Teen Options to Prevent Pregnancy (TOPP) program increased contraceptive use and reduced repeat pregnancy and repeat unintended pregnancy among adolescent parents. To facilitate access to contraceptives and support adolescents who wish to avoid repeat pregnancy, this 18-month program offers monthly motivational interviewing sessions with health care workers and assistance from social workers. This RCT examined whether program impacts on increased contraceptive use and reduced repeat pregnancies could be replicated in New York City (NYC).

Study Design: From 2020 to 2022, 702 pregnant and parenting adolescents ages 10 to 20 were enrolled from seven NYC hospitals. Participants were randomized to either NYC-TOPP or a usual-care control condition, which included potential access to contraceptives through either Title X or federally qualified health centers. 515 participants completed follow-up surveys approximately 18 months after enrollment. Differences in outcomes were assessed using ordinary least squares regression.

Results: The study did not detect impacts on receipt of reproductive health information, contraceptive knowledge, contraceptive use, repeat pregnancy (the pre-registered primary outcome), repeat unintended pregnancy, or other sexual risk behaviors. Participants in the treatment group agreed more strongly that they had received information to find community resources to support their family. The null results may be due to implementation challenges, including low treatment dosage, staff turnover, and limitations on in-person meetings and access to contraceptives related to the COVID-19 pandemic.

Conclusion: More research is needed to replicate evidence-based programs to support adolescent parents' reproductive planning.

Implications: An effort to replicate Teen Options to Prevent Pregnancy in NYC did not detect impacts on contraceptive use or repeat pregnancy outcomes. Future replications of this and other programs are needed to identify whether multicomponent programs can work in multiple contexts and at scale to support adolescent parents in achieving their reproductive health goals, such as avoiding repeat pregnancy.