title: Soccer and sexual health education: a promising approach for reducing adolescent births in Haiti.
abstract: OBJECTIVE
  To explore the effect of an innovative, integrative program in female sexual reproductive health (SRH) and soccer (or fútbol, in Haitian Creole) in rural Haiti by measuring the rate of births among program participants 15-19 years old and their nonparticipant peers.
  
  
  METHODS
  A retrospective cohort study using 2006-2009 data from the computerized data-tracking system of the Haitian Health Foundation (HHF), a U.S.-based nongovernmental organization serving urban and rural populations in Haiti, was used to assess births among girls 15-19 years old who participated in HHF's GenNext program, a combination education-soccer program for youth, based on SRH classes HHF nurses and community workers had been conducting in Haiti for mothers, fathers, and youth; girl-centered health screenings; and an all-female summer soccer league, during 2006-2009 (n = 4 251). Bivariate and multiple logistic regression analyses were carried out to assess differences in the rate of births among program participants according to their level of participation (SRH component only ("EDU") versus both the SRH and soccer components ("SO") compared to their village peers who did not participate. Hazard ratios (HRs) of birth rates were estimated using Cox regression analysis of childbearing data for the three different groups.
  
  
  RESULTS
  In the multiple logistic regression analysis, only the girls in the "EDU" group had significantly fewer births than the nonparticipants after adjusting for confounders (odds ratio = 0.535; 95% confidence interval (CI) = 0.304, 0.940). The Cox regression analysis demonstrated that those in the EDU group (HR = 0.893; 95% CI = 0.802, 0.994) and to a greater degree those in the SO group (HR = 0.631; 95% CI = 0.558, 0.714) were significantly protected against childbearing between the ages of 15 and 19 years.
  
  
  CONCLUSIONS
  HHF's GenNext program demonstrates the effectiveness of utilizing nurse educators, community mobilization, and youth participation in sports, education, and structured youth groups to promote and sustain health for adolescent girls and young women.
authors.affiliation: Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America, kckaplan@gmail.com.
authors.forename: Kathryn C
authors.initials: KC
authors.lastname: Kaplan
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut, Farmington, Connecticut, United States of America.
authors.forename: Judy
authors.initials: J
authors.lastname: Lewis
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut, Farmington, Connecticut, United States of America.
authors.forename: Bette
authors.initials: B
authors.lastname: Gebrian
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut, Farmington, Connecticut, United States of America.
authors.forename: Katherine
authors.initials: K
authors.lastname: Theall
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D001723:Birth Rate; D005260:Female; D006205:Haiti; D006801:Humans; D008403:Mass Screening; D011247:Pregnancy; D018873:Pregnancy Rate; D011253:Pregnancy in Adolescence / Q000517:prevention & control*; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012424:Rural Population; D012736:Sex Education / Q000458:organization & administration*; D012916:Soccer; D055815:Young Adult