title: Improved Contraceptive Use Among Teen Mothers in a Patient-Centered Medical Home.
abstract: The Generations program, a patient-centered medical home, providing primary medical care, social work, and mental health services to teen mothers and their children, offers a promising approach to pregnancy prevention for teen mothers. This study tested whether the Generations intervention was associated with improved rates of contraceptive and condom use among participants 12 months after program entry.
  
  
  
  This study compared teen mothers enrolled in Generations to those receiving standard community-based pediatric primary care over 12 months. Participants included African-American mothers ages 19 and younger, with infants under 6 months, living in Washington DC. A total of 83% of the baseline sample (150 mother-child dyads) was retained at follow-up.
  
  
  
  Generations participants had over three times the odds of contraceptive use, with an odds ratio (OR) of 3.35, and twice the odds of condom use (OR = 2.29) after 12 months, compared to participants receiving standard pediatric care. The odds remained comparable and significant when adjusting for differences in baseline use. Once additional covariates were entered into the model, the association was reduced to OR = 2.59 because being in a relationship with the baby's father was significantly associated with reduced contraceptive use. The same pattern was evident for condom use. Mothers in Generations had steady use of contraceptives over time, but there was a decline in use among comparison mothers, indicating that Generations prevented contraceptive discontinuation.
  
  
  
  Findings from this study suggest that the Generations program is an effective intervention for improving contraceptive use among teen mothers, a group at especially high risk for pregnancy.
authors.affiliation: Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland. Electronic address: alewin@umd.edu.
authors.forename: Amy
authors.initials: A
authors.lastname: Lewin
authors.affiliation: Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Mitchell
authors.affiliation: Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC.
authors.forename: Lee
authors.initials: L
authors.lastname: Beers
authors.affiliation: Goldberg Center for Community Pediatric Health, Children's National Health System, Washington, DC.
authors.forename: Kristine
authors.initials: K
authors.lastname: Schmitz
authors.affiliation: Department of Health Services Administration, School of Public Health, University of Maryland, College Park, Maryland.
authors.forename: Michel
authors.initials: M
authors.lastname: Boudreaux
mesh_terms: D000293:Adolescent; D001741:Black or African American; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D004219:District of Columbia; D005220:Fathers / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data*; D016017:Odds Ratio; D018802:Patient-Centered Care; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000517:prevention & control / Q000706:statistics & numerical data*; D015397:Program Evaluation; D011446:Prospective Studies; D012944:Social Support; D055815:Young Adult
keywords: Adolescent health; Adolescent pregnancy; Contraceptive use; Patient-centered medical home; Pregnancy prevention; Reproductive health; Teen pregnancy