1. Holly S. Ruch-Ross, Sc.D. and Suzanne G. McLone, M.P.H.
ISPP ™
Contraceptive Knowledge and Use of Contraception Among Adolescent Mothers Participating in the Illinois Subsequent Pregnancy Program
Pat W. Mosena, Ph.D.,
Holly S. Ruch-Ross, Sc.D. and Suzanne G. McLone, M.P.H.

2. The Illinois Subsequent Pregnancy Program
ISPP ™
The Illinois Subsequent Pregnancy Program
A community-based program to delay second pregnancies among adolescent mothers.
Begun as pilot project in Chicago 1990, implemented statewide –2007.
Supported by Illinois Department of Human Services
Program Goals:
Delay a second pregnancy
Use contraception correctly and consistently
Remain in and graduate from high school
There have been 3,000 participants in 30 communities
3% had second pregnancy,
85% graduated/remained in school

3. ISPP Methods ™ Program Data Measures
Illinois Subsequent Pregnancy Program
ISPP ™
Methods
Program Data
Four Years of Program Data: 2003 to 2006
Participant Characteristics Collected and Reported by ISPP Home Visitor
Self-Reported Participant Questionnaires
Measures
Contraceptive Knowledge : Percent correct of questions asked (16 to 21 questions, updated yearly to reflect new contraceptive choices and to drop outdated methods)
Contraceptive Behavior (yes/no responses):
Anything Last Sex: The last time you had sex, did [you] do anything to keep from getting pregnant?
Condom Last Sex : The last time you had sex, did your partner use a condom?

4. ISPP Methods ™ Data Collection Illinois Subsequent Pregnancy Program
Self-administered participant questionnaires completed during group meeting
Three time points:
Baseline
Contraceptive Knowledge Score
Contraceptive Behavior
Posttest (1 Month)
Follow Up (6 Months)

5. Questionnaire Completion: Baseline, 1 Month and 6 Months
Illinois Subsequent Pregnancy Program
ISPP ™
Questionnaire Completion: Baseline, 1 Month and 6 Months
Questionnaire Completion (N=239) n %
Baseline and Posttest (1 Month) Only 98
41.0
Baseline , Posttest (1 Months) and Follow Up (6 Months)
141
59.0
There are no significant differences between the sample subsets with completed questionnaires at baseline and posttest (1 month) only (n=98) versus those with completed questionnaires at baseline, posttest (1 month) and follow up (6 months) (n=141) for the following variables:
Age of mother at intake
Participant status at intake (parenting vs. pregnant)
Contraception Knowledge Scores (Baseline or Posttest)
Contraceptive Behavior: Anything Last Sex, Condom Last Sex (Baseline or Posttest)
The sample subsets did differ significantly on the following variable:
Ethnicity:
African Americans were more likely to have a follow up questionnaire on file
Mexican Americans were less likely to have a follow up questionnaire on file

6. Participant Characteristics, N=239
Illinois Subsequent Pregnancy Program
ISPP ™
Participant Characteristics, N=239

7. Participant Characteristics, N=239
Illinois Subsequent Pregnancy Program
ISPP ™
Participant Characteristics, N=239

8. Participant Responses on Questionnaires, N=239
Illinois Subsequent Pregnancy Program
ISPP ™
Participant Responses on Questionnaires, N=239
Contraceptive Knowledge Score, Baseline (% Correct)
Mean:
Range: 10.0 to 100.0
Contraceptive Knowledge Score, Posttest (1 Month)
(% Correct)
Mean:
Range: 15.0 to 100.0
Change in Contraceptive Knowledge Score, Posttest
(1 Month )
Mean:
Range: to 76.0
Contraceptive Behavior
Baseline
Posttest, 1 Month
Follow Up, 6 Months
Used Contraception Last Sex
Yes
57.0%
64.9%
81.4% n
228
225
129
Used a Condom Last Sex
54.8%
61.4%
74.0%
223
127

9. ISPP Change in Contraceptive Knowledge Score,
Illinois Subsequent Pregnancy Program
ISPP ™
Change in Contraceptive Knowledge Score,
Baseline to Posttest (1 Month) (N=239)
t =
p <0.001
Paired sample t-test statistic used

10. ISPP Changes in Contraceptive Behavior,
Illinois Subsequent Pregnancy Program
ISPP ™
Changes in Contraceptive Behavior,
Baseline to Posttest (1 Month) (N=239)
2 = 97.26
p =0.002
2 = 5.354
p =0.002
McNemar 2 test statistic used

11. ISPP Changes in Contraceptive Behavior,
Illinois Subsequent Pregnancy Program
ISPP ™
Changes in Contraceptive Behavior,
Baseline to Follow Up (6 Months) (n=141)
2 = 96.80
p =0.017
2 = 5.354
p =0.002
McNemar 2 test statistic used

12. Percent with a POSITIVE
Illinois Subsequent Pregnancy Program
ISPP ™
Bivariate Analyses: Changes in Contraceptive Knowledge Scores and Reported Contraceptive Behavior at Posttest (1 Month) and Follow Up (6 Months)
Percent with a POSITIVE
Change in Score 1
Mean Change of Score 2
Posttest (1 Month)
Used Contraception , Any Method, at Last Sex
87.0 %
26.9
Did NOT Use Contraception at Last Sex
78.5 %
26.1
Used a Condom Last Sex
89.1 % *
29.4
Did NOT use a Condom Last Sex
77.9 %
23.6
Follow Up (6 Months)
87.6 % *
28.6
66.7 %
19.6
85.1 %
28.1
81.8 %
22.3
Significance levels: * p<0.05
1 Fisher’s Exact 2 test statistic used
2 Independent sample t-test statistic used

13. Illinois Subsequent Pregnancy Program
ISPP ™
Logistic Regression Models: Contraceptive Behavior at Posttest (1 Month) and Follow Up (6 Months)
Standardized  Coefficients
Dependent Variables:
Anything Last Sex, 1 Month
Anything Last Sex, 6 Months
Condom Last Sex, 1 Month
Condom Last Sex, 6 Months
Any Method/Condom Use at Baseline
70.79***
4.78*
36.33***
2.12
Participant Aged 14 and Younger
4.72
4.07
10.42*
4.82
Participant Aged 15 to 17
6.17
6.85*
2.75
3.43
Ethnicity (African American)
1.90
0.36
1.77
0.95
Ethnicity (Caucasian)
13.66
0.23
4.75
1.23
Ethnicity (Mexican American)
1.76
0.31
1.16
0.53
Ethnicity (Puerto Rican)
22.41
2E+008
16.47*
6E+008
Pregnant at Intake
0.89
0.43
0.69
0.71
Score at Baseline
1.00
0.99
Positive Change in Score (Yes)
1.83
5.46*
0.81
Adjusted (Nagelkerke) R2
0.64
0.33
0.58
0.14
2 for Model (df=10)
115.16***
26.49**
103.31***
10.90 n
189
114
110
Independent Variables:
Significance levels: *** p<0.001; **p<0.01; * p<0.05; all two-tailed tests.

14. ISPP Key Findings ™ From Baseline to Follow Up (6 Months)
Illinois Subsequent Pregnancy Program
ISPP ™
Key Findings
From Baseline to Posttest (1 Month)
Reported contraceptive use increased among participants in the Subsequent Pregnancy Project:
Participants increased their use of contraception (any method) at last sexual intercourse
Participants increased their use of a condom at last sexual intercourse
Contraceptive Knowledge increased among program participants
From Baseline to Follow Up (6 Months)
A positive change in Contraceptive Knowledge score is independently associated with use of contraception (any method) at last sexual intercourse

15. ISPP Conclusions ™ Illinois Subsequent Pregnancy Program
These findings support the expected changes in contraceptive behavior among adolescent mothers participating in ISPP. After 6 months of program participation, there was in increase in the proportion of young mothers who:
Used a method of contraception at last sexual intercourse
Used a condom at last sexual intercourse
The ISPP Program Model has been shown to consistently increase contraceptive use, across time and diverse populations of adolescents:
In participants’ self-report (i.e. current analysis)
Home Visitors’ report at the end of the program year
Very low subsequent pregnancy rates for program participants (3%)
Using Contraceptive Knowledge in an effort to assess a mechanism for behavior change among ISPP participants, we found:
An increase in Contraceptive Knowledge at 1 month shows a positive association with contraceptive use at 6 months, controlling for other factors