An Evaluation of a Substance Abuse Education Program for Mississippi Delta Pregnant Adolescents
Sarvela, Paul D., Ford, Tess D., Journal of School Health
Fertility data indicate teens ages 15-19 give birth at a rate of 71 per 1,000 total live births in the U.S. In Illinois, 12% of all births are to women in this age range, and in the extreme southern Illinois counties which are a part of the Mississippi Delta, births to teens range from 10.9% to 33.1% of all live births.|1,2~
Concurrent with the problem of teen pregnancy in rural areas is adolescent drug and alcohol use. Studies confirm that substance abuse is not only an inner city problem but one affecting rural and small towns as well.|3,4~ One study in rural Illinois found that more than 70% of 3,907 junior and senior high school students had used alcohol and about 50% indicated use of tobacco. More than 20% had smoked marijuana at least once.|5~ In addition, about 42% of the high school seniors had driven a car after drinking or using drugs.|6~
Public health specialists are concerned about drug and alcohol use problems because research confirms these problems are related to neonatal complications and infant mortality.|1~ For example, a case-control epidemiologic study conducted in the Netherlands showed maternal alcohol consumption increased the risk of mental retardation significantly, as did paternal pipe or cigar smoking.|7~ Studies indicate cigarette smoking is related to low birth weight, intrauterine growth retardation, preterm birth, and perinatal mortality rates.|8-10~ Other studies have demonstrated an increased risk of prematurity and other complications when the expecting mother uses hard drugs. Feldman et al,|11~ studying an inner city population, contend that "our data support not merely an association between cocaine and preterm birth, but a substantive contribution of cocaine to prematurity within an inner-city community."
Writers of Healthy People 2000 call for reducing infant mortality in the US.|1~ As maternal substance use is a major risk factor related to infant mortality, a prenatal health education program known as ASPEN (Adolescent Substance Prevention Education Network) was designed to focus on reducing the drug use behavior of pregnant adolescents living in the Mississippi delta region of southern Illinois. This study determined effects of the substance abuse education program on patient knowledge, attitudes, and drug use behavior and examined the program's affect on newborns. Pretest baseline data for this study were reported previously.|12~ This report presents posttest data.
A non-equivalent control group design was selected as the evaluation design. Subjects were assigned to the control or experimental group based on county of residence. This design, quasi-experimental in nature, handles many of the major threats to internal experimental validity.|13~ In addition, by having the experimental and control groups coming from different geographic areas, the possibility of the experimental group "contaminating" those in the control group was reduced. It was much less likely someone from the experimental group would discuss the educational program with someone in the control group using this design than if a randomized controlled trial was used. In the case of a randomized controlled trial, two friends may have been put into different groups. If this occurred, it would be possible for the friends to discuss the program, making the treatment effect less "clean."
For the pilot study, observations and interviews were used to obtain information from 32 patients and staff members concerning the ease of use of the curriculum, implementation problems, readability, interest levels, curriculum attractiveness, and relevance to the target population. Guidelines found in Pretesting in Health Communications were used as a model for the pilot-testing and formative evaluation of the project.|14~ Clients participating in the pilot study were not part of the primary sample.
Data were collected from pregnant adolescents in 1989 and 1990 who were seeking care from two regional health centers. …