The long-term objective of this study is to reduce risk for HIV and other sexually transmitted diseases (STDs) during and after pregnancy among ethnically-diverse adolescents (aged 14-19) receiving prenatal care in public clinics in 2 cities: New Haven CT and Atlanta GA. Because women of all ages make numerous behavioral changes during pregnancy (e.g., improve diet; reduce/eliminate tobacco, alcohol and illicit drug use), we believe that pregnancy may also present an important window of opportunity to promote changes in high-risk sexual behavior. Behavior changes initiated in pregnancy could be maintained postpartum with an effective intervention. Integrating theories of diffusion of innovation, social learning theory, and theory of gender and power, specific aims of the proposed study are to: (1) Implement a unique group prenatal care intervention that focuses on risk assessment, educational/skills development, and social support to reduce health risk behaviors and promote health enhancing behaviors; (2) examine prospectively changes in behavior throughout the prenatal period and up to one year later, and to determine the effects of these behavioral changes on biological outcomes, including incidence of STDs and repeat pregnancy; and (3) Identify HIV risk-related psychosocial characteristics associated with biological and behavioral outcomes. As part of this randomized controlled trial, women entering prenatal care in the collaborating clinics will be randomly assigned to one of three treatment conditions: individual standard of prenatal care, standard Centering Pregnancy Program for group prenatal care, and enhanced Centering Pregnancy Program including HIV/STD skills development. The principal outcome will be subsequent chlamydial or gonorrheal infection, evaluated on an intent-to-treat basis by logistic regression analysis. The strengths of the proposed study include: its randomized, prospective longitudinal design; opportunity to maximize sexual risk reduction during and after teen pregnancy; integration of biological and behavioral outcomes; intervention implemented in two cities with high HIV/STD prevalence; change social norms regarding high-risk behavior during pregnancy/postpartum by conducting prenatal care in peer groups; and ability to sustain the intervention because prenatal care is covered by most standard reimbursement systems -- both public and private (i.e. ease of technology transfer).

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
1R01MH061175-01A1
Application #
6313549
Study Section
Special Emphasis Panel (ZRG1-AARR-7 (01))
Program Officer
Borek, Nicolette
Project Start
2001-04-24
Project End
2006-03-31
Budget Start
2001-04-24
Budget End
2002-03-31
Support Year
1
Fiscal Year
2001
Total Cost
$697,383
Indirect Cost
Name
Yale University
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
082359691
City
New Haven
State
CT
Country
United States
Zip Code
06520
Earnshaw, Valerie A; Rosenthal, Lisa; Cunningham, Shayna D et al. (2016) Exploring Group Composition among Young, Urban Women of Color in Prenatal Care: Implications for Satisfaction, Engagement, and Group Attendance. Womens Health Issues 26:110-5
Agrawal, Alpna; Ickovics, Jeannette; Lewis, Jessica B et al. (2014) Postpartum intimate partner violence and health risks among young mothers in the United States: a prospective study. Matern Child Health J 18:1985-92
Novick, Gina; Reid, Allecia E; Lewis, Jessica et al. (2013) Group prenatal care: model fidelity and outcomes. Am J Obstet Gynecol 209:112.e1-6
Magriples, Urania; Boynton, Marcella H; Kershaw, Trace S et al. (2013) Blood pressure changes during pregnancy: impact of race, body mass index, and weight gain. Am J Perinatol 30:415-24
Ickovics, Jeannette R; Reed, Elizabeth; Magriples, Urania et al. (2011) Effects of group prenatal care on psychosocial risk in pregnancy: results from a randomised controlled trial. Psychol Health 26:235-50
Arnold, Anna; Lewis, Jessica; Maximovich, Alexey et al. (2011) Antecedents and consequences of caregiving structure on young mothers and their infants. Matern Child Health J 15:1037-45
Gould Rothberg, Bonnie E; Magriples, Urania; Kershaw, Trace S et al. (2011) Gestational weight gain and subsequent postpartum weight loss among young, low-income, ethnic minority women. Am J Obstet Gynecol 204:52.e1-11
Kershaw, Trace S; Arnold, Anna; Lewis, Jessica B et al. (2011) The skinny on sexual risk: the effects of BMI on STI incidence and risk. AIDS Behav 15:1527-38
Kershaw, Trace S; Ethier, Kathleen A; Niccolai, Linda M et al. (2010) Let's stay together: relationship dissolution and sexually transmitted diseases among parenting and non-parenting adolescents. J Behav Med 33:454-65
Kershaw, Trace S; Magriples, Urania; Westdahl, Claire et al. (2009) Pregnancy as a window of opportunity for HIV prevention: effects of an HIV intervention delivered within prenatal care. Am J Public Health 99:2079-86

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