DISAPPOINTING RESULTS FOR PEER-LED SEX EDUCATION

A peer-led sex education program in England had no effect on students' behavior in up to seven years of follow-up.1 In a trial of the program, 27 schools, with a total of more than 9,000 students, were randomized to provide either the three-session peer-led intervention or regular teacher-led sex education to eighth graders (13–14-year-olds) in 1998 and 1999. Participants completed questionnaires at baseline, approximately six and 18 months after the intervention, and about 54 months after baseline; information on participants' abortions by age 20 (the main outcome assessed) and births by age 20.5 was obtained from national registries. In both the intervention and the control groups, 5% of females had an abortion during adolescence; 8% and 11%, respectively (statistically indistinguishable proportions), gave birth at least once. The data revealed no differences by intervention group for either males or females in a wide range of outcomes, including condom and contraceptive use at first and at last sex, feelings of regret about first intercourse, STD history, knowledge of emergency contraception, quality of current relationship and use of local sexual health services. Results of the trial, in the researchers' view, "may temper high expectations" of peer-led sex education.

1. Stephenson J et al., The long-term effects of a peer-led sex education programme (RIPPLE): a cluster ran domised trial in schools in England, PLoS Medicine, 2008, 5(11):1579–1590.

TEENAGER SEE, TEENAGER DO?

Teenagers who watch TV shows with a lot of sexual content have an elevated risk of being involved in a pregnancy before they are 20 years old, according to results of a national longitudinal study.1 The study was based on telephone interviews conducted with a sample of 12–17-year-olds in 2001, and follow-up interviews one and three years later. Questions included the frequency with which participants watched selected popular TV series, which the researchers analyzed for level of sexual content. In an analysis controlling for total exposure to TV and a wide range of demographic and psychosocial variables, exposure to sexual content on TV was positively associated with participants' likelihood of involvement in a teenage pregnancy. By the final interview, when participants were 16–20 years old, the probability of pregnancy involvement was 2–3 times as great among those who had been exposed to the highest level of sexual content as among those who had been exposed to the lowest level. The findings, the researchers remark, argue for teenage pregnancy prevention strategies "that factor in the role of portrayals of sexuality on television and in other media."

1. Chandra A et al., Does watching sex on television predict teen pregnancy? findings from a national longitudinal survey of youth, Pediatrics, 2008, 122(5):1047–1054.

INTENTION STATUS PREDICTS MATERNAL BEHAVIOR

Maryland women who had a live birth between 2001 and 2006 were more likely to engage in unhealthy pregnancy-related behavior before, during and after pregnancy if they had not intended to conceive than if they had.1 An analysis of data from the Pregnancy Risk Assessment Monitoring System shows that 41% of pregnancies ending in live births during the study period were unintended—31% were mistimed, and 10% unwanted. According to calculations that adjusted for women's demographic and socioeconomic characteristics, those who had not wanted to conceive were more likely than those with intended pregnancies to have consumed folic acid less than daily in the three months before becoming pregnant, smoked late in pregnancy or during the postpartum period, and been depressed after giving birth (odds ratios, 1.9–2.3); they were less likely than those whose pregnancies were intended to have begun prenatal care during the first trimester (0.3) and breast-fed for at least eight weeks (0.7). Women whose pregnancies had been mistimed had elevated odds of not having consumed folic acid regularly before conception (2.2) and having experienced postpartum depression (1.3); they had reduced odds of having begun prenatal care early (0.5). Prevention of unintended pregnancies, the analysts write, "will help to reduce the magnitude of these unhealthy perinatal factors."

1. Cheng D et al., Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors, Contraception, 2008, doi:10.1016/j.contraception.2008.09.009.

IS MORE LEAVE BETTER?

The European Commission plans to raise the minimum length of paid maternity leave from 14 to 18 continuous weeks—six weeks of mandatory leave after childbirth and 12 weeks before or after, at the parents' discretion.1 According to a draft of the plan, the purpose of the increase is to give women a greater chance to recover from pregnancy and delivery, more time with their children and an opportunity to breast-feed for a longer period. Despite the good intentions, though, not everyone is happy about the proposal. In Great Britain, for example, the government contends that it will create unnecessary expenditures for employers and the state, and some politicians think that it could work against women who want to get back to work as soon as possible after giving birth.2 Some British academics and business leaders go so far as to argue that job opportunities for women will shrink if employers are unable or unwilling to cover the costs of both maternity leave and temporary staff additions. The draft proposal, which includes measures intended to expand workplace protections for mothers, is slated to be considered by the full commission early in 2009.

1. Goldirova R, Brussels set to improve maternity leave conditions, EUobserver, Dec. 9, 2008, <http://euobserver.com/9/26732>, accessed Dec. 11, 2008.

2. Beckford M, European Commission to force women to take six weeks off after giving birth, Telegraph.co.uk, Nov. 20, 2008, <http://www.telegraph.co.uk/health/3485528/European-Commission-to-force-women-to-take-six-weeks-off-after-giving-birth.html>, accessed Nov. 20, 2008.

SQUEAKING BY ON PREMATURITY

To help raise awareness of "the growing crisis of preterm birth" in the United States, the March of Dimes has released its first Premature Birth Report Card, and the news is not good: As a nation, we are barely passing.1 Under Healthy People 2010, the goal is to ensure that no more than 8% of live births nationwide are preterm; in 2005, the latest year for which data are available, the proportion was 13%—high enough to rate a grade of D. No state earned an A, and only one (Vermont) got a B. Eight states got C's; 23 got D's; and 18 states, Puerto Rico and the District of Columbia flunked. Beside grading the states, the report card examines factors that affect the risk of preterm birth and outlines steps that various sectors can take to help reduce the risk. For example, it calls on the federal government to support research on prematurity and the care of preterm infants, on hospital leaders to ensure that all cesarean deliveries and labor inductions are performed in accordance with professional guidelines, and on policymakers to expand women's access to health care coverage. Grades in 2009 will take into account state actions aimed at lowering rates of prematurity.

1. March of Dimes, Nation gets a "D" as March of Dimes releases Premature Birth Report Card, new release, White Plains, NY: March of Dimes, Nov. 12, 2008.

GUIDELINES FOR PREVENTING VERTICAL HIV TRANSMISSION

Despite the availability of interventions that can prevent HIV infection from being transmitted from a mother to her newborn, vertical transmission still occurs in the United States—mainly because HIV-positive women are not always identified as such during pregnancy. As a result, the American Academy of Pediatrics has issued a policy statement emphasizing the key role that universal HIV testing of pregnant women plays in the prevention of mother-to-child transmission of the virus.1 Among the statement's specific recommendations are routine HIV testing of all pregnant women except those who opt out, repeat testing during the third trimester at least for women meeting certain risk criteria, and testing (using a rapid antibody test) of women in labor whose HIV status is unknown, followed by administration of antiretroviral treatment for those who are found to be infected. The statement also provides guidelines for testing and caring for newborns who were exposed to infection or whose HIV status is uncertain. Finally, it notes that care of affected women, fetuses, newborn and children should involve both obstetric and pediatric HIV infection specialists.

1. Committee on Pediatric AIDS, HIV testing and prophylaxis to prevent mother-to-child transmission in the United States, Pediatrics, 2008, 122(5):1127–1134.

SO, LIKE, TEENAGERS DON'T KNOW EVERYTHING?

Eighty percent of 11th and 12th graders surveyed in Toronto in 2006 said that they know what infertility is, but their grasp of the subject was shaky.1 For instance, nearly four in five thought that infertility affects only women, and three in five believed that it is completely curable. Only 58% knew that some STDs can lead to infertility; of these, 89% could not name an STD that can cause infertility, and no more than 6% mentioned any particular disease. The majority associated smoking (66%) and other substance use (78%) with increased risk, but not being overweight or underweight (43%). Seven in 10 respondents said that protecting their fertility is an important issue, and a similar proportion reported that they would be upset if they were infertile; still, only 55% would be willing to undergo annual STD screening, and only 62% were interested in learning more about how to protect their fertility. When asked to list ways of protecting their fertility, students most often said practicing safer sex (21%), avoiding alcohol and drug use (19%) and not smoking (16%); 6% gave incorrect responses. The researchers acknowledge the limitations of their descriptive study, but nevertheless believe that it demonstrates the importance of arming young people with knowledge about infertility and about how to protect their fertility.

1. Quach S and Librach C, Infertility knowledge and attitudes in urban high school students, Fertility and Sterility, 2008, 90(6):2099–2106.

LABOR'S PAIN'S LOST

Women's memory of labor pain appears to fade over time, unless they viewed childbirth overall as a negative experience.1 In a cohort study of 1,383 Swedish women who gave birth in 1999–2000, participants' average rating of the intensity of labor pain dropped from 5.6 (on a scale of 1–7) two months after delivery to 5.3 at one year and 5.0 at five years. Some 49% of women rated the pain as less severe at five years than at two months, while 35% gave the same response at both points and 16% remembered the pain as more severe at the last follow-up. At all three time points, participants who had had an epidural block remembered the pain as worse than others. Women who viewed childbirth as a positive experience consistently reported the least intense pain, and those who considered it a negative experience consistently reported the most; in the former group, pain scores declined significantly at each report, but the same was not true in the latter group. According to the researchers, the findings "do not provide simple answers as to how caregivers could help women deal with labour pain," but they suggest that pain during childbirth is generally "a manageable life experience."

1. Waldenstrüm U and Schytt E, A longitudinal study of women's memory of labour pain—from 2 months to 5 years after the birth, BJOG: An International Journal of Obstetrics and Gynaecology, 2008, doi:10.1111/j.1471-0528.2008.02020.x.