Molly Rosenberg1, Audrey Pettifor2, William C Miller3, Harsha Thirumurthy4, Michael Emch5, Sulaimon A Afolabi6, Kathleen Kahn7, Mark Collinson7, Stephen Tollman7. 1. Department of Epidemiology, Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, Center for Population and Development Studies, Harvard University, Cambridge, MA USA, mrosenb@hsph.harvard.edu. 2. Department of Epidemiology, Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. 3. Department of Epidemiology, Division of Infectious Diseases in the Department of Medicine, University of North Carolina-Chapel Hill, NC, USA. 4. Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, Department of Health Policy and Management. 5. Department of Epidemiology, Carolina Population Center, University of North Carolina-Chapel Hill, NC, USA, Department of Geography, and. 6. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Demography and Population Studies, School of Social Sciences, University of the Witwatersrand, Johannesburg, South Africa. 7. MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umeå University, Umeå, Sweden and INDEPTH Network, Accra, Ghana.
Abstract
BACKGROUND: Sexual activity may be less likely to occur during periods of school enrolment because of the structured and supervised environment provided, the education obtained and the safer peer networks encountered while enrolled. We examined whether school enrolment was associated with teen pregnancy in South Africa. METHODS: Using longitudinal demographic surveillance data from the rural Agincourt sub-district, we reconstructed the school enrolment status from 2000 through 2011 for 15 457 young women aged 12-18 years and linked them to the estimated conception date for each pregnancy during this time. We examined the effect of time-varying school enrolment on teen pregnancy using a Cox proportional hazard model, adjusting for: age; calendar year; household socioeconomic status; household size; and gender, educational attainment and employment of household head. A secondary analysis compared the incidence of pregnancy among school enrolees by calendar time: school term vs school holiday. RESULTS: School enrolment was associated with lower teen pregnancy rates [adjusted hazard ratio (95% confidence interval): 0.57 (0.50, 0.65)].This association was robust to potential misclassification of school enrolment. For those enrolled in school, pregnancy occurred less commonly during school term than during school holidays [incidence rate ratio (95% confidence interval): 0.90 (0.78, 1.04)]. CONCLUSIONS: Young women who drop out of school may be at higher risk for teen pregnancy and could likely benefit from receipt of accessible and high quality sexual health services. Preventive interventions designed to keep young women in school or addressing the underlying causes of dropout may also help reduce the incidence of teen pregnancy.
BACKGROUND: Sexual activity may be less likely to occur during periods of school enrolment because of the structured and supervised environment provided, the education obtained and the safer peer networks encountered while enrolled. We examined whether school enrolment was associated with teen pregnancy in South Africa. METHODS: Using longitudinal demographic surveillance data from the rural Agincourt sub-district, we reconstructed the school enrolment status from 2000 through 2011 for 15 457 young women aged 12-18 years and linked them to the estimated conception date for each pregnancy during this time. We examined the effect of time-varying school enrolment on teen pregnancy using a Cox proportional hazard model, adjusting for: age; calendar year; household socioeconomic status; household size; and gender, educational attainment and employment of household head. A secondary analysis compared the incidence of pregnancy among school enrolees by calendar time: school term vs school holiday. RESULTS: School enrolment was associated with lower teen pregnancy rates [adjusted hazard ratio (95% confidence interval): 0.57 (0.50, 0.65)].This association was robust to potential misclassification of school enrolment. For those enrolled in school, pregnancy occurred less commonly during school term than during school holidays [incidence rate ratio (95% confidence interval): 0.90 (0.78, 1.04)]. CONCLUSIONS: Young women who drop out of school may be at higher risk for teen pregnancy and could likely benefit from receipt of accessible and high quality sexual health services. Preventive interventions designed to keep young women in school or addressing the underlying causes of dropout may also help reduce the incidence of teen pregnancy.
Authors: Audrey E Pettifor; Brooke A Levandowski; Catherine MacPhail; Nancy S Padian; Myron S Cohen; Helen V Rees Journal: Int J Epidemiol Date: 2008-07-09 Impact factor: 7.196
Authors: Marie C D Stoner; Katherine B Rucinski; Jessie K Edwards; Amanda Selin; James P Hughes; Jing Wang; Yaw Agyei; F Xavier Gomez-Olive; Catherine MacPhail; Kathleen Kahn; Audrey Pettifor Journal: Health Educ Behav Date: 2019-02-28
Authors: George C Patton; Susan M Sawyer; John S Santelli; David A Ross; Rima Afifi; Nicholas B Allen; Monika Arora; Peter Azzopardi; Wendy Baldwin; Christopher Bonell; Ritsuko Kakuma; Elissa Kennedy; Jaqueline Mahon; Terry McGovern; Ali H Mokdad; Vikram Patel; Suzanne Petroni; Nicola Reavley; Kikelomo Taiwo; Jane Waldfogel; Dakshitha Wickremarathne; Carmen Barroso; Zulfiqar Bhutta; Adesegun O Fatusi; Amitabh Mattoo; Judith Diers; Jing Fang; Jane Ferguson; Frederick Ssewamala; Russell M Viner Journal: Lancet Date: 2016-05-09 Impact factor: 79.321
Authors: Jan-Walter De Neve; Omar Karlsson; Chelsey R Canavan; Angela Chukwu; Seth Adu-Afarwuah; Justine Bukenya; Anne Marie Darling; Guy Harling; Mosa Moshabela; Japhet Killewo; Günther Fink; Wafaie W Fawzi; Yemane Berhane Journal: Trop Med Int Health Date: 2019-11-26 Impact factor: 3.918
Authors: Wenwen Jiang; Lusi Osborn; Alison L Drake; Jennifer A Unger; Daniel Matemo; John Kinuthia; Grace John-Stewart; Keshet Ronen Journal: J Assoc Nurses AIDS Care Date: 2021 Mar-Apr 01 Impact factor: 1.809
Authors: Molly Rosenberg; Audrey Pettifor; Rhian Twine; James P Hughes; F Xavier Gomez-Olive; Ryan G Wagner; Afolabi Sulaimon; Stephen Tollman; Amanda Selin; Catherine MacPhail; Kathleen Kahn Journal: BMJ Open Date: 2018-01-10 Impact factor: 2.692
Authors: Christina Maly; Katherine A McClendon; Joy Noel Baumgartner; Neema Nakyanjo; William George Ddaaki; David Serwadda; Fred Kakaire Nalugoda; Maria J Wawer; Erika Bonnevie; Jennifer A Wagman Journal: Glob Qual Nurs Res Date: 2017-08-10