Interventions for preventing unintended pregnancies among adolescents

Chioma Oringanje; Martin M Meremikwu; Hokehe Eko; Ekpereonne Esu; Anne Meremikwu; John E Ehiri

doi:10.1002/14651858.CD005215.pub2

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Figure 1

Risk of bias summary: review authors' judgments about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Multiple interventions, Outcome 1 Unintended Pregnancy [individually randomized trials].

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Analysis 1.2

Comparison 1 Multiple interventions, Outcome 2 Unintended Pregnancy [Cluster‐randomised trials].

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Analysis 1.3

Comparison 1 Multiple interventions, Outcome 3 Initiation of sexual intercourse‐Individually RCT.

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Analysis 1.4

Comparison 1 Multiple interventions, Outcome 4 Initiation of sexual intercourse‐Cluster RCT.

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Analysis 1.5

Comparison 1 Multiple interventions, Outcome 5 Use of birth control methods‐Cluster RCT.

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Analysis 1.6

Comparison 1 Multiple interventions, Outcome 6 Use of birth control methods‐Individually RCT.

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Analysis 1.7

Comparison 1 Multiple interventions, Outcome 7 Sexually Transmitted Diseases‐Cluster RCT.

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Analysis 1.8

Comparison 1 Multiple interventions, Outcome 8 Sexually Transmitted Diseases‐Individually RCT.

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Analysis 1.9

Comparison 1 Multiple interventions, Outcome 9 Childbirth‐Individually RCT.

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Analysis 1.10

Comparison 1 Multiple interventions, Outcome 10 Second unintended pregnancy‐Individually RCT.

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Analysis 2.1

Comparison 2 Sensitivity analysis [Multiple intervention]: Unintended pregnancy, Outcome 1 Unintended Pregnancy [cluster‐randomized studies].

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Analysis 2.2

Comparison 2 Sensitivity analysis [Multiple intervention]: Unintended pregnancy, Outcome 2 Unintended Pregnancy [cluster‐adjusted+individual].

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Analysis 3.1

Comparison 3 Sensitivity analysis [Multiple intervention]: Initiation of intercourse, Outcome 1 Initiation of sexual intercourse‐Individually RCT.

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Analysis 3.2

Comparison 3 Sensitivity analysis [Multiple intervention]: Initiation of intercourse, Outcome 2 Initiation of sexual intercourse‐cluster RCT.

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Analysis 3.3

Comparison 3 Sensitivity analysis [Multiple intervention]: Initiation of intercourse, Outcome 3 Initiation of sexual intercourse‐cluster‐adjusted + individual).

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Analysis 4.1

Comparison 4 Educational intervention, Outcome 1 Initiation of Sexual Intercourse‐Cluster RCT.

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Analysis 4.2

Comparison 4 Educational intervention, Outcome 2 Use of birth control methods‐Cluster RCT.

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Analysis 5.1

Comparison 5 Contraceptive Intervention, Outcome 1 Unintended Pregnancy‐Individually RCT.

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Analysis 5.2

Comparison 5 Contraceptive Intervention, Outcome 2 Initiation of sexual intercourse‐Cluster RCT.

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Analysis 5.3

Comparison 5 Contraceptive Intervention, Outcome 3 Use of birth control methods‐Cluster RCT.

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Analysis 5.4

Comparison 5 Contraceptive Intervention, Outcome 4 Use of birth control methods‐Individually RCT.

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Analysis 5.5

Comparison 5 Contraceptive Intervention, Outcome 5 Sexually Transmitted Diseases‐Individually RCT.

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Table 1. Studies That Can Not Be Included in Meta Analysis

Intervention	Outcome	Study ID	Number Assessed	Case affected	Control affected	summary Of effects by authors	Test Statistics	95% CI	p‐value
Educational Intervention	Pregnancy	O'Donnell 2002	195	6.8%	18.5%	Favour intervention	‐	‐	‐
		Mitchell‐DiCenso 1997	1701	‐	‐	Favour intervention	OR: 0.97	0.98 to 1.0	0.04
		Allen 1997	560	‐	‐	Favour intervention	OR: 0.41	‐	‐
	Initiation of Intercourse	Clark 2005	156	‐	‐	No significant effect	Beta: 1.604 and SE: 1.00	‐	< 0.11
		O'Donnell 2002	195	40.1%	66.1%	Favour intervention	OR: 0.39	0.20 to 0.76	0.005
	Use of birth control at last sex	Mitchell‐DiCenso 1997 (females)	109	42.2%	46.7%	No significant effect	OR: 1.03	1.00 to 1.07	0.03
		Mitchell‐DiCenso 1997 (males)	214	39.3%	35.9%	No significant effect	OR: 1.06	1.02 to 1.77	0.005
	Use of condom at last sex	Okonofua 2003	1896	39.1%	31.9%	Favour intervention	OR: 1.41	1.12 to 1.77	‐
Multiple Intervention	Pregnancy	Coyle 2006	308	‐	‐	No significant effect	OR; 0.84	‐	0.61
		Diclemente 2004	460	‐	‐	No significant effect	OR: 0.53	0.27 to 1.03	0.06
		Stephenson 2004	1172	2.3%	3.3%	No significant effect	‐	‐	0.07
		Kirby 2004	2145	‐	‐	Favour Intervention	OR: 1.34	0.98 to 1.84	0.07
		Coyle 2006	417	‐	‐	No significant effect	OR: 0.77	0.49 to 1.23	0.28
		Smith 1994	95	‐	‐	Favour intervention	‐	‐	< 0.05
	Initiation of sexual intercourse (Mixed gender)	Coyle 2006	94	‐	‐	No significant effect	OR: 1.23	0.51 to 2.97	0.65
		Smith 1994	95	.Mean: 1.19	.Mean: 2.74	Favour intervention
		Basen‐Engquist 2001	8326	‐	‐	No significant effect	OR: 1.03	0.88 to 1.21	0.69
	Initiation of sexual intercourse (Males)	Coyle 2004	1412	19.3%	27.7%	Favour Intervention	model R²: 0.118	‐	0.02
		Kirby 2004	809	‐	‐	No significant effect	OR: 1.08	0.80 to 1.46	0.63
		Stephenson 2004	8156	32.7%	31.1%	No significant effect	OR: 0.90	0.65 to 1.23	0.35
		Eisen 1990	408	36%	44%	Favour Intervention	‐	‐	‐
	Initiation of intercourse (female)	Coyle 2004	1417	20.3%	22.1%	No significant effect	model R²: 0.145	‐	0.53
		Kirby 2004	1220	‐	‐	No significant effect	OR: 0.88	0.59 to 1.31	0.54
		Stephenson 2004	8156	34.7%	40.8%	Favour intervention	OR: 0.80	0.66 to 0.97	0.008
		Eisen 1990	480	27%	22%	No significant effect	‐	‐	‐
	Use of condoms at last sex	Kirby 2004	2145	‐	‐	Favour intervention	OR: 1.38	1.06 to 1.79	0.02
		Coyle 2006	359	‐	‐	No significant effect	OR: 1.00	0.49 to 1.23	0.99
		Diclemente 2004	460	‐	‐	Favour intervention	OR: 3.94	2.58 to 6.03	< .001
		Downs 2004	258	‐	‐	No significant effect	OR: 2.13	‐	0.15
	Childbirth	Henderson 2007	4196	300/1000	274/1000	No significant effect	OR: 14.6		0.32
	Abortion	Henderson 2007	4196	127/1000	112/1000	No significant effect	OR: 26.4		0.40

Table 1. Studies That Can Not Be Included in Meta Analysis

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Comparison 1. Multiple interventions

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Unintended Pregnancy [individually randomized trials] Show forest plot	2	858	Risk Ratio (M‐H, Fixed, 95% CI)	0.72 [0.51, 1.03]

2 Unintended Pregnancy [Cluster‐randomised trials] Show forest plot	5	3149	Risk Ratio (M‐H, Random, 95% CI)	0.50 [0.23, 1.09]

3 Initiation of sexual intercourse‐Individually RCT Show forest plot	3	1546	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.77, 0.96]

3.1 Gender mixed or not specified	3	1546	Risk Ratio (M‐H, Fixed, 95% CI)	0.86 [0.77, 0.96]
4 Initiation of sexual intercourse‐Cluster RCT Show forest plot	6	7954	Risk Ratio (M‐H, Random, 95% CI)	0.90 [0.77, 1.06]

4.1 Female	2	3499	Risk Ratio (M‐H, Random, 95% CI)	0.97 [0.87, 1.08]
4.2 Male	2	2969	Risk Ratio (M‐H, Random, 95% CI)	0.99 [0.87, 1.13]
4.3 Gender mixed or not specified	4	1486	Risk Ratio (M‐H, Random, 95% CI)	0.77 [0.47, 1.28]
5 Use of birth control methods‐Cluster RCT Show forest plot	5		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

5.1 condom use at last sex	3	1956	Risk Ratio (M‐H, Random, 95% CI)	1.01 [0.87, 1.16]
5.2 consistent condom use	2	296	Risk Ratio (M‐H, Random, 95% CI)	2.78 [0.98, 7.84]
5.3 Hormonal contraceptives	3	3987	Risk Ratio (M‐H, Random, 95% CI)	1.01 [0.72, 1.43]
6 Use of birth control methods‐Individually RCT Show forest plot	5	1332	Risk Ratio (M‐H, Random, 95% CI)	1.09 [0.89, 1.34]

6.1 Condom use in last sex	2	388	Risk Ratio (M‐H, Random, 95% CI)	1.03 [0.95, 1.13]
6.2 Consistent Condom use	3	944	Risk Ratio (M‐H, Random, 95% CI)	1.10 [0.74, 1.64]
7 Sexually Transmitted Diseases‐Cluster RCT Show forest plot	2	420	Risk Ratio (M‐H, Fixed, 95% CI)	0.76 [0.27, 2.14]

8 Sexually Transmitted Diseases‐Individually RCT Show forest plot	1	60	Risk Ratio (M‐H, Fixed, 95% CI)	0.45 [0.18, 1.15]

9 Childbirth‐Individually RCT Show forest plot	1	484	Risk Ratio (M‐H, Fixed, 95% CI)	0.67 [0.31, 1.45]

10 Second unintended pregnancy‐Individually RCT Show forest plot	1	149	Risk Ratio (M‐H, Fixed, 95% CI)	0.48 [0.22, 1.02]

Comparison 1. Multiple interventions

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Comparison 2. Sensitivity analysis [Multiple intervention]: Unintended pregnancy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Unintended Pregnancy [cluster‐randomized studies] Show forest plot	2	497	Risk Ratio (M‐H, Random, 95% CI)	0.20 [0.10, 0.39]

2 Unintended Pregnancy [cluster‐adjusted+individual] Show forest plot	3	871	Risk Ratio (M‐H, Fixed, 95% CI)	0.49 [0.33, 0.74]

Comparison 2. Sensitivity analysis [Multiple intervention]: Unintended pregnancy

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Comparison 3. Sensitivity analysis [Multiple intervention]: Initiation of intercourse

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Initiation of sexual intercourse‐Individually RCT Show forest plot	1	550	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.71, 1.09]

1.1 Gender mixed or not specified	1	550	Risk Ratio (M‐H, Fixed, 95% CI)	0.88 [0.71, 1.09]
2 Initiation of sexual intercourse‐cluster RCT Show forest plot	3	1033	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.51, 1.65]

2.1 Gender mixed or not specified	3	1033	Risk Ratio (M‐H, Random, 95% CI)	0.92 [0.51, 1.65]
3 Initiation of sexual intercourse‐cluster‐adjusted + individual) Show forest plot	4	1583	Odds Ratio (M‐H, Fixed, 95% CI)	0.87 [0.70, 1.09]

3.1 Gender mixed or not specified	4	1583	Odds Ratio (M‐H, Fixed, 95% CI)	0.87 [0.70, 1.09]

Comparison 3. Sensitivity analysis [Multiple intervention]: Initiation of intercourse

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Comparison 4. Educational intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Initiation of Sexual Intercourse‐Cluster RCT Show forest plot	1	525	Odds Ratio (M‐H, Fixed, 95% CI)	1.02 [0.67, 1.54]

1.1 Gender mixed or not specified	1	525	Odds Ratio (M‐H, Fixed, 95% CI)	1.02 [0.67, 1.54]
2 Use of birth control methods‐Cluster RCT Show forest plot	2	1431	Risk Ratio (M‐H, Random, 95% CI)	1.18 [1.06, 1.32]

2.1 condom use at last sex	2	1431	Risk Ratio (M‐H, Random, 95% CI)	1.18 [1.06, 1.32]

Comparison 4. Educational intervention

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Comparison 5. Contraceptive Intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Unintended Pregnancy‐Individually RCT Show forest plot	2	3440	Risk Ratio (M‐H, Fixed, 95% CI)	1.01 [0.81, 1.26]

2 Initiation of sexual intercourse‐Cluster RCT Show forest plot	1	3006	Risk Ratio (M‐H, Fixed, 95% CI)	0.95 [0.85, 1.07]

2.1 Female	1	1446	Risk Ratio (M‐H, Fixed, 95% CI)	0.89 [0.76, 1.04]
2.2 Male	1	1560	Risk Ratio (M‐H, Fixed, 95% CI)	1.02 [0.87, 1.21]
3 Use of birth control methods‐Cluster RCT Show forest plot	1	415	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.69, 1.18]

3.1 Hormonal contraceptives	1	415	Risk Ratio (M‐H, Fixed, 95% CI)	0.90 [0.69, 1.18]
4 Use of birth control methods‐Individually RCT Show forest plot	2		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

4.1 Condom use in last sex	2	3091	Risk Ratio (M‐H, Random, 95% CI)	0.95 [0.87, 1.04]
4.2 Consistent condom use	1	1950	Risk Ratio (M‐H, Random, 95% CI)	0.90 [0.71, 1.15]
4.3 Hormonal contraceptives	2	3091	Risk Ratio (M‐H, Random, 95% CI)	2.22 [1.07, 4.62]
5 Sexually Transmitted Diseases‐Individually RCT Show forest plot	2	3440	Risk Ratio (M‐H, Fixed, 95% CI)	0.92 [0.75, 1.13]

Comparison 5. Contraceptive Intervention

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