The Effect of Monetary Incentives and Peer Support Groups on Repeat Adolescent Pregnancies A Randomized Trial of the Dollar-a-Day Program

Objectives. —To test the hypotheses that (1) a monetary incentive promotes peer-support group participation; and (2) peer-support group participation decreases repeat adolescent pregnancies.

Design. —Two-year, prospective, randomized controlled trial.

Setting. —Denver, Colo.

Participants. —A total of 286 primiparous girls younger than 18 years, whose infants were younger than 5 months.

Intervention. —Participants were randomized to 4 interventions: monetary incentive and peer-support group, peer-support group only, monetary incentive only, or no intervention.

Main Outcome Measures. —Consistency of participation in planned intervention and repeat pregnancy.

Results. —Participation in interventions was generally low. Hypothesis 1 was supported: 58% of those offered a monetary incentive participated in the peersupport groups, compared with 9% of those who were not offered the incentive. Hypothesis 2 was rejected: the peer-support group experience failed to prevent repeat pregnancies. The incidence of second pregnancies at 6 months (9%, 22/248), at 12 months (20%, 49/248), at 18 months (29%, 72/248), and at 24 months (39%, 97/248) following delivery did not vary significantly in relation to intervention strategy. Background sociodemographic characteristics significantly affected the timing of subsequent conceptions but not intervention participation.

Conclusion. —A monetary incentive draws adolescent mothers to sites where they can discuss the costs and benefits of contraception and conception with knowledgeable adults and supportive peers. These discussions do not prevent repeat pregnancies. Further studies are needed to determine if an intervention that produces substantive changes in the daily living environment will eliminate the sexual practices that are responsible for the high rate of repeat pregnancy in this population.