青少年妊娠和社会不利因素：整合对照试验的系统性综述定性研究  

Teenage pregnancy and social disadvantage： systematic review integrating controlled trials and qualitative studies

作　　者：Angela Harden Ginny Brunton Adam Fletcher Ann Oakley 郭齐(译)[4] 潘凌亚(校) 张拓红(校)[5] 

机构地区：[1]Institute of Health and Human Development, University of East London, London, E154LZ [2]Social Science Research Unit, Institute of Education, University of London, London WC1H0NR [3]Department of Public Health & Policy,London School of Hygiene & Tropical Medicine, London, WC1E7H [4]北京协和医院妇产科 [5]北京大学公共卫生学院卫生政策与管理学系

出　　处：《英国医学杂志中文版》2010年第1期16-26,共11页The BMJ Chinese Edition

摘　　要：目的确定尽力解决与早为父母相关的社会不利因素的干预对青少年妊娠的影响，评估这种干预对英国青年人的适当性。设计系统性回顾，包括一个对早为父母干预的对照试验的统计学荟萃分析，以及一个定性研究的主题综合，调查了生活在英国的青年人对早成为父母的观点。数据来源12个电子目录式数据库，5个核心期刊，相关研究的引用列表，研究作者，以及该领域的专家。回顾方法2名独立的研究员分别对所有研究的方法学质量进行评估和数据摘要。结果纳入10个对照试验及5个定性研究。对照试验评估孩童时期早期干预或青年发展计划。全部汇集效应的排列结果表明，在接受过一项干预的个体中，青少年的妊娠率较接受标准实践或无干预的个体低39％（相对危险度0．61；95％可信区间0．48～0．77）。定性研究显示，3个主要因素与早为父母相关：厌学，恶劣的物质条件及不幸的童年，以及对未来的期望过低。对这些因素相关的、对照试验中采用计划的内容与青少年妊娠的比较显示，孩童时期的干预和青少年发展计划，二者对于减少无意的青少年妊娠都是适当的策略。这些计划的目标在于，通过学业支持促进与学校的接合，通过指导和社会救助改善不幸的童年，通过职业发展和工作经历唤起渴望。然而，这些途径都不能直接解决所有影响年轻人早为父母之路的社会、社区及家庭层面的因素。结论这一小的、但可靠的证据支持，早期孩童时期的干预和青少年发展计划对于减少无意的青少年妊娠是有效和适当的。结合对照试验和定性研究的发现，为有效的公共政策提供了一个有力的循证基础。Objective To determine the impact on teenage pregnancy of interventions that address the social disadvantage associated with early parenthood and to assess the appropriateness of such interventions for young people in the United Kingdom. Design Systematic review, including a statistical meta-analysis of controlled trials on interventions for early parenthood and a thematic synthesis of qualitative studies that investigated the views on early parenthood of young people living in the UK. Data sources 12 electronic bibliographic databases, five key journals, reference lists of relevant studies, study authors, and experts in the field. Review methods Two independent reviewers assessed the methodological quality of studies and abstracted data. Resnlts Ten controlled trials and five qualitative studies were included. Controlled trials evaluated either early childhood interventions or youth development programmes. The overall pooled effect size showed that teenage pregnancy rates were 39% lower among individuals receiving an intervention than in those receiving standard practice or no intervention （ relative risk 0.61; 95% confidence interval 0. 48 to 0. 77 ）. Three main themes associated with early parenthood emerged from the qualitative studies： dislike of school; poor material circumstances and unhappy childhood; and low expectations for the future. Comparison of these factors related to teenage pregnancy with the content of the programmes used in the controlled trials indicated that both early childhood interventions and youth development programmes are appropriate strategies for reducing unintended teenage pregnancies. The programmes aim to promote engagement with school through learning support, ameliorate unhappy childhood through guidance and social support, and raise aspirations through career development and work experience. However, none of these approaches directly tackles all the societal, community, and family level factors that influence young people＇s routes to early parenthood. Conclusions

关 键 词：青少年妊娠 对照试验 系统性综述 早期干预 试验评估 系统性回顾 相对危险度 荟萃分析 

分 类 号：R-05[医药卫生]