Teenage Pregnancy and Fertility in English Communities: Neighbourhood, Family and Peer Influences on Behaviour

PhDThe British government established the Teenage Pregnancy Unit in 1999 to reduce early pregnancy. Current policy initiatives have a significant geographic dimension: specific English neighbourhoods have been identified as the sites where most early pregnancy occurs and have been targeted for intervention. The aim of this thesis is to explore the factors that influence teenage sexual and reproductive behaviour by drawing on the neighbourhoods effects literature. Within this body of research, teenage reproduction is believed to be affected by a multiplicity of factors operating within different domains. The analysis (of survey data and qualitative material collected in three locations) was guided by two research questions: which factors within neighbourhoods, family and peer contexts are the most important in elucidating the causal pathways to teenage sex, pregnancy and fertility; and do the importance of these factors vary between neighbourhoods? Overall, factors within neighbourhood and peer contexts were found to be less significant than family and individual-level factors. The analysis of British Cohort Study data showed that, for example, women who experience teenage pregnancy or birth lived in deprived areas at age 16, but other neighbourhood variables were not significant in multivariate analysis. There were some differences between neighbourhoods, but the cohort member's attitude to school was, generally, the most important factor associated with teenage sexual and reproductive behaviour. The qualitative data supported these statistical results. There was little evidence that women had been influenced by either their friends or others within their neighbourhoods (though some women reported knowing high numbers of teenage mothers), and nearly all the young mothers had low educational attainment. In conclusion, individual and family-level influences on sexual and reproductive outcomes are paramount, but behaviour is also subtly informed by wider social factors

Mapping service activity: the example of childhood obesity schemes in England

Background: Childhood obesity is high on the policy agenda of wealthier nations, and many interventions have been developed to address it. This work describes an overview of schemes for obese and overweight children and young people in England, and the 'mapping' approach we used.Methods: Our search strategy, inclusion criteria and coding frame had to be suitable for describing a potentially large number of schemes within a short timeframe. Data were collected from key informants, scheme publicity and reports, and via a web-survey. To be included, schemes had to be based in England, follow a structured programme lasting at least two weeks, promote healthy weight, and be delivered exclusively to overweight and/or obese children and young people (age range 4-18). Data were entered into a coding frame recording similar information for each scheme, including any underpinning research evidence, evaluation or monitoring reports. Priority questions were identified in consultation with colleagues from the Department of Health and the Cross Government Obesity Unit.Results: Fifty-one schemes were identified. Some operated in multiple areas, and by using estimates of the number of schemes provided by multi-site scheme leads, we found that between 314 and 375 local programmes were running at any time. Uncertainty is largely due to the largest scheme provider undergoing rapid expansion at the time of the mapping exercise and therefore able to provide only an estimate of the number of programmes running. Many schemes were similar in their approach, had been recently established and were following NICE guidelines on interventions to promote healthy weight. Rigorous evaluation was rare.Conclusions: Our methods enabled us to produce a rapid overview of service activity across a wide geographic area and a range of organisations and sectors. In order to develop the evidence base for childhood obesity interventions, rigorous evaluation of these schemes is required. This overview can serve as a starting point for evaluations of interventions to address obesity. More generally, a rapid and systematic approach of this type is transferable to other types of service activity in health and social care, and may be a tool to inform public health planning