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Beth Barnet, MD; Carmen Arroyo, PhD; Margo Devoe, MS; Anne K. Duggan, ScD

Arch Pediatr Adolesc Med. 2004;158:262-268.

Background  Adolescent pregnancy is associated with increased school dropout rates. Dropping out amplifies the probability of persistent social and economic disadvantage. Whether school-based health centers might help reduce school absenteeism and dropout rates in this group has not been well studied.

Objective  To examine the association of school-based prenatal services on school attendance and dropout rates.

Methods  In this retrospective cohort study, using school rosters from an alternative school, we identified adolescents aged 18 years or younger who delivered a baby between July 1, 1995, and August 30, 1997, in Baltimore, Md. We linked school records spanning 3 years with medical records and birth certificates. School variables such as attendance and dropout rates were examined in relation to the teen's year of pregnancy and prenatal care setting (school-based vs non–school-based). Hierarchical logistic regression was used to examine effects of school-based prenatal care on dropout and promotion or graduation rates, with adjustment for baseline group differences.

Results  We identified 431 predominantly African American, low-income adolescents who attended the alternative school in their pregnancy school year. In the year prior to pregnancy, most performed poorly in school and had significant absenteeism. During their pregnancy school year, teens receiving school-based prenatal care were absent 12 fewer days, as compared with those receiving non–school-based care (P = .001), and their dropout rate was half that of those receiving non–school-based care (6% vs 15%; P = .02). Hierarchical logistic regression analyses, with adjustment for baseline prepregnancy differences, demonstrated that teens receiving school-based prenatal care were less likely to drop out of school during the pregnancy year (adjusted odds ratio, 0.39; 95% confidence interval, 0.15-0.99; P = .048).

Conclusions  Absenteeism and dropout rates were reduced for pregnant adolescents receiving prenatal care at a school-based health center in an urban alternative school. Findings underscore the importance of funding and evaluating school-based health centers and other interventions that may ameliorate negative outcomes among childbearing adolescents.

From the Department of Family Medicine, University of Maryland School of Medicine (Drs Barnet and Arroyo and Ms Devoe), and the Department of Pediatrics, Johns Hopkins University School of Medicine (Dr Duggan), Baltimore, Md.

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