Science The infant simulator fiasco

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Teenage pregnancy is bad. At least, that’s what most people think, so they are trying to lower the rates. One team of academics got the bright idea of exposure therapy. The idea is that babies are annoying and difficult to deal with, so if we can mimic this with a toy for young girls, this will make them realize how little they want to have a baby, and thus lower the pregnancy rates:
  • Brinkman, S. A., Johnson, S. E., Codde, J. P., Hart, M. B., Straton, J. A., Mittinty, M. N., & Silburn, S. R. (2016). Efficacy of infant simulator programmes to prevent teenage pregnancy: a school-based cluster randomised controlled trial in Western Australia. The Lancet, 388(10057), 2264-2271.
Background
Infant simulator-based programmes, which aim to prevent teenage pregnancy, are used in high-income as well as low-income and middle-income countries but, despite growing popularity, no published evidence exists of their long-term effect. The aim of this trial was to investigate the effect of such a programme, the Virtual Infant Parenting (VIP) programme, on pregnancy outcomes of birth and induced abortion in Australia.
Methods
In this school-based pragmatic cluster randomised controlled trial, eligible schools in Perth, Western Australia, were enrolled and randomised 1:1 to the intervention and control groups. Randomisation using a table of random numbers without blocking, stratification, or matching was done by a researcher who was masked to the identity of the schools. Between 2003 and 2006, the VIP programme was administered to girls aged 13–15 years in the intervention schools, while girls of the same age in the control schools received the standard health education curriculum. Participants were followed until they reached 20 years of age via data linkage to hospital medical and abortion clinic records. The primary endpoint was the occurrence of pregnancy during the teenage years. Binomial and Cox proportional hazards regression was used to test for differences in pregnancy rates between study groups. This study is registered as an international randomised controlled trial, number ISRCTN24952438.
Findings
57 (86%) of 66 eligible schools were enrolled into the trial and randomly assigned 1:1 to the intervention (28 schools) or the control group (29 schools). Then, between Feb 1, 2003, and May 31, 2006, 1267 girls in the intervention schools received the VIP programme while 1567 girls in the control schools received the standard health education curriculum. Compared with girls in the control group, a higher proportion of girls in the intervention group recorded at least one birth (97 [8%] of 1267 in the intervention group vs 67 [4%] of 1567 in the control group) or at least one abortion as the first pregnancy event (113 [9%] vs 101 [6%]). After adjustment for potential confounders, the intervention group had a higher overall pregnancy risk than the control group (relative risk 1·36 [95% CI 1·10–1·67], p=0·003). Similar results were obtained with the use of proportional hazard models (hazard ratio 1·35 [95% CI 1·10–1·67], p=0·016).
Interpretation
The infant simulator-based VIP programme did not achieve its aim of reducing teenage pregnancy. Girls in the intervention group were more likely to experience a birth or an induced abortion than those in the control group before they reached 20 years of age.
For those wondering:
1673068913440.png

The actual intervention is pretty simple and brief:

The Virtual Infant Parenting (VIP) Programme is a school-based preconception pregnancy prevention programme, a component of which is an infant simulator. It is a Western Australian adaptation of the US programme created by Realityworks (Eau Claire, WI, USA) and often referred to as “Baby Think It Over”. The programme seeks not only to delay pregnancy in the teenage years but also to improve knowledge and awareness of preconceptual health issues. Although “Baby Think It Over” is often implemented by teachers, nurses, or doctors, the VIP programme was implemented by school health nurses over 6 consecutive days with four main components to the curriculum: four educational sessions in small groups of four to five girls, a comprehensive reference workbook, a video documentary of teenage mothers talking about their own experiences, and caring for the infant simulator from the last school lesson on Friday afternoon through to the first class on Monday morning.

So caring for the infant is only over the weekend. Nevertheless, the results:
1673068941162.png

Graphically:
1673069143258.png

In terms of the stats:
  • Overall large study, with cluster (school-level) randomization
  • The randomization produced a kinda imbalanced split in that the control group was worse off on social status, early drinking etc.
  • But whether one adjusts for this or not, the results are fairly clear. The worst p value comes out at .016 (Cox model), which is not great, but at least not .049 bad
  • If we buy the results, it seems even this brief intervention increased teenage births by some 10-70%, with a best guess of 35%.

I can’t find a big replication study, as this study was intended as a big replication study of prior studies (that were inconclusive). However, there are some academics — Swedish of course — who used a robot baby with “young people with intellectual disability” to help them “in their process of deciding about parenthood”. Given the above results, I guess this is a kind of dysgenic study in itself.

Assuming we accept the results, I think we should consider this a promising avenue for fertility programs. This is important because the usual economic policies are pretty ineffective. It appears that the exposure to babies, even if they are really robots made of plastic, primes girls/women to think more of motherhood, and not in a bad way as intended. It is not too surprising as many people can recall the longing looks at babies by girlfriends? “He’s so cute” she says, while looking at you (hint: it means I WANT THIS). So while we might not want to promote teenage pregnancy, we should certainly promote pregnancy among university students. So how about some trials of this? One could mandate (or incentivize with some bonus) infant simulator treatment at the final year of studies for female students to prime them for getting started after finishing their education.
 
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Doesn't this program already exist? They just use eggs instead of dolls. And they include the boys, so you can simulate marital conflict and schedule juggling. And they don't call the egg program VIP like there's supposed to be any prestige to it.
 
I'm not familiar with abtests on humans, but the amount of participants look low to have any meaningful result
Two groups of 1200 and 1500 people respectively seem low to you? They're not fruit flies brah (Australia's rule #1 takes care of that)
 
Perhaps the type of girl that would choose home-ec as an elective would also be more likely to want to have a baby and end up a teen mom. I was not a teen mom but I definitely chose to take home-ec because I wanted to be a mom and was excited to raise the electronic baby. (I failed btw, those things are either rigged or mine was defective. The cry way too much, I put it in the closet and piled blankets over it. A real baby crying that much probably would’ve been diagnosed with colic or reflux or something).
 
Perhaps the type of girl that would choose home-ec as an elective would also be more likely to want to have a baby and end up a teen mom. I was not a teen mom but I definitely chose to take home-ec because I wanted to be a mom and was excited to raise the electronic baby. (I failed btw, those things are either rigged or mine was defective. The cry way too much, I put it in the closet and piled blankets over it. A real baby crying that much probably would’ve been diagnosed with colic or reflux or something).
In this case, the 'virtual infant simulator'-enhanced course replaced a regular health class for a randomly selected group of schools. Data was normalized for socioeconomic factors and prior sexual activity etc. A not-ridiculously overfitted model produced a 'p-value' (broadly, the estimated probability of receiving the result obtained if in fact there was no difference) of 0.016- much better than the usual cutoff used in real science let alone social science of 0.05/5%.

The 'confidence interval' for how large the actual increase in motherhood was among those girls who did the virtual mothering is still reasonably wide, but it's probably about 35% more- but almost certainly something between 5% more and 70% more.

It does look like they fucked up either their abstract or their actual tables of statistics ("proportional hazard models (hazard ratio 1·35 [95% CI 1·10-1·67], p=0·016" in the abstract should presumably be "proportional hazard models (hazard ratio 1·35 [95% CI 1·06-1·73], p=0·016)."), but only one error is pretty good going for social scientists.
 
Not shocked at all by the outcome of increased births amongst the intervention group. Both men and women like babies as a general rule. Women obviously more men, but I digress. Hand someone a child, even a fake one and chances are they'll want one of their own.
 
Just simulate popping its head out from around your crotch area and bash its fucking head in, like a partial birth abortion. Problem solved.
 
It demonstrates loud and clear that girls are geared towards having kids and explains the inane push to masculinise female interests in little girls as a pregnancy limiter. The girls who received the fake baby were significantly more likely to be holding a real one a few years later. That statistical gap is huge as far as these sort of studies go. Not three or four generations ago they'd be holding family member's babies in a shared house at that age. It's what girls do.

We've massively fucked up. Our ridiculous solution is to try to instill fear and negative emotions in young women rather than fix society so that it is fit to raise a child within. Boys too, there's precious celebration of fatherhood. It's satanic in the sense of telling a child over and over and over again the exact wrong thing to do. I knew a woman who burst into tears and became hysterical for three days at the age of 27 upon learning she was pregnant. She was rich, she loved her nice industrious husband, they already owned their own spacious home and two cars, you name it, they were set up to succeed as parents. Yet she'd been raised from a very early age to associate getting knocked up as the very worst thing that could ever happen to her, and thus acted accordingly in the event. They went on to have three more kids, and pretty much embody Happily Ever After.

There has to be a middle ground between "by the way kids, sex makes babies" and "getting pregnant is the end of your whole entire life, don't ever let things get that bad..."
 
so if we can mimic this with a toy for young girls
Girls? We all had to lug around Baby-Think-It-Over in high school. I was, at the time, a fairly serious student, and also a kissless virgin, so I thought it was a nigh-criminal waste of time and school district money. I was taking five AP tests, none of them were about dangers of all the unprotected sex I wasn't having. With many years to reflect on that hotheaded teenager's opinion and a much wider view of society, I think it was, in fact, a nigh-criminal waste of time and school district money.
 
In this case, the 'virtual infant simulator'-enhanced course replaced a regular health class for a randomly selected group of schools.
I detect the confounding factor: the selected students learn years before their peers that "but baby!" gets them out of a lot of bullshit. Once you figure out the grind you can mostly neglect these proxies. Being a good parent is hard, not outright killing an infant (especially a proxy for one) is actually pretty straightforward. The only thing worse you could do is take these students who have no concept of the value of a dollarydoo and have some abbo welfare queen explain how she survives on gibsmedats. The intention will be to expose them to crushing poverty. The outcome is a bunch of teenagers learning that getting knocked up means the government gives you a decent cell phone's worth of money every month.
 
Maybe instead, we can teach them how awesome having a job is by sitting all weekend in a fabric box with a laptop and a PowerPoint assignment.
 
Girls? We all had to lug around Baby-Think-It-Over in high school. I was, at the time, a fairly serious student, and also a kissless virgin, so I thought it was a nigh-criminal waste of time and school district money. I was taking five AP tests, none of them were about dangers of all the unprotected sex I wasn't having. With many years to reflect on that hotheaded teenager's opinion and a much wider view of society, I think it was, in fact, a nigh-criminal waste of time and school district money.

If they gave me one of these at that age I provably would have chucked it out the window and got written up. Not because I wanted to chuck real babies. But because I would have found it an insulting waste of time.

I don't really like that these dolls collect data. I'd be worried about just how much surveillance there. We're being watched enough as is and we don't need plastic pretend babies doing it too.
 
Girls? We all had to lug around Baby-Think-It-Over in high school. I was, at the time, a fairly serious student, and also a kissless virgin, so I thought it was a nigh-criminal waste of time and school district money. I was taking five AP tests, none of them were about dangers of all the unprotected sex I wasn't having. With many years to reflect on that hotheaded teenager's opinion and a much wider view of society, I think it was, in fact, a nigh-criminal waste of time and school district money.

Ah, another High School AP Autist. I bet there are a bunch of us around here.
 
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