Addressing Teen Pregnancies in Low Income Women There have been many efforts in the United States to combat

the high rates of teen pregnancy over the course of the past thirty years. These public health programs put in place have helped reduce the pregnancy rate among American adolescents but there is still a great need for more effective programs to help protect these young women from unwanted pregnancies and all the health and social ris s that are associated with teen pregnancies. !a"ority of teen pregnancies occur in females ages #$ to #% with very few pregnancies occurring before the age of #$. There are many health ris s for both the mother and their baby associated with having a child at such a young age such as low birth rate and improper prenatal care. There are also social implications with teen pregnancy such as an increase ris of poverty and lower education at both the high school and college level. In efforts to protect American youth from these ris s many educational public health programs have been put in place that embrace a variety of public health theories from self efficacy theory to social cognitive theory. The &enter for 'isease &ontrol cites less se(ual activity among teens and an increase in the use of birth control methods as the reasons for the decline in teen pregnancy. These practices are a result from public health interventions. These public health interventions have had varying degrees of success but over all have helped contribute to the decline in adolescent births in the United States. )Teen Pregnancy *raphics 'ata 'escriptions+. According to the U.S 'epartment of ,ealth and ,uman Services and the -ffice of Adolescent ,ealth the teen birth rates for ./#. were .%.0 births for every #1/// adolescent females. In total that ma es 2/$1233 babies born to mothers with ages ranging from #$ to #%. This is a considerable decline from "ust a few decades ago1 if you compare the rates from #%%# the number of teen mothers is appro(imately cut in half. The -ffice of Adolescent ,ealth states the teen birth rates for #%%# was 4#.3 births per #1/// females ages #$5#%. That is a 2..0 decrease per #1/// female teens. America has made great strides in the reduction of teen pregnancies but the problem is still far from solved. -f the

2/$1233 babies born to teen mothers in the year ./#. eighty5nine percent of them were born to unwed mothers putting these children at greater ris s for poverty and educational difficulties. An alarming rate of these teen pregnancies are occurring to females who have already given birth to one or two children. The -ffice of Adolescent ,ealth reports of the 2/$1233 adolescent births nearly # in $ of these births were to mothers that have given birth before. That means that #6 percent of these children are born to mothers who already have one or two children. This indicates that the educational programs offered to teen mothers are not effective in preventing more teen births. The multiple teen births puts both the mother and the babies at higher ris for living in poverty and not completing their education. This is why it is so important to reduce the teen pregnancy rates even more to help combat many of the factors for poverty in the United States. )Trends in Teen Pregnancy and &hildbearing+. Although the rates of teen pregnancy in the United States has been on a steady decline since the year #%%/ it is still a cause for concern for the American public. 7ven with the decline in numbers the United States still has the highest teen pregnancy rates out of any industriali8ed nation. In a chart released by The World 9an the United :ingdom;s adolescent birth rates were only .4 births per #1/// adolescent females for the year .//% while the United States had 24 births per #1/// adolescent females during the same year. These counties are relatively similar in terms of development1 wealth and education so the dramatic difference in teen pregnancy rates is alarming. With all of our resources and educational systems the prevalence rate for teen pregnancy is much higher than it should be. It is important to reevaluate the current health programs that are in place to see what has been effective in reducing teen pregnancy and what areas need to be improved to prevent more teen pregnancies. )Adolescent <ertility =ate )births per #1/// women ages #$5#%++. There are many factors that could contribute to teen pregnancy1 one of them is race. There is significant difference between rates of teen pregnancy amongst race in the United States. The &enter for 'isease &ontrol and Prevention released a chart showing the teen pregnancy rates by race in the

United States for the years .///5./##. The statistics represented by this chart show the ,ispanic population has the highest rate of teen pregnancy followed by African Americans1 followed by White Americans and Asian Americans with the lowest rate of teen pregnancy. The ,ispanic population had a pregnancy rate almost three times the rate of white Americans. This indicates that race plays a role in teen pregnancy. ,owever the ,ispanic population also saw the greatest decline in teen pregnancy over the course of the .///5./## time period. 9y ./## there was only a . births per #1/// adolescent females difference between ,ispanics and African Americans. Time as shown that race is becoming less significant in terms of indication for becoming a teen mother. As time goes on and the gap between race declines this will no longer be a contributing factor. )Teen Pregnancy *raphics 'ata 'escriptions+. Another contributing factor to teen pregnancy is family structure. The type of home a child is raised in can contribute to their li elihood of becoming a teen parent. A teen from a household that is run by two married parents in much less li ely to become pregnant at an early age. A teen from a female headed household is statistically more li ely to become a teen parent than a teen from any other family structure. As mentioned before eighty5nine percent of births to teen mothers occur out of wedloc . This means that ma"ority of those children are raised in female headed households putting children of teen mothers at greater ris of becoming teen mothers themselves. This is a cycle that needs to be bro en. )Teen Pregnancy> The importance of Prevention+. Poverty is the number one factor of teen pregnancy in today;s society. =ace and family structure can be indicators for socioeconomic status which is why they are also contributing factors to teen pregnancy because socioeconomic status plays such a large role in teen pregnancy. In an article written by Sara Ipatenco it states that a woman from a low income family has a .6 percent chance of becoming pregnant during her teen years. )Ipatenco1 Sarah+. The previously mentioned statistics and charts of teen pregnancy based on race loo almost identical to the charts of poverty based on race released by the ,enry ?. :aiser <amily <oundation. The ,ispanic population in America has the

highest rates of poverty "ust li e they have the highest rates of teen pregnancy. While White Americans have a significantly lower rate of poverty1 appro(imately ./ percent lower than ,ispanics1 and a significantly lower rate of teen pregnancy. )Information on Poverty and Income Statistics+. <amily structure also plays a large role in socioeconomic status. A report released by the U.S 'epartment of ,ealth and ,uman Services -ffice of The Assistant Secretary for Planning and 7valuation shows that in ./##1 06.4 percent of children living in female headed households were living in poverty while only #/.% percent of children from married couple families were living in poverty. )Trends in Teen Pregnancy and &hildbearing+. There are multiple reasons for the increase in adolescent births among members of the lower class. !i aela &onley cites one of the e(planations as their lac of availability to afford both contraceptives and emergency contraceptives. The most common forms of birth control and emergency contraceptives are e(pensive. A teen living in poverty cannot afford to spend money on birth control methods while they are struggling to afford basic necessities li e food. 7mergency contraceptives are e(tremely e(pensive costing on average fifty dollars1 this ma es them even more unobtainable by low income teens. )&onley1 !i aela+. The Teen Pregnancy Prevention Initiative provides funding for America;s youth to receive se( education and development programs. The initiative provides public and private entities grants and contracts to both educate the public and evaluate the effectiveness their programs. The Teen Pregnancy Prevention Initiative is run by the -ffice of Adolescent ,ealth1 the Administration for &hildren and <amilies1 and the &enters for 'isease &ontrol and Prevention. 7ach program is personali8ed towards the target population1 geographical location1 and ma"or ris factors associated with the community. Although each program is different they share a common goal which is to create @medically accurate and age5appropriate programs that reduce teen pregnancy and associated ris behaviors and covers costs associated with administering and evaluating the program.A )<act Sheet> The President;s Teen Pregnancy Prevention Initiative+.

-ne of the programs funded by the Teen Pregnancy Prevention Initiative )TPPI+ is Its Your Game: Keep it Real. This program is based in ,ouston Te(as and is run by The University of Te(as ,ealth Science &enter at ,ouston )UT,ealth+. This program received B21///1/// from TPPI and reaches adolescents in ## school districts1 and is located in %6 middle schools and 36 high schools in the ,ouston area and surrounding suburbs all within ,arris &ounty. This program is e(pected to educate 2/1/// students annually. )Poverty =ate by =aceC 7thnicity+. The Its Your Game: Keep it Real program is designed to ta e place over the course of two years1 during 6th and 3th grade1 with an evaluation of results ta ing place the following year1 during %th grade. The program focuses on promoting abstinence and delayed se(ual activity1 education on condoms and contraceptives1 and the importance of regular pregnancy and ST' tests when se(ually active. The program ta es place through .0 classroom lessons over the course of two years. The lessons use a vast array of activities including group activities1 computer5based lessons1 role modeling1 "ournaling1 and group discussion to help the student learn safe se( practices and reduce ris y behavior that can lead to teen pregnancy or other health issues associated with se(ual activity. The first year of the program1 6th grade1 focuses on human development1 friendships1 personal limits1 and refusal methods. This allows the youth to evaluate what they personally feel comfortable with and how to maintain their comfort level by surrounding themselves with friends that will respect their limits and how to protect themselves when their limits are being tested. The second year1 3th grade1 focuses on more mature topics such as dating1 using condoms and contraceptives1 and the importance of regular ST' and pregnancy tests once se(ually active. -nce the two years and .0 lessons are complete the students have entered high school the effectiveness of the program is evaluated in a follow up survey. This program has shown success in delaying the start of se(ual activity among its students. The follow up evaluation showed the the students who had not already engaged in se(ual activity before starting the program were significantly less li ely to engage in se(ual activity after finishing the program.

)Poverty =ate by =aceC 7thnicity+. This intervention facilitated by UT,ealth utili8es two ma"or public health theories1 self efficacy and social cognitive theory. 9y combining these two theories the Its Your Game: Keep it Real program was able to create a strong sense of self within the individual participants as well as a sense of community within the classroom and school setting. 9oth are ey to creating long lasting results in preventing teen pregnancy and living a healthy lifestyle for years to come. Self 7fficacy is ey in creating long lasting results. !a ing sure the students maintain a high level of self efficacy will increase the li elihood of the students continuing the safe se( practices they learn through the Its Your Game: Keep it Real intervention. The program allows the students to create their own personal goals and limits in regard to se(ual activity. &reating their own goals and limits ma es the students ta e ownership of their behavior ma ing them more invested in the result. This increases their self efficacy to maintain these practices because the individual students evaluate their own abilities and habits. The students are unli ely to create personal goals and limitations that they cannot uphold. If the goals and limitations were not self created the self efficacy for this program would decline which would in turn lower the success of the program. Social cognitive theory plays a large role in Its Your Game:

Keep it Real because so much of the program is community based within the classroom setting. The students have many opportunities to learn from one another through group discussion1 group activities1 and role modeling. These activities give the students the opportunity to observe and listen to one other;s e(periences helping them learn as a result. When one student hears a story about how one of their classmates successfully utili8ed a refusal method to get out of a situation they felt uncomfortable in they are also more li ely to believe that they can successfully use a refusal method. Seeing other student;s success increases the individual;s self efficacy as well. This ties the two public health theories together1 creating a successful program. Another public health intervention that has been funded by the Teen Pregnancy Prevention

Initiative is the @Se( 7ducation ProgramA )S7P+. The @Se( 7ducation ProgramA was created and has been run by the University of Te(as ,ealth Science &enter at San Antonio )UT,S&+ for the past eight years and received B3$#10$/ in grants for the ./## fiscal year. S7P targets low income communities in the southern San Antonio area by partnering with ?udson Independent School 'istrict and has reached over %/1/// students during the duration of the program. )Poverty =ate by =aceC 7thnicity+. The @Se( 7ducation ProgramA incorporates many different forms of education and support to its students including in class sessions with group discussion and activities1 tutoring1 mentoring1 service learning1 parent wor shops1 and referrals to health services. San Antonio;s @Se( 7ducation ProgramA also teaches the Worth the Wait curriculum which is an abstinence until marriage program to students in 4th through %th grade. The Worth the Wait curriculum teaches topics in addition to abstinence including puberty1 anatomy1 and se(ual abuse. The @Se( 7ducation ProgramA focusses on improving its students lives in many different aspects not "ust preventing pregnancy. 9y providing support for families as well as educational and mentoring support this program proves to be one of the most versatile of the Teen Pregnancy Prevention Initiative programs. )Poverty =ate 9y =ace and 7thnicity+. The @Se( 7ducation ProgramA mainly utili8es the social cognitive theory to implement change within the San Antonio community. !a"ority of the forms of eduction involve the students learning from their peers1 mentors and parents. 9y providing the students with mentors the student is e(pected to learn from the mentor and model their behavior after their actions and behaviors. Involving parent wor shops in this program adds and e(tra level of cognitive learning for the students. The parents are informed of the educational material and can start promoting good health behaviors li e regular doctor;s visits. This behavior is observed by the student and reinforced for future behavior. The social cognitive theory can also tie together with the self efficacy theory. 9y seeing their mentors1 parents1 and peers succeed in utili8ing positive health behaviors they are more li ely to believe they can utili8e the same positive health behaviors.

There has been a shift in approach in terms of se( education in the United States. This shift can be attributed for the declining adolescent birth rates. In previous decades abstinence has been the ey and sometimes only focus for many of the public health programs implemented for America;s youth. Although abstinence is an effective form of birth control it is not always a practical e(pectation of all adolescents. 9y focussing on telling teens to abstain from se( the teens are lac ing the important nowledge they need to protect themselves if they chose not to abstain. This is why the shift in approach is ey. 9y informing teens how to have safe se( to help prevent pregnancy and the transmitting of se(ually transmitted diseases and giving them the resources to practice safe se( teens are better eDuipped to ma e healthy choices. 7ducation on safe se( practices can be combined with abstinence tal s to give teen choices. 9y teaching teens to be safe educators are not encouraging se(ual behavior1 rather they are preparing teens if the situation arrises. !a"ority of the pregnancy prevention health interventions are focussed on delaying se(ual activity in adolescents therefore address the issue of teen pregnancy with a target audience of the ages #. to #$. While it is important to teach adolescents early on about safe se(ual practices the population that is most at ris for teen pregnancy1 ages #$5#%1 tends to be neglected. I believe the concepts around safe se( need to be reinforced in later teen ages in addition to early adolescents. !y proposed intervention plan would be two tiered1 the first focussing on adolescents ages #.5#$ and the second focussing on teens ages #45#3. The first tier to the proposed intervention would be conducted in middle school health class rooms in low income communities. !uch li e ,ouston;s Its Your Game: Keep it Real program the proposed program would incorporate group discussion1 group activities1 individual goal and limit setting and "ournalling. 9y doing group activities the students feel more comfortable tal ing about sensitive topics and begin to trust and respect one another1 creating a support system. The group activities also help student;s learn from their peers. The individual activities help the students evaluate

themselves and where they stand on the topic and form their own goals and limitations. The second tier to the proposed intervention would be conducted in a high school classroom setting. The target audience for this portion of the intervention is high school "uniors and seniors ma"ority of whom are ages #45#3. This is the age range where the ma"ority of teen pregnancies occur and a significantly higher percentage of teen are engaging in se(ual activity. 9ecause of the differences in demographics a shift must be made from delaying se( and teaching abstinence to safe se( and changing the student;s attitudes about se(. This portion would ta e a more serious approach to the ris s related to having unsafe se( such as teen pregnancy and se(ually transmitted diseases. This program would also provide referral to health providers so students can obtain condoms1 contraceptives1 pregnancy testing1 and ST' testing if desired. !y proposed intervention combines a few different public health theories1 the first tier focussing predominately social cognitive theory and self efficacy theory1 and the second tier focussing mainly on the theory of reasoned action and the health belief model. !y proposed intervention is essentially adding on a reinforcement step to the program already put in place by the University of Te(as ,ealth Science &enter at ,ouston. As mentioned previously while evaluating the public health theories behind the Its Your Game: Keep it Real intervention the first tier of my proposed intervention is based on the self efficacy theory as well as social cognitive theory. The intervention is based on building adolescentEs self esteem and belief that they can maintain a healthy lifestyle by uploading their personal goals and limitations )self efficacy+ as well as learning from their peer;s e(periences )social cognitive theory+. The second tier is informed by the theory of reasoned action and the health belief model. The age range for this portion of the intervention was the ey determinant of which theories should be implemented. A large percentage of high school "uniors and seniors have perceived notions or attitudes toward safe se( practices and a large percentage of this age group has already engaged in se(ual

activity. The theory of reasoned action focusses on the teen;s attitudes and sub"ective norms. If a student nows that it is in their best interest to engage in safe se(ual practices and has a positive attitude towards them and hears their friends and peers are engaging in safe se(ual practices they are li ely to have the behavioral intention to actually participate in safe se(ual practices. The purpose of the program will be to create positive attitudes towards safe se( and to highlight the uses of safe se( in order to create sub"ective norms for the students. The health belief model also informed the second tier to the proposed intervention. The program will highlight the ris s of having unprotected se( which will create a perceived seriousness and perceived susceptibility which leads to the perceived threat of teen pregnancy and se(ually transmitted diseases. The students will understand the benefits of safe se( and what barriers need to be overcome to eep themselves safe. The students also create a sense of self5 efficacy. The availability to be referred to health services helps brea down the perceived barriers. This referral can also serve as a call to action for the students. All of these aspects combine to create the li elihood of the students engaging in safe se( practices. The e(pected outcome of this proposed intervention is a significant decline in the number of teen pregnancies in females ages #45#3 and the decline of se(ually transmitted diseases in the low income communities that this program is implemented into. This decline in teen pregnancies should also lead to higher high school graduation rates among these low income females because fewer girls will need to drop out of high school to ta e care of their newly born babies. The decrease in teen pregnancy can also have a positive affect on the poverty rate in these communities. There will be less teen mothers living in poverty and the young woman of the community will have a higher education level which leaders to better employment.

Wor s &ited FAdolescent <ertility =ate )births per #1/// Women Ages #$5#%+.F Data. The World 9an 1 n.d. Web. .2 Apr. ./#0. &onley1 !i aela. FPoor Teens Lac Access to 7mergency &ontraception.F ABC News. A9& Gews Getwor 1 .0 ?an. ./#.. Web. #% !ar. ./#0.

F<act Sheet> The PresidentEs Teen Pregnancy Prevention Initiative.F Siecus. G.p.1 n.d. Web. .. Apr. ./#0. HFSupport SI7&USIF SI7&US. G.p.1 n.d. Web. .. Apr. ./#0.J. FInformation on Poverty and Income Statistics> A Summary of ./#. &urrent Population Survey 'ata.F Information on o!ert" an# Income Statistics: A Summar" of $%&$ Current opulation Sur!e" Data. G.p.1 n.d. Web. .# Apr. ./#0. Ipatenco1 Sara. FWhy Are Low Income Teens Li ely to 9ecome PregnantKF '!er"#a" (ife. 'emand !edia1 n.d. Web. #% !ar. ./#0. FPoverty =ate 9y =aceC7thnicity.F o!ert" Rate )" Race*'thnicit". G.p.1 n.d. Web. .# Apr. ./#0. FState Profile> Te(as.F Siecus. G.p.1 n.d. Web. .. Apr. ./#0. H ,LP7=LIG: Fhttp>CCwww.siecus.orgCdocumentCdocWindow.cfmK fuseactionMdocument.view'ocumentNdocumentidM#4#Ndocument<ormatIdM#6%F http>CCwww.siecus.orgCdocumentCdocWindow.cfmK fuseactionMdocument.view'ocumentNdocumentidM#4#Ndocument<ormatIdM#6%J. FTeen Pregnancy *raphics 'ata 'escriptions.F Centers for Disease Control an# re!ention. &enters for 'isease &ontrol and Prevention1 .. ?an. ./#2. Web. .# Apr. ./#0. FTeen Pregnancy> The Importance of Prevention.F Center for Disease Control an# re!ention. G.p.1 n.d. Web. .. Apr. ./#0. H ,LP7=LIG: Fhttp>CCwww.cdc.govCTeenPregnancyCinde(.htmF http>CCwww.cdc.govCTeenPregnancyCinde(.htmJ. FTrends in Teen Pregnancy and &hildbearing.F +ffice of A#olescent ,ealth. G.p.1 n.d. Web. .. Apr. ./#0.