Running Head: PREVENTING TEEN PREGNANCY 1

Child and Maternal Health: Preventing Teen Pregnancy in Duval County

Alex Cardoso

Nikki Coble

Adisa Rajkovic

Lauren Welle

Meghann Wheeler

University of North Florida

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In the past few decades, unplanned adolescent pregnancy has become a major area of

concern across the United States. The U.S. Centers for Disease Control and Prevention (CDC)

declared teen pregnancy one of its seven “winnable battles” and a public health priority because

it can have lasting impacts on different avenues of health (Mueller et al., 2017). Currently, the

United States is one of the leaders in all developed countries in teen pregnancy rates (The

National Campaign, 2016). Many programs have been developed to address teen pregnancy,

however, despite the development of these programs, studies have shown that the unplanned teen

pregnancy rate has remained largely unchanged over the years (Lindley & Walsemann, 2015).

Teen pregnancy in Duval County continues to remain higher than the state average, with county

health rankings showing that Duval County is ranked 39 out of 67 counties in the state of Florida

(County Health Rankings, 2017). Additionally, Youth Risk Behavior Survey trends show that

Duval County is currently experiencing a decline in condom use among adolescents, and in 2015

40.2% of sexually active teens reported not using a condom the last time they had sex (Youth

Risk Behavior Survey, 2015). This decline in condom use leads to an increase in unplanned teen

pregnancy, and shows that currently Duval county teenagers need to become more aware of the

benefits of condom use.

According to the Jacksonville Child Trends and Statistics, the teen birth rate for Duval

County, as of 2005, was 49.5 per 1,000. Not only does teen pregnancy affect the mother, babies

who are born to teen mothers also have greater chances of developing birth defects, and Duval

county has a higher percentage of low birth weight babies than the state of Florida and the U.S.

(Florida Department of Health and Vital Statistics, 2005). Additionally, the percentage of teen

births and low birth weight babies are twice as likely to come from Hispanics and African

Americans than Caucasians (Florida Department of Health and Vital Statistics,

PREVENTING TEEN PREGNANCY 3

2005). According to The National Campaign to Prevent Teen Pregnancy, Hispanic and African

American teens are almost twice as likely to become pregnant before the age of 20 as compared

to white teens (2008). Teen births are greatly associated with the short term and long term

negative health, social, and economic outcomes for both the mother and child (Khan et al.,2017).

In the United States, babies born to mothers under 20 years old are at significantly greater risk

for having gastroschisis, cyanotic congenital heart disease, and limb reduction defects (National

Vital Statistics Report, 2018). Lack of prenatal care is also a contributing factor to the increased

risk of birth defect in babies born to teen mothers. In the state of Florida in 2008, 43.5% of teen

mothers had no prenatal care during their first trimester compared to 20% of mothers aged 25 to

34 (CDC & Florida Department of Health, 2008). Based on the epidemiological and disparity

data provided, African American and Hispanic teenagers in Duval county will be the target

priority of unplanned and teen pregnancy program prevention.

There are various behavioral factors that lead to high teen pregnancy rates in specific

populations. One of the leading behavioral factors for teen pregnancy rates is that a high number

of high school students believe that a significantly large percentage of their peers are engaging in

sexual activity when in reality the reverse is true. In 2015 only 40% of high school students in

Florida reported ever having sexual intercourse (Youth Risk Behavior Survey, 2015). This leads

to many teenagers engaging in sexual behavior earlier than they normally would because of the

belief that their peers are already engaging in sexual behavior. Another behavioral risk factor

that is associated with teen pregnancy is alcohol and drug consumption before sexual intercourse.

Drug and alcohol consumption lowers a person’s inhibitions and can lead to fewer teenagers

practicing safe sexual behaviors. Duval County Youth Risk Behavior Survey data shows that one

in five sexually active teenagers in Duval County were consuming drugs or alcohol before they
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last engaged in sexual intercourse (Youth Risk Behavior Survey, 2015). Other risk factors that

have been shown to be associated with unplanned teen pregnancy include living in single-parent

households, living in areas with high neighborhood violence rates, low family income, and living

in crowded households (Vázquez-Nava, et. al., 2014). The 2012 Duval County Community

Health Assessment shows that Health Zone 1 has the highest poverty rates in the county,

showing that Health Zone 1 has the highest need for a teen pregnancy prevention program

(Abarca et.al., 2012).

Educating adolescents in the United States, especially in Duval County has become

increasingly challenging due to having such incredibly diverse backgrounds. This requires

cultural awareness of safe sex behaviors as well as special attention to those who are already

sexually active at a young age. Teen pregnancy rates are directly correlated with sexual

behaviors, specifically sexual intercourse, and contraceptive use. Research suggests the

disparities between the United States and Europe in the rates of teen pregnancies are due to the

lower rates of contraceptive use, including lower rates of oral contraceptive use, among U.S.

adolescents (Santelli et al.,2009). In 2007 condom use in the United States dropped from 63% to

61.5 % (Santelli et al.,2009). Additionally, only 53% of high school seniors reported using

contraceptives while sexually active (Kann et al.,2014). The Center for Disease Control (CDC)

has found supporting research that by eliminating socioeconomic disparities, such as low

education, teen pregnancy rates are likely to decline. Research shows that many of the

participants of comprehensive programs that support both abstinence and safe sex behaviors

increased contraceptive use (Kirby, 2007). This suggests that education and contraceptive

promotion are key factors in changing teen pregnancy rates.

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To determine the target population for this program, we began by looking at national,

state and county level data. The Youth Behavior Risk Survey is conducted in Duval county every

two years and divides the county into six health zones. When analyzing 2015 survey data, Health

Zone 1 showed the most need for a teen pregnancy prevention program for several reasons. The

National Campaign to Prevent Teen Pregnancy shows that Hispanic and African American teens

have a significantly larger chance of becoming pregnant before they turn 20 (The National

Campaign to Prevent Teen Pregnancy, 2008). According to the 2012 Community Health

Assessment, Health Zone 1 had the highest minority rate for all of Duval County. Additionally,

Health Zone 1 was shown to have the highest percentage of teens who did not use any method to

prevent pregnancy during the last time they engaged in sexual intercourse. These statistics show

that Health Zone 1 would receive the most benefit from a teen pregnancy prevention program.

When selecting and planning our intervention, we wanted to utilize a program that not

only taught abstinence as a method to prevent pregnancy, but also safe sex behaviors to educate

high school students who are already sexually active. Although it is not specifically designed to

prevent teen pregnancy. the evidence based teen pregnancy prevention program Be Proud! Be

Responsible! has been shown to be effective at increasing condom use among sexually active

teenagers, which in turn protects against unplanned pregnancy. We will also be utilizing

additional components of proven health theories, specifically the Health Belief Model, to help

reinforce safe sex behaviors. We will be providing students with free condoms and giving them

information on where to get more free condoms around Jacksonville whenever they need more,

and will show students how to use condoms correctly. In addition, we will be putting posters up

throughout the intervention school to remind students to practice condom use to prevent teen

pregnancy. While current sex education programs focus on abstinence only education, our
PREVENTING TEEN PREGNANCY 6

program will also teach safe sexual behaviors to ensure that students who are sexually active or

plan on becoming sexually active will have the tools and resources necessary to do so safely.

In conclusion, the purpose of this review is to bring attention to and emphasize unplanned

teen pregnancy rates in Duval county. Though rates of teen pregnancy have begun to decline in

the United States, local data shows that there is still a large need for a teen pregnancy prevention

program in Health Zone 1. Data shows a strong correlation between low condom usage and high

unplanned pregnancy among adolescents, further demonstrating the need for a sex education

program that addresses safe sexual behaviors such as condom use . Bringing attention to one

specific health zone and customizing a prevention program based upon the needs of that

community in which seems to have the highest numbers would benefit high schoolers

tremendously. By providing high schoolers with information on the benefits of safe sexual

behaviors and the lifelong negative impacts of pregnancy, we will help prevent future increases

in teen pregnancy rates in Duval county.

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