hej

Article

Health Education Journal

69(3) 333–343
Perceptions of teen pregnancy © The Author(s) 2010
Reprints and permission: sagepub.
among high school students in co.uk/journalsPermissions.nav
DOI: 10.1177/0017896910364568
Sweet Home, Oregon http://hej.sagepub.com

Tim Little, Jessica Henderson, Peggy Pedersen

and Linda Stonecipher
Western Oregon University, Monmouth, USA

Abstract
Background:  The purpose of this study was to gain insights into the perceptions and attitudes about teen
pregnancy among high school students in a rural area with high teen pregnancy rates.
Methods:   Five focus groups were conducted with: (1) females in 9th–10th grades; (2) females in 11th–12th
grades; (3) males in 9th–10th grades; (4) males in 11th–12th grades; and (5) pregnant/parenting females in
9th–12th grades.
Results:   Common themes among the students were that: (1) the number of teen pregnancies was
increasing and was a growing concern; (2) financial difficulties and harm to education were associated with
teen pregnancies; (3) teen females had many reasons for wanting a baby, but teen males just wanted to have
sex; and (4) pregnancy happened by chance, or was simply an inadvertent consequence of having sex.
Conclusions:  To reduce teen pregnancy, the developmental asset model offers community members,
teachers and parents guidelines to work together to develop key assets in youth that may protect against
risky sexual behaviours.

Keywords
teen pregnancy, Developmental Asset Model, sex education

Introduction
Sex education has been an important part of the health curriculum in American schools for decades, yet
unplanned teen pregnancies remain a major public health concern. About one in three American females
become pregnant before the age of 191. The birth rate among teenagers 15–19 years old increased
by 3 per cent in 20062. Teen moms are less likely to complete high school, and they and their infants
are more likely to live in poverty3,4. Teen births cost over nine billion dollars annually in the US4.
Given these enduring public health concerns and the current political and social controversies
regarding sex education5,6, it is crucial to develop a clearer understanding of factors related to teen
pregnancy, particularly for specific adolescent populations defined by geography, age, or racial/ethnic
groups7. For example, in rural areas in Oregon, a new mother is twice as likely to be a teen as

Corresponding author:
Jessica Henderson, PhD, Professor of Community Health Education, Division of Health and Physical Education,
345 North Monmouth Avenue, Western Oregon University, Monmouth, OR 97361, USA
Email: hendersj@wou.edu

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334 Health Education Journal 69(3)

compared with a new mother in urban areas of Oregon8. Specifically, a recent survey of 8th grade
students in Sweet Home (a rural community in central Oregon), found that 61 per cent of the students
reported being sexually active within the past 3  months, and only 12 per cent reported using a
condom9.
Traditionally, adolescent behaviour has been conceptualized in a risk-based framework, particularly
in the areas of teen pregnancy. This approach focuses on negative factors of teens that need to be
‘fixed’, rather than focusing on strengths that may be important for healthy teen sexuality.
The strength-based approach, based on 40 developmental assets important to middle school and
high school adolescents, was developed by the Search Institute10. The Developmental Asset
Framework proposes that research into youth health behaviours should not just be about risk factors,
but also protective factors. The 40 assets that protect youth from risky behaviours include 20 exter-
nal assets such as family support, caring school climate and adult role models, and 20 internal assets
such as school engagement, self-esteem and resistance skills. In general, the more assets a young
person has, the less likely the youth will engage in risky health behaviours; in fact, the developmen-
tal assets may explain 20–30 per cent of risk behaviours over and above demographic factors11.
Several studies have shown that youth assets have a protective effect on risky sexual behav-
iours. A higher total count of assets has been correlated to delayed sexual intercourse12–14. The
external asset of parental support has been consistently related to reduced sexual risk among female
adolescents15–19. In addition, school support and positive peer support were each associated with
less risky sexual behaviours13,15,16,20,21.
Research suggests that sexual behaviour by adolescents is influenced by perceptions, attitudes,
and beliefs22–25. In a review of 250 studies on adolescent sexual behaviour, Kirby identified more
than 100 individual and environmental factors that lead to sexual activity among adolescents, and
perceptions was one of the strongest predictors26. Cost/risk perceptions and benefit perceptions
were each individual predictors of sexual initiation and later sexual behaviour in a longitudinal
study of 14,871 adolescents 15–19 years old27.
Identifying perceptions about teen pregnancy will help build and influence practices and curri-
cula to make education more effective in preventing teen pregnancy. The purpose of the present
study was to examine perceptions of teen pregnancy among high school students in a rural com-
munity with high teen pregnancy rates.

Methods
We conducted five focus groups with female and male students during the spring of 2007.
Participants attended a high school in Sweet Home, Oregon, located in a rural area with almost 800
students (94 per cent Caucasian). Participants were purposely selected by a health teacher at the
school.
The questionnaire and data collection protocol for the study were approved by the Institutional
Review Boards at Western Oregon University and Sweet Home High School District. Written
informed consent was obtained from each student and her/his parent.
Focus group protocol followed the recommendations of Focus Group Practice28. Notes were
taken during the focus group session and also incorporated a de-briefing session among facilitators
at the end of each group meeting.
Each focus group was limited to 90 minutes and included a maximum of six people. Each
participant answered a one-page written questionnaire for demographic data. Participants were
informed that they were being audio taped and that there would be no identifying information

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Henderson et al. 335

in the transcriptions. They were offered a snack and the facilitator followed the script devel-
oped for this study.
The five focus groups were composed of:

(1) Females in 9th–10th grades;

(2) Females in 11th–12th grades;
(3) Males in 9th–10th grades;
(4) Males in 11th–12th grades;
(5) Pregnant and/or parenting females in 9th–12th grades.

The participants were asked the same five questions that were asked of the Oklahoma City teens
in the study by Kegler et al29. The questions served as the foundation for gathering teen perceptions:

(1) How big is the problem of teen pregnancy at your school?

(2) What are some negative consequences of having a baby while you are a teenager?
(3) What are some reasons why a teen girl might want to have a baby?
(4) What are some reasons why a teen boy might want to have a baby?
(5) If one of your friends became pregnant (or got someone pregnant), how would you react?

Data from the transcripts were grouped by categories and analysed for themes and patterns that
emerged from the five questions. Independent analyses by three researchers of the typed transcrip-
tions and notes verified themes and categories for reliability. Descriptive and representative quotes
from focus group participants were used to illustrate or stress common themes.

Results
Sample
Thirteen females and nine males participated in five focus groups at Sweet Home High School,
Oregon, during May, 2007. Twenty-one students were Caucasian and one student self-identified as
Hispanic.
Only nine of the 22 students lived with both biological parents – none of the pregnant/parenting
females lived with both biological parents. One-third of the students’ mothers and/or fathers did not
graduate from high school. Forty per cent of the participants reported an annual household income
under $20,000. Notably, all of the pregnant/parenting females were in this lowest income group.
Only four of the 22 students reported that their household income exceeded $40,000 annually.

Q1: How big is the problem of teen pregnancy at your school?

All participants in this study agreed that the rate of teen pregnancies had increased in recent years
and that the issue of teen pregnancy was a growing concern – more so at their own school than at
others (see Table 1).

• …this year everywhere you turn it seems like you hear about someone being pregnant or
having a bump on her belly. (pregnant/parenting female)
• …it seems like babies are the new fad – even in my classes we are talking about it being the
highest in the state. (11th–12th grade female)

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336 Health Education Journal 69(3)

Table 1.  How big of a problem is teen pregnancy in your school?

Pregnant/Parenting Females Females Males Males
Females 9th–12th 11th–12th 9th–10th 11th–12th 9th–10th
Themes grades grades grades grades grades
More teen pregnancy now than in X X X X X
the past
Teen pregnancy is a big problem X X X X
Teen pregnancy due to female X X
responsibility
Teen pregnancy is a ‘situation’, X
not a problem

• …you look around and there are pregnant girls everywhere. (9th–10th grade female)
• Oh yeh, it’s getting out of hand. (9th–10th grade male)
• …I think it’s pretty bad here in Sweet Home. (11th–12th grade male)

Interestingly, the pregnant/parenting female students in this study objected to the word ‘problem’,
instead preferring the word ‘situation’ to describe teen pregnancy.

• When you say that it is a problem, it reminds me of a disease or something. It just sounds
bad. (pregnant/parenting female)
• I don’t think it’s a problem, it’s just like, like it’s starting to elevate, but it is not a ‘problem’.
(pregnant/parenting female)
• …the ‘situation’… is humungous, jumbo. (pregnant/parenting female)

Even though the topic of ‘responsibility’ for teen pregnancy was not solicited, all the groups
offered opinions about the female’s role.

• In order to not have a baby, you have to keep your legs shut, and not many are very good
about that around here. (11th–12th grade female)
• Everyone is all about sex and stuff, even girls. (9th–10th grade male)
• It has gotten worse with girls thinking that having an older boyfriend is cool. (9th–10th
grade male)

Q2:What are some negative consequences of having a baby while you are a teenager?
Financial impact of teen pregnancy was the first topic brought up and was a theme common to each
focus group (see Table 2).

• …all the day care and all this stuff takes money. And [teens] don’t have a lot. (9th–10th
grade male)
• …it is hard to support her baby and her fiancé at a young age. (11th–12th grade female)
• A lot of them don’t have jobs and like they don’t have the money to take care of the kid and
have to look towards their parents. (11th–12th grade male)
• You know a normal teenager who has a job normally just goes shopping with it, but now you
have to provide for a whole other life. (pregnant and parenting female)

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Henderson et al. 337

Table 2.  What are some negative things about having a baby as a teenager?
Pregnant/Parenting Females Females Males Males
Females 9th–12th 11th–12th 9th–10th 11th–12th 9th–10th
Themes grades grades grades grades grades
Costs money, inability to support X X X X X
child, and child support
Loss: education, future plans, X X X X X
freedom, childhood
Have to take care of baby X X X X
Father absent; quality of life X X X X
issues for baby
Damage to reputation/negative X X X
reaction from others
Relationships more difficult X X
for mother
Guilt/feel bad getting help X
with baby

The concept of loss – loss of education, freedom, and childhood were also common themes.

• A baby, it just makes everything that much more difficult. … You might not be able to have
an education. (11th–12th grade female)
• …there are times when you want to get away, but you can’t. (pregnant/parenting female)
• You have a baby and you have to take care of it. You can’t be going skateboarding and stuff
like that. (9th–10th grade male)
• Guys have the idea that high school and college years are supposed to be the funnest years
of your life, and why would they want a kid to take away all the fun? (11th–12th grade male)
• You wouldn’t be able to go out at all (9th–10th grade female)
• You won’t have as many chances to go to college. (11th–12th grade male)

Interestingly, all groups, with the exception of the pregnant/parenting female group, discussed the
absence of the father and/or quality of life for the baby as possible consequences of teen pregnancy.

• The kid being raised up isn’t going to have a very good life. The person will not have a job…
and it will affect that baby by living in a really crappy house. (9th–10th grade male)
• I think that a lot of times the guy will just get the girl pregnant and leave them. There are a
lot of girls at our school where the boyfriend isn’t around or they don’t even know who the
father is. (11th–12th grade male)

Three of the five groups associated teen pregnancy with a negative reputation for the mother
and difficulty with relationships.

• (My thing is my) reputation, because everybody thought I was like this bad person and slept
around, and then they expected me to like drop out of school and do nothing with my life.
(pregnant/parenting female)
• One of my friends is pregnant right now, and she always feels awkward coming to our
church. She feels like everyone is looking at her. (9th–10th grade female)

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338 Health Education Journal 69(3)

Table 3.  What are some reasons a teen girl may want to have a baby?
Pregnant/Parenting Females Females Males Males
Females 9th–12th 11th–12th 9th–10th 11th–12th 9th–10th
Themes grades grades grades grades grades
Loneliness; want to love or be X X X X X
loved; get attention
Unintended consequence of sex X X X X
Maintain a relationship X X X X
Want to be a parent; have a X X X X
family; family responsibility
Girls think babies are cute X X
‘In’ thing to do, see other girls pregnant X X

• It is going to be a lot harder [for the female] to get a boyfriend if you have a kid. (11th–12th
grade male)
• …people talk about them and they are looked down upon because they made a mistake.
(11th–12th grade male)
• Your parents… are mad at you for having it. (11th–12th grade female)

Q3:What are some reasons a teen girl might want to have a baby?
To love, be loved, or avoid loneliness was the overwhelming theme of each focus group (see Table 3).

• …because your family is either broken, or you know, you don’t have a family around that
often so you run off and have a kid, and try to make that family for themselves. And you
know, make it okay. (11th–12th grade female)
• If they don’t have someone at home saying that they love you, then like, they will want some-
one to love and that will love them back. (9th–10th grade female)

The pregnant/parenting female group was the only group that did not talk about having a baby
to maintain a relationship – this was a theme for all others.

• Maybe she is like crazy-obsessed with the guy she’s with and wants to save the relationship,
so she gets pregnant. (9th–10th grade female)
• I think a lot of them do it to keep a guy. Like if the guy is going to break up with them, they
get pregnant to keep him, to make them commit to you. (11th–12th grade male)

A major theme was that the pregnancy happened by chance, or was simply an inadvertent
consequence of having sex.

• I truly think that it just sort of happens more than anything. (pregnant/parenting female)
• I think that they just get caught up in the moment and don’t think about anything. (pregnant/
parenting female)
• They aren’t thinking. Or, either they’re at a party, and like drunk or high, and that gives them
an excuse to make a bad decision. (9th–10th grade female)

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Henderson et al. 339

Table 4.  What are some reasons a boy in his teens may want to have a baby?
Themes Pregnant/Parenting Females Females Males Males
Females 9th–12th 11th–12th 9th–10th 11th–12th 9th–10th
grades grades grades grades grades
Unintended consequence of sex X X X X X
Don’t want to have one X X X X X
Prove something, show off, be cool X X X
Want responsibility; feel grownup X X

Both male student groups perceived that female teens may want to have a baby because they are
‘cute’. This was not mentioned by any female students.

• I’m not going to lie, guys think kids are cute, but can you imagine what a girl would think
when they are all about cute things, especially kids. They just think, especially with all the
baby clothes, they just think ‘how cute’. (9th–10th grade male)
• …and I think that girls see little babies at the mall or around town and think ‘how cute’ and
they want one. (11th–12th grade male)

A theme unique to the pregnant/parenting female group was that a teen girl may want to have a
baby because they may want to show that they are responsible.

• If they saw someone in their family, you know, who wasn’t being a good parent or something,
it’s just like, ‘ah – I can show them that I can do much better’. (pregnant/parenting female)

Q4:What are some reasons a teen boy might want to have a baby?
The first response to this question in every group, both male and female, was a round of laughter.
They struggled with this question, even though all participants easily came up with many reasons
why girls in their teens may want to have a baby (see Table 4).

• I never heard of a boy in his teens wanting to have a baby. (11th–12th grade female)
• I don’t know any guys that would want to have a baby right now – they just want to have sex
with their girlfriend. (11th–12th grade male)

Again, the teens agreed that pregnancy was an inadvertent consequence of sex.

• They don’t think with their brains, they just think with their material. (pregnant/parenting female)
• Sex. They just want sex and they think that they don’t have to deal with it at first… They just
think about sex a lot, pretty much. (9th–10th grade male)

Q5: If one of your friends became pregnant (or got someone pregnant),
how would you react?
‘Supportive’ was the primary theme, although initially they expressed ‘surprised’ toward the
females and ‘perturbed’ toward the males (see Table 5).

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340 Health Education Journal 69(3)

Table 5.  How would you react if one of your friends got pregnant (or got someone pregnant)?
Themes Pregnant/Parenting Females Females Males Males
Females 9th–12th 11th–12th 9th–10th 11th–12th 9th–10th
grades grades grades grades grades
Initial surprise or negative initial reaction X X X X
Provide support/advice X X X X X
Excited/happy to hear news X X
Change in relationship with friend X

• I would slap him, if it was a boy. And if it was a girl, I would help her out as much as I pos-
sibly could. (9th–10th grade female)
• I would be like ‘oh, shit. You are screwed’ and laugh a little. (9th–10th grade male)
• I would be pretty mad because we couldn’t hang out and stuff anymore. He would have to
start living an adult life and wouldn’t be able to hang out. (11th–12th grade male)
• I would be supportive. I wouldn’t freak out or anything. I mean it’s their decision, but to
freak out is just rude. (11th–12th grade female)
• I would just be supportive, and if they were wanting to have an abortion, I would… maybe
try to talk them out of it. (pregnant/parenting female)

Discussion
Seven months before the latest statistics were released that showed a nationwide increase in
teen births for the first time in 15 years2, the Sweet Home students perceived that teen preg-
nancy was a growing concern and that teen pregnancy rates were increasing, particularly at
their school.

• Babies are the new accessory, like a Gucci bag. (11th–12th grade female)

Results from this study reveal the perceptions of teen pregnancy among female and male high
school students in a rural area with high teen pregnancy rates. The four primary themes were: (1)
the number of teen pregnancies were increasing and were a growing concern; (2) financial difficul-
ties and harm to education were associated with teen pregnancies; (3) teen females had many rea-
sons for wanting a baby, but teen males just wanted to have sex; and (4) teen pregnancy happened
by chance, or was simply an inadvertent consequence of having sex.
Overall, the perceptions of the Sweet Home students were similar to those of students in
Oklahoma City, who were asked the same questions about teen pregnancy29. However, the Sweet
Home students delineated more differences between the sexes than the Oklahoma City students:
teen pregnancy is primarily a female matter; females want to have a baby because they are ‘cute’,
and, males don’t want a baby, they just want sex.
A major finding in our study was that students perceived ‘pregnancy happens’, even though
they were aware of contraception methods and the consequences of teen pregnancy. There was an
overwhelming theme that becoming pregnant was simply an inadvertent consequence of being
sexually active.

• I didn’t want one, it just kind of happened. It’s not an accident, it just sort of happened.
(pregnant/parenting female)
• …they are just in it for the pleasure and then it is like ‘oops’. (9th–10th grade female)

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Henderson et al. 341

• Basically the guys are in it just for the sex… (9th–10th grade male)
• …I think that the reasons why teens even start having sex is for today’s satisfaction, not tomor-
row’s. So then if that turns into a baby… it will mess up your plans. (11th–12th grade female)

This suggests that the students’ perceptions of the consequences of teen pregnancy are often
incongruent with their sexual behaviour, and that an ‘accident’ has no personal responsibility. One
explanation for these perceptions may be the outcome of abstinence-only programmes, similar to
the curriculum found in Sweet Home High School, which have been shown to be less effective than
abstinence-based programmes30. These students may have the most to gain from sexual health
programmes that teach and empower students about contraceptive use, refusal skills and assertive
communication skills. This is a key recommendation from this study to shift away from the theme
that teen pregnancies happen by chance.
By integrating an abstinence-based programme with the developmental asset framework, stu-
dents can acquire the external and internal youth assets to develop necessary skills and strategies
for pregnancy prevention that are in accordance with their perceptions31. After completion of this
study, the Sweet Home School District adopted a new health education curriculum that included an
abstinence-based approach and met the Oregon Administrative Rules for sexuality education. In
addition, the following steps were implemented to increase youth assets: established five after-
school, non-sport clubs (Amnesty International, computer gaming, art, web site design, and for-
estry); made changes in school policy to address truancy problems; engaged students in choosing
names for the wings in their high school to help establish identity and ownership with their school;
and coordinated efforts to increase meaningful volunteer experiences for students.
The primary limitation of this study is that the findings may not be generalized to the US teen
population. However, the findings of this study give insights into the perspectives of students in a
low-income rural community with high pregnancy rates – an area where there is a dearth of knowl-
edge. Future research should examine perceptions of teen pregnancy among diverse racial/ethnic
groups in order to tailor culturally appropriate sexual health messages.
Implications of the findings of this study are that (1) establishing knowledge and skills about
pregnancy prevention is a valid school-based approach as part of a sexual health strategy; and
(2) sexual health education within the context of the developmental asset framework will promote
healthy sexual behaviours. In particular, the external assets of support – from parents, peers, and
the school – should be a central part of the education programmes and policies to promote healthy
sexuality. As Rosenthal and Dowsett wrote, ‘Sex is not just socially produced – social life is
increasingly sexual’32. School health professionals can partner with parents, health care providers,
community organizations and the media to develop innovative ways to build the support assets in
young people.

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