HLTH 511-B02 Brieana Driskill
A Research Proposal Addressing the Effects of Teen Pregnancy and Multiple Births
Brieana Driskill
HLTH 511-B02
Liberty University
September 9, 2014
HLTH 511-B02 Brieana Driskill
Research Proposal
The topic addressed in this paper is teen pregnancy and repeat births. According
to The Centers for Disease Control, a repeat teen birth is the 2nd (or more) pregnancy
ending in a live birth before age 20.1 Nearly 1 in 5 births to teen mothers, ages 15 to 19,
is a repeat birth.1 Some teens are giving birth to a 3rd (13% of repeat births) or 4th up
to 6th child (2% of repeat births).1 About 183 repeat teen births occur each day in the
US.1 The question that I will address with this research is, “Is there a significant
relationship between teen pregnancy and multiple births?”
Studies conducted by the Center for Disease Control show that 18% of teen
pregnancies are repeat pregnancies.1 American Indian and Alaskan Natives, Hispanics,
and black teens are about 1.5 times more likely to have a repeat teen birth, compared to
white teens.1 Infants born from a repeat teen birth are often born too small or too soon,
which can lead to more health problems for the baby.1 Studies have shown that teens
who become pregnant put their families at risk for poverty and struggle.1 One-fourth of
teen mothers will end up on welfare within the first three years of their child’s life and
less than 40% get a high school diploma.1 Teen pregnancy has cost American’s over
$11 billion dollars.
The following paper: “A Research Proposal Addressing the Effects of Teen
Pregnancy and Multiple Births”, aimed to explore the effects of the independent
variable, multiple births, on the dependent variable, teenage pregnancy among
adolescents. More specifically, the proposed study examined if the occurrence of a
pregnancy between the ages of 13 and 18 had a significant effect towards teens giving
HLTH 511-B02 Brieana Driskill
birth to a second, third or even fourth child. A confidential survey was used to gather
data through anonymous questionnaires, socio-economic status surveys, and
demographic assessments. Current or previously pregnant teenage mothers from area
high schools will be the target population for this study.
Previous research suggests that there is a link between teen pregnancy and
multiple births. In this study, Mann-Whitney U Tests and Crosstabs was used as the
statistical methods to assess risk behaviors among two different groups of adolescents.
These groups consisted of randomized females who have given birth during their teen
years. Throughout the course of this paper I provided a background on the topic and
addressed the scope, rationale and desired population for the study.
Introduction
Studies among adolescents who have experienced repeat pregnancies have
been researched for years. Previous research suggests a link between adolescent
pregnancy and sexual abuse history.1 Other forms of research showed links between
repeat pregnancies and depression and self-esteem.1 The need for repeat teen
pregnancy research has grown among the years. Teen pregnancy research is an
important issue for a host of reasons. There are many health issues and risks
adolescent mothers and their children are at a higher risk from which to suffer.1,2 These
issues range from emotional problems to health and social issues. Teens are also at an
increased risk to suffer from complications during pregnancy.2
The purpose of this observational study is to determine whether there is a significant
relationship between depression and socioeconomic status in teen mothers and repeat
births. According to the Centers for Disease Control, nearly 1/5 of teen births are repeat
HLTH 511-B02 Brieana Driskill
pregnancies.2,3 Although birth rates among teens has declined in recent years, birth
rates still remain high, especially in Indian, African American and Hispanic
communities.3 Studies have also shown that only 22% of teen mothers use a type of
birth control that is 99% effective, such as birth control pills.3
The type of study we will conduct is the Mann-Whitney U Tests and Crosstabs as the
statistical methods to assess risk behaviors among two different groups of adolescents.
This will allow us to understand the relationships between depression and repeat teen
pregnancy among low-income mothers. The independent variables will be the
individuals (pregnant teen mothers) and their specific answer to depression symptoms.
The dependent variable will be depression symptoms.
Literature Review
Teenage pregnancy outcomes have become an increasing concern in the United
States.4 Education and support of pregnant teens are critical factors that may determine
good or poor pregnancy outcomes. Poor outcomes may include low birth weight,
developmental delays, and poor academic performance.4 Repeat pregnancy among
adolescent mothers is a major problem facing healthcare providers today.5 Adolescents
who experience multiple pregnancies often are subjected to overwhelming physical,
social, economic, and psychological outcomes.5 Research between the link of
depression and repeat pregnancies have been done.
According to the National Library of Medicine, pregnancy may often serve to
protect pessimistic teenagers from experiencing depression.6 The subsequent demands
of motherhood may remove any protection from depression afforded by the pregnancy.6
The experience of depression being relieved by another pregnancy may be a previously
HLTH 511-B02 Brieana Driskill
unidentified risk factor for repeated pregnancies in teenagers.6 Repeat pregnancies
represent part of the overall rate of births among adolescents.7 Repeat pregnancies
have become a critical focus for intervention programs geared towards teen mothers.7
The social predictors of repeat adolescent pregnancy are varied and have previously
been usefully grouped into predictors operating at individual, couple, family, community
and social levels.7
In a secondary analysis of data drawn from two consecutive longitudinal risk
reduction interventions, researchers from the University of Maryland discovered that
depressive symptoms were associated with a 44% increase in risk of subsequent
pregnancy among 269 predominantly African American and low income teens.8 The
study included 297 pregnant teens between the ages of 12–18 who received prenatal
care at one of five community-based prenatal sites.8 At enrollment, the teens underwent
a baseline structured interview and were randomly assigned to a pregnancy prevention
intervention or to a usual-care control.8 Research staff administered structured follow-up
questionnaires at one and two years postpartum. Out of 269 teens who completed at
least one of the follow-up questionnaires, 46% had depressive symptoms at baseline.8
Of the 245 teens who completed to years of follow-up, 120 experienced a subsequent
pregnancy within two years of childbirth.8,9
Research done by the Centers for Disease control has found that after reviewing
electronic articles, socioeconomic factors were determinants of teen childbearing.
These articles analyzed family-level socioeconomic influences. The authors found that
lower education levels among respondents' parents were associated with teen births for
both racial/ethnic groups.10 In a cross-sectional analysis of data from the National
HLTH 511-B02 Brieana Driskill
Survey of Family Growth, researchers used retrospective event history data from 4,653
women to construct fertility behaviors of teen women, finding that parental education
was inversely associated with initiating sexual intercourse, becoming pregnant, and
giving birth.10
Methods
Sample:
A convenience sample of 50 teenagers between the ages of 13-18 were used.
Equipment:
Participants were 50 African American adolescent mothers from 3 local high schools.
Prospective data were collected using written surveys. Mann-Whitney U Tests and
Crosstabs was used to determine if depression is a predictor of repeat pregnancy.
Survey Example:
1. Age
2. Do You Suffer From Depression? : yes or no
3. Number of Pregnancies/Births (Participants are asked to record all pregnancies.
This will include pregnancies carried into full term and terminated pregnancies)
Questionnaire data was recorded and entered into an SPSS database. The first
column was Participant ID, the second column was Age, the next column was
Depression Symptoms and the last column was Number of Pregnancies and Births.
HLTH 511-B02 Brieana Driskill
Statistical Procedures and Variables
Study Cohort Demographics (N=50)
The Mann-Whitney U test was used to understand whether depression
symptoms had an effect on repeat pregnancies in teenage girls ages 13-18. In the
dataset, we have information about each teen girl. We distinguish the teens between
those who suffer from depression and those who don’t, as well as the number of
children they have. The basic procedure behind this test involves combining all
information obtained from our simple survey and ranking it. If a real difference between
those who suffered from depression and those who did not existed, then the alternative
hypothesis would be accepted.
File Information
Variable Information
Variable
Positi
on Label
Measure
ment
Level Role
Colum
n
Width
Alignm
ent
Print
Format
Write
Format
id 1 Participant ID Nominal Input 8 Right F8 F8
age 2 Age Scale Input 8 Right F8 F8
depression 3Depression
Symptoms Ordinal Input 8 Right F8 F8
births
4
Number of
Pregnancies and
Births
Nominal Input 8 Right F8 F8
Variables in the working file
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Variable Values
Value Label
age 1 13
2 14
3 15
4 16
5 17
6 18
depression 1 Yes
2 No
births 1 1 birth or pregnancies
2 2 or more births or
pregnancies
Hypothesis tested:
H0: There is no significant relationship between depression and repeat pregnancies in
adolescents.
Ha: There is a significant relationship between depression and repeat pregnancies in
adolescents.
Hypothesis tested at the 0.05 level of significance.
Mann-Whitney U Test and Crosstabs Tabulations were created by using SPSS 22.
HLTH 511-B02 Brieana Driskill
Results
The simple pie graph explains the survey results of the percentage of young women
who gave birth or became pregnant. About one-fourth gave birth to one child, 55% gave
birth to two children and 22% recorded three or more births/children.
HLTH 511-B02 Brieana Driskill
Crosstabs
Case Processing Summary
Cases
Valid Missing Total
N Percent N Percent N Percent
Depression
Symptoms * Number
of Pregnancies and
Births
50 100.0% 0 0.0% 50 100.0%
Depression Symptoms * Number of Pregnancies and Births Crosstabulation
Number of Pregnancies and Births
Total
1 birth or
pregnancies
2 births or
pregnancies
3+ births or
pregnancies
Depression Symptoms Yes Count 3 24 9 36
% within
Depression
Symptoms
8.3% 66.7% 25.0% 100.0%
% within
Number of
Pregnancies
and Births
30.0% 82.8% 81.8% 72.0%
No Count 7 5 2 14
% within
Depression
Symptoms
50.0% 35.7% 14.3% 100.0%
% within
Number of
Pregnancies
and Births
70.0% 17.2% 18.2% 28.0%
Total Count 10 29 11 50
HLTH 511-B02 Brieana Driskill
% within
Depression
Symptoms
20.0% 58.0% 22.0% 100.0%
% within
Number of
Pregnancies
and Births
100.0% 100.0% 100.0% 100.0%
The crosstabs table explains the results from the survey of depression symptoms and
number of pregnancies and births. The table shows that the young women who suffered
from depression seemed to also give birth or become pregnant more than the young
women who did not suffer from depression symptoms.
NPar Tests
Descriptive Statistics
N Mean
Std.
Deviation Minimum Maximum
Number of Pregnancies
and Births 50 2.02 .654 1 3
Depression Symptoms 50 1.28 .454 1 2
HLTH 511-B02 Brieana Driskill
Mann-Whitney Test
Ranks
Depression
Symptoms N Mean Rank
Sum of
Ranks
Number of Pregnancies
and Births
Yes 36 28.38 1021.50
No 14 18.11 253.50
Total 50
Test Statisticsa
Number of
Pregnancies
and Births
Mann-Whitney U 148.500
Wilcoxon W 253.500
Z -2.522
Asymp. Sig. (2-
tailed) .012
a. Grouping Variable: Depression
Symptoms
Discussion
In an effort to determine whether depression had a significant effect on
repeat pregnancy in teenagers, a simple survey was obtained from fifty teenage
young women, between the ages of 13 and 18. The results shown in the tables
above indicate that depression had a significant effect on teen mothers to have a
repeat pregnancy.
HLTH 511-B02 Brieana Driskill
Limitations
One limitation of the study is that it was based on a very small sample that is
composed primarily of low-income, minority teenagers. Another potential limitation is
that retrospectively asking young women about their pregnancy and sexual history may
result in young ladies omitting the truth. However, this study is important in helping
others research the reasons for teen repeat pregnancies and the link to low self-esteem
and depression.
References
1. Centers for Disease Control and Prevention. Repeat Pregnancies. Accessed:
September 10, 2014
2. Saewyc E., Magee L., Pettingell S. Guttmacher Institute. Teenage Pregnancy
and Associated Risk Behaviors Among Sexually Abused Adolescents. Volume
36.2004. Accessed: September 17, 2014
3. National Conference of State Legislatures. Teen Pregnancy Prevention.
www.ncsl.org. Accessed: September 18, 2014
4. Center for Disease Control. Teen Pregnancies. www.cdc.gov. Accessed:
September 18, 2014
HLTH 511-B02 Brieana Driskill
5. The Journal of School Nursing. Strunk J. The Effect of School-Based Health
Clinics on Teenage Pregnancy and Parenting Outcomes: An Integrated Literature
Review. http://jsn.sagepub.com . Accessed: September 21, 2014
6. Nelson PB. National Library of Medicine. Repeat Pregnancy Among Adolescent
Mothers: A Review of the Literature. http://www.ncbi.nlm.nih.gov. Accessed:
September 21, 2014
7. National Library of Medicine. Wagner KD., Berenson A.,Harding O., Joiner T.
Attributional Style and Depression In Pregnant Teenagers.
http://www.ncbi.nlm.nih.gov. Accessed: September 21, 2014
8. Brazilian Medical Journal. Whitaker R., Hendry M., Booth A., Williams N.
Intervention Now To Eliminate Repeat Unintended Pregnancy in Teenagers: a
systematic review of intervention effectiveness and cost-effectiveness, qualitative
and realist synthesis of implementation factors and user engagement.
www.http://bmjopen.bmj.com . Accessed: September 21, 2014
9. Clinical Psychiatry News. Depression and Repeat Pregnancy in Teen Mothers.
http://www.clinicalpsychiatrynews.com. Accessed: September 21, 2014
10.Association of Schools of Public Health. Carter M., Kourtis A., Penman-Aduilar
A., Socioeconomic Disadvantage as a Social Determinant of Teen Childbearing
in the U.S. Accessed: September 22, 2014
