A Literature and Data Review of Teen Pregnancy Prevention Programs
__________________________________________________________
Promoting Sexual Education and Teen Pregnancy Prevention
Interventions
By
Brieana Driskill
HLTH 634
Liberty University
Introduction
Promoting Sexual Education and Teen Pregnancy Prevention Interventions will address
and focus on risk and protective factors that are the most amenable to change. There is a wide
array of teenage pregnancy preventions programs. The goals of the programs can be divided into
two main groups: programs that address teen’s sexual risk factors (sex education with abstinence
focus, sex education with conception component and comprehensive sex education) and
programs that address teens’ social risk factors (early childhood and development programs). Sex
education with abstinence are directed at teen sexual risk factors and have a primary or
overarching goal of preventing teen pregnancy by specially addressing the way in which sexual
beliefs and values of teenagers can be oriented to avoid sexual behavior that could result in
pregnancy. Sex education with conception component have a similar focus, but while abstinence
is advocated, these programs also focus on sexual risk factors with a central goal of preventing
harms to individual health, specifically STI/HIV/AIDS, which result from risky sexual behavior
by teens. My intervention program will be a combination of all of these.
Description of the Intervention:
Sponsored by Planned Parenthood of Memphis, TN, “Promoting Sexual Education and Teen
Pregnancy Prevention Interventions” is a comprehensive youth development program for
economically disadvantaged teens that enter the program at ages 13-19. The program will be
provided after school at local community centers and churches, and will run for about three hours
each weekday. It will include four main activities, as follows:
a. Daily academic assistance (e.g., tutoring, homework help, assistance with college
applications);
b. Job Club 1-2 times per week, including such activities as learning to complete a job
application and interview for a job;
c. Family life and sex education 1-2 times per week, led by a reproductive health
counselor;1,3,8
d. Individual sports and recreation activities 1-2 times per week (e.g. tennis, swimming,
arts).
The program will also provide free health and medical care through alliances with local health
care providers. A key component is reproductive health care, including physical exams, testing
for sexually transmitted infections, a range of contraceptive options, and counseling. Our
program staff will schedule the teens’ appointments and accompany them on their visits.
The goal of the project is to reduce the incidence and behavioral risk factors for teen
pregnancy among Memphis ages 13-19, by implementing teen pregnancy prevention evidence-
based interventions, such a contraceptive use and abstinence. This initiative promotes healthy
behavior, responsible decision making and increased opportunities for at-risk youth. My
initiative is a comprehensive youth development program for economically disadvantaged teens,
a key component of which is reproductive health care. The guiding principle for this initiative
will be geared toward the investment of all community members in increasing the awareness and
ownership of the risks, costs and problems associated with teen pregnancy, in order to create
local solutions.
I will be using the Health Belief Model Theory.
The core components of HBM include:
·Perceived susceptibility—the subjective perception of risk of developing a particular health
condition
Show students videos which have youth like them with the condition.
Ask youth to complete confidential personal risk assessments.
Present recent statistics of youth their age, or from their community.
Have them explore web sites that show teens who have experienced teen pregnancy.
·Perceived severity—feelings about the seriousness of the consequences of developing a
specific health problem
Show graphic photos of people suffering with teen pregnancy, STIs and HIV.
Share case studies of people experiencing difficult consequences of the condition.
Lead a visualization having youth imagine they have the condition and are dealing with
its consequences.
·Perceived benefits—beliefs about the effectiveness of various actions that might reduce
susceptibility and severity (taken together, perceived susceptibility and severity are labeled
"threat")
Present the desired action in various ways — explain it, post it, distribute it in print, and
reinforce it throughout the session.
Be sure students have all the information they need to take the action (e.g., where to get
condoms, how to choose, how to store, when to use them, how to put them on and
remove them, etc.)
·Perceived barriers—potential negative aspects of taking specific actions
Have the group brainstorm all imagined barriers to taking action. Then ask each youth to
pick out one or two barriers that apply to them.
·Cues to action—bodily or environmental events that trigger action
Provide youth with incentive items (e.g., pencils, key chains) which contain visual
reminders of the message or recommended action.
Hang posters with the action messages in your setting.
The Health Belief Model (HBM) has been applied to a variety of health education topics
including sexuality education. An example of an organization that has used this framework is the
University of California-San Francisco Bixby Center For Reproductive Health Research and
Policy. The Health Belief Model has been applied to a broad range of health behaviors and
subject populations that they study. Three broad areas can be identified : 1) Preventive health
behaviors, which include health-promoting (e.g. diet, exercise) and health-risk (e.g. smoking)
behaviors as well as vaccination and contraceptive practices. 2) Sick role behaviors, which refer
to compliance with recommended medical regimens, usually following professional diagnosis of
illness. 3) Clinic use, which includes physician visits for a variety of reasons. Other
organizations for teen pregnancy prevention have used the Health Belief Model to affirm that
readiness for action stems from an individual’s estimate of the threat of illness or, as applied to a
pregnancy prevention intervention, pregnancy and sexually transmitted diseases. This readiness
for action also assumes the likelihood of being able, through personal action, to reduce that
threat. Specifically, the Health Belief Model considers the individual’s perceived susceptibility(a
person’s subjective perception of risk of contracting a condition); perceived severity(death,
disability, pain, or other feelings about the relative seriousness and consequences of contracting
illness, as well as effects on work, family or other social consequences); perceived
benefits(beliefs about the relative effectiveness of various actions that could be taken to reduce
the threat); and perceived barriers(the potentially negative aspects of a particular health action,
including expense, danger, side effects, and pain).
The Health Belief Model proposes that individuals consciously consider and weigh all the
different variables in deciding the actions they will pursue. A kind of “cost-benefit analysis” is
thought to occur in which an individual weighs opposing or conflicting options. The cost side
consists of susceptibility and severity factors, while the perceived benefits of taking action and
the ability to overcome perceived barriers to action make up the benefit side. Other variables can
affect either costs or benefits. Individuals are most likely to take action when they believe they
are susceptible, when the condition is severe, when the available course of action is beneficial in
reducing susceptibility or severity, and when the costs of inaction outweigh the benefits. Also
inherent in this theory are the concepts of self-efficacy and outcome expectancy: individuals
must not only believe a specific action will lead to a particular desired outcome, but they must
also believe they will be able to initiate the behavior required to produce the outcome. Thus, an
adolescent who desires to graduate from high school and proceed to college will need to weigh
the pros and cons of being involved in a relationship that might result in an unplanned pregnancy
that might well interfere with their life plans.
A concept that was not originally part of this theory, cues to action, has become a
prominent component of the Health Belief Model. Put simply, cues to action activate and
stimulate behavior. For example, a negative pregnancy test may give an adolescent such a scare
that she begins to practice effective and consistent contraceptive use from that point on or may
opt to become abstinent. An adolescent may also model behavior he or she sees through the
media. For example, if sexual situations presented in a television show do not include
contraceptive cues, or effective negotiating skills to delay or abstain from sexual intercourse, a
unique opportunity to help shape behavior has been missed.
In applying this theoretical framework to a pregnancy prevention intervention, a
counseling component might be included that stresses cues to action and personal perceptions of
the negative consequences of an unplanned child or a sexually transmitted disease, particularly in
relation to the adolescent’s education and career aspirations. Counseling should also address such
perceived barriers to action (an important factor in the Health Belief Model) as poor
communication between the partners about delaying sexual relations, or using birth control if
they do have sex. The Health Belief Model emphasizes personal goals and optimism about the
future, self-efficacy, threat appraisal, and problem-solving and decision-making skills, all of
which could be incorporated into educational interventions that feature counseling, youth
development, and mentoring components
Articles were included in this review if they were peer reviewed, were published in the
U.S. between January 2006 and July 2013, and included outcome evaluation measures that
specifically addressed adolescent pregnancy prevention among African American and/or Latino
youth. The 6-8 year date range was selected in order to include programs recently implemented
that may have potential for continued use and improvement. In order to be included, the program
descriptions that I researched explicitly mentioned pregnancy prevention. For this reason, several
programs labeled as evidenced-based adolescent pregnancy programs by the Office of
Adolescent Health were excluded due to the program description in the evaluation as an “HIV
prevention program” with no mention of adolescent pregnancy. Any measure used for the
purpose of gauging pregnancy prevention could be included.
Body of Evidence
The importance of teen pregnancy prevention continues because, despite the substantial
drop in teen pregnancy in the US since 1991, as of 2004, the US has manifested the highest teen
pregnancy rate and teen birth rates among developed countries.1,2,3,16 The USA date has been two
to six times higher than Western Europe. This prevalence has prevailed even though sexual
activity rates are similar or higher among Western European teenagers than among teenagers in
the United States.1,2,3 An array of social costs is imposed on American society due to teen
pregnancy.1,2,3
High rates of teen pregnancy, sexually transmitted infections (STIs), and associated
sexual risk behaviors remain a troubling issue in the United States. Nationwide, 47 percent of
high school students have had sexual intercourse, and 24 percent report having had four or more
partners by graduation.3 In 2011, nearly 40 percent of sexually active high school students had
not used a condom during their last sexual intercourse.3 These behaviors increase the risks of
pregnancy and STIs, including HIV. Preliminary national data for 2011 indicate there were
approximately 31.3 births per 1,000 females 15 to 19 years of age, a rate higher than in most
other industrialized countries.2,3 In addition, estimates suggest that adolescents and young adults
account for half of all new STI cases in the United States every year.2,3
This report addresses two dimensions of prevention programs directed at preventing teen
pregnancy and limiting teen sexual behavior. First, a review of literature pertaining to prevention
programs is conducted. The objective of the present literature review is: (a) to provide a
compilation of prevention programs, from the 1990’s until 2013, according to research-based
dimensions, and (b) to place prevention programs activities within the context of a public policy
evaluation that will provide a basis for appraising the appropriateness for various types of
prevention programs.10,11 Second, data applicable to prevention programs is identified.
Highlights of the review of teen pregnancy prevention literature are as follows:
Various reports have shown a continued decline in adolescent pregnancy rates in the
United States, but minorities remain disproportionately affected. Rates of teen pregnancy among
African American and Latino youth in the U.S. are 2:3 times higher than rates among white
youth.1,3 In fact, more than half of all Latinas will experience a pregnancy before the age of 20.3
Higher adolescent pregnancy rates among minority teenagers represent a continuing
health disparity in the U.S. that demands public health attention. Adolescent pregnancy is
associated with adverse medical, economic, and social outcomes. Adolescents who become
pregnant have are at a greater risk for diseases, including HIV and anemia.1,2,3,10 Babies born to
adolescents are also at increased risk for low birth weight, preterm birth, and death in infancy.1,2
Teenage mothers are less likely to achieve in school or finish high school, and more likely to
have children who become pregnant during adolescence.1,3,4 In addition, nearly two-thirds of
births to adolescents under the age of 18 years are unintended, which increases the likelihood
that the mother is less emotionally and financially prepared for pregnancy and parenting.10,15
Children of adolescent mothers are more likely to utilize public healthcare, and are more likely to
be placed in foster care.
The economic cost of teen pregnancy to society adds up to billions of dollars per year
including increased healthcare costs, incarceration, foster care, and lost productivity.1,3,6 Recent
proposed federal legislation intended to increase the number of adolescent pregnancy programs
for minority populations has failed to pass.5,6 The rationale for expanding access to these
programs is to complement and support existing programs to decrease the adolescent pregnancy
rate.6 In order to support further development of adolescent pregnancy prevention among
minority youth, it is important to survey the characteristics of existing programs in the U.S. To
strengthen the efficacy and expansion of adolescent pregnancy prevention it is vital to understand
the components, as well as the strengths and weaknesses of existing programs before developing
more.
In April of 2013, an article entitled: Programs to Reduce Teen Pregnancy, Sexually
Transmitted Infections, and Associated Sexual Risk Behaviors was released and focused on teen
pregnancy prevention and the study of the prevalence of sexually transmitted infections are
addressed. The paper presented findings from an ongoing systematic review of research on teen
pregnancy and STI prevention programs, sponsored by the U.S. Department of Health and
Human Services to help support evidence-based approaches to teen pregnancy prevention.4,5
The review was conducted in four steps. First, multiple literature search strategies were
used to identify relevant studies released from 1989 through roughly January 2011. Second, all
studies identified through the literature search were screened against pre-specified inclusion
criteria. Third, studies that met the inclusion criteria were assessed by teams of two trained
reviewers for the quality and execution of their research designs. Fourth, for studies that passed
this quality assessment, the review team extracted and analyzed information on the research
design, study sample, evaluation setting, and program impacts.4
A total of 88 studies met the review criteria for study quality and were included in the
data extraction and analysis.4 The studies examined a range of program models delivered in
diverse settings. Most studies had mixed-gender and predominately African American research
samples (70 percent and 51 percent, respectively). Randomized controlled trials accounted for
the large majority (87 percent) of included studies. Most studies (76 percent) included multiple
follow-ups, with sample sizes ranging from 62 to 5,244.4 Analysis of the study impact findings
identified 31 program models with evidence of a statistically significant positive effect (and no
adverse effects) on teen pregnancy, STIs, or sexual activity.4 The determination of whether any of
the prevention programs realize their goals requires conducting a rigorous research inquiry into
their outcomes. The achievement of outcomes indicates that a program realizes efficacy or it is
efficacious. The outcomes, or goals, of prevention programs are dissimilar within the separate
prevention program designs. In particular, the goals of programs with abstinence focus are
inconsistent and incompatible with the goals of other prevention programs.6,7
Conclusion
In conclusion, in the first analysis from “Programs to Reduce Teen Pregnancy, Sexually
Transmitted Infections, and Associated Sexual Risk Behaviors”, it was found that the number
and rigor of evaluation studies on teen pregnancy and STI prevention programs has grown
substantially since the late 1980s. Key strengths of the literature are the large number of
randomized controlled trials, the common use of multiple follow-up periods, and attention to a
broad range of program models delivered in diverse settings. Two main gaps are a lack of
replication studies and the need for more research on Latino youth and other high-risk
populations. In addressing these gaps, studies must overcome common limitations in research
quality and reporting standards that have negatively affected prior research.2,3,4,5
The most efficacious prevention programs are comprehensive sex education ones.16
Efficacy gains have been verified for a considerable proportion of these types of programs.1,3 The
diversity of outcomes and their affirmation for concluding efficacy would not allow confirmation
of which programs are the most functional for society.1,8 Programs for which the evaluations
have attributed efficacy should be replicated in order to assess the transferability of the
intervention. Additional analysis of the positively evaluated programs should be undertaken to
encompass a longer time frame for a follow-up of participants. Evaluation of youth development
programs manifest inconsistent results across programs, i.e., the achievement of outcomes were
dissimilar for various programs. Results of this review allow us to see a larger picture of how
adolescent pregnancy programs have been used with minority youth in order to promote
successful programs and to suggest areas of improvement. In addition, this review supports
further research to determine best practices in tailoring adolescent pregnancy prevention for
minority populations.
1. Centers for Disease Control and Prevention. Teen Pregnancy.www.cdc.gov/teenpregnancy.
Accessed: May 26, 2014
2. Rickert, V.; Tiezzi, L.; Lipshutz, J.; León, J.; Vaughan, R.; and Westhoff, C. (2007). Depo Now:
Preventing Unintended Pregnancies among Adolescents and Young Adults. Journal of Adolescent
Health, 40: 22–28. Accessed: May 26, 2014
3. Centers for Disease Control and Prevention. HIV Risk Reduction Efficacy Review Methods.
http://www.cdc.gov/hiv/topics/research/prs/rr-efficacy-review-methods.htm.Accessed: May 26,
2014
4. Goesling B.,Colman S., Trenholm C.,Terzian M., Moore K. Programs to Reduce Teen
Pregnancy, Sexually Transmitted Infections and Associated Sexual Risk Behaviors: A Systematic
Review. U.S. Department of Health and Human Services. 2013. Accessed: May 26, 2014
5. Administration for Children and Families. “State Personal Responsibility Education Program.”
Washington, DC: Administration on Children, Youth, and Families (ACYF)/Family and Youth
Services Bureau (FYSB), Administration for Children and Families, U.S. Department of Health
and Human Services, 2010. Accessed: May 26, 2014
6. The National Campaign to Prevent Teen and Unplanned Pregnancy; 2008.
www.thenationalcampaign.org/why-it-matters. Accessed: May 12, 2014
7. Advocates for Youth. “Science and Success, 2nd edition.” Washington, DC: Advocates for Youth,
2008. Accessed: May 26, 2014
8. Ball, V., and K.A. Moore. “What Works for Adolescent Reproductive Health: Lessons from
Experimental Evaluations of Programs and Interventions.” Washington, DC: Child Trends,
2008. Accessed: May 26, 2014
9. DevaneyB., Trenholm C., Wheeler J., Fortson K., Clark M. Impacts of Four Title V, Section 510
Abstinence Education Programs. 2007. Mathematica Policy Research. Accessed: May 26, 2014
10. Kirby D., The Impact of Abstinence and Comprehensive Sex and STD/HIV education programs
on adolescent sexual behavior. SpringerOpen Journal. 2008. Accessed: May 26, 2014
11. Bryan, A. D., S. J. Schmiege, and M. R. Broaddus. “HIV Risk Reduction Among Detained
Adolescents: A Randomized, Controlled Trial.” Pediatrics, vol. 124, no. 6, 2009,
pp. e1180–e1188. Accessed: May 26, 2014
12. U.S. Department of Health & Human Services. Headings, Titles and Labels: Use Clear
Category Labels. http://www.usability.gov. Accessed: May 23, 2014
13. U.S. Department of Health & Human Services. Graphics, Images and Multimedia: Ensure
Web Site Images Convey Intended Messages. http://www.usability.gov. Accessed: May 13,
2014
14. U.S. Department of Health & Human Services. Content Organization: Ensure that
Necessary Information is Displayed. http://www.usability.gov. Accessed: May 13, 2014
15. DiCenso A., Guyatt G., Griffith W. Interventions to Reduce Unintended Pregnancies Among
Adolescents: Systematic Review of Randomized Controlled Trials. Accessed: May 26, 2014
16. National Prevention Council, Office of the Surgeon General, U.S. Department of Health and
Human Services. National Prevention Strategy. 2011. Accessed: May 26, 2014
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