Adolescent Pregnancy Prevention Research Articles

Infant Simulator Lifespace Intervention: Pilot Investigation of an Adolescent Pregnancy Prevention Program

This quasi-experimental study of 48 high school students clearly demonstrates the impact of a very realistic infant simulator on adolescents' attitudes and beliefs about what their future parenting experiences might be like. After their experience of the three-day lifespace intervention, the teenagers who participated had much more realistic notions about the responsibilities and demands involved in childrearing. Nearly all of them (90%) scored higher on a measure of realistic parenting expectations than the average adolescent in a comparison group did. Also of practical significance was the finding that the intervention even seemed to positively impact classmates of the primary intervention group, adolescents who merely observed others tending to ‘infants.’

Using Behavioral Theories to Design Abstinence Programs

If adolescents abstain from sex, or delay having sex, the risk of pregnancy is essentially zero, and the sexual transmission of a communicable disease is diminished substantially. Whatever other, nonpublic health reasons one may have for preferring abstinence as an approach to the prevention of teen pregnancy, the potential for a sizable reduction in rates of adolescent pregnancy supports abstinence as a reasonable strategy. The issue of abstinence as an approach has less to do with the desirability of the goal than with figuring out successful ways to persuade adolescents to comply. While numerous abstinence programs have been implemented, no “silver-bullet” strategies have been identified to date. Abstinence interventions (like most efforts to prevent teen pregnancy) are usually ad hoc, implemented opportunistically, or designed on the basis of a personal hunch. Few programs have been evaluated, and among those with evaluations, most have shown very little effect on the timing of sexual debut. When effects are found, they have been fairly small, with teens delaying sex for a matter of months, when the goal is to delay sex for years. While hunches and experience in the field provide useful insights, it is time to be more systematic in developing new intervention approaches and incorporating research knowledge and theory. This paper highlights scientific evidence regarding the factors most likely to influence the onset of sexual activity during adolescence and examines program strategies with the greatest potential to affect adolescent sexual behavior given research findings. The importance of rigorous evaluations, and suggestions for strengthening the evaluation of abstinence- focused interventions and adolescent pregnancy prevention programs in general, is discussed.

Data, publication, and program archives addressing adolescent sexuality, pregnancy, and STD's

The Data Archive on Adolescent Pregnancy and Pregnancy Prevention (DAAPPP) a collection of original machine-readable data and documentation from over 130 exemplary studies--many of them longitudinal--on the incidence prevalence antecedents and consequences of teen sexuality pregnancy and parenthood in this country. Data sets in DAAPPP have been selected by a National Advisory Panel of scientists on the basis of scientific merit substantive utility and program and policy relevance. Data sets can be obtained singly in any combination of two or more data sets or as a complete package of 133 data sets--in users choice of diskette mainframe tape or CD-ROM. CD-ROM purchasers receive software to: 1) search and retrieve those variables corresponding to a users specification of variable topic type study number and keyword in question or answer and 2) create an extract file containing only those variables needed for a particular analysis. (excerpt)

Adapting Developmental Research to Intervention Design: Applying Developmental Psychology to an AIDS Prevention Model for Urban African American Youth

This article describes a program of research aimed at informing and improving AIDS prevention efforts during the transition to adolescence for urban African American youth and their families. The overall goal of this program is to apply basic developmental psychology research to intervention design and program delivery. Discussion of a theoretical model and preliminary descriptive data is presented, with specific attention paid to the implications for preventive intervention work and the need for ongoing collaboration with intervention and applied researchers as well as with communities targeted for intervention. INTRODUCTION Current developmental research stresses the importance of considering both process (Sameroff & Chandler, 1975; Spencer & Dornbusch, 1990) and context (Bronfenbrenner, 1979; Moen, Elder, & Luscher, 1995) across a variety of domain-specific paradigms (Maccoby, 1984). More recently, the utility of these paradigms for the design and implementation of adolescent disease and pregnancy prevention and intervention programs has been of interest (Miller, Card, Paikoff, & Petersen, 1992; Millstein, Petersen, & Nightingale, 1993). In this newer research, the focus on programs and services is two-fold: first, to understand service use from the perspective of the service user; and second, to propose programs of research and intervention that will improve both users' perceptions of services and the impact of these services on promoting health and preventing health risk. Appropriate methods to promote healthy behaviors among adolescents can best be determined through a combination of basic research and evaluation studies. Initial efforts that have been promising include those aimed at improving social problem-solving skills and assertiveness (Schinke & Gilchrist, 1984; Howard & McCabe, 1990; Miller et al., 1992). However, maximizing the efficacy and power of these approaches is likely to require a focus on specific groups to be targeted by the interventions as well as efforts aimed at developing basic and intervention research approaches to address the complexity of different contexts. Thus, it is important to consider the issues of social problem-solving and life skills training in a broader contextual model, an approach frequently exalted but seldom actually used (Szapocznik, 1996). A developmental approach can assist with determining the most effective agents of influence, the salient issues that increase an individual's motivation to adopt targeted behaviors, and the appropriate behavioral outcomes to target. As has been written elsewhere (Brooks-Gunn & Paikoff, 1993; Feldman & Elliot, 1990; Paikoff, 1995; Parfenoff, Paikoff, Brooks-Gunn, Holmbeck, & Jarrett, 1995), important concerns for the transition to adolescence include issues of social relations, cognitive changes, and physical development. Until recently, however, developmental studies were seldom designed with the purpose of providing data for health promotion and disease prevention efforts in mind. Similarly, individuals involved with health promotion and disease prevention have seldom consulted with developmental psychologists to better target and inform these efforts. Two important conclusions can be drawn from the existing developmental literature as it relates to adolescent health promotion and disease prevention interventions. The first of these is that an understanding of the integration of normative developmental processes is important in order to devise optimal programs to promote health and prevent risk. The second is that almost none of the developmental data relevant to this line of inquiry pertains to or addresses the needs of African American youth living in urban poverty. Thus, a basic research study was undertaken to better understand the integration of these processes for these youth and to assist with the design and implementation of primary prevention programs targeting this population. …

Adolescents at Risk: Shaping Programs to Fit the Need

This article analyzes data revealing that about one-third of teenagers are at extremely high risk because they do it all, one-third are involved in several high-risk behaviors, and one-third are at relatively low risk. Because adolescents have different needs for support, the author suggests that (a) prevention programs focus on the common characteristics of high-risk youngsters, not on separate substance, sexual, and delinquent behaviors; and (b) programs dealing with families, schools, and community institutions incorporate individual attention, enhancement of basic cognitive and social skills, exposure to career choices, and other known common elements of successful interventions. Comprehensive school-community partnerships are proposed to package all the requisite elements. INTRODUCTION Many people maintain that all adolescents are at equal risk because they all live in risky environments of one kind or another, are all exposed to the same dangerous influences, and are all going through phases of adolescent development that make them vulnerable. Others assert that young people growing up today are located in very different risk environments depending on their gender, race, ethnicity, social status, family strengths, community, employment opportunities, and other determinants. I am firmly in the camp of those who believe that young people fall into different risk categories depending on the settings in which they live. This position maintains that children today are growing up with vastly different odds of making it-that is, getting on the pathway to becoming responsible adults who can function well intellectually, play meaningful parts in the labor force, become effective parents, and be able to participate in the political life of the nation. Part of the affluence of the United States is our profusion of categorical approaches. We have separate programs and specialized researchers for almost every kind of problem ranging from substance abuse, teen pregnancy, delinquency, and school failure, to suicide. As new problems such as AIDS/HIV emerge, we quickly categorize them as well. Universities perpetuate this situation by departmentalizing knowledge into separate disciplines such as psychology, social work, public health, education, educational psychology, and so forth; and the learned journals follow suit. As a result, we have carved up our adolescents into many disconnected pieces, often losing sight of the personhood we claim to care so much about and seek to treat. As Zoccolillo (1990) maintains: Research . . . has usually focussed . . . on single independent problem behaviors, and assumed that the same cause applied equally to each adolescent with the behavior in question. The academic discipline of the investigator has often influenced the hypothesis about the behavior in question (i.e., high-school dropout viewed by educators as due to inadequate schools, or teen pregnancy as due to lack of education about birth-control). (p. 1) My own work on high-risk behaviors began in the categorical field of adolescent pregnancy prevention. Beginning in the 1980s, when it seemed that we were far from solving that problem, I started to look beyond my specialized domain to search for meaningful answers. I wanted to gain a better understanding of the context in which early unprotected sexual intercourse was taking place. The questions I asked myself then were: Is teenage pregnancy an isolated phenomenon, or is there a relationship between early sexual behavior and other behaviors?; and generally, what is going on in the lives of young people? In 1990 I published a book, Adolescents-at-Risk: Prevalence and Prevention, which summarized the then-current findings about the incidence of major high-risk behaviors in three categorical domains-substance abuse, delinquency, and school failure-along with early unprotected intercourse (Dryfoos, 1990). It was clear to me that problem behaviors among adolescents were highly interrelated. …

Are adolescents who report prior sexual abuse at higher risk for pregnancy?

Adolescents who report prior sexual abuse are at increased risk for adolescent pregnancy. This may result from earlier, more frequent, less well-protected sexual activity or from a greater desire to conceive. To determine the relative contribution of these two possible explanations to the reported association between sexual abuse and adolescent pregnancy, we studied the reproductive and sexual histories of 200 sexually active 13–18 year old females in relation to self-reported sexual abuse. Anonymous questionnaires revealed that 40 (20%) of the 200 subjects reported sexual abuse. Analyses revealed no group differences in the median age of first voluntary intercourse, the frequency of sexual intercourse, or the consistency of birth control use. Compared to their nonabused peers, however, teenagers reporting abuse were more likely to be trying to conceive (35% vs. 14% p < .01), to have boyfriends pressuring them to conceive (76% vs. 44% p < .01), and to have fears about infertility (38% vs. 16% p < .01). Our findings suggest that childhood sexual abuse may increase the risk of adolescent pregnancy by fostering the desire to conceive. Further study is needed to determine why a disproportionate number of sexually abused adolescents desire pregnancy. The efficacy of adolescent pregnancy prevention programs may be improved by identifying previously abused adolescents and by designing educational interventions that specifically address their desire to conceive.

Adolescent Pregnancy Prevention

The birth rate among unmarried United States teens has been sufficiently high over the last several decades that large numbers of public and private agencies have implemented a range of primary prevention strategies in hopes of reducing the number of adolescent pregnancies. Prevention strategies reported in the literature have varied in philosophy, purpose, structure, and content (Orbuch, 1989). Some interventions have focused solely on education and some on getting adolescents to abstain from coital activity, whereas others have concentrated on teaching adolescents cognitive and interpersonal skills thought to decrease the chance of youthful pregnancy. This article reviews published evaluations of these primary prevention strategies with a two-fold purpose. First, it will identify prevention efforts that have been adequately evaluated and whose results have been published in peer reviewed journals, with a primary focus on those programs that have demonstrated some level of behavioral success with sexual activity and birth control use. Behavioral outcomes are focused on here because the relationship between these variables and pregnancy is clearer than the relationship of other variables, such as attitudes or behavioral intentions. Second, the applied implications of these findings will be explored. The Need for Primary Prevention The need for pregnancy prevention efforts among U.S. youth has been consistently documented since the early 1970s. Although the age of first coitus and the frequency of coitus for adolescents in our society is comparable to other Western developed countries, the pregnancy, abortion, and birth rates among our youth far outstrip these other nations (Jones et al., 1985). The most recent figures can be extrapolated to suggest that over one million teens in the U.S. will become pregnant annually in coming years (Henshaw & Van Vort, 1989). Moreover, the most recent trend has been for single mothers to keep their children rather than relinquish them through adoption (Miller & Moore, 1990). This movement significantly contributes to increases in the number of children in poverty conditions. Many of these mothers are at serious risk for giving birth to additional children while single, thereby compounding their families' life challenges. The differences in adolescent pregnancy rates between the United States and other Western countries have often been pointed out (cf. Hayes, 1987). Such disparate figures raise serious questions about why differences exist. Jones et al. (1985) compared the U.S. to six other Western nations and concluded that differences in how the problem was defined contributed to the discrepant rates in teen pregnancies. They found that teen sexual activity, although not always seen as appropriate, is accepted as inevitable in most other countries. Although the value of abstinence and postponing coitus is often stressed, policy makers in these nations believe that programmatic emphasis needs to be centered on preventing pregnancies among adolescents because of potential costs to youth, their offspring, their families, and society. The U.S., however, has yet to clearly define the focus of the problem and attempts to do so are highly politicized. Whereas there are some who take a stance similar to that found in other Western countries, others feel that the problem rests in preventing sexual intercourse from occurring among youth. Unfortunately, the discourse surrounding problem definition is rarely dispassionate. Quite the opposite, the announcement of any intended adolescent pregnancy prevention effort within a community is likely to be met with impassioned rhetoric from concerned groups of citizens who strongly believe their approach is the correct one (cf. Kenney, 1986; Kirby, Barth, Leland, & Fetro, 1991). The ramifications of this social and cultural environment on practice will be explored later in this article. BASIC RESEARCH EVIDENCE ON THE EVIDENCE OF SEX EDUCATION One source of evidence about the relationship between sex education and pregnancy prevention comes from several national probability surveys that have been intermittently conducted since the mid-1970s. …

Understanding the Impact of Effective Teenage Pregnancy Prevention Programs

A review of five rigorously evaluated adolescent pregnancy prevention programs shows that all five incorporate an emphasis on abstinence or delay of sexual initiation, training in decision-making and negotiation skills, and education on sexuality and contraception. Four of the five directly or indirectly provide access to contraceptive services. Comparisons between treatment and control groups show that all four programs that measured changes in rates of sexual initiation among adolescents had a significant effect on that outcome, reducing the proportion of adolescents who initiated sexual activity by as much as 15 percentage points; the programs were most successful when they targeted younger adolescents. Three of these four programs also significantly increased rates of contraceptive use among participants relative to controls; the most successful programs, which increased contraceptive use by as much as 22 percentage points, provided access to contraceptive services and targeted adolescents who were younger and those who were not yet sexually experienced. Two programs significantly decreased the proportion of adolescents who became pregnant; these programs were the two that were most active in providing access to contraceptive services.

Handbook of Adolescent Sexuality and Pregnancy: Research and Evaluation Instruments

Items and Scales Measuring Adolescent Pregnancy and its Antecedents and Consequences - James L Peterson and Josefina J Card A Minimum Data Set for Evaluating Programs Aimed at Caring for Adolescent Mothers and their Children - Dennis McBride A Minimum Data Set for Evaluating Programs Aimed at Preventing Adolescent Pregnancy - Claire Brindis and Marvin Eisen Instruments in the Data Archive on Adolescent Pregnancy and Pregnancy Prevention - Bonnie Sherman-Williams et al

When Children Have Children: The Teen Pregnancy Predicament

Despite developments in contraceptive technology and changes in societal norms, adolescent pregnancy remains a key issue for politicians, social scientists, health care providers, and educators. The adolescent's access to contraception and abortion services continues to spark legal debate. The implications of research call for the development of innovative programs to address larger issues, such as poverty and limited access to health care, in the management and prevention of adolescent pregnancies. Clinical interventions, such as school-linked clinics to provide contraception and prenatal care programs to reduce perinatal morbidity, have varied in their approaches and their subsequent success.

Teen Incentives Program: evaluation of a health promotion model for adolescent pregnancy prevention.

The decision to prevent an unintended adolescent pregnancy is a key factor in a young person's ability to achieve or maintain self-sufficiency. Many youths are not, however, capable of making careful fertility-related decisions. Poor self-perception and external locus of control are considered major factors in determining the quality of decisions which adolescents make in this regard. The author developed a three-phase program to provide freshmen at an inner-city high school in New York City with skills to enhance self-perception and abilities to exercise greater control in their lives, especially in terms of their sexual behavior. The program involved eight weeks of interpersonal skills training in small groups, six weeks of career mentorship, and role playing, writing, and acting out skits. No difference was found at the pre-test between the control group and experimental group. Each group included sixty subjects, 31 males and 89 females overall. Subjects were mainly Black American, West Indian, and Hispanic. Post-test results found a significant decrease in the frequency of sexual activity reported by the experimental condition participants. Moreover, contraceptive use among sexually active subjects in the experimental group increased by more than 50% after treatment. These findings indicate that a skills training intervention promoting health behavior can achieve a significant decrease in sexual activity and an effective increase in contraception use among inner-city high school students.

School-age pregnancy: why hasn't prevention worked?

Adolescent pregnancy or sexually transmitted disease (STD) reduction has not occurred, despite sexuality education and abstinence programs, and intensive publicity and community initiatives. An obstacle to adolescent pregnancy, STD, and childbearing prevention is the assumption that adolescent sexuality is a closed system of activity among peers. When a nation is consumed with the preoccupation of condoms versus chastity debates, and is ignoring high poverty levels and abuse of the young, adolescent girls will seek escape from harsh childhoods in early family formation with young adult men. There is a high correlation between poverty rates and teenage birth, AIDS, and STD rates. Schools are not able to produce magical solutions to teenage pregnancy when adult lawmakers abnegate their responsibility to provide for youth well-being. Adolescent pregnancy will occur regardless of the expansion of curative programs such as school-based clinics; fundamental changes in assumptions, attitudes, and policies are needed. Beneficial aspects of programming appear to be fact-based sexuality and contraceptive education, counseling and referrals for youths with histories of child abuse, and child care classes and flexible school schedules for parenting students. A statistical profile in California indicates that 85% of all fathers of babies born to girls between ages of 11 and 18 years were adults. More than 50% of mothers aged 11-15 years were impregnated by adult men. Fathers' average age for births among junior high school mothers was 15-26 years, when the youngest and the oldest 2.5% of fathers are eliminated. There is a greater likelihood that a man older than 23 years will impregnate a junior high girl than will a junior high boy. The partner age gap is greatest among the very young girls. The California profile of father's age is similar to birth patterns in other states and similar to the national average. An examination of STDs shows a higher rate of STDs among females younger than 20. AIDS cases and HIV infections also appear higher among girls ages 13-19 years. The patterns indicate that teenage female STDs are likely to have been acquired by contact with older men by rape or voluntary intercourse. Fathering in abortion cases is not well documented. The predominate neglect of the role of adult-teen intercourse is a major omission. Teenage sex behavior for births, abortion, and STDs is often controlled by the behavior of adult partners.

Prevention of Adolescent Pregnancy: Self-Understanding from an Adlerian Perspective

Some of the underlying processes involved in teenage preg nancy are highlighted and purposiveness and goals of behavior as well as intervention strategies are discussed.

Developing and maintaining state-wide adolescent pregnancy prevention coalitions: a preliminary investigation.

This paper presents the results of a study of state-wide adolescent pregnancy prevention coalitions. Key informants in five states throughout the southern United States were given semi-structured interviews regarding the adolescent pregnancy prevention coalitions in their states. From these interviews and other documents, conclusions were drawn regarding the nature and importance of the environments within which these coalitions operate, the universe of activities in which coalitions engage, and the stages of development of these coalitions. Katz and Kahn's model of social organizations served as the basis for understanding coalitions in terms of these three considerations. Future research should consider the utility of organizational models that can explain more fully the organization--committee hybrid structure that tends to characterize these coalitions.

Adolescent pregnancy: combating the problem from a multi-systemic health perspective.

Presented is a multi-systemic theoretical model of adolescent pregnancy that incorporates the school-peer-family-community systems and defines a role for health educators. It is noted that teenagers receive conflicting messages from the adolescent socialization community--all the institutions, individuals, and mass media that influence and shape development. To cope with these multiple, inconsistent messages, many adolescents respond with inconsistent behavior given the impossibility of pleasing all sources of influence. Health educators must coordinate the school-peer-family-community systems to achieve more congruence and less competition surrounding inputs into the daily life of young people. The potential to disseminate sex education is greatest in the school context, where information can be provided on a systematic, regular basis to reinforce learning. Since peers are a major reference group during adolescence, per counseling can be used effectively to discuss factors that lead to unwanted pregnancy and help clarify values. Sex education programs are strengthened by the involvement of parents, and interventions aimed at promoting parent-child communication around sexual issues have been demonstrated to delay the onset of sexual activity. The availability of an adolescent health clinic, either in the school or close by, has been shown to reduce adolescent pregnancy. Overall, the most effective adolescent pregnancy prevention programs are those that are comprehensive in substance and duration.

Update on pregnancy, condom use, and prevalence of selected sexually transmitted diseases in adolescents

Adolescent pregnancy and its consequences continue as major sources of morbidity in the United States. A teenager who becomes a parent is at a significant disadvantage in becoming a contributing adult, both psychosocially and economically. The physician who cares for adolescents has the responsibility of helping parenting teens to find needed support so that they will be able to overcome this significant hurdle. Attention from public agencies has focused on increasing condom use as one approach to adolescent pregnancy prevention. The major advantage of using condoms is that they also prevent transmission of sexually transmitted diseases. Of note is that level of knowledge about condoms is not related to their use, and engaging in high-risk behaviors is related to a decreased likelihood of condom use. With rates of condom use estimated at less than 50%, rates of sexually transmitted disease remain high, as reported in recent surveys.

Adolescent pregnancy prevention for Hispanic youth: the role of schools, families, and communities.

A sociodemographic profile of Hispanic youth is presented as well as a description of the incidence of adolescent pregnancy and parenting in this population. Strategies and recommendations that should be implemented to provide Hispanic youth with viable options and assistance in delaying early childbearing also are offered.

Adolescent pregnancy prevention strategies used by school nurses.

This survey identified a range of adolescent pregnancy prevention activities used by school nurses in selected Mid-Atlantic public schools. A purposive sample of 224 public school nurses completed the School Nurse Questionnaire adapted from an instrument used previously to survey school nurses. Based on a 54% response rate, a task analysis revealed that respondents performed only one pregnancy prevention activity frequently. A sub-sample of nurses, serving students in grades 6-12, used seven of 21 pregnancy prevention activities frequently. Though nurses did not actually perform the remaining activities, they felt prepared to do so. However, the structure of school nursing services often does not allow adequate time or opportunity to engage in adolescent pregnancy prevention activities.

Project Taking Charge: An Evaluation of an Adolescent Pregnancy Prevention Program

The research reported in this article is an evaluation of an abstinence-based intervention program, Project Taking Charge, a combined sex and vocational education program for seventh grade students in high pregnancy-risk areas. A pretest/posttest control group research design was used. Predicted changes in adolescent self-esteem, educational aspirations, and sexual attitudes and behavioral intentions were not found. Neither were predicted changes found on several measures of parent-adolescent communication about sexual and vocational issues. However, both adolescents and parents realized significant knowledge gains in the areas of human sexuality, sexual development, and sexually transmitted diseases (STDs).

Educational Levels of Adolescent Childbearers at First and Second Births

This study employed the 1985 birth records of a midwestern state to assess the educational levels of white, black, and Hispanic adolescents, 15-19 years of age, having first and second births. There were age and ethnic differences in the relationship of first and second births to educational levels of adolescents. Marriage was differentially related to educational level among the three ethnic groups. The educational level of fathers, when reported, was significantly correlated with the adolescent childbearers' educational level. Implications of these findings for future research and for programs and policies related to adolescent pregnancy prevention and to educational improvement are discussed.