Teen Pregnancy

Precede-Proceed Phase 1: Although we have seen pregnancy rates decline in the past two

decades, substantial health disparities remain in both social and economic aspects for teenagers

that are at risk. Many individuals are affected nationwide directly and indirectly, from being the

teenagers who face unplanned pregnancies to lost tax revenue. Both social and behavior factors

exist and have a major impact on teenagers living in the United States. Many teenagers are

easily influenced by their peers, but they also serves as targets of the media. We must improve

adolescent reproductive health in central San Diego by improving the behaviors with

encouraging positive attitudes, extracurricular activities, and offering counseling services.

Strategies used in sex education courses at high schools can be improved by including

information about health services that are offered in the community and not only encourage the

delay of sexual intercourse, but also provide education on the risks associated risky sexual

behavior. There are many studies that have been conducted on sex education and teen

pregnancy. Our health promotion program and plan will incorporate the most effective strategies

previously used.

Precede-Proceed Phase 2 (National Level): “Despite declines since 1991, the teen birth

rate in the United States remains as much as nine times higher as in other developed countries”

(Pazol, et. al. 2011). This is unusual for being such an industrialized, developed country. “Each

year, teen childbearing costs the United States approximately $6 billion in lost tax revenue and

nearly $2 billion in public expenditures” (Pazol et. al, 2011). According to Jessica Pika,

Assistant Director, Communications for The National Campaign to Prevent Teen and Unplanned

Pregnancy Organization states, teen pregnancy is a major issue for the U.S. because it not only

affects pregnant teens, but their family, friends, and people they have never met (i.e., taxpayers

who pay for “teen childbearing costs” (personal communication, November 20, 2012). Teen

pregnancy affects everyone (J. Pika, personal communication, November 20, 2012). Since teen

pregnancy can be prevented, this is a lot of money that the country is losing annually.

“Approximately one third of the teenaged females in the United States becoming pregnant and

once pregnant, are at risk of becoming pregnant again” (Basch, 2011). Getting pregnant once

during one’s teenage years raises the risk of conceiving again. In a recent interview with Marcy

Clayson an Engagement Specialist at Planned Parenthood a statement she made advocates for

Basch’s belief about teen pregnancy risks of conceiving again, she stated, “A lot of our teen

moms are children of teen parents. That is a common factor. It’s almost a social norm in their

communities. We make sure that our teens know that they can prevent an unplanned for a second

pregnancy once they’ve graduated and received further education.”

Precede-Proceed Phase 2 (State Level): On the state level, in 2005, teen pregnancy of

Californian girls, ages 15-19 years old, according to The National Campaign to Prevent Teen and

Unplanned Pregnancy (2012), was 96, 490. The 2005 California teen pregnancy rate for girls of

the same age range (i.e., 15-19 years old) was 75 compared to the United States (U.S.) teen

pregnancy rate of 70 (The National Campaign to Prevent Teen and Unplanned Pregnancy, 2012).

The number of California teenage girls who gave birth in 2010 ages 15-19 years old was 43, 149

(The National Campaign to Prevent Teen and Unplanned Pregnancy, 2012). Furthermore,

during 2010, the number of Californian “girls under 15” who gave birth was 433 (The National

Campaign to Prevent Teen and Unplanned Pregnancy, 2012). The 2010 California “teen birth

rate” for girls ages 15-17 years old was 16.4 while girls ages 18-19 years old was 53.4 (The

National Campaign to Prevent Teen and Unplanned Pregnancy, 2012). The “number of teenage

births” data in California was further narrowed down to “race/ethnicity” (The National

Campaign to Prevent Teen and Unplanned Pregnancy, 2012). Therefore, “Hispanic girls” in

2010 had 31, 580 teenage births (The National Campaign to Prevent Teen and Unplanned

Pregnancy, 2012). This population had the highest “number of teenage births” than other

ethnicities (e.g., “Non-Hispanic White girls” had 5, 800 teenage births and “Non-Hispanic Black

girls” had 3, 737) (The National Campaign to Prevent Teen and Unplanned Pregnancy, 2012).

Furthermore, “Hispanic girls’” 2010 California “teen birth rate”, 48.1, also had the highest rate

than other ethnicities (e.g., “Non-Hispanic White girls” had 14.1 and “Non-Hispanic Black girls”

had 37.7) (The National Campaign to Prevent Teen and Unplanned Pregnancy, 2012).

Precede-Proceed Phase 2 (Local Level): With a teen population of 709, 916 in the city of

San Diego alone, according to the County Health Ranking, statistics within the past year, there

have been 26,385 teen pregnancies. (County Health Rankings. 2012) In a city with such a diverse

group of ethnicities it has been found that when it comes to teen pregnancy, San Diegans with

Hispanic background tend to have a higher pregnancy rate. Pregnancy and birth rates among

teenage Latinas are actually high nationwide and locally. Rates among Latina teens have failed

to decline as rapidly as rates among other ethnic groups. While Latinos comprise just over a

third of the teenage population in San Diego County, Latinas account for more than three-

quarters of teen births in the area. (National Campaign to Prevent Teen and Unplanned

Pregnancy, 2012)

Precede-Proceed Phase 2 (Risk Factors at the National Level): It is commonly found that

teenagers, who live in areas where their community has a lower socioeconomic status, have a

greater risk of risky sexual behavior and getting pregnant. “Many studies show that adolescents

who live in disadvantaged communities with high poverty rates are more likely to have sex,

become pregnant, and give birth. In contrast, teens who live in more affluent communities are

less likely to engage in risky sexual activity” (Manlove et. al, 2002). Unfortunately, it has also

been shown that “teen childbearing also perpetuates a cycle of disadvantage; teen mothers are

less likely to finish high school, and their children are more likely to have low school

achievement, drop out of high school, and give births themselves as teens” (Pazol, 2011).

According to Talia Perez, a Community Engagement Specialist from Planned Parenthood of the

Pacific Southwest, Planned Parenthood has a program called Teen Success. The national average

of teens that have a second pregnancy is 20%. Perez explains that Teen Success is for pregnant

or parenting teens and helps these individuals prevent a second pregnancy by helping them focus

on school, graduate from high school, and seek secondary education. Teen Success started in

1990. For teens enrolled in Teen Success, only 4% have a second pregnancy, which is

significantly lower than the national average. There are many risk factors associated with teen

pregnancy and risky sexual behavior. These not only include gender, age, race and ethnicity but

also the following: attitudes (i.e. peer pressure, social acceptance), the adolescent’s family, and

involvement in activities. According to a study conducted on teen pregnancy and the risk

factors, “Teens whose parents talk about sex and birth control with their children, and

communicate strong disapproval of sexual activity, are more likely to have positive reproductive

health outcomes” (Manlove, et. al, 2002). To support this statement, Jessica Pika, Assistant

Director, Communications for The National Campaign to Prevent Teen and Unplanned

Pregnancy Organization states, open and honest and communication between parents and teens

will help increase awareness about how to prevent and reduce teen pregnancy because teens are

knowledgeable about the options of abstinence, having safer sex with the use of contraceptives,

or having unsafe sex with a higher risk of becoming pregnant (personal communication,

November 20, 2012). Parents who also talk to their teens not only on sex, but also love, dating,

and good relationships increase their teens’ awareness on sex and relationships (J. Pika, personal

communication, November 20, 2012). In addition, it also has to do with social acceptance, the

teenagers’ attitudes on sex, and the perception of sex among their peers. One major factor is,

“those who believe sexual experience will increase others’ respect for them are also more likely

to have sex” (Manlove, et. al, 2002). Another report shows that school involvement and/or

involvement in extracurricular activities play a significant role. “Adolescents’ engagement and

performance in school, religious activities, and sports (among girls) are all associated with more

positive reproductive health behaviors, which indicates that involving teens in positive activities

may help them avoid other risk-taking behaviors” (Manlove, et. al, 2002).

Precede-Proceed Phase 2 (Risk Factors at the State Level): No single state has the same

number of racial/ethnic populations. Therefore, teen pregnancy may affect different racial/ethnic

populations differently. In the state of California, African American and Latina teens have the

highest number and risk for teen pregnancy. Many studies have not shown any genetic risk

factors associated to teen pregnancy yet. However the risk factors that greatly affect teenagers,

such as Latina teens who reside in California, are behavioral and environmental. According to

MedlinePlus (2012), “poor academic performance” and poverty can be both behavioral and

environmental risk factors that increase the risk of teenage girls becoming pregnant. For

example, “poor academic performance” can be both behavioral and environmental because some

teenagers do not believe that education is important or they may have to fill in the role of a

parent to a younger sibling if they live in a single parent household, which in turn leads them to

not have education as their number one priority (MedlinePlus, 2012). Furthermore, where a

teenager lives may not have the best schools/universities, hence “poor academic performance”

(MedlinePlus, 2012). Latina teenagers have the risk factors that MedlinePlus listed. To support

this claim, Frost and Driscoll (2006) explain, “Latinas’ higher rates in poverty and lower

educational attainment place them at a higher risk of teen pregnancy and also translate into fewer

resources to cope with the difficulties of teen parenting” (as cited in Biggs, Antonia, Ralph,

Minnis, Arons, Marchi, Lehrer, Braveman, Brindis, 2010, p. 78). From this quote, having fewer

resources is an environmental risk factor for teenagers regardless of their race/ethnicity because

they have fewer coping and educational methods if they have disadvantaged lives. Another

behavioral risk factor that increases the risk of teen pregnancy is having an “older male partner”

(MedlinePlus, 2012). In California, Latina teens “are more likely than teens of other

racial/ethnic groups to choose partners who are significantly older, placing them at higher risk

for early childbearing” (Darroch, Landry, & Oslak, 1999 as cited in Biggs et al., 2010, p. 79).

An environmental risk factor that increases the risk of teenage girls becoming pregnant is

experiencing “gangs and gang activity” in their neighborhood (Richardson & Nuru-Jeter, 2012,

p. 69). “Studies show that adolescent involvement with gangs is associated with risky sexual

behavior, including lower use of condoms” (Richardson & Nuru-Jeter, 2012, p. 69). Thus, teen

girls (e.g., Latinas) whose partners are affiliated with a gang have a high “incidence of

pregnancy” (Richardson & Nuru-Jeter, 2012, p. 70).

Precede-Proceed Phase 2 (Risk Factors at the Local Level): Latino teens in fact share

many of the same common goals and concerns with those of other ethnic backgrounds.

However, it is still clear that there are also differences as well. Young Latina mothers are likely

to face different circumstances than those of non-Hispanic mothers. Latinos not only have lower

educational and income levels throughout San Diego, but they are also more likely to be located

in high poverty neighborhoods (e.g., Skyline, Lincoln Park, Paradise Hills, Barrio-Logan, Logan

Heights, etc.) (Murphy-Erby, 2011). The types of contraception used by Latinos also contribute

to higher pregnancy rates. Latino teens are less likely than other ethnic groups to use condoms

and are less likely than white teens to use birth control pills. Furthermore, Latino teens are more

likely to use less effective approaches, such as the pull out method as well as the rhythm methods

(East, 2010).

Precede-Proceed Phase 3 (Predisposing, Enabling, and Reinforcing factors): One

predisposing factor of teen pregnancy is not having the knowledge of contraceptives. Some teens

have never been educated about contraceptives where they are available. Another predisposing

factor is the glamorization of teen pregnancy on television/movies. An enabling factor of teen

pregnancy low income/ underserved teens do not have “access to health care facilities” because

they are not aware that they can utilize their community health clinic services (Mckenzie,

Neigor, & Thackeray, 2009, p. 22) Another enabling factor is resources are not available, such as

health care facilities and social support from family and friends, without these resources teens

have a higher risk of risky and unsafe sexual activities. One reinforcing factor of teen pregnancy

is peer pressure. Having an older partner or being in a long-term relationship, a teenage girl

might be pressured to have sex without protection. Another reinforcing factor is some teens do

not have parents that discourage risky and unsafe sexual activities because parent-teen they do

not have an open and honest parent-teen relationship

Precede-Proceed Phase 4 (Goal, Objectives, and Interventions) are listed below:

The teen pregnancy rates have declined nationally but at state and local areas, there do still exist

issues. This is especially the case among Latino adolescents. Our goal is to reduce the teen

pregnancy rates within the Latino community in central San Diego County. San Diego Teen

Pregnancy Prevention Program (STEPPP) will help lower the teen pregnancy rate in central San

Diego by incorporating new curriculum in the high schools’ sex education course. Students will

be offered the chance to enroll in the sex education course upon parental consent. We will pilot

test STEPPP in the central San Diego area to compare between STEPPP at Garfield High School

and the current sex education course at Lincoln High School, using the quasi-experimental


1.1 Process Objective: STEPPP would be pilot tested at Garfield High School and Lincoln High

School (control). Program staff members and volunteers will disseminate informational

brochures on how to prevent and reduce teen pregnancy. In addition, there will be flyers listing

resources that are available at local community health clinics. The information will be targeting

25% (target: entire freshman class) of high school students when they are taking a sex education

course (upon parental consent).

1.1 Activities/Strategies: The informational brochures and flyers will be available at schools and

other facilities such as the following locations: YMCA, school nurse’s office, school

advisor/counselor’s office, and where parent-teacher conferences are generally held. The

information would not only reach our target population but also parents and others in the


2.1 Learning (Awareness) Objective: After listening to guest speakers, half of the students in the

sex education course would be able to identify multiple risk factors of teen pregnancy that

individually affect them.

2.1 Activities/Strategies: Guest speakers (e.g., pregnant teens, teen mothers, family and friends

of pregnant teens, health care workers who work with pregnant teens and their families) will

visit and share personal experiences with the students enrolled in the sex education course. The

students will be able to have open discussions with the guest speakers after they have made

their presentation.

2.2 Learning (Knowledge) Objective: During the group discussions, 2 out of 4 high school

students will be able to explain the risk factors of teen pregnancy and how those risk factors

impact their life in an ecological perspective.

2.2 Activities/Strategies: The class will be divided into small groups to complete an assignment

through discussion. The instructor(s) will have handouts for the students. These handouts will

include teen pregnancy topics in an ecological perspective. Each group will also be given a

script/scenario to role-play/act out in front of the class. Role-playing in certain scenarios can

help students learn more about teen pregnancy and how they can protect themselves. Incentives

(e.g. gift cards, movie tickets, etc.) will be given after the completion of the group


2.3 Learning (Attitude) Objective: After the completion of the sex education course, 50% of

students would pledge to refrain from unsafe sexual activities.

2.3 Activities/Strategies: Pledge cards will be handed out to the students and they will have the

opportunity to make their pledge individually.

2.4 Learning (Skill) Objective: Upon completion the sex education course, at least 75% of

student can demonstrate resistance strategies to having unsafe sexual activities.

2.4 Activities/Strategies: Pre- and post-test assessments/surveys will be given to Garfield high

school students to gather information and data to see if they are grasping the concepts and other

learning objectives of the course. Handouts and pamphlets on teen pregnancy prevention will

be given to the students. Multiple group discussions will be held in the duration of the sex

education course to help the students further understand the risk factors and potential

disadvantages of those directly/indirectly affected by teen pregnancy.

3.1 Action/Behavioral: By the end of a semester, the majority of the students who complete the

sex education course will comply with their pledge to refrain from unsafe sexual activities.

3.1 Activities/Strategies: Pledge cards will be handed out to the students and they will be given

the opportunity to make their pledge individually.

4.1 Environmental Objective: During the sex education course, a majority of students will have

access to newly built-in/placed condom dispensers in the advisor/counselor’s and school nurse’s


4.1 Activities/Strategies: Newly built condom dispensers will be installed in the school advisors

and school nurse’s offices.

4.2 Environmental Objective: As part of the sex education course, 100% of the students (those

with parental consent) will participate in a field trip to local community health clinics, which will

allow them to learn more about the facilities and their services.

4.2 Activities/Strategies: Field trip to local community health clinics; access to community

resources. Each community health clinic will have a tour guide (staff member who works at the

facility) to show students the different areas of the clinic. The tour guide will also explain to the

students the different services and classes that are offered to teenagers. The students will have

the chance to make appointments or sign up for classes if they so choose to and ask questions

during the field trip.

4.3 Environmental Objective: During the sex education course, 100% of students will have

access to the newly created student Facebook page (co-partnered with local community health

clinics through community organization and community building) that will include not only the

upcoming events of the high school, but links to local community health clinics and their

upcoming events. This will serve as a resource for students, parents, and others in the

community. Instructors and other staff members can encourage students to visit the high school’s

Facebook page to access information. On the Facebook page, there will be public service

announcements (PSAs) that students can watch.

4.3 Activities/Strategies: The students will have a classroom activity that includes browsing the

Internet for local community health clinics. The Facebook page will serve as one of the internet

resources and as a social media tool for the students. There will be public service announcements

for students to watch.

5.1 Outcome: To lower teen pregnancy rates among the Latino population in central San Diego

by 10% within a year time span.

Activities/Strategies: Implementation of the objectives’ activities and strategies listed above into

the sex education course.

Precede-Proceed Phase 5 (Implementation): STEPPP will be pilot

tested/implemented at Garfield High School and compared the current sex education course at

Lincoln High School. This will begin January 2013 for the spring semester of the academic year.

Precede-Proceed Phase 6 (Process Evaluation): Key informant interviews from local

community health clinics will be conducted prior to the start of STEPPP. Data will also be

gathered from internet sources and other agencies/organizations associated with teens and teen

pregnancy prevention in the community. In order for the pilot testing to begin, it must be

presented to and be approved by the stakeholders. During the pilot testing, the program will take

effect and be available to students at Garfield High School. The program will include multiple

group activities that will help reinforce making healthy choices. By implementing new strategies

into the sex education course, we can better equip each generation with tools to make healthier,

safer decisions in life. In addition, collaboration with local community health clinics will help

with facilitating field trips and other activities. For satisfaction evaluation of STEPPP, we can

include questions in the pre- and post test assessments. Many of the interventions will be

measured through the pre- and post test assessments. Evaluators will be assigned to sit in the sex

education class during key classroom activities (those mentioned in the Learning Objectives) to

observe the interactions between students and instructors. Surveys will be given to students after

each key classroom activity for the evaluators to interpret and prepare for monthly staff

meetings. Monthly meetings will be held for program staff members to assess the quality and

effectiveness of the current methods used as the learning objectives of STEPPP.

Precede-Proceed Phase 7 (Impact Evaluation): According to McKenzie, Neiger, and Thackeray

(2009), “impact evaluation relates to changes in behavior, and, in some cases, changes in

awareness, knowledge, attitudes, and skills” (p. 359). As program planners of STEPPP, we will

evaluate these changes (i.e., behavior, awareness, knowledge, attitudes, and skills) in high school

students through observations and pre- and post-test assessments/surveys. There will be a weekly

assessment of number of people accessing student Facebook page by using a website counter.

Program staff will observe students throughout the course of the sex education program. As for

the field trip, we will assess the number of participating students who signed in the sign-in sheet.

They will observe the students’ behaviors through the various activities/strategies implemented,

such as visiting guest speakers, group discussions, and role-playing scenarios. Changes in the

students will also be evaluated through pre- and post-test assessments/surveys. These pre- and

post-test assessments/surveys will have both closed and open- and closed-ended questions. An

agency will be assigned to evaluate, analyze, and interpret the results.

Precede-Proceed Phase 8 (Outcome Evaluation):

Outcome: By the end of program the evaluating consultant will identify that the quasi-

experimental design was implemented throughout STEPPP. With our target population mainly

aimed towards Latino teens to the Central San Diego region we concentrated our focus on two

specific schools that we felt would benefit most with the program (Lincoln High School and

Garfield High School.) Both schools we’re chosen due to their location and student population.

Garfield High School is well known for taking in troubled teens as well as teen moms/soon to be

teen mothers throughout the San Diego county, therefore implementing the program into the

school would give those students who need it the most the proper education and allow them to be

aware of different available resources that are open for their taking. Lincoln High school was

also chosen because of a Regional Occupational Program (ROP) that they already have

implemented into their school. We felt that by being able to compare Lincoln High School’s

ROP to STEPPP would improve education to the teens in the future.

Reporting: After one academic school year, the results of STEPPP will be presented to

the program staff, Garfield High School’s officials, Lincoln High School officials, parents, the

San Diego County Office of Education, the community, the local community health clinics, and

the County of San Diego: Health and Human Services Agency. The STEPPP results will be

reported to these stakeholders in order to evaluate and improve the quality and effectiveness of

the program for future endeavors (McKenzie, Neiger, & Thackeray, 2009, p.336). Further

explanations and presentations will be given to show how much of an impact the program has

made on the students at Garfield High and the possibilities that could arise if implemented to

Lincoln High School as well. Key informants will also be brought back to emphasize on the

different area’s they found would be beneficial to implement within the STEPPP program, to

further explain the thought process and reasoning as to why certain activities were chosen. A

display of numerous activities (pre- and post tests, surveys, field trip sign in sheets etc.) that were

done by the students would be displayed for the viewers to see and take note on the progress

STEPPP has made in educating them. STEPPP continues its program at Garfield high, and is

also implemented at Lincoln the following year. Other local schools in the Central San Diego

region are open to partake in the STEPPP and eventually will be open to all of San Diego in the

coming years.


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