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Teen Pregnancy

Teen Pregnancy. Stephanie Cheetham, MD June 19, 2012. Some good news…. number of pregnancies and births per 1,000 girls aged 15-19 in USA. Henshaw, S. (2003). U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24 . New York: The Alan Guttmacher Institute.

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Teen Pregnancy

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  1. Teen Pregnancy Stephanie Cheetham, MD June 19, 2012

  2. Some good news… number of pregnancies and births per 1,000 girls aged 15-19 in USA Henshaw, S. (2003). U.S. teenage pregnancy statistics with comparative statistics for women aged 20-24. New York: The Alan Guttmacher Institute. After increasing 23 percent between 1972 and 1990 (including 10 percent between 1987 and 1990), the teen pregnancy rate for girls aged 15-19 decreased 28 percent between 1990 and 2000 to a record low.

  3. More Good News… • Teen pregnancy and birth rates are down. • Decreasing percentage of teens who have ever had sex (16%). • Decreasing percentage of teens with four or more partners (24%). • Increasing condom use (25%). Note: changes over 1991-2001 from the YRBS, high school students in grades 9-12.) Source: http://www.cdc.gov/mmwr/PDF/wk/mm5138.pdf

  4. Some Bad News… The U.S. still has the highest rate of teen pregnancy in the industrialized world.

  5. 34% of Girls Get Pregnant at Least Once Before the Age of 20 Source: National Campaign to Prevent Teen Pregnancy analysis of Henshaw, S.K., U.S.. Teenage Pregnancy Statistics, New York: Alan Guttmacher Institute, May, 1996; and Forrest, J.D., Proportion of U.S. Women Ever Pregnant Before Age 20, New York: Alan Guttmacher Institute, 1986, unpublished.

  6. This translates into: • About 850,000 pregnancies to teens per year in the US. • Almost 100 teen girls get pregnant each hour. • Half of all pregnancies in the US are unplanned – about 3 million a year • 6/10 pregnancies in women age 20-24 are unplanned

  7. By Race/Ethnicity • In 2008, the teen pregnancy rate among Hispanic and black teen girls age 15-19 was more than two and a half times higher than the teen pregnancy rate among non-Hispanic white teen girls age 15-19. • The teen pregnancy rate was 43 per 1,000 for non-Hispanic white teen girls in 2008. Since 1990, the teen pregnancy rate has decreased 50% among non-Hispanic white teens. • The teen pregnancy rate was 117 per 1,000 for black teen girls in 2008. Since 1990, the teen pregnancy rate among black teen girls has decreased 48%. • The teen pregnancy rate was 107 per 1,000 among Hispanic teen girls in 2008. Since 1990, the teen pregnancy rate has decreased 34% among Hispanic teen girls.

  8. North Carolina • #/1000 pregnancies in girls age 15-19, 2007 • 49.4 All races • 33.1 Non hispanic White • 65.1 Non hispanic Black • 149.3 Hispanic

  9. North Carolina • Idle Youth: Proportion of Teens 16-19 Who Are Not in School and Not Working, 2009 • North Carolina 10% • United States 9% • School Dropout: Proportion of Teens 16-19 Who Are Not Enrolled in High School and Are Not High School Graduates, 2009 • North Carolina 7% • United States 6% • The Annie E. Casey Foundation(2011). KIDS COUNT 2011 Data Book online. Retrieved fromhttp://datacenter.kidscount.org/ [October 2011].

  10. North Carolina • Costs of Teen Childbearing, 2008 • North Carolina $391,000,000 • United States $10,900,000,000 • Between 1991 and 2008 there have been approximately 272,824 teen births in North Carolina, costing taxpayers a total of $7.7 billion over that period.

  11. Why? • “The proportions of sexually active (nonvirgin) teens are likewise similar across the industrialized countries, with the exception of Sweden, where higher proportions of teens are sexually active at every age. Thus, earlier or more frequent sexual activity among US teens is not the cause of the higher teen pregnancy and birth rates in the United States. What then accounts for these rates? The answer lies in differences in contraceptive use patterns among sexually active teens. American teenagers are less likely to use contraceptives when having sex than are their European counterparts. Those American teens who do use contraceptives are less likely to use effective contraceptives such as the pill. They are also less likely to use contraceptives with regularity.”

  12. In Sweden teenagers are sexually active even earlier than they are in the U.S., and they are exposed to even more explicit television. However, the Swedish National Board of Education has provided curriculum guidelines that ensure that, starting at age seven, every child in the country receives a thorough grounding in reproductive biology and by age ten or twelve has been introduced to the various types of contraceptives • In Holland, sex is similarly demystified. While the country has no mandated sex-education program, teens can obtain contraceptive counseling at government-sponsored clinics for a minimal fee. http://www.time.com/time/magazine/article/0,9171,1074861,00.html#ixzz1y6JkMqlO

  13. Pressure and Regret • About 1 in 10 girls who have sex before age 15 describe it as “non-voluntary.” Many more describe it as relatively “unwanted.” That is, while the sex wasn’t forced, they still did not want to have sex when they did. • According to a National Campaign survey, the younger a teen, the more likely he or she is to wish he or she had waited to have sex. • 63% of all sexually experienced teens (aged 12-19) say they wish they had waited longer before having sexual intercourse. • 81% of 12-14 year olds who have had sex wish they had waited.

  14. Contraception and Pregnancy • Sexually active young teens are less likely to use contraception than those who first have sex when they are older. • Slightly more than half of girls and about two-thirds of boys aged 12-14 say they used contraception the most recent time they had sex. • About 1 in 7 sexually experienced 14-year-old girls reports having been pregnant. Results: 20,000 pregnancies and 8,000 births annually.

  15. Dating • Two key risk factors for early sex and pregnancy are: • close romantic attachments • significant age differences between partners • About half of 12-14 year olds have been on a date or had a romantic relationship in the past 18 months.

  16. Dating, Continued • Among those in a romantic relationship, about ¼ have a partner 2 or more years older (girls far more than boys). • 13% of same-age relationships among 12-14 year olds include sexual intercourse, compared to 33% of relationships where the partner is 3 or more years older.

  17. Other Risky Behaviors • Sexually experienced young teens are more likely to engage in other risky behavior, such as smoking, illegal drug use, and drinking once a week or more. • For example, 43% of sexually experienced teens said they had tried marijuana, compared with 10% of virgins.

  18. Where Teens First Have Sex (16-18 Year Olds)

  19. When: Timing of First Sex • 70% of teens had first sex in the evening or night. • 42% had sex between 10pm and 7 am • 28% between 6 pm and 10 pm. • June has the highest proportion of first sex among teens (13.7% of teens reported first sex)

  20. Lack of Formal Sex Ed • According to 2002 data, for instance, one-third of teens have not received any formal instruction about contraception—impacting them not only in their teen years but in their 20s. • A fifth have received abstinence-only education with no instruction in birth control methods.

  21. What is working • Decrease in sexual activity • Increase in contraceptive use • Many players • Community groups • Schools • Non profits • Government • Problem in what is actually working • No evidence based studies

  22. In the 1990’s • Renewed emphasis on abstinence • Two primary reasons • Immoral to have sex outside of marriage • Only sure way to prevent STI’s and pregnancy • Positive view of teen sexuality • Teaching what healthy and responsible sex means • Doing away with the “problem” or “disease” model • STI/HIV/AIDS Prevention programs • Some programs designed for high-risk sexually active populations (gay, bisexual, runaways, drug using, incarcerated teens)

  23. In the 1990’s • Community-wide initiatives • Increase in scale of teen pregnancy prevention programs • Youth Development programs • Earlier intervention – elementary or junior high • Teach beyond abstinence – ex. Academic remediation, job training • Goals: high school graduation, post graduation employment • “Best contraception is a bright future”

  24. In the 1990’s • State and Local government initiatives • For sex education, statutory rape laws, media campaigns with messages on pregnancy prevention • “You play, you pay” in North Carolina, Marlyland • National campaign to Prevent Teen Pregnancy • Founded in 1996

  25. Cooperative Agreement funded by the Centers for Disease Control and Prevention (CDC). • Goal: Enhance the ability of state and local organizations to incorporate science-based approaches into their teen pregnancy prevention efforts. • Produce high-quality, research-based, user-friendly materials. • Use these materials to encourage states, communities, and national organizations to incorporate research-based practices into their work. • Go beyond the “usual suspects” and reach out to media executives, state legislators, funders and other opinion leaders.

  26. National Campaign • taking a strong stand against teen pregnancy and attracting new and powerful voices to this issue; • enlisting the help of the media; • supporting and stimulating state and local action; • leading a national discussion about the role of religion, culture, and public values in an effort to build common ground • making sure that everyone’s efforts are based on the best facts and research available

  27. Characteristic #1 Have a Specific, Narrow Focus on Behavior • Effective programs tend to focus on specific behavioral goals such as delaying first sex or using contraception. • Typically, they do not spend significant time on such topics as gender roles, dating, or being a parent.

  28. Characteristic #2 Based on Theoretical Approaches That Have Been Effective in Influencing Other Risky Health-Related Behavior • Includes such theories as reasoned action, cognitive behavior theory, and theory of planned behavior. • These theories help identify the particular risk and protective factors that the curricula try to change, which in turn may lead to voluntary change in sexual or contraceptive behavior.

  29. Characteristic #3 Provide Clear Messages About Sex and Protection Against STDs or Pregnancy • A particularly important characteristic in distinguishing between effective and ineffective programs. • Activities directed towards convincing students that not having sex or using contraception consistently and carefully is the right thing to do, as opposed to simply laying out the pros and cons of different sexual choices.

  30. Characteristic #4 Provide Basic, Not Detailed, Information • Emphasize the basic facts that young people need to avoid unprotected sex, instead of detailing all the different methods of contraception and STDs. • Also, present information that might lead to positive changes in beliefs and attitudes, and what are perceived as values – the “norms” of their friends.

  31. Characteristic #5 Address Peer Pressure • Discuss situations that might lead to unwanted sex or “lines” that are often used to get someone to have sex. • Also, address beliefs and misconceptions among groups of teens, such as “everyone is doing it.”

  32. Characteristic #6 Teach Communication Skills • Provide information about communication, negotiation, and refusal skills. • Demonstrate those skills (ex: how to say no to sex or sex without contraception), and then provide repeated practice in those skills.

  33. Characteristic #7 Include Activities That Are Interactive • Help teens personalize the information through engaging games, simulations, small group discussions, videos, role-playing, and written exercises. • Some programs use peer educators or videos featuring people with whom students can identify.

  34. Characteristic #8 Reflect the Age, Sexual Experience, and Culture of the Young People in the Program • Because few young adolescents have had sex, curricula for middle school students tends to focus on postponing sexual involvement. • For high school students, who tend to have more sexual experience, programs usually emphasize avoiding unprotected sex, stressing that abstinence is only 100% sure bet, and that contraception should be used every time if they do have sex.

  35. Characteristic #9 Last Longer Than Several Hours • Because having a real influence on behavior is a difficult task, programs that are only a few hours cannot markedly change the risk and protective factors affecting sexual behavior. • Programs that last 14 or more hours and that have a greater number of different activities have a greater effect.

  36. Characteristic #10 Carefully Select Leaders and Train Them • Place a high premium on recruiting teachers and/or peer leaders who believe in the program, and provide them with training. • Training sessions are generally from six hours to three days and provide them with both information and teaching strategies.

  37. From Delilah Mcdonald (GEMS) • Consistency • Once enrolled, are expected to continue through graduation • Better than a 6-8 week program • Ex. Contraception methods brought up multiple times • Exposure to life outside of their neighborhood

  38. Additional considerations • Teen girls and young women who receive emergency contraception (EC) from clinics in advance of having sex are not more likely to have sex

  39. The Candies Foundation • Started in 2001 • They have appeared in over 500 million media impressions in all major teen media outlets, including:• Print: Seventeen, Vibe, The Source, Blender, Teen Vogue, J14, Elle, InStyle, and Cosmopolitan• Broadcast: MTV, ABC, NBC, CBS, Fox, ABC Family, and the CW• Online: AOL, MTV, The-N, MyYearbook.com, Seventeen.com, Black Planet.com, and perezhilton.com • Many celebrities have participated in the campaigns • Cry Baby App

  40. References • Cord, Jennifer. “Teen pregnancy prevention: Do any programs work?” Annu. Rev. Public Health. 1999. 20:257–85 • The National Campaign To Prevent Teen and Unplanned Pregnancy. www.thenationalcampaign.org

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