Year of Publication

2014

College

Public Health

Date Available

5-1-2014

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Linda Alexander, EdD

Committee Member

Kate Eddens, PhD

Committee Member

Dr. Pamela Teaster

Abstract

Adolescents (ages 10 to 19) and young adults (ages 20 to 24) make up 21% of the population of the United States. Therefore, the topic of adolescent health is an important focus in Healthy People 2020.5 The HP 2020 initiative describes adolescent health as a fairly broad topical area that encompasses smaller subjects such as teen smoking, pregnancy, and suicide. Due to its recent decline, teen pregnancy is often overlooked as an epidemic problem in the United States. According to the CDC, “…the sexual and reproductive health of America’s young persons remains an important public health concern: a substantial number of youth are affected, disparities exist, and earlier progress appears to be slowing and perhaps reversing. These patterns exist for a range of health outcomes (i.e., sexual risk behavior, pregnancy and births, STDs, HIV/AIDS, and sexual violence), highlighting the magnitude of the threat to young persons’ sexual and reproductive health.”6(p13) In 2009 the U.S. birth rate for females aged 15-19 years was 39.1 births per 1,000 females.2 Compared to the peak rate of 61.8 births per 1,000 females in 1991, the teen birth rate in 2009 was approximately 37% lower.4 This significant change has likely been due to a steady decline in the proportion of sexually experienced teenagers—those who have ever had sex—and an increase in the proportion of teens who use contraception during intercourse.4 Additionally, female teenagers are using and have more access to a wide variety of highly effective contraceptive methods.4 Although these trends demonstrate a drop in the initiation of sexual activity and an increase in protective sexual behaviors, it should be noted that most of this progression occurred before 2007.11 Data collected since then have shown no significant changes in these behaviors. 3 Despite the decreasing rates in recent years, the teen birth rate in the United States still remains as much as nine times higher as other developed countries.9 Compared with the births of adult women, births to teenagers are at greater risk for low birth weight, preterm birth, and death in infancy. Teen childbearing is also associated with cyclic truancy and increased dropout rates for teen mothers. Children of teen mothers are more likely to have low school achievement, drop out of high school, and give birth themselves as teens.9 Not only is there an individual economic burden associated with teenage pregnancy, but there is also an alarming national economic burden. In 2008 teen pregnancy cost taxpayers in the U.S. $10.9 billion dollars. According to The National Campaign to Prevent Teen and Unplanned Pregnancy, "Teen pregnancy and childbearing is closely linked to a host of other critical issues---educational attainment, poverty and income, overall child well-being, health issues, and others."1(p1) Research has provided evidence of specific influences affecting adolescent pregnancy rates. Findings suggest that parent/child connectedness, parental supervision or regulation of children's activities, and parents' values against unprotected teen intercourse are all protective factors decreasing the risk of adolescent pregnancy. Risk factors for teen pregnancy include the following: residing in dangerous neighborhoods, lower socioeconomic status, living with a single parent, having sexually active or pregnant/parenting siblings, and being a victim of sexual abuse.14 Several biological factors such as the timing of puberty, hormone levels, and genetics are also related to adolescent pregnancy risk.13 A family history of teen births is a strong predictor for increased risk among teenage girls as well. According to two studies examining teen birth trends among 4 nationally representative samples in the United States and Great Britain, the teenage birthrate of daughters of teenage mothers was more than twice that of daughters of women who were 20 or older at first birth.12 Another study found that adolescents whose mothers gave birth at a young age were likely to also be involved in an early pregnancy, a finding that held true for both genders.13 This link may exist due to the mother's unstable marital status, inept parenting techniques, or the socioeconomic hardship associated with being a teen mom. The relationship between mothers' and daughters' young ages at first birth is partially explained by teen mothers’ limited education and potential lack of emphasis on their children’s schooling.12 Due to the advanced costs of teenage births and the cyclical nature of teen parenting, it is important that evidence-based sexual education programs be implemented and evaluated—especially for high-risk teens. Clinical and program personnel who teach sex education should identify girls who are more vulnerable to risky sexual practices resulting in teen births. Prevention programs that target these youths should be implemented within comprehensive sex education.12 After all, comprehensive sexual education programs have been associated with positive health outcomes among youth reducing rates of teen pregnancy, STIs, and HIV.10 Moreover, comprehensive curricula have been correlated with positive behavior change including the delay of sexual initiation, reduction in frequency of sexual intercourse, reduction in the number of sexual partners, and an increase in the use of effective methods of contraception.7 Unfortunately, the position that sexual education plays in the initiation of sexual activity and risk of teen pregnancy is somewhat contentious in the United States among the population at large. However, comprehensive programs seem to be growing with 5 support from parents, community members, some faith-based institutions, and many professionals and professional organizations.8 Based on a review of risk reduction programs in the U.S., comprehensive sex education has been associated with a decline in negative sexual behaviors and an increase in protective factors. Evidence for abstinence only education was found to be inconclusive with several outcome inconsistencies.11 Results suggest that these comprehensive interventions provide broader benefits and are appropriate to youth ages 10-19 of all genders, races, and sexual experience, and in both school and community settings. However, it was noted that interventions may be more effective for boys than girls.10 If this is true, then it is even more important that high risk females be targeted for comprehensive risk reduction programs. Nonetheless, sexual risk behavior has been found to be driven strongly by parental influence in addition to—or possibly more than—curriculum content within comprehensive sex education.3 Parents “provide structure (in the form of parental monitoring), support (through a positive parent–child relationship), and information (by communicating about sexual topics).”13(p507) Parents also serve as role models for their adolescent children in a multitude of ways, including sexual behaviors and attitudes. Still, little research has been done looking into parental modeling of sexual behavior and its predictive value remains uncertain.13 There is a gap in the sexual education literature in differentiating the effectiveness of sexual education specifically for girls with a family history of teen births. Not only can these girls be compared to those without a family history of teen births, but their data may be stratified within the group to look at differences between those with no sex education, abstinence only education, and the comprehensive programming. It is vital that 6 we determine how past family history of teen births moderates the effects of comprehensive sex education to ensure we aren’t missing this group of high risk individuals and to better serve program planning and intervention efforts designed to delay or reduce pregnancy among this age group. This study hypothesizes that a family history of teen births will change the effectiveness of sex education, decreasing program efficacy for these high-risk individuals. Alternatively, family history will play no part in the ability of comprehensive sex education to prevent teen birth outcomes. For the present study, data from the 2006-2010 National Survey of Family Growth (NSFG) were obtained to determine how family history of teen births tempers the efficacy of comprehensive sexual education on teen births.

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