Mecosta County Teen Pregnancy Presented By Rebecca Dick

Mecosta County Teen Pregnancy Presented By: Rebecca Dick, Brittany Dixon, Heidi Ertman, and Sarah Rousseau

ANALYSIS

Analysis of teen pregnancy in the United States � The United States has the highest rate of teen pregnancy among developed nations. � “Thirty-four percent of young women become pregnant at least once before they reach the age of 20 --about 820, 000 a year” (Family First Aid, 2010). � The rates of both Hispanics and African American teens have the highest birth rates (Shore, 2009). � Teen pregnancy costs the U. S. at least $7 billion annually (Family First Aid, 2010).

Mecosta County � There were 441 births in Mecosta county in 2008 � 9. 9% of those births were teen pregnancies � Teen birth rates have decreased 2. 5% since 2004 � But has increased 5. 7% with repeat teen births � 38% were to unwed teen mothers � 22. 1% of births in 2008 to teen mothers with no diploma or GED � 46. 8% Medicaid paid births Data provided by: Michigan League for Human Services

Mecosta County 9. 9%

Susceptibility/Risk Factors �Socioeconomic Status �Puberty �Peer Pressure �Less Stigma

Socioeconomic Factors � “Poverty is not a precursor to teenage pregnancy but an effect of it. Roughly 80% of teenage mothers were living at or near poverty levels before they became pregnant” (Glick, 2010). � Factors associated with low-income households, including low educational attainment, lack of employment, and single parenthood, are more influential than poverty itself (Shore, 2010). � 20% of teen mothers drop out of school prior to becoming pregnant. � Neighborhoods and ethnicity can be contributing factors.

Puberty “A trend toward earlier puberty for girls (with African American girls reaching puberty nearly a year sooner than their white peers). Earlier maturation has been associated with earlier sexual activity” (Shore, 2010).

Peer Pressure The 2009 national Youth Behavior Survey indicates that among U. S. high school students: Sexual Risk Behaviors � 46% ever had sexual intercourse. � 6% had sexual intercourse for the first time before age 13 years. � 14% had sexual intercourse with four or more persons during their life. � 39% did not use a condom during last sexual intercourse. � 77% did not use birth control pills or Depo-Provera before last sexual intercourse to prevent pregnancy. Alcohol and Other Drug Use � 22% drank alcohol or used drugs before last sexual intercourse. U. S. Department of Health and Human Services

Less Stigma “Other contributing factors include a lessening of the stigma associated with teen birth and diminished educational career opportunities as a result of changing economic conditions” (Shore, 2010).

Nursing Implications Education and Prevention � Education and awareness regarding abstinence, safe sex, and sexually transmitted diseases and high risk behaviors � Risks and consequences of teenage pregnancy � Methods and correct use of birth control � Provide resources

Special Groups � Reflections program (231 -592 -0129) Provides intensive outreach counseling, temporary shelter, and after care services. Services are free for a period of 3 months. � Right to Life of Mecosta County (rtlmecostacounty. org) A non-profit organization dedicated to protecting the right to be alive. Provide educational materials, faith and minority outreach, along with advocates for better care.

� Care Net of Big Rapids (231 -796 -4919 Carenetbigrapids. org) Provides pregnancy testing, information on pregnancy, abortion alternatives and adoption counseling, prenatal care, parenting and a life skills mentoring program called “Earn while you learn. ” Offers baby and maternity items as well as provide mentoring programs, referrals to community services (Bethany Christian Services), agencies, and doctors. All services through Care Net are free and confidential. Information provided by Daana Vandellen

� Help Pregnancy (231 -976 -4919) A crisis pregnancy center. Their motto is “a friendly office committed to helping women. ” � Mecosta County Department of Health and Human Services (231 -796 -4300) Has a child protective services and adult protective services unit. DHS has cash, food, child support, medical support, child care, and emergency services programs. Information provided by Daana Vandellen

Funding � The Reflections program is funded through Mecosta county taxpayers, community fundraisers and volunteers. � Right to Life of Michigan is funded primarily through donations. � Care Net of Big Rapids is also funded by charitable donations and fundraising.

Right to Life of Michigan Financials (Right to Life of Michigan, 2010) Income Donations 97. 9% Program services 1. 91% Other. 19% � Donations 1, 837, 628 � Program Services 23, 594 � Other 8, 045 � TOTAL INCOME 1, 869, 267

Right to Life of Michigan Financials (Right to Life of Michigan, 2010) Expenses � Program Services 1, 119, 710 � Mgmt & General 119, 137 � Fund Raising 58, 260 � TOTAL INCOME 1, 297, 107 Program services 86. 3% Mgmt & General 9. 2% Fund raising 4. 5%

Community Interest Mecosta County offers food banks and second-hand stores which are only functional because of the support and generosity of the Mecosta County community. There also domestic abuse shelters and safe houses that are available to those that are in abusive situations.

NURSING DIAGNOSIS Risk of increased teenage pregnancy amongst the rural population of Mecosta County related to lack of sex education and/or pregnancy prevention education

PLAN

Primary Prevention of Teen Pregnancy Three Goals of Primary Prevention Delayed participation in sexual activity Healthy People 2010 set a goal of increasing the proportion of teens aged 15 to 17 who have never had sex to 75% up from 62% females and 57% males in 1995.

Primary Prevention of Teen Pregnancy Access to contraceptives Healthy People 2010 set a goal to increase the proportion of sexually active teens who use contraception and barrier protection to 83% males, 75% females up from 72% and 69% in 1995.

Primary Prevention of Teen Pregnancy Reproductive education and strengthening of future life goals Healthy People 2010 goal of increasing those with reproductive education to 88% females and 85 % males up from 86% and 83% in 2002.

Secondary Prevention The Care of Pregnant Teenagers Nursing care directed toward healthy outcomes includes: 1. Early Detection of Pregnancy 2. Pregnancy Resolution Services 3. Prenatal Health Care 4. Childbirth Education 5. Parenting Education Maurer (2009)

Promoting a Science-Based Approach To Teen Pregnancy Prevention (PSBA) � Community level prevention with a multisystem model using a proactive application of the Interactive System Framework (ISF). � Three interactive systems: 1. 2. 3. Prevention Delivery Prevention Support Prevention Synthesis and Translation (Lesesne, et al, 2008, p. 380)

Definition of a Science-Based Approach to Teen Pregnancy A science based approach includes the following: Ø Using demographic, epidemiological and social-science research to identify populations at risk of early pregnancy and/or sexually transmitted infections, and to identify the risk and protective factors for those populations. (Lesesne, et al, 2008, p. 382)

Definition of a Science-Based Approach to Teen Pregnancy � Using health behavior or health education theory to guide the selection of risk and protection factors that will be addressed by the program, and to guide the selection of intervention activities. � Using a logic model to link risk and protective factors with program strategies and outcomes. (Lesesne, et al, 2008, p. 382)

Definition of a Science-Based Approach to Teen Pregnancy � Selecting, adapting if necessary, and implementing programs that are either science-based or are promising (have characteristics of science-based programs). � Conducting process and outcome evaluation of the implemented program, and modifying approach based on results. (Lesesne, et al, 2008, p. 382)

Process and Outcome Evaluation Questions Have local organizations improved the delivery of prevention programs by using a science-based approach? Ø Selection and implementation of program Ø Improvement of pre-existing program Ø Implementation of program with fidelity and for a sustained period of time Once programs are in place the goals of Healthy People 2010 can be assessed for outcomes. (Lesesne, et al, 2008, p. 388)

Interventions

What program is best? Ø According to Lundy & Janes, (2009), there is no exact answer to which intervention program is best except to tailor the programs to the specific area. Ø Mecosta County: Rural Middle Class Less primary preventative structures in place Ø Mecosta's 'Right to Life' program and 'Care-Net' only offer secondary and tertiary prevention care to mother and baby Ø Secondary and tertiary programs are important but to create health promotion and support preventative care there needs to be a shift to primary prevention care Ø Education to peers and community outreach by utilizing the school systems and mentoring to families Ø Best practices: Life option, Peer education and Teen Outreach Ø

Life Option Ø “A promising approach. . . ” (Lundy & Janes, 2009, 690) Ø Foundation: Academic skill building Ø Employment skills Ø Goal-planning skills Ø Ø“. . . future-oriented, goal-directed adolescents are less likely to become pregnant, the expected result is a reduction in the rate of adolescent pregnancies” (Lundy & Janes, 2009, 690).

Life Option (continued) Ø Interactive and Educational approach: Educating youth about what teen motherhood involves Ø Seminars with mothers ages 15 -19 Ø Discussion of barriers (ie. Finances) Ø Tools to prevent barriers Ø Goal planning and motivation for higher education Ø Career planning Ø Small group workshops Ø Education on options to resist negative behaviors Ø Actions create consequences that require responsibility Ø Knowledge of other options to sex Ø Abstinence Ø

Peer Education Ø “The peer education model shows great promise for use in adolescent pregnancy prevention because the peer group is a common source for information about sex” (Lundy & Janes, 2009, p. 690). Ø Positive peer pressure Teens supporting teens to wait for marriage and/or use contraceptives Ø “. . . empowers youth, and encourages personal responsibility” (Lundy & Janes, 2009, p. 690). Ø Peers interact as equals Ø Give teens ability to still feel autonomous in sexuality decisions Ø

Peer Education (cont) Peer education is utilized as a positive method for teens 15 -19 Ø Peer educators (trained) Ø Teenagers that work directly with adult mentors but provide more identifiable option for teens Ø Confidential relationship Ø Teenage advisory board Ø Give insight to what would motivate teenagers Ø Small group discussion Ø Interactive learning by role playing to prevent peer pressure Ø Discussion of barriers to postponing sex Ø

Peer Education (cont) Ø Education about risky behavior Ø STD's and HIV Ø Financial obligation of teen mothers and fathers Ø Avoid shame and guilt and focus on education of facts

Teen Outreach Ø According to Lundy et al, (2009), Postpone, prevent and prepare (PPP) is the oldest teen outreach program beginning in 1989 and spans four different countries. Ø PPP Program at middle-schools and high-schools: Educational classes that utilize interactive learning Ø Empower youth to gain correct information about sex and risks Ø Learning the difference between “love” and “lust” Ø Abstinence Ø Dis-spell pregnancy myths Ø “It won't change my life that much” Ø

Future implications Ø Ø Ø All interventions require the community and peer involvement Ø Permission from teen parents for teen to attend workshops and seminars at school High school and Middle school involvement Ø Seminar sessions quarterly for large workshops Ø Peer educators designated as resources in each school to mediate and be resources on a weekly basis Family involvement Ø Parents need to allow teens to participate Ø Parents have to foster support to principles

EVALUATION

Successful Interventions Teen Pregnancy Prevention Initiative “Since 1990, adolescent pregnancy (46%) and birth (42%) rates in Michigan have decreased more than the U. S. has over the last 16 years. What is most notable is that Michigan had the 6 th best percent of decrease out of all states for the period of 1991 -2006. 1 Even though Michigan has experienced many years of successful decline in birth rates, it experienced an increase in 2006 and 2007, just as the U. S. and almost all other states did”. Source: Teen Pregnancy Prevention Initiative

Youth Attention and Runaway Services Goals: Reunite the youth and family; to provide information and referral services to the youth and family.

Children’s Aid Society-Carrera Program � An experimental evaluation of the CAS-Carrera Program conducted in New York City between 1997 and 2000 primarily showed positive outcomes for females. At the end of the third year of Carrera, girls in the program demonstrated a reduced likelihood of having sex and becoming pregnant � http: //www. stopteenpregnancy. com/

Learn and Serve America � This intervention was evaluated using a quasi-experimental design. Short-term evaluations conducted after the program indicated that students who participated in the program were less likely to experience or cause a pregnancy. The findings did not remain significant in longer-term evaluations. � http: //www. learnandserve. gov/

Multidimensional Treatment Foster Care � Evaluation ◦ Girls who had been assigned to out-of-home foster care because of delinquency were randomly assigned to either the Multidimensional Treatment Foster Care program or to more restrictive community-based group home care. The youth completed follow up assessments at six, 12, 18, and 24 months after baseline, and reported on whether or not they had experienced a pregnancy at the 12 - and 24 -month follow -up. In both settings, sexual health issues were discussed, but they were not the focus of either treatment. � Results ◦ At the 24 -month follow-up, girls in MTFC were 60% less likely to have had a pregnancy since starting the treatment.

Project TALC (Teen and Adults Learning to Communicate) � Evaluation ◦ The intervention was evaluated using a randomized controlled trial. Participants were recruited to receive the intervention or standard care. Compared to those receiving standard care, adolescents in the intervention group were significantly less likely to experience a birth over the 4 years of the intervention. Approximately one-quarter (24%) of participants in the intervention became a teen parent compared to 34% of participants in the control condition. � http: //chipts. ucla. edu/interventions/manuals/intervhra 1. html

Additional Components in Preventing Teen Pregnancy � Parents need to speak to their children and have an open relationship about sex. � School run sex education programs � Not allowing students to test out of health programs � Community based programs about preventing teen pregnancy, cost of teen pregnancy � Support groups that include current teen parents

PUBLIC POLICY IMPLICATIONS

Policy �Federal level of teen pregnancy prevention: The National Campaign to prevent teen and unplanned pregnancy 2009 nonprofit organization to support public policies to reduce and prevent teenage pregnancy Include pregnancy prevention in healthcare reform Cost-effective Give states and communities funding and interventions to educate young people Increase male responsibility in pregnancy Reconnect pregnancy to healthy relationships and marriage

Policy (cont) Ø State level of teen pregnancy prevention: Ø Teen pregnancy prevention initiative (TPPI) Ø Mission: Reduce rate of teen pregnancy between ages 10 -18 Ø “The interventions must provide at least 14 hours of activities were participants can opening talk about all the factors of sex to learn to communicate, negotiate, refuse, decision-making, and resist peer/social pressures effectively” (Michigan Policy Network, 2009).

Policy (cont) Local level of teen pregnancy prevention: ØSecondary and tertiary programs in place, such as Care-Net but a severe lack of primary preventative programs What is missing? Ø Mecosta County interventions and policies Ø Primary preventative programs are more prevalent in urban communities rather than rural Ø Rural communities have similar percentage of teenage pregnancy and require same primary interventions Ø

Policy – Community Involvement Alpha Women Center – Counseling and baby care items (231) 652 -1548 Ø Every Womans Place – Counseling & Shelter (231)759 -7909 Ø Women’s Information Service – Supportive Counseling 1 -800374 -WISE Ø Healthy Beginnings/Teen Parent Program (231)689 -6447 Ø Bethany Christian Services – Crisis pregnancy counseling, Looking Glass for runaways, Homeless youth services (231)924 -9860 Ø

Policy – Community Involvement � Continu-Care, Maternal and infant support services 1 -800 -968 -1331 � District #10 Health Dept – many varied services for primary and secondary prevention (231)592 -0130 � MOMS – Mothers offering mother support (231)689 -6447 � Family Independence Agency (231)796 -4300 � Community Care Center (989)382 -5437

Policy – Community Involvement � Care Net of Big Rapids – supportive counseling, pregnancy prevention programs for schools, support services for families (231)796 -4919 � Catholic Charities West Michigan – counseling/teaching (231)689 -6701 � Birth Mother Assistance – 1 -800 -943 -0400 � HELP Pregnancy Center (231) 796 -4919 � Planned Parenthood – family planning services (231)796 -8612

Policy – Community Involvement � Mecosta County Right to Life – Pregnancy support and prevention education info@rtlmecostacounty. org � Women, Infants and Children Services – Mecosta County – (231)592 -9440

Policy – Public Involvement � Health and Resource Service Information (HRSA) www. ask. hrsa-gov � Association of State and Territorial Health Officials (ASTHO) www. astho. org � National Association of County and City Health Officials (NACCHO) www. naccho. org � Public Health Foundation (PHF) www. phf. org

References � Family First Aid. (2010). Help for Troubled Teens. Retrieved from http: //www. familyfirstaid. org/teen-pregnancy. html � Glick, G. C. (2004). On the Demographic Stratification in U. S. Teenage Pregnancy Rates. Retrieved from www. drake. edu/artsci/Pol. Sci/2004/Glick. pdf � Lesesne, C. A. , & Lewis, K. M. , & White, C. P. , & Green, D. C. , & Duffy J. L. & Wandersman, A. (2008). Promoting science-based approaches to teen pregnancy prevention: proactively engaging the three systems of the interactive systems framework. American Journal of Community Psychology, 41(319 -392) doi: 10. 1007/s 10464 -008 -9175 -y � Lundy, K. S. , & Janes, S. 2009. Community health nursing-caring for the public's health. Jones and Bartlett's publications: Sudbury, MA. � Maurer, F. A. & Smith, C. M. (2009). Community/ public health nursing practice (4 th edition). St. Saunders Elsevie � Michigan Policy Network. 2009. Michigan's low teen births rate. Retrieved from: http: //www. michiganpolicy. com/index. php? option=com_content&view=article&id=611: michigans-low-teen-birthsrate&catid=48: morality-and-family-current-issues&Itemid=185 � Right to Life of Michigan. (2010). Pulling the Life Welcome Wagon. Retrieved from www. rtl. org/aboutus/pdf/Annual. Report_web. pdf � Shore, B. (2009). Kids Count: reducing the teen birth rate. The Annie E. Casey Foundation. Retrieved from www. kidscount. org � The National Campaign. Retrieved from: http: //www. thenationalcampaign. org/resources/public_policy. aspx � U. S. Department of Health and Human Services. (2010). Teen Pregnancy Prevention and United States Students. Retrieved from www. cdc. gov/healthyyouth � Vandellen, D. (2010). Ferris State University. Louis, MO: