Improving Global Health Outcomes for Teenage Pregnancy Prevention: Intervention Programs in the United States, Canada, China and the Philippines
Sternas, Kathleen A.
Scharf, Mary Ann
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Session presented on Friday, July 25, 2014: Purpose: The number of teen births remains high. Teenage birth rates are higher in the United States than in Canada and China (Bielski, 2013; McKay, 2012). Teen pregnancy rates are increasing in China and the Philippines (InterAksyon, 2012; Santos, 2012; Wang et al., 2002; Zhang, 2002). Sexual activity in teenagers contributes to teenage pregnancy and health problems (Chen, et al., 2000; Li, et al., 2003; Ma et al., 2006; National Campaign to Prevent Teen and Unplanned Pregnancy, 2011; Parish et al., 2003; Zhang et al., 2002). Societal and economic changes, education, media, and teenagers' attitudes are related to teenage pregnancy (Chelala, 2008; National Summit on Teen Pregnancy, 2012; Santelli, Melnikas, 2010; Wang, et al, 2007). Teenage pregnancy is associated with dropping out of school, poverty, remaining unmarried, and children at risk for poverty and health problems. This presentation describes: global perspectives on teenage pregnancy and intervention programs to prevent or reduce teenage pregnancy in the United States, Canada, China and the Philippines; outcomes for an evidence-based intervention program in the United States which promotes sexual abstinence; and outcomes for intervention and comparison participants. Methods: A pretest post-test design was used. Four intervention schools (n=230 girls; 221 boys) and five comparison schools (n=134 girls; n=110 boys) participated. The sample included 6th, 7th and 8th graders, primarily of African American ethnicity. Bandura's Social Learning theory guided the intervention program which focused on sexuality discussions, mentoring, health and fitness classes, cultural events, community service, and a recognition ceremony. Intervention participants were randomly selected. Comparison participants were a convenience sample. Comparison and intervention schools were matched on grade, ethnicity, and socioeconomic status. Instruments were the AFL Core Baseline/Follow-up and Demographic Questionnaires. Trained staff administered the questionnaires to the participants in a school setting. Pearson Chi Square and Mann Whitney U statistical tests and .05 level of significance were used. Results: Abstinence education, comprehensive sex education, and health promotion education are used to prevent/reduce teen pregnancy in the United States, Canada, China and the Philippines (Bennett, Assefi, 2005; Chelala, 2008; Franklin et al., 1997; Kirby, 2002; Lou, et al. 2004; National Campaign to Prevent Teen and Unplanned Pregnancy, 2011; National Summit on Teen Pregnancy, 2012; Wang et al., 2005). Early prevention education on teenage pregnancy, sexual norms, and managing peer pressure are utilized to promote abstinence. Post-Test III Results for the evidenced-based intervention were: Significantly more intervention than comparison participants: talked to parents about no sex (p=.005) and life (p=.023); said no to wrong activities (p=.012); had an adult who was available to talk about problems (p=.012) and who provided encouragement (p=.020); reported self-confidence (p=.001). Significantly more intervention than comparison participants reported: it was important to get a good education (p=.003), to have a good marriage/family life (p<.001), to remain abstinent (p<.001), and for future spouse to remain abstinent (p<.001); abstinence prevents STDs/pregnancy/health problems(p<.001). Significantly more intervention than comparison participants admire teens who are abstinent (p<.001); had friends who admire teens who are abstinent (p<.001). Significantly more comparisons than intervention participants reported : it was okay to date younger or older persons (p=.006); sex is okay if dating a long time (p<.001); more control over life (p=.001). More intervention than comparison girls reported: remaining abstinent (p<.001); abstinence prevents STDs/pregnancy/health problems (p<.001); important for future spouse to remain abstinent (p<.001); premarital sex makes it difficult for good marriage/family life (p=.004); sex is for married people (p<.001). More intervention than comparison girls reported: talking about puberty (p=.018); saying no to wrong activities (p=.013); staying away from trouble (p=.020); importance of a good education (p=.028) and marriage and family life (p=.002); success at plans (p=.015); and self-confidence (p=.014). Post-Test IV Results: Significantly more intervention than comparison participants reported: bright future (p=.019); important to remain abstinent until marriage (p=.001), and future spouse should remain abstinent (p=.003); only married people should have sex (p<.001); abstinence is the way to avoid STDs, pregnancy and health problems (p=.002). Significantly more intervention girls than comparison girls reported: feeling accepted/supported by peers (p=.005); and reported a bright future (p=.010). Significantly more intervention boys than comparison boys reported: having an adult who encourages them (p=.036); important to remain abstinent until marriage (p=.031); abstinence is a way to avoid STDs/pregnancy/health problems (p=.028). Conclusion: Abstinence education, comprehensive sex education, and health promotion education are used to prevent or reduce teen pregnancy in the United States, Canada, China and the Philippines. Results from the evidenced-based intervention indicated intervention participants have more significant outcomes related to abstinence behaviors/attitudes than comparison participants. Findings suggest the intervention promotes abstinence and prevents teenage pregnancy. Findings have implications for development of intervention programs which promote abstinence attitudes and behaviors in teenagers.