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Perceptions of teen pregnancy among high school students in Sweet Home, Oregon
Tim Little, Jessica Henderson, Peggy Pedersen and Linda Stonecipher Health Education Journal 2010 69: 333 originally published online 2 July 2010 DOI: 10.1177/0017896910364568 The online version of this article can be found at: http://hej.sagepub.com/content/69/3/333
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Article
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Health Education Journal 69(3) 333343 The Author(s) 2010 Reprints and permission: sagepub. co.uk/journalsPermissions.nav DOI: 10.1177/0017896910364568 http://hej.sagepub.com
Perceptions of teen pregnancy among high school students in Sweet Home, Oregon
Tim Little, Jessica Henderson, Peggy Pedersen and Linda Stonecipher
Western Oregon University, Monmouth, USA
Abstract
Background: The purpose of this study was to gain insights into the perceptions and attitudes about teen pregnancy among high school students in a rural area with high teen pregnancy rates. Methods: Five focus groups were conducted with: (1) females in 9th10th grades; (2) females in 11th12th grades; (3) males in 9th10th grades; (4) males in 11th12th grades; and (5) pregnant/parenting females in 9th12th grades. Results: Common themes among the students were that: (1) the number of teen pregnancies was increasing and was a growing concern; (2) financial difficulties and harm to education were associated with teen pregnancies; (3) teen females had many reasons for wanting a baby, but teen males just wanted to have sex; and (4) pregnancy happened by chance, or was simply an inadvertent consequence of having sex. Conclusions: To reduce teen pregnancy, the developmental asset model offers community members, teachers and parents guidelines to work together to develop key assets in youth that may protect against risky sexual behaviours.
Keywords
teen pregnancy, Developmental Asset Model, sex education
Introduction
Sex education has been an important part of the health curriculum in American schools for decades, yet unplanned teen pregnancies remain a major public health concern. About one in three American females become pregnant before the age of 191. The birth rate among teenagers 1519 years old increased by 3 per cent in 20062. Teen moms are less likely to complete high school, and they and their infants are more likely to live in poverty3,4. Teen births cost over nine billion dollars annually in the US4. Given these enduring public health concerns and the current political and social controversies regarding sex education5,6, it is crucial to develop a clearer understanding of factors related to teen pregnancy, particularly for specific adolescent populations defined by geography, age, or racial/ethnic groups7. For example, in rural areas in Oregon, a new mother is twice as likely to be a teen as
Corresponding author: Jessica Henderson, PhD, Professor of Community Health Education, Division of Health and Physical Education, 345 North Monmouth Avenue, Western Oregon University, Monmouth, OR 97361, USA Email: [e-mail]
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compared with a new mother in urban areas of Oregon8. Specifically, a recent survey of 8th grade students in Sweet Home (a rural community in central Oregon), found that 61 per cent of the students reported being sexually active within the past 3 months, and only 12 per cent reported using a condom9. Traditionally, adolescent behaviour has been conceptualized in a risk-based framework, particularly in the areas of teen pregnancy. This approach focuses on negative factors of teens that need to be fixed, rather than focusing on strengths that may be important for healthy teen sexuality. The strength-based approach, based on 40 developmental assets important to middle school and high school adolescents, was developed by the Search Institute10. The Developmental Asset Framework proposes that research into youth health behaviours should not just be about risk factors, but also protective factors. The 40 assets that protect youth from risky behaviours include 20 external assets such as family support, caring school climate and adult role models, and 20 internal assets such as school engagement, self-esteem and resistance skills. In general, the more assets a young person has, the less likely the youth will engage in risky health behaviours; in fact, the developmental assets may explain 2030 per cent of risk behaviours over and above demographic factors11. Several studies have shown that youth assets have a protective effect on risky sexual behaviours. A higher total count of assets has been correlated to delayed sexual intercourse1214. The external asset of parental support has been consistently related to reduced sexual risk among female adolescents1519. In addition, school support and positive peer support were each associated with less risky sexual behaviours13,15,16,20,21. Research suggests that sexual behaviour by adolescents is influenced by perceptions, attitudes, and beliefs2225. In a review of 250 studies on adolescent sexual behaviour, Kirby identified more than 100 individual and environmental factors that lead to sexual activity among adolescents, and perceptions was one of the strongest predictors26. Cost/risk perceptions and benefit perceptions were each individual predictors of sexual initiation and later sexual behaviour in a longitudinal study of 14,871 adolescents 1519 years old27. Identifying perceptions about teen pregnancy will help build and influence practices and curricula to make education more effective in preventing teen pregnancy. The purpose of the present study was to examine perceptions of teen pregnancy among high school students in a rural community with high teen pregnancy rates.
Methods
We conducted five focus groups with female and male students during the spring of 2007. Participants attended a high school in Sweet Home, Oregon, located in a rural area with almost 800 students (94 per cent Caucasian). Participants were purposely selected by a health teacher at the school. The questionnaire and data collection protocol for the study were approved by the Institutional Review Boards at Western Oregon University and Sweet Home High School District. Written informed consent was obtained from each student and her/his parent. Focus group protocol followed the recommendations of Focus Group Practice28. Notes were taken during the focus group session and also incorporated a de-briefing session among facilitators at the end of each group meeting. Each focus group was limited to 90 minutes and included a maximum of six people. Each participant answered a one-page written questionnaire for demographic data. Participants were informed that they were being audio taped and that there would be no identifying information
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in the transcriptions. They were offered a snack and the facilitator followed the script developed for this study. The five focus groups were composed of: (1) (2) (3) (4) (5) Females in 9th10th grades; Females in 11th12th grades; Males in 9th10th grades; Males in 11th12th grades; Pregnant and/or parenting females in 9th12th grades.
The participants were asked the same five questions that were asked of the Oklahoma City teens in the study by Kegler et al29. The questions served as the foundation for gathering teen perceptions: (1) (2) (3) (4) (5) How big is the problem of teen pregnancy at your school? What are some negative consequences of having a baby while you are a teenager? What are some reasons why a teen girl might want to have a baby? What are some reasons why a teen boy might want to have a baby? If one of your friends became pregnant (or got someone pregnant), how would you react?
Data from the transcripts were grouped by categories and analysed for themes and patterns that emerged from the five questions. Independent analyses by three researchers of the typed transcriptions and notes verified themes and categories for reliability. Descriptive and representative quotes from focus group participants were used to illustrate or stress common themes.
Results Sample
Thirteen females and nine males participated in five focus groups at Sweet Home High School, Oregon, during May, 2007. Twenty-one students were Caucasian and one student self-identified as Hispanic. Only nine of the 22 students lived with both biological parents none of the pregnant/parenting females lived with both biological parents. One-third of the students mothers and/or fathers did not graduate from high school. Forty per cent of the participants reported an annual household income under $20,000. Notably, all of the pregnant/parenting females were in this lowest income group. Only four of the 22 students reported that their household income exceeded $40,000 annually.
Q1: How big is the problem of teen pregnancy at your school?
All participants in this study agreed that the rate of teen pregnancies had increased in recent years and that the issue of teen pregnancy was a growing concern more so at their own school than at others (see Table 1). this year everywhere you turn it seems like you hear about someone being pregnant or having a bump on her belly. (pregnant/parenting female) it seems like babies are the new fad even in my classes we are talking about it being the highest in the state. (11th12th grade female)
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Table 1. How big of a problem is teen pregnancy in your school?
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Themes More teen pregnancy now than in the past Teen pregnancy is a big problem Teen pregnancy due to female responsibility Teen pregnancy is a situation, not a problem
Pregnant/Parenting Females Females Males Males Females 9th12th 11th12th 9th10th 11th12th 9th10th grades grades grades grades grades X X X X X X X X X X X X
you look around and there are pregnant girls everywhere. (9th10th grade female) Oh yeh, its getting out of hand. (9th10th grade male) I think its pretty bad here in Sweet Home. (11th12th grade male) Interestingly, the pregnant/parenting female students in this study objected to the word problem, instead preferring the word situation to describe teen pregnancy. When you say that it is a problem, it reminds me of a disease or something. It just sounds bad. (pregnant/parenting female) I dont think its a problem, its just like, like its starting to elevate, but it is not a problem. (pregnant/parenting female) the situation is humungous, jumbo. (pregnant/parenting female) Even though the topic of responsibility for teen pregnancy was not solicited, all the groups offered opinions about the females role. In order to not have a baby, you have to keep your legs shut, and not many are very good about that around here. (11th12th grade female) Everyone is all about sex and stuff, even girls. (9th10th grade male) It has gotten worse with girls thinking that having an older boyfriend is cool. (9th10th grade male)
Q2:What are some negative consequences of having a baby while you are a teenager?
Financial impact of teen pregnancy was the first topic brought up and was a theme common to each focus group (see Table 2). all the day care and all this stuff takes money. And [teens] dont have a lot. (9th10th grade male) it is hard to support her baby and her fianc at a young age. (11th12th grade female) A lot of them dont have jobs and like they dont have the money to take care of the kid and have to look towards their parents. (11th12th grade male) You know a normal teenager who has a job normally just goes shopping with it, but now you have to provide for a whole other life. (pregnant and parenting female)
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Table 2. What are some negative things about having a baby as a teenager? Pregnant/Parenting Females 9th12th grades X X X X Females 11th12th grades X X X X Females 9th10th grades X X X X X Males 11th12th grades X X X X X X X X
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Themes Costs money, inability to support child, and child support Loss: education, future plans, freedom, childhood Have to take care of baby Father absent; quality of life issues for baby Damage to reputation/negative reaction from others Relationships more difficult for mother Guilt/feel bad getting help with baby
Males 9th10th grades X X X
The concept of loss loss of education, freedom, and childhood were also common themes. A baby, it just makes everything that much more difficult. You might not be able to have an education. (11th12th grade female) there are times when you want to get away, but you cant. (pregnant/parenting female) You have a baby and you have to take care of it. You cant be going skateboarding and stuff like that. (9th10th grade male) Guys have the idea that high school and college years are supposed to be the funnest years of your life, and why would they want a kid to take away all the fun? (11th12th grade male) You wouldnt be able to go out at all (9th10th grade female) You wont have as many chances to go to college. (11th12th grade male) Interestingly, all groups, with the exception of the pregnant/parenting female group, discussed the absence of the father and/or quality of life for the baby as possible consequences of teen pregnancy. The kid being raised up isnt going to have a very good life. The person will not have a job and it will affect that baby by living in a really crappy house. (9th10th grade male) I think that a lot of times the guy will just get the girl pregnant and leave them. There are a lot of girls at our school where the boyfriend isnt around or they dont even know who the father is. (11th12th grade male) Three of the five groups associated teen pregnancy with a negative reputation for the mother and difficulty with relationships. (My thing is my) reputation, because everybody thought I was like this bad person and slept around, and then they expected me to like drop out of school and do nothing with my life. (pregnant/parenting female) One of my friends is pregnant right now, and she always feels awkward coming to our church. She feels like everyone is looking at her. (9th10th grade female)
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Table 3. What are some reasons a teen girl may want to have a baby?
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Themes Loneliness; want to love or be loved; get attention Unintended consequence of sex Maintain a relationship Want to be a parent; have a family; family responsibility Girls think babies are cute In thing to do, see other girls pregnant
Pregnant/Parenting Females Females Males Males Females 9th12th 11th12th 9th10th 11th12th 9th10th grades grades grades grades grades X X X X X X X X X X X X X X X X X X X X X
It is going to be a lot harder [for the female] to get a boyfriend if you have a kid. (11th12th grade male) people talk about them and they are looked down upon because they made a mistake. (11th12th grade male) Your parents are mad at you for having it. (11th12th grade female)
Q3:What are some reasons a teen girl might want to have a baby?
To love, be loved, or avoid loneliness was the overwhelming theme of each focus (see group Table 3). because your family is either broken, or you know, you dont have a family around that often so you run off and have a kid, and try to make that family for themselves. And you know, make it okay. (11th12th grade female) If they dont have someone at home saying that they love you, then like, they will want someone to love and that will love them back. (9th10th grade female) The pregnant/parenting female group was the only group that did not talk about having a baby to maintain a relationship this was a theme for all others. Maybe she is like crazy-obsessed with the guy shes with and wants to save the relationship, so she gets pregnant. (9th10th grade female) I think a lot of them do it to keep a guy. Like if the guy is going to break up with them, they get pregnant to keep him, to make them commit to you. (11th12th grade male) A major theme was that the pregnancy happened by chance, or was simply an inadvertent consequence of having sex. I truly think that it just sort of happens more than anything. (pregnant/parenting female) I think that they just get caught up in the moment and dont think about anything. (pregnant/ parenting female) They arent thinking. Or, either theyre at a party, and like drunk or high, and that gives them an excuse to make a bad decision. (9th10th grade female)
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Table 4. What are some reasons a boy in his teens may want to have a baby? Themes Pregnant/Parenting Females 9th12th grades X X Females Females 11th12th 9th10th grades grades X X X X X X
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Males Males 11th12th 9th10th grades grades X X X X X X X
Unintended consequence of sex Dont want to have one Prove something, show off, be cool Want responsibility; feel grownup
Both male student groups perceived that female teens may want to have a baby because they are cute. This was not mentioned by any female students. Im not going to lie, guys think kids are cute, but can you imagine what a girl would think when they are all about cute things, especially kids. They just think, especially with all the baby clothes, they just think how cute. (9th10th grade male) and I think that girls see little babies at the mall or around town and think how cute and they want one. (11th12th grade male) A theme unique to the pregnant/parenting female group was that a teen girl may want to have a baby because they may want to show that they are responsible. If they saw someone in their family, you know, who wasnt being a good parent or something, its just like, ah I can show them that I can do much better. (pregnant/parenting female)
Q4:What are some reasons a teen boy might want to have a baby?
The first response to this question in every group, both male and female, was a round of laughter. They struggled with this question, even though all participants easily came up with many reasons why girls in their teens may want to have a baby (see Table 4). I never heard of a boy in his teens wanting to have a baby. (11th12th grade female) I dont know any guys that would want to have a baby right now they just want to have sex with their girlfriend. (11th12th grade male) Again, the teens agreed that pregnancy was an inadvertent consequence of sex. They dont think with their brains, they just think with their material. (pregnant/parenting female) Sex. They just want sex and they think that they dont have to deal with it at first They just think about sex a lot, pretty much. (9th10th grade male)
Q5: If one of your friends became pregnant (or got someone pregnant), how would you react?
Supportive was the primary theme, although initially they expressed surprised toward the females and perturbed toward the males (see Table 5).
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Table 5. How would you react if one of your friends got pregnant (or got someone pregnant)? Themes Pregnant/Parenting Females Females Males Males Females 9th12th 11th12th 9th10th 11th12th 9th10th grades grades grades grades grades X X X X X X X X X X
Initial surprise or negative initial reaction Provide support/advice X Excited/happy to hear news X Change in relationship with friend
I would slap him, if it was a boy. And if it was a girl, I would help her out as much as I possibly could. (9th10th grade female) I would be like oh, shit. You are screwed and laugh a little. (9th10th grade male) I would be pretty mad because we couldnt hang out and stuff anymore. He would have to start living an adult life and wouldnt be able to hang out. (11th12th grade male) I would be supportive. I wouldnt freak out or anything. I mean its their decision, but to freak out is just rude. (11th12th grade female) I would just be supportive, and if they were wanting to have an abortion, I would maybe try to talk them out of it. (pregnant/parenting female)
Discussion
Seven months before the latest statistics were released that showed a nationwide increase in teen births for the first time in 15 years2, the Sweet Home students perceived that teen pregnancy was a growing concern and that teen pregnancy rates were increasing, particularly at their school. Babies are the new accessory, like a Gucci bag. (11th12th grade female) Results from this study reveal the perceptions of teen pregnancy among female and male high school students in a rural area with high teen pregnancy rates. The four primary themes were: (1) the number of teen pregnancies were increasing and were a growing concern; (2) financial difficulties and harm to education were associated with teen pregnancies; (3) teen females had many reasons for wanting a baby, but teen males just wanted to have sex; and (4) teen pregnancy happened by chance, or was simply an inadvertent consequence of having sex. Overall, the perceptions of the Sweet Home students were similar to those of students in Oklahoma City, who were asked the same questions about teen pregnancy29. However, the Sweet Home students delineated more differences between the sexes than the Oklahoma City students: teen pregnancy is primarily a female matter; females want to have a baby because they are cute, and, males dont want a baby, they just want sex. A major finding in our study was that students perceived pregnancy happens, even though they were aware of contraception methods and the consequences of teen pregnancy. There was an overwhelming theme that becoming pregnant was simply an inadvertent consequence of being sexually active. I didnt want one, it just kind of happened. Its not an accident, it just sort of happened. (pregnant/parenting female) they are just in it for the pleasure and then it is like oops. (9th10th grade female)
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Basically the guys are in it just for the sex (9th10th grade male) I think that the reasons why teens even start having sex is for todays satisfaction, not tomorrows. So then if that turns into a baby it will mess up your plans. (11th12th grade female) This suggests that the students perceptions of the consequences of teen pregnancy are often incongruent with their sexual behaviour, and that an accident has no personal responsibility. One explanation for these perceptions may be the outcome of abstinence-only programmes, similar to the curriculum found in Sweet Home High School, which have been shown to be less effective than abstinence-based programmes30. These students may have the most to gain from sexual health programmes that teach and empower students about contraceptive use, refusal skills and assertive communication skills. This is a key recommendation from this study to shift away from the theme that teen pregnancies happen by chance. By integrating an abstinence-based programme with the developmental asset framework, students can acquire the external and internal youth assets to develop necessary skills and strategies for pregnancy prevention that are in accordance with their perceptions31. After completion of this study, the Sweet Home School District adopted a new health education curriculum that included an abstinence-based approach and met the Oregon Administrative Rules for sexuality education. In addition, the following steps were implemented to increase youth assets: established five afterschool, non-sport clubs (Amnesty International, computer gaming, art, web site design, and forestry); made changes in school policy to address truancy problems; engaged students in choosing names for the wings in their high school to help establish identity and ownership with their school; and coordinated efforts to increase meaningful volunteer experiences for students. The primary limitation of this study is that the findings may not be generalized to the US teen population. However, the findings of this study give insights into the perspectives of students in a low-income rural community with high pregnancy rates an area where there is a dearth of knowledge. Future research should examine perceptions of teen pregnancy among diverse racial/ethnic groups in order to tailor culturally appropriate sexual health messages. Implications of the findings of this study are that (1) establishing knowledge and skills about pregnancy prevention is a valid school-based approach as part of a sexual health strategy; and (2) sexual health education within the context of the developmental asset framework will promote healthy sexual behaviours. In particular, the external assets of support from parents, peers, and the school should be a central part of the education programmes and policies to promote healthy sexuality. As Rosenthal and Dowsett wrote, Sex is not just socially produced social life is increasingly sexual32. School health professionals can partner with parents, health care providers, community organizations and the media to develop innovative ways to build the support assets in young people. References
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