School-based pregnancy prevention program

Abstract
Adolescent sexual activity can lead to consequences that are beyond their maturity. The choice to become sexual active and the consequences can bring about depression, poverty, recipient of welfare, and inability to maintain healthy relationships. This target behavior continues to be important policy concerns in the United States. “In 2009, almost 40 percent of sexually active high school students did not use a condom during their last sexual intercourse, and 12 percent did not use any method of contraception” (CDC, 2010a). It is important to have preventative and educational programs available to our youth as they enter the age of risk of unintended pregnancies.

SCHOOL-BASED PREGNANCY PREVENTION PROGRAMS
Introduction
The United States continues to experience the highest teenage pregnancy rate among developed countries; the phenomenon remains a complex occurrence for families, educators, health care professionals and the United States government (Hardy & Landry, 2000; Kerby, 2009; Little & Rankin, 2001). Being a teenager and figuring out the challenging world around you is nothing new. There are many stressors that teenagers encounter while trying to find themselves and their purpose in life. They deal with mid-term exams, finals, SATs to friends, and relationships that could potentially be sexual.

Teenage pregnancy is a social issue that should not go unnoticed. How do we ensure that adolescents are educated on the issue and have the resources needed to make an informed decision on whether to make that step into a sexual relationship? Pregnancy prevention programs are the key to offering adolescents the knowledge with hopes of preventing unintended pregnancies as the outcome. Adolescents who are expecting a child are faced with many challenges that they are incapable of managing without support from their family, community, or support groups.

Their level of success is a determination of the amount of support and guidance that is available to them. Bouts of depression, living in poverty, and the need to apply for welfare services are common factors for an adolescent that is an expectant parent or already a parent. Pregnancy among our young will never be a thing of the past, but having preventative measures available can lower those numbers. That is part of the goal of the selected intervention and includes preventing adolescent pregnancies.

Description of Setting
This school-based pregnancy prevention program will aim to change, enhance, or supplement existing services and support within the local community. It will be a starting point and an avenue for teenagers to openly talk about their questions and concerns to the topic most people fear with teenagers. Information will be provided on sexual health, relationships, and sex education topics. Contraceptives is another highlight of the program as the purpose is to lower the number of pregnancies. Teenagers enrolled within this program will increase their knowledge of certain sexual behaviors, prevention methods, and will also have the opportunity to witness and hear about the life of being a teenage parent.

Statement of Research Objectives
An outcome objective is defined by York (2009) as the intended result of the service process in regard to a targeted behavior. My focus will be providing a pregnancy prevention program that offers access to contraceptives and sex education. Newswire (2011) reports that, “Americans consistently rate teen pregnancy as one of the top 10 biggest health problems for young people and the U.S. still has the highest teen birth rate among all industrialized countries--despite decreases in the birth rate during the past 20 years”. With such an alarming statistic, the outcome objective of the pregnancy prevention program will be a tough task, but not unattainable.
Analysis of Target Behavior
Pregnancy prevention programs are influential and powerful to convey the importance of sexual relationships and making smart choices in regards to contraceptives. Teenagers are easily influenced; what better way to provide positive influence then having a group of them learning a tremendous life lesson without actually living through it. The target behavior that the program is focused on includes teenage sexual activity and contraceptive use. “Comprehensive sex education approaches generally include information on both the benefits of abstinence and risk mitigation through condom and contraceptive us for sexually active adolescents” (Shearer, et al., 2005, p. 2).
The preventative programs that focus on these target behaviors are based on the assumption that they are lacking the guidance and education to practice abstinence of if they are sexually active they don’t have the means to seek out contraceptive. As a society, I have noticed that we focus on how to provide assistance and medical care to teenage mothers. What if we took that initiative a few steps back and put forth the effort into educating our teenagers about healthy sexual relationships and preventing pregnancy with the use of various contraceptives?

Analysis of Intervention
“Teenage pregnancy is a complex problem, influenced by many factors, including individual biology, parents, family, peers, schools, religion and faith communities, and the media” (Hulton, 2007). Teenagers that are participants in a prevention program “could potentially increase their knowledge about sexual behavior risks, develop positive views on abstinence and delaying pregnancy, improve their communication skills and relationship quality, and reduce consumption of drugs and alcohol, or improve their academic performance” (Smith & Colman, 2012). The purpose of the program is for teenagers to be more aware of the risks and consequences in which they will be able to make a more informed decision on the path they want to take. This is the most crucial time for their development into adulthood and can be the most difficult life changer if pregnancy were to occur.

Population & Sampling
The outcome objectives are to provide pregnancy prevention programs that provide information on health, relationship, sex education topics, and access to contraceptives. Adolescents that are participants in a prevention program could potentially increase their knowledge about sexual behavior risks, develop more positive views on abstinence and delaying pregnancy, improve their communication skills and relationship quality, reduce consumption of drugs and alcohol, or improve their academic performance (Smith & Colman, 2012). The program will highlight on “the potential” of a teen rather than their “at risk” factors.
Its purpose is to develop the capacity and desire to avoid adolescent pregnancy and find their creativity and strengths that will benefit them in the workforce. Youth in pregnancy prevention programs might increase their knowledge about sexual behavior risks, develop more positive views on abstinence and delaying pregnancy, improve their communication skills and relationship quality, reduce consumption of drugs and alcohol, or improve their academic performance (Smith & Colman, 2012).
“An intervention is defined as a program with a set of components or services designed and implemented to achieve specific outcomes” (Shearer, Guyaben, Gallagher & Klerman, 2005). The preventative program will be an individual or group-based that encourages teens to make smarter decisions when it comes to sexual activity with one or more partners. The idea behind the program is to teach teenagers the negative effects sexual activity can have on their future. Topics that will be covered during the duration of the program are:
1. Abstinence
2. Contraception
3. STDs
4. Pregnancy & Childbirth
5. Individual counseling
Programs will only be successful with qualified personnel assigned to teach and facilitate the lessons mentioned above. A healthcare professional is the best option to educate about the different types of contraceptive methods available and if teens aren’t careful with their choices, the possible STDs that can be contracted. A licensed counselor is available for individual counseling after the program ends.
Abstinence education programs focus on delaying sexual initiation, and many of these programs focus specifically on delaying sexual activity until marriage. By contrast, comprehensive sex education approaches generally include information on both the benefits of abstinence and risk mitigation through condom and contraceptive use for sexually active adolescents (Shearer, et al., 2005, p. 2). The preventative programs that are available to adolescents are based on the assumption that they are lacking the guidance and education to practice abstinence or if they are sexually active they don’t have the resources to seek out contraceptive. York (2009, p. 372) provides that, “the model of the intervention identifies the underlying assumptions that are being made about the dynamics of the target behavior”. The sample study consists of 9th graders from the local high school with parental consent. It is anticipated approximately 150 females will cycle through the preventative program. The age of the females for the study varies from 13-15 years old.
“Probability sampling is best because it increases the likelihood of obtaining samples that are representative of the population” (Sampling, n.d.). The selection is random which provides no bias to the race, education level, or social class of the teenager. The definition of the population has implications for the question of the group to whom we can generalize our findings (York, 2009, p. 196). In program evaluation, we can generalize about a large population by sampling a portion of that specific population.
Measurement
A measuring tool is important to a research study as it is a determining factor on how successful a program is and/or what improvement are needed to meet the outcome objective. “A tool will not be valid if it uses words differently from the common usage of a given culture” (York, 2009, p. 296). It is important to understand the culture in which the research study is implemented. It is advised by York (2009) “to pretest an instrument with the designated population”. The measuring tool I selected is a self-assessment survey at the beginning of the program, mid-way through the program, and follow-up at 6-months after completing the program. According to Trochim (2006), “Survey research is one of the most important areas of measurement in applied social research. The broad area of survey research encompasses any measurement procedures that involve asking questions of respondents”. When curious about a person, the first reaction is to ask with hopes of getting an explanation. “Research methods that take the approach of asking the person directly are known as self-report methods, and mainly take the form of interviews, questionnaires, and rating scales” (Parker & Pistrang, 2003, p. 96).

The survey that is conducted within the prevention program is used to measure the level of knowledge teens have of contraceptive options, the potential consequences of being sexually active, and resources available for teenage adolescents. The type of measurement tool I chose for the program is a questionnaire. The questionnaire is utilized to assess the level of understanding of contraceptives, sex education, and teenage pregnancy. The format of questioning consists of dichotomous as well as filter or contingency. “Sometimes you have to ask the respondent one question in order to determine if they are qualified or experiences enough to answer a subsequent one” (Trochim, 2006). “An examination of the dynamics of the target behavior provides a rationale for the selection of the intervention” (York, 2009, p. 177). A preventative program cannot be successful without fully understanding the factors that might influence against the outcome objective. Factors that will affect the behavior of sexual activity are social influences, socioeconomic status, limited knowledge of contraception and use of condoms, and resources available for the teenager to refer to. Social influences affect a young teen’s likelihood of engaging in sexual activity and nonuse of condoms. Teenagers will copy and/or approve the behavior of their friends. Socioeconomic status is a major factor, they potentially live in a single-parent home with little to no supervision that will leave them open to experimenting with risky behaviors.

Research Design
The questionnaire will be conducted three times throughout the five-month program; first session, midway, and at the 6-month follow-up. The program will take place at the local high school and is strictly voluntary and will count as a health credit upon completion. It is similar to the classes available in high school through the years, but this is more detailed about the issue and not just about the struggles of taking care of a baby. The outcome objective of these programs is to prevent that type of behavior and potential situation.

The group setting will be 80 adolescent females and/or males per semester that is divided into four different class periods. The first day of class, each class of 20 will be given the questionnaire that tests their knowledge and level of maturity. Three and a half months in to the program, they will be re-evaluated to gauge where their mindset has led them in making smarter decisions when it comes to sexual activity and prevention. The final survey will be offered to the participants by two options--e-mail or paper questionnaire through first class mail--see how effective the program was and if it accomplished its intended goal. Everyone knows we cannot save every teen from becoming a teen parent or attracting sexually transmitted diseases, but if the percentage is lower than when the program began that will show the program has served its purpose.

The label for the research design is pretest-posttest one group design. This is to assume that “there are no variables other than the treatment that affect the client’s target condition” (York, 2009, p. 218). People can change over time on their own, but having a positive influence can help deter them from the target behavior in this research study. The program study is only a semester (5 months) with a follow-up in 6-months, which is not a long program at all. York (2009) points out that, “The shorter the period of treatment, the less we need to be concerned about either maturation or history as alternative explanations for client change”.
“When we measure client behavior, we make the assumption that observed changes are due to the intervention rather than something else” (York, 2009, p. 218-219). Internal validity means that the purpose of the program attributed to the outcome of the study. Certain threats can occur to include history and maturation. “Changes in the environment, independent of the treatment, may have caused changes in the client’s behaviors” (York, 2009, p. 219). Some people mature and outgrow their issues or find ways to better cope with the situation.
Discussion
A tearful, “I’m pregnant!” isn’t easy for any parent to hear. The emotions; worry, disappointment, and anger are usually the reaction a teenager might expect from their parents or guardian. No parent wants to hear that phrase from their teenage daughter because you visualize them sacrificing their life to now raise a child of their own. Lack of education about healthy sexual relationships and contraceptives is a major cause of unplanned pregnancies among our teens. So wouldn’t you rather sign a consent form to allow your teenager to be a part of the pregnancy prevention program than hearing them announce that they are pregnant?
Participation in the program is voluntary and is offered as an elective in high school. Although being part of the program is voluntary it’s not necessarily confidential in the school setting since it will be offered as a class on sex education. However, teenagers will have to get approval from their parents or guardians and turn in the permission slip to be eligible to sign up for this program. As York (2009) mentions, “It is appropriate to collect information that identifies you, but your information should be treated confidentially, unless you have agreed otherwise”.
Conclusion
Education on sexual behavior and learning about preventative measures is crucial in order to reinforce the importance of taking care of oneself. Conducting surveys can measure the knowledge of a participant in a specific area in relation to a human service program, the benefit of the program, and the after effects of having attended the program. Pregnancy among our young will never be a thing of the past, but having preventative measures available can lower those numbers.

Reference
Barker, C., & Pistrang, N. (2003). Self-Report Methods. Research Methods in Clinical Psychology an Introduction for Students and Practitioners. Chichester: John Wiley & Sons.
Innovative teen pregnancy prevention programs get strong public support.. PR Newswire. Retrieved April 22, 2014, from the ProQuest database.
Little, C., & Rankin, A. Why do they start it? Explaining reported early-teen sexual activity. Sociological Forum, 16, 703-737.
Trochim, M. (2006, October 20). Survey Research. . Retrieved April 22, 2014, from http://www.socialresearchmethods.net/kb/survey.php
Centers for Disease Control and Prevention. "Youth Risk Behavior Surveillance--United States, 2009." MMWR, vol. 59, no. SS-5, 2010a, pp. 1-142.
Hardy, J., & Landry, D. Pregnancy, sexually transmitted diseases, and related risk behavior among United States adolescents. New England Journal of Medicine, 33, 1161-1162.
Hulton, L. An evaluation of a school-based teenage pregnancy prevention program using a logic model framework. The Journal of School Nursing, 23, 104-10. Retrieved May 11, 2014, from the ProQuest database.
Kirby, D. (2007). Emerging answers 2007: New research findings on programs to reduce teen pregnancy: A full report. Retrieved May 11, 2014, from http://www.thenationalcampaign.org/ resources/reports.aspx
Sampling: Types of sample. (n.d.). . Retrieved April 22, 2014, from http://psychology.ucdavis.edu/faculty_sites/sommerb/sommerdemo/sampling/type
Shearer, D. L., Gallagher, S., & Klerman, L. Selecting, implementing, and evaluating teen pregnancy prevention. Journal of Adolescent Health, 37.
Smith, K., & Colman, S. (2012, October). Evaluation of Adolescent Pregnancy Prevention. . Retrieved April 21, 2014, from http://www.hhs.gov/ash/oah/oahinitiatives/assets/ppa_design_report.pdf
York, R. O. (2009). Evaluating Human Services: A Practical Approach for the Human Service Professional. Boston: Pearson Education .