Improving Global Health Outcomes for Teenage Pregnancy Prevention: Intervention Programs in the United States, Canada, China and the Philippines

Sternas, Kathleen A.

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 6^th, 7^th and 8^th 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 STD’s, 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.