Abstract
Despite historic lows in teen birth rates, the U.S. still maintains the highest teen birth rate of any industrialized nation, and significant disparities exist between ethnicities and socioeconomic status (SES). The factors influencing teen birth are vast and intertwined. The socio-ecological model (SEM) provides a natural theoretical framework to study and address these multiple levels of influence, which include individual, interpersonal, institutional/organizational, and public policy. This chapter will include a summary of recent studies, and drawing from empirical findings guided by the socio-ecological model, will identify and suggest strategies at each level for reducing the teen birth rate. By addressing the overlapping layers together, as opposed to a single layer, interventions have greater potential for success.
TopIntroduction
Despite historic lows in teen birth rates, the U.S. still maintains the highest teen birth rate of any industrialized nation, and large disparities exist between ethnicities and between socioeconomic status (SES) groupings. The factors influencing teen pregnancy are vast and intertwined. The Socio-Ecological Model (SEM) provides a natural theoretical framework to address these multiple levels of influence. This chapter will include a summary of recent studies and drawing from empirical findings guided by the Socio-Ecological Model, will present suggestions for developing prevention programs that will address the many factors that influence teen pregnancy. Specifically, the objectives of this chapter are to:
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Provide a comprehensive overview of the Socio-Ecological Model (SEM);
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Provide a practical application of the SEM in at-risk communities with exceptionally high teen-pregnancy birth rates;
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Describe strategies to promote positive sexual health among adolescents, involving their attitudes, beliefs, and behaviors;
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Identify strategies to promote healthy communication about sexual health between teens and their parents;
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Provide strategies to effectively engage the community in preventing teen pregnancy in at-risk communities, including faith-based organizations, medical providers, and service providers; and
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Identify strategies to advocate for public-policy changes that directly impact teen pregnancy prevention.
TopBackground
Teen Pregnancy Prevention
The birth rate among teens aged 15-19 years old in the U.S. has gradually declined over time, with a new record low in 2015 of 22.3 births per 1,000 females in the age group. This rate is an 8% decline from the rate in 2014 (24.2) and a 64% drop from the long-time high of 61.8 in 1991 (Martin, Hamilton, Osterman, Driscoll, & Matthews, 2017). However, U.S. teen birth rates remain high, compared to those of other industrialized countries (Sedgh, Finer, Bankole, Eilers, & Singh, 2015; Vexler & Suellentrop, 2006). Almost 4 in 5 pregnancies among adolescents are unintended (Finer & Zolna, 2016; Mosher, Jones, & Abma, 2012). Adolescent pregnancy leads to negative outcomes for parents, children, and children of adolescent parents, who experience poorer educational, behavioral, and health outcomes (Hoffman, 2008; The National Campaign to Prevent Teen and Unplanned Pregnancy, 2013).
Teen pregnancy prevention is complicated and often controversial. Teen pregnancy spans multiple sectors, often creating a complex interplay involving individuals, friends, family, schools, and neighborhoods.
The purpose of teen pregnancy-prevention programs should be multifaceted, to include educating teens, addressing subjective norms, increasing awareness about teen pregnancy rates in communities, educating parents and key stakeholders, and improving policies to support teens and address teen pregnancy-prevention barriers. These domains must be addressed in prevention programs for change to occur, knowing as we do that “complex problems often necessitate broad intervention programs with multiple, highly focused components to address more than a single core issue or problem domain” (Borkowski, Smith, & Akai, 2007, p. 232).
Key Terms in this Chapter
Theory-Based: A framework of constructs and ideas for understanding and explaining a phenomenon.
Primary Prevention: The first level of prevention that aims to reduce the likelihood of an illness or health behavior from occurring (e.g., sexual education prior to initiation of sexual activity).
Public Policy: A system of laws established by a governing body to regulate a community or group of individuals.
Comprehensive Sexual Education: A teaching system that focuses on the benefits of multiple teaching methods about sexual health (e.g., abstinence, contraceptive use, safe sex practices, etc.).
Key Stakeholder: A valuable member of the community who can affect or may be affected by an action.
Construct: Concepts used in a specific theory to provide understanding to a phenomenon.
Evidence-Based: A valid practice or intervention that has been implemented and tested for significant change in behavior.
Socio-Ecological Model: A theory-based framework that demonstrates the interconnectedness of multiple sectors that impact health behavior. This model includes five sectors: intrapersonal, interpersonal, community, organizational, and policy.
Abstinence-Only Education: A teaching system that focuses on the social and health benefits of delaying sex until marriage.
Community Mobilization: The process of identifying, gathering, and connecting community resources to address an issue affecting the community: collaborative partnerships.