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Teen pregnancy is a major public health issue in the United States. American Pregnancy Association defines teen pregnancy as a pregnancy that occurs for women under the age of 20 (American Pregnancy Association, 2017). Even though the teen pregnancy rate for females aged 15-19 years, have declined in the nation from 61.8 to 22.3 per 1000 between 1991-2015, the US is one of the countries with highest teen pregnancy rates amongst the developed nations (Mueller et al., 2017). In 2015, Texas was ranked five out of 51 states (including District of Columbia) representing the highest birth rates among females aged 15-19 years.
On the same year, the teen birth rate on Texas was almost 55 percent higher than the national average of 22.3 per 1000 births (U.S. Department of Health and Human Services, 2017). Although the national rates of teen pregnancy are declining, the decline rate of Texas is slower and unfortunately, the birth rate for Tarrant County is almost as high as Texas average of 34.3 per 1000 births for the same age group of 15-19 years (Centers for Disease Control and Prevention, 2019; Knox, 2017).
Hence, we need more effective interventions to minimize this birth rate for young adolescent females.
Making Proud Choices! (MPC) is one of the interventions designed for teenagers to help them make responsible choices about sexual behaviors. It is designed to increase knowledge, confidence, and skills required to minimize the risk of pregnancy either by practicing abstinence or using a condom if they choose to have sex (U.S. Department of Health and Human Services, 2019a). The program can be effective by reducing the incidence of risk-associated sexual behaviors through the installation of the sense of pride and responsibility on the participants.
This program can be implemented in community settings, schools or community-based organizations for adolescents of ages 12-18. It is based on three major behavioral theories viz. the social-cognitive theory, the theory of planned behavior and the theory of reasoned action. The concepts of self-efficacy, perceived behavioral control and outcome expectancies are utilized to design this program. The first two concepts are related to an individual’s ability to perform a behavior and outcome expectancies are related to the beliefs about the consequences of the behavior (U.S. Department of Health and Human Services, 2019a).
The program content focuses on four major types of behavioral beliefs and outcome expectancies. First, goals and dreams belief, which is related to the belief that unprotected sex can hinder the achievement of career goals and dreams. Second, prevention belief, which is related to the belief that condoms use minimizes the risk of pregnancy. Third, partner reaction belief, which is associated with the beliefs about how a partner might not approve the condom use and react negatively to this behavior and lastly, hedonistic belief, which is related to the belief about how condom use might affect sexual pleasure (U.S. Department of Health and Human Services, 2019b). The eight modules of this program then incorporate the methods and materials to cover all these beliefs and educate the teenagers to make rational decisions and adopt safe sexual behaviors. Each module could be an hour long and should be delivered to a group of eight teenagers per facilitator. Trained health educators, nurses or social workers could be facilitators for the program and the ideal time of program completion is two weeks. Moreover, videos, role plays, group activities, handouts, visual presentations etc. can be used to deliver this program in the community (U.S. Department of Health and Human Services, 2019b).
In the late 1990s, 659 African-American adolescents from 6th and 7th grades who came from low-income families were recruited for intervention in Philadelphia. They were subjected to baselines surveys about their recent sexual activity and attitudes towards risky sexual behaviors (Jemmott, Jemmott, & Fong, 1998). The participants were stratified into three intervention groups- Making proud choices! or safer sex- groups (n=221), Making a Difference! or abstinence-based group (n=220) and a health promotion or control group (n=218). For each intervention group, eight-hour long modules were scheduled for two consecutive Saturdays. When compared to the control group, participants in Making Proud Choices! group had better condom use knowledge and increased self-efficacy. Three months later a follow-up result showed that participants in the MPC group were found to report fewer instances of unprotected sex. Follow-up was also done at six and 12 months. A six-month follow-up showed participants in MPC groups had reduced frequency of sexual intercourse than the control group (Jemmott et al., 1998).
In 2011, the Alameda County Public Health Department of California on receiving five-year federal Teen Pregnancy Prevention Grant adopted the MPC program on 6th-grade students. After a year of study, they developed a survey to determine the effectiveness of the program. The findings of the survey suggested that the program had a positive impact on those students’ sexual behavior. After the implementation of the intervention, the students showed an increased understanding of condoms use and pregnancy prevention. 88 percent of total students reported MPC will help them make better and responsible sexual choices in the future (Alameda County Public Health Department, 2014).
Recently, a replication of MPC was done by the Department of Health and Senior Services in Missouri in the areas where risks for teen pregnancy were higher. The program was implemented in highly diverse areas more particularly, six rural counties and two urban counties. Results showed that it was effective over these diverse geographic regions. The results were also found to be consistent over different demographic groups. It was concluded that MPC was equally effective for foster care youths, for whites as well as for African-American adolescents (Cronin, Heflin, & Price, 2014).
MPC is a comprehensive sex education program and is deemed effective to prevent teen pregnancy in different parts of the country but, due to cultural and religious beliefs, parents may not always favor this approach. Cultural competency comes into play in such situations. Hence, before implementing this program the health educators, nurses, social workers, or anyone involved should be trained enough to address the cultural and religious aspects in the community. This could be a potential limitation for implementing MPC as more time and resources need to be allocated to align with the needs of the community. Moreover, the curriculum of MPC should consider including additional lessons and activities that keep adolescents more informed about the anatomy of the reproductive system. Getting to knowing their own bodies would probably help them make most out of the program (U.S. Department of Health and Human Services, 2019c).
The Texas Campaign to Prevent Pregnancy reported that in Tarrant County birth rate for adolescent females ranging from 15-19 years is 36 per 1000 (Knox, 2017). With such high birth rates for teens, it is evident that we need more interventions to address this issue. Besides, Texas law hasn’t mandated sex education yet. Due to the lack of comprehensive sex education and religious factors, Tarrant County has been experiencing high teen pregnancy rates (Knox, 2017). Moreover, the Hispanic and African American adolescents constitute a significant portion of Tarrant County population (North Texas Community Foundation, 2016). Meanwhile, it is also evident that Hispanic and Black adolescent females are more than twice as likely as white females to become pregnant (Wiltz, 2015). Hence, it is high time for implementing evidence-based programs like Making Proud Choices! By implementing programs as such in a culturally appropriate way and providing comprehensive sex education to the adolescents, their knowledge, attitudes, and skills to adopt safer sexual behaviors could be increased which in turn will help in minimizing the risk of teen pregnancy in Tarrant County.
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