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I S S U E S A N D IN N O V A T I O N S I N N U R S I N G P R A C T I C E

Community perspective on a model to reduce teenage pregnancy


Marian M. Tabi
PhD RN

Assistant Professor, School of Nursing, Georgia Southern University, Statesboro, Georgia, USA

Submitted for publication 6 June 2002 Accepted for publication 30 July 2002

Correspondence: Marian Tabi, School of Nursing, Georgia Southern University, PO Box 8158, Statesboro, Georgia 30460, USA. E-mail: mtabi@gasou.edu

T A B I M .M . ( 2 0 0 2 )

Journal of Advanced Nursing 40(3), 275284 Community perspective on a model to reduce teenage pregnancy Design. Qualitative methodology was used to validate elements of an educational career youth developmental model (ECYDM) to reduce teenage pregnancy among African American teens in two inner city urban communities. The specic aims of the study were to gain understanding of the factors contributing to teenage pregnancy and to identify a pregnancy prevention programme relevant to the needs of African American youth. Methods. Data were collected from a convenience purposive sample of 43 African American teens and adults. Teen participants included males and non-pregnant, pregnant, and parent females. Adult participants included parents, school staff, and community clergies. Data were collected using demographic questionnaires, structured individual and focus group interviews. Approval from the Institutional Review Board was obtained before conducting the study. Findings. Findings supported elements of the ECYDM as a pregnancy prevention programme for African American teens in inner city urban communities. Participants identied an educational-career motivational programme that utilizes mentoring to teach, counsel, and provide information to improve youths health, education, career, and social outcomes as the pregnancy prevention programme for youth in urban communities. Conclusions. These ndings have important implications for future programme design and research. Teenage pregnancy must be addressed within the context of the individual, family, and community. Community partnership and collaboration of resources is necessary to reduce teenage pregnancy. Educational-career programmes are needed to provide information and knowledge to young men and women to make sound informed decisions. Continued qualitative research is also needed to gain understanding of pregnancy prevention programmes. Keywords: adolescent pregnancy prevention programme, African American teens, Teenage Pregnancy Prevention Model

Introduction
I always used to think for years that I am never going to have sex till I get married. I am never going to have any kids until I am married. I am never going to end up in any situation that I didnt want to be in and not try to get out. But I thought wrong. When I met this boy and weve been together for over a year and a half I ended [sic] having sex with him, unprotected most of the time, and I ended up pregnant and all. I was having a lot of problems with my family. My brother didnt have 2002 Blackwell Science Ltd

much time for me. He was too busy with his ance e or school. My uncle, he has two jobs and he was working seven days a week. Then my mum, you know, she is an alcoholic and she didnt respect people much, and really didnt care anything about how other people feel. And my dad gone, and a lot of other family members gone, I felt that he was the only person that I had to go to because he was the one who was always there. And when I got pregnant, everything just changed it around. He started not showing his butt and was going around cheating on me and everything. He was helping me before I got 275

M.M. Tabi pregnant and told me he will help me take care of the baby if I got pregnant. Since the baby came he hasnt done anything. I mean I have to make him buy some Pampers, and all he did, was buy two packages of Pampers and a bar of soap which isnt anything. There are at [sic] times that she has been needing things and he comes to my house with a pocket full of money and wont buy anything. Things just didnt work out and now I am the one that kind of look stupid but I dont regret having my baby and all. Because, you know, she makes me happy. Its not that hard to have her as long as I have someone to watch her while I am in school. My sister always wants to help me out. But I do regret meeting him though, because, he has totally messed up my whole life and I did things that I never wanted to do and I cant change it now. An excerpt from a 15-year-old parent teen, study participant

teenage pregnancy among African American teens in inner city urban communities? (b) What type of prevention programme is needed to reduce pregnancy among African American teens in inner city urban communities? (c) Are the elements in the educational-career youth developmental model congruent with community members perception of a pregnancy prevention programme needed to reduce early pregnancy and parenthood among African American teens in inner city urban communities?

Signicance of the study


Pregnancy prevention programmes are often designed for African American adolescents who live in inner city urban communities and who are at greatest risk for early pregnancy and parenthood (Weatherly et al. 1986, Adelman et al. 1993, Brooks-Gunn et al. 1993, Brewster 1994). Research studies investigating the effects of these programmes have not demonstrated strong and consistent support for their success in reducing teen pregnancy (Card et al. 1992, Kirby 1997). Few studies have explored teenage pregnancy prevention from an ethnic or cultural perspective with respect to providing programmes for intervention. To date, nearly all research on teen pregnancy prevention programmes has been quantitative. Missing in the literature is the use of qualitative research methodology that examines in depth the key elements in designing pregnancy prevention programmes for African American adolescents from a community perspective of clergy, teens, parents, and school administrative personnel. Qualitative research methods can be useful in understanding the interventions needed to make pregnancy prevention programmes effective in reducing pregnancy and parenthood, especially among youth in inner city communities. Moreover, to address the problem of teenage pregnancy in urban communities, it is important to have an understanding of the pregnant individual, the contributing factors, and approaches that help nd solutions (Aquilino & Bragadottir 2000, Hacker et al. 2000). Without such information, it is difcult for planners and administrators to be successful in designing effective pregnancy prevention programmes for minority youth in inner city urban communities.

Teenage pregnancy and early parenthood among African American teens is a complex problem rooted in a set of identiable demographic and social factors that require multifaceted interventions (Barnes 1987, Comer 1989, Dore & Dumois 1990, Crane 1991, Coulton & Pandey 1992, Aday 1993, Hill et al. 1993, Resnick et al. 1996). It has been documented in the literature that adolescents who become pregnant are often minorities from low income, single-parent families and inner city urban communities (Alan Guttmacher Institute 1994, Barnes 1987, Brewster et al. 1993, BrooksGunn et al. 1993, Brewster 1994, Kirby 1997). Though there is some truth in this statement, minority youth, particularly African American teens, become pregnant and parents too early not only because of their low socioeconomic status and the communities in which they live, but also because of the lack of adequate resources and support systems available to help young people achieve their education and career goals (Smith 1982, Franklin & Boyd-Franklin 1985, Hamburg 1985, Hogan & Kitagawa 1985, Comer 1989, Hart 1989, Crane 1991, Coulton & Pandey 1992).

The study
Purpose, aims and questions
The purpose of this qualitative study was to validate community members perspective on teen pregnancy prevention with elements of an educational-career youth developmental model (ECYDM) to reduce teenage pregnancy among African American teens in two inner city urban communities. The specic aims were: (a) to gain understanding of the factors contributing to teenage pregnancy; and (b) to identify a pregnancy prevention programme relevant to the needs of African American youth. The following research questions were addressed: (a) What are the factors contributing to
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Educational-career youth developmental model as a conceptual framework


Background 1 The ECYDM in Figure 1 was designed in 1998 by the investigator as a pregnancy prevention guide for young adolescents in middle and high schools. The objective of the model is to show the main factors contributing to teenage

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Environmental resource availability Support systems Parents Peers Mentors Community resources

Individual characteristics Personal goals Age Gender Race/ethnicity Socio-cultural factors Socio-economic status Knowledge about reproduction

High-risk social behaviours Early initiation of sexual activity Poor academic achievement School drop-out Drug use Teenage pregnancy Early parenthood

Primary prevention intervention (PPI) Organizing and delivering effective interventions in: Health education Educational preparation Career preparation Social development to improve youth outcomes Desired outcomes Short term Improved academic grades Improved school attendance Improved orientation to educational and career goals Available environmental resources

Long term Delayed pregnancy Delayed early parenthood Graduated from high school Attended college Low-risk for pregnancy and parenthood

Figure 1 Educational-career youth developmental model.

Limited environmental resources

High-risk for pregnancy and parenthood

pregnancy and early parenthood, and to provide opportunities and alternatives to enhance youth outcomes. The ECYDM reects the best effort to represent the ndings of research and the logic of current theories about how these elements shapes the lives and development of youth and yield differential success for adolescents from disadvantaged backgrounds (Crane 1991, Coulton & Pandey 1992, Hogan & Kitagawa 1985). The ECYDM is based on Banduras (1986) social learning theory which emphasizes that interventions address not only behaviour change at the individual level but also within the environment to support behavioural change (Bandura 1986). The ECYDM proposes that in order for at-risk youth to avoid pregnancy and pursue higher education and professional careers, an adequate level of environmental resources and support are necessary to assist the individual (Smith 1982, Comer 1989, Brooks-Gunn et al. 1993). Youths who have adequate resources to support their educational and career ambitions will not only be low risk for pregnancy and other high-risk behaviours, but will also have better grades, a better school attendance record, and will graduate from high school. In addition, such youths will enter college for higher education and career training. Early identication of highrisk youth is necessary to develop appropriate interventions to reduce high-risk social behaviours. The key normative position for this model is that programmes should be

designed to help disadvantaged or at-risk youth with opportunities to attain their educational and career aspirations in order to delay pregnancy and early parenthood. Conceptual elements The ECYDM in Figure 1 has ve essential elements: individual characteristics, environmental resources availability, high-risk social behaviours, primary prevention intervention, and desired outcomes. The elements of the model are dened as follows. Individual characteristics are demographics essential to developing age-appropriate interventions to improve desired outcomes. Individual characteristics include personal goals, age, gender, race and ethnicity, socio-cultural factors, socioeconomic status, and knowledge about reproduction. Environmental resources availability are support systems and community factors that enhance individual growth, education, career, and social development. Environmental resources availability includes support systems, parents, peers, mentors, and community resources. High-risk social behaviours are activities that may have negative consequences for a youths future development and result in outcomes that may affect the overall well-being and quality of life of an individual. The high-risk social behaviours include early initiation of sexual activities, poor
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academic achievement and school dropout, drug use, teenage pregnancy and early parenthood. Primary prevention intervention is organizing and delivering relevant activities to achieve desired outcomes based on the assessment of individual youth characteristics, environmental resources availability, and high-risk social behaviours. The goals of primary prevention intervention are: (a) to reduce the number of adolescents at risk for pregnancy and early parenthood; and (b) to enhance health, educational, career, and social outcomes of youth in inner city urban communities. Desired outcomes are results of appropriate interventions provided to minimize the risks of adolescents. Outcomes are short and long term. The desired short-term outcomes are improved academic grades, improved school attendance, and improved orientation to educational and career goals. The desired long-term outcomes are delayed pregnancy and parenthood, graduation from high school, and attendance at college.

Data collection Data collection began in September 1998 and ended in December 1998. Data were collected using a structured interview guide, demographic questionnaires, and observation. Data collection involved individual and focus group interviews. Four focus groups were conducted with 19 adolescents, and 24 individual interviews were conducted; nine with adolescents, and 15 with adults. Focus group interviews took place in school after classes and lasted 4590 minutes; the average time was 60 minutes. Individual interviews took an average of 45 minutes and were conducted in homes, classrooms, ofces, and social rooms. The researcher conducted all interviews, which were tape recorded with participant permission. Participants each received $10 as compensation for their involvement. Instruments The development of the items in the structured interview guide and demographic questionnaire were based on the ECYDM, the review of literature on adolescent pregnancy, and the researchers years of experience working with disadvantaged minority youth. Attention to construct and content validity strengthened the study. Construct validity was ensured by the use of multiple sources of evidence, including observations, interviews, and questionnaires. Data collection from different role-sets, including adolescents (males, non-pregnant, pregnant, and parent females), parents, school staff (teachers, counsellors, a social worker, a nurse, a principal), and clergy provided multiple data sources with diverse perspectives. Dissertation committee members and a sample of adolescents ascertained face and content validity for the questionnaires and interview guide. Reliability was determined by examining consistency and variation of responses of (a) each individual; (b) within a group; and (c) between groups. Data analysis Audiotapes from focus group and individual interviews were transcribed verbatim before beginning analysis. Transcripts were initially read to identify themes, patterns, and various categories. Categories were on the concepts and domains of the ECYDM. Qualitative data were coded using ATLAS.ti for Windows 40, a software programme for visual qualitative data analysis.

Study methods
This exploratory and descriptive study used qualitative methodology to validate elements in ECYDM with the perspective of community members on teen pregnancy prevention for minority youth in urban communities. Data were collected from a convenience purposive sample of 43 teens and adults in two urban public high schools in two communities in a major mid-western city. All study participants were African Americans who met the criteria for inclusion. To be included in the study, teen participants had to be: (a) an African American between the ages of 13 and 19 years old; (b) attending one of the selected study high schools; and be (c) a male or female teen, non-pregnant, pregnant, or parent. Criteria for adult participants were that the adult be: (a) African American; (b) reside or work in one of the selected communities; or (c) have a teenager attending school at any of the study schools; or (d) be a school principal, career counselor, teacher, social worker, or a school nurse at one of the selected schools. A sample size of 4050 participants was anticipated; 43 were recruited. Ethical considerations Approval from the Institutional Review Board was obtained before beginning recruitment. Participation in the study was voluntary. A consent form was obtained from each participant. A parental signature was obtained for all student participants less than 18 years of age who had not reached the legal status of majority. Written permission was obtained from the principal of each high school prior to conducting the study.
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Findings
Four parents participated in the study; three females and one male. All were African Americans and had lived in the community for an average of 16 years. Two of the parents

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had a 4-year college education, three were married, and all were employed. Two female parents had been teen parents at 17 and 18 years of age. Nine school staff and two ministers participated in the study; only one lived in the community, and eight had worked in the community for <10 years. Of the 11 school staff and ministers, four were males and seven were females; six were over 41 years of age; seven were parents to teens, and four did not have any children. The educational background included three participants with a bachelors degree, seven with a masters, and one with a doctorate. The school staff included a principal, two counsellors, four teachers, a social worker, and a school nurse. All 28 teens were African American; six were males and 22 were females; 75% lived in the communities where the study was conducted. Participants ages ranged from 14 years to 18 years, with a mean age of 16 years; the modal age was 17 years. Of the participants, 17 were non-pregnant, ve pregnant, ve parents, and one was a repeat pregnancy. There were no teen fathers. Ages of pregnant and parent teens ranged from 14 to 18 years, with a mean age of 16 years (SD 108). The majority of teen participants reported living with their parents; 12 came from two-parent households and 11 were from single-parent homes; two lived with their guardians, three indicated other; and 12 indicated mother as the sole income earner in their household. Of the teen participants two were freshmen, six sophomores, 11 juniors, and nine seniors.

These kids have no sense of future direction and most of them often do not know what they want to be or do. They think they dont need an education and a lot of times they just go to school without thinking about what they want to do.

Perspectives on the elements in conceptual model domains


Findings of the study are discussed in relation to community members perspective on the factors contributing to teenage pregnancy, type of pregnancy prevention programme needed, and validation of community members perspective on teenage pregnancy prevention with elements of the ECYDM.

Participants perceived age as a contributing factor to teenage pregnancy. Teens, parents, school staff including school nurse, and ministers indicated that teenage pregnancy was a problem in their schools and communities. They indicated too many girls become pregnant at the age of 13, 14, 15, and 16 years. Lack of parental consent for contraceptives for minors was mentioned as a contributing factor to teenage pregnancy. Gender was also perceived as a contributing factor in teenage pregnancy; as was lack of male responsibility in teenage pregnancy. From the teen males perspective: Some girls may have a little self-esteem and that will cause them to look for a father in a boyfriend and if the male is not a gentleman he may take advantage of her. Some of the pregnant and parent teens mentioned they became pregnant because they wanted to have their own experience of childbearing and motherhood. Teen parents perceived achieving motherhood as a sign of independence from parental control and authority. The perception that teenage pregnancy and early parenthood are more common among African Americans resonated among the participants. A majority of the parents, school staff, and ministers mentioned that African American teens who becomes pregnant often come from families with a history of teenage pregnancy. The majority of teens, including males and females, perceived teenage pregnancy as the norm in their families and communities. Several teens stated:
Most of us, our mothers had us when they were young; that has been going on for years, like young teenagers having babies. My family members, like my brother and my sister, they had children at an early age.

Factors contributing to teenage pregnancy


Individual characteristics Within the domain of individual characteristics, participants perceived personal goals, age, gender, race and ethnicity, socio-cultural factors, socioeconomic status, and knowledge about reproduction as the factors contributing to teenage pregnancy. Participants mentioned lack of personal goals, ambition, determination, sense of direction, as well as lack of educational or career goal as factors contributing to teenage pregnancy. One teacher stated:

Though the majority of school staff and ministers indicated that pregnancy and early parenthood create problems for teens continuing their education; they were also cautious in dening teenage pregnancy as a problem. While they acknowledged the economic hardships for teen parents, the behaviour was neither condoned nor discouraged. Participants perceived family upbringing, beliefs, a dysfunctional family, moral values, and spiritual values as socio-cultural factors contributing to teenage pregnancy. From the participants perspective, teenage pregnancy prevention begins at home with household discipline. Comments by several teens to exemplify this point included If you raise your child well, you wont have to worry about her becoming pregnant,
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It starts with household discipline, The problem starts at home without a father gure. The perception that African American teens from lowincome families and communities become pregnant and early parents as a result of socioeconomic status was reported by several teens and school staff. School staff and parents mentioned lack of nancial resources for abortions as a contributing factor to teenage pregnancy. In their view, White and Black teens from middle-class societies who become pregnant from premarital sex receive nancial support from their families for abortions. The majority of African Americans in low-income, inner city communities often cannot afford abortion for unplanned pregnancies. Participants also perceived lack of knowledge and information about reproduction as factors contributing to teenage pregnancy. Parents, ministers, and school staff including a school nurse mentioned the only way teens can protect themselves from becoming pregnant is by education. Several of the participants stated: Teens should be well informed of the consequences and risks, so that the decisions they make will not be made in ignorance. Most of the girls do not have the knowledge about their bodies to stay out of trouble. In this study, 33% of teen males and 55% of females had engaged in unprotected sexual activities. This implies that more than 50% of the teens were not using condoms to protect themselves from sexually transmitted diseases. Environmental resources availability Family members were the most mentioned support systems that directly or indirectly contributed to teenage pregnancy. Participants perceived lack of parental involvement, lack of support, and lack of supervision and monitoring of teens activities as factors contributing to teenage pregnancy. One minister stated:
I have seen them become pregnant, the same teen pregnant again and again and grandma has the child. Grandparents take on too much responsibility and they end up being the mother and allow the child to go on just to resume life. When you have aunties and grandmothers taking care of the baby while the teen is out there doing the things she was doing before becoming pregnant, they do not get to learn the hardships of raising a child.

in parenting. They prefer their peers who have been through the experiences to talk to them instead of older adults. In their view, adults tend to be judgemental and often do not listen to young people. According to several of the teens, adults often say, Dont have sex, dont do this, dont do that because to adults you just got to be a teenager. A majority of the participants described their community as impoverished with few resources. Participants perceived lack of recreational and constructive activities in disadvantaged communities as a factor contributing to teenage pregnancy and other high-risk social behaviours. The school nurse stated: There is lack of structure in terms of providing activities here in the school and in the community. They have a lot of spare time and they are bored. The phrase there isnt much around here for the kids to do was echoed by a majority of the participants. High-risk social behaviours Drugs, gangs, violence, and safety, were mentioned as concerns. In this study, 61% of the teen participants indicated their involvement in high-risk behaviours. High-risk social behaviours identied by participants included early sexual activity, poor academic achievement, school dropout, prostitution, drug use, gangs, violence, teenage pregnancy, and early parenthood. Several participants mentioned prostitution, drugs, and violence as major problems facing young people in their schools and communities. One teacher stated:
Just the loss of innocence meaning they are exposed to so many things so early in life, negative things like prostitution, drugs, violence in the home and outside of the home. Loss of innocence if kids are forced to go to work early in life, much too early to help make ends meet at home. Thats a problem in the community. Just having to grow up overnight and handle adult types of things, which lead to them doing other adult kinds of behaviour.

Participants perceived peer pressure and negative peer modelling as factors contributing to teenage pregnancy. Several of the teens mentioned that girls pressure their peers to have sex. Pregnant and parent teens glamorize parenthood and do not tell their peers about the hardships. The majority of the teens mentioned that it would be helpful to have pregnant and parent teens talk to their peers about the hardships involved
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Participants viewed lack of role models rather than lack of mentors as a key element in teenage pregnancy. Participants indicated youth in their communities often do not have responsible adults to model positive behaviours in their homes. Participants also perceived society and the media as factors contributing to teenage pregnancy and other high-risk behaviours. According to participants, teenage pregnancy has become more socially acceptable, making it easier for young people to become pregnant and early parents. Images on television glamorize adolescent sexuality. One school staff member stated:
Society has made it more acceptable; there isnt as much stigma as it has been. It is acceptable more because society accepts it and it is

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A model to reduce teenage pregnancy

Desired outcomes
Participants perception of culturally relevant interventions in prevention programmes to achieve desired outcomes was congruent with the ECYDM. Decreased pregnancy rates and early parenthood, improved school attendance and grades, increased high school graduations, and increased college attendance were supported in the ECYDM as desired outcomes of the prevention programme. Additional outcomes perceived by participants as important were improved parenting skills of young parents, decreased school dropout, and increased programme enrolment.

Type of prevention programme


Participants perception of an educational-motivational programme to reduce pregnancy among African American teens was congruent with the ECYDM. Thirty-eight of the participants mentioned a motivational programme as the type of prevention programme needed to encourage and motivate teens to delay pregnancy and parenthood to pursue their educational and career goals. Several of the participants including the school nurse mentioned, a motivational programme to mentor, motivate, stimulate, and prepare young people at an earlier age for success through education would be the key to pregnancy prevention. The school nurse stated such a programme has to be multifaceted. Components of the programme would include health education, educational and career preparation, and youth social development. Programme services would include individual and group counselling, teaching, and information giving. Education about sex, reproductive health, contraception, condom use, prenatal care, parenting, and sexually transmitted diseases were topics suggested by participants as important to be taught to young people in the prevention programme. Condential service for individual counselling was strongly recommended by participants. Incentives to reward teens participation and attendance were also recommended. One teen stated, Make it fun and something that you are going to pay attention to. If its going to be everyday same old boring stuff, you will be tired of it. Educational preparation of teens would include college tours and visits, information sessions on grants, loans, and scholarships. Career preparation would include activities such as career fairs, eld trips, and invited speakers from different professions to increase young peoples awareness of available occupational elds. Problem-solving and coping skills, job programmes, etiquette and social skills training, community or voluntary service, discussion on adolescent sexuality, dating, relationships, recreational and cultural activities, and exposure to different geographical settings and cultures were mentioned by participants as essential inclusions of the programme to promote youth social development. Several of the participants also mentioned childcare as an essential component of the programme. The school nurse stated:
Childcare seems to be a major issue that causes most of our girls to drop out. They miss many days of school because of childcare. Providing childcare either near in proximity to the school building or in the building will be tremendous help to young mums in class.

Congruency in community perspectives and the model


The ndings supported elements in the ECYDM as a pregnancy prevention programme for African American teens in inner city urban communities. With a few additional concepts such as role models, prostitution, violence, society and media that emerged from the study, all of the elements proposed in the ECYDM were supported to reduce teenage pregnancy among African teens in inner city urban communities. Findings also supported the ECYDMs underlying premise of the model that environmental resources shape individual youth characteristics and help youth to avoid highrisk social behaviours, including teenage pregnancy and early parenthood. Based on the ndings, changes were made to the model. A newly revised model is presented in Figure 2.

Discussion
Analysis of participants perspective on teenage pregnancy
Teens perspectives Teen perspectives came from males, and non-pregnant, pregnant, and parent females. Teens perceived gender, parents, peers, and high-risk social behaviours as the key factors contributing to teenage pregnancy. In their view, most girls become pregnant as proof of love to their male partners and also to secure the relationship. In addition, young girls engage in sex for fear of losing their boyfriends. Hence, a majority of girls go to great lengths to gain the attention and love of their male partner. According to the males, poor self-esteem among the girls and the desire for a father gure place adolescent girls from unstable homes at risk of becoming pregnant and early parents. Boyfriends take advantage of the girls low self-esteem to give girls misinformation about their fecundity and contraception. There is a need to teach young people, particularly girls,

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Environmental resource availability Support systems Parents Peers Role models Community resources Society and media

Individual characteristics Personal goals Age Gender Race/ethnicity Socio-cultural factors Socio-economic status Knowledge about reproduction

High-risk social behaviours Early initiation of sexual activity Poor academic achievement School dropout Prostitution, drug use, violence Teenage pregnancy Early parenthood

Primary prevention intervention (PPI) Educational-motivational programme with the following components: Health education Educational preparation Career preparation, social development, and Childcare resources to improve youth outcomes Desired outcomes Short term Improved academic grades Improved school attendance Improved orientation to educational and career goals Increased programme enrollment Available environmental resources Long term Decreased pregnancy rate Delayed early parenthood Decreased school dropout Increased high school graduates Increased college enrolles Improved teen parenting skills Low-risk for pregnancy and parenthood

Limited environmental resources

High-risk for pregnancy and parenthood

Figure 2 Revised educational-career youth developmental model.

how to experience quality boy-girl relationships and enhance their self-esteem. Parental involvement in teens education and social development was perceived by teens as a great need. According to the teens, the majority of parents work two or three jobs to make ends meet. As a result, parents are never home for quality family activities or available for parental supervision and monitoring of childrens activities. In addition, a majority of parents do not attend school meetings and often do not show concern for their childrens education. The lack of parentchild communication, love and affection, and home sex education were perceived by teens as essential factors contributing to teenage pregnancy. The need for quality and better parentchild relationships was strongly emphasized by teens in this study. Peer pressure and negative peer modelling were perceived by teens as factors contributing to high-risk social behaviours. Young men and women are pressured to join gangs, take drugs, and become sexually active or pregnant. According to the teens in this study, those who refuse to conform often suffer consequences from gang members in the school or community. Boredom and lack of recreation, constructive activities, and job programmes, were mentioned as the factors contributing to high-risk behaviours. Life on the streets for recreation becomes the norm rather than the
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exception, and the pressure to conform to negative behaviours becomes greater.

Adult perspectives
Adult perspectives came from parents, school staff including a school nurse, and clergy. From the school staff perspective, teens that become pregnant are often from low-income, single parent families with minimum nancial resources and support for education. In the view of the adults, a majority of low-income teens do not consider college education to be a viable option beyond high school. Pregnancy and parenthood become a self-fullling means to an end. From the school nurses perspective, peer pressure, lack of parental support, role models, and child care resources were factors that contributed to high-risk social behaviours. Teens need close monitoring and the help to make appropriate decisions regarding health care, social and parenting issues. Early grooming and socialization of youth for success must begin in elementary schools. From the parents and clergys perspectives, the lack of parental discipline in the home contributes to teens engaging in high-risk social behaviours. A majority of young people are disrespectful of their parents authority and have too much freedom in their homes to do as they please. In addition,

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mothers and grandmothers contribute to early pregnancy and parenthood. Mothers do not discourage their daughters from becoming pregnant, and grandmothers contribute to the process by participating in the childrearing and expressing happiness. Furthermore, laws and regulations protecting children make it difcult for parents to exercise appropriate control and discipline in raising their children. From the clergy perspectives, teens from families with strong religious and moral values are at less risk of engaging in high-risk social behaviours. In their view, the lack of spiritual development or growth among youth and their families contributes to teenage pregnancy. Similarities in responses of participants indicated that adults and teens perceived age, personal goals, race and ethnicity, socio-cultural factors, lack of role models, and knowledge about reproduction as factors contributing to teenage pregnancy. Both adults and teens perceived an educational-motivational programme that promotes health education, career preparation as the pregnancy prevention programme for youth in inner city communities. The need to organize a prevention programme involving the community was strongly indicated by participants.

none of which were fathers. These male teens seemed more knowledgeable and had a positive attitude toward contraception and prevention. Thus, they may have not represented the average male teen in the target population. The use of a single investigator for data collection and data analysis may also have increased the risk of bias. The similarities in responses among participants were much greater than the differences. The use of different role-sets for the study such as male teens, female teens who were non-pregnant, pregnant, and parenting, parents, nurse, school principal, and clergy enhanced the credibility of ndings.

Conclusions
These ndings have implications for programme design, future research, and nursing education. The ndings suggest that a piecemeal approach to reducing teenage pregnancy in inner city urban communities will be ineffective. To achieve desired outcomes, programme interventions must be designed from a holistic perspective to address identied high-risk behaviours in the community that affect youths growth and development. Although the ndings cannot be generalized beyond the participants, it can provide directions for future research. Research is needed to develop an instrument that will assess the stability and consistency of the elements of the ECYDM. Furthermore, longitudinal studies to test the implementation of the model are needed. Adolescents present a challenge to nurses as well as an opportunity to promote health values. Advanced educational and clinical preparation of nurses is necessary for nurses to intervene with adolescents in a knowledgeable and effective manner. For nursing to assume leadership in service, research, and public policy in adolescent health, educational institutions must provide students with the opportunity to develop expertise about the health needs, health care system and service delivery of this vulnerable population.

Strengths and limitations


The main strengths of this study are its preliminary data on an educational-career programme as an alternative approach to reduce teenage pregnancy in inner city urban communities and the possibilities it offers for further research. The study was an attempt to improve the understanding and effectiveness of pregnancy prevention programmes aimed at young men and women in low-income inner city urban communities. However, several limitations exist. Data collection was cross-sectional and the ndings cannot be generalized beyond the schools and communities in this study. Data collection from different role sets might have been affected by differences in age, educational level, and community settings although coding results were similar within groups. Selection, history, and maturational effects may also have inuenced data collection methods. The views and perspective of parents, school staff, teens, and ministers in the study on teenage pregnancy prevention may not represent those of the general population. Personal interest and family history of teenage pregnancy may have inuenced the voluntary participation of participants. Additionally, data collection may have been inuenced by differences in unequal group sizes. The sensitivity and the comfort level of discussing teenage pregnancy may have affected sample size. Only 4 of 30 parents agreed to participate in the study, and only six male teens participated,

Acknowledgements
The author would like to acknowledge the Primary Health Care Research Training Program, National Institute of Nursing Research, US National Institutes of Health (NIH) for it support of this study through a Predoctoral Fellowship (NRO 7079).

References
Aday L. (1993) At risk in America: The Health and Health Needs of Vulnerable Populations in the United States. Jossey-Bass, San Francisco.

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