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Discussion Topic: HN430

This week’s discussion will focus on incidence rates and interventions related to teen pregnancy.

Use the internet or other resources to find the incidence and frequency rates of teenage pregnancy in your community or in your state. What do you think are the primary factors that contribute to these rates (whether they are high or low) and influence high risk sexual behaviors? How does positive relationships with parents associate with lower teen pregnancy?

Review the case study in Box 9.1 on page 199 of the textbook. What do you think were the greatest influences on her situation? How would you advocate for Susan? What referrals would you make or resources would you recommend? What ethical interventions would an advocate need to consider when working with Susan?

Case Study:BOX 9.1: Daddy’s Girl

When 16-year-old Susan and her father came for counseling to work on their relationship, she appeared sullen, depressed, and angry. When I met with her alone, she explained that her father had tricked her into coming by telling her he was taking her shopping. She confided that she was pregnant, that her father did not know, and that she hadn’t been able to hold down food for three straight days. Susan’s mother had “run off years ago.” Susan reported that she had had one abortion already and was very reluctant to have another one. When I saw her father alone, he told me that he knew she was pregnant—“Well, that’s why I brought her to you.” He emphasized several times, “I’m a hundred percent behind her. I support Susan all the way.” He told her the same thing when the two were brought together and she acknowledged her pregnancy. In the same breath he told her, “The decision is totally up to you. But, of course, if you decide not to get an abortion, you’ll have to live somewhere else.”

Susan did not show up for her next appointment. She sounded tearful when she answered the phone.

“Couldn’t you make it in today?” I asked.

“No, I’m sick. Well … I had an abortion this morning.”

Despite repeated calls and letters to her father, he would not bring her in for additional counseling. So far as her “supportive” father was concerned, Susan no longer had a problem.

© Cengage Learning 2013

Read Chapter 9, " Teen Pregnancy & At Risk Sexual Behaviors."

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Sexual Behavior • • A young girl-woman, without education, without resources, stressed and depressed, rears her baby alone and bends like the poplar. Gentle summer rains nourish the soil … but where do the poplars and the waters meet? CHAPTER OUTLINE The Scope of the Problem: Teen Pregnancy The Scope of the Problem: AIDS and Other Sexually Transmitted Diseases Precursors of Risky Sexual Behavior: Background Characteristics Adolescent Development Antecedent Characteristics Interpersonal Influences Box 9.1 Daddy’s Girl Precursors of Risky Sexual Behavior: Media Influences Television and Other Media Internet Pornography, Sexual Solicitation, and Sexting Positive Media Potential Box 9.2 A Sexting Tragedy Consequences of Early Childbearing Socioeconomic Consequences Educational Consequences Health-Related Consequences Family Development Intervention Strategies Focused on Risky Sex Nonsexual Antecedent Program and Approaches Sexual Antecedent Programs Specific Intervention: An Adlerian Model Purposiveness of Behavior Goals of Misbehavior • • • Attention Power Revenge Box 9.3 Lying for Revenge • • Assumed Inadequacy Summary Corrective Procedures • • • • Corrective Procedures for AGMs Corrective Procedures for Power Corrective Procedures for Revenge Corrective Procedures for Assumed Inadequacy Natural and Logical Consequences Encouragement Conclusion • Problems related to adolescent sexual activity are broad-ranging and complex, including pregnancy, abortion, sexual identity difficulties, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), other sexually transmitted diseases (STDs), childhood molestation and incest, and sex-related violence. No one chapter can fully attend to the interpersonal, psychological, and social implications of these issues. We focus on two critical problems related to a young person’s sexuality, sexual development, and sexual activity: the problem of “babies having babies” and HIV/AIDS and other STDs. More specifically, in this chapter we discuss (a) the incidence and frequency of teenage pregnancy, (b) incidence of AIDS/HIV and other STDs among teens, (c) background factors associated with risky sex among teens including media influences, (d) the consequences of risky sex, and (e) prevention and treatment strategies. THE SCOPE OF THE PROBLEM: TEEN PREGNANCY After steady increases in the teen pregnancy rate in the 1980s, the United States has made clear progress in reducing it. By 2005, the rate had fallen 41% from its 1990 peak (Finer, 2010). This decline in teen pregnancy and birthrates is attributed to decreased sexual activity and increased use of contraceptives; undoubtedly, part of the credit goes to the many, varied pregnancy and STD/HIV prevention programs that have been instituted. In 2005, teen birthrates were at their lowest recorded level, although the rate increased 3% in 2006 and some expect it to continue to rise (Kost, Henshaw, Carlin, 2010). Currently, teenage girls give birth to over 1,200 babies each day. Even with the reported decreases, over half of U.S. adolescents start having sex during their teen years, a figure that has been fairly stable over the past decade; 6 out of 10 teens have sex by the time they graduate from high school; 1 in 5 report having sexual intercourse before age 15, and more than 1 in 3 teenage girls get pregnant before age 20. Approximately 78% teen pregnancies continue to be unplanned (Kost, Henshaw, Carlin, 2010; National Campaign to Prevent Teen Pregnancy, 2005). Even with recent declines, the United States still has the highest teen pregnancy and birthrates among comparable industrialized nations. Teen birthrates in the United States have declined but remain high, especially among African American, Latino, and southern state adolescents (Centers for Disease Control and Prevention/CDC, 2011). In addition, the United States has higher teen pregnancy rates than most developing nations (Centers for Disease Control and Prevention/CDC, 2011). In countries with lower teen pregnancy rates, contraceptive services are confidential, widely available, and very inexpensive or free (Brown & Eisenberg, 1995). Only 13% of U.S. teens have had sex by age 15; by the time they graduate from high school, however, about two-thirds of all students have had intercourse (Abma, 2010). When younger girls first have intercourse, they are more likely to have had involuntary or unwanted first sex (National Campaign to Prevent Teen Pregnancy, 2001). Regular use of alcohol, cigarettes, and marijuana by 14- and 15-year-olds is also related to their engagement in sexual intercourse with boys more likely than girls to have used alcohol or drugs. Also, European American (28%) and Latino (24%) students are more likely than African American students (18%) to use alcohol or drugs at sexual intercourse (Centers for Disease Control and Prevention, 2002). Although contraceptives can prevent pregnancy, they can be complicated to use and difficult and expensive to obtain. They may also seem unnecessary to teenagers, even though a sexually active teenage girl who does not use contraceptives continue to have a very high chance of becoming pregnant. Teen girls use contraceptives much more sporadically than older women (AGI, 1999). Teenage contraceptive use at first intercourse rose from 48% to 65% during the 1980s, mostly due to the doubling in condom use. By 1995 contraceptive use at first intercourse reached 78% (AGI, 1999). However, more than 1 in 5 students failed to use condoms at last sexual intercourse, leaving them at risk for pregnancy and sexually transmitted diseases (Kann et al., 1998). Meanwhile, consistent contraceptive use has been significantly related to factors such as high academic expectations, good relationships with both parents, lower rates of involvement in delinquency and substance use, lower association with deviant peers, and more frequent attendance of religious services (Costa et al., 1996). About 33% of students in grades 9 through 12 nationwide reported that they are currently sexually active (CDCP, 2002), and more than 40% reported that they had not used a condom during last sexual intercourse. Male African American students were more likely to report condom use than European American or Latino students. Female and European American students reported birth control pill use more than male, Latino, and African American students. Teenage women would experience an estimated 385,800 additional unintended pregnancies annually if publicly subsidized contraceptive services were not available; therefore, publicly funded contraceptive services annually avert about 154,700 teen births, 183,300 abortions, and 47,800 miscarriages or spontaneous abortions every year (Forrest & Samara, 1996). The response of adolescents to pregnancy is changing as well. The teen abortion rate in the United States declined by 21% between 1991 and 1995, and more teens chose to give birth rather than to terminate their pregnancies (Henshaw, 1998). Nonetheless, teenagers receive more than 25% of all the abortions performed in the United States, giving the United States the highest rate of teen abortion among developed, industrialized countries (Brown & Eisenberg, 1995). In addition, formal adoption among teens has declined sharply in recent decades, with less than 1% placing their children for adoption (Child Trends, 1996). Children of teens in Latino, African American, and Native American families are often parented or informally adopted by a member of the extended family. Current trends also suggest that many adolescent girls would rather have an abortion than carry an unwanted pregnancy to term and relinquish the baby for adoption. Of course, in addition to pregnancy, risky sex also has the potential danger of Sexually Transmitted Diseases (STDs) including HIV/AIDs. We discuss these problems next. THE SCOPE OF THE PROBLEM: AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES Approximately 9 million new STDs occur among teens in the United States every year (AGI, 2011). Gonorrhea, genital warts, herpes, and syphilis are all too common. In a single act of unprotected sex with an infected partner, a teen girl has a 1% risk of acquiring HIV, a 30% risk of getting genital herpes, and a 50% chance of contracting gonorrhea. Chlamydia, an infection of the vagina or urinary tract, is the most frequently diagnosed STD among adolescents. Each day 54 young people under the age of 20 are infected with HIV. The total number of reported AIDS cases among 13- to 24-year-olds in the United States exceeded 31,000 in the year 2000, and most of those in the 20- to 24-year-old age group were infected during their teens. African American and Latino youth are vastly overrepresented in AIDS cases in the 13- to 19-year-old age group, representing 61% and 21% of new AIDS cases, respectively (Devieux et al., 2005). Young people are most likely to have contracted AIDS via sexual contact with men, with only about 10% of reported cases resulting from intravenous drug injection (CDCP, 2000). Finally, although rates of contracting AIDS are declining overall, there has not been a comparable decline in HIV cases among youth (CDCP, 2002). Forty-six percent of a nationally representative sample of high school students had experienced sexual intercourse, and only 19% reported condom use. One in six teenagers has had a sexually transmitted infection (SDI), and half of all new HIV infections in 2001 occurred in those under age 25 (CDCP, National Center for Health Statistics, 2003). Knowledge regarding STDs is low among teenagers. For example, one survey found that only 12% of teens were aware that STDs infect as many as one-fifth of people in the United States, and 42% of teens could not name a single STD other than HIV/AIDS (American Social Health Association, 1995). Even more alarming, in a study of sexually active female adolescents, 81% indicated that they had “never done anything that could give them a chance of getting AIDS,” and most believed that their chance of contracting HIV was “very low” (36%) or “nonexistent” (37%). Their reasons for feeling safe included that they were currently monogamous, they believed their partner was safe and faithful, they believed that they were good at choosing partners carefully, they used condoms, and they did not use injection drugs (Overby & Kegeles, 1994). Note that only one of these reasons, using condoms, is a reliable (though not guaranteed) means of reducing risk of HIV transmission. Teens tend to feel invulnerable to something as catastrophic as AIDS—“It can’t happen to me!” or else “Even if I get it, there will be a cure before it affects me.” That attitude, coupled with sexual activity, multiple sex partners, and ineffective, sporadic, or no condom use, makes teenagers very vulnerable for contracting HIV/AIDS. Sexually active adolescent gay males are particularly vulnerable to HIV infection. When adolescents experiment sexually with both male and female partners, teenage boys who experiment with unprotected sex with other males may not see themselves at risk if they do not selfidentify as gay, which many do not (Ryan & Futterman, 1998). Research on young men who have sex with men indicates high rates of risky activity. Two studies indicated that 38% to 55% or more of respondents reported unprotected anal intercourse (HIV Epidemiology Program, 1996; Valleroy, MacKellar, & Jacobs, 1996). Sexually transmitted diseases (STDs) have extremely serious health consequences that may be irreversible and, in the case of herpes and AIDS, are incurable. The fluctuations in adolescent risky sexual activity and subsequent STDs, pregnancies, abortions, and births can be attributed to a variety of factors. We review these next. PRECURSORS OF RISKY SEXUAL BEHAVIOR: BACKGROUND CHARACTERISTICS Family and social issues as well as psychological and interpersonal characteristics contribute to teen pregnancy. In this section we discuss (a) issues related to adolescent development; (b) antecedent characteristics that set the stage for teen pregnancy; (c) interpersonal influences, such as peer relationships and family dynamics; and in the next section we consider various form of the media that influence risky sexual behavior. Adolescent Development In view of the normal challenges of adolescence, it is not surprising that many teens are involved in sexual activity or that pregnancy so frequently results. One of the primary ways in which adolescents attempt to negotiate the transition from childhood to adulthood is through sexual activity. Even though most teenage parents never expected or wanted to conceive a child, many teens see sexual activity as a way to develop adult identity. Teens look to the opposite sex for validation and approval. Sexual behavior also provides a means of challenging parents on the way toward independence. Adolescence is an important time in the formation of sexual identity. Experimentation with sex is often a part of the learning experience. Interestingly, young people engaging in same-sex activity often do not identify as gay or lesbian. One study of male adolescents who reported same-sex intercourse found that only 54% identified themselves as gay (Ryan & Futterman, 1998). Models of gay or lesbian identity development characterize the process of developing a positive gay, lesbian, or bisexual (GLB) identity as a series of nonlinear and potentially reoccurring stages (Fassinger, 2000; E. H. McWhirter, 1994). For GLB teens of color, the process of developing a positive ethnic identity may conflict with the development of a positive sexual identity. GLB adolescents confront the task of forming a stigmatized identity just at a time when sameness and affiliation with peers are very important, and they may withdraw from their peers, stifle expression of their feelings and experiences, or develop a false identity. All of these strategies create anxiety. Not surprisingly, drug use, running away, family rejection, and risky sex are significant problems among GLB adolescents. Preparation for career, marriage or partnership, and family life is part of this developmental period for all adolescents, and sexual activity serves as a way for young people to test these future roles. When an unwanted pregnancy occurs, the developmental process is accelerated. Adolescents must cope immediately with adult roles: parenthood, finding a job, and dealing with social isolation and loneliness. In many cases they become dependent on public aid for survival. In addition, these adverse consequences for mothers and their children impose high public sector costs (Centers for Disease Control and Prevention/CDC, 2011). For many girls, pregnancy limits life options. However, if already restricted in opportunities, having a child may not alter their beliefs about options. Antecedent Characteristics Some personal and demographic characteristics place teens at risk for premature pregnancy; some serve as protective factors. For example, higher self-esteem decreases the risk of pregnancy for Latino and African American teens (Berry et al., 2000), but delinquent activity and alcohol use often precede teen pregnancy (Hockaday et al., 2000). Among urban African American girls, living in a more disorganized neighborhood, having low school expectations, holding deviant values, being a gang member, and engaging in early status offenses are the greatest risk factors for sexual activity. For these girls pregnancy may represent a source of gratification and independence (Lanctot & Smith, 2001). Pregnant African American girls are proportionally more likely to participate in status offenses than their sexually active but nonpregnant peers (Berry et al., 2000). Teens at risk for pregnancy are also likely to reject social norms, to have limited knowledge of their own physiology, to have difficulty using information about birth control, to be biologically mature, and to be less religious (Brown & Eisenberg, 1995; Haveman & Wolfe, 1994). Finally, a young woman’s socioeconomic status (Berry et al., 2000), perception of opportunity, and educational expectations are crucial determinants of pregnancy (Hockaday et al., 2000; National Campaign to Prevent Teen Pregnancy, 2001). Teens born to poor and less-educated teenage parents are more likely to bear children during adolescence (Berry et al., 2000; National Campaign to Prevent Pregnancy, 2001). Lower educational and career opportunities and coming from a single-parent family or from a family with marital strife and instability also increase risk. School dropouts are more likely to start sexual activity earlier, fail to use contraception, become pregnant, and give birth (Brewster et al., 1998; Darroch, Landry, & Oslak, 1999; Manlove, 1998). Teens who give birth are much more likely to come from poor or low-income families (83%) than teenagers who have abortions (61%) or teenagers in general (38%; AGI, 1999). Finally, early childbearing is associated with conduct disorder as well as with lower IQ, lower educational attainment, and lower SES (Jaffee, 2002). Interpersonal Influences A teen’s relationship with his or her parents is associated with adolescent pregnancy. Perceptions of high levels of warmth, love, caring, and connection with parents, as well as parental disapproval of teen sex, have been associated with delay of sexual activity among teenagers. Girls, more than boys, talk with their parents about “how to say no to sex” or about birth control (Martinez, Abma, & Casey, 2010). A close mother–daughter relationship, in particular, encourages girls to turn to their mothers for nurturance. Communication between mother and daughter about sexual issues, feelings, and behaviors can significantly help daughters learn and practice responsible sexual behavior. Girls who are close to their mothers are more likely to abstain from sex or to practice birth control (Dittus & Jaccard, 2000). Apparently, a good mother–daughter relationship provides a girl with a model for responsible sexual behavior and for maintaining a good relationship with a future partner. However, even though most parents see it as their responsibility to talk to their children about sexuality, most do not engage in in-depth discussions with their children about sex (Byers, 2011). In fact, many teens who have had sexual intercourse have never spoken with their parents about sex (Centers for Disease Control and Prevention/CDC, 2011). Families characterized by poor interpersonal relationships, ineffective communication, and limited problem-solving skills typically encourage teens to turn to peers, which often leads to risky behavior and irresponsibility. In one study, the only significant predictor of teenage girls’ attitudes about pregnancy was their boyfriends’ attitudes toward having children (Cowley & Tillman, 2001). Peers can provide support, fairly clear norms, and the structure that most adolescents want. Along with the media, peers are a primary source of information about sex. Unfortunately, adolescents who confidently share information may lack knowledge and may encourage premature and irresponsible sexual decisions. Finally, once a girl becomes pregnant, her mother usually has the most influence on the outcome, but not always (see Box 9.1). Often the mother pressures her pregnant daughter to keep the child. In this case, the relationships between mother, daughter, and baby tend to become confused, with the new grandmother taking on primary responsibility for the infant. Although these teen mothers may indeed have family support, the decision to keep the baby in the family often restricts their educational and occupational. Often this choice places the babies in a similar situation of restricted future options, and the cycle of “babies having babies” is perpetuated. BOX 9.1: Daddy’s Girl Wh ...
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Teenage Pregnancy

While there has been a significant decrease in the teen pregnancies in the USA, approximately an
8% decrease since 2014, there is still more that needs to be done. The picture becomes clearer
when one compares the statistics from the USA and other developed countries. The USA
remains as having one of the largest numbers of teen pregnan...

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