Adolescent pregnancy is associated with a variety of health, social, economic, and educational consequences including an increased risk of pregnancy and birth complications, higher risk of premature birth, high rates of financial insecurity, and less educational attainment (Eliner et al., 2022; Hillis et al., 2004; Cone et al., 2021). Due to these concerns, the reduction of adolescent pregnancy is an important public health goal defined by the Office of Disease Prevention and Health Promotion (U.S. Department of Health and Human Services, 2020). Hamilton County has the highest rate of teenage pregnancy in Florida, indicating that this region of the state requires particular attention and resources (Florida Department of Health, 2022). The proposed intervention is targeted at adolescents aged 15-19 attending Hamilton County High School.
When trying to further understand the root causes of teenage pregnancy, it has been suggested that a history of childhood trauma and other adverse childhood experiences (ACEs) may contribute to an increased risk of becoming pregnant during adolescence (Hillis et al., 2004). These findings indicate that it may be possible to target rates of teen pregnancy by using an intervention that mitigates some of the intermediary factors between ACEs and adolescent pregnancy. The proposed intervention uses a public health framework as well as trauma-informed and theory-based principles to improve rates of adolescent pregnancy in Hamilton County, Florida. The specific goals of the intervention are to improve knowledge of ACEs, the risks of adolescent pregnancy, and the connection between ACEs and teen pregnancy. Additionally, students will improve their knowledge of community resources for family planning and the most effective methods for reducing the risk of an unwanted pregnancy. Peer and social support and access to contraceptives will be emphasized through the program activities.
Program activities will include a three pronged-approach - education, peer mentorship, and access to contraceptives in the form of free male condoms. Students will be matched with a young adult mentor who will provide social support. Evaluation will occur with the use of pre- and post-intervention questionnaires.
Levels of Social Ecological Model, Trauma-Informed Principles, and Public Health Framework
This intervention focuses on three levels of social ecological influence from the CDC Social Ecological Model - individual, relationship, and community (CDC, 2022). At the individual level, the intervention will provide education and skill-building to improve sexual risk-taking behaviors. At the relationship level, peer mentorship will provide social support. And at the community level, the program will be integrated into school activities which will improve community culture around relationships, sex, and teenage pregnancy.
All program staff and mentors will receive training on trauma-informed principles. This project has been designed and developed using the 6 principles for trauma-informed approaches from the Substance Abuse and Mental Health Services Administration (Oral et al., 2016). These principles are safety, trustworthiness & transparency, peer support, collaboration & mutuality, empowerment & choice, and cultural, historical, and gender issues (Oral et al., 2016).
In addition to trauma-informed approaches and a social ecological perspective, this intervention will be developed and implemented using a public health framework. The major work of public health is to improve the health of communities and populations by using a multi-pronged, upstream approach that recognizes the various contributing factors to health problems (Trauma-Informed Philanthropy, n.d.). In this project, a public health framework will help to increase collaboration with community partners and tackle the concern of adolescent pregnancy from a variety of angles. This approach recognizes the importance of utilizing policy changes to improve the health of communities. Therefore, this project hopes to contribute to policy changes after the program has been evaluated and relevant information has been discovered.
References
Centers for Disease Control and Prevention. (2022, January 18). The social-ecological model: A framework for prevention. Centers for Disease Control and Prevention. https://www.cdc.gov/violencepr...ecologicalmodel.html
Cone, J. N., Hendrick, C. E., Owotomo, O., Al-Hamoodah, L., & Maslowsky, J. (2019). Socioeconomic well-being in early adulthood among repeat versus one-time teenage mothers. Youth & Society, 53(7), 1090–1110. https://doi.org/10.1177/0044118x19892455
Eliner, Y., Gulersen, M., Kasar, A., Lenchner, E., Grünebaum, A., Chervenak, F. A., & Bornstein, E. (2022). Maternal and neonatal complications in teen pregnancies: A comprehensive study of 661,062 patients. Journal of Adolescent Health, 70(6), 922–927. https://doi.org/10.1016/j.jadohealth.2021.12.014
Florida Department of Health . (2022). Births by mothers’ age - florida health charts - florida department ... Florida Health Charts. https://www.flhealthcharts.gov...ort=Birth.Dataviewer
Hillis, S. D., Anda, R. F., Dube, S. R., Felitti, V. J., Marchbanks, P. A., & Marks, J. S. (2004). The association between adverse childhood experiences and adolescent pregnancy, long-term psychosocial consequences, and fetal death. Pediatrics, 113(2), 320–327. https://doi.org/10.1542/peds.113.2.320
Oral, R., Ramirez, M., Coohey, C., Nakada, S., Walz, A., Kuntz, A., Benoit, J., & Peek-Asa, C. (2016). Adverse childhood experiences and trauma informed care: The Future of Health Care. Pediatric Research, 79(1–2), 227–233. https://doi.org/10.1038/pr.2015.197
Trauma-informed philanthropy: Philadelphia Aces. ACES Philadelphia. (n.d.). https://www.philadelphiaaces.o...InformedPhilanthropy
U.S. Department of Health and Human Services. (2020). Reduce pregnancies in adolescents - FP‑03. Reduce pregnancies in adolescents - FP‑03 - Healthy People 2030. https://health.gov/healthypeop...es-adolescents-fp-03
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