Melissa Hendrickson Auburn University NURS 7350 Teenage Pregnancy Melissa Hendrickson Auburn University NURS 7350

Goal The overall goal of this community assessment is to increase awareness of teenage pregnancy and identifying at risk individuals in Baker County, Georgia. One of the goals of Healthy People 2020 is to improve the healthy development, health, safety, and well-being of adolescents and young adults. It identifies that adolescents are influenced by their environment and by providing a positive environment healthy behaviors are established for a healthy, productive future population. Identifying the problem of teenage pregnancy and taking the steps necessary to provide information and activities to make a positive impact on the lives of the individual at risk for becoming pregnant can help meet this Healthy People 2020 goal. The goal of my assessment is to focus on identifying at risk individuals in the Baker County community and raise awareness of this growing problem.

Background Health Social Cost Increased risk of preterm delivery, low birth weight, & infant mortality. Children of teenage mothers are at an increased risk of child abuse, neglect, and foster care placement. Social Teenage mothers are more likely to do poorer in language and math. Are not married and are more likely to never get married. Cost Public health care for teenage pregnancies cost the average taxpayer roughly $44 million per year. The number of teenage pregnancies has risen over the last several years. Ultimately, a majority of teenage mothers never finish school. 25% of teenage mothers have a repeat pregnancy within two years. Children of teenage parents are more likely to follow in their parents footsteps and become teenage mothers themselves. By evaluating the health, social, and financial impact teenage pregnancies cause as well as the cycle of continued teenage pregnancies, I feel that this is a significant problem that needs to be addressed.

Population Between 2007-2010 the population of Baker County, Georgia were as follows: Total population – 3,805 Population less than 18 years old – 23% 46% Caucasion 49% African American 4% Hispanic Having a good understanding of the patient population in an area can help identify possible disparities that exist. Educational opportunities can be tailored to the identified population. This slide explains how of the total population of over three thousand residents of Baker County, Georgia, 23% are under the age of 18. This is further broken down into the different races/ethnicities in order to assess the risk behaviors specific to each group. For example; African American male teenagers living in lower income, single parent households are more likely to have intercourse verses their Caucasian or Hispanic counterparts Baker County, GA

Youth Risk Behavior Surveillance System (YRBSS) Assessment Tool Youth Risk Behavior Surveillance System (YRBSS) Sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection. Alcohol and other drug use The tool used to assess the risk behavior of local area teenagers was adapted from the Youth Risk Behavior Surveillance System (YRBSS). The YRBSS monitors six types of health-risk behaviors that are the leading causes of injury and death to the teenage population. The reason I chose to use questions from the YRBSS tool is because it not only asks questions about the sexual history, but also includes other risk taking behaviors that could contribute to an unwanted teenage pregnancy. This tool is a national school based survey that is administered by the CDC and state and local governments. The data collected from the YRBSS survey are used to measure progress toward achieving national health objectives for Healthy People 2020 and other program and policy indicators. Results from the YRBSS also assess trends in priority health-risk behaviors among high school students and evaluate the impact of broad school and community interventions at the national, state, and local levels. A two test-retest reliability study was done on the YRBSS and approximately ¾ of the questions rated as having substandard or higher reliability. Although no test has been done to measure the validity of the YRBSS survey tool, the CDC identified that these types of behaviors are affected by both cognitive and situational factors and the validity of the YRBSS survey is not threatened.

Assessment Tool My name is Melissa Hendrickson and I am a student in Auburn University’s Primary Care Nurse Practitioner program. I am doing a community assessment project on teenagers risk taking behaviors in our area. Would you please take a moment to complete the following questions? Please don’t put your name on the survey. All surveys will be kept completely confidential. Thank you for your help with my assessment of our community! -Melissa Hendrickson . Have you ever had sexual intercourse? . Yes . No . How old were you when you had sexual intercourse for the first time? . N/A . Less than 14 . 14-16 . 17-19 . During your life, with how many people have you had sexual intercourse? . 1 . 2-5 . 5-8 . Greater than 8 . Did you drink alcohol or use drugs before you had sexual intercourse the last time? . The last time you had sexual intercourse, what one method did you or your partner use to prevent pregnancy? . Condom . Birth Control Pill . Other _________________ . Have you ever been taught about AIDS or HIV infection in school? . During your life, on how many days have you had at least one drink of alcohol? a. I don’t drink alcohol . I’m not sure . __________________________ . How old were you when you had your first drink of alcohol other than a few sips?____________ . How old were you when you tried marijuana for the first time?___________________________ 0. During the past 30 days, how many times did you use marijuana? . Less than 5 . 5-10 . 11-15 . Greater than 15

Method An anonymous 10 question youth risk behavior survey was used. The survey obtained data regarding health-risk behaviors including alcohol, marijuana, and intercourse. To perform this survey, I randomly selected teenagers in the community over two days that were willing to complete the survey. The participant did not use his or her name and the survey was placed in a manila envelope in order to maintain anonymity.

Participants Ranged from 15-18 years of age. Consisted of African American and Caucasians Equal mixture of males and females. Although a majority of teenagers approached agreed to do the survey, some did not feel that anonymity would be maintained and were afraid of the repercussions or felt they would be judged.

Results Intercourse Alcohol Marijuana 65% Sexually active 35% 14-16 Years old Prevention HIV/AIDS Alcohol 15 Years old Marijuana 16 Years old Results from the community assessment survey identified that 65% of participants were sexually active. 35% have been participating in sexual activity as early as 14 years old and having as many as five to eight partners since they began intercourse. Only ¼ of participants admitted to using alcohol or drugs prior to intercourse. Many individuals stated that they did not use any form of birth control. If birth control was used it was either a condom or the Depo-Provera shot. Every participant had been taught HIV and Aids prevention in school. The mean age of initiation of alcohol consumption was 15 years old and the mean age of marijuana use initiation was 16 years old.

Health Disparities Disparities affecting teenage pregnancy found in this area include Socioeconomic status Education Rural Surroundings The median household income for Baker County is $27,255 and 35.9% of individuals who reside in the area live below poverty level. 30.5% are from single parent households. Baker County is an area with little development. It is mainly a farming community without many extracurricular activities available, especially to teenagers. All of these factors have been identified as leading causes of teenage pregnancy.

Health Factors Rural public health district Substance abuse Social One health department Substance abuse Alcohol Drugs Social Peer pressure The availability of resources in this area are limited. One health department is available but it has made little attempt to be involved with bettering the community including teenage pregnancy prevention. When the lack of resources available to teenagers was discussed with the county nurse manager at the health department, it was brought up that the health department is currently under renovation and that it is hoped that the result of these changes will allow for more community involvement. Drug and alcohol use is a health factor affecting teenage pregnancies and was identified as a problem on the survey. The social issue affecting overall health involves peers and peer pressure. During teenage years, peer pressure can be an important factor when an individual is deciding whether or not to engage in activities that could result in pregnancy.

Strategies Community Health Collaborative Classes Field trips Positive role models Resources I feel that by getting community leaders involved to form a collaborative to intervene early, would benefit the area as a whole. Activities such as classes about sewing or cooking and field trips to area parks would give the teens a positive outlet instead of turning to activities that could predispose them to pregnancy. Providing a positive role model for not only the girls but the boys to look up to as well. This role model can be someone in the community who formed goals early in life and worked hard to reach those goals. Have resources for teenagers to turn to in order for them to receive the correct information about such things as alcohol, drugs, and unprotected intercourse instead of hearing incorrect information from their peers.

Interesting Facts Open to discussion Interested in opportunities Goal identification While conducting the survey I came across some interesting facts. Teenagers today are not as opposed to opening up about their sexual experiences and history. The participant that discussed the project with me appeared to be in favor of increasing community activities in order to provide education about life skills in order to prevent them from turning to destructive habits. Many stated that they believe that identifying a life goal would help them to make better choices in regards to their choices of activities.

References Boatright, S.R. (2010). The Georgia County Guide (28th ed.). Athens, GA: The University of Georgia Printing Department. Gaudie, J., Mitrou, F., Lawrence, D., Stanley, F., Silburn, S., & Zubrick, S. (2010). Antecedents of teenage pregnancy from a 14-year follow-up study using data linkage. BMC Public Health, 1063. doi:10.1186/1471-2458-10-63 Healthy People 2020. (n.d.). Adolescent health. Retrieved from http://www.healthypeople.gov OASIS Mapping Tool – Teenage pregnancy statistics. (n.d.). Retrieved from http://oasis.state.ga.us/oasis/ Simpson, C., personal communication, Summer, 2013 Teenagers prefer to use school-based sexual health clinics. (2008). Nursing Standard, 22(42),11. Retrieved from http://ehis.ebscohost.com.spot.lib.auburn.edu/ U.S. Census Bureau State and County Quick Facts: Baker Co. Georgia. Youth risk behavior surveillance system. (2013). Retrieved from http://www.cdc.gov/HealthyYouth/yrbs/index.htm