Planned Community Change Promote Prevention of Teen Pregnancy in Kent County, MI Sandra Gilman, Amy Herrington, Rebecca Joostens, Tamara Putney & Kimberly Weigel (City Data, 2009)

Problem Analysis  When comparing all industrialized nations, the US ranks highest in teen births (Hamilton, Martin, & Ventura, 2010).  Michigan ranks 32 nd in the US for overall rate of teen births (Martin et al., 2011).  Kent County teen birth rates are very high and surpass the State of Michigan numbers (Kent CoCHNA, 2010 and Hamilton, Martin, & Ventura, 2010) KENT MICHIGAN NATIONAL (Kent CoCHNA, 2010 and Hamilton, Martin, & Ventura, 2010)

Problem Analysis (Annie E. Casey Foundation, 2012, Centers for Disease Control, 2011, Kent CoCHNA, 2012) KENT= 61.1 per 1000 MICHIGAN= 53.2 per 1000

Who does this problem affect? Overall Population Composition Kent County versus Michigan (U.S. Department of Commerce, 2012) Birth Rates by Race and Ethnicity (Martin et al., 2011 ) Comparing Kent County to US statistics for births related to ethnicity: The percentage of Latino pregnancies is higher than that of black and white non-Hispanic (Michigan Department of Education, 2010). Kent County : Hispanic teen Births in 2009 was 1382 compared to 690 for all other races (U.S. Department of Commerce, 2012)

Why is the teen pregnancy rate so high?  Rape Between 43 & 62% of teens acknowledge that they were impregnated by an adult male, and 2/3 report that their babies' fathers are as old as 27 (Langham, 2010). Approximately 5 percent of all teen births are the result of a rape (Langham, 2010).  Peer Pressure Three out of 4 girls (75 %) report that the reason they have sex is because their boyfriends want them to (Michigan Department of Education, 2010). Twenty nine percent of pregnant teens reported that they felt pressured to have sex, and 33% of pregnant teens stated that they felt that they were not ready for a sexual relationship, but proceeded anyway because they feared ridicule or rejection (The Kaiser Foundation, 2012).  Pregnancy is Glamorous Movies and reality television focused on teenage pregnancy can influence teens to believe it is acceptable (Langham, 2010). (Langham, R.Y., 2010) (Michigan Department of Education, 2010) (The Kaiser Foundation, 2012).

What are contributors to Teen pregnancy? Comparison of Kent County and the US Teen Drinking :  Seventy six percent of children in Kent County have consumed alcohol at least once.  Forty four percent of Kent County high school students admit to drinking between ages 13 and 16.  Ninety percent of high school students attending an alternative school in Kent County report they can easily access alcohol. Rates of excessive drinking among teens (State of Michigan, 2011).  National is 8%  Kent County is 18%

What are contributors to Teen pregnancy? Comparison of Kent County and the US Lack of Knowledge of Contraception :  There is an inconsistent use of birth control with only 62.8% condom use.  Many Kent County Schools teach abstinence-only sex education.  Teenagers are uninformed of contraception secondary to this abstinence-only education. (Kent CoCHNA, 2012).

What are contributors to Teen pregnancy? Comparison of Kent County and the US Absent Parents  Statistics of single parent households: Kent County: 31% Michigan: 32% National Benchmark: 20% (County Health Rankings & Roadmaps, 2012).  Other Kent County statistics: 11.6% of households in Kent County had a female head of household with no husband present (Access Kent, 2012).  While 35% of female never-married teenagers who lived with both parents were sexually experienced, compared with 54% among those who lived in any other parental arrangement (CDC, 2011b). County Health Rankings & Roadmaps, 2012, Centers for Disease Control [CDC], 2011b, Access Kent, 2012)

Social Determinants of Teen Pregnancy  Socioeconomic status - Low income  Single Parent Homes  Geographic location- Urban  Substance abuse  Social norms- Peer pressure

The Ecological Model Main Ideas  All processes between people and environment cannot exist without each other.  History, characteristics, environment, and culture all need to be taken into consideration when considering change.  Behavior results from knowledge, values, beliefs, social networks, relationships, and community. Levels  Ontogenetic: Belief outcomes related to self efficacy, communications, skills, and more.  Microsystem: Beliefs associated with peers, family, etc.  Exosystem: Degree of social isolation, social networks, support, poverty.  Macrocultural: Beliefs regarding gender roles and views on racism. (Harkness, G.A. & DeMarco, R.F., 2012)

As Related to Teen Pregnancy   Ontogenetic: Higher rate of teen pregnancy in African Americans and Hispanic.   Microsystem: Higher rate of teen pregnancy among children in single parent homes.   Exosystem: Higher rate of teen pregnancy in low income families.   Macrocultural: Teen pregnancy is accepted as the norm in many African American and Hispanic cultures. Ecological Health Model (Harkness, G.A. & DeMarco, R.F., 2012)

Existing Resources: National  Advocates for Youth Partners with policy makers to drive change at a National level.  Healthy Teen Network Provide educational resources to professionals.  National Campaign to Prevent Teen and Unplanned Pregnancy Works with stakeholders to change policy, and provides resources. (Advocates for Youth, 2008) (Healthy Teen Network (2012). (The National Campaign to Prevent Teen and Unplanned Pregnancy, 2012a)

Existing Resources: Local  Pregnancy Resource Center Provides information to teen once pregnant, yet lacks prevention resources.  Michigan Department of Community Health Working on the Teen Pregnancy Prevention Initiative throughout Michigan, which includes comprehensive sexual education.  School Education programs that deliver sexual education Current variance between what is taught, most Kent County Schools focus on abstinence. (Pregnancy Resource Center, 2012). (Michigan Department of Community Health, 2012).

Existing Resources: Local  Planned Parenthood of West Michigan Provides resources and participates in educating the community.  Alpha Women’s Center Offers counseling and membership to pregnant women, education offered to the community centers on abstinence. (Alpha Women’s Center, 2008). (Planned Parenthood, West & Northern Michigan, 2012).

Adequacy of Resources

What evidence indicates that this problem is appropriate for community nursing intervention? This problem is appropriate for community nursing intervention because there are measureable outcomes that can be obtained if interventions are successful.  Currently, there are high pregnancy rates in teens ages in Kent County.  There are high birth rates in Kent County in teens ages 15-19, especially with the Latino population.  There is a high Infant Mortality Rate in Kent County teens age 15-19, especially with African American girls. According to the CDC (2012) some goals should be to:  Reduce the rates of pregnancies in teens ages  Promote prevention of pregnancy by increasing access to resources, programs, information, education and contraception.  Teens and communities need to be empowered with knowledge to make smart choices. (Centers for Disease Control [CDC], 2012b).

Key Stakeholders to Initiate Change  Parents  Teachers  Healthcare providers, including physicians and nurses  School nurses  Churches  Community groups and coalitions  All existing resources

Problem Statement There is an increased risk of teen pregnancy among Kent County teens age 15-19, especially in the African American and Hispanic teen population, related to many environmental, and health factors such as low socioeconomic status, lack of education, lack of access to or use of contraception, lack of access to sexual health resources, high teen drinking rates, peer pressure, and lack of social support available for the teenage population as evidenced by a Kent County teen pregnancy rate of 61.1/1000 compared to an overall Michigan teen pregnancy rate of 53.2/1000. For this same age group the birth rates in Kent County are 42/1000, while Michigan is at 33/1000, and the National rate comes in at 39/1000. (Annie E. Casey Foundation, 2012, Centers for Disease Control, 2011, Kent CoCHNA, 2012)

Intervention:  Target Population: The adolescent population of Kent County age  Intervention Staff: Local parents, clergymen, nurses, and schools.  Program Partners: Government Agencies, Health Department, Planned Parenthood, Alpha Women’s Center, local churches, schools, charitable organizations, and Salvation Army. WHO?

Interventions:  To improve the overall health and quality of life of Kent County teens.  To prevent teenage pregnancies  To decrease unnecessary health care costs.  Halt the cycle of teenage pregnancy WHY? (Centers for Disease Control [CDC], 2012b).

Intervention:  Outreach Center Provide a community teen activity center. Build trusting relationships Provide education and resources including contraception.  Social Media Education and awareness WHAT? (After-School All-Stars, 2011). (Morphy, Erika, 2007).

Intervention:  Outreach Location Salvation Army Kroc Center Grand Rapids Community College Alpha Women’s Center  Media Facebook  Direct Service Activities Planned Parenthood Local participating physicians Health Department WHERE?

Intervention:  PLANNING: October 1 st 2012 Identifying partnerships with willing physicians, charitable organizations and outreach centers. Determine interventions, goals and desired outcomes.  IMPLEMENTATION: January 1 st 2013  EVALUATION: Yearly analysis of public health records. WHEN? (Harkness, G., & DeMarco, R.,2012)

Intervention:  Collaboration Community partners Healthcare organizations  Funding Fundraisers Grants Private donations, from community, businesses, individuals, and churches HOW?

Evaluation of project

Evaluation  Desired Outcome Reduce teen pregnancy rates in Kent County in the year old population to create an overall healthier community.  Methods Utilizing the “Getting to Outcomes Framework” we will evaluate both long and short term.  Long Term Statistical tracking of US Census numbers for Birth Rates Track the odd year “Michigan Profile for Healthy Youth”  Short Term Track monthly birth records in Kent County. Program participation/attendance records for the outreach centers. Assess social media website, Facebook page, to evaluate we would track “Like” and “Friend” counts. (Michigan Department of Education, 2010).

Conclusion Clearly teen pregnancy affects the entire community, from the teen who is pregnant to the United States tax payer. By implementing interventions and empowering youth to make informed decisions the rate of teen pregnancy will likely decrease. This will lead to better health outcomes for the entire nation.

References Access Kent. (2012). County profile and overview. Retrieved from Advocates for Youth. (2008). Mission. Retrieved from After-School All-Stars. (2011). Facts about after school programs & at risk youth: Factoids. Retrieved from c=enJJKMNpFmG&b= Alpha Women’s Center. (2008). About us. Retrieved from Annie E. Casey Foundation. (2012). Teen pregnancies ages (number) Kids count data center: Michigan. Retrieved from Centers for Disease Control [CDC]. (2011a). Vital signs: Teen pregnancy United States Morbidity and Mortality Weekly Report. 60(13), Centers for Disease Control [CDC]. (2011b). Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, national survey of family growth. Vital Health and Statistics, (23) 31. Retrieved from Centers for Disease Control [CDC]. (2012a). About teen pregnancy. Retrieved from Centers for Disease Control [CDC]. (2012b). Teen pregnancy prevention 2010–2015 integrating services, programs, and strategies through communitywide initiatives: The President’s teen pregnancy prevention initiative. Retrieved from City Data.com (2009). Kent County Michigan. Retrieved from Community Health Needs Assessment for Kent County [Kent CoCHNA]. (2012). Kent County: 2011 community health needs assessment and health profile. Retrieved from County Health Rankings & Roadmaps. (2012). Kent County. Retrieved from Hamilton, B., Martin, J., Ventura, S. (2010). Births: Preliminary data for National Vital Statistics Reports. 59(3),1-26.

References Harkness, G., & DeMarco, R. (2012). Community and public health nursing: Evidence for practice. Philadelphia, PA: Lippincott Williams & Wilkins. Healthy Teen Network (2012). Making a difference in the lives of teens and young families: Step #8 outcome evaluation. Retrieved from Langham, R.Y. (2010). What are the causes of teenage pregnancy? Retrieved from teenage-pregnancy/ Martin, J., Hamilton, B., Ventura, S., Osterman, M., Kirmeyer, S., Mathews, T., & Wilson, E. (2011). Births: Final data for National Vital Statistics Reports.60(1), Michigan Department of Community Health. (2012). Teen pregnancy prevention initiative. Retrieved from _4911_54150_ ,00.html Michigan Department of Education. (2010). Michigan profile for healthy youth: Sexual behavior. Retrieved from reports/XReport.aspx?r=SexualBehavior_ct&e=41&c=4&t=HC&v=1 Morphy, Erika (2007). Social networking. TechNewsWorld. Retrieved from Planned Parenthood, West & Northern Michigan. (2012). Retrieved from Pregnancy Resource Center. (2012). About us. Retrieved from State of Michigan. (2011). Michigan Drunk Driving Audit. Retrieved from _DDA_Audit_For_Web_Deployment_390162_7.pdfRape The National Campaign to Prevent Teen and Unplanned Pregnancy. (2012a). Fast facts: Teen pregnancy in the United States. Retrieved from

References The Kaiser Family Foundation. (2012). U.S. Teen Sexual Activity. Retrieved from and-Young-Adults-in-the-US.pdf United Department of Commerce, United States Census Bureau. (2012). State and county quickfacts: Kent, County Retrieved from United Nations Demographic Yearbook. (2008). Live births by age of mother and sex of child, general and age specific fertility rates: Latest available year Retrieved from Yoder-Wise, P.S. (2011). Leading and managing in nursing. St. Louis, MO: Elsevier Mosby.