1. Teen Pregnancy in Oceana County, MI
Ferris State University BY: Tina Bogart, Amber Carlson, Tara Hall Autumn VanDusen, Mariah Wallace

2. Oceana County Community
Oceana County is located on the West side of Michigan and consists of roughly 26,000 people.
Oceana County is comprised of mostly Caucasian individuals. The poverty and education levels are lower than the state of Michigan as a whole by 4% and 10 % respectively.
A larger problem in Oceana County is the rate of teen pregnancies. This rate is higher than District Health Department 10’s and Michigan's.
Oceana County is located on the Western coast of Michigan. Its population consists of approximately 26,000 with 95% being Caucasian and 15% being
Hispanic (Michigan Dept of Community Health, 2014). Oceana County has a high rate of teenage pregnancies when compared to the Michigan level and the rate of the other counties within the District Health Department 10 area (District Health Department 10, 2014).

3. Teen Pregnancy Rates
Oceana County’s teen pregnancy rate is 59.4%, based on pregnancies per 1,000 females between
District Health Department 10 is 47.7% and Michigan's overall rate is over 14% lower at 45%.
This problem affects other areas in Oceana county also, including poverty percentage and education level mentioned earlier.
Teen pregnancy is an issue in Oceana County. The prevention of teen pregnancy is important because the implications that adolescent pregnancy has can be detrimental. According to the US Department of HHS (2016), a teen mother is less likely to finish high school, more likely to be on welfare, more likely to live in poverty as an adult and has poorer outcomes for their children, including: poorer educational opportunities, more behavioral issues, and more health issues when compared to children born to older mothers.
Risk factors for teenage pregnancy include living in poverty, low education level, low self-esteem, having a single parent home, and early sexual activity (US Dept. of HHS, 2016). Several of these risk factors are prevalent in Oceana County. These include a 19.9% poverty rate compared to Michigan’s overall poverty rate of 16.8%. Additionally, only 84% of Oceana County residents are high school graduates compared to the Michigan rate of 89% (District Health Department 10, 2014).

4. Learning Theories
Learning theories are used to help the community member make small steps toward a health goal.
The learning theory that best fits helping the teen pregnancy population is the Health Belief Model.
This model uses cues to promote the prevention of teen pregnancy.

5. Prevention of Teen Pregnancy using the Health Belief Model
Education on the severity of becoming pregnant at an early age. (this cue is the most important) If the individual does not believe they can be successful in taking action against pregnancy this model will be unsuccessful.
The risks teenagers take when engaging in intercourse including sexually transmitted diseases and pregnancy.
The benefits of taking preventative action.
Addresses what is standing in the teenagers way of taking action toward the goal of not becoming pregnant.
The Health Belief Model may apply to Oceana County’s problem of high teen pregnancies by reminding community members of the importance of healthy choices, ways to promote changes, and uniting individuals as one community for education on prevention strategies. Other disciplines that can be incorporated into implementing changes for Oceana’s adolescents could include physicians, nurses, nurse practitioners, teachers, public health service workers, governmental funding, adoption agencies, and most influential- involved parents (Harkness & DeMarco, 2012).

6. Theories of Social Support
Family members, friends, neighbors, and adjacent communities can influence change by offering social support- instrumental assistance, informational support, emotional support, and appraising support
Nurses and other health professionals can organize and develop social support systems as well, to assist teens with opportunities that will promote pregnancy prevention.
Offering a strong support system can influence change. Those who are involved in the adolescent's life are able to be a source of encouragement and assistance. Whether it be by providing transportation to obtain contraception, or providing information on preventing teen pregnancy, having the support of family, friends and the community can help a teenager to achieve and maintain their goals (Harkness and DeMarco, 2012).

7. The Ecological Model
Behavior is a result of the knowledge, values, and beliefs of people, as well as numerous social influences such as relationships, social support networks, and community structure.
Includes four levels of influences that represent biological, environmental, and social influences as a dynamic and collective group of variables that need to be considered as a whole.
The ecological model maintains that people and the environment are interdependent (Harkness and DeMarco, 2012). When there is a behavior change in a person, we must look as the social context to truly understand it. A person’s behavior is a result of their knowledge, values and beliefs. The way an adolescent was raised, including their parental situation, school situation, or income level, all effect their behavior. These can effect whether or not they have the support to make wise decisions or have access to healthcare and contraception.

8. The Ecological Model
Four areas are used to assist in health promotion and minimize teen pregnancy:
Personal factors such as mental health, age, education, sexual history, sexually transmitted infections.
Relationships and influences in interactions in relationships.
Stressors or buffers that influence risky behavior.
Values and beliefs
The four areas of influence that must be considered to change behavior (Harkness and DeMarco, 2012). These influences may promote risk or add a protective factor. The four variables must be addressed in a prevention strategy to develop an adequate plan for teen pregnancy prevention. When each factor has been considered, the program will be very inclusive and will be able to appeal to an adolescent on a more personal level.

9. Community Focused Nursing Diagnosis:
Risk of unplanned pregnancies among residents of Oceana County related to poverty, lack of educational resources, and knowledge deficit as demonstrated by teen pregnancies per 1,000, which is the highest rate in all ten of the District Health Department #10 Counties and the state of Michigan, which is 44.5 per 1,000.
After assessing the data of Oceana County, compared to the other counties in the District 10 health department and Michigan as a whole, it was decided that teen pregnancy was an outstanding issue that should be addressed. Numerous factors play a role in the high rate of teen pregnancies.

10. SMART Objectives
By June 1st, there will be more promoted programs offered at the Oceana County Health Department to educate the public on services offered to help decrease unwanted pregnancy.
By September 30th, 2016 Family Planning Clinics will include evening and weekend appointments to increase availability of services to clients.
By December 30th, the Oceana County Health Department will provide an occasional mobile clinic to assist in reaching clients without transportation in designated locations to obtain Family Planning services.
By 2017, the annual report for the District Health Department #10, the cases of unplanned pregnancy will be decreased to lower than 35 teen pregnancies per 1,000.
By setting realistic goals it can be determined if headway is being made in the quest to decrease the adolescent pregnancy rate. These goals are mainly focused on making services more readily and easily available to the public. By offering services at different times or in different locations, more adolescents will be able to utilize the services, gaining the knowledge and products necessary.

11. Intervention Positive Youth Development:
A program that engages youth in positive activities within their communities
Promotes positive outcomes by providing constructive opportunities, building relationships, and offering support
Integrates necessary resources from the school, community and adolescent’s family
Positive youth development (PYD) is a program that relies heavily on building positive social relationships (Dept. of Health and Human Services, 2016). The program works to encourage adolescents by enhancing their strength, and promoting positive outcomes by providing opportunities, creating positive relationships, and providing the support needed. The youth are supported in making positive choices, and are encourage to pursue opportunities with positive outcomes. If this program was implemented into the health department or the schools in Oceana County, the adolescents would have a positive outlet and strong support system. The youth would be able to see future possibilities and have the support and encouragement to reach beyond their limitations. This type of program is beneficial for all involved. According to Youth.gov (2015) adolescents who are surrounded by positive opportunities for engagement are exposed to less risk and show higher rates of successful transitions into adulthood. Additionally, the data suggests that the opportunities provided and skills offered in a PYD program can lead to better health, social, and educational outcomes.

12. Intervention Planned Parenthood
Teen Pregnancy Prevention Initiative (TPPI)
Targets youth between 13 and 18 years old
Utilizes community programs and Adult/Parent education
Builds skills necessary for making safe and smart decisions
The Teen Pregnancy Prevention Initiative (TPPI) is program through Planned Parenthood and the Department of Health and Human Services (Planned Parenthood, 2016). TPPI aims to promotes personal respect, increase self awareness, teach responsibility, and builds skills for dealing with peer pressure. The program utilizes 8 to 10 hours of direct teaching per adolescent to help participants learn and subsequently practice specific skills such as communication, refusal, decision making, and how to resist to peer pressure (Planned Parenthood).
This comprehensive program is effective in preventing teenage pregnancy by changing the overall way that adolescents think and behave. According to Kohler et al. (2008) programs that combine medically accurate information on a variety issues including abstinence, contraception, safer sex, and the risks of unprotected intercourse and how to avoid them, are most effective. This program can decrease the number of Oceana residents becoming pregnant as an adolescent by teaching them the consequences of intercourse, and how to avoid them, as well as empowering the youth to make wise decisions.

13. Policy Implications
Getting a committee together to help designate a leader of the new programs offered
Having the same committee help find funding and resources to utilize
Find volunteers to help out at the evening and weekend appointments by watching the children brought in or even prepare a healthy snack for those in the waiting room
Find a vehicle to be used for the mobile clinic and try to get it donated for the cause
Some implications for starting these programs included starting a committee, funding, and limited resources. It may be difficult to get volunteers to run the programs, as they would be a huge commitment. The schools and health department may be willing to host these programs, as they would be able to reach the target audience with little difficulty. Currently, the only program for preventing teen pregnancy in Oceana County is available through the District 10 Health Department. The current program offers access to multiple birth control supplies and education on those options, pregnancy testing, counseling and referrals, testing for sexually transmitted infections, client education and risk reduction counseling (District Health Department 10, 2014). While this is a helpful start, this program does not aim to change the behaviors leading to teen pregnancy. PYD and TPPI are long term prevention programs that change the adolescent's outlook and behavior.

14. Evaluating Our Goals Self-Administered Surveys
Assess current pregnancy prevention methods
Assess knowledge on teen pregnancy and consequences thereof
Data from Health Department
Hard statistics detailing the teen pregnancy rate in Oceana County
To assess the effectiveness of the programs, we can use self administered surveys. One survey may be administered during the first program to assess the adolescents’ current knowledge of safe sex practices, pregnancy prevention methods, number of pregnancies, etc. Then, after completion of the program, a second survey in the form of post mail, , or a phone call from a nurse, will be sent to the participant after a set period of time, for example, two months. This allows us to evaluate if the teens are following the recommendations and putting their knowledge into practice. It also allows us to see if the views and perceptions of pregnancy, and its prevention methods, have changed based on the education received. We can also use the survey to find out what is working and what needs to be changed regarding the programs.
Additionally, utilizing the statistics from the District 10 Health Department the teen pregnancy rate can be effectively gauged. By monitoring the annual reports, and observing whether the teen pregnancy rate is trending up or down, we can evaluate whether our programs are positively or negatively effecting Oceana County. However, we recognize that the numbers will not reflect only the influence of our programs, as other variables are at play as well.

15. Conclusion
The teen pregnancy rate in Oceana County, MI is much higher than other counties and the state of Michigan.
Decreasing the teen pregnancy rate is in everyone’s best interest
Early intervention with support, positive opportunities and contraceptive resources decreases the teen pregnancy rate
The interventions must be evaluated to determine their effectiveness

16. References
District Health Department 10. (2014) Annual report. Retrieved from
Harkness, G.A., & DeMarco, R.F. (2012). Community and public health nursing practice: Evidence for practice. Philadelphia, PA: Wolters Kluwer/Lippincott, Williams & Wilkins.
Kohler, P.K. et al. (2008). Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health. 42(4), 344–351.
Lindgren, T., Duetsch, K., Schell, E., Bvumbwe, A., Hart, K., Laviwa, J., Rankin, S. (2011). Using Mobile Clinics to deliver HIV testing and other basic health services to rural Malawi. Rural and Remote Health Journal. Retrieved from:
Oceana County. (2014). Michigan Department of Community Health. Retrieved from

17. References
Planned Parenthood. (2016). Teen pregnancy prevention initiative. Retrieved from education-training/programs-workshops/teen-pregnancy-prevention-initiative
US Department of Health and Human Services. (2016). Teen pregnancy and childbearing. In Office of Adolescent Health. Retrieved from topics/reproductive-health/teen-pregnancy/
US Department of Health and Human Services. (2016). A checklist for putting positive youth development characteristics into action in teen pregnancy prevention programs . Retrieved from checklist.pdf
Webber, G., Spitzer, D., Somrongthong, R., Cong Dat, T., Kounnavongsa, S. (2012). Facilitators and barriers to accessing reproductive health care for migrant beer promoters in Cambodia, Laos, Thailand and Vietnam: A mixed methods study. Globalization and Health. Retrieved from:
Youth.gov. (2015). Effectiveness. Retrieved from positive-youth-development-programs