2. Teen Pregnancy Kent County, MI Karilyn Bufka William McKinley Jessica Riley Kaylee Sullivan

3. Nursing Diagnosis  High incidence of avoidable teen pregnancy in teens ages 15-19 years old in Kent County, MI related to unprotected sexual activity as evidenced by… (see next slide) (Mathematica Policy Research, Inc., n.d.)

4. Statistics (Michigan Public Health Institute, 2011)  Pregnancy rates for teens ages 15-19 years old per 1,000 individuals:  Kent County: 61.5  Michigan: 53.6 Statistical evidence indicates this problem is appropriate for community nursing intervention due to higher rates in Kent County in comparison to rates overall in the state of Michigan.

5. Analysis of Data Critical Area of Need: (Brann, 2012) ("Care foster care," 2012)

6. Causative/Modifiable Factors  Number of teens engaging in sexual intercourse  Lack of/insufficient contraceptive use  Lack of knowledge  Lack of supervision  Belief that “it won’t happen to me” (Black Youth Project, 2011)

7. Kent County Risks  Modifiable:  Education programs  Teen Sexual Activity  Parent Involvement  Teen & Parent Knowledge  Nonmodifiable:  Demographics  Religious Denomination (SPL, n.d.)

8. Barriers  Parents/targeted population unwilling to participate in program  Cost  Resistance from religious groups (Rogers, 2012)

9. Health Belief Model  Four Characteristics  Severity of the potential illness or physical challenge  Level of conceivable susceptibility  Benefits of taking preventive action  Barriers that stand in the way of taking action toward the goal of health promotion (Harkness & DeMarco, 2012)

10. Health Belief Model Continued Severity of the potential illness Premature sexual activity has many or physical challenge risks and consequences such as unwanted pregnancy and sexually transmitted diseases Level of conceivable Susceptible teenagers in Kent County susceptibility between the ages 15-19 years old Benefits of taking Benefits include decreasing unwanted preventive action pregnancy, reducing the risk of sexually transmitted diseases, and strategies to strengthen parent-child communication Potential barriers Lack of education and lack of communication and decision making (Harkness & DeMarco, 2012)

11. Existing Resources  Michigan Teen Pregnancy Prevention Initiative  Reducing the Risk (RTR)  Talk Early & Talk Often workshops  School: Sex Education curriculum  Planned Parenthood  All appear to be adequate in information although statistical data proves resources are not recognized/enforced to the targeted population  Existing community resources indicates striving toward wanting positive outlooks for teens and likelihood of successfully addressing the problem

12. INTERVENTIONS (eHow, n.d.)

13. Evidence Based Practice (EBP)  All programs should utilize Healthy Teen Network which provides the following:  Training in EBP  Technical Assistance (proper selection of programs)  Resources (Healthy Teen Network, n.d.)

14. Interventions: Who  Kent County Health Department  Michigan Department of Community Health  Community Members  Local Businesses  School Systems  Media  Health Care Providers  Planned Parenthood of West Michigan  Parents

15. Interventions: What  Reducing the Risk (RTR)  16-session research-based curriculum designed to reduce the rate of teenage pregnancy and exposure to sexually transmitted diseases.  Topics covered include: STDs, HIV, abstinence and birth control methods  Targets youth between the ages of 14 and 18  Focuses on:  Delaying or reducing the frequency of intercourse  Increasing the use of contraception and condoms  How to obtain and use contraception  Risks/consequences of sexual activity  Decision making, negotiation and refusal skills  Tactics to prevent & delay sexual activity  Strategies to strengthen parent-child communication (Access Kent, 2012)

16. Interventions: What (cont.)  Michigan’s Teen Pregnancy Prevention Initiative (TPPI)  Implementation of comprehensive, evidence-based interventions that target the sexual and non-sexual factors for ages 10 and 18 (up to 21 for special education populations) and their parents/adults/caregivers  Delayed initiation of sex  Increased condom or other contraception use  Promotes personal respect and responsibility  Builds skills for dealing with peer pressure  Age, gender and culturally relevant  14 hours of direct programming per youth per year are required  Skills such as communication, negotiation, refusal, decision-making, and resistance to peer/social pressure  State funded (“Teen Pregnancy Prevention”, 2012)

17. Interventions: What (cont.)  Talk Early & Talk Often  Aimed at helping parents of middle school youth talk with their child about abstinence and sexuality  Two hour workshop  Free admission  Parents will:  Learn ways to open the door to conversation about abstinence and sexuality  Learn how to recognize and use teachable moments to communicate important facts and values  Have the opportunity to practice answering difficult questions  Learn to listen and respond with greater confidence and skill ( (R u TETOing?, 2012)

18. Interventions: Where  Schools with a pre-existing sex education curriculum for RTR Castro (2012)

19. Direct and Indirect Measures  Sex education curriculums can assess direct measures of teen comprehension regarding pregnancy by incorporating learning tools such as term papers, presentations, and class projects  Indirect measures of teen comprehension of pregnancy in Kent County, MI would be evaluated by city reports and statistics

20. Interventions: When o During school hours o After school hours o Weekdays during office hours (Dougherty, 2011)

21. Interventions: How  Health fairs held at schools  Pass out information at local businesses  Incorporate Reducing the Risk curriculum into sex education classes  Take home project for students (life-like infant)  Information provided to parents through parent/teacher conferences and mailings  Incorporate technology in learning about safe sex practices

22. EVALUATION

23. Anticipate < 6 month – 1 year for change in behavior to occur o No noted teen pregnancies o Increased compliance o Increased knowledge and awareness Desired Outcomes/Goals

24. Healthy People 2020 (United States Department of Health and Human Services [HHS], Healthy People 2020, 2011).  Objective: Reduce teen pregnancy  Target Rate: 36.2 per 1,000 individuals  Current Rate: 40.2 per 1,000 individuals  Reduction goal: 10%

25. Indications of Success  Decreased number of pregnant teens (ultimate goal)  Increased knowledge  Increased contracts to maintain abstinence  Participation of parents/role models  Attendance of targeted population (USQEDU, 2012)

26. Evaluation  Survey (Parents, Teens, & Educators)  Hospital Records  Pre/Post Intervention  School Reports (time dedicated to sex education)

27. References Access Kent (2012). Health education programs. Retrieved from http://www.accesskent.com/Health/HealthDepartment/Health_Promotion/Health_Educati on.htm Harkness, G.A, & DeMarco, R.F. (2012). Community and public health nursing: Evidence for practice. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. Healthy Teen Network (n.d.) Evidence Based-Resource Center. Retrieved from http://healthyteennetwork.org/index.asp?Type=B_BASIC&SEC={5E80FC23-E52F-4B64-8E81- C752F7FF3DB6} Michigan Public Health Institute (2011). 2011 community health needs assessment and health profile. [PowerPoint slides]. Retrieved from http://www.kentcountychna.org/pdfs/KentCoCHNA_Final.pdf R u TETOing? (2012) What is TETO? Retrieved from http://www.michigan.gov/documents/mdch/Talk_Early__Talk_Often_Parent_Workshop_29 6539_7.pdf Teen Pregnancy Prevention Initiative (2009). Retrieved from http://www.michigan.gov/documents/mdch/TPPI_Overview_302996_7.pdf United States Department of Health and Human Services, Healthy People 2020. (2011, June 29). Healthy People 2020 Objectives. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/pdfs/HP2020objectives.pdf

28. Photo References Black Youth Project (2011). Teen Pregnancy Way Down, But Not for Everyone. Retrieved from http://www.blackyouthproject.com/2011/04/teen-pregnancy-way-down-but- not-for-everyone/ Brann, J. B. (Photographer). (2012). Teen pregnancy rate. [Web Photo]. Retrieved from http://images.search.yahoo.com/images/view;_ylt=A0PDoKjsUZdQeGoAiTKJzbkF;_ ylu=X3oDMTBlQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://images.search.yaho o.com/search/images?p=teen+pregnancy&fr=yfp-t-701&fr2=piv Castro, M. (2012). Should sex education be taught in middle school? Retrieved from http://blog.plazafamilia.com/should-sex-education-be-taught-in-middle-school/ Dougherty, V. (2011). Should sex-education programs be brought into Mecklenburg County public schools? Retrieved from http://www.examiner.com/article/should-sex- education-programs-be-brought-into-mecklenburg-county-public-schools eHow (n.d.). How to avoid teenage pregnancy. Retrieved from http://www.ehow.com/how_4430284_avoid-teenage-pregnancy.html

29. Photo References Healthy Teen Network (n.d.) Evidence Based-Resource Center. Retrieved from http://healthyteennetwork.org/index.asp?Type=B_BASIC&SEC={5E80FC23-E52F-4B64- 8E81-C752F7FF3DB6} Mathematica Policy Research, Inc. (n.d.) What Is the Evaluation of Adolescent Pregnancy Prevention Approaches? Retrieved from http://www.pregnancypreventionapproaches.info/ Rogers, S.T. (2012). A Message from Dentists in Colorado Springs: Stubborn Teens, Listen Up! Retrieved from http://www.worldclassid.com/profiles/blogs/a-message-from-dentists- in-colorado-springs-stubborn-teens-listen SPL (n.d.). Consultation Skills - Managing teenage pregnancies. Retrieved from http://www.gponline.com/Education/article/1103531/Consultation-Skills---Managing- teenage-pregnancies/ USQEDU (2012). No title. Retireved from http://usqedu.files.wordpress.com/2012/10/pic- 5.jpg

30. Photo References (2012). Care foster care programs criminal justice to avoid teen pregnancy. (2012). [Print Photo]. Retrieved from http://images.search.yahoo.com/images/view;_ylt=A0PDoKjsUZdQeGoAizK JzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGsDaW1n?back=http://ima ges.search.yahoo.com/search/images?p=teen+pregnancy&fr=yfp-t- 701&fr2=piv- web&tab=organic&ri=10&w=467&h=485&imgurl=www.thehealthmagic.co m/wp-content/uploads/2012/04/Teenage- Pregnancy.jpg&rurl=http://www.thehealthmagic.com/teenage- pregnancy-untimely-pregnancy-can-be-precarious.html&size=42.8 KB&name=.. care foster care programs criminal justice to avoid teen pregnancy&p=teen pregnancy&oid=1985e234d67569359a50b68ffe764334&fr2=piv-web&fr=yfp- t- 701&tt=..+care+foster+care+programs+criminal+justice+to+avoid+%3Cb%3 Eteen+pregnancy%3C%2Fb%3E&b=0&ni=96&no=10&ts=&tab=organic&sigr= 12p6lttck&sigb=138gb4thv&sigi=1272shkb2&.crumb=ejDhHR6x0Td