Date: May 18th, 2016
By: Pat Paluzzi
Healthy Teen Network has long proposed a comprehensive approach to teen pregnancy prevention that moves us beyond an individually-based prevention approach to one that promotes healthy sexual and reproductive outcomes for all youth, and includes:
- Utilizing evidence and innovation to affect outcomes;
- Using a systematic framework to select and implement programs that best fit a specific community and address data-defined needs; and
- Investing in programs and services that move beyond addressing individual behavior change and encompass a Youth 360⁰ holistic health promotion.
Two recently released federal reports, results of the first set of evaluations from the Office of Adolescent Health (OAH) Teen Pregnancy Prevention (TPP) Program grantees and the Centers for Disease Control and Prevention (CDC) findings on teen births, substantiate this approach.
The results of the first round of evaluations of OAH TPP programs offer us eight new programs identified as evidence-based; 40% of evidence-based programs that were replicated were done so successfully; and we learned a great deal more about what works with whom and under what conditions.
Specifically, these results enhance our evidence base by adding new programs to the repository of evidence-based programs currently available, and by underscoring the importance of “fit.” A finding that 40% of previously proven effective programs produce similar results may, on the surface, appear to be a less than stellar outcome; however, a replication result of 40% is not unusual with this type of study. And what these results confirm for us is the significance of selection and implementation. When viewed in full, the data tell us that adaptation may not always be successful, that programs must be selected because they address the well-defined needs of the target population, and appropriate capacity-building support is necessary for successful implementation.
In April 2016, the Centers for Disease and Prevention (CDC) reported a 50% decrease in teen births among Black and Hispanic teens, bringing the Nation’s rate of teen births to an even lower historic low. While promising, however, the rates of teen births for these two groups of minority women remain 2-3 times higher than for White teens. CDC Director Tom Frieden, M.D., M.P.H. responded, “By better understanding the many factors that contribute to teen pregnancy we can better design, implement, evaluate, and improve prevention interventions and further reduce disparities.” Education and employment were cited as significant determinants that impact youth outcomes in general, and specifically can affect teen birth rates.
Implications for the Field: How and Where Youth Live, Learn, and Play Matters
Teen pregnancy prevention is but one part of the equation to achieve better outcomes for all youth. The social determinants of health, or how and where youth live, learn, and play matters, and must be addressed to achieve more comprehensive and sustained outcomes. It is past time to change our language and approach from attempting to change individual behavior without recognition that change is challenging in the best of circumstances, and nearly impossible without adequate support, to one that recognizes and addresses environmental factors. Should we stop using pregnancy prevention language altogether and reframe our work as promoting sexual and reproductive health?
And what of the continued disparities in outcomes across racial/ethnic groups? If poverty, education, and employment are key factors affecting young people’s decisions regarding parenting, then any program that hopes to close these gaps must address these and other environmental factors to be effective.
This means forming new relationships and partnerships, redefining our role and relevance in the work that we do based on the outcomes we hope to achieve, and it may mean new methods of funding so that innovative and holistic approaches are promoted.
In 2013, Healthy Teen Network launched our Youth 360° initiative for holistic health promotion. We recognized then that social determinants associated with teen pregnancy, such as low parental educational attainment, and limited opportunities for education and employment are more common in communities with higher proportions of racial and ethnic minorities, contributing to health disparities.
We’d love to hear more from you on these thoughts. Please join us (@HealthyTeen) on Thursday, May 19th, 2016, at 2:00PM ET for a Twitter Chat to continue this conversation about moving beyond teen pregnancy prevention. And we hope to see you in November our annual conference, where we will continue to explore Relationships, Roles, and Relevance in the Changing Landscape of Teen Pregnancy. We would love to hear from you regarding your views of the future of teen pregnancy in the US.
About the Author
Patricia Paluzzi, CNM, DrPH, President and CEO of Healthy Teen Network, has been active in the fields of reproductive, and maternal and child health for over 40 years, as a clinician, researcher, administrator, and advocate. Her clinical and content expertise spans the full scope of midwifery care, substance abuse, intimate partner violence, high-risk maternal child health (including pregnant teens), incorporating men into clinical services, and trauma-informed approaches.