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1 GOAL ASPIRATIONS AMONG NU L LIPAROUS AND PAROUS ADOLESCENT GIRLS AGES 1 6 19: A QUALITATIVE STUDY By EVELYN C. KING MARSHALL A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2013
2 2013 Evelyn C. King Marshall
3 To my family, my parents, my in laws, Venette, Desha, and Madelyn aka Bean who have pr ovided support, patience and motivation throughout this process
4 ACKNOWLEDGMENTS dreams and teaching me that persistence is the key to success, and my siblings and grandpar ents for being supportive every step of the way. I owe my gratitude to my husband, Desha Marshall, and the entire Marshall Family for being a consistent avenue of support, love and understanding and showing me, that it truly takes a village to raise a chil tunnel and a being a constant source of joy and amusement after long days. I would also like to thank my friends and colleagues who have provided much needed motivation throu ghout this process Venette Pierre who has been beside me as a roommate, friend, and now cousin since my f irst year of college; I sabel Polanco and Melissa Vilar o who were my office mates, confidants, and guides during throughout this journey; and Emmett Ma rtin for providing much needed humor and motivation. I want to express my keep gratitude and appreciation to my advisor and mentor, Dr Barbara Curbow, she has helped orientate me academically, professionally, and personally and provided a professional t emplate for the demanding albeit wonderful world of academia. I would also like to thank my committee members Dr. Tracey Barnett, Dr. Peoples Sheps, Dr. Barbara Lutz, and former member Dr. Bridgette Rahim Williams. All of which have guided me from concept ion to conclusion. Dr. Tracey Barnett whose knowledge and experience helped me anticipate and prepare for the unknown. Dr. Barbara Lutz and the qualitative analysis group who have helped nourish my love and passion for qualitative research. Dr. Peoples Sh eps whose professional experience and knowledge of maternal and child health history, policy and practice have
5 guided me along the way. Dr. Rahim Williams, my mentor who has provided advice and support personally and professionally throughout my career. I want to express gratitude to the Behavioral Science and Community Health Department for support and guidance and the Academic Affairs Committee for their financial support allowing my research aspirations to become reality.
6 TABLE OF CONTENTS page ACKNOWLEDGMENTS ................................ ................................ ................................ .. 4 LIST OF TABLES ................................ ................................ ................................ .......... 10 LIST OF FIGURES ................................ ................................ ................................ ........ 11 ABSTRACT ................................ ................................ ................................ ................... 12 CHAPTER 1 INTRODUCTION ................................ ................................ ................................ .... 14 Overview ................................ ................................ ................................ ................. 14 Background and Context ................................ ................................ ........................ 15 Pregnancy ................................ ................................ ................................ ........ 16 Teen Birth ................................ ................................ ................................ ......... 17 Repeat Birth ................................ ................................ ................................ ..... 18 Research Purpose ................................ ................................ ................................ .. 19 Research Aims ................................ ................................ ................................ 20 Research Questions ................................ ................................ ......................... 20 Conceptualiza tion of the Problem ................................ ................................ ........... 21 Methods ................................ ................................ ................................ .................. 22 Overview of the Chapters ................................ ................................ ....................... 23 Ch apter 1 Conclusion ................................ ................................ ............................. 24 2 REVIEW OF THE LITERATURE ................................ ................................ ............ 27 Adolescent Development ................................ ................................ ........................ 27 Adolescent Risk Taking ................................ ................................ .......................... 29 Risk Factors ................................ ................................ ................................ ............ 34 Risky Sexual Behavior ................................ ................................ ..................... 34 Adolescent Pregnancy and Birth ................................ ................................ ...... 37 Repeat Pregnancy and Birth ................................ ................................ ............ 40 Unique Circumstances: Adolescent Pregnancy in F oster Care ........................ 44 Protective Factors ................................ ................................ ................................ ... 45 Implications for Adolescent Pregnancy, Birth, and Repeat Birth ............................. 47 Adolescent Birth ................................ ................................ ............................... 47 Repeat Birth ................................ ................................ ................................ ..... 48 Intervention and Prevention Programs ................................ ................................ .... 49 Successful Programs ................................ ................................ ....................... 49 Mixed Reviews ................................ ................................ ................................ 54 Unsuccessful Programs ................................ ................................ .................... 55 Suggested Programs: ................................ ................................ ....................... 57 Adolescent and Repeat Pregnancy Prevention Summary ................................ 57
7 Theoretical Framework ................................ ................................ ........................... 58 Meaning of Success ................................ ................................ ......................... 59 Professional Goal Aspirations ................................ ................................ .......... 60 Personal Aspirations ................................ ................................ ........................ 61 Perceived Advantages and Disadvantages of Adolescent Parenting ............... 62 Media Influences ................................ ................................ .............................. 63 Summary ................................ ................................ ................................ ................ 65 Chapter 2 Conclusion ................................ ................................ ............................. 65 3 RESEARCH DESIGN and METHODS ................................ ................................ ... 70 Overview ................................ ................................ ................................ ................. 70 Approach ................................ ................................ ................................ ................ 70 Research Setting ................................ ................................ ................................ .... 72 Population Estimates ................................ ................................ ........................ 73 Socio Economic Status (SES) ................................ ................................ .......... 73 Health Status and Adolescen t Risk Behaviors ................................ ................. 74 Sexual, Maternal, and Child Health ................................ ................................ .. 75 Interviews ................................ ................................ ................................ ................ 76 Sample ................................ ................................ ................................ ............. 76 Inclusion and Exclusion Criteria ................................ ................................ ....... 76 Recruitment ................................ ................................ ................................ ...... 77 Recruitment Difficulties ................................ ................................ ..................... 79 Procedure ................................ ................................ ................................ ......... 80 Instrument Development ................................ ................................ .................. 82 Focus Group ................................ ................................ ................................ ........... 83 Sample ................................ ................................ ................................ ............. 83 Inclusion and Exclusion Criteria ................................ ................................ ....... 83 Recruitment ................................ ................................ ................................ ...... 83 Procedure ................................ ................................ ................................ ......... 84 Instrument Development ................................ ................................ .................. 85 Quant itative Instrument Development ................................ ................................ ..... 85 Rosenberg Self Esteem Scale (RSE) ................................ ............................... 86 The Mastery Scale ................................ ................................ ........................... 88 Life Orientation Test ................................ ................................ ......................... 89 Positive and Negative Affect Schedule ................................ ............................. 90 Data Analysis ................................ ................................ ................................ .......... 91 Quantitative Analysis ................................ ................................ ........................ 91 Qualitative Analysis ................................ ................................ .......................... 92 Thematic analysis ................................ ................................ ...................... 93 Case study analysis ................................ ................................ ................... 95 Ethical Considerations ................................ ................................ ...................... 95 Chapter 3 Conclusion ................................ ................................ ............................. 97 4 FINDINGS ................................ ................................ ................................ ............. 108 Overview ................................ ................................ ................................ ............... 108
8 RQ 1. What are the Similarities and Di fferences in Demographics, Family Dynamics, Family/Peer History of Teen Pregnancy, Religion, and Psychosocial Constructs Such as Self Esteem, Mastery, Optimism, and Positive/Negative Affect between Nulliparous and Parous Adolescents? .......... 109 Background Characteristics ................................ ................................ ............ 109 Family Dynamics ................................ ................................ ............................ 110 Family History of Teen Pregnanc y ................................ ................................ 111 Sexuality and Teen Parenthood among Peers ................................ ............... 111 Psychosocial Constructs ................................ ................................ ................ 112 RQ 2. What are the Similarities and Differences in Definitions of What it means to have a Successful Life between the two groups? ................................ .......... 114 Meaning of Success ................................ ................................ ....................... 114 Profile of Success ................................ ................................ ........................... 116 Characteristics of Successful and Unsuccessful Members in the Community 117 Success Rankings ................................ ................................ .......................... 118 Facilitate Success ................................ ................................ .......................... 120 RQ 3. What are the similarities and differences in definitions of pe rsonal and professional goal aspirations between the two groups? ................................ .... 122 Personal Aspirations ................................ ................................ ................ 122 Professional Aspirations ................................ ................................ .......... 124 RQ 4. How do Adolescent Girls (Ages 16 19) who have Never Been Pregnant Perceive Pregnant or Parenting Peers? What are their Views on Adolescent Pregnancy/Motherhood in the Media? ................................ ............................... 130 Sexually Active Peers ................................ ................................ ..................... 130 ................................ ................................ ......... 131 Best Perceived way s of Preventing Pregnancy and Sexually Transmitted Disease s (STDs) ................................ ................................ ......................... 133 Media ................................ ................................ ................................ ............. 139 Effect of 16 and Pregnant and Teen Mom on Tee n Pregnancy ......... 139 Media and Reality ................................ ................................ .................... 140 Other Media ................................ ................................ ............................. 140 RQ 5. How do Primiparous Adolescent Girls (Ages 16 19) describe the Context Surrounding Initial Birth? ................................ ................................ ................... 141 Discovery ................................ ................................ ................................ ........ 141 Birth ................................ ................................ ................................ ................ 145 Motherhood ................................ ................................ ................................ .... 146 RQ 6. How do Multiparous Adolescent Girls (Ages 16 19) Describe the Context Surrounding Subsequent Births? ................................ ................................ ....... 150 ................................ .................. 150 ................................ ............... 154 ................................ ..................... 159 Unexpected Findings: Adolescent Mothers in Foster Care ................................ ... 162 Summary of Findings ................................ ................................ ............................ 164 Chapter 4 Conclusion ................................ ................................ ........................... 165
9 5 DISCUSSION AND CONCLUSIONS ................................ ................................ .... 175 Overview of the Study ................................ ................................ ........................... 175 RQ 1. What are the Similarities and Differences in Demographics, Family Dynamics, Family/Peer History of Teen Pregnancy, Religion, And Psychosocial Construct s Such As Self Esteem, Mastery, Optimism, and Positive/Negative Affect between Nulliparous and Parous Adolescents? ... 175 RQ 2. What are the Similarities and Differences in Definitions of What It Means to Have a Successful Life between the Two Groups? ..................... 176 RQ 3. What Are the Similarities and Differences in Definitions of Personal and Professional Goal Aspirations between the Two Groups ? ................... 179 RQ 4. How do Adolescent Girls (Ages 16 19) Who Have Never Been Pregnant Perceive Pregnant or Parenting Peers? ................................ ...... 181 RQ 5. Ho w Do Primiparous Adolescent Girls (Ages 16 19) Describe The Context Surrounding Initial Birth? ................................ ................................ 184 RQ 6. How Do Multiparous Adolescent Girls (Ages 16 19) Describe The Context Surrounding Subse quent Births? ................................ ................... 186 Additional Findings: Adolescent Motherhood in Foster Care .......................... 187 Strengths and Limitations ................................ ................................ ..................... 1 89 Implications for Policy ................................ ................................ ........................... 190 Implications for Practice ................................ ................................ ........................ 194 Implications for Theory and Suggestions for Future Research ............................. 197 Chapter 5 Conclusion ................................ ................................ ........................... 200 APPENDIX A PARTICIPANT INTAKE FORM ................................ ................................ ............. 201 B NULLIPAROUS ADOLESCENT INTERVIEW GUIDE ................................ .......... 210 C PRIMIPAROUS/ MULTIPAROUS ADOLESCENT INTERVIEW GUIDE ............... 217 D FOCUS GROUP SCRIPT AND QUESTION GUIDE ................................ ............. 224 REFERENCES ................................ ................................ ................................ ............ 230 BIOGRAPHICAL SKETCH ................................ ................................ .......................... 249
10 LIST OF TABLES Table page 2 1 Risk Factors of Risky Sexual Behavior, Adolescent Pregnancy, and Repeat Pregnancy ................................ ................................ ................................ .......... 68 2 2 Pregnancy and Repeat Pregnancy Prevention Components of Successful, Mixed, and Unsuccessful Programs ................................ ................................ ... 69 3 1 Data amended from Florida Charts County School aged Child and Adolescent Profile (2 011) and County Health Status. ................................ ........ 98 3 2 Inclusion and exclusion criteria for interview participants ................................ 100 3 3 Inclusion and exclusion criteria for focus group participants ............................. 100 3 4 Interview guide themes and corresponding interview questions ....................... 101 3 5 Focus group themes and corresponding questions ................................ .......... 102 3 6 Interview and focus group sample demographic. ................................ ............. 103 3 7 The Mastery Scale (Perlin & Schoo ler, 1978). ................................ ................ 104 3 8 The Rosenberg Self Esteem Scale (Rosenber g, 1965) ................................ ... 105 3 9 The Life Orientation Test (Scheier & Carver, 1985 ) ................................ .......... 106 4 1 Research aims and research questions ................................ ........................... 166 4 2 Population demographics ................................ ................................ ................. 167 4 3 Standardized scale means ................................ ................................ ............... 169 4 4 Description of participant sample ................................ ................................ ...... 170 4 5 Summary of research findings by res earch question ................................ ........ 171
11 LIST OF FIGURES Figure page 1 1 Birth Rates for women ages 15 19 by race and Hispanic origin: United States 2005, 2007 & 2010 ................................ ................................ ............................ 26 2 1 Risk Factors of Risk Factors for Risky Sexual Behavior, Adolescent Pregnancy, Repeat Pregnancy ................................ ................................ ........... 67 3 1 Adolescent Birth rate, national distribution. (Birth Rate per 1,000, ages 15 19, 2010.) Original Image (Kaiser Foundation, 2012) ................................ ............... 98 3 2 Alachua and Marion County sited on Florida Map (Florida Counties, 2013) ....... 98 4 1 Box Plot presentation of PANAS mean difference ................................ ............ 172 4 2 Characteristics of Successful people in the community identified by Nulliparous and Parous participants ................................ ................................ 173 4 3 Characteristics of Unsu ccessful people in the community identified by Nulliparous and Parous participants ................................ ................................ 174
12 Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy GOAL ASPIRATIONS AMONG NULLIPAROUS AND PAROUS ADOLESCENT GIRLS AGES 16 19: A QUALITATIVE STUDY By Evelyn C. King Marshall August 2013 Chair: Barbara Curbow Major: Public Health Risky sexual behavior a mong adolescents can lead to adolescent pregnancy, and repeat pregnancy Understanding t he context of index and subsequent pregnancies among primiparous and multiparous ad olescents is essential to reducing rates of adolescent pregnancy and repeat pregnancy Research suggests that life goals compatible with motherhood may influence rates of adolescent pregnancy and repeat pregnancy, thus making it imperative to investigate the influence of the meaning of life success and personal and professio nal goal aspira tions on adolescent sexual decision making and pregnancy. I used focused ethnography methods to explore the meaning of success and the differences in personal and professional goal aspirations among n ulliparous and parous participants. I explored the perc eptions of adolescent motherhood among nulliparous participants and the context of single and subsequent births in primiparous and multiparous adolescents. This research included five research aims and six research questions. I addressed these questions t hrough conducting 30 in depth interviews with nulliparous primiparous and multiparous adolescents and two focus groups with parous
13 adolescents. I collected demographic information, and self reports of self esteem, optimism mastery, and positive/negative affect The average age of participants was 17.5 years old. A mong the sample, 57% were Black, 25% were White, 12.5% were other, and 6.3% were Hispanic. Findings concluded no statistical difference between nulliparous and parous adolescents on self esteem, optimism, mastery, or positive/negative affect; however, participant means were consistent with those in the literature. Nulliparous as being significantly more importa nt to reaching personal success than did parous pa rticipants. Nulliparous adolescents perceived adolescent motherhood as hard for personal, social, and romantic reasons. Parous participants described being shocked, scared, or excited at pregnancy discovery and characterized adolescen t specifically not as hard as they (society) predicted. The easiest part of motherhood was caring for their child, and the hardest part was lack of financial independence. Overall, p articipants descri bed succe ss using one of three ideologie s: dis tance traveled, goals achieved, and status achievement. Additionally, personal independence was embedded in each ideology There were no differences in professional aspirations; however, parous participants described changing goals to include degree progra ms that took less time since motherhood.
14 CHAPTER 1 INTRODUCTION Overview Compared to adults, adolescents typically have to make decisions regarding risky behavior under time pressures in a specific context and with possibly uncertain consequence s (Down s & Fischhoff, 2009). One specific consequence of risky sexual behavior is adolescent pregnancy. Despite best efforts, the consequences of adolescent pregnancy are numerous; significant ramifications for society, the community, the adolescent, and the infa nt have been identified Identified consequences continue to grow overtime, resulting in a malicious and unyielding cycle. Adolescent pregnancy has been linked to detriments to the individual (adolescent and infant health), the family unit (breakdown in fa mily structure), and society (decreased earning potential and increased system burden). There are varying definitions of the terms adolescent, teen and teenager. The adolescence period as described by Lerner ( 2001 1980 ) pers (Lerner, et al., 2001, p. 12) Rivara Park, and Iwin (2009), concur tha t adolescence is an age of transition from childhood to adul thood. Although the adolescent age group varies by source and purpose literature identifies early adolescents (ages 10 13), adolescent (ages 14 18), and late adolescent or young adulthood (ages 1 9 24) as primary subcategories (Rivara, Park, & Irwin, 2009) or early (10 14), middle (ages 15 17), and late (ages 18 20) (Auslander, Roshenthal, & Blythe, 2006) Due to small sample size s and inconsistency in data collection, most studies characterizing adolescent childbearing limit the ages to
1 5 15 19 (Phipps & Sowers, 2002) National data on childbirth among pre adolescent s and early adolescent (ages 10 14) is substantial, but it is inconsistent at the state level. Adolescent as used throughout this dissertation, refers to individuals ages 13 19 unless otherwise specified. Pre adolescent and adolescent birth (occurring at or before the age of 19); is associated with varying d eficits in life achiev ement such as lower rates of high school graduation, college attendance, marriage, and substantive employment (Fergusson & Woodward, 2000; Rowlands, 2010; The National Campaign to Prevent Pregnancy, 2011). As such, these life course penalties result in inc rease d economic cost s and social consequence s Background and Context According to the C enters for D isease C 2011 Youth Risk Behavior Survey, approximately 47% of high school students reported ever having sexual intercourse and one third reported not using a condom the last time they had sex ( Centers for Disease Control and Prevention ( CDC ) 2013) About one third ( 34% ), of participants reported being sexually active, defined as having had sexual intercourse with at least one perso n during the three months prior to the survey Among sexually active students, 60% used a condom and 12% used some other type of pregnancy prevention during last sexual intercourse However 22% of sexually active adolescents reported drinking alcohol or using drugs before last sexual intercourse (CDC, 2013) Sex ually transmitted diseases, HIV/ Aids, unplanned pregnancy and premature death are a few of the many long lasting consequences associated with risky sexual behavior s (R ivara, Park, & Irwin, 2009)
16 As noted, a dolescent (under the age of 1 9 ) pregnancy can result in a number of negative outcomes for the teen and the child. Additionally daughters of adolescent mothers are more likely to become pregnant as teenagers and the ir sons are more likely to be incarcerated at some point in their lives (NCPP, 2011). In addition to the negative consequences of teenage pregnancy, teens who give birth at an especially young age are more likely to give birth again before the age of 19 (N CPP, 2011) Adolescent mothers a re more likely to drop out of high school and subsequently live in poverty. In fact, of all mothers on welfare, 52% had their first child as a teenager (National Campaign to Prevent Pregnancy (NCPP), n.d) Jaffee (2002) fou nd that although individual and family factors accounted for some poor outcomes such as lower high school graduation, and higher welfare usage, adolescent birth exacerbated the negative outcomes. Social consequences include almost 10.9 billion dollars spe nt on early pregnancy outcomes in 2008, money paid by taxpayers at the federal, state, and local levels. These economic losses are attributed to lost tax revenue and increased public health care, child welfare and state priso n costs ; costs are proportiona te to the rates of teen motherhood within these states (NCPP, 2011) Texas taxpayers experienced the highest monetary los s due to teen childbearing, followed by California then Florida; North Dakota, Vermont, and Maine taxpayers experienced the lowest asso ciated loss (NCPP, 2011) Pregnancy Each year there are approximately 750,000 pregnancies among teenagers ages 15 19 in the United States ( Kost, Henshaw, & Carlin, 2010; Ventura, Mathews, Hamilton, Sutton, & Abma, 2011). Historically, the teen pregnancy r ate in the US is more than twice as high as in Canada and other industrialized countries (Finer &
17 Henshaw, 2006) Approximately 82% of adolescent pregnancies are unplanned; they account for about 20% of all unplanned pregnancies in the US each year (Finer & Henshaw, 2006; Ventura, Mathews, Hamilton, Sutton, & Abma, 2011) In 2006, the majority of teen pregnancies (59%) resulted in birth (Figure 1 1 ) and the teenage abortion rate was 19.3 per 1,000 in the US (Finer, 2006). Overall, teen pregnancy rates have declined over the past decade. Rates for minorities have experienced a more dramatic decline than among their white counterparts. The pregnancy rate for Black females ages 15 19 fell from 223.8 to 126.3 per 1,000 during the period of 1990 to 2006 (Finer, 2 006). In 2006, of all unintended pregnancies in Florida, 49% resulted in birth, 40% resulted in induced abortion, and 11% resulted in fetal los s (Finer & Kost, 2011) Teen Birth In 2009 10, the overall birth rate dropped 9 percent from 37.9 to 34.3 per 1,000 women ages 15 19 (Martin, et al., 2012; Hamilton & Ventura, 2012) Hispanic and Black youth had higher birth rates compared to their White counterparts (Martin, et al., 2012) In 2010, birth rates per 1,000 were 55.7 for Hispanics and 51.5 for Blacks compared to 23.5 for Whites ages 15 19 in the United States (Martin, et al., 2012; Hamilton & Ventura, 2012) R ates were significantly higher among women ages 18 19, but a disparate trend still oc curs -90.7 per 1,000 for Hispanics, 85.6 for Blacks, and 42.5 for Whites (Martin, et al., 2012) Please see F igure 1 1. At the state level, in 2010, there were 32 births per 1,000 to Florida teens ages 15 19. Mississippi had the highest rate (55.0 per 1,000), followed closely by New Mexico (53.0), and Arkansas (52.5) (Martin, et al., 2012) States with the lowest rates were New Hampshire (15.7), Massachusetts (17.2), and Vermont (17.9) (Martin, et al.,
18 2012) States with a higher minority population and those located in the Southern region of the US typically have higher rates of teen birth (Hamilton & Ventura, 2012) Within Florida countie s in 2009 2011, Hardee County had the highest rate of birth among teens ages 15 19 at 81.06 per 1,000; Alachua County had the lowest rate (20.7 per 1,000) (Florida Charts, 2009). Possible reasons for this wide discrepancy may be related to demographic diff erences. Hardee is a rural county as defined by Florida Statue, located in the S outhern region of Florida ; it has less than 100 people per square mile (Legistlature, 2012) In 2010, 26% of Hardee residents lived below 100% pov erty, with an average median income approximately $10,000 less than the state average ($37,466 vs. $47.661) (Florida Charts, 2013) Alachua County is a suburban county located in north central Florida with an average year ly income of $40,644; 20% of residents live below 100% poverty (Florida Charts, 2013) For additiona l information on Alachua County, see Chapter 3 Research Design and Methods. Repeat Birth A repeat birth is defined by Florida Charts (2009) as a live birth in which the mother has had at least one previous live birth or births (Schelar, Franzetta, & Jennifer, 2007) The r ate of repeat birth in 2010 for all adolescents ages 15 19 was 5.4 per 1, 000 (Martin, et al., 2012) Minority adolescents show disparately higher rates of repeat birth when compared to their white counterparts. The rate of repeat birth among Whites ages 15 19 was 4.9 per 1,000 compared to 10.0 among Hispanics 8.6 among Blacks, and 6.9 among American Indian/ Alaska Natives (Martin, et al., 2012) Rates of repeat birth are also higher among older adolescents (ages 18 19) : 11.0 per 1,000 for all races, 10.1 among Whites, 17 .2 among Blacks, and 14.4 among American Indian/ Alaska Native (Martin, et al., 2012) Although, the percent of repeat births is typically higher among
19 Black adolescents this group experienced the largest decline compared with Hispanic and White adolescents (Martin, et al., 2012) Nationally in 2010, repeat births to females under the age of 20 were the highest in Texas (22%) and the lowest in New Hampshire (11%) (US Department of Health and Human S ervices (US DHHS), 2013) In 2010, the percent of repeat births in Fl orida was slightly higher (18%) than in the US overall (17%) (US DHHS, 2013) Repeat births rates among Florida teens ages 15 17 declined from 9.6 per 1,000 in 2006 08 to 8.9 in 2009 11 ( Florida Charts: Florida Department of Health, 2013) In 2009 11, the Florida c ounties of Holmes (24.7%), Gadsden (24.1%), and Hamilton (23.7%), had the highest percentages of repeat births. Gadsden, Holmes, and Hamilton c ounties are all located in the Flor ida panhandle, adjacent to Georgia or Alabama and each ha s a population density of less than 100 people per square mile. In Holmes County (41.6) and Hamilton County (28.6 ) (United States Census Bureau, 2013) They are all defined as rural counties Additionally, Hamilton and Gadsden c ounties both have a high (35% and 56%) proportion of Non White residents (United Stat es Census Bureau, 2013) which may also contribute to higher rates of repeat birth. Alachua County had the 16 th highest (19.8%) and Santa Rosa County had the lowest percent (10.9%) of repeated pregnancies ( FDOH 2011) Research Purpose Although researc h on the risk and protective factors associated with teen pregnancy and repeat pregnancy is abundant (Raneri & Wiemann, 2007; Rowlands, 2010) our current understanding of the complexities of adolescent childbearing and repeat childbearing is limited. The purpose of this research project was to investigate the definition of life success and personal and professional life aspirations among
20 nulliparous primiparou s and multiparous adolescents. Current literature provides a detailed account of the epidemiology of teen pregnancy and repeat pregnancy and the ri sk and protective factors (C hapter 2: Review of Literature ) while this research provide s a contextual framework for understanding adolescent birth and repeat birth there is still much that is unknown Th e goal of this research was to provide a preliminary investigation of life success definitions and personal and professional goal aspirations of nulliparous primiparous and multiparous adolescent girls ages 1 6 19. Results from this study and follow up stu dies can lead to the development of specialized repeat pregnancy interventions utilizing goal development and achievement strategies to reduce rates of repeat pregnancy. Research Aims The research aims for the project were the following: 1. To explore the role of factors such as demographics, family dynamics, family / peer history of teen pregnancy religion, and psychosocial constructs such as self esteem, mastery, optimism, and positive/negative affect on single a nd subsequent adolescent births among girls 16 19 ; 2. To explore the themes associated with what it means to have a su ccessful life between nulliparous and parous adolescent girls (ages 16 19) ; 3. To explore the themes associated with personal and professional aspirations between nulliparous and parous adolescent girls (ages 16 19); 4. To investigate the explanatory models of nulliparous adolescent girls (ages 16 19) associated with parous peers, and their views on adolescent motherhood in the media ; and 5. To explore the described context of conception, del ivery and motherhood (for single and subsequent pregnancies) among parous adolescent girls (ages 16 19) Research Questions The research questions for the project were the following:
21 1. What are the similarities and differences in demographics, family dynam ics, family/peer history of teen pregnancy, religion, and psychosocial constructs such as self esteem, mastery, optimism, and positive/negat ive affect among nulliparous and parous adolescents? 2. What are the similarities and differences in definitions of wha t it means to hav e a successful life between the two groups? 3. What are the similarities and differences in definitions of personal and professional goal aspirations between the t wo groups? 4. How do adolescent girls (ages 16 19) who have never been pregnant p erceive pregnant or parenting peers? What are their views on adolescent pregnancy/motherhood in the media ? 5. How do primiparous adolescent girls (ages 16 19) describe the context surrounding initial birth? 6. How do multiparous adolescent girls (ages 16 19) de scribe the context surrounding subsequent births ? Conceptualization of the Problem Herman (2006) investigated girls regarding how they thought teen pregnancy and birth affected their relationships, vocation, and self. Never pregnant teens reported pregna ncy and birth would have a negative effect on friendship and peers, while parenting/pregnant teens reported both negative and positive effects. Parenting teens reported a positive impact on vocation describing an increase in motivation towards school, whi le non parenting teens believed it would cause an increase in difficulties associated with being a parent and a student (Herman, 2006) Arai (2007) found limited effects of peer influence on parenting adolescents. Using qualitative methods, the author inve stigated the effect of neighborhood and peer influences on pregnancy and their behavior; however early childbearing may be normative in some communities (Arai, 2007, p. 8 7) Although these mothers sought advice from peers and some
22 recognized negative local attitudes towards their pregnancy from the community, none reported a long term impact (Arai, 2007). Camerena (1998) found that adolescent mothers reported varying degr ees of change in life aspirations after giving birth. Some participants des cribed feelings of resilience, some described no change, and some described resignation. Among participants who reported resignation (tone reflected more struggle than hope) the rea lity of their new life was a source of frustration (Camerena, 1998 pg 132). However, those who reported resilience or adjustment described a renewed focus due to giving birth (Camerena, 1998). Similar to Herman (2010) and Camerena (1998), SmithBattle (2007 ) reported a renewed sense of focus on education and success among some parenting adolescents while others were victim to family, financial and school difficulties that compelled school withdrawal. Goals that are compatible with motherhood and an ambivalen t disposition towards pregnancy have also been linked to repeat pregnancy (Sheeder, 2009; Sheeder, 2010; Rosengard, 2009). Considering goals compatible with motherhood as a link to repeat pregnancy, I sought to highlight the differences in both personal an d professional goal aspirations among primiparous and multiparous adolescents. In addition, I compared these findings with nulliparous adolescents. Methods I conducted an explorative qualitative research project grounded in ethnographic methodology. Ethno graphy allows for exploration based on culture (Richards & Morse, 2007). Ethnographic research explores themes within cultural contexts from the perspectives of the members of the group; during data collection, it is essential to reflect on the cultural va lues, beliefs, and behaviors of the group (Richards & Morse, 2007 pg
23 55). Observational data, field notes, surveys, and interviews (unstructured, semi structured and structured) are classic ethnographic methods Ethnographic methods address observational questions, descriptive questions about values, beliefs and practices of cultural groups and what is happening within the culture (Richards & Morse, 2007). Using key informants and snowball sampling methods, I conducted thirty interviews among nulliparous primiparous and multiparous adolescent girls ages 16 18. I also conducted two focus groups among pregnant or parenting adolescents ages 1 6 19. The interviews and focus groups covered general information about life for girls their age, the meaning of suc cess, and adolescent sexuality and pregnancy. Specific questions investigated their current and previous goal aspirations, perceived benefits of adolescent pregnancy The qua ntitative strategy included collecting demographic information and self reported responses to the Positive and Negative Affect Scale (PANAS) (Watson, Clark, & Tellegen, 1988) The Rosenberg Self Esteem Scale (Rosenberg 1965) T he Mastery Scale (Perlin & Schooler, 1978) and the Life Orientation Test (Scheier & Carver, 1985) I conducted a statistical analysis using SPSS 22. Overview of the Chapters In Chapter 1, I have provided a brief introduction into the topic of adolescent pregnancy and repeat pregnancy as well as an overview o f the current epidemiologic data. In Chapter 2, I provide a detailed examination of the literature surrounding adolescent pregnancy and contributing theories or factors. A dditionally, I pr esent a review of the risk and protective factors associated with teen pregnancy, teen birth, and
24 repeat birth. Reviews o f the literature on success and goal aspirations among adolescents, at risk adolescents and pregnant or parenting adol escents are also included In Chapter 3, I provide a detailed description of the research methods and design. Information on the research setting, recruitment strategy, participant sample and t he development and varying components of the qualitative and q uantitative instruments are located in C hapter 3 I conclude Chapter 3 with a guide of the qualitative and quantitative methods employed in this dissertation In Chapter 4, I discuss the results of the dissertation. I present the quantitative and qualitati ve findings as they relate to each research question Quantitative results related to specific measures such as the PANAS (Watson, Clark, & Tellegen, 1988) The Mastery Scale (Perlin & Schooler, 1978) The Rosenberg Self esteem Scale (Rosenberg 1965) and the Life Orientation Test (Scheier & Carver, 1985) are highlighted In the conclusion, Chapter 5, I provide a summary and a discussion of the findings and their implications for theory, policy, and practice. Chapter 1 Conclusion Adolescent pregnancy, birth, and repeat birth have numerous and long lasting adverse effects on the adolescent and the child (NCPP, 2011; Jafee, 2002) Although rates are improving, adolescent birth and repeat birth continue to be issue s in the United States as compared to other industrialized countries (Singh & Darroch, 2000; Kost, Henshaw, & Carlin, 2010) This study explored the contextual factors related to adoles cent birth and subsequent birth, the meaning of success an d personal and professional goal aspirations among a select sample of primiparous, nulliparous and multiparous adolescents. The overall aim was to assess differences and similarities o n select constructs success and goal aspirations and the effect of pr emature
25 childbearing among the three groups ( nulliparous primiparous, multiparous girls). This was produced with the use of qualitative methods, specifically focused ethnography, and supported by quantitative methods including the use of validated scales.
26 Figure 1 1 Birth Rates for women ages 15 19 by race and Hispanic origin: United States 2005, 2007 & 2010 Data amended from US National Data Report (Hamilton & Ventura, 2012) 0 10 20 30 40 50 60 70 80 90 All Races Non-Hispanic White Non-Hispanic Black Hispanic A I / A N Asian/ P I Rates per 1,000 2005 2007 2010
27 CHAPTER 2 REV IEW OF THE LITERATURE Adolescent pregnancy and repeat pregnancy occur within biological, psychological, and social contexts. In C hapter 2 Review of the Literature, I will review adolescent development, adolescent risk taking, and risk taking theory. Follo wing risk taking theory I will discuss the risk and protective factors related to risk y sexual behavior, adolescent pregnancy and repeat pregnancy ( summarized in Table 2 1 and Figure 2 1), followed by implications of adolescent p regnancy, and a review of intervention and prevention programs (summarized in Table 2 2 ). I conclude Chapter 2 with the theoretical framework applied to this research, which considers goal aspirations, the meaning of success, and the context o f motherhood among adolescents Adolescent Development Normal adolescent development encompasses increasing independence, autonomy, peer affiliation, sexual awareness, and cognitive maturation (Igra & I rwin, 1996, p. 36) theory are 1) developing an identity or gaining autonomy and independence; 2) 4) developing a sense of achievement (Erickson, 196 3 ) Strickland et al (2006) summarized similar goals of adolescence including 1) achievemnt of autonomy and indpendence; 2) establisment of self identity; 3) development of social competence ; and 4) acqu isition of cognitive abilities Adolescence is generally defined as the period between 10 20 and split into three phases. Although the terms, early, middle, and late adolescence are often used, the age distribution differs among researchers. Auslander
28 et a l (2006) defined adolescence by early (10 14), middle (ages 15 17), and late (ages 18 20). However, Rivara, Park, and Irwin (2009), defined early adolescents (ages 10 13), adolescent s (ages 14 18), and late adolescent s or young adulthood s (ages 19 24) Du ring the adolescent period, individuals transform via a period of biological, cognitive, social, and behavioral development (Adams, 2005) with long term consequences. Adolescent biological development is most often noted for t he preparation and onset of puberty. Changes in hormones, increased body hair, and other changes in physical appearance may initiate risk behaviors, especially in early or late maturing adolescents. Adolescent cognitive development includes fluctuation in intelligence quotient ( I Q ) often a steady increase, and the transformation from concrete thinking to more abstract thinking (Adams, 2005) During adolescence emotional development, tasks include learning 1) to regulate intense emotions ; 2) self soothing techniques ; 3) to be aware of their own emotions ; 4) to understand the consequences of emotions for others ; 5) to distinguish feelings from facts ; 6) to manage emotional arousal; and 7) to manage feelings of love, hate or indiffe rence in romantic relationships (Adams, 2005, p. 12) Adolescent social development consists of a greater attachment to peers and earn ing autonomy and independence from parents (Adams, 2005) During early a dolescence, there is strong conformity to peer pressure and the need to belong. During middle adolescence, there are typically larger peer groups, resulting in less confirmatory and increased tolerance of differences. During late adolescence, peer groups t ypically consist of groups of couples, which provide an environment of intimacy, and dyadic relationships (Adams, 2005)
29 Adolescent sexual development often occurs within the context of romantic relationships (Auslander, Roshenthal, & Blythe, 2006) In early adolescence, typical sexual development includes understanding how to feel in romantic relationships (Connolly & Goldberg, 1999; Auslander, Roshenthal, & Blythe, 2006) During middle and late ad olescence, teens become more sexually experienced and the qualities of intimate relationships become more important (Connolly & Goldberg, 1999; Auslander, Roshenthal, & Blythe, 2006) These changes in biological, cognitive, social, and sexual development risk taking and deviant activities. Behavioral development for most adolescents, an estimated 80% per generation, is uneventful and consists of age appropriate actio ns such as active compliance with school, sports, homework, and religious requirements (Adams, 2005) However, an estimated 20% participate in serious risky behaviors, drug use/abuse, sexual, criminal, or delinquent (Adams, 2005, pp. 13 14) also known as risk taking behaviors. Adolescent Risk Taking Risky beh avior is a leading contributor to premature death ; up to an estimated 70% of morbidity among adolescents can be attributed to risk takin g behaviors (Adams, 2005; Rivara, Park, & Irwin, 2009) Risk behaviors, defined and measured by the Youth Risk Behavior Surveillance System (YBSS), are behaviors that contribute to the leading causes of death and disability among youth and adults (Youth Risk Behavior Survellance System (YRBSS), 2013) Risky behaviors include those that contribute to unintentional injury and violence, alcohol and other drug use, tobacco use, unhealthy dietary behaviors and inadequate physical activity (YRBSS, 2013) Risky sexual
30 behaviors are defined as those that contribute to unintended pregnancy and sexually transmitted diseases such as HIV /AIDS (YRBSS, 2013) risk taking has often been used to link potentially health d amaging behaviors such as substance use, precocious sexual behavior, reckless vehicle use, homicidal and suicidal behaviors, eating disorders, and delinquency (Igra & Irwin, 1996, p. 35) Tobacco, drug and alcohol use as well as the rate of sexually transmitted disease s, peak in the late teens and early twenties (Rivara, Park, & Irwin, 2009) E xcess death attributable to these risky behaviors is especially troublesome because the behaviors are modifiable. Risky sex ual behavior, including but not limited to having unprotected sex and numerous sexual partners, although declining is still common among adolescents in the United States (Kost, Henshaw, & Carlin, 2010) There was no significan t decrease in the percent of high school students reporting sexual intercourse before age 13 from 2009 (5.9%) to 2011 (over 6.0%) (Youth Risk Behavior Surveillance United States, 2011; 2012) In 2011, rates of adolescents reporting sexual intercourse bef ore age 13 were higher among Blacks (14%), than Hispanics (7%), and Whites (4%) (Youth Risk Behavior Surveillance -United States, 2011, 2012) The prevalence of having four or more sexual partners did not change significant ly from 2001 (14.2%), to 2009 (13.8%), to 2011 (15.3%) (Youth Risk Behavior Surveillance -United States, 2011; 2012) Epidemiological reports indicate that almost half of all new STD cases were among young people ages 15 24 in 2009 and young people ages 1 3 29 accounted for 39% of all HIV infections (CDC, 2013). Decision Making : Decision making can occur in multiple steps. The first step to decision making is to identify options, the second is to begin evaluation of these options
31 (Downs & Fischhoff, 2009) For example, adolescents might make the decision to have sex or not to have sex, based on potential consequences of each option. However, these steps falsely assume that people, specifically adolescents know what they want and the steps lack the influential impact of the context (Downs & Fischhoff, 2009) Singer and colleagues (2006) explored social and cultural contexts to understand sexually transmitted disease rates in inner city minority women. C ontext driven decision making related to sexual risk behaviors included information about the partner (attractiveness, social standing, family background, and personal history), personal relationship status, and availability of condoms (Singer, et al., 2006) Nelson and colleagues (2011), found that among African American a dolescent mothers, condom use decision making varied by partner type and emotional and relationship factors. Type of sexual partners, such as being steady ver sus a casual relationship influenced the decision making schema (Nelson, Morrison Beedy, Kearney, & Dozier, 2011) Participants reported always using a condom with a one night stand perceived as someone t hey did not know or trust and with whom they had an existing prior relationship and prior unprotect ed sex (Nelson, Morrison Beedy, Kearney, & Dozier, 2011) Not using a condom, not using birth control, or havin g multiple sexual partners, are all poor health decisions and risky sexual behaviors; risky behaviors have been investigated via many avenues including theories of risk taking. Risk Taking Theories : Ris k taking literature has explored several explanations for adolescent behavior Among the most widespread are views that risk taking has biological psychological, and social and environmental explanations or the
32 combinations of all factors, the bio psychosocial model of risk taking (Sales & Irwin, 2009) Biologically based theories for risk taking suggest that risk taking results from genetic predispositions, hormonal influences, asynchronous pubertal timing and brain and central nervous system development (Sales & Irwin 200 9 p 33 ). Family studies have suggested that certain risky behaviors such as alcohol use and misuse have genetic links (Bierut, et al., 1998) Others have stipulated that hormonal influences and that early and late onset of pubert y is related to risky sexual behavior (Adams, 2005) Ariely and Loewenstien (2006) investigated contextual factors related to sexual risk taking. Specifically, researchers investigated the effect of sexual arousal on judgment, and hypothetical decision making among male college students (Ariely & Loewenstein, 2006) Results indicated that responses to hypothetical questions about risk taking and sexual responsibility (condom use) were significantly in fluenced by sexual arousal; sexually aroused men were less likely to anticipate behav ing in sexually responsible ways (Ariely & Loewenstein, 2006) As such, sexual decision making among adolescents can be especially complex due to multiple developmental changes, biological conditions and the context of the decision. Psychologically based theories of risk taking examine the role of cognition, personality, and dispositional characteristics on adolescent risk taking (Sales & Irwin, 2009) Some theories stipulate that risk taking is a normal and essential part of growing up (Adams, 2005;Jessor, 1982; ) others address the role of personal fable on decision making and risk taking (Steinberg, 2002) hypothesizes that problem behavior is a normal part of adolescent development; as
33 such it is instrumental in establishing autonomy, gaining peer acceptance, and coping with anxiety and frustration (Jessor, 1982) Research by Greene and colleagues indicated that risk seeking predicted delinquent behavior such as alcohol use and concluded t hat adolescents that experience high personal fable and high sensation seeking participated in the most risk taking behavior (Greene, Krcmar, Walters, Rubin, & Hale, 2000) f that the individual is unique, indestructible, and invulnerable to risk (Quadrel, Fischoff, & Davis, 1993) Social and environmental theories of risk taking look at the roles of peers, family structure, function, and ins tituti ons ( i.e. schools or churches) on risk taking (Sales & Irwin, 2009) Social and environmental theories examine the role of nature, such as social learning on risk taking. These theories suggest that risk taking behaviors ma y be a direct or indirect result of parental, peer or school influences (Sales & Irwin, 2009) Adolescents may learn risk taking behaviors such as alcohol use by mimicking parents or risky sexual behaviors by mimicking peer s. Societal influences such as media and community norms have been linked to risk taking among adolescents. R esearch indicates that media outlets such as television and music may serve as a sexual super peer (Brown, Halpern, & L'Engle, 2005) The bio psyc hosocial model of risk taking integrates the relationship of biological development and the relationship of risk taking behaviors to psychosocial associations of behavior (Sales & Irwin, 2009) According to this model, biol ogical, psychological, and social or environmental variables mediated by perceptions of risk and peer gro u p char acteristi cs predict adolescent risk taking (Sales & Irwin, 2009, p. 42) Variables
34 specific to adolescent risk taking are biological variables such as the timing of puberty (Dunbar, Sheeder, Lezotte, Dabelea, & Stevens Simons, 2008) psychosocial variables such as self esteem and optimism (Paul, Fitzjohh, Herbison, & Dickson, 2000; Whitbeck, Yoder, Hoyt, & Conger, 1999) and social influences such as having peers who are sexually active (Adams, 2005; Dogan Ates & Carrion Basham, 2007) These variables differ slightly depending on the specific ri sk behavior; however, research provides con sistent support for this model for understand ing adolescent risk taking (Sales & Irwin, 2009) Despite the complexities of adolescent development, risk taking, and decision making, researchers have identified risk and protective factors associated with risky sexual behavior, adolescent pregnancy and repeat pregnancy. Risk Factors Numerous studies have investigated the risk and protective factors associated with adolescent sexual be haviors, specifically early sexual intercourse, teen pregnancy, and repeat pregnancy. These r isk factors can be placed on a continuum of biological, socio demographical, and psychosocial factors Please see Table 2 1 for an outlin e of risk factors organized by the categories of the socio ecological model. Risky Sexual Behavior Family influences, adolescent characteristics and behaviors, and peer influences have all been hypothesized to be predicators of early sexual intercourse ( Whitbeck, Yoder, Hoyt, & Conger, 1999) Individual factors, as found by Whitbeck et al (1999), include self ratings of low self esteem and low mastery as statistically significant predicators of early sexual intercourse. Other factors include participatio n in deviant behaviors and average IQ. Deviant behaviors such as smoking and alcohol and drug use were found to have main effects on early sexual intercourse (Whitbeck, Yoder,
35 Hoyt, & Conger, 1999) Cigarette smoking and IQ in the middle range were both f ound to be statistically significant for sexual initiation before age 16 among females (Paul, Fitzjohh, Herbison, & Dickson, 2000) Furthermore, contradictory to Whitbeck et al (1999), having a higher self esteem score was ass ociated with sexual initiation prior to age 16 (Paul, Fitzjohh, Herbison, & Dickson, 2000) For males, low reading scores and a diagnosis of conduct disorder in early adolescence predicted sexual initiation before age 16 (Paul, Fitzjohh, Herbison, & Dickson, 2000) Personal factors that influence sexual initiation among Mexican American women include being foreign born and preferring to speak Spanish (Gilliam, Berlin, Kozlo ski, Hernandez, & Grundy, 2007) Family and relationship factors that influence early sexual intercourse are contextual parental and partner factors. Having a mother who had her first child before age 20 was significantly associated with sexual initiation before age 16 among females but not among males (Paul, Fitzjohh, Herbison, & Dickson, 2000) Having a boyfriend or girlfriend who was greater than or equal 2 years older was found to be associated with early sexual initiation when investigated in an urban sample of 6 th graders (Marin, Coyle, Gomez, Carvajal, & Kirby, 2000) Furthermore, participants with a current or previous older boy/girlfriend were more likely to be Hispanic, to report more unwant ed sexual advances, to have more friends who were sexually active, and the girls were more likely to have reached menarche (Marin, Coyle, Gomez, Carvajal, & Kirby, 2000) These factors, Hispanic ethnicity, sexually active peers and early menarche, are associated with risky sexual behavior, adolescent pregnancy and repeat pregnancy (Adams, 2005 ; Coard, Nitz, & Felice, 2000; Dogan Ates & Carrion Basham, 2007; Woodw ard, Fergusson, & Horwood, 2001 ) Moreover, women who acknowledged a
36 strong role for partners in their sexual decision making were more likely to have sex at a younger age (Gilliam, Berlin, Kozloski, Hernandez, & Grundy, 2007) Gilliam et al (2007) found that girls whose family believed in e ducation over marriage and abstinence pregnancy was related to early sexual initiation (Gilliam, Berlin, Kozloski, Hernandez, & Grundy, 2007) Another family and relationship factor is family instability. Fomby et al (2007) found that family stability or instability defined by multiple transitions in family structure was correlated with cognitive achievement within white adolescents; but not among Black adolescents. Cognitive achievement was measured with the math ability, reading recognition and reading comprehension subscales of Peab ody Individual Achievement Test (Fomby & Cherlin, 2007) Cognitive achievement has been linked to sexual risk behavior (Paul, Fitzjohh, Herbison, & Dickson, 2000 ; Woodward, Fergusson, & Horwood, 2001) .Wu and Thompson (2001) found that for White women, but n ot for Black, changes in family situations were positively related to the risk of early sexual intercourse. However, for Black women, but not White, there was an increased risk of having lived in a mother only, father only, or mother stepfather household v ersus an intact nuclear family during adolescent years (family transition) (Wu & Thomson, 2001) Whitbeck and colleagues (1999) us ed logistic regression to analyze factors that predict sexual intercourse as a discrete occurren ce among adolescents from 8 th to 10 th grades. School activities and homework completion were negatively associated with early sexual intercourse (Whitbeck, Yoder, Hoyt, & Conger, 1999) Alcohol use, permissive sexual attitudes, delinquent friends, and stea dy dating were positively
37 associated with early sexual intercourse each increas ing the likelihood of early sexual intercourse (Whitbeck, Yoder, Hoyt, & Conger, 1999) Factors such as not having outside home interests at age 13, no religious activity at age 11, and not being attached to school at age 15 predicted sexual initiation before the age of 16 among males (Paul, Fitzjohh, Herbison, & Dickson, 2000) Predictors for females included not being attached to school, being in tr ouble at school, and planning to leave school early (Paul, Fitzjohh, Herbison, & Dickson, 2000) Low socio economic status was an identified social system factor predicting sexual initiation before the age of 16 for females, bu t not for males (Paul, Fitzjohh, Herbison, & Dickson, 2000) Factors such as multiple sexual partners, forcing or having been forced to have sex, and intercourse while drunk or high (O'Donnell, O'Don nell, & Stueve, 2001) increase the probability of experiencing an adolescent pregnancy or repeat pregnancy. As such, risk factors for adolescent birth and repeat birth are similar to those identified for risky sexual behavior. See Table 2 1 for a comparison of the risk factors for risky sexual behavior, adolescent pregnancy, and repeat pregnancy. Adolescent Pregnancy and Birth Individual factors associated with adolescent pregnancy include low self esteem, minority race/ethnic i dentity, low educational achievement, and history of sexual abuse. Studies suggest that females who have higher self esteem are less likely to engage in risky sexual activity. Women who have higher self esteem are also better equipped to negotiate safe sex practices with their sexual partners (Etheir, et al. 2006). Woodward and Fergusson (1999) and Woodward Fergusson, and Horwood (2001) concluded that girls with aggressive and antisocial tendencies measured by documented conduct problems from parents and teachers, wer e at an increased risk for teen pregnancy,
38 along with those with a history of illicit drug use. Other individual risk factors include race and ethnicity; prevalence data illustrates that African American and Hispanic teens are more likely to b ecome pregnant than their White counterparts (Florida Charts, 2009). Biological factors associated with teen pregnancy include pubertal changes, such as early menarche (Dunbar, et al., 2008) and early sexual development (Woodward et al 2001). Additionall y, w omen with no educational qualifications were more lik ely to have had a child before age 20 than women with higher education; this association was stronger for women than men (Wellings, Wadsworth, Johnson, Field, & Macdowall, 1999) Early sexual experience and poor educational attainment were both independently associated with teenage pregnancy (Wellings, Wadsworth, Johnson, Field, & Macdowall, 1999) Adolescents who had experienced sexual abuse w ere also more likely to become adolescent mothers (Erdmans & Black, 2008) Erdmans and Black (2008) found that victims of sexual abuse were more likely to be victims of statutory rape, to have abusive partners, to have behaviora l problems, and to be less integrated in high school, all of which have been linked to adolescent pregnancy (Dogan Ates & Carrion Basham, 2007; Marin, Coyle, Gomez, Carvajal, & Kirby, 2000; Woodward, Fergusson, & Horwood, 2001) Researchers speculate that future aspirations factor into adolescent pregnancy. Wolfe et al (2007) used a two stage econometric model to determine whether the perceptions of adverse income and marital or cohabitation relationship cons equences attributed to non marital adolescent birth. Findings suggest that teens placed greater
39 weight on potential relationship consequences than income consequences but that both influenced non marital birth choices (Wolfe, Haveman, Pence, & J, 2007) F amilial factors associated with teen pregnancy include family disruption, family dynamics and maternal and sibling history of teen pregnancy A dolescents who reported a high level of parental conflict were significantly more likely to have a teen pregnanc y in a longitudinal study based in New Zealand (Woodward et al, 2001). Maternal characteristics that are associated with teen pregnancy are low education al achievement (Woodward et al 2001) and having a mother who was a teen mo ther (National Campaign to Prevent Pregnancy n.d ). Wellings et al (1999) found that the prevalence of teenage parenthood was higher for both men and women who lived in one versus two parent households. Furthermore, Molborn( 2010) found that married or cohabiting adolescent parents who lived with no or one parent had a 73% lower odds of graduating high school than those living with two parents. Peer and community risk factors associated with adolescent pregnancy include having friends who are pregnant, low academic achievement, and h igh school disengagement (Scales & Leffert, 1999). Young et al (2004) investigated the effect of internal poverty factors, including loc us of control, future expectations, and high school graduation confidence and external poverty factors such as occupation, socio economic status ( SES ) and perceptions of parental educational expectations. The internal poverty factors of low locus of control, low educational expectations, and low confidence in graduating from high school and the external poverty factor of low parental education were most predictive of teen pregnancy (Young, Turner, Denny, & Young, 2004) Researchers have investigated the
40 effect of peer relationships on adolescent pregnancy Ara i (2007) found that from the childbearing may be normative in some geographic communities, thus affecting social and cultural influences of teen pregnancy (Arai, 2007) Young et al (2004) found that one of the greatest predictors of adolescent pregnancy was decreased confidence in graduating from high school. Furthermore, studies suggest t hat t hose teens who participate d in comprehensive sex education programs we re less likely to become pregnant compared to abstinence only or no t participating in sex education (Kohler, 2008). However, there wa s no significan t delay in sexual contact between the two groups (Kohler et al 2008). Social system risk factors include d low sch ool involvement, low socioeconomic status and low community involvement (Scales & Leffert, 1999). Repeat Pregnancy a nd Birth The risk factors associated with repeat adolescent pregnancy and birth are similar to initial pregnancy. Individual risk factors a re early age at first pregnancy low educational achievement, and having a planned first pregnancy (Dunbar, 2008; Rowlands, 2010; Sheeder, 2009). Teens who have positive attitudes towards early childbearing, want to have a baby, and select oral contracepti on over long term contraception have also been found to have higher rates of repeat teen pregnancy ( Rowlands et al 2010). Individual factors identified by Raneri and Wiemann (2007) are planning to have another baby within five years and not using long ac ting contraception within 3 months post index delivery Lack of contraception use before and after index pregnancy has been linked to repeat pregnancy (Lemay, Cashman, Elfenbein, & Felice, 2007) Analysis of focus group data fr om adolescent mothers found that prior to first pregnancy the beliefs that pregnancy could not or would not happen and a lack of focus
41 on steps to prevent pregnancy were associated with repeat pregnancy (Lemay, Cashman, Elfenbein & Felice, 2007) Adolescents were also likely to report switching or planning to switch birth control methods thus putting them at a greater probability for a repeat pregnancy during a gap in contraceptive use Common reasons for changing or selecting contraception after initial pregnancy were convenience, perceived effectiveness, familiarity, and side effects (Lemay, Cashman, Elfenbein, & Felice, 2007) Wolfe ( 2007) found that when modeling the long term relationship expec tations and income expectations, teens who predicted higher incomes and a long term relationship with the father of their child were more likely to experience repeat adolescent pregnancy. Relationship level risk factors include marriage before or after the index pregnancy, a partner who is three or more years older and having a partner who wants a child (Rowlands, et al 2010). Rowlands et al (2010) also found that intimate partner violence and a discontinued r elationship with the father of the index chi ld were associated with repeat pregnancy. Similarly, Raneri and Wiemann (2007) concluded that not being in a relationship with father of the index child three months after delivery, being more eriencing intimate partner violence within three months after delivery were associated with higher rates of repeat pregnancy Boardman et al (2006) investigated risk factors for unintended versus intended repeat pregnancy. The authors concluded that inten ded first pregnancy, prior poor birth outcome and intended pregnancy by the partner we re associated with intended repeat pregnancy; however, marriage was associated with decreased risk for unintended pregnancy (Boardman, Allswort h, Phipps, & Lappane,
42 2006) Kelly, et al (2005), found that primiparous adolescents ages 13 21 who lived with their boyfriend and those who delivered prematurely were more likely to participate in postpartum sexual intercourse but there was no relation to contraception use. Similar to teen pregnancy, family level risk factors for repeat pregnancy as found by Rowlands and colleagues (2010), are poor mother daughter relationships, lack of family support, and having a mother who was a teen parent. Commu nity risk factors include having friends who have experienced pregnancy (Raneri & Wiemann, 2007) dropping out of school prior to index pregnancy, not going to school after delivery low e ducational aspirations, low socioeconom ic status and low educational status (Rowlands, 2010) Rapid Repeat Pregnancy : R apid repeat pregnancy is defined as a repeat pregnancy within 24 months of the index pregnancy and it is a growing concern (Boardman et al 200 6; Crittenden, 2009; El Kamary, et al., 2004). Individual risk factors associated with rapid repeat pregnancy, as found by Crittenden (2009) include failure to initiate use of long acting contraceptives after initial delivery and a discontinued relations hi p with the father of the first child High risk a dolescents were also less likely to have taken steps to accomplish personal goals (Crittenden, 2009) or to have identified goals that we re compatible with childbearing (Sheeder, Tocce, Stevens Simon, 2009) Coard et al (2000) concluded that among a n urban sample of first time adolescent mothers type of contraceptive method (birth control pills versus IUD) was associated with repeat pregnancy at year one. Low c ontraceptive use, young maternal age, history of previous miscarriages and the use of birth control pills instead of the IUD
43 postpartum were associated with repeat pregnancy at year two (Coard, Nitz, & Felice, 2000) Steven Simon et al (2001) found that long acting con traception was the greatest protective factor for rapid repeat pregnancy. However, there are significant di fferences associated with those who initiate long acting birth control and those who do not. Factors c orrelated with for RRP were desire for a child within two years of first birth and no t using bir th control in the year following the index pregnancy (El Kamary, et al., 2004) Family and relationship factors include poor parent child relations, conflicting support for the te en mother role such as perceived lack of support by the adolescent versus perceived complete responsibility by the mother/grandmother, and limited social pressures for effective fathering (Bull & Hogue, 1998) Other factors are significant age difference between mother and father of first pregnancy the male three or more years older, and experiencing intimate partner violence soon after delivery (Crittenden et al 2009). Peer and community level factor s, also identified by Critte nden et al (2009) are not returning to school quickly postpartum and having many friends who are adolescent parents. Gray (2006) found that primiparous adolescents who became pregnant within 6 months of delivery were less likely to be in school or to be high school graduates. S ocial system factor s are limited access to social services for the household according to focus group data from adolescent parents and their mothers (Bull & Hogue, 1998) and lack of access to prenatal services in the second year, post index child (El Kamary, et al., 2004) An overview of the risk factors associated with teen pregnancy and repeat pregnancy are detailed in Table 2 1
44 Unique Circumsta nce s : Adolescent Pregnancy in Foster Care Studies suggest that adolescents in foster care have increased risk for participating in risky sexual behaviors and experiencing adolescent pregnancy. One reason for increased risk for sexual behavior and pregnancy is the reported low access to high quality sexual education. Inconsistent adult relationships, placement changes, mental health problems, and developmental needs are identified barriers to pregnancy preventative services including sex education (Svoboda, Shaw, Barth, & Bright, 2012) Knight and colleagues (2006), found that emotional vulnerability as illustrated by distrust, loneliness and rejection, lead to adolescent pregnancy. Adolescents reported multiple and abrupt foster placements making it difficult to learn about sex, relationships, and contraception (Knight, Chase, & Aggelton, 2006) Findings also indicate that infants may fill feelings of loneliness and isolation from being removed from th eir birth families and having to adapt to several foster care placements in short periods (Knight, Chase, & Aggelton, 2006) a contributing factor to pregnancy among adolescents in foster care. Coleman Cowger, Green and Clar k (2011) found that when compared with a non foster care sample, adolescents in foster care reported higher internal mental distress, behavior complexities, and general victimization. Researchers also found that within the foster group sample, internal men tal distress predicated past pregnancy (Coleman Cowger, Green, & Clark, 2011) Connolly et al (2012) conducted a meta synthesis of pregnancy and motherhood within child protective services and identified several overarching th emes. They concluded : 1) an infant is used to fill an emotional void ; 2) there is a lack of consistent education and a lack of sexual education ; 3) there are multiple adversities in motherhood ; 4) there was a mistrust of others and a social
45 stigma associat ed with being a mother ; 5) there is a perception of motherhood as positive and stabilizing ; 6) teens experience internal strengths and wanting to do better ; and 7) support contributes to a positive motherhood experience (Connoly Heifetz, & Bohr, 2012) As such, these identified themes pertaining to adolescent pregnancy in foster care, can serve as an explanatory model to reduce adolescent pregnancy within foster care and nurture increase access of and utilization of sexual hea lth series. Barth et al (1990) found that 40% of adolescents (mean age 17.6) recently aged or emancipated from foster care experienced sexually related difficulties such as unplanned pregnancy, sexually transmitted disease, and inconsistent or never use o f birth control. He also found that 57% reported not using social service family planning services (Barth, 1990) Protective Factors Given what we know about adolescent risk taking and sexual decision making, it makes sense that certain groups have been f ound to be at a higher risk for participating in risky behaviors. Excessive adolescent anxiety, extreme family conflict, unsupervised or over supervised socialization, early and late onset puberty and delayed identify formation have all been linked to ri sk taking in adolescents (Adams, 2005, p. 15) Vulnerability is the increased likelihood of a negative outcome when exposed to identified risk (Fergus & Zimmerman, 2005) However, resilience as defined by Masten, Best, and Garmezy 1990 is the capacity for the outcome of successful adaption despite challenging or threating circumstance (as cited in Blinn -Pike, 1999) Resilienc e can be in the form of assets, internal positive factors and resourc es, or external positive factors ; they both help youth avoid negative outcomes in the face of risk (Fergus &
46 Zimmerman, 2005) Positive or protective factors against risky sexual activity, adolescent pregnancy, and repeat pregn ancy are consistent. Religious influences and affiliations are often noted as protective factors for refraining from sexual intercourse ( Fergus & Zimmerman, 2005; Sinha, Curtis, Jayakody, Viner, & Roberts, 2007) In a qualitative study based in England, mo re young women than men (ages 15 18) mentioned religion as a reason for limiting sexual acti vi ties (Sinha, Curtis, Jayakody, Viner, & Roberts, 2007) House and colleagues (2010), found that adolescent pregnancy programs that fo stered the development and encouragement of spirituality was protective against initiation of sex, ever having sex, and frequency of sex, and it was associated with increased contraceptive use. Family connectedness has also been found to be protective fact or for risky sexual behavior. Aronowitz and Morrison Beedy (2004), found that among African American adolescent females ages 11 15, girls with feelings of connectedness to their mothers were more likely to have an extended time perspective and fewer risk b ehaviors. Findings indicated that future time perspective was a mediator between maternal connectedness and resilience (Aronowitz & Morrison Beedy, 2004) Future time perspective was measured with a combination of scales that a feel hopeful about the future), and future aspirations (I will live beyond age 35) (Aronowitz & Morrison Beedy, 2004) Mother connectedness was measured by scales that ass ess maternal caring, mother daughter activities, and mother presence, and it was analyzed against multiple risk behaviors such as violence, sexual behaviors and substance abuse (Aronowitz & Morrison Beedy, 2004) Among self rep orted abstinent youth the top reason for remaining sexually abstinent was fear -fear of AIDS, fear of
47 becoming pregnant or getting someone pregnant, and fear of getting a disease (Blinn Pike, 1999) The next most frequen t reasons were conservative values, believing it was wrong to have sex before marriage, and wanting to wait until marriage to have sex (Blinn Pike, 1999) The least frequent reasons were emotionality and confusion, being embarrassed to use birth control or protection, and not knowing where to get birth control and protection (Blinn Pike, 1999) Sources of information have been linked to foster adolescent resiliency. Bleakley, Hennsey, Fi shbein, and Jordan (2009) found that certain sources of sexual information could influence sexual decision making. Learning about sex from parents, grandparents, and religious leaders was associated with beliefs likely to delay early sex (Bleakley, Hennessy, Fishbein, & Jordan, 2009) However, i nformation about sex from friends, cousins and the media were associated with beliefs that increased the likelihood of having sex (Bleakley, Hennessy, Fishbein & Jordan, 2009) Additional protective factors against risky sexual behaviors in adolescents include higher self esteem, more school achievement and attachment, higher participation in extracurricular activities, increased safer sex intention, residing with both parents, positive peer norms for sexual behavior, and higher family socioeconomic status (Fergus & Zimmerman, 2005) Implications for Adolescent Pregnancy, Birth, and Repeat Birth Adolescent Birth Adolescent birth ha s negative implications for the extended family, the adolescent, and the infant. Siblings living in the house with an adolescent mother have an increased risk of becoming an adolescent mother (East, 1998) Daughters of adolesce nt mothers are more likely to become adolescent mothers, and sons are more
48 likely be incarnated (The National Campaign to Prevent Pregnancy, 2011) Nelson and re likely to experience maternal depressive symptoms when experiencing high parental stress over the first three years. Outcomes for the infant include preterm birth, being small for gestational age, and having low birth weight at birth (Chan, Dekker, & Keane, 2002) Furthermore, w hile there have been several noted biological and health implications for adolescent pregnancy, especially among early adolescents, the disadvantages for society (economic responsibilities) are plenti ful (Wellings, Wadsworth, Johnson, Field, & Macdowall, 1999) Adolescent fathers who were working at least half time were less likely than non working fathers to graduate from high school however, fathers who were the primary caregivers had elevated odds of graduating (Molborn, 2010) Decreased education, decreased earning power, and increased cost to social services (52% of mothers on welfare had their first child as adolescents) result in monetary losses (The National Campaign to Prevent Pregnancy, 2011) Repeat Birth The implications of adolescent pregnancy are exasperated by repeat pregnancy. Blankson et al (1993) found that among multiparous Black and White adolesc ents there was a decreased utility of prenatal care such as entering care later and attending fewer visits, an increase in pre pregnancy BMI, and an increase in preterm births. Research also suggests that compared to first teenage birth, second birth almos t triples the risk of pre term delivery and still birth (Smith & Pell, 2001) Futhermore, rapid repeat pregnancy compounds social inequality due to less participation in education and work/training (Gr ay, Sheeder, O'Brien, & Stevens Simon, 2006) In a sample of American Indian primiparous adolescents, intimate partner violence was reported in 61% of adolescent
49 mothers, 37% reported abuse during pregnancy, and 22% reported sexual violence (Mylant & Mann, 2008) I ntervention and Prevention Programs There are reporting biases associated with the determination of successful teen pregnancy and repeat pregnancy programs. Pregnancy prevention programs often include and measure er ratic factors such as actual behavior change versus intent to change. Furthermore, study design can have a significant impact on the perceived and actual program efficacy. Guyatt et al (2000) compared randomized trials versus observational studies in adol escent pregnancy prevention and determined that observational trials reported a significantly higher impact. Study outcomes of adolescent pregnancy prevention programs such as initiation of intercourse, pregnancy, responsible sexual behavior, and birth con trol use within observational studies suggested a statically significant results; however, randomized control studies suggested results equal to non intervention group s (Guyatt, DiCenso, Farewell, Willan, & Griffith, 2000) Bas ed on published research findings I have highlighted successful, unsuccessful, and mixed review programs that prevent/reduce adolescent pregnancy and repeat pregnancy below, please see Table 2 2 for a succinct summary of program c omponents. Successful Programs Specific characteristics of adolescent prevention programs are known to enhance protective factors against risky sexual behavior. Adolescent prevention programs that foster the d evelopment and encouragement of prosocial norm s prosocial involvement and commitment to avoid specific risk behavior s have been found to be protective against initiation to have sex, ever having sex, less frequency of sex and increased
50 contraceptive use ( Fergus & Zimmerman, 2005; House, Mueller, R eininger, Brown, & Markham, 2010) Furthermore, programs that foster self efficacy to refuse drugs and to use condoms, positive attitudes towards condoms, HIV and reproductive health knowledge and seeing sex as non normative, which are all known protective factors (Fergus & Zimmerman, 2005) have decreased risky behavior. Adolescent Pregnancy : A simulation intervention evaluation revealed that adolescents 2 to 3 years post participation were able to recall and describe insight and feelings about parental responsibility and consequences of teen pregnancy (Didion & Gatzke, 2004) Study findings suggest success was attributed to the simulated experience as an effective learning strategy (Didion & Gatzke, 2004) A review of abstinence only programs, abstinence as the sole approach to prevent pregnancy and STDs, and abstinence plus programs, abstinence and other prevention methods, found the two abstinence plus programs and one of six abstinence only programs to be successful in that they showed measurable behavior change (Thomas, 2000) Components of successful programs include d, strong evidence on abstinence, a firm grounding in health behavior theor ies, and parental participation and address ed social and media influences on adolescent sexual behavior (Thomas, 2000) Frost and Forrest (1995) concluded in a meta analysis of five adolescent pregnancy prevention programs tha t four were successful in reducing the proportion of adolescents who initiated in sexual activity; this was especially true when the programs targeted younger adolescents. Three of those programs, the most successful, also increased rates of contraceptive use among participants and two programs significantly decreased the proportion of adolescents who became pregnant (Frost & Forrest, 1995)
51 Successful programs were the most active in providing access to contraceptive services (Frost & Forrest, 1995) Repeat Pregnancy : Intervention programs to reduce rates of repeat pregnancy have had mixed success. Some programs have been successful in reducing rates of repeat pregnancy in year one, but have had limi ted success in year two. Other programs have been successful in improving health outcomes of the infants but unsuccessful in delaying repeat pregnancy. Furthermore, feasibility and attrition are documented logistical issues in sustaining repeat pregnancy p rograms. Comprehensive programs that include goal setting and case management services typically show higher rates of success when compared to usual care. The Family Support Center provided comprehensive support in the form of home visits, parenting classe s, school advocacy, and case management services in order to reduce repeat pregnancy and school dropout rates (Solomon & Liefeld, 1998) The Family Growth Center was effective in reducing repeat pregnancy (10% versus 38%) and d ropping out of school (9% versus 42%) compared to the control group (Solomon & Liefeld, 1998) A randomized control trial comparing a specialized program, including follow up, discussion of school, health teaching, family plann ing, and usual care found significant results (12% versus 28%) in preventing repeat pregnancy but not for returning to school (O'Sullivan & Jacobsen, 1992) Program components included daily presence of public health nurses, mo nthly pregnancy tests and surveys, health counseling and referral, and group health education classes (Schaffer, Jost, Pederson, & Lair, 2008) This comprehensive strategy is attributed to the success
52 The Second Chan ce Club, a school based repeat pregnancy prevention program, revealed significant success in preventing repeat pregnancy (6%) when compared to the control sample (37%) (Key, Barbosa, & Owens, 2001) Program components included w eekly group meetings focused on parenting, career planning, and group support, participation in school events, social work services such as case management and home visits, and medical care for mothers that included contraception services well baby visits for the infants via linked services (Key, Barbosa, & Owens, 2001 ; Key, O'Rourke, Judy, & McKinnon, 2005 2006 ) A secondary analysis of the a total r ebound after the compl etion of the program, four years later (Key, O'Rourke, Judy, & McKinnon, 2005 2006) Key et al (2005 2006) speculated some limitations in the analysis might be due to rural versus urban community distribution throughout the stat e and the intervention area. Adolescents in rural communities generally have higher rates of teen pregnancy and repeat pregnancy, as well as decreased access to prevention and intervention services (Key, O'Rourke, Judy, & McKinno n, 2005 2006) Koniak Griffin et al (2003) found that when compared to traditional public health nursing, postpartum adolescent mothers who participated in an early intervention of nurse home visits fared better. Intervention group infants were hospital ized less and seen less in the emergency room and the adolescent mothers experienced 15% fewer repeat pregnancies (Koniak Griffin, et al., 2003) Colorado Adolescent Maternity Program (CAMP) was a comprehensive, multidisciplinary prenatal, delivery, and postnatal care program located in a large urban teaching hospital (Stevens Simon, Kelly, & Kulick, 2001) Results of CAMP included a
53 repeat pregnancy rate of 14% at year one, and 35% at year two. The re sults indicated that a failure to use a long acting birth control six weeks after birth was the strongest predictor of repeat pregnancy in year two (Stevens Simon, Kelly, & Kulick, 2001) Program evaluation for the Paquin School Program, a School Based Comprehensive program for pregnant teens based in Baltimore City found promising results (Amin & Sato, 2004) When compared to a comparison sample, Paquin School Program participants enrolled from 1999 to 2001 were more likely to be using contraception or to have expressed intention to use contraception in the future were more likely to use Depo Provera, a higher report their desire for not having more children (Amin & Sato, 20 04) A follow up qualitative analysis including participants enrolled between 2000 and 2001 concluded participants were more likely to have higher educational aspiration, better reproductive health outcomes, higher contraceptive use, and more breastfeedi ng practice and intention than a comparison sample (Amin, Browne, Ahmed, & Sato, 2006) A randomized control trial of routine contraceptive care compared to an advanced supply of emergency contraception determined program succ ess (Schreiber, Ratcliffe, & Barnhart, 2010) Providing emergency contraception resulted in decreased incidence of repeat pregnancy (Schreiber, Ratcliffe, & Barnhart, 2010) Fifty postpartum teens w ere randomly assigned to routine postpartum contraceptive care or a one week supply of emergency contraception and unlimited supply upon request; the intervention group experienced three (13%) repeat pregnancies compared to eight (30%) in routine care (Schreiber, Ratcliffe, & Barnhart, 2010)
54 Overall, repeat pregnancy programs that encourage long term contraceptive use soon after index birth are more successful in reducing repeat pregnancy. Comprehensive programs that include p arent education, home visits, peer mentoring, and career counseling are more effecting in improving return to high school rates and reducing negative health impact to the infants. Mixed Reviews Adolescent Pregnancy : An abstinence only intervention among middle school teens was shown to be successful in increasing knowledge and abstinence beliefs but unsuccessful in decreasing intention to have sex and increasing condom use (Borawaski, Trapl, Lovegreen, Colabianchi, & Block, 2005 ) Corcoran et al (2007) conducted three separate meta analyses of pregnancy prevention programs investigating sexual activity, contraceptive use, pregnancy rates, and childbirths as outcomes. Results suggest that of those programs included, there were no effects on sexual activity, significant effects on increasing contraceptive use, and moderate effects on reducing pregnancy (Corcoran & Pillai, 2007; Franklin, Grant, Corcoran, Miller, & Bultman, 1997) Repeat Pregnancy : The Dollar A Day Program in Gr eensboro, North Carolina was established in 1990 to prevent repeat pregnancies among adolescents under the age of 16 (Brown, Saunders, & Dick, 1999) The program components included a weekly meeting, goal setting and reporting, and a reward of one dollar a day for each day the teen remained non pregnant (Brown, Saunders, & Dick, 1999) Program results at 5 years reveled 15% of the total sample (N=65) experienced subsequent pregnancies, compared to 30% and 35% reported in similar programs, indicating success in reducing repeat births (Brown, Saunders, & Dick, 1999) Project Redirection
55 was implemented from 1980 1983, program components directly or indirectly offered services s uch as employment training, peer group sessions, goal development (Polit & Kahn, 1985) This program was shown to be effective at year one but not at year two (Polit & Kahn, 1985) A Home Visiting Program revealed mixed results at the 6, 12, and 24 month follow ups; they found that lack of consistent contraceptive use was highly associated with repeat pregnancy and that discussion and interventions related to lapses in contraceptive use were only do cumented in 30% of the home visits (Gray, Sheeder, O'Brien, & Stevens Simon, 2006) A repeat pregnancy prevention program designed for Hispanic adolescent mothers had limited success due to high attrition (up to 40%). Reasons for attrition were attributed to the lack economic stability and high mobility of the participant population (Erickson, 1994) The repeat pregnancy rate for participants who were followed for one year was 17%, and it was 35% fo r those followed for two years (Erickson, 1994) The Teen Parents as Teacher program, implemented in the Salinas Valley of California, had similar issues with attrition (57%), despite a monetary incentive for participants ( unkn own amount) Reasons for attrition were attributed to the instability of the teen population (Wagner & Clayton, 1999) Unsuccessful Programs Adolescent Pregnancy: Programs that targeted older adolescents and those that did not provide access to contraceptive services were less successful than other programs (Frost & Forrest, 1995) Chin and colleagues (2012) conducted a meta analysis on the effectiveness of group based comprehensive and abstinence educ ation interventions to prevent adolescent pregnancy, HIV, and sexually transmitted diseases.
56 Authors concluded that group based comprehensive risk reduction interventions were successful on all of the measured outcomes, current sexual activity, use of prot ection, pregnancy, and sexually transmitted diseases (Chin, et al., 2012) However, the meta analysis on abstinence only education showed inconsistent findings, study designs, and follow up times resulting in inclusive effect e stimates (Chin, et al., 2012) Components of unsuccessful pregnancy prevention programs as found by Thomas (2000), include those with high attrition, not based in health behavior theory, included non generalizable homogenous sample, and were inconsistent. Repeat and Rapid Repeat Pregnancy : El Kamary et al (2004) found no effects for a home visiting program based in Hawaii. Study results revealed no program impact for the Healthy Start home visiting program and there were sever al factors were associated with a rapid repeat pregnancy such as mothers with desire for a child within 2 years and women who had never used birth control ( RRR) (El Kamary, et al., 2004) A RRR was defined as a birth occurring within 24 months after a previous birth (El Kamary, et al., 2004) Using a randomized design, Stevens Simons et al (1997) found that although monetary incentives promote d peer support group participation, exclusive pe er suppo rt group participation wa s not effective in reducing repeat pregnancies. Monetary incentive was successful in enticing participation (58% vs. 9%) ; however repeat pregnancy rates at 6 months (9%), 12 months (20%), 18 months (29%), and 24 months (39%) did no t statistically differ from the control group (Stevens Simons, Dolgan, Kelly, & Singer, 1997)
57 Suggested Programs : There have been several wide ranging intervention suggestions for reducing rates of repeat pregnancy inc luding phototherapy (Blinn, 1987) and Computer Assisted Motivational Intervention (Barnet, Rapp, DeVoe, & Mullins, 2010) Blinn (1987) suggested phototherapy as an intervention for reducing repeat pr egnancy by directly affecting (increasing) adolescent self concept. Phototherapy is a process of interacting with photographic image as well as the image of self as a strategy of improving self concept (Blinn, 1987) Computer A ssisted Motivational Intervention (CAMI) was shown to significantly reduce repeat births when compared to usual care (Barnet, Rapp, DeVoe, & Mullins, 2010) CAMI utilized a computer software program to assess the s tage of change (for contraceptive and condom use), based on the (Barnet, et al., 2009) Increasing access to emergency contraception has been hypothesized to reduce rates of unplanned pregnancy in adolescents. Belzer et al (2003) found that among adolescents who reported unprotected sex, top reasons for not using emergency contraception (EC) were not having access to EC at home, forgetting the re was EC, and not knowing where to get EC (Belzer, et al., 2003) A meta analysis of repeat pregnancy prevention programs concluded that although repeat pregnancy programs are effective at least 19 months follow up, there is l ittle evidence that supports comprehensive programs over others (Corcoran & Pillai, 2007) Adolescent and Repeat Pregnancy Prevention Summary The United States has several initiatives in place to reduce the rate of teen preg nancy. Although states develop or tailor specific youth programs, most center on
58 one of two principles abstinence only or comprehensive sex education. Abstinence only advocates the absence of sex until marriage (Kohler et al 2008). Comprehensive curric ulums provide abstinence messages in addition to information on birth control and barrier protection for STD prevention (Kohler et al 2008). Teens who receive comprehensive sex education coupled with risk and consequence identification are at a decreased risk for teen pregnancy (Ponton, 2001). Such programs include information on self esteem self efficacy and other constructs related to self and are tailored to the target population. Repeat pregnancy or rapid repeat pregnancy can be reduced using comprehensive prevention programs; Corcoran et al (2007) found that among sixteen secondary pregnancy prevention studies there was a 50% reduction in the odds of repeat pregnancy compared to the control group. Comprehensive programs include health care for both the adolescent and infant, sex education contraception education parenting training, and social support (Corcoran & Pillai, 2007) Theoretical Framework Based on the risk and protective factor literature the t heoretical framework for this research aimed at assessing the influence of socio demographic variables, goal aspirations, media, and perceived benefits and disadvantages of adolescent pregnancy on adolescent pregnancy and repeat pregnancy by nulliparous p rimiparous and multiparous adolescents. Merrick (1995) postulated that childbearing among African American youth should be evaluated as a career choice; she stipulated several explanations from the ecological framework. That said, an understanding of profe ssional and personal goal aspirations, as a context for and a potential preventative strategy for adolescent childbearing, is essential.
59 Aspirations provide a standard for adolescents to measure the weight of their decisions; furthermore, they provide a m otivational force for achievement (Camerena, Minor, Melmer, & Ferrie, 1998) Adolescents who have recently transitioned to motherhood reported that parenting resulted in an adjustment but not a dramatic change in expectations; however, few reported adequate support for achieving life goals (Camerena, Minor, Melmer, & Ferrie, 1998) Meaning of Success The meaning of success among adolescents may influence decision making as they transition into role s that require greater independence. Research suggests that the meaning of success may be routed in class, gender, and ethnic trends (Bradford & Hey, 2007) Varying ethnic groups in England described versions of success. Stayin g focused, building educational capital and human capital, was identified by Sikh adolescent males, and building psychological capital was identified by Hindu adolescent females (Bradford & Hey, 2007) The meaning of success am ong Australian adolescents ages 14 19 consisted of wealth and possessions (reported most frequently), occupational or educational status, attributes of personality, secure job, and family of procreation (Katz, 1964) Adolescent females were significantly more likely to report attributes of personality as a definition of success (Katz, 1964) Academic achievement may be used as a current measure of success among adolescents. Zhang and colleagues (201 0) found that among Chinese adolescents low academic achievers were more likely to tailor their behavior based on situational cues, compared to non low academic achievers. Implications include adolescent females with low academic achievement and greater po tential to engage in impression management may experience decreased self efficacy to make safe sex decisions
60 Professional Goal Aspirations Career or work goals have been hypothesized to influence personal identity; youth with carefully reasoned work goals may have a more coherent personal identity and may be better able to demonstrate the ability to maximize their potential than those without (Yeager & Bundick, 2009) Waterman (2007) concluded that people are more likely to exp erience an enhanced well being when they have realize d self generated goals and satisf ied personal needs (Waterman, 2007, p. 239) Research suggests that there are more gender differences than ethnic and racial difference s in aspirations and career goals (Arbona & Novy, 1991) Kenny et al (2007) utilized qualitative interview m ethods to investigate post high school goals among 16 low to high academic achievers attending an urban high school. A cademic achievement level was outlined via school reported GPA Barriers to success as expressed by research participants included antisocial values and lack of social attachment, as well as lack of self discipline and family issues such as f amily misfo rt une and neglect or lack of care (Kenny, et al., 2007) While investigating the gap between vocational aspirations and expectations, Hellenga, Aber, & Rhodes ( 2002) determined that adolescent mothers with depression and anxiet y symptoms and childcare provided by relatives were more likely to experience a gap in vocational aspirations and expectations. Those with higher grade point averages, who lived with biological parents, and had a career mentor, were more likely to experien ce congruency between expectation and aspiration (Hellenga, Aber, & Rhodes, 2002) Research suggests that adolescents who have purposeful work goals report more meaning in life and schoolwork (Yeager & Bundick, 2009) Adolescents who think
61 about what they want to accomplish may be inspired to learn and to create a life purpose (Yeager & Bundick, 2009) Achievement goal theory, often utilized to conceptualize achievement motivation and school motivation, is now known as the primary framework for conceptualizing student motivation and framing the development of educational interventions (Kaplan & Flum, 2010) Kaplan et al (2010) sought to iden tify the theoretical links between achievement motivation theory and adolescent identity formation; their findings suggest that both theories emphasize the differences in mental frames of self development and self validation. Personal Aspirations Studies suggest adolescent pregnancy can result in personal implications such as decreased rates of marriage, i ncreased divorce among those married young, and increased welfare usage (Lichter & Graefe, 2001;The National Campaign to Prevent Pregnancy, 2011). Salmi valli, et al (2009) investigated the amount of variance in social goals and self and peer perceptions which was due to the context of relationship s. Study findings concluded social goals as well as self and peer perceptions, are to a great extent relat ionship specific ; therefore, they need to be studied in context (Salmivalli & Peets, 2009) Low income women who choose motherhood before marriage often describe several reasons for their priority. Theorists have explored the decline in marriage over the decades especially prevalent among low income and ethnic minority populations (Edin, 2003) Four theories of non marriage ar e currently mainstream. Theory one is economic independence ; women who ca n earn a living on their own will find marriage less attractive. This theory does not hold true for low income women whe n marriage
62 will in fact increase earnings, and as partner income rises so does their probability of marriage (Becker, 1974) Theory two involves the decline in male economic position s as the rate of men in consistent employment declines so will marriage rates (Edin, 2003) Theory three decline in male economic position s as the r ate of men in consistent employment declines so will marriage rates This theory s tate wo men have traded dependence on male s to dependence on support from welfare or government assistance (Edin, 2003) Th eory four highlights cultural influences ; as women move into the paid labor force traditional gender roles have evolved therefore creating a mismatch in sex roles in poor men and women and decreasing marriage rates (Edin, 2003) Perceived Advantages and Disadvantages of Adolescent Parenting Although few may argue the extent for wh ich a teen mom can provide for her child, there are discrepancies within the parenting community. Bull and Hogue (1998) analyzed focus group respons e s of adolescent parents and their mothers and found that young mothers and grandmothers often disagree on the burden of childcare. Adolescent mothers described bearing full responsibility for the infant, while the grandmothers, in a separate focus group, described a discrepant situation (Bull & Hogue, 1998) This raises questions about the meaning of motherhood and infant responsibility among adolescent mothers and their mothers. Rosengard, Pollock, Weitzen, Meers, and Phipps ( 2006) investigated the perceived advantages and disadvantages of teen pregnancy among a group of pregnant adolescents ages 12 17. Described advantages included no advantages, connections such as enhancing relationships, family building, having someone to love, closer in age to child, positive changes such as forcing them to grow up, take
63 responsibility, provide them with a purpose in life and practical considerations such as still looking young, eliminating concerns about future fertility (Ronsengard, Pollock, Weitzen, Meers, & Phipps, 2006) Disadvantages included no disadvantages, lack of preparedness, being too young, not being ready, not having a job or resources, changes such as having to revise life goals, making da ily lif e more difficult, requiring fellow students looking at them differently (Ronsengard, Pollock, Weitzen, Meers, & Phipps, 2006) Spear et al (2004) found among a sample of pregnant mothers that while knowledge on how to prevent pregnancy was prevalent, inconsistent contraception use and indifferent sexual behaviors resulted in pregnancy. Future expectations from participants consistently included support from the father of their un born child and often times resiliency (Spear, 2004, p. 341) SmithBattle (2007), found that motherhood led adolescents to reevaluate priorities, and motivated them to remain in or return to school, thus indicating that motherhood may provide foster resiliency in some otherwise at risk youth. Media Influences Bleakley et al (2009) examined how sources of sexual information are associated with adolescent s behavioral, normative, and control beliefs about having sexual intercourse Their findings suggest t hat most frequent sources of sexual information were friends, teachers, mothers, and the media ( Bleakley, Hennessy, Fishbein, & Jordan, 2009) Brown et al (2006) c oncluded that expo sure to sexual content in music, movies, television, and magazines may accelerate teens sexual activity especially in W hite adolescen ts However, B lack teens seem to be more
64 influenced by perceptions of their parent expectations (Brown, et al., 2006) In adolescents ages 12 17, results of a regression analysis indicated that those who viewed more sexual content at baseline were more likely to initiate intercourse and to progress to advanced sexual activities during the subsequent year (Collins, et al., 2004) Braun Courville and Rojas (2009) found that teens who were exposed to sexually explicit websites were mo re likely to have multiple sexual partners, have more than one sexual partner in the last three months, and to have engaged in anal sex. Results from a longitudinal study determined that exposure to sexual content predicted teen pregnancy when adjusting fo r the covariates age, race, and SES (Chandra, et al., 2008) Teens who were exposed to higher levels of sexual content (90 th percentile) were twice as likely to experience pregnancy in the subsequent three years than those who were exposed to lower levels (10 th percentile) (Chandra, et al., 2008) social comparison theory or modeling. Research suggests that unrealistic im ages in the media of females confound the pressures adolescent girls feel to maintain a certain body image (Morrison, Kalin, & Morrison, 2004) Zhang et al (2000) found that viewing videos with heavy sexual imagery is related to more sexually permissive attitudes among adolescents and young adults (Zhang, Miller, & Harrison, 2008) Although we have confirmed that sexuality in the media is common and usually shown in a positive light (Gruber, 2000) and that adolescents use media sources of information to learn about sex and relationships (Gruber, 2000; Bleakley, Hennessy, Fishbein, & Jordan, 2009) the direction of the relationship between media and sexuality remains unclea r (Gruber, 2000) According to Brown, Halpern, and L'Engle (2005), earlier maturing girls
65 reported more interest in seeing sexual content in movies, television, and magazines and in listening to sexual content in music, regardle ss of age or race. Earlier maturing girls were also more likely to report listening to music, reading magazines watching TV with sexual content, and interpreting the messages as approving of teens having sexual intercourse (Br own, Halpern, & L'Engle, 2005) Summary Although there is an abundance on literature of adolescent pregnancy and repeat factors and demographics of the target popul ation As indicated by our current teen pregnancy and birth rates one size programs do not prove effective Strengths in the literature include program evaluation studies, assessment of risk and protective factors, and meta analysis of current research. A lthough authors have speculated on the effect of pregnancy and repeat pregnancy on personal and professional outcomes, using cross sectional studies there is only limited data on the effect of pregnancy on personal and professional aspirations. Furthermore my literature search did not result in any studies on success or the meaning of success among American adolescents. As such, meaning of success and adolescent pregnancy seems to be under investigated. Further investigation on goal development, assessment and success and risk avoidance is needed. Chapter 2 Conclusion In Chapter 2 I have described the multifaceted factors related to adolescent pregnancy and repeat pregnancy. There are both risk and protective factors for pregnancy and repeat pregnancy i n the literature; the effects of some factors depend on contextual variables. Following the risk factors, and implications of adolescent
66 pregnancy and repeat pregnancy I provided an overview of the most effective adolescent pregnancy and repeat pregnancy p revention programs, as well as those that were deemed unsuccessful, or concluded mixed reviews. Although abstinence education is important providing contraceptive education and information on access to services is essential to reducing teen pregnancy. Prog rams that utilized home visits, peer counseling opportunities, and access to long acting contraception were most effective in reducing teen pregnancy. To conclude Chapter 2 I outlined the literature surrounding my theoretical background. Contributing fa ctors to both adolescent pregnancy and repeat pregnancy are adolescent development, goal aspirations, the perceived advantages, and disadvantages of motherhood, and media influences. Considering these factors in the development and evaluation of public hea lth programs is essential.
67 Figure 2 1 Risk Factors of Risk Factors for Risky Sexual Behavior, Adolescent Pregnancy, Repeat Pregnancy
68 Table 2 1 Risk Factors of Risky Sexual Behavior, Adolescent Pregnancy, and Repeat Pregnancy Ecological Model Risky Sexual Behavior Adolescent Pregnancy Repeat Pregnancy Social system Middle to low SES Low SES Low SES Urban or suburban neighborhood Peer/ community Negative attitudes towards school Trouble in school Peer influences Frie nds that are sexually active Having friends who are parents Dropped out of school before index pregnancy Having friends who are parents Not going back to school after delivery Dropped out of school before index delivery Low educational aspirations Fa mily/ Relationship Mother having first child before age 20 Family instability Boyfriend that was > 2 years older Mother who was a teen parent Sibling who is a teen parent From a single parent household Partner wanting a child Partner > 3 years older Poor mother daughter relationship Cohabiting with father of the index child Married before or after index pregnancy Partner wants a child Experience intimate partner violence Individual Deviant behaviors (tobacco, alcohol, drug use) Self esteem Early menarch e Early pubertal changes Minority status Low self esteem Aggression Age at first birth Minority status Intended first pregnancy Prior poor pregnancy outcome Not starting long acting contraception soon after index birth
69 Table 2 2 Pregnancy and Repeat Pregnancy Prevention Components of Successful, Mixed, and Unsuccessful Programs Pregnancy Prevention Strategies Repeat Pregnancy Intervention Strategies Successful Target younger adolescents Comprehensive (abstinence and contrace ption information) Provide access to contraception services Comprehensive (home visits, service referral, peer groups) Provide and encourage long acting contraception use Access to emergency contraceptive Unsuccessful One size programs Those with little to no information on contraception Monetary incentives increase enrollment but not effectiveness. Exclusive or abbreviated programs Mixed Reviews May Influence Knowledge Limited effect on behavior Increase condom use, but have no effect on sexual ac tivity May influence rates in year 1, diminished results in year 2 May reduce teen pregnancy but not school attendance and vice a versa. Results of the program may rebound after program completion.
70 CHAPTER 3 RESEARCH DESIGN and METHODS Overview This r esearch study was conducted primarily in Alachua County and Marion County, Florida. I used explorative research methods to investigate the similarities and differences in the meanings of life success and personal and professional goal aspirations among nul liparous primiparous and multiparous adolescents. Qualitative research methods, supported by quantitative data including demographic and psychosocial variables, formed the basis of the findings. Adolescent girls ages 16 19 who met specified inclusion crit eria participated in a research interview and/ or a focus group. Each interview and focus group was digitally recorded, transcribed, and analyzed with thematic coding. In this section, I describe the steps for instrument development, participant recruitmen t, data collection, and data analysis. Approach Qualitative research is best when the research question and or data necessitate explorat ory methods (Richards & Morse, 2007) According to Creswell (2009), qualitative research seeks to explore and understand how individuals or groups assign meaning to social or human problems. Qualitative methods work well when there is little known about the subject, to make sense of complex situations, to learn from participants about the way they experience reality, to construct a theory or theoretical framework, or to understand phenomena deeply and in detail (Richards & Morse, 2007, pp. 29 30) This research project utilized explorative qualitative res earch grounded in ethnographic methodology. Ethnography allows for exploration based on culture
71 (Richards & Morse, 2007) Ethnographic research explores themes within cultural contexts from the perspectives of the members of th e group; during data collection, it is essential to reflect on the cultural values, beliefs, and behaviors of the group (Richards & Morse, 2007, p. 55) Typically, ethnography is conducted in the natural setting of the l ives of the members of the participant group. The researchers often become integrated in the lives of the people they are studying (Richards & Morse, 2007) Observational data, field notes, surveys, and interviews (unstructured semi structured and structured) are classic ethnographic methods. Ethnographic methods address observational questions; descriptive questions about values, beliefs, and practices of a cultural group as well as what is happening within a culture (Richards & Morse, 2007) There are four different types of ethnography. The first type is traditional ethnography, which is usually conducted in an u nknown culture that is unfamiliar to the researcher and requires prolonged residence and engagement within the culture (Richards & Morse, 2007) The second is focused ethnography, which is used to evaluate or elicit information on a special topic or shared experience T he topic is identified before the research er commences the study and research can be conducted in a sub cultural group. The third type is participatory action research, (PAR), which uses the ethnographic method of conducting field research using interviews and observations (Richards & Morse, 2007) The fourth type is action research (AR); in this method a team of professional action researchers and stakeholders conduct research together (Richards & Morse, 2007). For this research, focused ethnography served as the theor etical guide to investigate the shared experience of adolescent pregnancy among parous participants and special topic of adolescent pregnancy among nuliparous
72 participants. In depth interview questions were utilized to investigate the meaning and experien ce of adolescent pregnancy among nulliparous and parous participants. Weiss (1997 ) used similar strategies termed Explanatory Model Interview Catalogue (EMIC) to understand illness experience. EMIC sought to investigate the distress, perceived causes, pref erence for help seeking, and general illness beliefs among participants with general or specified health conditions (Weiss, 1997) Kleinman et al. (1978) determined that explanatory models of disease may determine how individua ls understand and respond to disease/illness diagnoses. Research strategies used for this project are similar to explanatory model investigation (Kleinman, Eisenberg, & Good, 1978) and explanatory model interview catalogue (Weiss, 1997) Research Setting This research was conducted in North Central Florida, in the Southern Region of the United States. Although in 2010 Florida had moderate rates of teen birth, disproportionately higher rates of teen birth and repeat birth typically occur in the southern United States (Schelar, Franzetta, & Jennifer, 2007) As depicted in Figure 3 2 the highest rates of teen birth in 2010 were located in the Southern states (Kasier Family Foundation, 2012) 1 Throughout this section, I present the most current data related to population characteristics, the socio economic profile, general health status, risk behaviors, and sexual, maternal and child health stat istics. All of these factors help provide a framework for understanding adolescent pregnancy within the specified 1 The Kaiser Family Foundation statehealthfacts.org Data Source The Centers for Disease Control and Prevention, National Vital Statistics Reports. Births: Final Data for 2010, Vol. 61 No. 01, August 2012. Available at http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf Accessed 11/1/12.
73 location. This information is outlined for the State of Florida and Alachua and Marion c ounties. Table 3 1 provides a side by side comparison of key statistics. Population Estimates The population of Florida in 2010 was 18,820; t here were approximately 1,650,274 ages 12 18, of which 71% were White, 22% were Black and 27% were Hispanic (Florida Department of Health (FDOH), 2013). L ocated in North Central Florida (Figure 3 2), the population of Alachua County in 2010 was population in 2010 was estimated to include 25,850 adolescents ages 12 18. Of these, 6 5% were White, 25% Black, and 11% Hispanic (Florida Charts, 2013) The US Census college age) who have resided in the housing unit for mo re than two months are counted in these data (US Census Data). The University of Florida and Sante Fe College (two large college systems) are both housed in Alachua County and thus influence the US census data. Located just south of Alachua County ( F igure 3 1), Marion County had a population of 331,314 in 2010 (Florida Charts, 2013) The county seat is Ocala. In 2010 there were approximately 25,774 adolescents ages 12 18 in Marion County Seventy five percent of the adole scent population was White, 19% was Black, and 16% was Hispanic (FDOH, 2011) Among Marion County adolescents, 5.1 per 1,000 lived in foster care compared to 4.8 in Alachua County and 4.5 in the State (FDOH, 2011) Socio Economic Status (SES) The median family household income for Florida was $47,661 in 2010, compared to $40,644 in Alachua County and $40,339 in Marion County (Median Household
74 Income, Florida Charts 2013). Approximately 14% of Flori da residents lived below 100% poverty, similar to the 13.1% in Marion County, but much lower than then 24% in Alachua County (Median Household Income, Florida Charts 2013). The state unemployment rate in 2011 was 10.5%, lower than Marion County (13.8%), bu t higher than Alachua County (7.7%) (FDOH, 2013) The high school graduation rate in 2009 10 was 81% in Florida, slightly higher than Alachua (77%) and Marion c ounties (80%) (FDOH, 2013). In 2010, similar to Marion County (15%) but higher than Alachua county high school diploma or its equivalency (FDOH, 2013) In 2011, almost 60% of Florida middle school youth qu alified for the free or reduced lunch program, compared to 66% in Marion County and 47% in Alachua County (FDOH, 2011) Among Alachua County adolescents ages 12 17 in 2011, 4.8 per 1,000 were in foster care, similar to the stat e rate (4.5) and the rate for Marion County (5.1) (FDOH, 2011) Review summary Table 3 1 for a side by side comparison of SES at the state and county levels. Health Status and Adolescent Risk Behaviors Approximately 83% of Flo rida adults reported having some type of health insurance in 2010, compared to 80% in Marion County and 86% in Alachua County (FDOH, 2013) The age adjusted 3 year death rate in 2009 11 was 676.2 per 100,000 in Florida, lower than in Alachua County (758.8) and Marion County 756.9 (FDOH, 2013). In 2009 11, the total infant mortality in Florida was 6.6, lower than in Marion County (7.7) and Alachua County (8.7) (Florida Charts: FDOH, 2013). In 2010, rates of risk behaviors among Florida, Alachua, and Marion c ounties were similar. Thirty eight percent of Florida high school youth, compared to 37% of Alachua County and 37% in Marion County reported using alcohol in the past 30 days
75 (FDOH, 2011). Rates of binge drinking among high s chool youth were 19% in Marion County, 22% in Alachua County and 20% in Florida (FDOH, 2011). Marijuana use in the past 30 days among high school youth was higher in Alachua County (23%), than Marion County (15%) and Florida (19%) (FDOH, 2011). Fifteen per cent of high school youth in Marion County reported smoking cigarettes in the past 30 days compared to 10% in Alachua County and 10% in Florida (FDOH, 2011). Sexual, Maternal, and Child Health The 3 year rate of sexually transmitted diseases (STDs) 2 in 2 009 11, amon g Florida youth ages 15 19 was 2,473.9 per 100,000, lower than both Marion County (2943.4) and Alachua County (3197.5) (FDOH, 2011). The rate of new HIV/AIDS cases among youth ages 13 19 was 14.2 per 100,000 in Florida, however the count in bot h Alachua and Marion County was less than 10 (FDOH, 2011) The percent of Florida women who began prenatal care in the first trimester was 79%, slightly higher than Alachua County (77%) and Marion County (66%) (FDOH, 2013) Almost 9% of Alachua C ounty babies were low birth weight (under 2500 grams) in 2009 11, compared to 8.7% in Florida and 7.8% in Marion County (Florida Charts, 2013) The three year non white Alachua County infant death rate was 10.9 per 1,000 live births in 2009 11, compared to 13.5 in Marion County and 11.3 in Florida (FDOH, 2013). From 2009 11 the three year rate of births to youth 15 17 was 22.3 per 1,000 in Marion County, higher than Alac hua County (11.8) and Florida (15.4) (FDOH, 2011) Also during 2009 11, the birth rate to mothers ages 18 19 was 59.3 per 1,000 in 2 Data includes STD data for Chancroid, Chlamydia, Gonorrhea Granuloma inguinale, LGV, Syphilis
76 Florida, higher than Alachua (30.1), but lower than Marion County (85.4) (FDOH, 2011) The percent of repeat births to Florida mothers ages 15 19 during the same period (2009 11) was 18%, slightly lower than both Marion County (21%) and Alachua County (20%) (FDOH, 2011) .See Table 3 1 for a side by side comparison of maternal and child health characteristics at the state and county levels. Interviews Sample 27% percent were White, 53% were Black, 6.7% were Hispani c, and 20% were other. Forty percent of participants had never been pregnant, 50% had one child, and 10% had two or more children. Fifty three p ercent resided in Marion County, 43% in Alachua County and 4 % in Union County. Inclusion and Exclusion Criteri a Primary i nclusion criteria for the research interviews were: adolescent girls between the ages of 16 and 18 who resided in Gainesville or the surrounding areas. Participants under the age of 18 required the consent of a parent or guardian before they cou ld participate. Research participants were required to meet one of three specific criteria: (1) has had no known pregnancies; (2) has had one child or, (3) has had two or more children. Primiparous and multiparous adolescents were required to have given bi rth to one or more children but were not required to be currently parenting. Additional criteria required participants to be unmarried and to speak, read and understand Engli sh. Please see Table 3 2 a summary of the inclusion and exclusion criteria of inte rview participants.
77 Recruitment This research study utilized a variety of methods to recruit participants all of which focused on a purposive sampling strate gy. Purposeful sampling requires participant selection that will best help answer the specified r esearch question (Creswell, 2009) I selected participants who met specific research criteria, there by providing insight into each of the research questions. I utilized snowball sampling, key informants and research flyers to r e cruit participants who met the eligibility criteria. The first step was to conduct a preliminary analysis of the exta nt teen pregnancy, birth and repeat birth rates in Gainesville and surrounding cities. This analysis was conducted with the use of State and county statistics available via Florida Charts. Florida Charts is sponsored by the Florida Department of Health Division of Public Health Statistics & Performance Management (FDOH, 2013) I also contac ted agencies within Ala chua and Marion c ount ies who work with or serve adolescent mothers. I obstetricians, gynecologists, and pediatricians), schools, the Woman Infant and Child (WIC ) program, and Healthy Start as potential point s of contact for rese arch recruitment. During research recruitment, I posted research flyers at each of these sites. The second step included meeting with the director and or student educator of the adolescent pregnant and parenting programs in Alachua and Marion counties. D uring these meetings (average two meetings per site), I assessed the population demographic s strength s and weakness es of research recruitment and the steps necessary to conduct research recruitment. I gathered and analyzed information such as race, ethni analysis I proceeded with research recruitment at both locations; however, due to
78 considerable barriers to participant access at Alachua County Continuing Education Program for Pregnant / Parenting Teens (ACCEPT ) this recru iting avenue was unsuccessful ( recruitment difficulties). The third step was the use of key informant interviews to gather information on recruitment and data collection strategies. I met with an African American, 17 year old mother of one and an 18 year old never pregnant African American female both of who m resided in Gainesville Florida. I asked the primiparous participant about key recruitment strategies of adolescent mothers and repeat mothers. I also asked both participants about interview question formatting and their suggestions for revisions. A formal cognitive interview was conducted with the nulliparous participant prior to Institutional Review Board ( IRB ) submission 3 C ognitive interviews allow for underst andi ng the meaning of the questionnaire from the participants perspective (Drennan, 2003) .This is especially useful in instances when questions may be considered sensitive or intrusive (adolescent sexuality and pregnancy) and for specific groups for which the questionnaire completion may be an issue (Drennan, 2003) The initial response to the question, the mea ning of the question, and potential adjustments to the question. Based on the cognitive interview, several questions were revised or understanding of the topic. Upon IRB approval, t he original key informants were contacted for assistance with participant access and recruitment. The primiparous adolescent was lost for follow 3 Data from the cognitive interview was not intended for report or publishing, therefore IRB approval was not obtained beforehand, per personal conversation with IRB 01 Summer, 2011.
79 up and unable to be contacted for formal participation or participant referral. Gatekeepers at key agen cies pro ved the most effective in participant recruitment. Key personnel at Healthy Start, Youth Parenting Program (YPP ) a parenting program for adolescents in Marion County and Hands of Mercy Everywhere (HOME ) a foster home for parenting adolescents, provided essential access to participant recruitment. In addition to key personnel, snowball sampling served as the primary recruitment strategy. Snowball sampling is often used for hard to reach or hidden populations. Hidden populations, defined by Heckathorn (1 997) are populations for which there are privacy concerns due to stigmatized or illegal behavior and for which there is no sampling frame. Snowball sampling was used in this project due to the stigma associated with teen pregnancy and the difficulty assoc iated with gain ing access to the population Following completion of the interview, each participant was given three project contact cards to distribute to friends or relatives who met the research criteria. Recruitment Difficulties Alachua County School District maintains a program for pregnant and parenting teens; Alachua County Continuing Education Program for Pregnant/Parenting Teens (ACCEPT) is a voluntary program designed to address the needs of pregnant and parenting teens. It provides prenatal and parenting courses to participants as well as an onsite day care center (Alachua County Public Schools, 2013) ACCEPT is housed at magnet progra m for vocational careers. ACCEPT is available to adolescents enrolled in the Alachua County School District and provides school bus transportation (with car seats) for participants (Alachua County Public Schools, 2013) Althoug h ACCEPT is
80 open to all pregnant and parenting adolescents, adolescents who do not need the available daycare often choose to remain at their base school. The Alachua County School Board research office and the individual school principal must first appro ve potential research before recruitment can be conducted on school premises. Upon, University of Florida IRB approval, and approval from the Alachua County School Board, the research project and recruitment flyers were submitted to Loften High School (the ACCEPT program), Gainesville High School, and Eastside High School principals for approval Personal, phone and email attempts with each school principal were unsuccessful and it is it is unknown if the research flyers were approved or d istributed Proce dure Data collection occurred in several steps: assess interest and eligibility, schedul e interview conduct interview and complete the post interview procedure. Interested participants made contact with me via email or phone. During a phone conversation (initial or follow up) I introduced the study, the purpose, and research requirements. Study eligibility, age, and parent/ guardian availability w ere assessed prior to scheduling the interview. Research interviews were scheduled over the phone at a time / pl ace that w as convenient to both the researcher and participant. Typical research locations park or library. The partici pant/parent dyad was consented/ assented simultane ously Participants under the age of 18 were unable to consent to participation and thus provided her assent per IRB guardian, often a parent, was present during the informed consent process and
81 provi ded legal consent. Immediately following consent the researcher and participant relocated to a private area. Immediately prior to the research interview participants com pleted the participant intake f o r m (quantitative instrument). This typically took 10 2 0 minutes to complete. During this time, I answered questions regarding the intake questionnaire as needed. Representative questions consisted of terminology clarification e.g what does jittery mean, referencing the Positive Affect Negative Affect Schedul see Table 3 10 for a complete list of the PANAS (Watson, Clark, & Tellegen, 1988) The intake form was reviewed for completion and clarification bef ore starting the interview. Subsequently, I reviewed the interview procedure and reminded participants of the confidentially policy and its exceptions, the digital recorder, and participant responses to sensitive issues. Each interview was recorded with an Olympus digital recorder and lasted an average of 47 minutes. At the conclusion of the interview, participants were asked to complete a worksheet that assessed their perception of their individual placement on a life success ladder and characteristics of successful and unsuccessful members in their community. At the conclusion of the worksheet, each participant was given a $25.00 gift card to Wal Mart (originally $20, revised and approved by IRB on 8/4/12), and three research invitations to distribute to friends who might be interested in participation. On the following workday, each interview was uploaded to the UF encrypted file server, and erased from the digital recorder. Quantitative data were subsequently entered into the SPSS data file and the int erview was submitted for transcription.
82 I conducted 29/ 30 research interviews and both focus groups. A second researcher was consulted to conduct interviews when necessary. This researcher was a recent graduate of the UF Master of Public Health program a nd consulted on cases when there was a potential for conflict of interest between the participant and the researcher. Instrument Development The qualitative interview consisted of several overarching themes: success, future aspirations, professional futur e, personal future, relationships, sexuality, pregnancy, motherhood, media, and hopes for the future. Each construct consisted of one or two interview questions and several probes that were used as needed. See Table 3.4 for a complete list of each intervie w theme and the corresponding interview questions. up worksheet that required a list of characteristics des cribing successful and unsuccessful people in the participant s community. Future aspirations were assessed by interview questions Tell me about your life 3 years from now, Tell me about your career plans and hopes for the future questions included multiple probes t o investigate adjustments in aspirations and the reason behind these adjustments. Nulliparous adolescents were asked to think about a peer who was an adolescent mother and reflect on the positive and negative things about adolesc ent childbearing. Primiparous and multiparous adolescents were asked to reflect on the
83 easiest and hardest thing s about being a mom as well as motherhood effect on their educational, personal, and romantic plans. All participants ( nulliparous primiparo us and multiparous) were also asked to reflect on MTV shows 16 and Pregnant and Teen Mom and their comparison to the reality of teen pregnancy and motherhood. Focus Group Sample ars. Race/ethnicity was reported as Black (54%), White (18%), Hispanic (18%), and other (10%). The majority of the sample had one child (82%) and 18% had two or more children. All of the focus group participants resided in Marion County Inclusion and Excl usion Criteria The focus group participants were required to be between the ages of 14 19. Participants under the age of 18 required the consent of a parent or guardian before they could partake Other inclusion criteria required participants to be unmarri ed, and able to speak, understand, and read English. See Table 3 3 for a complete list of the inclusion and exclusion criteria for focus group participants. Recruitment One focus group was conducted at each of the major recruiting facilities YPP and HOM E director. During these meetings (an average of one meeting per site), I explained the study, eligibility criteria and data collection procedure, and scheduled a follow up meet a nd greet with potential participants.
84 The second step was to conduct the meet and greet session with potential participants. The purpose of these sessions was to inform, assess interest, and schedule the focus group. To inform the participants, I introduc ed myself and the study, and explained eligibility and the study procedure. After answering preliminary questions and concerns, I assessed participant interest. Prior to scheduling a tentative time, date, and location for the focus group, I gave interested participants a study face sheet. Each participant was asked to complete a study face sheet that included name, age, and contact information. Participants returned the face sheet on the day of the session and received an Informed Consent Form (ICF). I reviewed the ICF and consented participants. A completed ICF was required prior to focus group participation. Procedure Each focus group lasted between 1.5 to 2 hours. At the beginning of each focus group, I reminded the participants about the nature of the study. During this time, I emphasized that participation was voluntary and could be withdrawn at any time. I also collected completed informed consent forms and reminded participants that information shared in the group must remain confid ential. Immediately following the introduction to the group, each participant completed an intake form. Intake forms were completed individually and took approximately 20 minutes. I addressed questions about the intake form as needed; the majority of quest ions concerned vocabulary terms in the Positive and Negative Affect Schedule (Watson, Clark, & Tellegen, 1988) The Mastery Scale (Perlin & Schooler, 1978) The Rosenberg Self Esteem Scale (Rosenber g M. 1965), and the Life Orientation Test (Scheier & Carver, 1985) See Tables 3 7, 3 8, 3 9 and 3 10 for a complete description of each scale. Following completion of the intake form, I began the focus group. Each focus group was audio recorded with th e use of two digital
85 recorders. Participants were asked to refrain from using names whenever possible, but each transcript was de identified during data clean up At the conclusion of the focus group, each participant received a $5.00 gift card to Wal Mar t and a goody bag. Each goody bag contained a variety of items for the participants or their children. Sample items included a picture frame, Chap Stick, infant washcloths infant sun block lotion, pens, pencils, or highlighters. The value of each goody b ag was $5.00. Instrument Development The focus group guide imitated the components of the individual interview ; however, it allowed for group reflection on sexuality and media and excluded questions about personal relationships. Please see Table 3 5 fo r a complete list of focus group questions and their corresponding construct s Quantitative Instrument Development The intake form consisted of demographic information, pregnancy and parenting status, living arrang ement and environment, relationship status, family and peer history of teen pregnancy the Mastery Scale (Perlin & Schooler, 1978) Rosenberg Self Esteem Scale (Rosenberg, 1965) Life Orientation Test (Scheier & Carver, 1985) and the PANAS (Watson, Clark, & Tellegen, 1988) Please see Table 3 9 and 3 10 for a list of each scale and the corresponding participant means and standard deviations. Research has h ighlighted several risk factors for adolescent pregnancy and repeat pregnancy such as race, family history of teen pregnancy, poor family dynamics, and low self esteem ( Boardman, Allsworth, Phipps, & Lappane, 2006; East, 1998; Etheir, Kershaw, Lewis, Milan & Ickovics, 2006 ). In order to investigate these risk factors as they relate to the sample, each participant completed a n intake form prior to
86 completing the interview or focus group. The intake form assessed demographic variables such as age, race and e thnicity family dynamics ( such as current living environment ) fa mily history of teen pregnancy, and psychosocial variables, perceptio n of control (The Mastery Scale, Perlin & Schooler, 1978) self esteem (Rosenberg Self Esteem Scale Rosenberg, 1965) op timism deposition ( LOT, Scheier & Carver, 1985) and mood / affect (PANAS Watson, Clark, & Tellegen, 1988) Rosenberg Self Esteem Scale (RSE) The RSE is a widely used self report measurement for individual self esteem (Gray Littl e, Williams, & Hancock, 1997) The original RSE was a 10 item Guttman scale guided by ease of administration, time considerations, dimensionality, and face validity (Rosenberg, 1965) Self attitude to (Rosenberg, 1965, p. 30) Typically high self enough (Rosenberg, 1965) Low self esteem implies self rejection, self dissatisfaction, or self contempt (Rosenberg 1965) Robins et al (2001) analyzed the construct validity of the Rosenberg Self Esteem Scale (RSE) and a Single Item Self Esteem Scale (SISE) across four studies. Their findings conclude that the RSE and SISE have nearly identical correlations with several constructs ; however, the RSE had improved convergent validity in child population sample s (Robins, Hendin, & Trze sniewski, 2001) Various studies have investigated self esteem related to adolescent health, and sexual behavior. Donnellan, et al (2005) found that low self esteem among an international and national sample (comparative sample of New Zealand and the U S) of
87 adolescents and young adults was related to aggression, antisocial behavior, and delinquency. This relationship held true after controlling for parent child relationships, peer relationships, and socioeconomic status (Donne llan, Trzensniwski, Robins, Mofitt, & Capsi, 2005) Rosenberg and Perlin (1978) also found that when compared to adults adolescent self esteem showed a lower association to social class (defined using the Hollingshead Index of Social Position). The autho rs proposed that the fundamental meaning of social class differed in the two groups (achieved versus assigned) thus creating a different effect on self esteem (Rosenberg & Pearlin, 1978) Whitbeck et al (1999) found that hi gher levels of self esteem were negatively associated with early sexual intercourse. Lower participant scores (under 15) suggest lower levels of perceived self esteem. The scale mean was for this study 3 2 5 4 (SD 5.0 ) ; and t was 81 ; sli ghtly lower than those reported in Pallant (2002) whose mean was 33.5 and among a diverse group of young adults (college age) However, among a small group (N=21) of parenting adolescents (ages 15 19), the mean score for R SE was 14.72, and the re ported alpha coefficient was 86 (Hudson, Elek, & Campbell Grossman, 2000) These participants also scored high levels of depression (Center for Epidemiologic Studies Depression Scale f or Children), howeve r the two scores were not significantly related (Hudson, Elek, & Campbell Grossman, 2000) Hockaday, Crase, Shelley, and Stockdale (2000) analyzed adolescent pregnancy prospectively and its association with self esteem, aspirati ons, and expectations The 4 Mean based after recode of negative items.
88 study participants reported a mean of 30.98 among parenting teens a lpha was .84. The Mastery Scale This scale was designed to measure perceptions of control (Pallant & Lae, 2002) De veloped by Perlin and colleagues it assesses the degree to which participant s regard their life chances as und er their control compared to fatalistica lly ruled (Perlin & Schooler, 1978) It addresses confidence in problem solv ing, sense of helplessness, and control over things that happen to the participant (Whitbeck, Yoder, Hoyt, & Conger, 1999) Perlin (1978) discovered that stress as it relates to marriage, parenting, and household economics depends heavily on self reporte d mastery. Researchers also fo und that within the population younger subgroups were more likely to entertai n a sense of mastery than were older subgroups; however, both mastery and self esteem were closely associated with achieved status (successfully reac hed a preset life goal) (Perlin & Schooler, 1978) The Mastery Scale is a 7 item scale for which participants select how much they agree (strongly agree, agree, disagree, strongly disagree) with each statement related to perce ption of control (Perlin, Lieberman, Menaghan, & Mullan, 1981) These items There is really no way I can solve some of the problems I have to assess the participants overall perceptions of control and p ossible implications to meaning of success and parenting status. Whitbeck et al included the Mastery Scale and RSE to investigate predictors of early sexual intercourse among 457 middle school students (Whitbeck, Yoder, Hoyt, & Conger, 1999) Results con cluded small statistically significant effects indicating higher levels of self esteem and self confidence were negatively associated with early
89 intercourse (Whitbeck, Yoder, Hoyt, & Conger, 1999) Ben Zur (2003) foun d that among adolescents and college students, high levels of mastery and optimism were negatively associated with the Negative Affect (NA) scale of the PANAS (PA: M= 3.77, SD=.75. NA: M = 2.43) (M=5.21, SD= 99), and optimism (M=3.75, SD=.80) were positively associated with Subjective Well Being (Ben Zur, 2003) Mastery, dispositional optimism, and affect were used as a measure for Subjective Well Being (Ben Zur, 2003) Higher participant scores indicate high levels of perceived mastery. The scale mean was 22.16 (SD 2.9). Similar to a Shanahan (2004), whose reported mean for 22.8 (SD= 3.18). by Whitbec k Whitbeck (1999), whose C .87 for adolescents across mulitple survey points See Table 3 7 for participant mean score by item. Life Orientation Test The Life Orientatio n Test (LOT) (Scheier & Carver, 1985) was developed to measure depositional optimism things in life (Vera, et al., 2008) it was proposed that low dispositional optimism c ould have clear health related and behavioral consequences (Scheier & Carver, 1985) Scale psychometrics revealed a two factor analysis (negatively and positively worded items) retest reliability of .79 (Scheier & Carve r, 1985) The final scale consists of eight items although it is often presented with filler items to disguise the overall meaning of the scale. See Table 3 9 for a complete list of items Optimism was found to positi vely correlated with Mastery (RS = 57 ), among college students (N=97) and (R=.46) among adolescents ( N=185 -P<.001) (Ben Zur,
90 2003) Vera et al (2008) found moderate positive correlations with Mastery, and Self Esteem (R=.34 and .48) Creed, Patton and Bartum (2002), found that using the LOT R, adolescents who scored high levels of optimism reported higher levels of career decisions and career related goals. Those with higher pessimism reported low levels of career and deci sion making knowledge, were more career indecisive and had low er levels of school achievement (Creed, Patton, & Bartum, 2002) Puskar et al (1999 ) found that among rural adolescents ages 14 19, the mean score was lower (NS) t han comparable college students, and that rural adolescent females scored slightly lower than adolescent males. The Life Orientation Test Revised (LOT R) includes 5 of the original 8 items, two items found to measure coping rather than optimism were remove d an additional positively phrased item was included, and a negatively worded item was removed from scoring ( Creed, Patton, & Bartum, 2002; Scheier, Carver, & Bridges, 1994 ) Higher participant scores imply higher optimism (scale 0 24). The participant me an was 23. 8 (SD=4.5) 21.73 (SD=3.69) reported among urban, ethnic diverse adolescents ages 12 15 (Vera, et al., 2008) See Table 3 9 for a complete list of items, scale means, and standard deviations. P ositive and N egative A ffect S chedule The Positive and Negative Affect Schedule (PANAS) was utilized to assess overall affect tendency. The PANAS is a validated measure that sugge sts a consensual two factor model (i.e. positive and negative affect; Watson, Clark, & Tellegen, 1988). According to Watson, Clark, and Tellegen (1988), Positive Affect (PA) reflects the extent to which a person feels enthusiastic, active, and alert and Ne gative Affect (NA) consists
91 of adverse mood such as anger, contempt, disgust, guilt, fear, and nervousness (Watson, Clark, & Tellegen, 1988) Please see Table 3 10 for a complete list of the scale var iables and their corresponding domain. Assessment of each affect domain is assessed with 10 items scored on a 5 point Likert scale. Crocker (1998) de termined that among a youth sport sample ages 10 .11) of both Positive and Negative Affect scales. Each of these scales was included to provide an objective measure of constructs that may be associated with risky behaviors or resilience in adolescent groups. Ames and Archer (1988) investigated motivational processes among middle and high school students. Students who perceived an emphasis on mastery goals reported more effective goal a chievement strategies and held a stronger belief that success and effort were linked (Ames & Archer, 1988) Higher participant scores after adding positive scale items indicate high er levels of Positive Affect (scale 10 50). T he mean score for Positive Affect was 30.5 (SD= 7.8) compared to 33.5 (SD=6.85) reported by Vera, et al., (2008), among 151 diverse urban adolescents ages 12 15. Lower participant scores represent lower levels of negative affect (scale 10 50). The mean sco re for Negative Affect was 21.9 (SD=7.1), lower than a mean 26.73 reported in Vera et al (2008). The A lpha was .85 for PA, and .77 for NA. See Table 3 10 for participant mean score by item. Data Analysis Quanti tative Ana lysis The quantitative portion of this study was used to provide a demographic profile of the participant population and to address Research Aim 4: To explore the role of factors such as religion, personal expectations, family dynamics and family history o f
92 teen pregnancy as they relate to single and subsequent adolescent births. Due to the small sample size (n=32), very few statistical inferences can be determined; however, general trends and averages among varying groups are presented in Chapter 4: Resear ch Findings. I used SPSS to analyze this data. The averag e age of participants was 17.6 years ; the majority of the sample was African American/ Black (N= 18, 56 % ), were attending high school full time (N=21, 65%), and looking for a job (N=19, 60%) Focus group participants were either pregnant or parenting at the time of participation ; 40% of interview participants had never been pregnant. A demographic profile of the sample is presented in Table 3 6 Qualitative Analysis The qualitative portion of this s tudy (interviews and focus groups) helped to address research questions 2 6 : 2) what are the similarities and differences in definitions of what it means to have a successful life between the two groups? ; 3) w hat are the similarities and differences in def initions of personal and professional goal aspirations between the two groups? ; 4) h ow do adolescent girls (ages 16 19) who have never been pregnant perceive pregnant or parenting peers? What are their views on adolescent pregnancy/motherhood in the media? ; 5) How do primiparous adolescent girls (ages 16 19) describe the context surrounding initial birth?; 6) How do multiparous adolescent girls (ages 16 19) describe the context surrounding subsequent births? Due to difference in sample size, primiparous and multiparous transcript data were analyzed using thematic analysis and I conducted case study analysis on multiparous adolescent data.
93 Thematic a nalysis T here are several approaches to qualitative data analysis such as grounded theory analysis (involves open and axial coding) case study and ethnographic research (involves a detailed description of the s etting), and phenomenological research (involves generation of meaning units; Creswell, 2009) For this research, I relied mostly on thematic analysis. Th ematic analysis is the search for themes that emerge as important to the issue (Daly, Kellehear, & Gliksman, 1997) Based on Creswell (2009) and Fereday & Muir Cochraine (2006) I used the following steps for thematic anal ysis: 1) o rganized and prepared data for analysis 2) r ead through all the data 3) s ummarized data and identified themes 4)h and coded the data 5)d eveloped a code manual 6) c omputer coded the data 7) a pplied template of codes and additional coding 8) c onnected the codes and themes 9) i nterpreted the meaning of themes and 10) c orroborated the coded themes (Creswell, 2009) (Fereday & Muir Cochraine, 2006) The first step I employed was to organi ze and prepare for data analysis. Data preparation consisted of review and cleaning of each transcription, assessing for privacy concerns (remove names and dates) and accuracy. Creswell (2009) includes transcription, typing filed notes, and data arrangemen t in this step. The purpose of the second step is to obtain a general sense of the information and to reflect on overall meaning of the data (Creswell, 2009, p. 185) During this step, I assessed the overall depth, credi bility and use of the data (Creswell, 2009) Step three, was the process of summarizing data and identifying themes (Fereday & Muir Cochraine, 2006) I read transcripts and listened to raw d ata. During this step, I also reviewed memos created during the data collection process.
94 During step four I read each transcript and conducted a preliminary hand code of the data for each construct and interview question. Coding is the process of taking d ata, organizing them into categories, and labeling the categories (Creswell, 2009, p. 186) There are several different types of coding including descriptive (storing information), topic (gathering material by a specific topic), and analytic (coding aimed at developing concepts (Richards & Morse, 2007, p. 134) Based on the hand codes I created a codebook that was used for the compute r coding analysis ; this was step f ive The codebook can serve as a data management tool and is often referenced for scientific rigor and interrater reliability (Fereday & Muir Cochraine, 2006) In order to test the reliability of my codes, I consulted the use of a qualitative da ta analysis team and a dissertation committee member to assist in some coding. During step six I used the codebook and a computer based data management tool. I conducted an additional level of coding for which the computer sys tem N Vivo was used. I coded the text from each transcript into prescribed nodes that imitated the hand codes finalized in the codebook. The last steps of analysis included application and collaboration of codes and themes. During step seven, I applied the codes created during hand a nd computer coding to identify subsets of expressive text similar to techniques described by Fereday (Fereday & Muir Cochraine, 2006) In steps 8 10, I connected the codes identif ied themes and corroborat ed coded themes. Corroboration, as defined by Crabtree and Miller (1999; p. 170), is the process
95 of confirming findings. This was done with the use of the data analysis tea m and qualitative research collea gues. Case s tudy a nalysis A case study analysis of the multiparou s adolescents was used to address the sixth research question ( How do multiparous adolescent girls (ages 16 19) describe the context surrounding subsequent births ?) Case study research (CSR), as defined by Woodside and Wilson (2003), is an inquiry focusing on describing, understanding, predicting and / or controlling the individual (Woodside & Wilson, 2003, p. 493) CSR is often used to provide descriptions of phenomena, develop theory, and test theory (Drake, Shanks, & Broadbent, 1998) Although useful, Flyvbjerg (2006) identified five misinterpretations about CSR. These misinterpretations are : 1 ) Theoretical knowledge is more valuable than practical knowledge, 2 ) CSR is more useful in generatin g hypothesis than hypothesis testing and theory building, 3 ) CSR creates difficulty in generalizability, 4 ) CSR lends to bias to verification, and 5 ) it is difficult to summarize using CSR (Flyvbjerg, 2006) Ethical Considerat ions There were several ethical considerations when designing, collecting, and analyzing qualitative data in a setting such as this. The first is the inclusion of several potentially vulnerable populations. Vulnerable populations are groups that could be h armed, manipulated, or deceived by researchers due to reduced competence or disadvantage d status (Rogers, 1990) This may include the poor, women, children, and ethnic minorities (Martin, 1995). This research included participa nts who were under the age of legal consent ( a verage 17.4 17.8 y ears o ld); therefore, per IRB regulations these participants gave the assent to participate but required parental consent. Furthermore,
96 given the nature of the research study, some participant s were pregnant at the time of enrollment. IRB regulations require additional safeguards whenever pregnan t women participate in research; these regulations were enacted to protect the mother and fetus. Before the commencement of this research project speci fic information and justification for the inclusion of pregnant women and children (under the age of 18) was required. The second ethical consideration was investigation of potentially sensitive topics. Sex, relationships, and pregnancy are sensitive issu es when speaking with adolescents. Crowles (1988) note d several issues within qualitative research regarding sensitive topics. One issue is timing ; participants who have recently experienced a life changing experience (childbirth) may be unwilling or unabl e to participate in research (Cowles, 1988) According to Cowles (1988), t o be prepared for participant emotional responses the researcher should have contingency plan and a noted prescribed provision within the informed consen t process. Particularly important for adolescents in research are the issue s of confidentiality and or anonymity (Cowles, 1988) ; in this case, each participant was insured that responses were completely confidential except for ma ndatory reporting of abuse such as physical, or sexual Finally, researcher response and objectivity are both issues in qualitative research and investigation of sensitive issues (Cowles, 1988) Research of sensitive issues can be emotionally taxing for the researcher as well as the participant; ample planning prior to the research interview is essential to help prepare for possible researcher responses during the interview. Objectivity requires the researcher to remain empathic while impartial; this is usually displayed within the researcher response (Cowles, 1988)
97 The Institutional Review Board 01 at the University of Florida provided research approval on this project from 2/29/12 to 2/14/13, the IRB number is 685 2011. Chapter 3 Conclusion I focused on group differences and similarities in the factors related to personal and professional goal aspirations and m eaning of success. I conducted thirty individual interviews and two focus groups in Gai nesville and Ocala, Florida. Due to the limited data available from multiparous adolescents, these interviews were analyzed using a case study approach. I analyzed potential trends in quantitative responses using The Mastery Scale (Perlin & Schooler, 1978) the Rosenberg Self Esteem Scale (Stevens Simons, Dolgan, Kelly, & Singer, 1997) and The Positive and Negative Affect Scale (Watson, Clark, & Tellegen, 1988) Qu alitative data were analyzed using Nvivo software and quantitative data were analyzed using SPSS software.
98 Figure 3 1 Adolescent Birth rate, national distributi on. (Birth Rate per 1,000, ages 15 19, 2010.) Original Image (Kaiser Foundation, 2012) Figure 3 2. Alachua and Marion County sited on Florida Map (Florida Counties, 2013)
99 Table 3 1 Data amended from Florida Charts County School aged Child and Adolescent Profile (2011) and County Health Status. Data provided is the most recent data available. (Florida Charts, 2011; Florida Charts, 2013). 5 6 5 Decimals are rounded up to the nears whole number. 6 Data presente d is the most recent available data. Year Alac hua County Marion County Florida Adolescent Race/ Ethnic Distribution ages 12 18 White 2010 65% 75% 71% Black 2010 25% 19% 22% Hispanic 2010 12% 16% 27% Socioeconomic Status Median Household Income 2010 $40,644 $40,339 $47,661 100 % below povert y 2010 24% 13% 14 % HS Graduation Rate 2009 10 77% 80% 81% Sexual, Maternal and Child Health STDs Youth 15 19 (3 Year) per 100,000 2009 11 3197.5 2943.4 2473.9 Births Females 15 17 (3 Year) Per 1,000 2009 11 11.8 23.3 15.4 Repeat Births Fem ales 15 19 (Percent) 2009 11 20% 21 % 18 %
100 Table 3 2 Inclusion and exclusion criteria for interview participants Inclusion Exclusion Nulliparous 16 18 No past known pregnancies Unmarried Speak, understand and read English Parent or legal guardian available to sign a consent if under the age of 18 < 16 or > 18 Married Unable to speak, understand and read English Parent or legal guardian unavailable to sign consent if under the age of 18 Primiparous 16 18 1 prior pregnancy carried to term Unmarrie d Speak, understand and read English Parent or legal guardian available to sign a consent if under the age of 18 < 16 or > 18 Married Unable to speak, understand and read English Parent or legal guardian unavailable to sign consent if under the age of 1 8 Multiparous 16 18 2 or more prior pregnancies carried to term Unmarried Speak, understand and read English Parent or legal guardian available to sign a consent if under the age of 18 < 16 or > 18 Married Unable to speak, understand and read English Parent or legal guardian unavailable to sign consent if under the age of 18 Table 3 3 Inclusion and e xclusion c riteria for f ocus group participants Inclusion Exclusion 14 19 Unmarried Speak, understand and read English Parent or legal guardian available to sign a consent if under the age of 18 < 16 or > 18 Married Unable to speak, understand and read English Parent or legal guardian unavailable to sign consent if under the age of 18
101 Table 3 4 Interview guide themes and correspondin g interview questions Theme Lead Interview Question Introduction Tell me about life for girls your age. Success about someone you consider successful, tell me about this person. Fut ure Aspirations would you like to be doing? Professional Future Can you tell me your career plans and hopes for the futur e? Personal Future you tell me about your family ten years from now? Relationships When did you have your first romantic relationship? Sexuality eep in mind, this interview will remain between us, and none of your friends, teachers or parents will see your answers. When did you first learn about sex? Tell me about your first sexual experience. Pregnancy ( Nulliparous adolescents) Next, I woul d like to talk about girls who have babies in high school. I would like you to think for a minute about a girl your age who has had a baby. Can you describe what you think it is like for girls who have a baby in high school? Pregnancy (Primiparous & Mu ltiparous adolescents) will remain between us and you can skip any question that makes you uncomfortable. Tell me what it was like when you first found out you were pregnant. Motherhood (Primiparous & Multiparous adolescents) Can you describe what you think it is like for a teen mother? Media MTV has two popular television shows about teen pregnancy 16 and Pregnant Teen ? Past Self If you coul d go back and change one thing about the past related to your personal past what would it be? Why is that? Future Self Is there any one thing you are excited about, or looking forward to in the future? Why is that? Conclusion Is there anything else you would like to tell me about being a teenager? Is there anything else you would like to tell me about being a mother ?** For Parenting adolescents
102 Table 3 5 Focus g roup themes and corresponding questions Theme Lead Focus Group Question Introductio n Tell me about life for girls your age. Success about someone you consider successful, tell me about this person. Future Aspirations from now. What would you like to be doing? Professional Future Can you tell me your career plans and hopes for the future? Personal Future r personal life. Can you tell me about your family ten years from now? Sexuality interview will remain between us, and none of your friends, teachers or parents will see your answers. When did yo u first learn about sex? Tell me about your first sexual experience. Pregnancy Motherhood If you are a mother, or know a young mother, can you describe what it is like for a teen mother? Media MTV has two popular television shows about teen pregnancy 16 and Pregnant Teen ? Past Self If you could go back and change one thing about the past related to your personal past what would it be? Why is that? Fut ure Self Is there any one thing you are excited about, or looking forward to in the future? Why is that? Conclusion Is there anything else you would like to tell me about being a teenager? Is there anything else you would like to tell me about being a mother ?** For Parenting adolescents
103 Table 3 6 Interview and focus g roup sample demographic. Characteristic Interview Focus Group N=30 N=11 Age 17.48 17.80 Percent (N) Percent (N) Location Alachua 43 (13) Marion 54 (16) 100 (11) Other 3 (1) Race/Ethnicity Black/AA 54 (16) 54 (6) H ispanic 7 (2) 18 (2) White 27 (8) 18 (2) Other 13 (4) 9 (1) School Attendance HS Full Time 67 (20) 63 (7) HS Part Time 7 (2) 9 (1) Graduate HS 13 (4) GED 10 (3) 27 (3) HS Drop Out 3 (1) Employment Full Time Part Time 3(1) 9 (1) Looking for Job 64 (19) 63 (7) Does not work 33 (10) 27 (3) Sexual Activity Currently Sexually Active 40 (12) 54 (6) Used to be Sexually Active 20 (6) 18 (2) Not Sexually Active, had Sex 17 (5) 27 (3) Never had Sex 23 (7) Pre gnancy Status Never been Pregnant 40 (12) Pregnant Once 47 (14) 73 (8) Pregnant twice or more 13 (4) 27 (3) Parenting Status No children 43 (13) One Child 47 (14*) 82 (9) Two or more children 10 (3) 18 (2*) Relationship Status Sing le 37 (11) 18 (2) Girlfriend <6 mos 9 (1) Girlfriend >6 mos 3 (1) 9 (1) Boyfriend <6 mos 13 (4) 9 (1) Boyfriend >6 mos 37 (11) 55 (6) Engaged 7 (2) Other 3 (1)
104 Table 3 7 The Mas tery Scale (Perlin & Schooler, 1978) ** Items recoded for scale (e. What happens to me in the future mostly depends on me M = 3.75; g. I can do just about anything I set my mind to M =3.84) N M SD Strongly Agree 1 Agree 2 Disagree 3 Strongly disagree 4 a. There is really no way I can solve some of the problems I have. 32 3.1 .77 3% (1) 16% (5) 50% (16) 31% (10) b. I have little control over the things that happen to me 32 3.2 .69 0% (0) 16% (5) 50% (16) 34% (11) c. Sometimes I feel like I am being pushed around in life. 32 2.6 .94 6% (2) 50% (16) 19% (6) 25% (8) d. There is little I can do to change many of the important things in my life 32 2.9 1.06 12% (4) 22% (7) 28% (9) 38% (12) e. What happens to me in the future mostly depend s on me.** 32 1.25 .51 78% (25) 19% (6) 3% (1) 0% (0) f. I often feel helpless in dealing with the problems of life. 32 2.75 .84 3% (1) 41% (13) 34% (11) 22% (7) g. I can do just about anything I set my mind to. ** 32 1.2 .37 84% (27) 16% (5) 0% (0) 0% (0)
105 Table 3 8 The Rosenberg Self Esteem Scale (Rosenberg, 1965) ** Mean presented is after recode for congruency. Items recoded for scale (1 = strongly disagree to 4 = strongly agree N M SD Strongly Agree 1 Agree 2 Disagree 3 Strongly disagre e 4 a. I feel that I am a person of worth, at least on an equal plane with others. 32 1.5 .62 53% (17) 41% (13) 6% (2) 0% (0) b. I feel that I have a number of good qualities. 32 1.4 .56 63% (20) 34% (11) 3% (1) 0% (0) c. All in all, I am inclined to feel that I am a failure. ** 32 3.4 .87 6% (2) 6% (2) 31% (10) 57% ( 18) d. I am able to do things as well as most other people. 32 1.5 .57 50% (16) 47% (15) 3% (1) 0% (0) e. I feel that I do not have much to be proud of. ** 32 3.1 1. 1 12.5% (4) 16% (5) 22% (7) 50% (16) f. I take a positive attitude toward myself. 32 3.2 .64 12% (4) 57% (18) 31% (10) 0% (0) g. On a whole, I am satisfied with myself. 32 1.6 .75 47% (15) 44% (14) 6% (2) 3% (1) h. I wish I could have more respect for myself. ** 32 2.8 .99 12.5% (4) 19% (6) 41% (13) 28% (9) i. I certainly feel useless at times. ** 32 3.0 .87 3% (1) 25% (8) 38% (12) 34% (11) j. At times I think I am no good at all. 32 3.1 1.0 9% ( 3) 19% (6) 25% ( 8) 47% (15)
106 Table 3 9 The Life Orientation Test (Scheier & Carver, 1985 ) sample means, standard deviation and distribution. N M SD Strongly Agree 1 Agree 2 Disagree 3 Strongly disagre e 4 a. In uncertain times, I usually expect the best. 32 1.9 .89 37%(12) 41% (13) 16% (5) 6% (2) b. If something can go wrong for me, it will. 32 2.7 .93 9% (3) 34% (11) 34% (11) 22% (7) c. I always look on the bright side of things. 32 1.8 .79 41% (13) 44% (14) 12% (4) 3% (1) d. about my future. 32 1.7 .86 50% (16) 37% (12) 6% (2) 6% (2) e. I hardly ever expect things to go my w ay. 32 2.9 .97 9% (3) 22% (7) 37% (12) 31% (10) f. Things never work out the way I want them to. 32 2.8 .79 6% (2) 25% (8) 53% (1) 16% (5) g. 31 1.9 .73 25% (8) 56% (18) 12.5% (4) 3% (1) h. I ra rely count on good things happening to me. 32 2.7 1.0 16% (5) 25% (8) 31% (10) 28% (9)
107 Table 3 1 0 The PANAS Scale (Watson, Clark, & Tellegen, 1988) Means, Standard Deviation, and Distribution Over the past 2 weeks, how much have you N M SD Very slightly or not at all 1 A little 2 Moderat ely 3 Quite a bit 4 Extremely 5 a. Interested+ 32 3.3 1.3 12.5% (4) 12.5% (4) 25% (8) 34% (11) 16% (5) b. Distressed 32 2.5 1.3 28% (9) 28% (9) 16% (5) 22% (7) 6% (2) c. Excited + 32 3. 2 1.3 9% (3) 22% (7) 28% (9) 19% (6) 22% (7) d. Upset 32 2.8 1.2 12.5% (4) 31% (10) 25% (8) 19% (6) 12.5% (4) e. Strong + 31 3.3 1.3 6% (2) 26% (8) 26% (8) 16% (5) 26% (8) f. Guilty 32 1.7 1.3 72% (23) 3% (1) 9% (3) 13% (4) 3% (1) g. Scared 31 2.0 1.3 52% (1 6) 16% (5) 20% (6) 6% (2) 6% (2) h. Hostile 31 1.8 1.1 53% (17) 22% (7) 12.5% (4) 6% (2) 3% (1) i. Enthusiastic + 32 3.3 1.4 6% (2) 28% (9) 25% (8) 9% (3) 31% (10) j. Proud+ 32 4.0 1.2 3% (1) 9% (3) 19% (6) 25% (8) 44% (14) k. Irritable 31 2.7 1.3 26% (8) 19% ( 6) 23% (7) 23% (7) 10% (3) l. Alert + 32 3.5 1.5 12.5% (4) 16% (5) 22% (7) 12.5% (4) 37% (12) m. Ashamed 32 1.6 1.0 69% (22) 12.5% (4) 12.5% (4) 3% (1) 3% (1) n. Inspired + 32 3.6 1.2 3% (1) 19% (6) 19% (6) 31% (10) 28% (9) o. Nervous 32 2.7 1.3 25% (8) 16% ( 5) 25% (8) 28% (9) 6% (2) p. Attentive + 32 3.1 1.3 12% (4) 16% (5) 37% (12) 19% (6) 16% (5) q. Jittery 32 2.0 1.4 53% (17) 16% (5) 16% (5) 6% (2) 9% (3) r. Active + 32 3.4 1.3 9% (3) 16% (5) 25% (8) 28% (9) 22% (7) s. Afraid 32 1.9 1.1 50% (16) 22% (7) 22% (7 ) 3% (1) 3% (1)
108 CHAPTER 4 FINDINGS Overview Both quantitative and qualitative methods were u sed in this study. Chapter 4 provides both quantitative and qualitative findings organized by research question or research aim. This research project had six re search questions and five research aims. The research aims were: 1) t o explore the role of factors such as demographics, family dynamics, family / peer history of teen pregnancy religion, and psychosocial constructs such as self esteem, mastery, optimism, and positive/negative affect on single and subsequent adolescent births ; 2) t o explore the themes associated with what it m eans to have a successful life between nulliparous and parous adol escent girls (ages 16 19) ; 3) t o explore the themes associated wit h personal and professional aspirations between nulliparous and parous adolescent gir ls (ages 16 19) ; 4) t o investigate the explanatory models of nulliparous adolescent girls associated with parous peers, and their views on adolescent motherhood in the med ia ; and 5) t o explore the described context of conception, delivery and motherhood (for single and subsequent pregnancies) among paro us adolescent girls (ages 16 19). T able 4 1 depicts each research aim and i t s associated research question. The quantitativ e and qualitative findings are presented below by research question Tables 4 2 4 3 and 4 4 provide a more complete description of quantitative findings than those summarized. Following a description of findings by question, I have provide d a topic analy sis of t een motherhood in foster care.
109 RQ 1. What are the Similarities and Differences in Demographics, Family Dynamics, Family/Peer History of Teen Pregnancy, Religion, and Psychosocial Constructs Such as Self Esteem, Mastery, Optimism, a nd Positive/Nega tive Affect between Nulliparous and Parous Adolescents ? Quantitative analyses were conducted on demographic, family history, and family and peer dynamics related to nulliparous and parous status. However, due to a small sample size and skewed participant r esponses there were limited statistical tests that could be performed. Although chi square analysis is routine for categorical data this was not performed due to cells with zero responses and cells with less than 5 responses, b oth of which are violations t o chi square statistical analysis See Tables 4 1 through 4 3 for summary data on demographic, family dynamics, family history, peer dynamics, and standardized scale the Rosenberg Self esteem Scale (Rosenberg, 1965) the Mastery Scale (Perlin & Schooler, 1978) the Positive and Negative Affect Scale (Watson, Clark, & Tellegen, 1988) and the Life Orientation Test (Scheier & Carver, 1985) results. Statistical tests fo r significance are presented in Tables 4 1, 4 2 and 4 3 when possible Background Characteristics Detailed demographics are presented in Table s 4 1 and 4 2 Participant recruitment was determined by age and birth status. The average age of nulliparous part icipants (N=12) was 17.17 (SD = .85), the average age for parous (N=20) participants was 17.7 (SD .86). Of nulliparous p articipants 75 % were Black, 8% were White, and 17 % were other. Of parous participants 45% were Black, 35% were White, 10% were Hispani c, and 10% were other The majority of nulliparous participants were enrolled in high school full time and a few had graduated from high school. Half (50%) of nulliparous participants reported
110 getting good grades OK Slightly more than half of parous participants (60%) were enrolled in school full time; also a higher percentage than nulliparous participants had earned a GED Parous participants reported getting mostly OK grades (60%). See T able 4 1 for a more complete breakdown of participant responses. The majority of nulliparous participants reported being single (67%) ; a few (17%) reported being with a committed boyfriend for less than 6 months About half (55%) of parous participants re ported being with a boyfriend for more than 6 months ; the remaining participants were either single or had varied relationship statuses (identified in Table 4 2 ) Just over half (58%) of nulliparous participants reported never having sex and one third re ported being currently sexually active. However, almost half (45%) of parous participants reported currently being sexually active, and one third used to be sexually active. Demographic information reported separately for focus group and interview particip ants are reported in Chapter 3, Methods. See Table 4 1 for a summary of demographics by participant status. Family Dynamics Just under half of nulliparous participants (42%) reported living with their mother as did j ust under half of parous participants (45%) Parous participants were more likely to report living with a romantic partner (20% vs. 0 % ). Sixteen percent of parous participants reported not living with their child at the time of the interview Nulliparous participants reported living in a house (50 % ), followed by an apartment (33%) Parous participants reported living in house (50%), followed by a group home (30%).
111 Due to a revision to IRB half way through recruitment, 20 participants were asked about parental education, employment, and income status. The average years of school completed was 12.60 (SD = 2.4) for their mother s and 12.24 (SD= 2.0) for their father s Nulliparous participants reported their mothers average years of education as 13.80 years (SD= 1.87), significantly higher th an p arous participants (11.4 years, SD = 2.3 ) ( t = 2.5, df=18, p=.02 ). Nulliparous participants reported an average income of $31,000 yearly compared to $15,000 yearly for parous participants. About one third of nulliparous participants (33%) reported their mot time, and 42% reported full time employment for their fathers. Ten percent parous participants reported compared to 15% f or their fathers. Family History of Teen Pregnancy There were no sign ificant findings associated with family history of teen pregnancy among female or male relatives. Nulliparous and parous participants reported a higher incidence of teen pregnancy among their cousins, followed by an aunt or uncle. More nulliparous particip ants than parous reported having a grandfather who was a teen parent (33% versus 5%). Sexuality and Teen Parenthood among Peers A higher percentage of parous participants reported knowing girls who were s exually active (90% versus 67%) There is a slight difference in teen motherhood among friends of nulliparous and parous participants. Parous participants were more likely to reported having friends who were teen parents (65% versus 47%). Seventy five percent of nulliparous and 90% of parous participants reported knowing male peers who were sexually active More nulliparous participants than parous reported having male friends who were teen parents (58% versus 40%), but
112 parous participants reported having more best male friends who were male parents. Abou t one third (35%) of parous participants compared to 17% of nulliparous reported having male best friends who were parents One third of parous participants (30%) and nulliparous participants (33%) reported not knowing any males who were teen parents. Ps ychosocial Constructs Low levels of s elf esteem, optimism, and mastery have been predicted to be correlated to risky sexual behavior among adolescents which can lead to adolescent pregnancy and repeat pregnancy (Whitbeck, Yoder, Hoyt, & Conger, 1999) Ea ch participant completed a study intake form including validated measures of self esteem mastery, positive/negative affect, and optimism Participant means were consistent with those found in the literature; however, I identified no significant difference in means between nulliparous and parous participants The Rosenberg Self Esteem Scale: The mean score for the Rosenberg Self Esteem Scale (Rosenberg, 1965) among nulliparous participants was 32.3 (SD=3.6 ). The mean score for parous participants was 30.7 (SD=3.3 ) The t test results indicate d that the difference in means on the Rosenberg Self Esteem Scale (Rosenberg 1965) was not significant (t = .24, df = 30, p = NS) The Mastery Scale: The mean score for the Mastery Scale (Perlin & Schooler, 1978) among nulliparous participants was 22.6 (SD=2.9 ). The mean among parous participants was 21.9 (SD=3.01 ) The t t est results indicate d that the difference in mean s was not significant ( t = .75 df = 30 p = NS ) Positive and Negative Affect Schedule: The mean score for Positive Affect in the PANAS (Watson, Clark, & Tellegen, 1988) was nulliparous core for
113 nulliparous participants and 22.0 F igures 4 1 and 4 2 for a visual comparison in box pl ot s of the participants scoring on the PANAS (Watson, Clark, & Tellegen, 1988) by birth status. The t t est results indicate d that the difference s in Positive and Negative Affect mean s w ere not significant (PA t= 51 df = 30, p= NS; NA t= .08 df = 30, p= NS) The Life Orientation Test : The me an score for the Life Orientation Test (Scheier & Carver, 1985) among nulliparous participants was 24.7 ( SD= 4.9 ) The mean score for parous participants was 23.3 (SD=4.3 ) These dif ferences were not significant (t= 87 df = 30, p= NS ) Group Differences : I made an age comparison between participants 17.5 years or less (N=12) and those over the age of 17.5 years (N=20) Both age groups scored similarly on self esteem (30.6 versus 31.7), and on Mastery (21.1 versus 22. 8). Differences in the Life Orientation Test (Scheier & Carver, 1985) were not significan t ( t = 1.8 df = 30, p = .0 9 ), but those over the age of 17.5 years reported average dis positional optimism of 24.9 compared to 22.1 for those under the age of 17.5 years There was no significant difference found between groups related to Negative Affect; however, there was a statistically significant difference identified on P ositive A ffect. Participants over the age of 17.5 years ha d a higher Positive Affect mean (32.9) compared to those under the age of 17.5 years (26.7) (t= 2.3 df = 30, p=.03) There were no statistically significant differences between Black (Black; N=18) and n on Black p articipants (N=14) related to the Rosenberg Self Esteem Scale
114 (Rosenberg, 1965) t he PANAS (Watson, Clark, & Tellegen, 1988) t he Life Orientation Test (Scheier & Carver, 1985) or the Mastery Scale (Perlin & Schooler, 1978) RQ 2. What a re t he Similarities a nd Differences i n Definitions of What i t means t o have a Successful Life between the two groups ? The qualitative findings below are summarized for the research question and are emphasized with participant q uotes. Participants have been de identified and renamed for the purpose of analysis and publication. No real names were used in this review. Please see T able 4 4 for a complete list of participant pseu donyms, birth status, age, and race/ethnicity. Meaning of Success The participants meaning of success can be summarized in one of three ideologie s: distance traveled, goals achieved and status achieve d Although, some participants described success as a combination of two or three of the identified ideologies one ideology was usually more salient The prominent ideology was usually highlighted in the of a profile of success and their identified characteristics of successful and u nsuccessful people in the community. Ideology 1 distance traveled : Some participants felt that success was not determined by current achievements (amount of money earned) but it was based on current achievements relative to previous status. Success in thi s this circumstance was comparative to the quality and quantity of the barriers an individual has overcome to obtain specific achievements such as earning a GED or living on their own. Participants also thought that effort was essential to success. Carmell a characterized success as described success as coming through something, and
115 accomplishing what loved ones could not something She explain ed : She has her heart into w hatever she wants to do in life; whether it be going to college, diploma necessary. Ideology 2 goals achieved : Participants w ho subscribed to th is ideology felt that their personal and professional goals Participants thought that success was based on achieving preset individual goals. Lenore, doing what you set out to do ; this Roxie stated, he [mom ] actually did what she wanted to do i n life to describe som e one successful in her life. Some stipulate d that individuals had to possess goals to be successful and that they must be moving forward a step forward and being able to better your Ideolog y 3 Sta tus achieve d : Participants who subscribed to this ideology t hought that someone was successful based on preconceived goals often societ al norms. P articipants described actual or visible accomplishments that measured their personal me aning of success. These included earning a high school d iploma / GED, or college degree, financial stability such as being debt free, not struggling, and having the ability to their pay bills on time, renting or owning assets such as cars and houses, and bei ng self sufficien t by being able to provide for themselves and their family. Essential to each of these ideologi es was independence. Participants universally agreed, to be considered successful an individual must first be independent.
116 Independent in thes e terms meant not relying on others such as parents, family, or friends for necessities such as food, money, shelter, or transportation. Independence was especially important when raising a child and it was considered a prerequisite to adequately supportin g a family. Interviewer : what do you use to measure success? Lakisha : About their independent. Interviewer : independence, tell me more about that? Lakisha : Like if they have to depend on a lot of people to take them places or something like that. Profile of Success I asked each p articipant about specific individuals who they felt were successful. Participants identified individuals who were typically family members including mothers, grandmothers, aunts fathers grandfathers, brothers, fe male and male cousins friends, or famous persons. Family members were listed as successful due to the distance traveled; participants described them as co ming from nothing and gaining an education, independence, financ ial stability, tangible assets such as nice cars and house, and caring for and providing their family Alexandra describes her father has successful due to his willingness to provide for his family. Um, I think that my father is successful. And besides th e whole alcoholic thing, he has always done what he had to do for his kids. Like he will work like two jobs for his children. And he was in the military and he has never gone without working. Parous participants (3/20) listed friends who were also mothers but had achieved a higher level of perceived independence; these friends were identified as being good mother being
117 clo Eve describes multiparous par ticipant Carmella as successful due to some of these reasons. Carmella, the girl has got two babies and still in school. I think she does a wonderful but she puts on this happy, you know, they keep a positive attitude for her 100 percent. Famous perso n s (Oprah and Tyler Perry) were listed as successful due to high levels of accomplishments including monetary assets and altruism as demonstrated by giving back to the community and helping others to reach success Generation al differences in success centered on the perceived roles and achieved level of self sufficiency. Successful f emale adolescents (16, 17 or 18 years old) were expected to be doing well or have completed high school, be planning for or mothers taking care of their children. Successful male adolescents were ex pected to be doing all of the same things and additionally play ing sports if still in school and be ing sure to take care of any children they may have. Ten years later (26, 27, or 28 years old) women were expected to have a degree or two, have a good job, own their house, a good car, be married or engaged, and if they have children be taking care of them. Men of the same age were expected to be doing the same, with the added responsibility of supporting their family, not being on drugs, and not being in pr ison. Characteristics of Successful and Unsuccessful Members in the Community I asked participants to list characteristics of successful and unsuccessful people in their community. Nulliparous participants identified tangible items such as having a high school dipl oma, college degree, good job, house, and a car. Personality traits included being caring, hardworking, understanding, and goal oriented. Independence
118 and having their life on track w ere also considered successful characteristics among nulliparo us participants. Parous participants identified similar characteristics of successful people but included having a family and children as tangible characteristics of success. Parous participants were less likely to list personality characteristics of succe ss and more likely to emphasize the importance of independence (providing for your family, being on your feet, not struggling) essential attributes. See Figure 4 2 for a model depiction of successful community member charact eristics. Characteristics of un successful people in their community also included categories of lack of tangible accomplishments self sufficiency and having negative personality traits Nulliparous participants identified tangible characteristics such as being uneducated, having no mo ney, being alone, and not having a job. Some personality traits included being bitter, uncaring, rude or disrespectful, having no direction and not being goal oriented. Nulliparous participants, also identified being dependent o n others, living on the sy stem, using/dealing drugs, and homelessness as unsuccessful characteristics. Parous participants identified dropping out of school, not working, having no car or money, and being single as tangible descriptions of unsuccessful community members. They ident ified being lazy, unhappy, dishonest, lacking determination drug users, and dependent on others as descript or s. See Figure 4 3 for a model depiction of unsuccessful community member characteristics. Success Rankings Based on the characteristics of succ essful and unsuccessful community members participants were asked to rank themselves on a community ladder. Girls placed t he i r perceived rank currently, where they thought they would be in three years, and where they wanted to be in three years. Rank one was considered the bottom of
119 the ladder or among the unsuccessful people in the community, and rank 10 indicated the top or the most successful people in their community. Nulliparous participants ranked that they were currently at an average of 6.1 (SD=1.6 ) on a 10 point ladder compared to 5.5 (SD=1.7) among parous participants. The difference in means w as not significant. When asked to describe their current location nulliparous and parous defined as currently enrolled or graduated from school, getting good grades or improving their grades, looking for a job, and not doing drugs or alcoho l but that they were still a work in progress. They often identified transportation, money, and among parous participants to help care for their child. Roslyn described perseverance and determination as her main reason s for her perceived current level of success: Evelyn : So how are you on your way? Roslyn : Like I'm doi ng everything to put me on track to be there Like I'm staying in school, I have a plan, you know, I have a future and and I'm not gonna let anybody or anyone get in the way of it. Evelyn : so when you talk about not letting anyone get in the way, what d o you mean by that? Rosly n : Not gonna let boys, you know, just like push me like away like make me like drop outta college or do what they want. I'm not gonna let, you know, people's people's views of being a teenage mom, you know, not like let me be succe ssful. I feel like I can prove 'em wrong, you know, I can be a successful teenage mom. She described people around her who expect ed her to fail because she is an adolescent mother and her persistence Evelyn : When you talk about peo ple's views about teen motherhood, who are you talking about? Roslyn : expect myself to fail. I feel I can do it. You know. I just want to prove them wrong like, n o peopl
120 to laugh at them in their face you know. They just have their view, they B oth nulliparous and parous participants ranked that they thought they would be 2 t o 2.5 points higher in three years ( nulliparous = 8.0, parous 8.1). There was no significant difference between the two groups on where they wanted to be in three years, 9.5 (SD=.94) among nulliparous and 9.4 (SD= .73) among parous participants. When asked to describe the top of the success community ladder nulliparous and parous participants described environments included be ing enrolled in or finishing college, being independent, not wanting for anything, being wiser, more focused, and having accomplished their career goals. Facilitate Success From there, participants were asked to rank several specific accomplishments on h ow they would assist them i n getting to the top of the success ladder the fastest. The accomplishments ranked first (most helpful) to tenth (least helpful) Participant rankings were : 1) g raduate from high school (m=1.4) ; 2) g o to college ( m= 2.70) ; 3) g et a job ( m= 2.77) ; 4) h ave lots of money (m=4.93) ; 5) o wn something costly (car or house m=5.47 ) ; 6) g et m arried (5.80) ; 7) g o out more (6.80) ; 8) h ave a/another baby (m=7.40) ; and 9) o ther. Other was an open ended card that allowed participants to list a n accomplishment that was not included in the list. Most p articipants (18/30) did not specify an additional item. For those who added to the list being happy, working in a salon, having another baby, having grandkids and retir ement were added accomplishments. There were no significa nt differences in the rankings between the two groups except for accomplishment getting married. Nulliparous
121 participants ranked getting married significantly higher (5.1 ) than parous ( 6. 3 ) (t = 2. 3, df= 28, p =.03 ). See Table 4 4 for each accomplishment ranking and t t est results. Graduating from high school was listed first most frequently for both nulliparous and parous participants. The i dentified reason for bei ng the most important to facilitate success w as that it w as a means to an end. Graduating from high school was seen as necessary to go to college, which would then lead to a good job and more money. Some stated that it was essential to graduate or get a GE D Having a/another baby was listed as last (least helpful) for both nulliparous and parous participants. Nulliparous participants stated that having a baby would slow o r derail plans. Both nulliparous , and have everything in place before they had their first or another child. Some referred to it was important for th happiness that they were settled before bringing a baby into the world. Diana an 18 year because I want to have everything situated before I bring ano when asked why she identified having another baby as the least helpful to reaching the top of the ladder. Lauretta (primiparous, 17 years old) explained why having another I alread set I just gonna complicat e things even more. Following the finalization of their accomplishment rankings participants were asked how they made their final decision. Strategies for deciding what order to list the
122 accomplishments included thinking about what applied to the particip ant, picking a starting point (starting from the top or bottom), thinking about their goals and using their preset goals to guide them. RQ 3. What are the similarities and differences in definitions of personal and professional goal aspirations between t he t wo groups? One of the primary goals of this research project was to understand and investigate potential differences in personal and professional goal aspirations among nulliparous primiparous and multiparous adolescents. Participants were asked about their goals for their personal and professional future s as well as any adjustments in their goals. In this next section, I summarize the findings related to personal and professional aspirations of nulliparous and parous participants. Personal Aspiration s Parous participants described a personal future that included being engaged or married in 10 years and having additional children. Participants typically described being married to the father of their child or current boyfriend. One third of parous parti cipants (6/18) dreamed of being married in the near future (ages 18 and 19). These participants described being married to the father of their child or current boyfriend. Some r eported currently being engaged or promised. Tia described being engaged to her significant other (not the father of her children) for three years but ha ving limited contact with him s who were no longer in a relationship with the father of their child hoped to marry their current partner, and others dreamed of marring the father of their child. Diana who was
123 currently dating her high school sweetheart (not the father of her child), d escribed her partner as special due to his promise: But I guess what really makes him that special person is, when he found out I was feel safe with him, yeah. Diana has plans to be married by the age of 23. Claire who was not currently in a relationship with the father of her child still hoped th ey would be married by age 24. I like, he gonna look good. know Eve wants to have three kids and hopes f or a f uture with her boyfriend who is father of her child, but was unable to describe concrete personal aspirations due to unknown factors. When asked about additional children in 10 years she replie d It She explain ed Some parous participants (ages 28 35) ; they described being mar finished school, ha ving a good job and ha ving an apartment or house of their own. Although some participants characterized children after getting married, most did not stipulate getting married before having additional kids. The girls imagined additional children within the next 10 years (ages 26, 27 and 28), and typically described being finished with child ren by age 30 34. They wanted an average of 3 4 children total, and hoped for the next child after they were financially stable. L iza, narrated, After this one. Well, later on in life. Not right now, but yeah, I want a little boy. And then, I wanna put her [daughter] in like things like whatever interests her and you know like go out on trips with my family
124 Nulliparous participants also desired to be being engaged or married in 10 years. Those who within the next 10 years. Jerri was in a committed relationship, and although she thought she might get married sh Like, it to me, marriage my parents [were] married for 40 years. They stuck together. My grandparents on my life, and some. One participant had no desire to get married or have children T hree others also admitted to not wanting children, but stated they may reconsider when they were married. Those who strived to get married (11/12) in the future aimed to do so in the ir mid 28), specifically after they completed college, had a c areer and were settled described as being independent, ha ving a house or apartment, and being financially st able. Nulliparous participants who wanted children (8/12) wanted an average of 2 3 children but not until after they were settled but not necessaril y before they were married. Participants aimed to be done having children by the age of 28 30. Jennie was currently single and characterized her future husba nd as she planned for two children after she was married, but did not h ave a concrete time plan or either marriage for children. Professional Aspirations In addition to personal aspirations, I asked participants about their career plans er.
125 I probed participants on why they selected that career, if their career goal s had changed and if so, why it changed, and if their career plan was moving along as planned. Participants aspired to be in fields related to health, cosmetology, childcare, or other careers. Health Care Field : Careers in the health care field covered a wide range of technical and professional degrees. Fifteen participants (48%) listed career goals in the health fiel d. Health care related choices were nursing assistant, nursing, paramedic, psychology or counseling, and physician. Reasons for wanting to pursue a career in health care were their personal or famil positive or negative personal experiences, having a mo ther, sister or aunts in the health care field, being able to help others, possessing personality traits compatible with health care and the desire to work with children (pediatrician) Four parous adolescents and two nulliparous adolescents aspired to b e nurses. The main reasons for wanting to become a nurse were to help others, because of having a family member in the medical field, and personal experience, such as the Two nulliparous part icip ants desired to be doctors, specifically a pediatrician, OB/GYN, or general practitioner R easons included, wanting to working with children and pregnant women, wanting to provide patients and famil ies encouragement, and personal experience. Lilia stated p ersonal experience as her main reason for wanting to become a general practitioner But I really decided to stick with it after my mom died because she got the run around at I d
126 even emotionally Other health related fields, included nursing assistant, paramedic, psychology or couns eling and overall health field. One 18 year old white primiparous adolescent aspired to be a nursing assistant due to her positive experience while giving birth. A 16 year old nulliparous African American participant as pired to be a paramedic because she w anted to learn how to take care of people. Two participants one nulliparous and one primiparous desired to be a counselor due to positive and negative personal experiences with counseling. Lenore, a primiparous adolescent who was not parenting I had to have a lot of counseling and I just feel really failed, so I wanna be a The plan to work in the health field differed slightly for physicians th a n the other medical professionals. The part icipants plan s to become a doctor included getting good grades, graduating from high school, going straight to college, getting good grades in college, and applying to medical school. Participants plan s to become a nurse included getting good grades, gra duating from high school, enrolling in the local community college for a n AA degree and pursing a higher nursing degree after community college. Some participants stated they were on track for their career goal described as currently making good grades, p articipating in the ir high school health program, and being dua l l y enrolled at the local community college, while others felt they were not on track described as needing to be more studious or not participating in the high school hea lth program Cosmetol ogy : Six out of 3 0 participants ( 20 %) described cosmetology related career goals. Of these, five (83%) were primiparous adolescents. Reasons for wanting
127 to purse a degree or career in cosmetology were the opportunity for cr eativity, being self taught and/ o r the potential for independence in the field characterized as being your own boss and owning your own salon and personal learning style (hands on). Some participants described the ability to do for others such as making someone pretty or doing for someone who cannot do for themselves as a reason for choosing cosmetology. Amie stated I hate seeing someone just like down and everything. Like they have the stuff to look pretty, the y know how to do it. For t he majority of participants the cosmetology career plan was not new. The m ajority of the girls described a long time interest in doing hair or nails. Eve said she first made the decision when she was six; Amie describe d an interest at eight years old, whil e playing with her own hair. When probed about their plan to work in cosmetology, the majority of these participants stated they were on track and that their pla n was going the way they wanted well my best friend, I do her hair for her sometimes ing the way she wanted it to. Child Care or Child Development : Three participants all of wh om were mothers one participant had two children described a fut ure in childcare development or day care. Reasons for wanting to work in child development were personal experience experience babysitting, or family members who work in childcare and interest time child care described as quick and easy degree, good mon ey
128 independence characterized as being your own boss, owning own daycare) and benefit to own child or children. A personal interest in working with children and a personal and or family history of working with children was the number one reason for sel ecting childcare or child development. Participants described having mothers or aunts who worked in or owned a childcare service. Participants also expressed the benefit of being able to be home with their child or children and the benefit of the interacti on for their children; April When asked about their plan to pursue a career in childcare or child development, participants stipulated that they were on track. This typically mea nt that they had researched and or enrolled in child development courses at their local high school and had researched potential college programs in their area. Another sign of being on track w as their previous experience in childcare such as babysitting for family or friends in their earlier years. Other : Those participants who did not want to be in the health care field or cosmetology described a range of other career choices. Eleven participants (36%) discussed choices such as police officer, lawyer s ocial work er veterinary tech nologist real estate agent, graphic design er Army soldier and homemak er Two primiparous and one nulliparous adolescents aspired to work in criminal justice and social work for reasons such as solving a mystery, helping oth ers, and personal experience as a victim of rape. Participants described their plan as graduating high school or getting a GED, enrolling in community college, go ing to university and
129 on track because they w ere currently in school and had researched the requirements for careers in criminal justice. One nulliparous adolescent aspired to work as a veterinary tech nician due to her personal love fo r animals and the flexibility to work in a wide range of avenues. Another aspired to work in graphic design due to the flexibility and creativity associated with the position. Kathleen aspired to work as a chef for some of the same reasons, creativity, and the diff erent choices in foods. Noreen listed job and paycheck g uarantee s as her main reasons for selecting the Army as her future employer. Changes in Goal Aspiration : Almost all interview participants (N = 24 or 80%) were able to articulate whether their career goals had changed. Seven parous and three nulliparous p articipants attested to no change in their career goals for the future. Nine parous adolescents and five never pregnant adolescents described some change in career aspirations Reasons for adjustments in career aspirations were personal interest adjustment s I changed my mind as I got older less time in school/ training job placement concerns and money. Diana (primiparous) stated she used to want to be a traveling RN ; however due to time and money spent on college, she t hought cosmetology was a better c hoice since becoming a mother Carmella (multiparous) described a change from pediatrician to child development them behind just to go to college, and all that kind of stuff. I just wanna have something aking good money. described a similar decision path Well, I wanted to be a pediatrician, but they you gotta they say you gotta be in college for like four years for that. So I want to be like a well, I I could like d aycare or something watch kids Tia, a 17 year old, mother of three, described switching career choices from social work to day care to elementary school teacher due to time and money concerns.
130 As soon as I got a kid mine changed. I wanted to be a social worker but you have to go to good in that field. I was gonna do daycare worker, but all you get is minimum wage on that, so then I moved it to an elementary teacher so I can get benefits with it. Michelle described switching from psychology to the health care field due to job placement concerns: As I grew up I learned more and more about how many people have like gone to like big name universities and majored in psychology and those people are like out here lookin' I'm gonna do somethin' that will help me get a job RQ 4. How d o Adolescent Girls (Ages 16 19) w ho have Never Been Pregnant Perceive Pregnant o r Parenting Peers? What a re t heir Views o n Adolescent Pregnancy/Motherhood in the Media? Several cas ual and explanatory factors were explored as related to adolescent pregnancy, th ese included participation in risky versus safe se xual behavior, perceived sexual activity of peers, exposure and quality of informal and formal sex education, and beliefs asso ciated with preventing sexually transmitted diseases and pregnancy. In this section, I provide the themes associated with each of these factors. Sexually Active Peers Both nulliparous and parous participants noted friends or acquaintances who were sexual ly active. The majority of participants felt it was their [friends ] business, and the ir responsibility to ensure they were being safe by using condoms and birth control Lil i a a 17 year old nulliparous participant recalled this about a pregnant classmat e, about it, but she made that choice. She was upset that other people knew about it. difference towards their friend s
131 Participants were able to recall various degrees of formal and informal sex education. Formal sex education included sex education a t school from school personnel such as teachers or nurses and at home from parents or guardians. Informal sex education included lessons from peers such as friends, cousins, and siblings, media, and prior experiences of abuse 7 The described content of both formal and informal types of sex education is presented below. Formal Sex Education: The most common type of formal sex education was specific class grade and as being a mome ntous learning event in that year. Both nulliparous and multiparous adolescents a ssociated the talk with a discussion on puberty (girls get their period) and protection (if you have sex use condoms). The ng around the 5 th (50%) or 6 th (16%) grade, with a few recollecting their first introduction to sex education was as late as 8 th grade. S ome participants were unable to recall participating in sex education at school; these participants were typically resi ding in foster care and they reported not attending school regularly. When asked about sex education at school Rae, a 17 year old who was 6 months pregnant and had a 1 year Not really, cuz I my first time like actually going to scho on [the] run a Continuing sex edu cation at school was recalled infrequently. Those who stated receiving follow up education as they aged described it as occurring in distinct settings 7 Participants speculated that all incidences of abuse were reported to the authorities.
132 includin g science or health class, with varying degrees of coverage. Some participants meaning pregnancy and STD prevention, abstinence, condom use, and HIV/AIDS. Others recalled only discussing STD prevention or the science behind pregnancy and childbirth. Formal sex education at home occurred less frequently than at school and varied widely in detail. Nulliparous and parous adolescents described formal home sex initiation of puberty. Some girls d escribed being told everything including sex, STDs, pregnancy and birth control, others de scribed being told very little such as information about female anatomy and the menstrual cycle A few girls recalled the offer of birth control when they became sexually active to avoid pregnancy, contingent that they spoke with their mother upon sexual initiation. Claire explained that her mother put her on birth control when she was in 8 th grade to be safe. H owever, she was confus the time. Michelle, a nulliparous 16 year reaction, when her mother put her on birth control in the 9 th grade because mother discovered she was sexually active Michelle w as grateful to be rid of her period a welcomed side effect of birth control. One participant recall ed talk with her mother. Roxie a parous 16 year old explained that her mother planned to discuss sex with her at age 16; she b ecame pregnant with her son at age 15. Informal Sex Education : Informal sex education occurred in various settings and had varying degrees of accuracy. Both parous and nulliparous participants recalled being first introduced to sex by various forms of med ia. Some girls spoke of Lifetime movies they were forbidden to watch ; others described secretly watching pornography
133 with friends, sisters, and cousins. I asked Allie when she first learned about sex which she attributed to Lifetime about it cuz I watched so much Lifetime. I grew up on Lifetime My mom was a Lifetime freak, so I always really knew what it was. Five parous adolescents (four of w hom were in foster care) recalled their first introduction t o sex was in the form of sexual abuse between the ages of 4 8 years old. These participants described being confused and being unable to remember the details. Participants also recalled not receiving any formal sex education at home, and recalled inconsist ent sex education at school typically due to attendance. Other forms of informal sex education included information from peers, such as siblings and friends. Peers were rarely cited as their first introduction, but instead served as a secondary avenue fo r information. Participants described their friends as providing tale bearing information instead of educational. Lakisha, who plans on waiting to marriage to have sex, described talking about sex with her sexually active friends as awkward. Best Perceive d ways of Preventing Pregnancy and Sexually Transmitted Disease s (STDs) Participants were asked about the best way to prevent sexually transmitted diseases (STDs) and pregnancy. Almost 60% of nulliparous participants listed abstinence as the best way to pr event STDs and approximately 30% listed condoms as best. Other mechanisms such as getting tested, being faithful in the relationship and being with a pa rtner you can trust, were listed as the second best way s to prevent STDs by 33% of participants. Approx imately 41% of nulliparous participants listed condom use and 41% listed birth control as the best ways to prevent pregnancy. Abstinence was listed as a close second by 30% of participants.
134 Almost 65% of parous participants listed abstinence as the best w ay to prevent STDs and 35% listed condom use as the best way. Although, Allie stipulated abstinence as the best way to prevent sexually transmitted disease she follows up with a detailed contingency plan. nship where you are doing it you need to keep up with your partner, like you need not to do it with anybody else You need to know that he is committed with you 100 percent, you know Get him tested, get you tested every few months, like so on and so on. Forty seven percent of parous participants listed condom use as the second or third best way to prevent STDs. Other mechanisms such as being tested regularly, restricting your number of sexual partners, and trust were listed as the second or third best way to prevent STDs by 29% of parous participants. Forty one percent of parous participants listed abstinence as the best way to prevent pregnancy and 41% listed condom use as the best way to prevent pregnancy. Birth control was listed as the second or third best way to prevent pregnancy by 41% of participants ; 41% listed abstinence and 24% listed protection through condom use. Actual Pregnancy Prevention : Participants reported a range of current birth control methods to prevent pregnancy. Depo Provera (Depo) and birth control pills (the pill) were reported most often. Among nulliparous participants, 54% were virgins at the time of the interview and were using sexual abstinence as a way to prevent pregnancy. Despite claims to be preventing pregnancy, some nul liparous and parous adolescents were not taking active prevention measures, while others were behaving inconsistently. Three nulliparous participants (23%) reported us ing some form of birth control such as birth con trol pills, Depo, and the patch to preven t pregnancy and three reported not doing anythin g to prevent pregnancy. Jerri a nulliparous adolescent Yeah
135 when asked if she was currently trying to prevent pregnancy However, she rescinded her response when asked about her specific preven W ell, I guess, Jerri also admitted to several episodes of unprotected sex. Twenty nine percent of parous participants reported Depo as their method to prevent pregnancy. Four participants (23%) reported not using any method or recently stopping their previous form of birth control. Two participants reported using birth control pills ; the use of the NuvaRing, condoms, or Implanon w ere reported by one participant each. One parous participant reported using sexual abstinence to prevent pregnancy. ing what, but birth control, where infertility happens, or it messes with the hormones, or prevent having kids for a year, and then wind up never being able to have kids again. That just terrified me. Tia attributed all three of her pregnancies to sexual coercion or rape and therefore if she had not trusted the perpetrators in these situations she would no t have become pregnant. Similarly to Tia, other participants had strong feelings and beliefs related to various forms of birth control. Due to these beliefs, adolescents often described upcoming plans to switch birth control. The birth control pill was d escribed as difficult to use due to the responsibility placed on the user. Failure o f the birth control pill was often related to the strict requirement to take them daily and at the same time each day
136 Although easier to use because it is only received e very three months, Depo was often associated with negative side effects. Those using and not using Depo described the long acting birth control shot as making them fat or blown up. Roslyn, a 17 year old mother of one, stated she stopped taking the pill bec ause her boyfriend was in jail and it her boyfriend is released from jail Depo was sometimes associated with negative emotional responses. Noreen an 18 year old mother of one currently using the NuvaRing described being scared of Depo because of a medical history of depression and the potential for psychological side effects. Despite non use among the participants, many reported substantial side effects believed to be as sociated with the IUD. Diana, an 18 year old mother of one, who was currently using Depo but hoping to switch to Implanon, described a horror story Because, um, I had a family member die because she, well, she never went and got it checked. She got pregnant with one inside Others related information passed on by health care providers. Roxie, a 16 year old mother of one currently using low estrogen birth control rec alled asking her doctor about the IUD: Roxie also reported her insurance company dictat ed which method of birth Nulliparous percep tions of adolescent m otherhood : To further investigate the explanatory models of nulliparous adolescen t females associated with primiparous and multiparous peers nulliparous participants were asked to identify some reasons why
137 girls have a baby in high school. The context of sex was identified as the number one wanting to have sex, having sex for love, getting drunk and having sex, being forced to have sex, and not using protection due to lack of planning such not planning protection, or planning to hav e sex. Baby identified reasons were thinking it is cute to have a baby and wanting someone to love. Miscellaneous reasons for having a baby in high sch ool included needing a way out of their current situation and wanting a fast track to independence ; pregnancy was viewed as an e xcuse to drop out of school and get a job. In addition to these identified reasons for having a baby early, nulliparous participants thought it was hard, difficult, or a struggle to be a mother while still in school. Participants though t it would be harder to graduate, balance school and a child, and have to worry about baby related costs for diapers, formula, and medical bills Participants also thought it would be harder to attend college, achieve their goals, and get a job due to childcare and transportation constraints. Some identified positive outcomes associated with having a child while in high school include d love, increased motivation to better themselves, faster maturation and learning responsibility Perceived personal, romantic, and career adjustments are discussed further below Personal and Romantic Adjustments: Nulliparous participants described having to mature faster due to pr not being a teenager anymore not thinking about yourself and not being able to socialize such as party, shop, and hang out with friends as frequently as before. They stated the need to worry about everything including grades, bills, children, and the future due to having a child early.
138 Romantic adjustments due to pregnancy included the inability to date (time, s chool, childcare complications), and complications in finding a boyfriend/partner. Participants described it as being harder to find someone because of the unwanted responsibility of a child. Zelma described adolescent boys as no t wanting add ed responsibil ity , my friend Zelma attributes these changes to getting what he wanted sex Education Adjustments: Participant s typically described negative adjustments in education associated with being a teen mother. Expected adjus tments included delaying plans such as high school completion and college enrollment, changing goals such as having to get a GED instead o f a diploma or getting a faster degree financial planning such as needing a job and having to find and pay for daycare and psychosocial changes such being stressed and thinking about now instead of the future. Career Adjustments: Nulliparous participants thought t hat being a teen parent may have positive, negative or neutral effect s on career plans. A positive eff ect described is determination such as striv ing to get a job/career quicker and to work harder on the job. Negative effects listed were difficulty gettin g a job due to employers who may not want someone who is pregnant/has a young child, difficulty getting promoted due to being perceived as irresponsible because they are a teen parent, the need for pre planning including having to find a babysitter, and ad ded financial
139 responsibilities due to daycare and transportation expenses Neutral adjustments listed were the type and location of a job ; participants felt that teen mothers would need to work closer to home, and would prefer a career working with childre n. Media Participants were asked their opinions on two popular MTV shows that portray What are Effect of 16 and Pregnant and Teen Mom on Teen Pregnancy Nulliparous adolescents were more likely to believe that the two MTV shows portrayed the reality associated with teen pregnancy and motherhood. Jennie stated that she believed the show was successful in decreasing rates of teen pregnancy : I mean teens like not to get pregnant like what they could be going through. And I was watching it and the statistics from teen pregnancy has gone down since the show aired. And t think the show is like really successful Julianne expressed similar beliefs although she stated that she thought some teens may get pregnant to get on the show. Some participants felt the show might negatively i nfluence teen pregnancy. Erica t hought that both shows glorify teen pregnancy. we of their own. Selena a 17 year old primiparous participant teen pregnancy. Well, because you were seeing all these girls with their cute bellie s and
140 Media and Reality Parous adolescents were more likely to believe both 16 & Pregnant and Teen Mom distorted reality (10/13 or 77%), compared to nulliparous adolescents (7/12 or 58%). Parous ado lescents thought the show made teen pregnancy and motherhood in the world T hey s how the babies waking up crying; my baby is different she wakes up l aughing. Carmella an 18 year old mother of two stated : ort system from, like, your mom or your Nulliparous Adolescents were more likely to feel that the show provided an adequate descr iption of teen motherhood or that it downplayed the hardships associated with teen motherhood. Margery specified : I think it shows them in a better light, because, you know, they actually have stuff with t of them still have ave anybody to turn to. Zelma stated she thought the show was adequate because it was very similar to what a primiparou s friend experienced. Lil i a a 17 year old, nulliparous adolescent stated that the show tells teens what When parents, all my family, thi s is what happens when you decide to have sex, and then you have a baby. Other Media In all, approximately 50% of participants (14/27) could not recall other types of TV shows, movies, or other media that discuss teen pregnancy and motherhood. The
141 main typ es of other media that discussed teen motherhood were various Lifetime movies (16 and P regnant Pregnancy Pact ), TV shows on ABC F amily (The Secret Life of the American Teenager) and reality shows such as Pregnancy High Participants thought that o ther media types did a better job of portraying the various realities of adolescent motherhood, but specified they were Hollywood. These realities included abortion, adoption, mother or family raising the child and the teen being disowned by family. RQ 5 How do Primiparous Adolescent Girls (Ages 16 19) describe the Context Surrounding Initial Birth? The fifth research question was intended to explore the context surrounding birth among primiparous adolescents. Participants were asked about the discovery of their pregnancy, the duration of the pregnancy, the birth, and motherhood. Discovery Participants described a range of emotions when they first discovered they were pregnant. Fear, happiness, anxiousness, confusion, and distress were some of the emotio ns described at the discovery of pregnancy. Alexandra, a 17 year old White female describe d being happy and anxious to meet her child. Alexandra was the only participant who noted planning her pregnancy with her fianc. Six out of 18 interview participant pregnancy ; this feeling was sometimes linked to biological symptoms such as a missed period or nausea. Despite intuition, these same participants reported confusion, devastation, and f ear at pregnancy confirmation. Confusion was linked to the pregnancy decision making many girls described going through -abortion, adoption, or keepin g the baby. Although seven out eighteen girls specifically mention ed contemplating an
142 abortion, participa nts decided not to abort due to personal and family beliefs against abortion. Some girls describe d family members mostly mothers or fathers and the d mothers as being strongly against abortion. Amie, a 17 year old Hispanic mother of one described her state of mind after her first pregnancy insistence know. So af ter that we just went to the abortion clinic, and she paid like $400 just for it. And, um, I woke up, like three hours later, after my bleeding and you still have them like crazy. I feel like crap, and I just cried for like I cried for like a whole year. Just cried, cried, cried, cried. Evelyn : who did you tell f irst when you found out you were pregnant? Amie people to judge me. How can you have a baby right now and not have a Although, adoption was considered a better choice than abortion mothers typically opted against adop tion due to the predicted attachment formed with their child the child. Alexandra expressed her views on adoption and abortion when talking about the shows 16 & Pr egnant and Teen Mom P regnant ] is that they put a lot of moms on there that put their babies up for adoption. [I] bad because that happens but I could never. Abortion. Adoption No. I laid down and I had that baby. I made that, step up and be a mom Participants described feeling afraid and apprehensive to tell their family or
143 mother (9/20), father (2/20), or grandmother (1/20). One participant noted being fearful an 18 year old primiparous adolescent, who was not parenting, explained that although her boyfriend was mad, he r. but not at me. The majority of participants note d similar reactions from mot hers, fathers boyfriends, and friends to their pregnancy. Mothers were described as being upset or disappointed a t the initial news of pregnancy followed by acceptance during pregnancy excitement/happiness at delivery and bliss/enjoyment at the present day Some participants noted that their mother was not really mad disappointed that they got pregnant. Speculated reasons for their that it was du e to the context of conception such as lack of protection use, family histo ry of teen pregnancy, and the young age of participant Diana, an 18 year old mother of one stated her mom was disappointed because she repeated the cycle of adolescent M y because s as firmer Like Diana fathers were typically described as having a stronger reaction to the news of their pregnancy Participants noted their father was angry/mad at the initial news of pregnancy ; however most fathers resolved to being acc epting or happy at present da y. Diana noted that although her father seem ed better since she delivered he
144 still seemed to hold a grudge due to her status as a mother; she attribute d his feeling due to the family cycle of premature childbearing in the family. And he made me carry the baby, the bags, and everything in the house by myself. And when I stopped on the front porch. He was like. You know why I make you something you are supposed to be punished fo r. Yea I made the mistake I ? then a year later, 17 years old she had him and then, it just continued because she had 5 kids before she was I say when I was born she was T he current relationship status with the father of their children was variable described as committed, off an d on, or no relationship M others who attributed their pregnancy to a true accident, s father at conception described his feelings as initially shocked or angered followed closely by happy. The partners were described as being happy or pleased with the prospect of fatherhood. Participants also noted these dads/partne rs left the pregnancy decision of ab ortion, adopt ion, or to keep the child to the teen but promised to support them r egardless of t heir choice. Three participants, all in foster care noted they were unsure of the father of their child identity due to sexual promiscuity or being victims of abuse 8 during conception. Three mothers had broken up with the father of their chil d since conception. All three described a strained personal relationship with their previous partner and a non existent relati onship between their child and his/her father. Two of the three girls attribute d the relationship strain due to the repe at pregnancy with an outside female. Roslyn a 17 year old white mother of one who was 8 Reported to the authorities prior to study enrollment.
145 living in Foster Care despite being engaged to a different man described being confused at the situation with the father of her child. He didn't know [about delivery] f or weeks 'cause he like didn't have no way to contact me. So once I told him, like once he called me up and like heard the baby crying, he was like, "Who is that?" and I was like, "Your son," and he was ust everything went to hell. Evelyn : So when did he fall out of your life? Roslyn : When he met the other chick and got her pregnant. Evelyn : H ow far along is she ? Do you know? Roslyn : She's almost six months. Like what I found out is like I thought it was just him denying the baby, but his other like his other girlfriend, she was like, me. Roslyn then describe d her frustration with her ex partner and her anger for her son over the neglectful way her child is treated. It was hard because my baby's father lives up there and everything, which me and my baby's father, he got another female pregnant with twins, and his reason, he told me he don't want nothing to do with [son]. He s till denies [son] is his after our DNA test, and it makes me like it hurts my heart because I believe my son does like deserve to know his father, but it's just hard for me. Like I can't accept it, like there's so many times I find myself like cussing him out and getting mad 'cause I feel anger for my son. Birth The participants described the birth of their child in varying context s exciting, amazing, scary, fast, and dramatic. Some participants stated their labor was induced through breaking of their wat er, and / or Pitocin while others stated they went into labor naturally. Some participants recall ed being in labor, from initia l contractions through delivery for a short period of time (5 hours) while others were in labor for an extended period of time (20 plus hours). All of the participants had a vaginal birth. The majority of
146 participants (16/20) had varying forms of pain control such as an epidural and/or IV drugs during delivery. Four participants describe d drug/ epidural f ree birth s due to personal bel iefs fears or family tradition. Noreen opted against IV drugs because she she opted against an epidural due to horror stories associated with the procedure. that me. Mothers aunts, co usins, boy friends, and sometimes friends accompanied the adolescent throughout delivery. Some participants described their delivery as nice or amazing; others described it as scary, in tense or painful. Participants who described it as nice or amazing asso ciated t he delivery as being pain free, due to an epidural and fast Those who described their delivery as scary, intense, or painful often did not get an epidural ; two participants also described experiencing panic attacks during delivery. All participants noted a feeling of awe and happiness when meeting their child for the first time, described as an instant connection, love and enjoyment. Motherhood Overall changes to life since motherhood wer e adjustments to free time, not going out as much the need for pre planning, having to secur e a baby sitter and changes in priorities such as thinking of t heir child more than themselves The aspects of motherhood participants found to be easy includ ed l oving their child, being with their child, playing with, feeding, and changing their child. Some felt it was easy due to motherly attachment and instinct, Diana stated she felt it came naturally ; once she had
147 a baby it just clicked. Others felt it was easy because of their child temperament and described having a good baby who does not cry. Aspects that participants found hard or difficult about motherhood included their their ess, and finances Eve a 16 year [financially] for my baby which is sad ear infections, dia rrhea, a nd unexplained sickness and discomfort due to crying and helplessness at not being able to fix i t Others found that general and unexplained tears were difficult also due to helplessness. Despite difficult aspects of motherhood, most (19/20) chose to keep their baby and some specifically noted that it was not hard as hard motherhood was fairly easy. Claire stated that motherhood eased her loneliness and gave her someone to raise and and success depended heavily on support S he also thought having a child at age 13 or 14 was a lot worse. only do you have to depend on your parents, but your parents have to that just bothers me. Lenore, who made similar statements about the ease associated with loving her son, found the other aspects of mothe rhood so difficult she relinquished custody to her mother. Lenore you know, a bounci
148 hard. Following general feelings about motherhood, each participant was asked about personal, romantic, educational, and career adjustments due to becoming a mother. Participant responses are detailed below. Personal and Romantic Adjustments: Both primiparous and multiparous participants reported wide degrees of adjustment when they became a mother. Participants were asked about g eneral, personal, educational, career, and romantic changes since becoming a mother. Responses ranged from nothing changing through drastic changes. Personal changes were usually isolated to the amount and type of socializing before and after birth. Partic out as much as before. Others noted the need for pre planning, such as day care and transportation arrangements as opposed to just getting up and going. Some participants described the need to screen persona l connections and limit the type and amount of people around their children. Selena, a 17 year I I have to be more cautious about w discussing changes to her personal and romantic plans since becoming a mother and they descri bed the need for marriage and a father figure for their child. Education Adjustments : Educational changes were either noted as no change, a positive change or a negative change. Eight parous participants noted an increase in self motivation, determination and will since becoming a mother. The girls described
149 the need to be able to provide, monetarily, thus re quiring they do well and finish high school. Rae, who was 6 months mmy Actually makes me want to get my degree. So they can go to first and second pregnancy, Rae was on the run from foster care, and she acknowledged that she was not attending school. Alexandra who dropped out of high school prior to getting pregnant described renewed education motivation due to motherhood. Now a days you have to have an education to get somewhere, to have a job. want my son to look up t o me and to be like hey my mom is not a failure she has a degree she may not have had it while she was young but she did it for me. I just want my son to have someone to look up to. I want him to be able to look up to his parents and say hey, they did the best that they could for me. They did what they had to do for me. Negative educational changes associated with pregnancy were typically attributed to an adjustment or delay in educational plans/ goals. Girls described not being able to complete school havi ng t o get their GED instead of a high school diploma delaying enroll ment in college, and a subsequent delay in their timeline for completion of their high school or college education Four participants noted no change in education and described plans to c ontinue as necessary to go to school get a diploma, regardless of being a mother.
150 RQ 6. How d o Multiparous Adolescent Girls (Ages 16 19) Describe the Context Surrounding Subsequent Births? One of my primary research goals was to explore the differences between primiparous and multiparous adolescents. Unfortunately, I was unable to recruit more than three multiparous adolescents. Each story is unique and provides different contextual clues to the situation surrounding the i r first and subsequent pregnancie s. Although parts of their stories are included in the analysis of parous participants, in this next section I will introduce each participant and provide insight into he r stor y Carmella is a bright 18 year old Bl ack girl who lives with her mother, younger brother, and two children ages 1 and 3 months. Carmella is a senior in high school and child at age 24 and father at age 20 Carmella has both female and male cousins who were teen parents. Carmella was raised in a religious environment, attending church the father of her children who is a twin, who attends a private C atholic school and is a short time span, she reported being optimistic about her professional and personal future and somewhat realistic about her romantic future. First Pregnancy : Carmella discovered her first pregnancy due to a missed period. Although she stated she was scared, she recollected the discovery with nonchalance and humor. But, um, okay when I found out I was pregnant with [eldest] I never missed my period, like, ever, ever missed my period. Always came on the same time, so I always knew. And then when I missed my period for a whole month, and I
151 like that. And then, I got a home test. I took two, they were both positive. Carmella admits to not using any protection when she conceived her first child and as such she Carmella characterize d her mother as being both practical and supportive during this time ; her mother took her to get the pregnancy reaction was somewhat surprising. She w pregnant, we gonna do what we keep going on in life. sed by the unplanned pregnancy -they knew she was sexually active -and were very supportive throughout and after her delivery. y a t her delivery and has been supportive since. Second Pregnancy: both she, her mother, and boyfriend reacted di fferently to the news compared to her first pregnancy. T what ? I better go get on something that I kno take a pregnancy test Depo, so I was like Oh. Now that, it ei only in high school, was just lik It made me cry.
152 initially kicked her out of the house at the news of the second pregnancy. o t you However, after some cooling off, her mother calmed down, and talked with Carmella t Now this is when the fact came in, are you gonna keep it, are you gonna get rid of it, what are we gonna do And, um, I mean we just ll, you know, whatever you decide to do, Carmella recollects her decision (an abortion) as one she was unable to go through with although, her boyfriend/father of her children preferred it. She wa s frustrated with the limited financial support she was able to get for necessities such as diapers, contrary to the speed for which he was able to obtain the funds necessary for an abortion. hen I just had my first child, and I can call him and ask him for $20 so I can get some diapers, was li And I was like, um, it crossed my mind getting an abortion, like, man, ow what it could grow up got one. Motherhood : Carmela characterized motherhood as fun, a compr omise, and hard. Carmella t hought that going out with her sons was fun, and somethin g she anticipated Prior to motherhood she recalled fun times at the movies or a party ; as a
153 mother she has fun by taking her sons to the park and the library. She described a compromise associated with motherhood. I mean, you might not be able to go out e very weekend, like, to the movies, or to a party, or something like that, but having a kid, you make the best out of that You go to the park You find other things that can make you happy, um, just have fun. Although Carmella described fun times as a mo ther, when asked what was easy she an adolescent mother. Evelyn: what are some of the easiest things about being a mom? Carmella : There is not really anything eas y. Evelyn : Okay. Carmella : a teen parent. Everything is hard. You have no job, so you have no one of my kids, my mom is. So I mean, and that puts a toll on you how am I gonna take care of two kids? But nothing is easy. Carmella then articulate d the complexities of gaining her in dependence while being an adolescent mother. Evelyn: what are some of the hardest things about being a mom? C armella : the process I wanna get my own place, and it goes by y our income. I have no income, but if I put that my mom gives me $50 a month, somewhere else, where she gonna be payin g there, too? So I mean, ugh, Despite the current hardships associated with teen motherhood, Carmella illustrates resilience associated with her educational and personal plans. She even attributes motherhood to improving her romantic future.
154 Evelyn : And what about your romantic plans? Carmella : nowhere he can go, so yeah [Chuckle] Carmella conclude d the interview with a piece of advice f or her past self -to wait, and her excitement over the future. She stated the desire to have waited until she got married, until from, my kids, having sex, and all that. I love my kids to death, but I wish I Carmella is excited about graduating from high school, getting married and earning a degree. Although, she admits she may change her mind again, previously she wanted to be a pediatrician and currently she wants a ca reer in child development, she kids. ory : Told on September 27, 2012 Rae is 17 year old Black and Italian girl currently in the foster care system. Rae has been in foster care since the age of 12 due to sexual abuse by a family member. Rae talk ed of past abuse and hardship often ; however, her story is filled with hope for the future. Rae has an uncanny ability to remember dates; she recalled the details of her past with exceptional clarity, down to the exact date. Rae was attend ing high school full time and report ed getting good grades in scho ol (As and Bs). At the time of the interview, Rae was 6 months pregnant with her second child. Rae became pregnant with her first child at age 15 and gave birth when she wa s 1 year old at interview and was currently in state c ustody.
155 Rae described her adolescence in three stages : 1) before she became pregnant the first time, 2) after her daughter was removed from her care and 3) after she became pregnant the second time. Stage 1: Prior to becomin g pregnant Rae frequently mi ssed school, ran away from foster care, and got into fights resulting in multiple same age as Rae, but is not part of the foster care system. others in this analysis because she described her boyfr iend as wanting both pregnancies despite her apprehension. Rae described intentionally initiating birth control to avoid her boyfriend s planned pregnancy. Evelyn : So you mentioned that he was trying to get you pregnant. He wanted a baby ? Rae : He actually Evelyn : Oh, so why did h e, do you know why? Rae : He like, he told me before like with some girl, she had a abortion. And he said he the Rae described both of her moms biological mother and close f amily friend as being happy when they foun d out she was pregnant despite not expecting pregnancy h is mother and insisted on a DNA test to prove pregnancy. After deli very Rae described both her mother s, biological and close family friend and her boyfriend as being happy.
156 [foster home for pregnant teens # 1] and he would come up there, spend time with me and L* [oldest daughter]. He would take her some time. her caseworker for the delivery ; although it was diffic Rae : have Pitocin epidural, my cervix dilat ed real slow. And they almost had to do a C hurt you really bad And the contractions was like [snapping fingers] coming They were so intense And then like 24 hours and 30 minutes daddy and my guardian ad litem I was like, do this! I was panicking and my heart was beating so fast, and she came. I pushed for; I pushed 10 minutes and pushed her out for eight minutes. She was almost 11 pounds I was out to here Was like huge And then I, the ul trasound I had got while I was at JVC, like, three days before, I was about to She came out, I seen her. They put her on top of me and she just stretched he just stood there crying beautiful! It was funny. Although, she admits to not having a very close relationship with her mother, she opted to follow tradition in her family and have a drug free birth. Evelyn : So how did you decided on going natural, natural birth? Rae : Pitocin. She believes, basically, you did it, no medicine. your great get [drugs] after me. When her daughter was 2 Rae recalls a false accusation of abuse due to an IV bruise. Despite proof contrary to
157 abuse, Rae is resolved to Rae : And whe n I did have her, I loved it. And then they made false accusations against And I even had hospital records show that she had a needle in her arm, she had a needle in her leg. They [old facility] was telling somebody bruised her, I was like yeah, okay. Then I was like, I just want to get [the] case plan, get my baby back. Evelyn : a shot, she had shots? Rae : Yeah, in, it proved to the court He [the judge] was like, well, why did we take this Stage 2: Although she did not plan either pregnancy, Rae described being especially devastated at the news of her second pregnancy. Rae discovered she was pregnan t at her medical clearance for foster care placement; she described crying and being very upset at the news. Rae : Oh. I went to the hospital. I was on runaway. I went to the hospital to you know, get myself medically cleared so I can go into a group home. And they have a missed period. I actually had just gotten my period. And I was eating a lot, but I thought that was normal, cuz I always do that before my Evelyn : How far along were you? Rae : Six weeks and ying to get pregnant this time. p regnant last time. He was trying to get pregnant. Evelyn : So how did your boyfriend feel when you got pregnant the second time? Rae : [BF] Evelyn : How, how old was your daughter?
158 Rae : She had to be at least nine or 10 months, if not I think eight. Evelyn : And, and he was excited? Rae : He was. He thought it was the best thing on earth that ever happened Stage 3 : Although, she initially described returning to her old ways, after losing custody of her daughter she described a 360 upon her second pregnancy, w ith the help of a new placement and outlook on life. Rae : I used to run away a lot, get arrested. Then my daughter got took out of my custody. And then I started getting arrested a lot again. And then I got regnant. I found out June 8 th Came to Marion County and I just turned, did a 360 turn. Evelyn : .. Tell me about that 360 turn. Rae : I gave a life to G od. I go to school now Have not been arrested. That makes me o get my daughter back. Rae interprets things as going well since becoming pregnant and moving into her hree more classes probation. Her plan for success includes gaining custody of her daughter, aging out of the system, getting an apartment for herself and children, and getting her GED so she may begin college. Although Rae will be eighteen in 6 months, and admits to being a Rae : was time for me to put my big girl panties on Personally, the old teenager life I used to live was not good. Smoking weed, that, I think that teenager life now for me is like immature. Evelyn : Rae : No.
159 Evelyn : And, how do you feel about that? Rae : Rae regrets her academic past skipping school, a lot the most, and is most excit ed about getting her daughter back, having her second daughter, getting an apartment and Rae characterized on track as Doing and that d oing so, will make her feel good about herself. and coercion, but sprinkled with perseverance. Tia is 17 year s old and ha d three children ages 3, 2 and 11 days at the time of the interview. Tia was in foster care due to physical and sexual abuse by multiple family members including her biological mother. Tia earned her GED, finished one semester of college, and report ed earning good grades (As and Bs), while in school. Mul tiple Pregnancies her first child (father #1), although he was much older than she was and was essentially coerc ing her into having sex. She characterize d sex as something she did as a repayment f or love. it. I just did it because I thought, you know, he loved me for it. Following the dis covery of her pregnancy, she recalled the pressure from the father to blame the pregnancy on her ex boyfriend with whom she never had sex and have an abortion.
160 During her first pregnancy, she met the father of her second child, who also coerced her into having sex. Although she was somewhat aware of the coercive nature of the relationship, she stated satisfaction at just having him near. he was, kind of, my escape. I used my pregnancy to he used my pregnancy to, pretty much, get me to be with him. I think he seen me as weak and somebody he could just get along I mean someone that was about any At the discovery of her second pregnancy she recall ed not being scared of being pregnant but scared of the father of her child Her ex boyfriend (father #2), had become abusive and stalked her; although he is prison she is still afraid he will return to hurt her. Tia then recount ed excitement during the birth of her second child. She attributed the excitement to her old foster mom who grew into her mother Um, I had a really good support system, so I think I was pretty exci ted. Due to unforeseen circumstances, Tia was placed back into the foster system ; she recalled trusting the and thus ending up pregnant. And then I asked him [friend from GED Class] to take me home another time, and he said he had to drive by his house first to tell his dad that he was driving me we were kissing at first, and it was consensual, and wh With this newest pregnancy and birth, she has mixed feelings, both happiness at knowing father #3 will ne ver know about their daughter and a feeling of failure as a mom. Mainly because my [eldest] daughter had her f her? I mean, I told her that Jesus was her dad
161 have to tell them the same thing. Motherhood: Tia described motherhood as hard, challenging but doable. She stated routine and schedule are essential when having three kids. The easie st part for Tia as a mother is loving her children. She also state d that although motherhood takes compromise choice, not them ; she noted ty having kids Similar to Carmella the hardest part of motherhood for Tia was supporting her children. stuff for when I turn 18 and all that, but now, you know I have a newborn .. thing you do is just affected by having kids, I think. She state d that motherhood ha d a lter ed her educational plans to getting a GED instead of high school diploma and changed her career plans to c hoosing a career that would take less school such as an elementary teacher Tia also recognized that motherhood changed her romantic plans, and m ade her smarter about the men she dates to wait for the right person to come around ... This cha nge also coincide d with the biggest change she would make about her past being more choosey and waiting to be in relationships and the advice she has for her future -being smarter about guys She stated she would have waited until she finished school to
162 Unexpected Findings : Adolescent Mothers in Foster Care A proportion of the parous participants ( 30%, 6 /20), were in foster care at the time of study enrollment. Th ese participants highlighted the added complexities of being an adolescent mother in the foster c adolescent mother. In focus group and interview analysis, some participants (4/6) characterized motherhood while in foster care as being constant state of apprehension, fe could if they were not in foster care. Selena a 17 year old, White participant who had previously lost and then regained custody of her child, felt foster care was like being under a magnifying glass with people waiting for her to make a mistake: Selena : d to make common mistakes as a parent without, oh my Evelyn: ...y ou mentioned common mistakes in motherhood. What sort of mistakes are you talking about? Selena : Like you leave your baby on the bed and your baby rolls off the bed. I mean, a not your baby just rolled off the bed and has a bruise on its head. Oh, you just threw your common things Your baby has an ear infection Tabitha, alleged that instead of teaching you about parenting, foster care was more of a prosecution: cution. Like your child can hit the wall. Tabitha was also upset, about not being able to move in with a new boyfri end due t o foster care regulations and thought that
163 mother. Tia believed that being in foster care inhibited the way she could parent her children. Tia : do, but I feel like if I make, my kids can get taken from me, so it makes me put a tighter leash on them than I normally would. Evelyn : Like what sort of things? Tia : Like them being able to run around the house, something like that. I feel like I have roughhousing with each other a nd they just wanna play and be siblings, I bump head year old with three childre n to can lose them through anything. Selena also believed that foster care changed the she way would parent her child ; she characterized her parenting beliefs as similar to Attachm ent Parenting (Sears & Sears, 2001) but worried about the ramifications of those practices sleep. I do things that I wanna do with my child that to vaccinate my child because of my my Despite these generally negative feelings about parenting in foster care, the participants described their current placement (a home for parenting girls) was better than most. Participants characterized the ir current p lacement as homey, room y and more relaxed than some of the locations in which they were placed in the past. Other participants noted their foster mother spent more time with them and cared more about them when compared to previ ous foster mothers. Due to h er negative experiences as a mother in foster care and positive experiences in her current placement, Selena talked
164 about her desire to open up a facility for teenage mothers in foster care because she saw limited options f or girls in similar situations as a problem. Summary of Findings Based on statistical analysis there were no differences between nulliparous and multiparous participants on self esteem, optimism mastery or positive/negative affect. Nulliparous participants ranked getting married as mor e importance to achieving personal success than parous participants. Please see T able s 4 2 through 4 4, for demographic distribution and statistical findings. Success was described in one of three ideologies 1) determined by the quantity and quality of co nquered barriers, 2) determined by accomplishing individual and preset goals, and 3) determined by meeting society norms such as education, job, car, and independence. Independence is essential to all three ideologies of success and stipulates that the ind ividual does not have to rely on others for necessities such as food, shelter, money, or transportation. See Figure 4 3 and 4 4 for identified characteristics of successful and unsuccessful people in their community. Personal aspirations in 10 years includ e d being finished with school, owning a house, owning a car, being engaged, or married, and starting a family. Professional aspirations include d jobs in health care, childcare/child development, and cosmetology. Both groups described changes in professiona l aspirations; parous participants described changing career choices to have careers with shorter training requirements. Nulliparous participants perceived adolescent motherhood as hard, and predicted personal, romantic, career, and educational changes to motherhood. Parous participants described motherhood as not that hard. The easiest part was caring for the child; the hardest part was inconsolable /unexplained crying and financial dependency.
165 Parous participants felt the shows 16 & Pregnant and Teen Mom portrayed life as more difficult than reality; nulliparous participants thought the show was accurate. See T able 4 6, for a complete list of research question and associated themes. Chapter 4 Conclusion In Chapter 4 I have highlighted the quantitative an d qualitative findings by each research question. St a tistical analysis revealed very few statistically significant differences between nulliparous and multiparous participants. Qualitative findings highlighted that nulliparous participants perceived adoles cent motherhood as difficult and that it activated several personal and professional adjustments. Parous participants they were still hopeful for the future. The context and cons equence surrounding subsequent births in the multiparous participants differed for each multiparous participant and included birth control nonuse, misuse, and failure.
166 Table 4 1 Research aims and research questions Number Research aim or question Aim 1 To explore the role of factors such as demographics, family dynamics, family / peer history of teen pregnancy religion, and psychosocial constructs such as self esteem, mastery, optimism, and positive/negative affect on single and subsequent adolesc ent births. Research Question 1 What are the similarities and differences in demographics, family dynamics, family/peer history of teen pregnancy, religion, and psychosocial constructs such as self esteem, mastery, optimism, and posit ive/negative affect b etween nulliparous and parous adolescents? Aim 2 To explore the themes associated with what it m eans to have a successful life between nulliparous and parou s adolescent girls (ages 16 19). Research Question 2 What are the similarities and differences in definitions of what it means to have a successful life between the t wo groups? Aim 3 To explore the themes associated with personal and professiona l aspirations between nulliparous and parous adolescent girls (ages 16 19). Research Question 3 Wh at are the similarities and differences in definitions of personal and professional goal aspirations between the two groups? Aim 4 To investigate the explanatory models of nulliparous adolescent girls associated with parous peers, and their views on a dolescent motherhood in the media. Research Question 4 How do adolescent girls (ages 16 19) who have never been pregnant perceive pregnant or parenting peers? What are their views on adolescent pregnancy/motherhood in the media? Aim 5 To explore the d escribed context of conception, delivery and motherhood (for single and subsequent pregnancies) among parous adolescent girls (ages 16 19) Research Question 5 How do primiparous adolescent girls (ages 16 19) describe the context surrounding initial birth ? Research Question 6 How do multiparous adolescent girls (ages 16 19) describe the context surrounding subsequent births
167 Table 4 2 Population d emographics Characteristic Nulliparous (N= 12) Parous (N= 20) Age 17.48 17.80 Percent (N) Percent (N) Race/Ethnicity Black/AA 75% (9) 45% (9) White 8.3% (1) 35% (7) Hispanic 0 10% (2) Other 16% (2) 10% (2) School Attendance HS Full Time 75% (9) 60% (12) HS Part Time 8.3% (1) 10% (2) Graduate HS 16.7% (2) 10% (2) GED 0 15% (3) HS Drop Out 0 5% (1) Grades Good Grades 50% (6) 35% (6) Ok Grades 50% (6) 59% (10) Poor Grades 0 6% (1) Employment Full Time 0 0 Part Time 0 5% (1) Looking for Job 67% (8) 55% (11) Does not work 33% (4) 40% (8) Sexual Activity (S A) Currently SA 33% (4) 45% (9) Used to be S A 0 30% (6) Not SA had Sex 8% (1) 25% (5) Never had Sex 59% (7) X Relationship Status Single 67% (8) 15% (3) Same Sex <6 mos 0 5% (1) Same Sex >6 mos 0 5% (1) Boyfriend <6 mos 17% (2) 10% (2 ) Boyfriend >6 mos 8 % (1) 55% (11) Engaged 0 10% (2) Other 8.3 (1) 0 Religious Status Never Attend 0 20% (4) Attend on Holidays 25% (3) 40% (8) Attend once a week 25% (3) 30% (6) 50% (6) 10% (2) Living Environment House 50% (6) 50% (10) Apartment 33% (4) 15% (3) Mobile Home 17% (2) 5% (1) Group Home 0 30% (6)
168 Table 4 2 Continued Characteristic Nulliparous (N= 12) Parous (N= 20) Liv Mother Only 42% (5) 45% (9) Father Only 8% (1) 0 Mother & Father 8% (3) 15% (3) Grandmother 33% (4) 15% (5) Romantic Partner 0 20% (4) Child 0 80% (16) Teen Motherhood Older Sister 25% (3) 15% (3) Among Relatives Younger Siste r 0 5% (1) Cousin 58% (7) 55% (11) Aunt 50% (6) 40% (8) Grandmother 60% (7) 30% (6 None 8% (1) 25% (5) Teen Fatherhood Older Brother 17% (2) 20% (4) Among Relatives Younger Brother 0 5% (1) Cousin 42% (5) 55% (11) Uncle 42% (5) 30% ( 6) Grandfather 33% (4) 5% (1) None 33% (4) 35% (7) Female Peer Sexual Some girls 67% (8) 90% (18) Activity Some Friends 75% (9) 70% (14) Some Best Friends 58% (7) 60% (12) Very Best Friends 42% (5) 60% (12) None 8% (1) 5% (1) F emale Peer Teen Some girls 92% (11) 80% (16) Motherhood Some Friends 42% (5) 65% (13) Some Best Friends 33% (4) 55% (11) Very Best Friends 18% (2) 30% (6) None 0 15% (3) Male Peer Sexual Some guys 75% (9) 90% (18) Activity Some Friends 83 % (10) 75% (15) Some Best Friends 50% (6) 65% (13) Very Best Friends 50% (6) 70% (14) None 8% (1) 5% (1) Male Peer Some guys 58% (7) 60% (12) Teen Parenthood Some Friends 58% (7) 40% (7) Some Best Friends 16% (2) 35% (7) Very Best Friend s 25% (3) 30% (6) None 33% (4) 30% (6)
169 Table 4 3 Standardized scale means 9 9 IRB revision submission to add income therefore income data not av ailable on all participants. Characteristic Nulliparous Parous M (SD) M (SD) t test df p value Age at First child Mother 20 (3.7) 21 (5.4) .51 29 NS Father 22.5 (6.7) 24 (5.3) .73 26 NS Estimated Yearly Income 9 (average) $31,000 (10, 000 ) $15,000 (20, 000 ) ---Less than $10,000 25% (3) 35% (7) ---$10,000 to $19,999 8% (1) ---$20,000 to $29,999 17% (2) 5% (1) ---$30,000 to $39,999 8% (1) 5% (1) ---$40,000 to $49,999 ---$50,000 to $59,999 8% (1) ---$60,000 to $69,999 8% (1) ---$70,000 to $79,999 ---$80,000 or more ---Highest Grade Mother 13.8 (1.9) 11.4 (2.3) 2.5 18 .02 Father 12.6 (1.5) 11.8 (2. 5) .7 15 NS PANAS (Average) Positive Affect 31.5 (9.2) 30.0 (6.9) .51 30 NS Negative Affect 21.9 (6.6) 22 (7.4) .08 0 NS Mastery Scale 22.6 (2.9) 21.9 (3.0) .75 30 NS Rosenberg Self Esteem 32.3 (3.6) 30.7 (3.3) .24 .84 NS Life Orientation Test 24.7 (4.9) 23.3 (4.3) .87 30 NS Community Success Ladder Current Ladder 6.1 (1.6) 5.5 (1.7) .84 28 NS Want Ladder 8.0 (1.5) 8.1 (1.4) .10 28 NS Think Ladder 9.5 (.94 9.4 (.9) .35 28 NS Facili tate Graduate HS 1.58 (.9) 1.28 (.75) 1.0 28 NS Success* Go to College 2.4 (.8) 2.9 (.9) 1.5 28 NS Get a Job 2.9 (.9) 2.7 (.7) .86 28 NS Have lots of Money 4.5 (2.2) 5.2 (1.5) 1.2 28 NS Own something Costly 5.75 (.9) 5.3 (1.6) .91 28 NS Get Married 5.1 (1.8) 6.3 (1.0) 2.3 28 .03 Going out More 6.6 (1.7) 6.9 (1.5) .62 28 NS Having a/another baby 6.9 (2.5) 7.7 (1.0) 1.1 28 NS Other __________ 8.0 (2.5) 6.8 (3.3) 1.1 28 NS
170 Table 4 4 Description of particip ant sample Name Status Age Race Alexandra 2 months; Son 17 years 8 months White Allie 6 months; Daughter 18 years 0 months White/ Hispanic Amie 5 months; Daughter 17 years 8 months Hispanic April 5 months; Daughter 17 years 6 months Black Carmel la 1 year & 3 months ;Sons 18 years 6 months Black Claire 10 months; Son 18 years 2 months Black Diana 4 months; Son 18 years 5 months black Eleanor** 3 months; Daughter 19 years 3 months Black Erica Never Pregnant 18 years 5 months Black Eve 3 months; Son 16 years 8 months White Jennie Never Pregnant 16 years 1 months Hispanic Jerri Never Pregnant 18 years 10 months Black, Hispanic, American Indian Julianne Never Pregnant 18 years 10 months Black Kathleen Never Pregnant 17 years 6 mo nths Black Kenya Never Pregnant 18 years 0 months Black Lakisha Never Pregnant 16 years 9 months Black Lauretta 3 months pregnant (daughter) 17 years 2 months Black Lenore 1 year; Don (Not Parenting) 18 years 2 months Black Lilia Never Pregnant 17 years 0 months Black Liza 1 month; Daughter 18 years 6 months Black Lorrie Never Pregnant 16 years 7 months Black Margery Never Pregnant 16 years 1 months Black Michelle Never Pregnant 16 years 5 months Black Noreen 4 months; Daughter 17 year s 8 months White Rae 6 months preg, 1 year; daughters (Not Parenting) 17 years 7 months Black, Italian Roslyn 6 months; Son 17 years 9 months White Roxie 2 months; Son 16 years 0 months White Sandra** 2 months; Daughter 16 years 3 months Black Sel ena 10 months; Son 17 years 9 months Hispanic Tabatha 3 months; Daughter 16 years 10 months White Tia 3 yrs, 2 yrs, 11 days Daughter, Son, Daughter 17 years 6 months White Zelma Never Pregnant 16 years 6 months White
171 Table 4 5 Summary of research findings by research question Research Question Associated themes 1. What are the similarities and differences in demographics, family dynamics, family/peer history of teen pregnancy, religion, and psychosocial constructs such as self esteem, mastery, optimism, and positive/negative affect between nulliparous and parous adolescents? Average age 17.5 SD .87 56% were Black, 25% were white, 6.3% were Hispanic, and 12.5% were other Mothers of parous participants(11.4) had significan tly less reported education then nulliparous (13.8) ( t = 2.5, df=18, p =.02) No identified difference in self esteem, optimism, mastery or positive/negative affect between nulliparous and parous participants 2. What are the similarities and differences in definitions of what it means to have a successful life between the two groups? Three theories of success identified: a).Distance traveled~ success determined by characteristics of conquered barriers b) Goals achieved vs. goals set~ success determined by individuals preset goal. Participant has to be moving forward c) Status achievement ~ success determined by reaching society norms : education, job, financial stability, and independency 3. What are the similarities and differences in definitions of perso nal and professional goal aspirations between the two groups? Nulliparous participants rated getting married with higher importance. to success ( t =. 2.3, df= 28, p=.03) and described children less often in personal future (10 years) Both groups describe changes to professional aspirations Parous participants attributed professional change to time). 4. How do adolescent girls (ages 16 19) who have never been pregnant perceive pregnant or parenting p eers? What are their views on adolescent pregnancy/motherhood in the media? Nulliparous participants perceived adolescent motherhood as hard/difficult They predicted personal, romantic, and educational changes due to motherhood Participants described the s hows 16 & Pregnant and Teen Mom like to be a teen mom 5. How do primiparous adolescent girls (ages 16 19) describe the context surrounding initial birth? 6. How do multiparous adolescent girls (ages 16 19) des cribe the context surrounding subsequent births Participants felt shocked, scared and excited at discovery of pregnancy Family was described as being upset or disappointed at discovery, but happy at delivery easiest part was caring for their child, the hardest part inconsolable crying and financial dependency The context of subsequent pregnancies in multiparous participants differed for each girl.
172 Figure 4 1 Box P lot presentation of PANAS mean difference
173 Figure 4 2 Characteristics of Successful people in the community identified by Nulliparous and Parous participants
174 Figure 4 3 Characteristics of Unsuccessful people in the community identified by Nulliparou s and Parous participants
175 CHAPTER 5 DISCUSSION AND CONCLUSIONS Overview of the Study The primary goal of th is research study was to investigate the differences in the meaning of success and the professional and personal goal aspirations of nulliparous primiparous and multiparous adolescents. Additionally, I sought to investig ate how nulliparous adolescents perceive parous peers, the context of the index birth as described by primiparous adolescents, and the context of subsequent births among multiparous adolescents. I addressed these goals with qualitative methods, supported by quantitative methods. Some findings coincide with those in the literature, while some highlight newly emerging themes. RQ 1. What are the Similarities and Differences in Demograp hics, Family Dynamics, Family/Peer History o f Teen Pregnancy, Religion, And Psychosocial Constructs Such As Self Esteem, Mastery, Optimism, a nd Positive/Negative Affect between Nulliparous and Parous Adolescents? I conducted two focus groups with parous pa rticipants ages 16 19 (N=11), and thirty interviews with nulliparous and parous participants ages 16 18 (9 adolescents participated in both a focus group and an interview). The average age of interview participants was 17 .5; 53% were black, 27% were white, 20% were other, and 6.7% were Hispanic. The average age of focus group participants was 17.8 ; 54% were Black, 18% were White, 10% were Hispanic, and 10% were other. Participants self reported self esteem via the Rosenberg Self Esteem Scale was 32.5 (SD=5 .0 ) higher than results reported by similar studies ( s cale 10 40 ; higher scores represent higher self esteem) ( Hudson, Elek, & Campbell Grossman, 2000) Participants mean on the Mastery Scale (Perlin & Schooler, 1978) was 22. 2 (SD= 3.0) Higher scores indicated high levels of mastery (scale 7 28). This score is comparable to those found among
176 pregnant (M=20), parenting (M=20) and comparison teens ( M= 19.7) reported by (Barth, Schinke, & Maxwell, 1983) Self reported rankings of t he LOT (Scheier & Carver, 1985) and PANAS (Watson, Clark, & Tellegen, 1988) were also congruent with the literature (Purskar, et al., 2010) Participant s mean on the LOT was 23.8 (SD= 4.5 ) ; on which higher scores represent higher optimism (scale 8 32). The PANAS mean s w ere 30. 6 (PA SD= 7.7 ) and 21. 8 (NA SD=7.0 ) similar to values of mean s of 33.91 (PA) and 21.89 (NA) among 63 adol escent females (including a subset of adolescent mothers). Higher participant scores indicate high er levels of p ositive a ffect and lower scores represent lower levels of negative affect (scales 10 50). Socioeconomic status and family education achievement revealed significant differences between the two groups. Nulliparous participants reported an average yearly income of $31,000 compared to $15 ,000 among parous participants. Nulliparous participants reported their mother s average years of education as 13. 8 years, compared to 11.4 years among parous participants. There were no differences in average years of education among participant s RQ 2. What a re t he Similarities a nd Differences i n Definitions of What It Means to Have a Successful Life betwe en the Two Groups ? Participants descri bed success in one of three ways distance traveled, goals achieved, and status achieve d Ideology 1 D istance T raveled : Some participants characterized success as distance traveled -based on current achievements re lative to previous status. An example would be an ex con or drug dealer who had to work hard and overcome barriers to get and m aintain a good job and support a family He was potentially more
177 successful than an who did not have to overcome su bstantial hurdles along the way. Ideology 2 G oal s A chieved : According to the second explanation, goals achieved relative to goals set p articipants noted that success was proportionate to the individual s execution of preset goals. A participant describe d someone whose goal was to work at McDonalds and who was currently working at and enjoying his position at McDonalds, as successful. Ideology 3 Status Achieved : In explanation three, participants noted that someone was successful based on standard s, often societal norms such as graduating from high sch ool, earning a college degree, having a good job, and having adequate money to support their lifestyle. Participants described success as being free of debt and financial stressors, and being able to make fin ancial choices with ease (i.e. spontaneous purchases). These findings are similar to those found in Katz (1954) and Bradford and Hey (2007) authors discovered that the meaning of success was related to wealth and possessions followed by occupational or ed ucational status. Separate, but congruent with each of these explanations was the concept of independence. Both nulliparous and parous participants stated that in order for a post adolescent (aft er graduating from high school/ college ) to be considered su ccessful, she had to be independent. Independent in the ir terms meant not relying on parents family, or friends for necessities such as food, money, shelter, or transportation. Independence was especially important when raising a child and it was consid ered a pre requisite to adequately supporting a family.
178 Participant explanations of success centered on perceived roles and expected levels of self sufficiency Successful female adolescents ages 16, 17 or 18 were expected to be doing well in school, plan ning for or enrolled in college to at least have a license and/ or car and if they were mothers, taking care of their children. Successful male adolescents were expected to be doing all of the same things and playing sports if they were still in high school and if they were fathers, taking care of their children. Ten years later successful females ages 26, 27 or 28 were expected to have a degree or two, own their house, have a car, be engaged or married, and taking care of their children, if the y are mothers Men of the same age were expected to be doing all of the same things with the added responsibility of not being on drugs or in jail/prison. Characteristics of successful and unsuccessful s community differed slight ly b etween nulliparous and parous participants. Nulliparous participants characterized successful people as those that have met tangible accomplishments such as a high school diploma, job, college degree, money, and support. Characteristics of independence includ ed having their life on track and the ability to give their children a good future. Nulliparous participants described more personality traits signifying success, these included being caring, hardworking l o ving, understand ing, studious, strong mind ed and helpful. Parous participants described similar tangible accomplishments including having savings and a family, as well as similar descriptions of independence. Personality traits described by parous participants included being determined, driven, mo tivated, goal oriented, honest, and advising others
179 Characteristics of unsuccessful community members described by nulliparous participants include d lack of tangible items such as not having a job, having no money, having no one to support them, and being alone ; additional items include d using or dealing drugs, being homeless, and idle. Dependence related items includ ed living of f t he system, living with parents, and not taking care of their children. Nulliparous participants described unsuccessful/negativ e personality traits such as being bitter, uncaring, undisci plined, indecisive, impressionable, disrespectful and having no goals Parous partici pants described tangible items such as being uneducated having no money, no car, no family and being single; t hey also described being on drugs and on the streets as unsuccessful. Dependence related items includ ed having to rely on others, living with their parents, asking for money, and not taking care of their children. Parous participants listed fewer personali ty traits than nulliparous participants but these included being lazy, undetermined, unhappy, and having unrealistic goals There were no statistical differences bet ween the groups on their current perceived level of success (life ladder), where they pr ojected t hey would be in three years, or where they wanted to be in three ye ars. Additionally, analysis of participants achievement ranking s on steps needed to help them reach success (the top of the ladder), indicated a significant difference on the impo rtance of Nulliparous p arous participants. RQ 3. What Are the Similarities and Differences in Definitions of Personal and Professional Goal Aspirations between the T wo Gr oups? Parous participants were more likely than nulliparous participants to describe a personal future at ages 26, 27 or 28 as being engaged or married. These participants
180 often illustrated a future partnered with their current companion usually the fat her of their child or a boyfriend. Parous participants also illustrated a future with additional children ; however children were expected after the participant was settled. Settled, in some cases was synonymous with independence ; participants aspired to b e have finished high school and college, be financially stable, have a home or apartment, and have a good job/career. Nulliparous participants also illustrated a personal future with a spouse and children ; however a higher percentage described not wa nting to get married or not wanting to have children These differences in personal romantic expectations may be due to the context of relationship dynamics as hypothesized in Salmivalli, et al (2009) There were slight differences in professional aspiration trends illustrated by nulliparous and parous participants. Participants aspired to work in health, cosmetology, childcare, or other careers. Identified heal th careers were both technical such as nursing assistant, paramedic and professional e.g. medical physician. Reasons for these career choices were family professional experience, altruism, and negative or personal experience s in health care. More parous participants identified careers in cosmetology or childcare than nulliparous participants. Reasons i ncluded altruism, creativity, and professional independence associated with the desire to own their own business. Some additional careers identified by participants include d careers in criminal justice, social work, real estate, the military and homemak ing Reasons for these selected careers were personal interest, altruism, and personal and professional experience. These findings are similar to Yeager and Bundick (2009) who discovered
181 that 30% of adolescents aspired for occupations that would contribute to the world beyond themselves and 68% of careers were normative Hellenga, Aber, and Rhodes (2002), discovered that adolescent mothers with higher grade point averages, who lived with biological parents and had a career mentor were more likely to experienc e with expectation and aspirations A lthough participants did not describe gaps between expectation and aspirations, there were notable discrepancy in goal aspirations and realistic plans for achieving these goals, thus highlighting the need for a career mentor. Half of the parous participants and almost 30% of the nulliparous participants attested to some change in career aspirations. Reasons for adjustment included personal interest, time, job placement concerns, and money. Participants described changin g their interests as they got older, experienced more things, and learned about different careers. Parous participants often described concern for the amoun t of time required for college and opted for careers that required less training such as changing fr om social work to elementary school teacher. Both parous and nulliparous participants listed job placement concerns and money as motivation for career adjustments. RQ 4. How d o Adolescent Girls (Ages 16 19) Who Have Never Been Pregnant Perceive Pregnant o r Parenting Peers? Never pregnant participants attributed adolescent pregnancy among peers to a variety of reasons, including ignorance (not knowing how to prevent pregnancy), thinking x. Participants also thought there were some girls who wanted to have a baby because
182 up to adolescent motherhood, nulliparous participants uniformly thought that life, as an adolescent mother w ould be hard. Nulliparous participants perceived life as an adolescent motherhood as difficult for varying reasons. Some spoke of the difficulty (isolation and stigma) while being pregnant in a local high school. These findings c oincide with Wiemann et al (2005) ; they found that 40% of postpartum adolescents reported feeling stigmatized, which translated to increase d feelings of abandonment, fear of parent notification, and contemplation of abortion. Participants also theorized t hat having a child in high school added difficulties and potential personal, romantic, or career adjustments. Personal adjustments and hardships such as financial, social, and academic stress were the most frequen t ly noted Participants illustrated that it would be especially difficult to balance the added financial hardships associated with early motherhood due to the need to purchase necessities such as formula, diapers, childcare and health care. Participants also described perceived struggles with bal ancing school and homework due to the added responsibility of taking care of a child. Perceived social constraints associated with early child bearing included difficulty and restricted opportunity to socialize with peers. Nulliparous participants thought it out options when considering socializing as an adolescent mother : f ind ing a baby sitter or taking their child everywhere they went. Some also thought it would be irre sponsible to hang out or party when you have a child. Romantic adjustments to having a c hild while still in high school included difficulty dating. Girls spoke of difficulty finding a partner (boyfriend) who would support both the adolescent a nd her child. Girls noted that most
183 men their age (16, 17 and 18) would not want to date someone with a child and wo uld not take responsibility (play with or help financially support) for a non biologic child. Participants also perceived that in most cases of adolescen t pregnancy the father of the child would leave thus adding the stress of being a single mother. Career adjustments due to adolescent childbearing were described in three cases. Case 1, due to the added and competing responsibilities (child and school) t he girl would most likely perform poorly or drop out of school th u s limiting her ability to get a good job. Case 2 also due to added and competing responsibilities ( taking care of the child and work ) transportation stressors such as needing to maintain adequate transportation, and financial stressors associated with the need to work to pay for the child, the girl would most likely have to delay or decide against college thus limiting her ability to get a good job. Finally, case 3, due to financial and t ransportation issues the girl would most likely not be able to get and keep a good job. One participant suggested that a future boss or manager might perceive the girl as irresponsible due to poor decision making that led to an adolescent pregnancy, thus r estricting her ability to get hired, and once hired to get promoted. Similar to findings reported by Herman (2008), a few participants predicted positive personal adjust ments due to early childbearing. Potential positive adjustments included increased mat urity and accountability. Participants described friends who got it together finished sc hool, got a job, and got a car, due to having a baby and having a child increased their self motivation to care and do well for their child.
184 RQ 5. How Do Primiparou s Adolescent Girls (Ages 16 19) Describe The Context Surrounding Initial Birth? Participants described emotions su ch as fear, happiness, and anxiety at the discovery of their pregnancy. The m ajority of the participants noted inconsistent and inaccurate pr egnancy prevention behaviors or no pregnancy prevention efforts. Most partners were described as being shocked followed closely by being pleased and excited. Parents and guardians were described as being upset or disappointed, but were ultimately happy at the time of delivery. Although the literature describes a pregnancy decision tree among women facing unplanned pregnancy (Cohan, Dunkel Schetter, & Lydon, 1993) the majority of participants seem ed to go through this process very quickly. Participants eliminated abortion as an option due to personal beliefs, familial/partner beliefs, and predicted feelings of guilt later in life. They eliminated adoption due to attachment formed during the pregnancy and the predicted difficult y of giving up the child post delivery. The father of the ir chi ld/ boyfriend and family ( grandmother, aunts, or cousins ) and/or close friends, typically accompanied participants during their delivery Despite feelings at disc overy participants, partners, family, and friends were described as being excited and happy at the delivery of the baby In general, participants characterized both easy and difficult aspects to motherhood. They felt that it was easy to love, be with, fe ed, and take care of their child. They found it hard to deal with helplessness, associated with inconsolable or sick children and their reduced independence brought on by limited finances Although some participants felt it was especially frustrating to n ot be capable of taking care of
185 their children financially, most stated that adolescent motherhood was not as hard as adults, peers, media, and society predicted. Participants spoke of slight adjustments but they were characterized as being bearable and of ten welcomed changes. Some participants described a renewed motivation to do well academically to ensure a better future for their child. These findings are congruent with those of other researchers (e.g Ronsengard, Pollock, Weitzen, Meers, & Phipps, 2006; SmithBattle, 2007) Sex Education : Participants described exposure to formal and informal sex system. Participants most often attended this talk in the 5 th or 6 th gr ade. Few participants recalled continued or follow up sex education after t he initial lesson. Among those who participated in follow up sex education, it typically occurred in specific settings such as science class and it was not a school wide program Formal sex education at home from a parent or guardian who review ed comprehensive sexual issues occurred less frequently than school based education The quality of information varied from a comprehensive account of sex, STDs, pregnancy and birth to spec ific topics such as the female anatomy and the logistics of puberty. Participants were able to list the best ways to prevent pregnancy and sexual ly transmitted disease ; however, participants often described incorrect or inconclusive informati on about spec ific contraceptive method s (i.e. the IUD). Furthermore, very few sexually active participants (parous and nulliparous ) were practicing consistent behaviors to prevent pregnancy. Sixty percent (3/5) of sexually active nulliparous participants were not curre ntly using any birth control method to prevent pregnancy (birth control or condoms) and 22% of parous participants either were not currently
186 using any form of birth control or had recently quit using their birth control Similar to Wil son et al (2011), pa rticipants who were using contraception had varying levels of satisfaction with it and spoke of plans to switch methods in the near future. Barr et al (2003) identified that a possible explanation for the lack of preventive methods among parous participan ts may be the favorable community and peer perceptions of unwed adolescent mothers. Researchers who have investigated the risk for repeat pregnancy among primiparous African American youth found an association with social comparison, prototype favorability and risk images (Barr, Simons, Simons, Gibbons, & Gerrard, 2013) RQ 6. How Do Multiparous Adolescent Girls (Ages 16 19) Describe The Context Surrounding Subsequent Births ? Given the limited sample of multiparous adolescen ts, I conducted a case analysis of each participant. Each of the participants provided a unique context surrounding their index and subsequent pregnancies. Carmella, Rae, and Tia each attributed different factors and life events as leading to their pregna yearns for independence, she is aware that her options as an adolescent mother are limited Carmella hopes that furthering her education will award her the necessary opportunities to become independent. Rae has limited support from her family; however, she described her caseworker, guardian ad litem, and current foster mo ther as being sources of motivation and support. Rae is hopeful of a future during which she has completed school, regain ed custody of her child, has an apartment for herself and her two children, and has take n the steps necessary to complete the path to independence. Tia describe d a life with very little nurturing or supportive role models.
187 Tia characterize d her days as doing what she c an to raise her children in the best environment possible and instilling the Christian values she consider s important Tia noted look ing forward to aging out of foster care, completing a degree in elementary education, getting married, and raisi ng her children free of outside input or judgment. The context of repeat pregnancy for each participant illustrates different risk and protective factors. Participants each demonstrate a certain amount of resilience. Initiating long acting birth control m ay have prevented a repeat pregnancy (Stevens Simon, Kelly, & Kulick, 2001) pregnancy may be partly attributed to the unfavorable outcome of her first pregnancy of losing custody of her child (Boardman, Allsworth, Phipps, & Lappane, 2006) Tia possesses strong negative beliefs about most long acting birth control that stem from negative experiences of friends or family As such, fostering hope and self ef ficacy to make safe sex decisions may be more effective in reducing repeat pregnancy. Additional Findings : Adolescent Motherhood in Foster Care A subset of the parous participants were in foster care at the time of study enrollment. Bas ed on participant s tories adolescents in foster care have unique circumstances that may lead to adolescent pregnancy. The participants in foster care were more likely to report informal sex education attributed to sexual abuse situations 10 Research indicates that v ictims of sexual abuse are more likely to experience adolescent pregnancy (Francisco, et al., 2008) The participants were also more likely to report inconsistent school attendance and fewer sources of nurturing and supportive adults. B oth of these factors lead to decreased access to formal sex education and are 10 Reported to the authorities prior to study enrollment, sometimes the reason for foster care placement, among adolescents in foster care.
188 consistent with findings of similar research studies (Connoly, Heifetz, & Bohr, 2012; Svoboda, Shaw, Barth, & Bright, 2012) P articipants reported being in and out of foster care It was during t on the run episodes that most participants reported conceiving their child. The diagnosis of pregnancy was in most cases the catalyst that motivated participants to return to foster care. As a new mother, the foster care system highlighted several added complexities including added apprehension, fear of persecution and lack of autonomy. Participants described a motherhood under the threat of the Department o f Children and Families (DCF), such that consequences such as the loss of their child. These are similar to findings regarding homeless adolescent mothers who reported fear of theft of their child as a top concern (Scappaticci & Blay, 200 9) Participants felt that this fear of persecution restricted their autonomy and ability to make normal parenting decisions and mistakes ; similar findings were identified by (Connoly, Heifetz, & Bohr, 2012) Due to these rea sons participants stated that they were n o One participant recollected the immense pressure she felt to place her child up for adoption during her second and third pregnancies. Sh e recalled advice from her caseworker, guard ian ad litem, and foster mother to place her babies for adoption due to the perceived benefits of decrease d stress for her and increase d opportunity for the child. Despite lack of definitive plans for the futur e, participants were most excited about aging out of the system. Research suggests that motherhood could be a source of healing for adolescents in foster care through balancing previous experiences and
189 planning for a future outside the system (Pryce & Samuels, 2010) These findings require additional research because the participants were all currently living in the same placement and although some girls spoke of about their experiences in previous locations they were all locati ons in the state. Strengths and Limitations This project entails a variety of strengths and limitations. A strength of this study was the use of focused ethnographic methods, which is often used to evaluate or elicit information on a special topic or shar ed experience (Richards & Morse, 2007) Information on the meaning of success and personal and professional goal aspirations were elicited directly from the sample in question, adolescent mothers and peers Additionally, the qu alitative findings were strengthened by quantitative methodology used to elicit important background information about the sample such as family dynamics, familial and peer history of teen pregnancy, and psychosocial variables such as self esteem Further more, t he use of standardized scales, all of which were validated to assess self esteem, positive and negativ e affect, mastery, and optimism strengthened the quantitative findings of the study P articipant means on most scales were similar to those report ed in the literature thus validating the results. Some identified themes related to the context of motherhood, the effect of motherhood on future aspirations, adolescent motherhood in foster care are similar to those identified in the literature thus val idating the findings. New themes related to adolescent motherhood in the media, the meaning of success and differences in personal and professional aspirations between nulliparous and parous participants may c ontribute to understanding perceptions of adol escent pregnancy and new avenues to reduce the rates of adolescent pregnancy and repeat pregnancy.
190 Limitations to the study include issues related to recruitment methods and sample size. D ue to recruitment methods, purposeful and snowball sampling, the qu antitative findings cannot be generalized beyond the study participants. Also due to the small sample size limited statistical inferences can be made. Although the mean age of participants was 17.5 and the range was 16 18, quality of participant interview s suggest participants varied in matu rity, development, and literacy; further e vidence o f why these findings cannot be extrapolated out of the participant sample. There are also possibilit ies of reporting and interviewer bias Due to the sensitivity of som e of the interview questions and the young age of participants, participants may not have answered al l questions fully and truthfully; additionally, t he interviewer may have unknowingly influenced participant responses. Implications for Policy The researc h findings highlight several potential policy adjustments from va riou s avenues to reduce rates of adolescent pregnancy and repeat pregnancy Possible policy interventions could be tailored to the quantity and quality of school based sex education, adequate information about birth control methods, school based career planning information, and suggestions for special populations such as adolescents in foster care. Qualitative findings suggested th ere were little differences in exposure to sex education betwe en the nulliparous and parous groups. Participants described inconsistent access and quality of sex education. Beliefs, inaccurate information, and practice put nulliparous adolescents at risk for pregnancy and primiparous adolescents at risk for a repeat pregnancy. Policy adjustments that increase access to continued quality comprehensive sex education via the school system are essential. Bay Cheng
191 (2003) identified three critiques of school based sex education. The identified critiques were that school ba sed education attends exclusively to the dangers and risks associated with teen sex, it exemplifies narrow definitions of normal sex and it fails to address gender, race, class and sexua l differences (Bay cheng, 2003, p. 61 ) Furthermore, r esearch concluded that school based sex education is often met with political, policy, and community backlash (Bay cheng, 2003) Understanding these limitations of school based sexual education, and recognizi ng the school system as a safety net of captured teachable adolescents may influence a new direction in school based sex education. Participant responses suggest that although memorable school based sex education was infrequent and mostly nonexistent dur ing the critical period of adolescent sexuality development (high school years) Additionally, personal accomplishments such as getting married were expressed as having more importance to personal success among nulliparous than parous participants, furth er indication that an abstinence until marriage approach will not be effective among parous participants. Nation, state, and community wide policies that address quality and quantity school based education are necessary to counteract sporadic home based ed ucation and misguided informal education Policy adjustments to address access to pregnancy prevention services and health education campaigns related to birth control methods are essential. Information and an accurate clinical risks and benefit assessment of birth control method s was lacking based on participant responses. Incorrect and misguided information regarding birth control methods (specifically the IUD) was a common theme in the data. Although p articipants were aware of the IUD, most spoke unfavor ably of this birth control method
192 relating it to negative side effects such as sterility and death. This is c ontrary, to findings by Whitaker and colleagues (2008 ); they discovered that only 20% of participants ages 16 18 knew of the IUD prior to a health education intervention. Furthermore, sources of information about the IUD prior to intervention were professional (86%), peer (36%), family 29%, and the media (37%), suggesting that although most young women were unawa re, those who had prior knowledge, rec eived information from multiple sources (Whitaker, et al., 2008) In addition to misguided beliefs about some birth control methods, some reported difficulty accessing their preferred birth control method. Some parous participa nts stated they were unable to access their preferred birth control method the I mplanon due to provider and insurance restrictions. Research supports these participant s positive attitudes about the Implanon and indicates that long acting birth control m ethods such as the Implanon are associated with extended birth control use (24 months post partum) and reduced repeat pregnancy (Lewis, Doherty, Hickery, & Skinner, 2010) Lewis et al (2010) discovered that among parous adolesc ents who used the Implanon as their primary method of birth control participants liked that they did not have to remember it, that it was long acting, effective, and convenient. Furthermore, Kavanuagh et al (2013), found that among publically funded fami ly planning facilities nationwide 70% provide outreach to young people, 27% us e social network media as an outreach strategy and 64% have flexible hours. These facilities provide access to preferred birth control methods for adolescents and young adults and improving access and reducing limitations will reduce unplanned pregnancy. Al though alternatives to primary care providers may be available in the community such as Planned Parenthood, adolescent
193 populations may be unaware of these services and may be nefit from a dvocates to inform and assist them in navigating system politics. Identified youth related limitations reported by publically funded family planning facilities ; 33% report ed service costs were too high for adolescents, 30% report ed confidential ly concerns of adolescents, 25% report ed inadequate staff training or experience with adolescents and 15% report ed staff difficulty relating to adolescents (Kavanaugh, Jerman, Ethier, & Moskosky, 2013) Access to adequate and continued sex education for special popu lations within foster care is a possible policy intervention that can reduce rates of pregnancy within this unique population. Barriers to accessing adequate pregnancy prevention services such as sex education inclu de inconsistent adult relationships, placement changes, and developmental needs of the population (Svoboda, Shaw, Barth, & Bright, 2012) The parous participants in foster care reported less formal sex education than those not in foster care. Most reported that their mothers or foster guardians did not discuss s ex and they did not attend many school based sex education courses due to frequent delinquency Furthermore, those who did receive formal sex education received it from o ther affiliates of the foster care system such as a caseworker or guardian ad litem. Given that many of the participants reported multiple placement and subsequent school changes sex education from adult professionals who remain constant in the adolescent s life is essential. Foster care affiliates such as the caseworker and guardian ad litem should be trained in sex education and have access to pregnancy preventative services. Parous participants in foster care often described transitioning in and out of foster care supervision. As such they reported being on the run when they conceived and returning to foster care to receive health care services. Educating at risk
194 adolescents in foster care on how and where to seek pregnancy prevention servi ces when out of foster care supervision can assist in reduction of unplanned pregnancy within foster care and in a reduc tion system cost s Implications for Practice Basch, (2011) found that adolescent mothers are 10 12% less likely to complete high school and have a 14 29% lower rate of attending college. However, Yakusheva (2011) found that the economic disadvantages (lower education and increased poverty) experienced by adolescent mothers might be due to preexisting differences in educational and fertili ty expectations Additionally, although research suggests that lower academic achievement is associated with adolescent pregnancy (Scales & Lefferet, 1999) and that goals compatible with motherhood may indicate higher risk for repeat pregnancy (Camerena, Minor, Melmer, & Ferrie, 1998) my findings s uggest that some adolescents (parous and nulliparous ) possess un realistic expectations of career training and education requirements. Parous p articipants reported slight adjustment in professional aspirations apart from shifting to careers that we re perceived to be expectations and logistics. My f indings also suggest that partici pant goal aspirations are not rooted in realistic expectations, but are rooted in personal interest and are flu id as experiences and context s change. As such, fluctuations in professional aspirations may not be solely based on adolescent pregnancy but rat her on developmental processes and career information knowledge base This is signified by statements such as wanted to be a pediatrician but that takes four years pediatrician requires up to 11 years of education and trai ning (4 years undergraduate training, 4 years of medical school, and 3 years of residency). Unrea listic expectations
195 were also evidenced in incomplete and misguided plans for professional success. One 17 years old participant, who noted no change in profes sional aspirations at six months pregnant describe d plans to attend one of three universities six months from the interview; however she had not taken the necessary steps to secure acceptance or even apply to the aforementioned universities. Findings sugg est that career mentoring, planning and job skill assessment are nece ssary for all adolescents before career mentoring may be effective to reduce pregnancy and repeat pregnancy Services should start in the 9 th grade and continue through the 12 th grade. Ca reer mentoring to prevent adolescent pregnancy cann ot be effective if unrealistic professional aspirations are present. Recommendations for practice also include academic interventions that influence goal orientation and self efficacy. Caraway (2003) found that higher grade point average was predicted with higher self efficacy lower fear of failure and lower social desirability among a South Eastern high school student sample and that higher goal orientation and generalized efficacy predicted higher leve ls of school engagement. School programs that foster goal orientation and self efficacy can essentially increase school engagement and academic achievement and reduce risk for adolescent pregnancy. Currently pregnancy prevention and intervention program s utilize implications of adolescent pregnancy findings as avenues to reduce adolescent pregnancy. Unfortunately, my findings suggest that adolescent pregnancy and repeat pregnancy often stem from poor planning, and participants undertake the process of c ognitive dissonance when they become a new mother. As such, participants perhaps unknowingly change their beliefs and attitudes to better reflect their new role.
196 Furthermore, some participants reported renewed focus and motivation since motherhood, findi ngs supported by SmithBattle (2007) who found that participants often reported a renewed sense of focus on education and success. Although th ese may be useful coping strateg ies in that it may foster hope, it may counteract the efficacy of adolescent pregna ncy and repeat pregnancy programs. I recommend public health interventions that use an asset mapping approach, and thus recognize the coping strategies used by adolescent mothers and repeat mothers as a framework to prevent further unplanned pregnancies. K egler and colleagues used youth assets such as aspirations for the future, constructive use of time, and skills for meaningful employment to reduce risky behavior among adolescents (Kegler, Rodine, Marshall, Oman, & McLeroy, 2003 ) Similar programs that use assets of adolescent mothers and repeat mothers can mobilize the community (adolescent mothers) to reduce negative outcomes such as decreased high school graduation, college enrollment and associated economic consequences P arous participants within the foster care system reported inadequate support as an adolescent mother and excess judgment compared to adolescent mothers not in foster care. Participants reported pressure to place their child for adoption in place of access to training and parenting education. Changes in practice to improve and increase access to parent education and parenting programs that recognize the role of the essential. Compared to adolescents not in foster care, a ch ild may serve as the only consistent family member and source of love through multiple foster placements and guardians. Connolly (2012 ) found that among adolescents in foster care, the infant was used to fill an emotional void and motherhood
197 was perceived as positive and stabilizing. Recognizing these strengths to improve on repeat pregnancy prevention programs as well as policy interventions to improve access to pregnancy prevention services will decrease rates of adolescent pregnancy and reduce system bur den by reducing the rates of second generation foster children. Implications for Theory and Suggestions for Future Research Findings provide insight into the meaning of success among nulliparous primiparous and multiparous participants. Additional resear ch is needed to further explore the three identified themes and the construct of independence. Future research to investigate generational, gender and racial or ethnic differences in the meaning of success is needed. Research is also needed to address how preconceived meanings of success affect personal and professional goals and achievement. P arous participants recognized independence as paramount ultimate success However quantitatively most noted that they were successful or making ample progress in bec oming successful contrary to qualitative reports of dependence on others to meet the tangible needs of their child such as diapers, formula, day care, and money for health care expenses. These findings indicate further research on the meaning of self refle cted meaning of success and measures of success for outsiders. Findings also warrant further aspirations to be a good mother ; however based on current dependence on others to meet the basic needs of their children it may signify Research to investigate potential generational, gender, and racial or ethnic differences on the meaning of motherhood /fatherhood and being a good mother /father are essent ial to understand the context of adolescent pregnancy among adolescent parents.
198 Future research should include input from adolescent fathers and maternal grandmothers who were not included in this study. Nelson et al (201 2 ) found that among non married B lack adolescent mothers, participants felt that their babies father would always be a part of their lives, they would always care about their babies father, and that the babies father could always get sex as long as they were on good terms. Participants described mixed levels of support from the father of their children and less ove rall impact of parenthood o n the lives of the father. The impact was described as greater if the father lived with the adoles cent and child, otherwise child father interaction was often restricted to the weekend. Decreased impact of fatherhood may influence higher rates of unplanned /planned pregnancy by the male partner as indicated in the findings. One participant described a coveted repeat pregnancy on the part of her boyfrie nd who did not live with or participate daily in the ir oldest life. Two other participants characterized the father of the child as non existent an d contributed this partly due repeat pregnancies with outside women. Research indicates that co paren ting and soci al support have a greater effect on engagement for adolescent fathers than adult fathers suggesting that parent engagement needs to be fostered early in parenthood (Fagan & Lee, 2011) Furthermore findin gs from B oardman et al (2006) indicate that a prior poor birth outcome such as losing custody of your child may translate to adolescent fathers, suggest ing that co parenting can reduce rates of repeat pregnancy among male adolescents and young adults. The role of maternal grandmothers and other family members can have a substantial effect on the perceived difficult y or ease of motherhood among adolescent s Some participants described supportive and nurturing fam ilie s who assist the
199 adolescent in caring for her c hild and going to school. Others describe family members who provide tangible support and limited emotional and social support. Follow up research to investigate the differences in provided support from the adolescent and perspective and its effe ct on repeat pregnancy is needed. Perhaps social and emotional support is reflective of risk for repeat pregnancy ; coaxing adolescents to turn t o male partners for nurturing may increas e the risk for secondary pregnancies. Adolescent motherhood described by nulliparous participants was speculated as difficult and stressful. However, adolescents described life as a mother as an adjustment, and not that hard. Specifically not as hard as peers, parents, and society that be investi gated over time as perception s adjust and as parous participants experience reality. Additionally, p articipant views on the television shows 16 & Pregnant and Teen Mom reflect similar findings, suggesting the show s potential to influence adolescent pr egnancy may be diminished by incidence of adolescent pregnancy among close friends. Although the nulliparous perspective suggests both shows portray the hardships of m otherhood close friendships with parous participants who perceive life as not that hard may counteract perceptions of nulliparous participants. In conclusion, future research questions should include: 1. and if so how? 2. Does the meaning of success differ with d ifferent generation, gender, or ra ce/ethnic identity ? 3. How does the individual meaning of success a ffect personal and professional goal aspirations? 4. What is the meaning of motherhood among adolescent mothers and maternal grandmothers? How do their meaning s differ, and how are they the same?
200 5. What is the impact of fatherhood among adolescent fathers? How and why does this differ from experiences of adolescent mothers? 6. How does adolescent motherhood affect the lives of paternal grandmothers? How much respon sibility does the adolescent father and family b e ar in pregnancy prevention, pregnancy support, and raising the infant ? 7. How ha s adolescent motherhood in the media (16 & Pregnant and Teen Mom) affected perceptions of adolescent mothers among the adolescent population? Chapter 5 Conclusion Risk factors and implications of adolescent pregnancy and repeat pregnancy extend across the disciplines of epidemiology social and behavioral sciences, health policy, nursing, medicine and social work. As such, implicatio ns for practice should include input from each of these disciplines. Success had explicit meaning to the participants including having a good job, having a house and car, and being financially independent. The easiest part of motherhood for parous particip ants was caring for and loving their child, the hardest part was meeting the financial needs of their child. However, despite their admitted f ailure to meet their own defini tions o f success (independence), most state d that they were on their way. Additiona lly, primiparous and parous participants described motherhood as not that hard describing adjustments to life as an adolescent mother. Understanding these adjustments and their possible implications for repeat pregnancy are essential to foster hope in ado lescent mothers as a method to reduce rates of repeat pregnancy.
201 APPENDIX A PARTICIPANT INTAKE FORM To be completed and verified BEFORE the interview or after the focus group Demographic Information 1) Ag e: What is your date of birth? _______________ _________ 2) Race & Ethnicity : Please check the box (es) that describes you best (Check all that apply) 1 White 2 Native Hawaiian or Other Pacific Islander 3 Black or African American 4 American Indian or Alaska Native 5 Hispanic 6 Asian/ Asian American 7 O ther _________________________ 3) School Attendance : Please check the box that desc ribes you best (Check one) 1 I go to high school full time 2 I go to high school part time 3 I graduated from high school 4 I quit high school but got a GED 5 I quit high school 6 Other: ___________________ 3b) If you are in school how are you doing academically? (Check one) 1 I get really good grades (As and Bs) 2 I get ok grades (Bs and Cs) 3 I get poor grades (Ds and Fs) 4) Work Status : Are you currently working or looking for a job? (Check one) 1 I work full time 2 I work part time 3 I recently quit or stopped working 4 I am looking for a job 5 I do not work 5) Sexual Activity: Sexually active is defined as someone who has sex three or more times in the past month. ( Check one ) 1 I am currently sexually active 2 I used to be sexually active, but not anymore 3 I am not sexually active, but I have had sex 4 I have never had sex
202 6) Pregnancy Status : Please check the box that describes you best (Check one) 1 I have never been pregnant 2 I have been pregn ant once 3 I have been pregnant two or more times 7) Parenting Status : Please check the box that describes you best (Check one) 1 I have no children 2 I have one child 3 I have two or more children 7b) If you have children, tell me about the m. 1 st child 2 nd child 3 rd child 4 th child 5 th child Age Sex 8) Living Arrangement : Please check the box that describes you best. ( Answer Yes or No for each statement ) Currently in my home, Mom only 1 Yes No Dad only 2 Yes No Mom & Dad 3 Yes No Romantic partner 4 Yes No Friend 5 Yes No Grandmother or grand father 6 Yes No My C hild or children 7 Yes No Other 8 : ____ _____ ___________ ____ Yes No 9) Living Environ ment : Please check the box that describes you best. (Check one) I live in a 1 House 2 Apartment 3 Mobile Home 4 Group Home 5 Other: ________________ 10) Relationship Status : Please check the box that describes you best. (Check one) 1 Singl e 2 Same sex relationship (less than 6 months)
203 3 Same sex relationship (more than 6 months) 4 Committed Boyfriend (less than 6 months) 5 Committed Boyfriend (more than 6 months) 6 Engaged 7 Other: _______________ Family Dynamics 11a). To the bes t of your knowledge, p lease circle your highest grade in school completed: (circle one number ) Elementary: 0 1 2 3 4 5 6 7 8 High school: 9 10 11 12 GED: 12 College/technical school: 13 14 15 16 Graduate: 17 or more b If you live with your mom your MOM currently employed for pay? 1 Yes, full time 2 Yes, part time 3 No, retired 4 No, disabled 5 No, looking for work 6 Other__________________ c. To the best of your knowledge, how old was your MOM when she had her first c hild? __________________ 1 2a) To the best of your knowledge, p lease circle your DAD highest grade in school completed: (circle one number) Elementary: 0 1 2 3 4 5 6 7 8 High school: 9 10 11 12 GED: 12 College/technical scho ol: 13 14 15 16 Graduate: 17 or more b DAD currently employed for pay? 1 Yes, full time 2 Yes, part time 3 No, retired 4 No, disabled 5 No, looking for work 6 Other__________________
204 c. To the best of your knowledge, how old was your DAD when he had his first ch ild? ______________________ 13) To the best of your knowledge, please estimate your household yearly income: (check one box) 1 less than $10,000 6 $50,000 to $59,999 2 $10,000 to $19,999 7 $60,000 to $69,999 3 $20,000 to $29,999 8 $70,000 to $79,999 4 $30,000 to $39,999 9 $80,000 or more 5 $40,000 to $49,999 14) A teen parent is someone who is 18 or younger who is currently pregnant or has one or more children. ( Answer Yes or No for each statement ) My older sister is/ was a teen parent 1 Yes No My younger sister is/was a teen parent 2 Yes No My female cousin is/was a teen parent 3 Yes No My aunt(s) is/was a teen parent 4 Yes No My grandmother is/was a teen parent 5 Yes No I do not know of any female relatives who are teen parents 6 Yes No 15) A teen parent is someone who is 18 or younger who is currently pregnant or has one or more children ( Answer Yes or No for each statement) My older brother is/ was a teen parent 1 Yes No My younger brother is/was a teen parent 2 Yes No My male cousin is/was a teen parent 3 Yes No My uncle(s) is/was a teen parent 4 Yes No My grandfather is/was a teen parent 5 Yes No I do not know of any male relatives who are teen parents 6 Yes No 16) Religious Affiliation : ( Check one ) 1 Non religious/ spiritual environment (I never attended church/temple ) 2 Mildly religious/ spiritual environment (I attended church /temple on the holidays) 3 Moderately religious/spiritual environment (I attend church /temple once a week) 4 Highly religious/spiritual environment (I attend church /temple 2 or more times a week)
205 P eer Relationships 1 7 ) Sexually Active is defined as someone who has had sex three o r more times in the last month. ( Answer Yes or No for each statement) None of the girls I know are sexually active 1 Yes No Some of the girls I know are se xually active 2 Yes No Some of my girl friends are sexually active 3 Yes No Some of my best girl friends are s exually active 4 Yes No My v ery best girl friend is sexually active 5 Yes No 18) A teen parent is someone who is 18 a nd younger who is currently pregnant or has one or more children ( Answer Yes or No for each statement ) None of the girls I know are teen parents 1 Yes No Some of the girls I know are teen parents 2 Yes No Some of my girl friends are teen parents 3 Yes No Some of my best girl friends are teen parents 4 Yes No My very best girl friend is a teen parent 5 Yes No Male Relationships 19) Sexually Active is defined as someone who has had sex three o r more times in the la st month. ( Answer Yes or No for each statement) None of the guys I know are sexually active 1 Yes No Some of the guys I know are sexually active 2 Yes No Some of my guy friends are sexually active 3 Yes No Some of my best guy friends are s exually active 4 Yes No My v ery best guy friend is sexually active 5 Yes No 20) A teen dad is someone who is 18 and younger who has one or more children, or their girlfriend is currently pregnant. ( Answer Yes or No for each statement) None of the guys I know are teen dads 1 Yes No Some of the guys I know are teen dads 2 Yes No I have some guys friends who are teen dad s 3 Yes No Some of my best guy friends are teen dad s 4 Yes No My very best guy friend is a t een dad 5 Yes No
206 Mastery Scale 21) How much do you agree or disagree with the following statements. Strongly Agree 1 Agree 2 Disagree 3 Strongly disagree 4 A. There is really no way I can solve some of the problems I have. B. I have littl e control over the things that happen to me C. Sometime s I feel like I am being pushed around in life. D. There is little I can do to change many of the important things in my life E. What hap pens to me in the future mostly depends on me. F. I often feel helpless in dealing with the problems of life. G. I can do just about anything I set my mind to 22 ) Please tell me how you have been feeling over the last two week s Please check the amount of each emotion you have been feeling Over the past 2 weeks, how much have you Very slightly or not at all 1 A little 2 Moderately 3 Quite a bit 4 Extremely 5 A. Interested B. Distressed C. Excited D. Upset E. Strong F. Guilty G. Scared H. Hostile I. Enthusiastic J. Proud K. Irritable L. Alert M. Ashamed N. Inspired O. Nervous
207 Over the past 2 weeks, how much have you Very slightly or not at all 1 A little 2 Moderately 3 Quite a bit 4 Extremely 5 P. Attentive Q. Jittery R. Active S. Afraid 23 ) Please tell me how you see yourself. For the following statements, please check the box that describes you best. Strongly Agree 1 Agree 2 Disagree 3 Strongly disagree 4 A. I feel that I am a person of worth, at least on an equal plane with others B. Things never work out the way I want them to C. I feel that I have a number of good qualities D. At times I think I am no good at all E. All in all, I am incl ined to feel that I am a failure F. If something can go wrong for me, it will G. I am able to do things as well as most other people H. In uncertain times, I usually expect the best I. I feel that I do not have much to be proud of. J. On a w hole, I am satisfied with myself K. future L. I wish I could have more respect for myself M. I am a believer in the idea that N. I take a positive attitude toward myself O. I rarely count on good things happen ing to me P. I certainly feel useless at times
208 Strongly Agree 1 Agree 2 Disagree 3 Strongly disagree 4 Q. I hardly ever expect things to go my way R. I always look o n the bright side of things Is there anything you would like to add? _____________________________________ ______________________________________________________________________ ___________________________ ___________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ _____________________________________________________________________ ______________________________________________________________________
209 Thank you for your help! Please answer the questions below we will cut off this portion of the survey and keep it separately from your responses. ---------------------------------------------------------------------------------------------------Name: _______________________________ A. What is your preferred phone numbe r? ___________________________________________________________ B. What is your preferred time of day? ______________________________ Staff only -Study ID number: University of Florida
210 APPENDIX B NULLIPAROUS ADOLESCENT INTERVIEW GUIDE Good ____ _____( insert time of day, morning afternoon etc ), Thank you for agreeing to participate in this interview. I would like to confirm a few things before we get started. a. First, I have listed that you are ______ years old, is that correct? __________ b. I have listed that you have had no known pregnancies, is that correct? __________ c. I also correct? ________ d. say will be repeated. Your parents, teachers or friends will not see this interview. However, if you choose to tell me about any cases of abuse (physical or sexual) or report any harm to yourself or others I have to report i t to the authorities. If there are any questions that make you uncomfortable, you can choose not to answer that question. Part 1: Life Story Introduction 1. Tell me about life for girls your age. Probe if necessary: Describe a typical day for you. Probe if necessary : How does that compare to some of your friends? Probe if necessary: What are some things that are going well right now? Probe if necessary: What are some things that worry you? Probe if necessary: What is life like at home? Probe if necessary: (if in school) What is l ife like at school ? Probe if necessary : Are you working? Tell me about your job? Part 2: Future Success and Aspirations Success 2. consider successful, tell me about t his person Probe if necessary : What is it that makes them successful? Probe if necessary : What does success mean to you? Probe if necessary: Describe a successful ___ (insert participant age) year old young woman what about a man ? Probe if necessa ry: Describe a successful ____ (Insert participant age + 10 yrs) year old woman what about a man ? Probe if necessary: How do you decide if someone is successful? What do use to measure success? (Some measure success by the amount of money they have, car s, or nice things etc.) Future Aspirations
211 3. What would you like to be doing? Probe if necessary: What is your plan to get there? Probe if necessary : Has this always been your goal, or has it change d? Probe if necessary : Why has it changed? Probe if necessary: What do you think your life will be like in 10 years? Probe if necessary: Where will you be living? Probe if necessary: What type of job or career will you have? (location, living environmen t, family, friends, job) Professional Future 4. Can you tell me your career plans and hopes for the future? Probe if necessary : What type of job do you want after high school? Probe if nec essary : What about _________ career interests you? Probe if necessary : H ow did you arrive at that choice? Probe if necessary : Has this always been your goal, or has it changed? Probe if necessary : Why has it changed? Probe if necessary: What is your p lan to become a ________ ? Probe if necessary : Is your plan moving ahead the way you want? Probe if necessary: What do you think about college? Personal Future 5. family ten years from now? Probe if necessary: Do you see yourself with someone special? Probe if necessary: (if they mention marriage) How old do you want to be when you get married? Probe if necessary : How old do you think you will be? Probe if necessary: What do you think your wedding will be like? Probe if necessary: Can you describe your future husband? Probe if necessary: What role do children have in your future? Probe if necessary: How many children do you think about having? Probe if necessary: When do you want to have your first child? Probe if necessary: When do you want to be done having children ? Part 3: Past and present relationships The next few questions are about your past and present relationships. Please keep in mind this intervi ew will remain between us. However, if you choose to tell me about any cases of physical of sexual abuse I will report it. This includes cases about statutory rape (sexual relationship between older boy and underage girl). Relationships 6. When did you ha ve your first romantic relationship? Probe if necessary: H ow did you come about dating?
212 Probe if necessary: W hat are some things you liked about the relationship? Probe if necessary: W hat are some things you wanted to change about the relationship? Prob e if necessary: Are you currently in a relationship? Probe if necessary: Tell me about that person. Probe if necessary: How long have you been in a relationship? Probe if necessary: What are some things you like about the relationship? Probe if necessar y: What are some things you would like to change about the relationship? Sexuality 7. between us, and none of your friends, teachers or parents will see your answers. When d id you first learn about sex? Probe if necessary: What do you remember learning about sex? Probe if necessary: Where did you learn about sex? Was it at school? At home? Probe if necessary : What did you learn from friends? Probe if necessary: What wer e some of the biggest questions you had, when you first learned about sex? Probe if necessary : From your understanding what is the best way to prevent getting a STD? Probe if necessary : From your understanding what is the best way to prevent getting preg nant? 8. Tell me about your first sexual experience. Probe if necessary : ctiv is when you have sex three or more times in a month. Would you consider yourself sexually active? Probe if necessary: When is the last time you had sex? Probe if ne cessary : Are your friends sexually active? What do you think about that? Probe if necessary : Are you currently trying to prevent pregnancy? Probe if necessary : What are you doing to prevent getting pregnant? Part 4: Pregnancy, Motherhood and Media Ne instead use a made up a name. Please keep in mind your parents, friends and teachers will not see this interview Pregnancy (For nulliparous adolescents) 9. Next, I would like to talk about girls who have babies in high school. I would like you to think for a minute about a girl your age who has had a baby. Can you describe what you thin k it is like for girls who have a baby in high school? Probe if necessary: What are some good things about having a baby in high school ?
213 Probe if necessary: What are some difficult things about having a baby in high school? Probe if necessary: What are some reasons girls may have a baby when they are still in school? Probe if necessary: What are some reasons not to have a baby while you are still in school? Probe if necessary: What is your biggest reason for not having a baby right now? Motherhood 10. Can you describe what you think it is like for a teen mother? Probe if necessary: What do you think are some of the easiest things about being a teen mom? Probe if necessary: What do you think are some of the hardest thing s about being a teen mo m ? P robe if necessary: educational plans? Probe if necessary : personal plans? Probe if necessary: r omantic plans? Probe if necessary : or work plans? Media 11. MTV has two popular television shows about teen pregnancy and motherhood. 16 and Pregnant ? Probe if necessary: 16 and Pregnant ? Probe if necessary: How does the show compare to your thoughts about teen pregnancy? Probe if necessary: Teen Mom Probe if necessary: How does the show compa re to your thoughts about being a teen mother? Probe if necessary: Can you tell me about any other TV shows or movies that discuss teen pregnancy or motherhood? Probe if necessary: What are your thoughts about these TV shows or movies? Part 5 Future and past advice participating in the interview. I only have a few more questions. We are going talk a little more about your goals for the future. Past Self 12. If you could go back and change one thing about the past related to your personal past what would it be? Why is that?
2 14 Probe if necessary : If you could go back and change one thing about your academic past what would it be? Why is that? Probe if necessary : If you could go back and change one thing about your romantic past what would it be? Why is that? Probe if necessary : Do you have any advice for your past self? Future Self 13. Is there any one thing you are excited about, or looking forward to in the future? Why i s that? Probe if necessary : Do you have any advice for your future self? Conclusion 14. Is there anything else you would like to tell me about being a teenager? 15. Is there anything else you would like to tell me about being a mother? Worksheet In structions Ok, I have two more items before we finish up. First I would like to talk about community and success a little more. I am going to give you a handout (hand participant worksheet). On the sheet, please list some characteristics of successful and unsuccessful people in your community. I want you to think of your neighborhood, classmates, friends and family as your community. Second, I would like you to review the community ladder. The people you described as successful are at the very top of the ladder. Those you described as unsuccessful are at the bottom of the ladder. A. Mark an X on the ladder where you think stand at this point in your life. think you will be in three years want to b e in three years. Lastly, (Hand participant cards) to put them order. On the top put the item that is going to most help you get to the rung or level At the bottom put the item that will help you the least. If there is something not listed that you think is going to help you get to your top rung write it on the card marked other Now put the cards in order. What card did you put on top, what will make it easiest to get to the top rung. (Write order below) _____ Graduating from high school _____ Going to college or technical school _____ Getting a job _____ Having a baby
215 _____ Owning something costly; car, home, boat, music instrument _____ Getting married _____ Go ing out more _____ Having lots of money _____Other ________________________ Probe if necessary: I noticed that you put _________ on the top, why is that? Probe if necessary: I noticed that you put _________ on the bottom, why is that? Probe if necessary : How did you finally make the decision? it hard for you to reach your rung. On the top please put the item that is going to make it HARDEST to reach your top rung At the bottom put the item that is going to make things Easiest If there is something not listed mark this item on the card marked other. Now put the cards in order. What card did you put on top, what will make it hardest to get to the top rung. (Write order below). _____ Graduating from high school _____ Going to college or technical school _____ Getting a job _____ Having a baby _____ Owning something costly; car, home, boat, music instrument _____ Getting married _____ Going out mor e ______Having lots of money ___ ___ Other ________________________ Probe if necessary: I noticed that you put _________ on the top, why is that? Probe if necessary: I noticed that you put _________ on the bottom, why is that? Probe if necessary : How did you finally make the decision?
216 Interview Worksheet Where would you place yourself on this ladder? X where you think you stand at this time in your life relative to other people in your community. XX will be in 3 years XXX you want to be in 3 years What are some things you think desc ribe successful people at the top of the ladder. _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ __________________ _____________ ________________ ___ _______________________ Write some things you think describe unsuccessful people at the bottom of the ladder. ___________________ _______________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ __________________________________ Community Ladder At the top of the ladder are the people who have the highest standing in your community. At the bottom are the people who have the lowest standing in your community
217 APPENDIX C PRIMIPAROUS/ MULTIPAROUS ADOLESCENT INTERVIEW GUIDE Good ________ ( insert time of day, morning afternoon etc. ), Thank you for agreein g to participate in this interview. I would like to confirm a few things before we get started. a. First, I have listed that you are ______ years old is that correct ? __________ b. I have listed that you have _____ child/ children, is that correct? ________ __ c. And, their ages are ____________, is that correct? __________ d. Lastly, correct? ________ e. Ok, before we get started Nothing you say will be repeated. Your parents, teachers or friends will not see this interview. However, if you choose to tell me about any cases of abuse (physical or sexual) or report any harm to yourself or others I have to report i t to the authoritie s. If there are any questions that make you uncomfortable, you can choose not to answer that question. Part 1: Life Story I ntroduction 1. Please t ell me about life for girls your age. Probe if necessary: Describe a typical day for you. Probe if necessar y: How does that compare to some of your friends? Probe if necessary: What are some things that are going well right now? Probe if necessary: What are some things that worry you? Probe if necessary: What is life like at home? Probe if necessary: (if in school) What is life like at school? Probe if necessary: Are you working? Tell me about your job? Probe if necessary: ( if they have/ mention children ) Tell me about your daughter/ son/ children? Part 2: Future Success and Aspirations Success consider successful, tell me about this person Probe if necessary : What is it that makes them successful? Probe if necessary : What does success mean to you? Probe if neces sary: Describe a successful ___ (insert participant age) year old young woman what about a man ? Probe if necessary: Describe a successful ____ (Insert participant age + 10 yrs) year old woman what about a man ?
218 Probe if necessary: How do you decide if someone is successful? What do use to measure success? (Some measure success by the amount of money they have, cars, or nice things etc.) Future Aspirations 10. What would you like to be doing? Probe if necessary: What is your plan to get there? Probe if necessary : Has this always been your goal, or has it changed? Probe if necessary : Why has it changed? Probe if necessary: What do you think your life will be like in 10 years? Probe if necessary: Whe re will you be living? Probe if necessary: What type of job or career will you have? (location, living environment, family, friends, job) Professional Future 11. Nex to think about your future job or career. Can you tell me your career pla ns and hopes for the future? Probe if necessary : What type of job do you want after high school? Probe if necessary : What about _________ career interests you? Probe if necessary : H ow did you arrive at that choice? Probe if necessary : Has this always been your goal, or has it changed? Probe if necessary : Why has it changed? Probe if necessary: What is your plan to become a ________ ? Probe if necessary : Is your plan moving ahead the way you want? Probe if necessary: What do you think about college? P ersonal Future 12. family ten years from now? Probe if necessary: Do you see yourself with someone special? Probe if necessary: (if they mention marriage) How old do yo u want to be when you get married? Probe if necessary : How old do you think you will be? Probe if necessary: What do you think your wedding will be like? Probe if necessary: Can you describe your future husband? Probe if necessary: How many children d o you think about having? Probe if necessary: When do you want to be done having kids? Part 3: Past and present relationships The next few questions are about your past and present relationships. Please keep in mind this interview will remain between us. However, if you choose to tell me about any cases of physical of sexual abuse I have to report it. This includes cases about statutory rape (sexual relationship between older boy and underage girl). Relationships
219 13. When did you have your first romanti c relationship? Probe if necessary: H ow did you come about dating? Probe if necessary: W hat are some things you liked about the relationship? Probe if necessary: W hat are some things you wanted to change about the relationship? Probe if necessary: Are y ou currently in a relationship? Probe if necessary: Tell me about that person. Probe if necessary: How long have you been in a relationship? Probe if necessary: What are some things you like about the relationship? Probe if necessary: What are some thin gs you would like to change about the relationship? Sexuality 14. between us, and none of your friends, teachers or parents will see your answers. When did you first learn ab out sex? Probe if necessary: What do you remember learning about sex? Probe if necessary: Where did you learn about sex? Was it at school? At home? Probe if necessary : What did you learn from friends? Probe if necessary: What were some of the biggest questions you had, when you first learned about sex? Probe if necessary : From your understanding what is the best way to prevent getting a STD? Probe if necessary : From your understanding what is the best way to prevent getting pregnant? 15. Tell me about your first sexual experience. Probe if necessary : ctiv is when you have sex three or more times in a month. Would you consider yourself sexually active? Probe if necessary: When is the last time you had sex? Probe if necessary : Are your fri ends sexually active? What do you think about that? Probe if necessary : Are you currently trying to prevent pregnancy? Probe if necessary : What are you doing to prevent getting pregnant? Part 4: Pregnancy, Motherhood and Media some questions about your pregnancy and transition to your parents, friends and teachers will not see this interview. However, if you tell me about any cases of abuse I w ill have to report it. Pregnancy 16. us and you can skip any question that makes you uncomfortable. Tell me what it was like when you first found out you were pregnant Probe if necessary: How did you feel when you first found out you were pregnant?
220 Probe if necessary: Who did you tell about your pregnancy first? Why did you tell that person first? Probe if necessary: Who did you tell about your pregna ncy last? Why did yo u tell that person last? Probe if necessary: How did the father of your child view your pregnancy? How did he feel after you had the baby? Probe if necessary: H ow d id your parents view your pregnancy? How did they feel after you had the baby? Probe if n ecessary: How did your friends view your pregnancy? How did they feel after you had the baby? Motherhood 17. Can you describe a typical day as mother? Probe if necessary : What is it like to be a young mother? Probe if necessary : How have things changed since you became a mom? Probe if necessary: What are some of the easiest things about being a mom? Probe if necessary: What are some of the hardest thing s about being a mo m ? Probe if necessary: Tell me how motherhood has changed your educational plans? Probe if necessary : T ell me how motherhood has changed your personal plans? Probe if necessary: How has motherhood changed your romantic plans? Probe if necessary : Tell me how motherhood has changed your work or career plans? Media 11. MTV has two popu lar television shows about teen pregnancy and motherhood. 16 and Pregnant ? Probe if necessary: 16 and Pregnant ? Probe if necessary: How does the show compare to your thoughts about teen pregn ancy? Probe if necessary: Teen Mom Probe if necessary: How does the show compare to your thoughts about being a teen mother? Probe if necessary: Can you tell me about any other TV shows or movies that discuss teen pre gnancy or motherhood? Probe if necessary: What are your thoughts about these TV shows or movies? Part 5 Future and past advice participating in the interview. I only have a few more questions. We are going talk a little more about your goals for the future. Past Self 12. If you could go back and change one thing about the past related to your personal past what would it be? Why is that? Probe if necessary : If you could go back and change one thing about your academic past what would it be? Why is that?
221 Probe if necessary : If you could go back and change one thing about your romantic past what would it be? Why is that? Probe if necessary : Do you have any advice for your pa st self? Future Self 13. Is there any one thing you are excited about, or looking forward to in the future? Why is that? Probe if necessary : Do you have any advice for your future self? Conclusion 14. Is there anything else you would like to tell me about being a teenager? 15. Is there anything else you would like to tell me about being a mother? Worksheet Ok, I have two more items before we finish up. First I would like to talk about community and success a little more. I am going to give you a handout (hand participant worksheet). On the sheet, please list some characteristics of successful and unsuccessful people in your community. I want you to think of your neighborhood, classmates, friends and family as your community. Second, I would li ke you to review the community ladder. The people you described as successful are at the very top of the ladder. Those you described as unsuccessful are at the bottom of the ladder. A. Mark an X on the ladder where you think stand at this point in your li fe. think you will be in three years want to be in three years. Lastly, (Hand participant cards) to put them order. On the top put the item that is going to most help you get to the rung or level At the bottom put the item that will help you the least. If there is something not listed that you think is going to help you get to your top rung write it on the card marked other Now put the cards in order. What card did you put on top, what will make it easiest to get to the top rung. (Write order below) _____ Graduating from high school _____ Going to college or technical school _____ Getting a job _____ Having a baby _____ Owning something costly; car, home, boat, music instrument _____ Getting married _____ Going out more
222 _____ Having lots of money _____Other ________________________ Probe if necessary: I noticed that you put _________ on the top, why is that? Pr obe if necessary: I noticed that you put _________ on the bottom, why is that? Probe if necessary : How did you finally make the decision? it hard for you to reach your rung. On the top please put the item that is going to make it HARDEST to reach your top rung. At the bottom put the item that is going to make things Easiest If there is something not listed mark this item on the card marked other. Now put the cards in order. What card did you put on top, what will make it hardest to get to the top rung. (Write order below). _____ Graduating from high school _____ Going to college or technical school _____ Getting a job _____ Having a baby _____ Own ing something costly; car, home, boat, music instrument _____ Getting married _____ Going out more ______Having lots of money ___ ___ Other ________________________ Probe if necessary: I noticed that you put _________ on the top, why is that? Probe if nec essary: I noticed that you put _________ on the bottom, why is that? Probe if necessary : How did you finally make the decision?
223 Interview Worksheet Where would you place yourself on this ladder? X you think you stand at this time in your life relative to other people in your community. XX think you will be in 3 years XXX want to be in 3 years Write some things you think describe unsuccessful people at the bottom of the ladder. _________________________________ _________________________________ _________________________________ ________________________ _________ _________________________________ _________________________________ _________________________________ What are some things you think describe successful people at the top of the ladder. __________________________________ ___________________________ _______ __________________________________ __________________________________ __________________________________ __________________________________ ____________ ______________________ At the top of the ladder are the people who have the highest standing in your community. Community Ladder At the bottom are the people who have the lowest standing in your community
224 APPENDIX D FOCUS GROUP SCRIPT AND QUESTION GUIDE Good _________( insert time of day, m orning afternoon etc ), Thank you for agreeing to participate in focus group. girls your age. I want to know your opinion on school, home, sex, teen motherhood, and most importantly your personal and professional goals. Before we get started, I would like to go through some things. a. Those of you that are under eighteen must have parent / guardia n conse nt. (Assess situation) b. Each of you should have handed me a completed intake form. (Assess situation) c. Each of you should have a name badge, on th at name badge is your stage name for ot use real names. d. This focus group will be audio recorded. This is a friendly setting. Everyone will get a chance to speak. Try not to talk over or interrupt one another and be mindful of the digital recorder. Please do not yell, fight or use a lot of c urse words. e. Lastly this group will not know what you say here today. I ask that you all res pect And again, p lease do not use any real names in group. However, i f you choose to tell me about any cases of abuse (physical or sexual) or report any harm to yoursel f or others I have to re port i t to the authorities. If there are any questions that make you uncomfortable, you can choose not to answer that question. Draw Focus Group Set Up and Place Setting Names, Age, Ethnicity
225 Topic Focus Group Question Part 1: Life Sto ry Introduction Tell me about life for girls your age. Probe if necessary: Describe a typical day for you. Probe if necessary: How does that compare to some of your friends? Probe if necessary: What are some things that are going well for you all right now? Probe if necessary: What are some things that worry you all? Probe if necessary: What is life like at home What is life like at school, If you are you working, tell me about your job? Success each of you to think about someone you consider successful, tell me about this person. Probe if necessary: What is it that makes them successful? Probe if necessary : What does success mean to you? Probe if necessary: Describe a successful 17 year old woman what about a successful 27 year old woman. A man? Probe if necessary: What are some ways you decide if someone is successful? What do you use to measure success? (Some measure success by the amount of money they have, cars, or nice thing s etc.) Part 2: Future Success and Asp irat ions to do after you turn 18 or finish school. Future Aspirations now. What would you like to be doing? Probe if necessary: Describe your plan to get there. Probe if necessary: Has this always been your goal, or has it changed? Probe if necessary: What are some reasons your goal has changed? Probe if necessary: What d o you think your life will be like in 10 years? Probe if necessary: Where will you be living? Probe if necessary: What type of job or career will you have? (location, living environment, family, friends, job) Future Professional all to think about your future job or career. Tell me some of your career plans. Probe if necessary: What is your dream job 10 years from now? Probe if necessary: what is your back up job 10 years from now? Probe if necessary: What role does college p lay in your future?
226 Future Personal you tell me about your family ten years from now? Probe if necessary: Do you see yourself with someone special? Probe if necessary: Can you describe your future partner? Probe if necessary: Do you want to get married, What do you think your wedding will be like? Probe if necessary: What role do children have in your future? Probe if necessary: W hen do you want to have your first child? Whe n do you want to have your last child. Probe if necessary: How many children do you think about having? Part 3: Past and P resent R elationships The next few questions are about your past and present relationships. Please keep in mind this interview wil l remain between us. However, if you choose to tell me about any cases of physical of sexual abuse I will report it. This includes cases about statutory rape (sexual relationship between older boy and underage girl). Sexuality When did you first learn about sex? Probe if necessary: What do you remember learning about sex? Probe if necessary: Where did you learn about sex? Was it at school? At home? What did you learn from friends? Probe if necessary: What were some of the biggest questions you h ad, when you first learned about sex? Probe if necessary: From your understanding what is the best way to prevent getting a STD ? Probe if necessary: From your understanding what is the best way to prevent getting pregnant? Pa rt 4: Pregnancy, Motherhood and Media you or your friends who are pregnant or mothers. Try not to use real name, instead use a made up a name. Please keep in mind you r parents, friends and teachers will know what you say today. Pregnancy talk about girls who have babies in high school Probe if necessary: have a baby in high school? Probe if necessary: What are s ome reasons girls may have a baby when they are still in school? Probe if necessary: What are some reasons not to have a baby wh en they are still in school?
227 Motherhood If you are a m other, or know a young mother, c an you describe what it is like for a t een mother? Probe if necessary: How do you think motherhood will change a teen Probe if necessary: How do you think motherhood will change a teen Probe if necessary: How do you think motherhood will change a teen Media MTV has two popular television shows about teen pregnancy and motherhood. Have any of y 16 and Pregnant ? Probe if necessary: 16 and Pregnant Probe if necessary: How does the show compare to your thoughts about teen pregnancy? Probe if necessary: Teen Mom Probe if necessary: How does the show compare to your thoughts about being a teen mother? Probe if necessary: Can you tell me about any other TV shows or movies that discuss teen pregnancy or motherhood? Probe if necessary: What are your thoughts about these TV shows or movies? Part 5: Future and P ast advice k you all again for participating. I only have a few more questions. We are going talk a little more about goals for the future. Past Self If you could go back and change one thing about the past related to your personal past what would it be? Why is th at? Probe if necessary : If you could go back and change one thing about your academic past what would it be? Why is that? Probe if necessary : If you could go back and change one thing about your romantic past what would it be? Why is that? Probe if neces sary : Do you have any advice for your past self? Future Self Is there any one thing you are excited about, or looking forward to in the future? Why is that? Probe if necessary : Do you have any advice for your future self? Conclusion Is there anyth ing else you would like to tell me about being a teenager? Is there anything else you would like to tell me about being a mother?
228 Ok, we are almost finished with the focus group. Our last activity is a group task. I am going to split you into groups I am g oing to hand each group a work sheet and some index cards. (Split focus group into smaller groups of 3 4 people; hand each group a worksheet and index cards). 1. First, list your stage names at the top of the sheet. 2. Next, take the next 5 min utes and write down some characteristics (traits) of successful people in your community. Write these items in question 1. Think of your community as your neighborhood, classmates, friends and family 3. After you have finished with question 1, write dow n some characteristics (traits) of unsuccessful people in your community. Write these items down in question 2. 4. Next take a minute to look at the community ladder. The people you described in question one are at the top of the ladder. T hose you described in question 2 (unsuccessful people), are at the bottom of the ladder. 5. Using the index cards, put the cards in order from MOST important to LEAST important in helping you (the group) reach the top of the ladder. If there is something not listed in the cards, write that item on the card marked other. When you have finished put the order in question 3. 6. And finally, using the same index cards, put the cards in order using the item that is going to make it HARDEST to reach the top of the ladder. Put the item that is going to make it EASIEST at the bottom. If there is something not listed in the cards, write that item on the card marked other. When you have finished put the order in question 4. 7. Thank you, we are finished with the focus group, before you go please make sure to take a goody bag. If you have any questions or want to talk to me, I am available.
229 Group Handout Group Member Names ( Use Stage N ames ):_________________________________ 1. List some things you think describe successful people at the top of the ladder. ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________ ________ _________________________ ___ ____________________________ _______________________ 2. List some things you think describe unsuccessful people at the bottom of the ladder. _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ Community Ladder At the top of the ladder are the people who have the highest standing in your community 3. Rank the index cards. On the top put the item that is going to help you the MOST get to the top of the ladder. At the bottom put the item that will help you the LEAST. If there is something not listed that you think is going to help you get to the top, write it on the card Put the order below: _____ Graduating from high school _____ Going to college or technical school _____ Getting a job _____ Having a baby _____ Owning something costly (car, home, boat, music instrument) _____ Getting married _____ Going out more _____ Having lots of money _____ Other ________________________ At the bottom are the people who have the lowest standing in your community 4. Rank the index card s. On the top please put the item that is going to make it HARDEST to reach your top rung. At the bottom put the item that is going to make things easiest. Put the order below : _____ Graduating from high school _____ Going to college or technical school _____ Getting a job _____ Having a baby _____ Owning something costly (car, home, boat, music instrument) _____ Getting married _____ Going out more _____ Having lots of money _____ Other ________________________
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249 BIOGRAPHICAL SKETCH Evely n received a Bachelor of H ealth Science in 2005 and Master of Public Health in 2007, both from the Univers ity of Florida. a bstinence o nly, and then a t obacco e ducation program manager in two rural North Central Florida c ounties. Working at a small health department afforded her the op portunity to work closely with other public health programs including Healthy Start. Healthy S tart is a service referral and coordination program that aims t o improve the health o f mothers and babies up to age three. During her tenure at the health department, Evelyn becam e increasingly aware of the prevalence and consequences of teen pregnancy. She found it especially frustrating to observe adolescent mothers and repeat mothers attending the abstinence only curriculum. She thought the current program did not address the un ique needs dissertation research spun out of her experiences and inter actions with adolescent mothers and repeat mothers during her work at the health department Following graduation, Evelyn plans to continue to investigate goa l aspirations as a prevention/ reduction strategy for repeat births. She is particularly interested in working with primary and secondary prevention programs to foster mentoring and success modeling to reduce rates of teen pregnancy and repeat pregnancy Additionally, s he hope s to expand her research to include 1) goal aspirations among minority populations as a method to increase high school graduation and college enrollment ; and 2) improving maternal and child health outcomes among impoverished mothers