Social context and theoretical Teen Pregnancy Prevention.

Lack of a Theoretical Base

In the field of adolescent pregnancy prevention, the lack of a theoretical base has resulted in part from information gaps that arise when researchers do not have the opportunity to help programs understand the potential application of theory-based findings both to existing interventions and to the creation of new ones. In addition, program developers and providers often lack the training, the time, or the incentive to alter existing program practice by incorporating theoretically-based research and findings that are relevant to their programs. This information gap frequently results in a mismatch between research findings and the types of programs that are currently available to adolescents and their families through community settings. The failure to apply theoretical frameworks to programs for adolescents may also stem from stereotyping teenage behavior as irrational and impulsive, and thus not suitable to the application of rational theoretical models. Adler et al. have demonstrated that adolescents do in fact make rational decisions and are an appropriate target population to which theoretical frameworks can be applied

Selecting the Level of Program Intervention

On the individual level, many pregnancy prevention programs employ interventions aimed at changing cognitive, behavioral, and psychosocial characteristics that are shown to directly impact sexual antecedents, such as the number of sexual partners, onset of sexual activity, and the level of contraceptive use. These interventions are often curricular-based, such as HIV/AIDS and sex education (including abstinence-only programs), and aim to improve teenagers’ knowledge, attitudes, and beliefs about sexuality and teen pregnancy. These programs may also include other components, such as sex and HIV education targeting parents and families and reproductive health programs designed to improve access to condoms and contraceptives.

Interpersonal Level Interventions

The interpersonal level includes familial, peer, and other social relationships. At this level it is understood that such factors as relationships with family members, teachers, peers and significant others influence peoples’ feelings and actions. Programs at this level of analysis often include peer support and connections with mentors and other adults.

Social Structural Level Interventions

The social structural level emphasizes social and community factors, such as access to and distribution of financial and cultural resources, including family income, education, employment opportunities, and extra-curricular activities. Programs at this level of analysis often include cultural norms, access to care, and inequalities in educational and other community resources.

Evolution of Teen Pregnancy Prevention Program Interventions

Recognizing the limitations of the past, pregnancy prevention programs are shifting from a singular focus on knowledge, attitudes, and belief-based interventions and/or interventions focused on access, to services that emphasize multifactorial, multilevel approaches to teen pregnancy. As the field acknowledges a clustering of risk factors, programs are being developed accordingly—addressing the antecedents to teen pregnancy (e.g., academic failure) as well as preparing young people with the tools to navigate their adolescent years pregnancy-free. Despite this shift, many programs continue to emphasize individual level attributes and, thus, are directed at impacting sexual behavioral antecedents exclusively and do not pay attention to non-sexual antecedents, such as cultural norms and need for service learning, vocational education and employment opportunities, and adult connections. That is, few programs aim to shape

interventions based on what we know from theoretical research about the complexity of changing health risk behaviors and increasing protective behaviors. We contend that if programs are able to gain clarity on theoretical options, types of antecedents, and intervention choices, more effective interventions are possible. In fact, many of the theoretical frameworks include both personal (or internal) and environmental (or external) factors, and the interaction between the two.