Petals & Pearls Program Toolkit




          Organized by: Lusi M. Martin
           MS-MPH Graduate student
        Univ...
TABLE OF CONTENTS


CHAPTER 1: INTRODUCTION                3

CHAPTER 2: SUGGESTED BEST PRACTICES    5

CHAPTER 3: WHY PET...
CHAPTER 1: INTRODUCTION
ADOLESCENT PREGNANCY: DEFINING THE PROBLEM

In the United States, adolescent pregnancy rates are c...
pregnancy prevention programs established before these adolescents begin to think about
sexuality and/or experience peer p...
CHAPTER 2: SUGGESTED BEST PRACTICES
According to a review of the literature by Johns et al (2000) along with surveying of ...
CHAPTER 3: WHY PETALS & PEARLS?
The Petals and Pearls Program is sponsored through a collaboration between KAPPI and
the P...
CHAPTER 4: THE NUTS AND BOLTS
STEPS FOR CONDUCTING A PETALS & PEARLS PROGRAM.

 **Read through this section of the toolkit...
Step 2: Conduct a Needs Assessment

A. Decide community’s           Although adolescent pregnancy prevention is
readiness ...
Step   3: Implementation
Pre-Program Implementation

A. Determine Day for Petals & Pearls Program to be held

B. Post flye...
Step   4: Evaluation & Follow-up
Remind all participants of the Petals & Pearls event to fill out the evaluation sheet pro...
APPENDICES




    11
Appendix A

                        Task/Action Steps                                  Who’s Responsible      Timeline   R...
Appendix B
                                            Logic Model for Petals and Pearls Program


       INPUTS          ...
Appendix C                      Tri-Ethnic Center for Prevention Research
                                            Scor...
Dimension B: Community Knowledge of the Efforts
- 0
-
-
-
- 1       Community has no knowledge of the need for efforts add...
Dimension C: Leadership
                    (Includes appointed leaders and influential community members.)
- 0
-
-
-
- 1 ...
Dimension D: Community Climate

- 0
-
-
-
- 1 The prevailing attitude is that it’s an accepted part of community life. “It...
Dimension E: Community Knowledge About the Issue


- 0
-
-
-
- 1 Not viewed as an issue.
-
-
-
- 2 No knowledge about the ...
Dimension F: Resources Related to the Issue (People, money, time, space, etc.)
- 0
-
-
-
- 1 There is no awareness of the ...
Tri-Ethnic Center for Prevention Research

                                           Community Readiness Scoring
Staff: _...
CALCULATED SCORE




AVERAGE: ______________________ STAGE: _____________________

   COMMENTS about Calculated Score (if...
Tri-Ethnic Center for Prevention Research

                                    Scoring Instructions for the Community Read...
A score of 4.21 would be entered under “Average.”

7)      For “Stage”, you will enter the stage that is represented by yo...
Appendix D

            Petals and Pearls                                       Petals and Pearls
                   Save ...
Appendix E
                   Mother/Daughter Goal Plan
Objective:
1. To foster communication and team work skills between...
Planning Goals and Activities Worksheet

                                                                PERSON(S) COMPLET...
Appendix F
                            Manicure and Pedicure Day

Objective:
1. To help build trust between mother and dau...
Appendix G
                                    Fashion Show
Objective:
1. To promote positive body image and boost self-es...
Appendix H
                                  Creating Jewelry Together
    Objective:
    1. To promote and provide ease i...
Appendix I
                                Tune Time
Objective:
1. To learn about choices and feelings
2. To encourage com...
Appendix J
       Make Greeting Cards for One Another
Objective:
1. To learn how to express feelings to one another
2. To ...
Appendix K
                     Bake/Decorate Cookies
Goal:
To encourage a mother/daughter discussion about goals and plan...
Appendix L
              Create a Family Newsletter
Goal:
To have an increased awareness of personal accomplishments, goal...
Appendix M
                           Values Discussion
Goal:
Mothers and daughters will have a personal discussion on val...
Appendix N
                       The Girl’s Book Club
Goal:
To increase communication between mother and daughter, build ...
Appendix O


     MEEETING SIGN-IN SHEET
     PROGRAM:                          PROGRAM PLACE:
     TIME:
            MOTH...
Appendix P

                                  Petals & Pearls
                                           Date:___________
...
Appendix Q

                               Sample Introduction Dialogue


Welcome & Purpose

My name is ____________, and ...
    In 2007, 7.5% of high school students in Tennessee reported having engaged in sexual
       intercourse before age 13...
Appendix R
                                    Petals and Pearls
                                  A Mother Daughter Tea
 ...
LIKE MOTHER LIKE DAUGHTER
                  By: Ashley Gadison




   Like mother like daughter my mother and me,
        ...
TO BE YOUNG GIFTED & BLACK
          By: Nina Simone & Weldon Irvine


       To be Young Gifted and Black
           What...
Proper Etiquette Styles in 2009
                       How to Follow Tea Party Etiquette

   Know how to understand a tab...
References
Edwards, R. W., Jumper-Thurman, P., Plested, B.A., Oetting, E.R., & Swanson, L. (2000).
     Community readines...
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Petals And Pearls Program Toolkit

  1. 1. Petals & Pearls Program Toolkit Organized by: Lusi M. Martin MS-MPH Graduate student University of Tennessee, Knoxville Fall 2009 1
  2. 2. TABLE OF CONTENTS CHAPTER 1: INTRODUCTION 3 CHAPTER 2: SUGGESTED BEST PRACTICES 5 CHAPTER 3: WHY PETALS & PEARLS? 6 CHAPTER 4: NUTS & BOLTS 7 APPENDICES 11 REFERENCES 44 2
  3. 3. CHAPTER 1: INTRODUCTION ADOLESCENT PREGNANCY: DEFINING THE PROBLEM In the United States, adolescent pregnancy rates are considerably higher in comparison to most developed countries and remains a public health concern that cost a significant amount of U.S. healthcare dollars ($9.1billion) (Singh & Darroch, 2000; Hoffman, 2006). In 2007, there were a total of 4,317,119 adolescent births which was a 1% increase from 2006 (4,265,555), and the highest birth rate ever registered in the United States for adolescents (Center for Disease Control (CDC), 2007). According to reports from the 2007 Tennessee Youth Behavior Risk Factor Survey, 54.4% of high school students reported ever having sexual intercourse, a figure above the U.S. YBRFS of 47.8% (Tennessee State Health Department, 2007). The reports of higher percentage of adolescent pregnancy in Tennessee than national reports is a concern that needs attention as adolescent pregnancy entails short and long term social and economic implications for the teen parent and their children seen in Table 1 (CDC, 2009; Hoffman, 2006; Manlove et al., 2002). Table 1.1: Social & Economic Implications for Teen Parents and their Children.  Mothers are more likely to drop out of high school  Mothers are more likely to remain single parents  Children more likely to have lower cognitive attainment and proficiency scores at kindergarten entry,  Children are more likely to exhibit behavior problems,  Children are more likely to have chronic medical conditions,  Mother and children are more likely to rely more heavily on publicly provided health care,  Children are more likely to be incarcerated at some time during adolescence until their early 30s, and  Drop out of high school, give birth as a teenager, and be unemployed, or underemployed as a young adult. Healthy People 2010 Objectives have documented “Responsible Sexual Behavior” as one of the 10 leading health indicators. Under this health indicator, there are two main objectives and they are by 2010 to (Office of Disease Prevention and Health Promotion, 2000):  increase the proportion of adolescents who abstain from sexual intercourse or use condoms if sexually active  increase the proportion of sexually active persons who use condoms Evidence suggest that the issue of adolescent pregnancy in the U.S. is complex and affects numerous parties including families, healthcare professionals, educators, government, officials and youth (Singh & Darroch, 2000; Klein, 2005). Therefore, various intervention strategies is needed to tackle the adolescent pregnancy issue in the community (i.e. schools, families, community). Thus, it is important to have adolescent 3
  4. 4. pregnancy prevention programs established before these adolescents begin to think about sexuality and/or experience peer pressure. According to adolescent pregnancy experts there are several signs and predictors of early sexual intercourse during the adolescent years including but not all a history of sexual abuse, poverty, lack of attentive and nurturing parents, cultural and family family patterns of sexual experiences, lack of education or career goals, peer pressure, poor school performance or dropping out of school (Klein, 2005). All of these factors are important indicators that can be and needs to be addressed very early on in life to improve teen pregnancy rates. Evidence points to the importance of parent-child relationships in significantly impacting adolescent’s decisions to engage or to not engage in sexual behaviors (CDC, 2009; Manlove et al., 2009). 4
  5. 5. CHAPTER 2: SUGGESTED BEST PRACTICES According to a review of the literature by Johns et al (2000) along with surveying of local teen pregnancy and parenting programs located in schools and in the community, 10 best practices for practitioners in teen pregnancy programs were identified. These best practices include:  Youth Development  Programs to Improve Employment  Involvement of Family and Other Opportunities Caring Adults  Sexuality Education and AIDS  Male Involvement Education Programs  Cultural Relevance  Outreach in Teen Pregnancy  Community-Wide Campaigns Prevention Programs  Service Learning Programs  Access to Reproductive Health Services Of the 10 best practices, Johns et al (2000) conducted further analysis and identified 3 best practices of emphasis to strengthen practices and partnering in adolescent prevention programs: youth development, family involvement, and cultural relevance. Youth Development is an important aspect of adolescent pregnancy prevention because it provides adolescents with the skills and information that they need to make important decisions that can affect their life. Evidence have shown that teens that have educational and career goals are much more likely to delay pregnancy than their counterparts (ref). Thus, programs should include youth development focusing on encouraging “staying in school” and goal setting as well building self-efficacy can help reduce /delay early engagement in sexual behaviors that may lead to unplanned pregnancies (ref). Family Involvement was identified from the literature review as a component that was not always emphasized in adolescent pregnancy prevention programs. Johns et al (2000) identified involving families and other caring adults in prevention programs as important factors to obtaining successful outcomes in adolescent pregnancy prevention. Parents particularly have been recommended to be incorporated into adolescent pregnancy prevention programs (ref). Research has found that teens who spend time with their parents are least likely to engage in sexual behaviors reducing the likelihood of pregnancy (ref). Therefore, programs should incorporate parents along with their adolescents; assisting in building stronger relationships, opening communication and trust between two parties. Cultural relevance is not a novel concept, but a very important one. Programs should tailor interventions and educational materials to its audience. This may take some research for coordinators of the program to gather information, statistics and other relevant information about a particular population. However, culturally appropriate interventions will ensure improved outcomes in the long run and should be taken very seriously when tailoring interventions. 5
  6. 6. CHAPTER 3: WHY PETALS & PEARLS? The Petals and Pearls Program is sponsored through a collaboration between KAPPI and the Project Graduating Really Achieves Dreams (GRAD) Program in Knox County Schools. KAPPI is based at the Knox County Health Department (KCHD) and is part of a state wide effort to address the problem of teen pregnancy and parenting among youth. ProjectGRAD is a national initiative to increase the number of inner-city children attending college. In the past, Petal and Pearls Program have been held by KAPPI in conjunction with ProjectGRAD at Vine Middle School and KCHD. An old fashioned tea party is put together by these organizations (through the Petals & Pearls Program) to facilitate comfortable and meaningful dialogue between mother, aunts, grandmothers and daughters about sensitive or embarrassing topics. The program activities and emphasis includes the 3 best practice emphasis previously discussed in Chapter 2 : Youth Development, Family Involvement and Cultural Relevance. Activities included in this toolkit focus on building self-efficacy not only in teens, but also their mothers. These activities include goal setting and discussions pertaining to personal responsibility. In addition, Petals & Pearls also include parents particularly mothers and this is to help build trust and encourage open and honest communication between mothers and daughters. The program also provides activities requiring mother and daughters to work together to complete. Last but not least, the toolkit has been devised to be generalized to various groups. The abundance of activities allows planners to choose activities which they feel may relate to their specific populations. 6
  7. 7. CHAPTER 4: THE NUTS AND BOLTS STEPS FOR CONDUCTING A PETALS & PEARLS PROGRAM. **Read through this section of the toolkit before planning a Petals & Pearls event** Step 1: Planning for Petals & Pearls Program A. Develop a Petals & This team should consist of a group of individuals who Pearls Program have interest adolescent pregnancy prevention. The Planning Committee committee should meet regularly to discuss a timeline for implementation of a Petals & Pearls Program (i.e. when? How often a year? etc). In addition, it would be helpful to have professional guidance if needed (e.g. KCHD health educators/staff) available who can offer some insights, opinions and assist with the planning process. Use the information presented in the following sections to help jump-start your Petals & Pearls Program committee meetings! Appendix A provides a planning tool sheet to help guide your meeting and planning process. B. Review Logic Model A logic model is a “simplified picture of a program, initiative, or intervention that shows the logical relationship among the resources that are invested, the activities that take place, and the benefits of changes that result- a roadmap” (McKenzie, 2009). A logic model would be helpful during the planning for implementation phases. Use the example logic model in Appendix B to guide you and identify opportunities and threats early on so that your committee may problem solve and capitalize on opportunities. C. Utilize Petals & Make sure the toolkit is available at the planning Pearls Toolkit for meeting for references. guidance 7
  8. 8. Step 2: Conduct a Needs Assessment A. Decide community’s Although adolescent pregnancy prevention is readiness stage important, not ALL communities are at the same stage of readiness. Thus it is very important that the planning committee sit down and determine at which stage this particular “community” is at. See Appendix C for resources on how to determine community readiness stage (Tri-Ethnic Center for Prevention Research, 2008). Knowing the community’s readiness stage will help  Tailor program/interventions to the community’s readiness stage.  Efforts can be made to increase readiness. B. How many will be feasible? Consider the staff available to run the Petals & Pearls Program as well as the resources that are available. Remember that it is not necessarily the number of people who were in attendance, but the impact that you make on these mother and daughters relationship. Also, it is important that the group is able to carry out discussions and that whoever is leading discussion can control any distracters (if any). Thus, a group of 10 -12 pairs is ideal, however take location into consideration. C. Location Location !!!!!! It is important to choose a location that will accommodate your audience. Take into consideration these items when choosing a location  Theme of your Petals & Pearls Program  Transportation  # of people attending  Time of day (morning, afternoon, evening)  Size to accommodate participants and activities scheduled 8
  9. 9. Step 3: Implementation Pre-Program Implementation A. Determine Day for Petals & Pearls Program to be held B. Post flyers and distribute invitations to families in the community (school, church, etc). C. Keep track of respondents and RSVP’s until you have reached your maximum accommodation. D. Use the checklist used during the planning process to make sure major items have completed Appendix A E. Print out Petals & Pearls Program Invitation for distribution Appendix D F. Print out Petals & Pearls follow up Invitations for distribution Appendix D (just adjust wording accordingly) G. Print out at least 2 Mother and Daughter activities that can be done at the event Appendix E- N H. Purchase decorations, food, and gift bags or gift cards. **Remember that by now, the planning committee should have determined the theme of the event, what types of food to purchase, activities as well as whether incentives would be a gift bag or gift card. At this point, a list should be made on what should be purchased. DAY OF EVENT A. Staff should arrive 2 hours early to decorate and set up room. This will ensure that anything that was missed during the planning phase can be recognized early on and fixed. B. Set Registration Table at a location where mothers and daughters can see before entering the room where the event will take place.  Have at least one staff member at the table  Have registration sign-up sheet available Appendix O  Have Petals & Pearls Program available Appendix P  Once mother and daughter sign in, give them the Petals & Pearls Program.  Also have Petals & Pearls Follow up Invitations available for after the program to hand out to mothers and daughters Appendix D C. Once everyone has been registered and everyone is in attendance then, IT IS TIME to begin the Petals and Pearls Program!!! Appendix Q 9
  10. 10. Step 4: Evaluation & Follow-up Remind all participants of the Petals & Pearls event to fill out the evaluation sheet provided at each seat. From your evaluations, you will be able to adjust and/or refine the Petals & Pearls Program for improvement. Use the evaluation forms indicated in Appendix R to evaluate how successful your program was. 10
  11. 11. APPENDICES 11
  12. 12. Appendix A Task/Action Steps Who’s Responsible Timeline Resources Done? Set date, create task list and assign responsibilities for Petals & Pearls Program held in _________________  Choose activities from list that will be appropriate for your participant. *** Find/schedule motivational speaker  Gift bag/honorarium for speaker  Introduce speaker Reserve a place for the Petals & Pearls Program to be held  Reserve tables, chairs etc Market/advertise Petals & Pearls Program  Create /distribute Flyers  Print Announcements  Contact interested parents Tally number of RSVPs Decorations & Refreshments  What is the theme? Gift Bags or Gift Cards Print Petals & Pearls Program Registration the day of the event  Table workers  Keep track of nametags  Follow-up Additions: Tasks/Action Steps Who’s Responsible Timeline Resources Done? NOTES: 12
  13. 13. Appendix B Logic Model for Petals and Pearls Program INPUTS OUTPUTS OUTCOMES Activities Reach Short/Medium Long-term Resources:  Assessment of target  Adolescents  ↑Awareness of  ↓initiation rate in  Petals & Pearls Toolkit populations. adolescent adolescents  Community members*  Parents pregnancy issues in Goal:  Community  Interview adolescents & the community  ↓ adolescent To decrease parents. Learning Organizations  Community pregnancy rates adolescent  Schools Organizations &  Improve knowledge pregnancy rates  Knox County Health  Present “Teen Pregnancy Agencies & awareness of the  Reassess, in Knox County Department (KCHD) Issue” presentation to importance of reimplement and  Knox Adolescent community.  Stakeholders in parental reevaluate Petals & Pregnancy Prevention  Introduce purpose Knox County involvement & Pearl Program and its Initiative (KAPPI) and importance of communities communication activities as  *Volunteers Petals & Pearls necessary Program  Strengthen support Collaborations: of the stakeholders  Development of new  Schools attitude towards  KCHD  Advocate for Petals abstinence and  KAPPI & Pearls Program responsible sexual behaviors. Planning:  ↑community  Include in meetings involvement in  Community  Discuss progress and adolescent acceptance & sustainability of Petal pregnancy recognition of Petals and Pearls prevention & Pearls Program Stakeholders: are individuals who have something to gain or lose from the healthy vending policy. These individuals could be vending machine users (employees), managers & vendors. 13
  14. 14. Appendix C Tri-Ethnic Center for Prevention Research Scoring Sheets Dimension A: Community Efforts (Programs, Activities, Policies, etc.) - 0 - - - 1 No awareness of the need for efforts to address the issue. - - - - 2 No efforts addressing the issue. - - - - 3 A few individuals in the community recognize the need to initiate some type of effort, no immediate - motivation to do anything. - - - 4 Some community members have met and have begun a discussion of developing community efforts. - - - - 5 Efforts (programs/activities) are being planned. - - - - 6 Efforts (programs/activities) have been implemented. - - - - 7 Efforts (programs/activities) have been running for several years and are fully expected to run indefinitely, - no specific planning for anything else. - - - 8 Several different efforts (programs/activities) are in place, covering different age groups and reaching a - wide range of people. New efforts are being developed based on evaluation data. - - - 9 Evaluation plans are routinely used to test effectiveness of many different efforts, wide range of people. - New efforts are being developed based on evaluation data. - - - 10 14
  15. 15. Dimension B: Community Knowledge of the Efforts - 0 - - - - 1 Community has no knowledge of the need for efforts addressing the issue. - - - - 2 Community has no knowledge about efforts addressing the issue. - - - - 3 Some members of the community have heard about efforts, but the extent of their knowledge is limited. - - - - 4 Some members of the community are beginning to seek knowledge about efforts in their own, or in similar - communities. - - - 5 Some members of the community have basic knowledge about local efforts (i.e. purpose). - - - - 6 An increasing number of community members have knowledge of local efforts and are trying to increase - the knowledge of the general community about these efforts. - - - 7 There is evidence that the community has specific knowledge of local efforts including contact persons, - training of staff, clients involved, etc. - - - 8 There is considerable community knowledge about different community efforts, as well as the level of - program effectiveness. - - - 9 Community has knowledge of program evaluation data on how well the different local efforts are working, - and their benefits and limitations. - - - 10 15
  16. 16. Dimension C: Leadership (Includes appointed leaders and influential community members.) - 0 - - - - 1 Leadership has no recognition of the issue. - - - - 2 Leadership believes that this is not an issue in their community. - - - - 3 Leader(s) recognize the need to do something regarding the issue. - - - - 4 Leader(s) are trying to get something started. A meeting has been held to discuss the issue. - - - - 5 Leaders are part of a committee or committees and are meeting regularly to consider alternatives and - make plans. - - - 6 Leaders are supportive of the implementation efforts and may be enthusiastic because they are not yet - aware of the limitations or problems. - - - 7 Leaders are supportive of continuing basic efforts and are considering resources available for self- - sufficiency. - - - 8 Leaders are supportive of expanding/improving efforts through active participation in the expansion/ - improvement. - - - 9 Leaders are continually reviewing evaluation results of the efforts and are modifying support accordingly. - - - - 10 16
  17. 17. Dimension D: Community Climate - 0 - - - - 1 The prevailing attitude is that it’s an accepted part of community life. “It’s just the way things are.” - - - - 2 The prevailing attitude is “there’s nothing we can do” or “only ‘those’ people do that.” - - - - 3 Community climate is neutral, disinterested, or believes that the issue does not affect the community as a - whole. - - - 4 The attitude in the community is now beginning to reflect interest in the issue. “We have to do something - but we don’t know what to do.” - - - 5 The attitude in the community is “this is our problem” and they are beginning to reflect modest support - for efforts. - - - 6 The attitude in the community is “this is our responsibility “ and is now beginning to reflect modest - involvement in the efforts. - - - 7 The majority of the community generally supports programs, activities, or policies. “We have taken - responsibility.” - - - 8 Some community members or groups may challenge specific programs, but the community in general - is strongly supportive of the need for efforts. Participation level is high. “We need to keep up on the issue - and make sure what we are doing is effective.” - - 9 All major segments of the community are highly supportive, and community members are actively involved - in evaluating and improving efforts and demand accountability. - - - 10 17
  18. 18. Dimension E: Community Knowledge About the Issue - 0 - - - - 1 Not viewed as an issue. - - - - 2 No knowledge about the issue. - - - - 3 A few in the community recognize that some people here may be affected by the issue/ - - - - 4 Some community members recognize that this issue occurs locally, but information about the issue is - lacking. - - - 5 Community members know that this issue occurs locally and general information about the issue is - available. - - - 6 A majority of community members know that the issue occurs locally and there is enough information - about the issue to justify doing something. - - - 7 Community members have knowledge of, and access to, detailed information about local prevalence. - - - - 8 Community members have knowledge about prevalence, causes, risk factors, and consequences. - - - - 9 Community members have detailed information about the issue as well as information about the - effectiveness of local programs. - - - 10 18
  19. 19. Dimension F: Resources Related to the Issue (People, money, time, space, etc.) - 0 - - - - 1 There is no awareness of the need for resources to deal with this issue. - - - - 2 No resources available for dealing with the issue. - - - - 3 The community is not sure what it would take, or where the resources would come from to initiate efforts. - - - - 4 Some in the community know what resources are available to deal with this issue. - - - - 5 Some in the community are aware of available resources for this issue and a proposal has been prepared, - submitted, and may have been approved. - - - 6 Resources have been obtained from grant funds or outside funds. Programs or activities are time limited. - - - - 7 A considerable part of support of on-going efforts are from local sources that are expected to provide - continuous support. Community member and leaders are beginning to look at continuing efforts by - accessing additional resources. - - 8 Diversified resources and funds are secured and efforts are expected to be permanent. There is - additional support for further efforts. - - - 9 There is continuous and secure support for programs and activities, evaluation is routinely expected and - completed, and there are substantial resources for trying new efforts. - - - 10 The Tri Ethnic Center is honored to be able to supply this information to interested parties, and hopes that it can be useful, but please call the Center and seek permission before duplicating any of its materials. 19
  20. 20. Tri-Ethnic Center for Prevention Research Community Readiness Scoring Staff: _____________________ Date: _____________________ INDIVIDUAL SCORE INTERVIEWS: #1 #2 #3 #4 Dimension A: Dimension B: Dimension C: Dimension D: Dimension E: Dimension F: COMBINED SCORE INTERVIEWS: #1 #2 #3 #4 Dimension A: Dimension B: Dimension C: Dimension D: Dimension E: Dimension F: 20
  21. 21. CALCULATED SCORE AVERAGE: ______________________ STAGE: _____________________  COMMENTS about Calculated Score (if any): The Tri Ethnic Center is honored to be able to supply this information to interested parties, and hopes that it can be useful, but please call the Center and seek permission before duplicating any of its materials. 21
  22. 22. Tri-Ethnic Center for Prevention Research Scoring Instructions for the Community Readiness Questions 1) Move through the interviews one at a time [using the “Community Readiness Questions”], scoring each interview individually [using the “Scoring Sheets”]. Read through each interview before you begin to score to get a general feeling and impression from the interview. 2) Begin picking out statements and references that refer to specific dimensions, and then create a score for each of the six dimensions according to the anchored grading scales [detailed in the Scoring Sheets]. Each interview will encompass six different dimensions scores. Interviews are scored by dimensions and not by individual questions. 3) Under the section titled “Individual Score” [on the “Community Readiness Scoring” page], you are to fill in your scores for each dimension of each of the interviews. Please note: There may be more then four key informant interviews in a community. If this is the case simply add #5 and #6, handwritten to this form. 4) The section under the subheading “Combined Score” [on the “Community Readiness Scoring” page] represents the section where you and one other scorer that scored this same community will come together and agree on the scores for each interview on each of the dimensions. It is important that there be consensus on the scores by both scorers. Remember different people can have slightly different impressions and it is important to explain how you arrived at your decision. Enter your agreed upon score on one of the scoring sheets for each dimension and each interview. 5) After both scorers have agreed upon the scores in the above section, the mean will be calculated for the “Calculated Score.” For some (actually many) this can be confusing so let me give you an example. Let's say that under the “Final Score” section, myself and the other scorer have under Dimension A the following: Dimension A: #1 #2 #3 #4 3.5 5.0 4.25 4.75 I would then add the scores across for all interviews under Dimension A and divide by four (calculate the mean). So, I would get a calculated score for Dimension A of 4.37. This will then be entered under Dimension A, “Calculated Score”, and so forth by Dimension. 6) For the “Average” at the bottom of the page, below Dimension F, you will take the Calculated Score for each Dimension, add them together and divide by six (the mean for all of the dimensions combined). For example, if we had: Dimension A: 3.28 Dimension B: 5.67 Dimension C: 2.54 Dimension D: 3.29 Dimension E: 6.43 Dimension F: 4.07 25.28 25.28/6 = 4.21 22
  23. 23. A score of 4.21 would be entered under “Average.” 7) For “Stage”, you will enter the stage that is represented by your final average. In the above example, the “Calculated Average” represents the 4th stage or Preplanning. Please Note: The scores correspond with the numbered stage, so a score between a 1.0 and a 1.99 would be the first stage, a score of 2.0 to 2.99 would be the second and so forth. [For a list of the stages, visit http://www.open.org/~westcapt/crstages.htm] 8) Finally, under comments, write any impressions about this community, any unique outcomes, and qualifying statements that you wish to make regarding the score of the community. The Tri Ethnic Center is honored to be able to supply this information to interested parties, and hopes that it can be useful, but please call the Center and seek permission before duplicating any of its materials. Community readiness stages and goals (Edwards et al, 2000; McKenzie et al., 2009) Stage Goal 1. No awareness Raise awareness of the issue 2. Denial Raise awareness that the problem or issue exists in the community 3. Vague Awareness Raise awareness that the community can do something 4. Preplanning Raise awareness with the concrete ideas to combat condition 5. Preparation Gather existing information to help plan strategies 6. Initiation Provide community-specific information 7. Stabilization Stabilize efforts/programs 8. Expand and enhance service Confirmation/Expansion 9. Professionalism Maintain momentum and continue growth 23
  24. 24. Appendix D Petals and Pearls Petals and Pearls Save the Date! Save the Date! Request the honor of your presence at Request the honor of your presence at A Mother/Daughter Follow-up A Mother/Daughter Follow-up Date: Date: Time: Time: Place: Place: Address: Address: RSVP to RSVP to Phone #: Phone #: Attire: Attire: Come make memories with us!!! Come make memories with us!!! Gifts for Everyone  Gifts for Everyone  Petals and Pearls Petals and Pearls Save the Date! Save the Date! Request the honor of your presence at Request the honor of your presence at A Mother/Daughter Follow-up A Mother/Daughter Follow-up Date: Date: Time: Time: Place: Place: Address: Address: RSVP to RSVP to Phone #: Phone #: Attire: Attire: Come make memories with us!!! Come make memories with us!!! Gifts for Everyone  24 Gifts for Everyone 
  25. 25. Appendix E Mother/Daughter Goal Plan Objective: 1. To foster communication and team work skills between mother and daughter 2. To learn how to set goals together and how to achieve them Materials: 1. Paper 2. Pen Mother’s Goals (examples): Daughter’s Goals (examples): To be a hip mom To tell the truth To stop embarrassing my daughter To earn good grades To discuss everything openly and honestly To never drink and drive To keep my daughter from using drugs To keep my room clean To get to know my daughter better To respect my parents more Introduction: Working toward a goal can be as much fun as achieving the goal. If you want to add some real teamwork in your family and deepen your mother/daughter relationship, you could set goals with each other. When you reach a goal that you have set, you feel great! Sometimes that feeling is a reward in itself. Learn together how to set goals and achieve them. Step I: Make a list of everything that you think you want…all the goals you think you want to achieve. They may involve material things, or better relationships, a special trip, or a change in your personal attitudes or habits. List your thoughts below: Goal List (Add more as needed on the back of this page): 1._________________________________________ 2._____________________________________________ 3._________________________________________ 4._____________________________________________ 5._________________________________________ 6._____________________________________________ 7._________________________________________ 8._____________________________________________ Step II: Review your list with your mom/daughter. Ask her what goals she is interested in. Anything that you don’t feel strongly about should be removed from the list. Goal setting will not work if you’re not really motivated to achieve the goal. From your list above select your top two goals and write below: 1. Short term: 2. Long term: Step III. TOGETHER (mom & daughter), develop a plan to help you reach your goals. Use the planning worksheets to assist you with your goals. This worksheet is designed to help you set goals- “an ideal future”- and plan activities for meeting these goals. As you do this exercise, you should realize that your goals are not “set in stone”, they may change and that is okay. This important thing is that you begin the planning process and dream a little. 25
  26. 26. Planning Goals and Activities Worksheet PERSON(S) COMPLETION GOALS ACTIVITIES RESPONSIBLE DATE Mother’s Goal #1 1. 2. 3. Mother’s Goal #2 1. 2. 3. Daughter’s Goal #1 1. 2. 3. Daughter’s Goal #2 1. 2. 3. 26
  27. 27. Appendix F Manicure and Pedicure Day Objective: 1. To help build trust between mother and daughter 2. To encourage communication between mother and daughter Materials:  Fingernail polish (you can have them bring it from home)  Cotton balls  Nail polish remover (will help with messiness)  An index card (or piece of paper) with questions/statements (page 5 of notebook)  Nail files (optional) Goals: To create mother and daughter bonding by answering questions while giving pedicures or manicures Process: 1. Have the mothers and daughters work as pair 2. Each mother/daughter will give their daughter/mother a pedicure or manicure 3. While the ladies are being pampered, have then answer the following questions/statements (on page 5 of notebook) What should we talk about during our manicure/pedicure? 1. What does the word “trust” mean to you? 2. How does someone earn your trust? 3. Do you trust your mother/daughter? Why or why not? 4. Name 3 people who you trust completely: _____________ _____________ ______________ 5. Have you ever been hurt (physically or emotionally) by someone you trust? If yes, what happened? 6. Name 2 things you do to show that you are trustworthy? _________________ _____________ Discussion Questions: 1. Did you trust your mother/daughter would do a good job on your nails? 2. What does the worst “trust” mean to you? 3. Daughters-did your mother give you good idea of what she considers as being “trustworthy?” 4. Mothers- did your daughter give you a good idea of what she considers to be “trustworthy?” 5. Are you going to make any changes in your behavior/communication style based on today’s discussion? 6. What did you learn about your mother/daughter from today’s activity? 27
  28. 28. Appendix G Fashion Show Objective: 1. To promote positive body image and boost self-esteem 2. To build trust and open the line of communication between mother and daughter Materials:  “Dress up clothes” ( you can have them bring in high heels, hats, scarevs etc) OR  “Paper dress up clothes” (paper plates (hats), toilet paper (jewelry, outfits), garbage bags (dresses) etc)  Music (to walk the “runway” to)  Music player (CD, IPOD, etc…) Goal: To increase participants self-esteem and body image. Express to the participants that beauty comes both on the inside and outside, and in every shape and size. Process: 1. Have each mother and daughter pair up with one another 2. Give them either “dress up clothes” or “paper dress up clothes” 3. Tell the participants their job is to make their partner “look like a super-model” using only the materials given to them. 4. Once all the models are ready there will be a fashion show 5. Each participant will have their turn walking down the “runway” (an aisle), to music during the fashion show, while everyone else watches 6. End with discussion Discussion Questions: 1. Who is the most beautiful person you know (why did you pick them)? 2. Are you satisfied with your body (why or why not)? If not, what can you do about it? 3. How does your body image affect us? 4. Do you have a high self-esteem? 5. How does self-esteem affect us? 6. Did you feel confident walking down the “runway”? Why or Why not? 7. Name 3 beautiful things about your mother/daughter? 8. What can you do to increase your self-esteem or body image? 9. What did you learn from participating in today’s fashion show? 28
  29. 29. Appendix H Creating Jewelry Together Objective: 1. To promote and provide ease in sexual activity communication and discussion. 2. To encourage communication and between mother and daughter. Materials:  String  Beads with holes in the middle 9at least 8  Scissors different colors) Goal: To reinforce the importance of having values, self-esteem, and self-respect. Through the process of making jewelry the females will learn what values other people see in them and remind them of what they should look for in a partner. Process: 1. Assign a value to every color of bead for example  Orange- Friendship  Blue- Intelligence  White- Respect  Red- Love  Yellow- Patience  Pink- Honesty  Green- Trust (worthy)  Purple- Faith 2. Give each female a piece of string (long enough to fit around her wrist or neck) 3. Explain to each female that the piece of string represents them (their morals, self-worth, and values). 4. Set the beads (divided by their colors) in the middle of the table and tell the females what each color stands for. 5. Take turns going around the table and each female selects a color bead that represents a value someone else at the table possess. Each time a bead is given tell why that color bead is given to that person (for example Sue picks up a white bead and hands it to Jill while stating “Jill gets a white bead because she is respectful everyday to the teacher at school.” Jill then picks up a green bead and gives it to Debroah while saying “Deborah gets the green trust bead because I told her a secret and she never told anyone.” 6. Carry this pattern on (make sure all females have beads) until they have enough to make a bracelet or necklace. 7. Let the females arrange the beads in any pattern they want to. 8. When the jewelry is completed: explain to the girls that they are the values that they possess and potential partner should possess the same values. If the person they are engaging in sexual activity or thinking about engaging in sexual activity with does NOT possess these same values they need to WAIT. Stress the importance of self-worth and respect and they are worth waiting for. 9. Tell them to wear or carry the jewelry as a reminder to themselves stating what they are about and how others see them. Discussion Questions: 1. How did it feel to get beads? 2. How did it feel to give beads to other people? 3. Do you think you possess all the qualities your jewelry “says” you have? (Or did you get a bead you don’t think that you deserve?) 4. Are there any beads you wanted but did not get? 5. Why do you think you didn’t get a certain color bead? 6. Has the way you feel about yourself changed since the beginning of this exercise? 7. Are you going to do anything different (any change in behavior) after this activity? 29
  30. 30. Appendix I Tune Time Objective: 1. To learn about choices and feelings 2. To encourage communication between mother and daughter Materials:  Music (C.D. or IPOD) ** Inform participants to bring ahead of time** Goal: Mothers and daughters will have an increased amount of respect for each other following the activity. A better understanding of one another’s choices and feelings will follow. Process: 1. Ask each mother/daughter to bring in a song that they really like. 2. Have the participants play their song for the group one at a time. 3. After each song, have the participants (not the one who played it) share what they feel when they hear that song. 4. Have the person who played the song share why they chose to play that song for the entire group and what that song means to them. 5. Hopefully a better understanding one another will result after the discussion of feelings and choices. Discussion Questions: 1. Did the song that you mother/daughter chose surprise you? 2. Did you like the song that your mother /daughter chose? 3. How did you feel when your song was playing for the group? 4. Do you think that sometimes people express their feelings through the music that they play? 5. What does the word “RESPECT” mean to you? 6. Name someone in your life that you respect? 7. How can you show respect to your mother/daughter. 30
  31. 31. Appendix J Make Greeting Cards for One Another Objective: 1. To learn how to express feelings to one another 2. To encourage communication between mother and daughter Materials:  Construction paper  Stencils (optional)  Markers  Glitter (optional)  Glue  Scissors Goal: To have mothers/daughters express their feelings for each other by making a card. Process: 1. Give each participant a piece of paper 2. Tell them using the supplies available to make a card for their mother/daughter 3. If they are having trouble getting started, here are some suggestions for what type of card to make:  “I love you card”  “Friendship card”  “Thank you card”  “I’m sorry card” 4. After the completing the card, have the participants give the card to their mother/daughter. Discussion Questions: 1. What type of card did you make for your mother/daughter? 2. Why did you make that type of card? 3. Was it easier to express your feelings in a card rather than speaking? 4. What did you learn about your mother daughter from this activity? 31
  32. 32. Appendix K Bake/Decorate Cookies Goal: To encourage a mother/daughter discussion about goals and plans for the future while participating in a fun holiday activity. Materials:  Plain sugar cookies (or gingerbread, or graham crackers)  Icing  Sprinkles  Colored sugar  Anything to decorate cookies with Process: 1. Set up decorating stations evenly distributing the supplies 2. Give each participant a cookie to decorate 3. Decorate the cookie while engaging in a discussion about the following questions:  What goals have you set for yourself?  How do you plan to achieve your goals?  What is one thing you want to accomplish in the next year?  What is one thing you want to accomplish over the next five years?  Who is going to help you achieve your goals?  What role does your mother/daughter play in helping you achieve your goals?  What types of changes are you going to make in the New Year in order to achieve goals? 4. Let each participant eat their cookie or take it home Wrap-up Questions: 1. In your own words what is a goal? 2. How do you go about trying to achieve the goals you set for yourself? 3. What are some challenges that occur or do you foresee when you are trying to achieve your goals? 4. How can you overcome those challenges to achieving your goals? 32
  33. 33. Appendix L Create a Family Newsletter Goal: To have an increased awareness of personal accomplishments, goals, and an increase self-esteem. Materials:  Paper  Pencil Process: 1. Have the mother and daughter pair up 2. Give each pair a sheet paper and tell them to create a “family newsletter” The newsletter should contain the following: A. Info on what the current members of the family are doing B. Accomplishments of what family members have achieved (ex: making the honor roll, winning a track race, etc…) C. Activities that family members are involved in (ex: girl scouts, soccer, swimming, etc…) D. Fun things the family has done over the past year (ex: summer camping trip to the lake, went to Atlanta for holidays etc…) E. Things family members want to accomplish in the next year (ex: daughter is trying to make the honor roll at school, mother is trying to learn how to play golf, etc) F. Anything else extended family and friends and friends could be interested in 3. Remind participants that this letter should be shared with the entire family and friends (write letter accordingly) 4. Encourage participants to copy this “newsletter and send it to relatives/family friends (possibly in a holiday card) Wrap-Up Questions? 1. Was creating the newsletter fun? 2. Who would be interested in reading your newsletter? 3. What did you learn about your family from this activity? 33
  34. 34. Appendix M Values Discussion Goal: Mothers and daughters will have a personal discussion on values on what they believe is important. Materials:  An open heart and an open mind. Process: 1. Have mothers and daughters pair up and spread out through the room or if needed outside the room **Make sure they are in a spot where they can talk quietly amongst themselves** 2. Ask them the following questions and give them about one minute to discuss them between themselves. A. What is the hardest emotion for you to express and why (do you think) it’s hard for you to express this emotion? Follow-up: How would you (do you think) like to express this emotion? Do you know anyone who expresses this emotion well? Do you know anyone else who has a hard time expressing this emotion? B. What is the easiest emotion for you to express and why is it easy for you? Follow-up: Could you do better at expressing this emotion? Do you know anyone else who expresses this emotion well? Do you know anyone who has a hard time expressing this emotion? C. What is one goal you have for the next year? D. What is a motto you try to live by? E. What is the greatest challenge you are facing in your life right now? F. What do you like the most about yourself? G. What do you value in a friend? H. What do you value the most in life? I. What do you value in a loving relationship? Discussion Questions: 1. Did you find that you and your mother/daughter have a lot of the same values? Why do you think that is? 2. Is it always easy to stick with your values? 3. Have you ever been put in a situation where your values have been tested? 4. What have you learned from this activity? 34
  35. 35. Appendix N The Girl’s Book Club Goal: To increase communication between mother and daughter, build trust and to encourage responsible decision making in teens. Materials:  A short story (look at books of short stories such as Chicken Soup for the Soul series). Make sure that the story is short enough to read in about 5 to 10 minutes.  Photocopy the story so that each participant has copy to read Process: 1. Have both the mother and daughter read the story silently to themselves 2. Have the mother and daughter pair discuss the story amongst themselves for a moment. 3. Have the entire group participate in one big discussion about the story Discussion Questions: 1. How did this story make you feel? 2. What is the main lesson from this story? 3. Will this story have an impact on decisions that you will make in the future? 4. What would you have done if you were the main character in the story? 35
  36. 36. Appendix O MEEETING SIGN-IN SHEET PROGRAM: PROGRAM PLACE: TIME: MOTHER (M)/ Interested in NAME DAUGHTER (D) PHONE ADDRESS Follow-up Meeting? 36
  37. 37. Appendix P Petals & Pearls Date:___________ Time:___________ Location:___________ **TEA SERVICE** I. Welcome & Purpose (Name) II. Mother/Daughter Activities (Name) III. Introduction of Speaker (Name) IV. Motivational Speech (Name) V. Poem (read by teen) (Name) VI. Tea Overview & History (Name) VII. Proper Etiquette Styles (Name) VIII. Remarks (Name) IX. Closure (Name) X. **Special Thank You** (Name) XI. Evaluation (Name) 37
  38. 38. Appendix Q Sample Introduction Dialogue Welcome & Purpose My name is ____________, and it is my pleasure to welcome all of you to today’s Petals & Pearls Program. This program is a joint effort between the Knox County Health Department and ________________. The focus of this program is to provide mothers and daughters with a comfortable environment to learn about and discuss “sensitive” topics that may be challenging to talk about at home. The choices that you make today, this day, will potentially direct your life’s course and who you will become as an adult. We truly believe that your mothers, grandmothers, aunts have the experience and the knowledge that can be passed to their young daughters on how to protect themselves from danger. But in order for this to happen, open communication is very important. Let’s first very quickly go around the room and introduce ourselves.  Mothers, state your name, where you from, how many children you have and something you are proud of.  Daughters, you will state your name, what school you go to, what grade you are in and something you are proud of. Now, is there anyone in this group brave enough to say what are some sensitive topics that mothers and daughters may shy away from at home?  Sex  Pregnancy  Boys…. Yes, those are all correct and we want you to know that it is okay to ask questions here about those topics. So, why should you care about the Petals & Pearls Program? Well, we have done some research and came up with some facts that are important for all of you to know.  U.S. birth rates among young people declined from 17.8% in 1990 to 11.2% in 2006 per 1,000 females aged 10-17. Rates dropped from 72.6% to 53% per 1,000 females aged 15-19 in the same years. However it is important to note that teen birth rates, both nationally and in Tennessee, are substantially higher in the United States compared to other developed countries.  In 2007, 54.4% of all Tennessee high school students reported having had sexual intercourse at least once in their lives. 38
  39. 39.  In 2007, 7.5% of high school students in Tennessee reported having engaged in sexual intercourse before age 13 compared to 8.5% in 2005.  We also know that parenting plays a very important role in teenagers choice to engage in sexual intercourse and behaviors. Summary: The Petals & Pearls Program is here advocating for mothers and daughters to communicate with each other. It is encouraging parental involvement and it is also encouraging young girls to be aware of teenage pregnancy and the dangers that it can have. We know that teenage mothers are;  more likely to drop out of high school  more likely to remain single parents  their children are more likely to have lower cognitive attainment and proficiency scores at kindergarten entry,  their children are more likely to exhibit behavior problems,  their children are more likely to have chronic medical conditions,  mother and children are more likely to rely more heavily on publicly provided health care,  their children are more likely to be incarcerated at some time during adolescence until their early 30s, and  their children are more likely to drop out of high school, give birth as a teenager, and be unemployed, or underemployed as a young adult. So we want you to be aware of these problems and to be open with your mom, grandmother, aunt etc about any concerns you may have about teenage pregnancy. Okay so with that said, If you look at the papers in front of you, you should see an activity titled ______________________. This activity will hopefully, get you and your mother thinking and talking about things  39
  40. 40. Appendix R Petals and Pearls A Mother Daughter Tea Evaluations Thank you for your participation! We hope this program will serve as a beginning or continuation of open and honest communications between mother and daughter. Please Circle One The program was well designed Agree Disagree Undecided I will use ideas learned at this event Agree Disagree Undecided I would attend a similar event in the future Agree Disagree Undecided I would recommend a similar event to a friend Agree Disagree Undecided Please Circle One The teas and food were tasty and well-prepared Agree Disagree Undecided The room and tables were tastefully decorated Agree Disagree Undecided The music was enjoyable Agree Disagree Undecided Rate the following parts of the program: Please Circle One Somewhat Interesting Interesting Undecided Not Interesting Motivational Speech 1 2 3 4 History and Overview 1 2 3 4 Self Love 1 2 3 4 Mother/Daughter Activities 1 2 3 4 Which part of the program was most helpful? Please Circle your choice. Motivational Speech History and Overview Self Love Mother/Daughter Activities Which part of the program was least helpful? Please Circle your choice. Motivational Speech History and Overview Self Love Mother/Daughter Activities Comments and Suggestions (if any): 40
  41. 41. LIKE MOTHER LIKE DAUGHTER By: Ashley Gadison Like mother like daughter my mother and me, somehow I knew it was meant to be We run, play, jump, and we hide we didn’t do things quite right, but we always tried. I may be wrong and she may be right, We cry, we yell and we always fight. We try so hard with all our might Somehow we manage to still stay tight. Times are hard and times are bad, even good times may make us sad. We face troubles as it may seem, Although we never let anyone get in between. The bond we share is what only one can dream, But we always work together as a team. Like mother like daughter my mother and me, And somehow I still know it was mean to be. 41
  42. 42. TO BE YOUNG GIFTED & BLACK By: Nina Simone & Weldon Irvine To be Young Gifted and Black What a precious dream. To be Young Gifted and Black Open your heart to what I mean. In the whole world you know. There’re billion boys and girls Who are Young, Gifted and Black; And that’s a fact. You are Young, Gifted and Black! We must begin to tell our young, There’s a world waiting for you. Yours is the quest that’s just begun, And if you’re feeling real low There’s a great truth that you should know. When you are Young, Gifted and Black Your Souls’ intact! To be Young Gifted and Black Oh how I longed to know the truth, There are times when I look back And I am haunted by my youth. But my joy of today Is that we can all be proud to say, To be Young, Gifted and Black Is where it’s at! 42
  43. 43. Proper Etiquette Styles in 2009 How to Follow Tea Party Etiquette  Know how to understand a table setting. The dinner plate is always in the middle, with two forks to the left of it and a knife and two spoons to the right. You work from the outside in for each course.  Place the tea cup to the top right of the plate above the knives and spoons. Other dishes are on the table based on what is being served. In the case of a tea party, the main dish is used for sandwiches and breads and a smaller dish, set to the left, is for desserts.  Make use of your napkin. Proper etiquette is to place it on your lap unfolded before you start eating.  Dispose of tea bags properly. If the tea is not already brewed in a pot and you are using a tea bag, never discard it on the table. A good hostess will provide you with a little dish.  Be considerate if the party has a serving table set up. It is customary to wait your turn and not reach in front of or over other guests. If something needs replenishing, discretely inform the hostess or server.  Follow correct etiquette while mingling. Make good eye contact and listen to others when they speak to you. Never interrupt a person in mid- sentence. Be a good conversationalist and not too quiet. If a lull in the conversation arises, bring up a subject or a compliment what someone is wearing. Source: www.ehow.com 43
  44. 44. References Edwards, R. W., Jumper-Thurman, P., Plested, B.A., Oetting, E.R., & Swanson, L. (2000). Community readiness: Research to practice. Journal of Community Psychology, 28 (3), 291 – 307. Johns,M.J., Moncloa, F., Gong, E.J. (2000). Teen Pregnancy Prevention Programs: Linking Research and Practice. Journal of Extension, 38, (4), 4FEA1. Hoffman, S. (2006). By the numbers: the public costs of teen childbearing. Washington, DC: National Campaign to Prevent Teen Pregnancy. Kelin, JD. (2005). Adolescent Pregnancy: Current Trends and Issues. American Academy of Pediatrics 116 (1): 281- 286. Manlove, J., Humen, ET., Papillo, A., Franzetta, K., et al. (2002). Preventing teenage pregnancy, childbearing, and sexually transmitted disease: What the research shows. John S. and James L Knight Foundation. McKenzie, JF., Neiger, BL., Thackeray, R. (2009). Planning, implementing & evaluating health promotion programs (5th ed.). San Francisco, CA: Pearson Education. National Center for Disease Control. (2007). Reproductive health: data and statistics. Retrieved from: http://www.cdc.gov/reproductivehealth/Data_Stats/index.htm#Data on September 25th, 2009. National Center for Disease Control. (2009). Preventing teenage pregnancy: an update in 2009. Retrieved from: http://www.cdc.gov/reproductivehealth/AdolescentReproHealth/AboutTP.htm on September 25th, 2009. . Office of Disease Prevention and Health Promotion. (2000). Healthy People 2010: Understanding and Improving Health. Rockville, MD. Singh, S & Darroch, JE. (2000). Adolescent pregnancy and childbearing: levels and trends in developed countries. Family Planning Perspectives 32(1):14–23. Tennessee State Health Department. (2007). 2007 Youth Risk Behavior Survey( YRBS). Retrieved from: http://tennessee.gov/education/yrbs/07/index.shtml on September 30th, 2009. 44

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