1. Background & Implementation: Be Proud! Be Responsible!
Authors: Asad Ahmed & Madalasa Vedre | David Moskowitz, Ph.D., Advisor
Behavioral Sciences & Health Promotion | Epidemiology & Community Health | New York Medical College
Planned Parenthood Hudson Peconic (PPHP) went to different high schools in
the White Plains area including Palisades Prep, Lincoln High School, White
Plains High School, Rochambeau High School as well as residential facilities
(i.e., group homes, homeless shelters) to implement a CAPP-approved
intervention. One or more health educators from PPHP completed the six hour
“Be Proud! Be Responsible!” program at each intervention site. Since health classes
were roughly forty minutes long, it took the educator multiple class periods to
complete the program in its entirety; in Palisades Prep, eight classes; in Lincoln,
ten classes; White Plains, one class; and four classes at Rochambeau. Data was
collected by health educators who, firstly told all the teens participation was
voluntary, and secondly reminded teens participation was confidential. Health
educators gave kids in all schools a test with a large envelope. If they decided to
complete it, they would send it back to PPHP researchers. If they decided not to
complete it they would still send it back to the researchers. All data was
collected pre- and posttest and sent to Cornell for cleaning.
The intervention involved incorporating evidence-based, medically accurate
HIV/AIDS information and the adult experiential role theory into games, role
playing and brainstorming. There were no incentives for program participation
in schools. However, for after-school programs, students would receive a $25
gift card if they completed the whole six-hour class. There were some changes
health educators made to the program (e.g., adapting modules for time because
class was only forty minutes, changing a learning method in cases where role
playing was not effective. Every adaption had to be approved from the state.
There were four health educators: two Caucasian women, aged 25 and 26, one
Asian, aged 51, and one African-American, aged 24.
• CAPP program is a government funded, evidence-based curriculum and intervention method that has
been introduced and implemented in schools and community based organizations to a target
population of at-risk adolescents (American Public Health Association, 2015). Those who participate
in the program receive age-appropriate sexuality education, have access to reproductive health care
and family planning services, and receive educational, social and economic opportunities catered to
their needs.
• Be Proud! Be Responsible! was created in 1989 and is used by Planned Parenthood, a non-profit
sexual/reproductive health services center with over 59 independently incorporated affiliates
operating 661 health centers across the U.S., providing reproductive health services, sexual health
education and community outreach (Planned Parenthood, 2014). BPBR is based on three theoretical
frameworks combined together: Social Cognitive Theory, the Theory of Reasoned Action and the
Theory of Planned Behavior (TPB).“Be Proud! Be Responsible!” is an intervention program under the
CAPP umbrella. Adolescents aged 11-21 are educated through the intervention with six modules with
specific objectives.
These modules include:
• Introduction to HIV and AIDS
• Building Knowledge About HIV and AIDS
• Understanding Vulnerability to HIV Infection
• Attitudes and Beliefs about HIV/AIDS and Safer Sex
• Building Condom Use Skills
• Building Negotiation and Refusal Skills
• Interventions are multi-faceted, aiming to target teens through strategies involving minimizing risks,
(i.e., increasing knowledge about HIV/AIDS infection and teaching constructive, preventative
measures regarding condom and contraceptive use that will lead to behavior change).
• The program can be piloted in school settings or implemented as a community-based program. It
consists of six 50-minutes sessions conducted over the period of one to six days (ReCAPP, 2015).
• Examples of CAPP program partners include:
• Public schools
• Residential facilities
• CBO’s
• After-school programs
• Community mental health
• Substance abuse clinics
• Juvenile justice programs
• Summer camp programs
visits were for family planning services such as contraception, gynecological exams, pregnancy tests,
STI/HIV testing, etc. In the zip codes below, teen pregnancy rate varies from 26.3 to 59.3 per 1000
when compared to national average of 24.2 per 1000 women (CDC, 2016). PPH is widely used
among women, making it currently the largest provider of sexual education in the United States. In
2015, approximately 2.5 million patients were seen at PPH health centers. Roughly 2.9 million
patients received some form of contraceptive within the last year and 4.2 million received STI/STD
testing and treatment (PPH, 2015a). PPH places a strong emphasis on prevention. As a result, 80%
of patients receive services for family planning to prevent unintended pregnancies (PPH, 2015b). In
2014, PPHP services 33,000 and the education department reached almost 50,000 people through
the implementation of 1,700 programs (PPHP, 2015).
(NYSDOH, 2015)
Teen pregnancy is a major public health concern in the United States, especially amongst at-risk
youth. In the early 1990’s, the teen birth rate was recorded to be approximately 61.8 live births
for every 1,000 teenage girls. In 2010, there were approximately 625,000 women younger than
20 years of age who had become pregnant (Kost & Henshaw, 2014). The pregnancy rate
amongst sexually active teenagers, especially at-risk populations is relatively high. More recently,
the rate has dropped significantly to approximately 26.5 births for every 1,000 teenage girls (US
Department of Health & Human Services, 2015). Although the teen birth rate has been steadily
declining in the past two decades, the rates in the US remain higher than that of other developed
countries (Office of Adolescent Health, 2014). Racial and ethnic disparities are visibly seen
amongst adolescents of African American and Hispanic backgrounds.
The impacts of teen pregnancy are significant. These include increased risks for STDs and HIV,
increased poverty, higher infant mortality rates as well as health and cognitive issues for the child
and teen (CDC, 2015). At an early age, bearing and bringing up a child is challenging and negatively
affects the parents, child, and society. It costs U.S taxpayers billions because of lost tax revenue, and
increases in public health care and services for criminal justice (U.S. Department of Health &
Human service [HHS], 2016). For teen mothers, there are social and economic disadvantages. These
include delaying or dropping out of school, reliance on public support, general poorer education,
and behavioral outcomes for their children such as abuse or neglect (Hoffman & Maynard, 2008).
Introduction to Teen Pregnancy
Planned Parenthood Hudson
Peconic
Current Implementation
1. What are the baseline frequencies and attitudes towards sex, birth control, and condoms?
• Are males and females different with respect to their initial attitudes towards sex, birth control, and
condoms?
• Does race/ethnicity impact initial attitudes towards sex, birth control, and condoms?
• Which age group shows better initial responses regarding attitudes towards sex, birth control, and
condoms?
• What is the distribution of risk-groups as defined by sexual activity, birth control, and/or condom use?
2. Do participants show an increased frequency and change in attitudes towards sex, birth
control, and condoms from pretest to posttest?
• To what degree does gender, race/ethnicity, and age moderate the attitudes towards the outcome
variables?
• Does sexual experience at baseline have an impact on the change in attitudes towards the outcome
variables?
• Does preexisting condom use impact changes to the attitudes towards the outcome variables?
• Does preexisting birth control use impact changes to the attitudes towards the outcome variables?
Research Questions
Inception & Theoretical Basis of Be Proud! Be
Responsible
ASAD AHMED: My professional experiences are diverse ranging from public health project
management related to adolescent sexual health and to HIV quality control . I have previously
interned at the New York State Department of Health AIDS Institute National Quality Center,
Columbia University Mailman Scholl of Public Health Harlem Health Promotion Center and Services
for the Undeserved in NYC. Currently, I am a diversity fellow at the Westchester Institute for Human
Development in Valhalla, NY.
MADALASA VEDRE: My professional experience ranges from practicing dentistry internationally
to community oral health services. My goal is to provide quality care combining my experience gained
in dentistry and public health, with a strong focus in improving overall dental hygiene among all age
groups.
References
• Centers for Disease Control and Prevention. (2015). Teen pregnancy in the United States. Retrieved from. http://www.cdc.gov/teenpregnancy/about/index.htm.
• Hoffman, S. D., & Maynard, R. A. (Eds.). (2008). Kids having kids: Economic costs & social consequences of teen pregnancy. The Urban Institute.
• New York State Department of Health (NYSDOH). (2015). County/Zip code perinatal data profile- 2011-2013. Retrieved from
https://www.health.ny.gov/statistics/chac/perinatal/county/2011-2013/westchester.htm
• US Department of Health & Human Services. (USDHHS, 2015). Trends in teen pregnancy and childbearing. Retrieved from http://www.hhs.gov/ash/oah/adolescent-health-
topics/reproductive-health/teen-pregnancy/trends.html
• U.S department of health and human service (HHS). (2016). Overview - The Office of Adolescent Health. Retrieved from
http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/teen-pregnancy/#
• Ventura, S. J., Hamilton, B. E., & Matthews, T. J. (2014). National and state patterns of teen births in the United States, 1940-2013. National vital statistics reports: from the Centers for
Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 63(4), 1-34.
Hispanic Non-Hispanic Black American Indian-
Alaskan Native
Non-Hispanic
White
NumberofBirths
Adolescent Female Births Per1000, Race/ Ethnicity
National Vital
Statistics Report
201446.3 43.9 34.9 20.1
Planned Parenthood (PPH) is a national non-profit
organization with a focus on reproductive health services.
It was founded in 1942 and currently functions as the
largest provider of sex education in the country and
functions through health centers in Suffolk, Westchester,
and Rockland counties in New York (Planned Parenthood,
2015). Service organizations such as Planned Parenthood
have been established to address the needs of those unable
to afford or access patient-centered reproductive health
care. The organization “supports 59 independently
incorporated affiliates that operate 661 health centers
across the U.S., which have seen 2.5 million patients this
year” (Planned Parenthood, 2014-15). The majority of
![Background & Implementation: Be Proud! Be Responsible!
Authors: Asad Ahmed & Madalasa Vedre | David Moskowitz, Ph.D., Advisor
Behavioral Sciences & Health Promotion | Epidemiology & Community Health | New York Medical College
Planned Parenthood Hudson Peconic (PPHP) went to different high schools in
the White Plains area including Palisades Prep, Lincoln High School, White
Plains High School, Rochambeau High School as well as residential facilities
(i.e., group homes, homeless shelters) to implement a CAPP-approved
intervention. One or more health educators from PPHP completed the six hour
“Be Proud! Be Responsible!” program at each intervention site. Since health classes
were roughly forty minutes long, it took the educator multiple class periods to
complete the program in its entirety; in Palisades Prep, eight classes; in Lincoln,
ten classes; White Plains, one class; and four classes at Rochambeau. Data was
collected by health educators who, firstly told all the teens participation was
voluntary, and secondly reminded teens participation was confidential. Health
educators gave kids in all schools a test with a large envelope. If they decided to
complete it, they would send it back to PPHP researchers. If they decided not to
complete it they would still send it back to the researchers. All data was
collected pre- and posttest and sent to Cornell for cleaning.
The intervention involved incorporating evidence-based, medically accurate
HIV/AIDS information and the adult experiential role theory into games, role
playing and brainstorming. There were no incentives for program participation
in schools. However, for after-school programs, students would receive a $25
gift card if they completed the whole six-hour class. There were some changes
health educators made to the program (e.g., adapting modules for time because
class was only forty minutes, changing a learning method in cases where role
playing was not effective. Every adaption had to be approved from the state.
There were four health educators: two Caucasian women, aged 25 and 26, one
Asian, aged 51, and one African-American, aged 24.
• CAPP program is a government funded, evidence-based curriculum and intervention method that has
been introduced and implemented in schools and community based organizations to a target
population of at-risk adolescents (American Public Health Association, 2015). Those who participate
in the program receive age-appropriate sexuality education, have access to reproductive health care
and family planning services, and receive educational, social and economic opportunities catered to
their needs.
• Be Proud! Be Responsible! was created in 1989 and is used by Planned Parenthood, a non-profit
sexual/reproductive health services center with over 59 independently incorporated affiliates
operating 661 health centers across the U.S., providing reproductive health services, sexual health
education and community outreach (Planned Parenthood, 2014). BPBR is based on three theoretical
frameworks combined together: Social Cognitive Theory, the Theory of Reasoned Action and the
Theory of Planned Behavior (TPB).“Be Proud! Be Responsible!” is an intervention program under the
CAPP umbrella. Adolescents aged 11-21 are educated through the intervention with six modules with
specific objectives.
These modules include:
• Introduction to HIV and AIDS
• Building Knowledge About HIV and AIDS
• Understanding Vulnerability to HIV Infection
• Attitudes and Beliefs about HIV/AIDS and Safer Sex
• Building Condom Use Skills
• Building Negotiation and Refusal Skills
• Interventions are multi-faceted, aiming to target teens through strategies involving minimizing risks,
(i.e., increasing knowledge about HIV/AIDS infection and teaching constructive, preventative
measures regarding condom and contraceptive use that will lead to behavior change).
• The program can be piloted in school settings or implemented as a community-based program. It
consists of six 50-minutes sessions conducted over the period of one to six days (ReCAPP, 2015).
• Examples of CAPP program partners include:
• Public schools
• Residential facilities
• CBO’s
• After-school programs
• Community mental health
• Substance abuse clinics
• Juvenile justice programs
• Summer camp programs
visits were for family planning services such as contraception, gynecological exams, pregnancy tests,
STI/HIV testing, etc. In the zip codes below, teen pregnancy rate varies from 26.3 to 59.3 per 1000
when compared to national average of 24.2 per 1000 women (CDC, 2016). PPH is widely used
among women, making it currently the largest provider of sexual education in the United States. In
2015, approximately 2.5 million patients were seen at PPH health centers. Roughly 2.9 million
patients received some form of contraceptive within the last year and 4.2 million received STI/STD
testing and treatment (PPH, 2015a). PPH places a strong emphasis on prevention. As a result, 80%
of patients receive services for family planning to prevent unintended pregnancies (PPH, 2015b). In
2014, PPHP services 33,000 and the education department reached almost 50,000 people through
the implementation of 1,700 programs (PPHP, 2015).
(NYSDOH, 2015)
Teen pregnancy is a major public health concern in the United States, especially amongst at-risk
youth. In the early 1990’s, the teen birth rate was recorded to be approximately 61.8 live births
for every 1,000 teenage girls. In 2010, there were approximately 625,000 women younger than
20 years of age who had become pregnant (Kost & Henshaw, 2014). The pregnancy rate
amongst sexually active teenagers, especially at-risk populations is relatively high. More recently,
the rate has dropped significantly to approximately 26.5 births for every 1,000 teenage girls (US
Department of Health & Human Services, 2015). Although the teen birth rate has been steadily
declining in the past two decades, the rates in the US remain higher than that of other developed
countries (Office of Adolescent Health, 2014). Racial and ethnic disparities are visibly seen
amongst adolescents of African American and Hispanic backgrounds.
The impacts of teen pregnancy are significant. These include increased risks for STDs and HIV,
increased poverty, higher infant mortality rates as well as health and cognitive issues for the child
and teen (CDC, 2015). At an early age, bearing and bringing up a child is challenging and negatively
affects the parents, child, and society. It costs U.S taxpayers billions because of lost tax revenue, and
increases in public health care and services for criminal justice (U.S. Department of Health &
Human service [HHS], 2016). For teen mothers, there are social and economic disadvantages. These
include delaying or dropping out of school, reliance on public support, general poorer education,
and behavioral outcomes for their children such as abuse or neglect (Hoffman & Maynard, 2008).
Introduction to Teen Pregnancy
Planned Parenthood Hudson
Peconic
Current Implementation
1. What are the baseline frequencies and attitudes towards sex, birth control, and condoms?
• Are males and females different with respect to their initial attitudes towards sex, birth control, and
condoms?
• Does race/ethnicity impact initial attitudes towards sex, birth control, and condoms?
• Which age group shows better initial responses regarding attitudes towards sex, birth control, and
condoms?
• What is the distribution of risk-groups as defined by sexual activity, birth control, and/or condom use?
2. Do participants show an increased frequency and change in attitudes towards sex, birth
control, and condoms from pretest to posttest?
• To what degree does gender, race/ethnicity, and age moderate the attitudes towards the outcome
variables?
• Does sexual experience at baseline have an impact on the change in attitudes towards the outcome
variables?
• Does preexisting condom use impact changes to the attitudes towards the outcome variables?
• Does preexisting birth control use impact changes to the attitudes towards the outcome variables?
Research Questions
Inception & Theoretical Basis of Be Proud! Be
Responsible
ASAD AHMED: My professional experiences are diverse ranging from public health project
management related to adolescent sexual health and to HIV quality control . I have previously
interned at the New York State Department of Health AIDS Institute National Quality Center,
Columbia University Mailman Scholl of Public Health Harlem Health Promotion Center and Services
for the Undeserved in NYC. Currently, I am a diversity fellow at the Westchester Institute for Human
Development in Valhalla, NY.
MADALASA VEDRE: My professional experience ranges from practicing dentistry internationally
to community oral health services. My goal is to provide quality care combining my experience gained
in dentistry and public health, with a strong focus in improving overall dental hygiene among all age
groups.
References
• Centers for Disease Control and Prevention. (2015). Teen pregnancy in the United States. Retrieved from. http://www.cdc.gov/teenpregnancy/about/index.htm.
• Hoffman, S. D., & Maynard, R. A. (Eds.). (2008). Kids having kids: Economic costs & social consequences of teen pregnancy. The Urban Institute.
• New York State Department of Health (NYSDOH). (2015). County/Zip code perinatal data profile- 2011-2013. Retrieved from
https://www.health.ny.gov/statistics/chac/perinatal/county/2011-2013/westchester.htm
• US Department of Health & Human Services. (USDHHS, 2015). Trends in teen pregnancy and childbearing. Retrieved from http://www.hhs.gov/ash/oah/adolescent-health-
topics/reproductive-health/teen-pregnancy/trends.html
• U.S department of health and human service (HHS). (2016). Overview - The Office of Adolescent Health. Retrieved from
http://www.hhs.gov/ash/oah/adolescent-health-topics/reproductive-health/teen-pregnancy/#
• Ventura, S. J., Hamilton, B. E., & Matthews, T. J. (2014). National and state patterns of teen births in the United States, 1940-2013. National vital statistics reports: from the Centers for
Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, 63(4), 1-34.
Hispanic Non-Hispanic Black American Indian-
Alaskan Native
Non-Hispanic
White
NumberofBirths
Adolescent Female Births Per1000, Race/ Ethnicity
National Vital
Statistics Report
201446.3 43.9 34.9 20.1
Planned Parenthood (PPH) is a national non-profit
organization with a focus on reproductive health services.
It was founded in 1942 and currently functions as the
largest provider of sex education in the country and
functions through health centers in Suffolk, Westchester,
and Rockland counties in New York (Planned Parenthood,
2015). Service organizations such as Planned Parenthood
have been established to address the needs of those unable
to afford or access patient-centered reproductive health
care. The organization “supports 59 independently
incorporated affiliates that operate 661 health centers
across the U.S., which have seen 2.5 million patients this
year” (Planned Parenthood, 2014-15). The majority of](https://image.slidesharecdn.com/55c4e023-5b69-4900-94b8-b36baa7d1724-160426172321/85/mosk-editing-april-13-3-1-320.jpg)
