2. For example, the Coles et al. study found that Medicaid funding restrictions along with the mandatory waiting periods reported higher percentage of both unwanted and mistimed pregnancies than those who lived in states without these restrictions (Coles et al., 2010).
1. The study evaluates specific areas of abstinence-only education that can contribute or correlate with an increase pregnancy rates; (1) the level of emphasis on abstinence in state laws and policies, (2) teen pregnancy, abortion, and birth data, and (3) other external factors; socioeconomic factors, education attainment, ethnic composition, and Medicaid waivers for family planning (Stranger-Hall and Hall, 2010). This correlation approach identified abstinence-only education programs as ineffective at preventing teen pregnancy rates and outcomes mainly because these programs did not causes teens to practice abstinent behaviours.2. This indication that public polices directly contributes to teen pregnancy rates. Abstinence-only education programs are adopted through public policy, thus emphasizing the role of the state in policy implementation and federal support.
This calls for great consideration in regards to public policy change that can help alleviate poverty within specific ethnic groups that have been identified in the previous studies to be more at-risk for teen pregnancies.
The above research questions have been formulated to provide an overview of what the research will hope to answer.
The two interventions that will be used in evaluation the effectiveness of such programs is: Abstinence-Only curriculum, and a Comprehensive Sex Education Curriculum Reducing the Risk. Participants will be given a pre and a post-test in each curriculum, as well as a follow-up survey that will evaluate the effectiveness of both interventions as two separate entities. Data collected from both these surveys will be used in a comparison analysis. Sessions will be held at point of contact and sites will provide all the materials needed to implement these interventions.
Cohorts are given #’s and are represented as the last 2-digits in the participants ID#
2. This also includes notes taken by volunteers and audio recorded from both the focus groups and the in-depth interviews.
RESEARCHPROPOSALIris Santa • COMHE 413 • 09 MAY 2012
OVERVIEW INTRODUCTION REVIEW OF EXISTING LITERATURE OBJECTIVE OF THE STUDY PROPOSED METHODS DATA COLLECTION CONCLUSION Q&A
INTRODUCTION According to the CDC, of 2009 the rate of teen pregnancy has declined about 9%. Teen pregnancy continues to be the highest in the United States. Teen pregnancy is a multi-factorial issue: Socioeconomic factors Sociodemographic factors State-Adopted Policies
EXISTING LITERATURE Common themes: Using an economical model of cost & benefit of abortion, Marshall Medoff (2009), identified that teens choose the optimal alternative depending on their economic values and the information they have available to them (i.e. make an economically rational decision). Coles et al. (2006), identified Medicaid restrictions as factors in determining access to abortion services actually increase teen pregnancy rates.
OTHER THEMES Abstinence-Only Education: Studies have shown a positive correlation between abstinence-only programs and an increase in teen pregnancy (Stranger-Hall and Hall, 2010). Yang and Gydos (2010), also concluded through a similar correlational analysis of policy and culture, that higher abstinence funding per capita was observed among states with high teen birth rates.
PUBLIC POLICY: POVERTY Claire D. Brindis (2006) aims at examining certain public policy changes surrounding specific factors affecting teen sexual activity and pregnancy. The research has found: Socioeconomic status is an indicator of poor health. 70% of higher-income teenagers who become pregnant choose to postpone childbearing, whereas lower-income teens are more likely to give birth.
NEW RESEARCH New Research: The focus of new research in this area should be on the affects of public policy on teen pregnancy rates. Purpose: Eliminating state-adopted policies that limit access to reproductive health care that would decrease the rate of teen pregnancies and births.
OBJECTIVE & HYPOTHESIS The objective of this study is to further analyze how public policy affects teen pregnancy and births in the following categories: Abortions Evidence-based interventions Access to confidential reproductive health care Hypothesis: the more restrictions and limitations placed on access to abortion services, evidence- based sexual education, and access to quality reproductive health care due to public policy changes are more likely to increase both unintended pregnancies and teen births.
PROPOSED RESEARCH Research Questions: What are the effects of public policy changes on the rate of teen pregnancy and births? Do restrictive abortion laws increase the rate of teen pregnancy alone? Are there specific restrictions that are more or less likely to increase or decrease teen pregnancy rates and outcomes? How teen pregnancy rates and outcomes are differing across states with certain abortion restrictive laws? What are the underlying factors that lead to specific policy implications?
RESEARCH DESIGN Research uses a practical triangulation-based approach (Mixed Methods): Cross-sectional survey analysis Focus Groups In-depth Structured Interviews Policy Analysis Critical Evaluation of Literature Defining Variables Independent: Abortion Restrictions, Evidence- Based Interventions, and Access to Reproductive Health Care Dependent: Teens intent to become sexually active ,use contraception, and pregnancy rate and outcomes.
DETERMINING SAMPLE Sample Size Convenience Sampling: Overall sample size of study. InclusionCriteria: Age, and Sexual History (Pregnancy/Full-term Birth, Prior TOP, Currently Sexually Active.) Stratified Random Sampling: Poverty-Level, Race, and Insurance. The total number of participants recruited for the study will be 50 (N=50).
RECRUITMENT & ELIGIBILTY Recruitment will take place via: Community-health centres School-based health centres Community-based organizations Eligibility Survey Age Establishing a history of TOP Births Sexual Activity Interest in Study Method of Contact
RESEARCH SCHEDULE Base-Line Surveys (@ 0-Months) Evidence-Based Interventions (@ 0-3 Months) In-Depth Interviews and (@ 6-Months) Focus Group (@ 3-6 Months) Survey (@ 12-Months)
SURVEYS Surveys are given at base-line and 12-months Surveys are administered using the survey hosting site [polldaddy.com]. Surveys consist of questions that identify how teens “feel” or “react” to certain changes in policies that can affect their decision-making. Survey data is collected and analyzed via the survey hosting site. Data is categorized into common themes for open-ended questions.
FOCUS GROUPS There are a total of 3 sessions Focus groups are done once a month during months 3-6. 45 minutes Participants are compensated for transportation costs and are provided incentives at each meeting. Focus groups are designed to capture reoccurring themes and patterns. Each session is recorded for transcription and greater accuracy.
IN-DEPTH INTERVIEWS Participants will be selected for interviews by random sampling. Each interview is specific to participants cohort# Cohorts are categorized as such: Pregnant (01) Prior birth (02) Prior termination (not a parent-currently sexually active) (03) Prior termination (parent-currently sexually active) (04) Sexually active (not a parent and no prior termination) (05)
DATA COLLECTION Survey data is collected and analyzed through the survey hosting site. Qualitative data from focus groups and interviews will be categorized into common themes and safe-guarded to maintain confidentiality. All paper documents are stored in a secure location in the research directors office with limited access from external institutions until findings are published. All electronic documents are stored on the
DATA REPORTING Published as a peer-reviewed journal article: Journal of Adolescent Medicine. Published on the “Publications” tab on the NIRH website. Results presented at follow-up focus groups. Will be available for use in academic and research institutions for reference.
CONCLUSION Teens should not be limited by policies. It is a fundamental human right to access these services. Public policy has the ability to increase teen pregnancy and outcomes. Future research must focus on the affects of public policy on teen pregnancy. Modifications are to be to made to current policies to eliminate restriction.