Recognizing the Costs of Teen Pregnancy: “Baby Think it Over”

Despite recent improvements in teen pregnancy and birth rates, 2000 teens get pregnant each day in the U.S. Innovative strategies that are effective and acceptable within communities are needed to continue these declines in teen pregnancies. Captivating educational interventions enhanced by infant simulators, such as “Baby Think it Over” (BTIO), can discourage teen pregnancy. The purpose of this research was to evaluate a BTIO intervention to determine the effectiveness of the program in changing 236 high school students’ perceptions of the costs of teen parenting. From a comparison of pre-test/two post-test measures, it appears the participants recognized that teen parenting would be costly in terms of increased difficulty in making responsible decisions as well as the challenges of juggling school with parenting. They also recognized other costs including negative impacts on relationships, on feelings of personal worth, and the likelihood of diminished achievements in the future. DOI : 10.14302/issn.2324-7339.jcrhap-13-186 Corresponding author: Josie Weiss, Christine E. Lynn College of Nursing, Florida Atlantic University Email: jweiss21@fau.edu


Think it Over"
Teen pregnancy prevention is a national concern. While we have seen dramatic declines, the US continues to have one of the highest teen childbearing rates among industrialized nations [1]. Approximately 750,000 teens become pregnant each year [2]. year, is popular among students and teachers and assumed to be effective as teen pregnancy rates in the county have steadily declined during that time period.
Since the onset of the program, BTIO has grown from two classroom presentations in two high schools to over 21 classroom presentations in all six county high schools. During these 13 years the county has dropped from 28 th to 47 th in the rate of teen births [3]. While many initiatives are in place, it is possible that BTIO may have had an influence on these decreased rates. Prior to this research, the intervention had been evaluated using a brief survey assessing student satisfaction, which was consistently very positive. After conducting the program for a number of years the educators determined it was time for a more systematic evaluation to examine the effectiveness and to identify changes in order to strengthen the intervention.

Background
Teen pregnancy is an important public health concern often resulting in hardships for teen parents and their children, and contributing to poverty [4]. Children who are born to teen parents usually pay the greatest price for teen pregnancy. These children are more likely to have problems at birth, chronic health problems, and difficulty in school [5]. They are at greater risk for abuse or neglect and less likely to achieve their full potential due to poor school performance [4], difficulty sustaining employment, and criminal involvements [6] Theoretical Underpinnings This was an "opt out" program, so students who did not return consent forms participated in the educational component of the program, but were not eligible to take

Results
The repeated measures ANOVA indicated that no significant differences appeared on the total score of  Table 2). Of the 16 items in Part B designed to elicit information on any significant differences across time, 11 items revealed a desirable change in attitudes/beliefs about pregnancy as a result of the intervention. Following the intervention, teens were more confident that experiencing a teen pregnancy would cause them to "lose friends," but less confident that pregnancy would "bring boyfriends and girlfriends closer" or "make boyfriends stay in a relationship." They were less confident that they could "juggle school while being a parent" or that they would not "drop out of school." They were more convinced that they would "not achieve as much in future endeavors" and less confident that they would "be more responsible" or "make better decisions," and not "get in more trouble." Five items from Part B resulted in a change in attitudes/beliefs about pregnancy that were unexpected.
Following the intervention, the students were less convinced that their "parents/guardians would be angry," that they would have "less time to spend with friends," and that they would "lose sleep." Initially they strongly disagreed that a teen pregnancy would "make life easier," but became less convinced at the second post test.
Significant changes in student response patterns were apparent on 12 of the items in Part C. Following the intervention, students were more likely to endorse knowing where to "get birth control and protection" and having received "enough sex education in school." They were also less likely to agree that "some girls want to get pregnant." The results from Part C also provide evidence that after completing the intervention, teens had a stronger belief in the effectiveness of birth control, but also a stronger belief that "teaching teens about sex and birth control encourages teens to have sex." They  were also less likely to endorse a belief that "adults are truthful with teens about sex and pregnancy." A second analysis was conducted to determine if students who took home infant simulators perceived greater costs related to early childbearing/childrearing following the intervention than those who did not take simulators. To answer this question, a two-way mixed ANOVA with 3 levels of time (pretest, posttest one and posttest two) as the within-subjects factor and two levels of "took baby home" (yes or no) as the betweensubjects factor was used. There were three items that demonstrated significant differences between groups at one or more time points. When asked if they believed they would have "a better life" as a result of pregnancy, students who took a baby home were less likely to agree that they would have a better life than those who did not take home infant simulators at posttest two.
Another item asked students whether "Having teen parents talk to teens about what it is like to have their children prevents pregnancy." On this item, students who took home the infant simulators demonstrated more positive scores at post-test one as compared to those who did not take simulators. Finally, students who took home infant simulators were more likely to disagree with the statement "Making birth control available to teens makes teens more sexually active" both at post-test one and post-test two, as compared to those students who did not take simulators.
Gender, free lunch status, religious person, sibling pregnant, teen parent, and family structure were added as between-subjects variables to the analysis of the total score over time in order to determine whether there were any significant interactions or main effects previously overlooked. Based on the results of this analysis, no significant interactions or main effects of any of the between-subjects variables were noted.

Discussion
As with other Baby Think it Over programs, this one is popular with students, parents, and teachers, and is unique and tailored to the needs of the community. Most of the participants were engaged in the intervention and eager to take an "infant" home at the conclusion. However, due to the limited number of simulators, only 27% of participants could borrow one.
Some participants enjoyed this parenting experience more than others, but from their discussions, all seemed more aware of the challenges of teen parenting. All of the participants disagreed that they "would have a better life" as a teen parent, but those who took home simulators were significantly more certain of this. These participants also had a high degree of appreciation for the benefits of learning from teen parents and the benefits of having birth control available.
This research was helpful in identifying some other interesting attitudes of the students. These attitudes were consistent over the pre-and post-tests, although not impacted significantly by the intervention.
While some adults advocate for abstinence education, the majority of these adolescent participants disagreed with the statement "telling teens not to have sex Teen pregnancy is a concern to school health professionals because it can result in disruption of education and student loss. A significant number of participants in this study recognized that teen pregnancy often derails academic plans and future success.
Interventions that engage students and increase their awareness of the costs of teen parenting are a good investment if effective in preventing pregnancy.