Introduction & Background
On
March 3, 2013 Mayor Bloomberg, the Deputy Mayor for Health and Human Services
announced the roll out of a new campaign with the goal of further reducing
teenage pregnancy rates in New York City.
The campaign consists of posters in subway and bus terminals asking the
question, “Think being a teen parent won’t cost you?” and of toddlers and young
children saying things such as, “Honestly, mom… chances are he won’t stay with
you. What happens to me?” and “Dad, you’ll be paying to support me for the next
20 years. “One depicts a toddler crying with the text, “I’m twice as likely not
to graduate high school because you had me as a teen.” (1).
The second component to the intervention
is a text-based initiative in which the public can participate in learning the
“real cost of teen pregnancy” through games and quizzes via text message (1).
Many of the texts are just as harsh as the posters, where if you choose to
follow a pregnant teenage girl, her friends call her fat at prom, she loses her
best friend, and her parents kick her out of the house. New York has seen a
steady increase in teenage pregnancy over the past few years and mayor
Bloomberg believes that these harsh advertisements are the best way to further
prevent teen pregnancy. The press release launching the new campaign outlines
how the approach is meant to, “Address the issue from both an economic and
social perspective, the message focuses on responsibility and the impact
employment, family, education and the emotional and financial support of both parents
have on a child’s well-being.” (2).
Overview
Incorporating texting and technology familiar to
teens is increasingly being incorporated into public health interventions in
addition to traditional methods in order to meet adolescents at a point they
understand. Unfortunately most social media programs use Social Cognitive
Theory, Theory of Reasoned Action and the Theory of Planned Behavior to reach
teens and fail to realize important flaws in their design (3). New York’s new
Teen Pregnancy Prevention Program falls into the same trap as most public
health interventions. Specifically, the program incorrectly assumes that teens
believe they are at risk of becoming pregnant and fails to acknowledge positive
choices teens make by stereotyping the period of adolescence as one where you
make bad choices. Finally, the intervention invokes psychological reactance in
teens. By defining pre-marital sex as costly, inappropriate and shameful the
intervention effectively encourages teens to take risks sexually out of
defiance.
Flaw #1: Assumes teens accurately
perceive risk
The intervention
assumes that teens believe they are at risk of becoming pregnant, and that if
they believe they are at risk, they will change their behavior. The assumption
that adolescents believe they are at risk of pregnancy completely discounts the
overwhelming research that teens tend to feel a sense of invincibility, which
lowers perceived risk, in the realm of long-term health outcomes. Wickman,
Anderson and Greenburg (2008) sought out to understand adolescent perceptions
on what invincibility meant to them. As one teen put it, “somehow I think that it can never happen to me
because it is (only) other people who have bad things happen….”(7).
Almost all teens know that if they have unprotected
sex, there is a chance they will become pregnant. However, as Kershaw et al
(2003) write, sexual risk is not accurately perceived among adolescents, leading
them to engage in what they believe is a minimal risk activity, unprotected
sex. In a sample of adolescent females who had engaged in unprotected sex with
more than one partner (i.e. high-risk behavior for STI infection), 65% believed
that their behavior was only slightly or not at all risky (4). Underestimation of perceived risk only
increases as an individual engages in an increased number of risky interactions
(6). In other words, as frequency of risky acts increases, real risk also
increases, however perceived risk decreases, leaving those at the greatest risk
with the greatest sense of false safety.
Those at the greatest risk therefore are the least likely to recognize
these posters of crying babies as something to pay attention to. The posters
are hung in very public and busy spaces, where passersby are likely to ignore
the message, assuming it does not pertain to them. The texting aspect of the
campaign must be subscribed to, and since many teens do not see themselves as
needing a pregnancy prevention program, they will not subscribe.
Flaw #2: Stereotypes perpetuate
behavior, not change it.
Society
has effectively stereotyped adolescence as an emotionally taxing, physically
awkward and challenging time in our lives. We are all taught that teens make
bad choices, take unnecessary risks and disregard what parents tell them to do.
While some of these characteristics can be accurate to some degree, the
negative image placed on teenagers is detrimental to their health behavior. When
we apply overarching stereotypes to any group, they are more likely to live up
to, or down to, that stereotype. For example, the stereotypes exist that Asian
Americans are particularly intelligent in math and science and that women are
not as gifted in those subjects. After two separate groups of Asian American
females were reminded of each of these stereotypes, and given an exam,
participants scored relative to the stereotype they were reminded of (8). Those
that had gender inequalities on their mind had lower scores than those that had
ethnic differences on their minds. This simple experiment has important implications
for the Teen Pregnancy Prevention Program. Constantly reminding teens of their
risky health behavior stereotype may lead them to fulfill that stereotype. As
one teen describes, “media focuses on the negative
behaviors of teenagers and that because of an established negative stereotype,
teens do not have the chance to prove themselves.” (7).
In addition, the
intervention fails to address the reality that our society has effectively
sexualized almost every aspect of our lives. Advertisements crowd airwaves and
websites with overly sexual commercials advertising everything from deodorant
to alcohol to clothing. Mass media has a large role in socialization processes
of teens and has been referred to as “a sexual super-peer” in influencing teen
behavioral practices and exposure to hypersexual media has a strong association
with earlier initiation of sex among teens (5). The media’s role and the
messages sent by the public health community are conflicting yet both shed a
negative light on adolescents. Media constantly appeals to teens using sexual
ads as they try to adapt to the changes in their body physically and mentally,
and encourages teens to experience their sexual freedom. At the same time adults, and public
health interventions such as this remind teens of the risky decisions they
make. The intervention does nothing to support teens in defining themselves as
sexual beings in a healthy and supportive way, which would help them make
better decisions and change stereotypes.
Flaw #3: Threatens teens’ freedom by
stigmatizing deviant and ‘risky’ behaviors
The
Teen Pregnancy Prevention Program paints a harsh portrait of teen mothers,
accusing them of meaningfully putting children into an environment in which it
is near impossible to thrive. The posters have an authoritative tone to them,
stigmatizing teen parents as bad people. However the research shows that this
preachy and negative stereotype approach to sharing information in reality
completely shuts down teens’ willingness to listen. Negative stereotypes foster
a hostile relationship between adolescents and adults, and create an
“’us-against-them’” mentality (7). Hostile atmospheres in which adults try to
tell teens what to do invoke strong psychological reactance in adolescents.
Psychological reactance results in rebellion and pushes teens to experiment
with their sexuality in an unhealthy context. Teens exhibit psychological
reactance often through an, “No one can stop me,” or “I don't have to listen
to anyone,” attitude, leading them to make risky choices (7).
When the public health
community victimizes and shames teen parents, we are only promoting stigmatization
of adolescent sexual intercourse. Stigmatization effectively defines adolescent
sex as a ‘deviant’ behavior and subsequently limits teen’s feeling of sexual
autonomy. Psychological reactance theory describes how when we limit one’s
behavior and remove their freedoms they are actually more likely to engage in
that behavior. Psychological reactance has been shown to be an effective
predictor of engaging in risky sexual behavior, more predictive than sensation
seeking or consumption of alcohol or drugs (6). Therefore it is essential to include a prevention method of
reactance in public health interventions, something this campaign certainly
does not do.
Proposed Alternative Intervention
Interventions
to prevent teen pregnancy must be focused on the present, not the consequences
that are to come down the road. We must also work to change the negative
stereotypes surrounding teenagers and the choices they make by changing the
discourse of how we approach understanding how adolescents make choices.
Finally, we must not foster the “us-against-them” culture that ignites the
desire to make the unhealthy choice. Therefore I propose a community action-based
intervention that involves former teen parents, facilitates discussion and
promotes a culture of empowerment and changing stereotypes. Community based
interventions have shown promise in addressing health disparities in at risk
populations (12).
The
texting component of the NYC Teen Pregnancy Prevention Program is not a
terrible idea, however it must be implemented in a less authoritative and
accusatory way. Text-based
interventions allow teens to ask questions anonymously at anytime that is convenient
to them. Therefore my intervention would have a component in which teens are
provided with a phone number they can text any question they may have
concerning sexual or health in general.
Focus on the here and now
Adolescents,
and many adults are unable to act in logical ways in the present to protect
from outcomes in the future. They simply do not recognize that becoming
pregnant could really happen to them (8). Therefore it is essential to meet
teens where they are rather than forcing them to think about a future they
cannot envision. Showing teens the immediate implications, both positive and
negative, of their actions allows them to contextualize the action. For example,
Wickman et al (2011) found that telling adolescents not to smoke because their
lungs will turn black in ten years elicits no behavior change, yet an
intervention that tells teens their crush won’t want to kiss them because they
smell bad will (7).
Change the discourse, creating a safe
environment
Adolescents will
likely conform to stereotypes even if they are shifted from negative to
positive. Changing the discourse of the conversations about choices teens make
eliminates that negative environment and provides adolescents an opportunity to
prove adults wrong. Rather than behaviors being risky, it may be helpful to promote
“exploratory or experimental” behavior within a safe context. Rather then
telling teens their sexual desires are ‘bad’, change the discourse to trying to
understand where they are coming from. Shifting vocabulary however must be
accompanied by a shift in attitude by parents, community members and educators.
Adults must be open to creating a supportive environment in which teens can
learn and take calculated, educated risks within the context of a safe
environment.
Safe
environments in which to take risks greatly decreases the negative health
outcomes associated with those risky behaviors. For example, participation in
needle exchange programs as an injection drug user significantly decreases one’s
risk of HIV infection (10). By eliminating a risk factor an creating a culture
of measured risk we can greatly decrease teen pregnancy rates.
Empower
Young women must be empowered and encouraged to
take control of their sexuality. My proposed intervention discards telling
teens what to do and instead creates a community of teens who choose to have safe sex and are comfortable
in their sexuality. Goal oriented, inclusive and constructive programs reframe
teen pregnancy prevention and are essential to reaching the most at-risk
populations (11). Young women must
be included in discussions and accept their desire to be recognized as sexual
beings. Education programs telling them what to do will not change behavior,
therefore programs that include information about relationships and sexual
desire and empower them to take control of those relationships and desires will
have the greatest effect. “By empowering teens—especially teenage girls whose
desire is often denied or stigmatized—to recognize and take control of their
own desire, they will be more in control of their sexual behaviors.” (Sisson, 2011).
Conclusion
Overall
the Teen Pregnancy Prevention Program is an ineffective public health
intervention. The program fails to acknowledge some of the most basic
characteristics and personality traits of adolescents by assuming accurate
perception of risk of pregnancy, promoting negative stereotypes and disseminating
information with an authoritative tone. As public health professionals we must
address these faults to insure that young men and women have a safe environment
in which they can make educated decisions are supported by their community in
taking control over becoming sexual beings and accurately perceive risk in the
short term.
References
(1)
HRA- Teen
Pregnancy Prevention. “Think being a Teen Parent won't Cost you?” NYC Human
Resource Administration Department of Human Services. 28 April 2013.
http://www.nyc.gov/html/hra/html/programs/teen_pregnancy_campaign.shtml
(2)City of New York Office of the Mayor. MAYOR
BLOOMBERG, DEPUTY MAYOR GIBBS AND HUMAN RESOURCES ADMINISTRATION COMMISSIONER
DOAR ANNOUNCE NEW CAMPAIGN TOFURTHER REDUCE TEEN PREGNANCY, Press Release. 3
Mar 2013. http://www.nyc.gov/html/hra/downloads/pdf/press_releases/2013/pr_march_2013/teen_pregnancy_press_release.pdf
(3)Kylene
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(5) L’Engle,
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(6)Miller,
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(7)Wickman,
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(9)Ariely, Dan. Predictably Irrational: The Hidden Forces That
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(10)
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(11)
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(12)
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