PROMOTING HEALTHY MINDS AND PROMOTING HEALTHY MINDS AND BODIES OF TEENAGERS THROUGH AN BODIES OF TEENAGERS THROUGH AN EVIDENCE-BASED INTERVENTION TO EVIDENCE-BASED INTERVENTION TO

REDUCE RISKY BEHAVIORS AND REDUCE RISKY BEHAVIORS AND PROMOTE GOOD VALUES PROMOTE GOOD VALUES

Kathleen Sternas, Ph.D, RN, Mary Ann Scharf, Ed.D, RN,Kathleen Sternas, Ph.D, RN, Mary Ann Scharf, Ed.D, RN, Seton Hall University, College of Nursing, South Orange, N. J., Seton Hall University, College of Nursing, South Orange, N. J.,

RoseMarie Peterkin, MAT, Friends and Families United Inc. RoseMarie Peterkin, MAT, Friends and Families United Inc. Newark, N. J., Janet Summerly, MSN, RN, Seton Hall University, Newark, N. J., Janet Summerly, MSN, RN, Seton Hall University,

College of Nursing, South Orange, N. J.College of Nursing, South Orange, N. J.

AcknowledgementsAcknowledgements

This research study was funded by an This research study was funded by an Adolescent Family Life, Office of Adolescent Family Life, Office of Adolescent Pregnancy Prevention Grant, Adolescent Pregnancy Prevention Grant, Dept. of Health & Human ServicesDept. of Health & Human Services

PurposePurpose

This presentation describes: 1) outcomes This presentation describes: 1) outcomes for high risk teenagers in an evidenced-for high risk teenagers in an evidenced-based Adolescent Family Life based Adolescent Family Life intervention that promotes healthy minds intervention that promotes healthy minds and bodies by reducing risky behaviors, and bodies by reducing risky behaviors, promoting good values; and 2) compares promoting good values; and 2) compares intervention teenagers with a comparison intervention teenagers with a comparison group of teenagers who did not receive group of teenagers who did not receive the intervention. the intervention.

There are high rates of risky behaviors among There are high rates of risky behaviors among adolescents which affect health (Marti, Stice & adolescents which affect health (Marti, Stice & Springer, 2010; Schinke, Schwinn &Fang, Springer, 2010; Schinke, Schwinn &Fang, 2010).2010).

BackgroundBackground

Risky BehaviorsRisky Behaviors

Risky behaviors like drug and alcohol use, smoking, Risky behaviors like drug and alcohol use, smoking, and sexual activity leading to STD’s, HIV/AIDS, and and sexual activity leading to STD’s, HIV/AIDS, and teen pregnancy are prevalent among Newark teen pregnancy are prevalent among Newark teenagers. teenagers.

Risky behaviors affect health ( Sandfort et. al, 2008; Risky behaviors affect health ( Sandfort et. al, 2008; Weed et. al, 2008).Weed et. al, 2008).

Literature ReviewLiterature ReviewIllicit Drug UseIllicit Drug Use -- In 2007, an estimated 19.9 In 2007, an estimated 19.9

million Americans aged 12 or older were million Americans aged 12 or older were current (past month) users of an illicit drug.current (past month) users of an illicit drug.

TobaccoUse TobaccoUse -- In 2007, an estimated 70.9 million In 2007, an estimated 70.9 million Americans aged 12 or older were current (past Americans aged 12 or older were current (past month) users of a tobacco product.month) users of a tobacco product.

Alcohol UseAlcohol Use-- Slightly more than half of Slightly more than half of Americans aged 12 or older reported being Americans aged 12 or older reported being current drinkers of alcohol in a 2007 survey current drinkers of alcohol in a 2007 survey (51.1%). The rate of current alcohol use among (51.1%). The rate of current alcohol use among youth aged 12 to 17 was 15.9% in 2007.youth aged 12 to 17 was 15.9% in 2007.

From From http://www.drugabusestatistics.samhsa.gov

STD’sSTD’s

• The Center for Disease Control and Prevention The Center for Disease Control and Prevention (2008) reported nearly 3.2 million girls, ages 14 (2008) reported nearly 3.2 million girls, ages 14 to 19, is infected with an STD.to 19, is infected with an STD.

• African American girls are at higher risk. African American girls are at higher risk. Chlamydia rates among adolescent girls is up Chlamydia rates among adolescent girls is up by 1.8 % in 2009, and African Americans by 1.8 % in 2009, and African Americans represent 48% of all new cases of Chlamydia represent 48% of all new cases of Chlamydia and 71% of all new cases of gonorrhea (CDC, and 71% of all new cases of gonorrhea (CDC, 2009).2009).

http://www.cdc.gov/std/stats09.adol.htmhttp://www.cdc.gov/std/stats09.adol.htm

http://www.cdc.gov/std/stats09.minorities.htmhttp://www.cdc.gov/std/stats09.minorities.htm

HIV and STD Rates For HIV and STD Rates For Teenagers in New JerseyTeenagers in New Jersey

Incidence of HIV among 13-24 y.o.Incidence of HIV among 13-24 y.o.

1998:12.61998:12.6 2002:11.82002:11.8

Incidence of chlamydia, females 15-19 y.o.Incidence of chlamydia, females 15-19 y.o.

1998:1873.81998:1873.8 2003:1841.32003:1841.3

Incidence of gonorrhea, females 15-19 y.o.Incidence of gonorrhea, females 15-19 y.o.

1998: 622.71998: 622.7 2003: 619.02003: 619.0

Incidence of syphilis: 1998:1.3 2003:2.0Incidence of syphilis: 1998:1.3 2003:2.0

Per 100,000 of the populationPer 100,000 of the population

Teenage PregnancyTeenage Pregnancy

The U.S. has the highest rates of teen The U.S. has the highest rates of teen pregnancy and births of all developed pregnancy and births of all developed nations. The teen birth rate per 1000 girls nations. The teen birth rate per 1000 girls aged 15-19 in 2006 in the US was 41.9 aged 15-19 in 2006 in the US was 41.9 (National Campaign to Prevent Teen and (National Campaign to Prevent Teen and Unplanned Pregnancy, 2009).Unplanned Pregnancy, 2009).

Birth Rates For Teenagers in NJBirth Rates For Teenagers in NJ

The teen birth rate per 1000 girls aged 15-19 in The teen birth rate per 1000 girls aged 15-19 in 2006 in New Jersey was 24.9.2006 in New Jersey was 24.9.

Birth rates for females 10-14 years old in NJ Birth rates for females 10-14 years old in NJ declined from 0.6 in 1998 to 0.5 in 2002.declined from 0.6 in 1998 to 0.5 in 2002.

Birth rates for Black females 10-14 years old in Birth rates for Black females 10-14 years old in NJ declined from 2.3 in 1998 to 1.5 in 2002.NJ declined from 2.3 in 1998 to 1.5 in 2002.

The number of births to Black females aged 10-14 The number of births to Black females aged 10-14 in Essex County declined from 22 in 2000 to 7 in Essex County declined from 22 in 2000 to 7 in 2005.in 2005.

Teenage PregnancyTeenage Pregnancy

Teenage mothers are more likely to:Teenage mothers are more likely to:

-drop out of school-drop out of school

-live in poverty-live in poverty

-remain unmarried -remain unmarried

-have children who are at risk for growing up -have children who are at risk for growing up poor and experiencing neglect, and not poor and experiencing neglect, and not finishing school themselves.finishing school themselves.

Theoretical Framework and Theoretical Framework and InterventionIntervention

The intervention is guided by Bandura’s The intervention is guided by Bandura’s Social Learning Theory.Social Learning Theory.

The intervention has a seven component The intervention has a seven component curriculum which is implemented in curriculum which is implemented in schools that provides support, role schools that provides support, role models and education on delaying sex, models and education on delaying sex, and avoiding risky behaviors.and avoiding risky behaviors.

InterventionIntervention The intervention includes: 1) group sexuality discussions; 2) mentoring; 3) role The intervention includes: 1) group sexuality discussions; 2) mentoring; 3) role

modeling; 4) health and fitness classes; 5) cultural events; 6) community service; 7) modeling; 4) health and fitness classes; 5) cultural events; 6) community service; 7) and a recognition ceremony. and a recognition ceremony.

Activities provide supportive relationships, positive peer pressure, counseling, Activities provide supportive relationships, positive peer pressure, counseling, sexuality information and health lessons.sexuality information and health lessons.

Design: Design: Pretest post-test design. Pretest post-test design. Sample/Setting:Sample/Setting: Four intervention schools (n=190 Four intervention schools (n=190 girls; 193 boys ) and five comparison schools (n= 97 girls; 193 boys ) and five comparison schools (n= 97 girls; 72 boys) participated. Participants were 6girls; 72 boys) participated. Participants were 6 thth, , 77thth, 8, 8thth graders primarily of African American graders primarily of African American ethnicity. Intervention participants were randomly ethnicity. Intervention participants were randomly selected. Comparison participants were a selected. Comparison participants were a convenience sample who did not receive the convenience sample who did not receive the intervention. Comparison and Intervention schools intervention. Comparison and Intervention schools were matched on demographic variables (grade were matched on demographic variables (grade level, ethnicity, socioeconomic status). level, ethnicity, socioeconomic status).

MethodsMethods

InstrumentsInstruments-Adolescent Family Life Core Baseline/Follow-up -Adolescent Family Life Core Baseline/Follow-up

QuestionnairesQuestionnaires-Demographic Questionnaire-Demographic Questionnaire Paper and pencil administration of the Paper and pencil administration of the

questionnaires was done by trained staffquestionnaires was done by trained staff.

Statistical AnalysesStatistical Analyses Pearson Chi Square, Mann Whitney U statistical Pearson Chi Square, Mann Whitney U statistical

tests and a .05 level of significance were used.tests and a .05 level of significance were used.

Instruments and AnalysesInstruments and Analyses

ResultsResults

Demographic CharacteristicsDemographic Characteristics

- 6- 6thth , 7 , 7thth, and 8, and 8thth grade high risk girls and grade high risk girls and boys primarily of African American boys primarily of African American ethnicity from impoverished ethnicity from impoverished environments with high unemployment environments with high unemployment

- single parent households- single parent households

-violence in the community-violence in the community

ResultsResults Intervention vs Comparison Intervention vs Comparison

ParticipantsParticipants

Post-Test IV Results: Post-Test IV Results: Significantly more Significantly more intervention than comparison participants intervention than comparison participants reported:reported: a bright future (p =.019); band/ a bright future (p =.019); band/ chorus participation (p = .001); important to chorus participation (p = .001); important to remain abstinent (p = .001) and for future remain abstinent (p = .001) and for future spouse to remain abstinent (p = .003); spouse to remain abstinent (p = .003); abstinence is the only way to avoid STD’s, abstinence is the only way to avoid STD’s, pregnancy and other health problems pregnancy and other health problems (p=.002).(p=.002).

Results: Comparison vs Results: Comparison vs Intervention Participants Intervention Participants

Post-Test IV Findings: Post-Test IV Findings: Significantly more comparison Significantly more comparison than intervention participants reported: than intervention participants reported: having having friends who drink (p= .001)/ tried marijuana/other friends who drink (p= .001)/ tried marijuana/other drugs (p< .001).drugs (p< .001).

Post-Test IV Findings: Post-Test IV Findings: Significantly more Significantly more

intervention girls than comparison girls intervention girls than comparison girls reported: reported: feeling accepted (p= .005); and feeling accepted (p= .005); and a bright future (p = .010). a bright future (p = .010).

Results: Intervention vs Results: Intervention vs Comparison GirlsComparison Girls

Results: Comparison vs Results: Comparison vs Intervention GirlsIntervention Girls

Post-Test IV Findings: Post-Test IV Findings: Significantly more Significantly more comparison than intervention girlscomparison than intervention girls

reported: reported: having friends who drink having friends who drink (p= .007)/ tried marijuana/other drugs (p= .007)/ tried marijuana/other drugs (p< .001).(p< .001).

Results: Intervention vs Results: Intervention vs Comparison BoysComparison Boys

• Post-Test IV Findings: Post-Test IV Findings: Significantly more Significantly more intervention boys than comparison boys intervention boys than comparison boys reported: reported: adults encourage them adults encourage them (p= .036); important to remain abstinent (p= .036); important to remain abstinent (p = .031); (p = .031); abstinence is the only way to abstinence is the only way to avoid STD’s, pregnancy and other health avoid STD’s, pregnancy and other health problems (p=.028).problems (p=.028).

Results: Comparison vs Results: Comparison vs Intervention BoysIntervention Boys

Post-Test IV Findings: Post-Test IV Findings: Significantly Significantly more comparison than intervention boysmore comparison than intervention boys

reported: reported: having friends who drink having friends who drink (p= .030)/ tried marijuana/other drugs (p= .030)/ tried marijuana/other drugs (p< .014).(p< .014).

Conclusions Conclusions

Intervention participants have more significant Intervention participants have more significant outcomes related to less risky behaviors like outcomes related to less risky behaviors like drug/alcohol use, and good values like positive drug/alcohol use, and good values like positive abstinence behaviors/attitudes than comparison abstinence behaviors/attitudes than comparison participants. Findings suggest the intervention participants. Findings suggest the intervention reduces risky behaviors like using drugs and reduces risky behaviors like using drugs and promotes abstinence. Abstinence attitudes and promotes abstinence. Abstinence attitudes and behaviors help prevent teenage pregnancy, behaviors help prevent teenage pregnancy, STD’s and other health problems, thereby STD’s and other health problems, thereby promoting adolescent health.promoting adolescent health.

  

Implications Implications

Findings have implications for the Findings have implications for the development of intervention programs development of intervention programs for teenagers which promote healthy for teenagers which promote healthy minds and bodies by reducing risky minds and bodies by reducing risky behaviors and promoting good values. behaviors and promoting good values.