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Ducks Have Ducks Unless…

2003; American Academy of Pediatrics; Volume: 111; Issue: 2 Linguagem: Inglês

10.1542/peds.111.2.446

1098-4275

Catherine Stevens–Simon,

Adolescent Sexual and Reproductive Health

To the Editor.—Given the legacy of failure they inherited, Ginsburg and colleagues1 are to be congratulated for asking a group of urban adolescents what “factors they believe would make the most difference in influencing whether they would have a positive future.” Although I and the prevention research literature generally agree with their overall conclusion that the principle of emphasizing the benefits of engaging in behaviors that promote health and well-being over the disadvantages of not doing so has the potential to bring about the broadest range of successful health-related behavioral changes,2–8 their finding that in most cases teen pregnancy did not even make it onto the radar screen as an “impediment to a positive future”1 deserves emphasis and further comment as it is indicative of a crucially important fallacy their conclusion (“Although they also have a keen awareness of the social problems that impact negatively on their opportunities ”) eludes to. Any professional who is also a parent does not need scientific evidence (which parenthetically abounds references 8 through 13) to understand that even poor women who postpone childbearing beyond high school graduation reap numerous social and economic benefits for themselves and their children because it is harder to pursue the careers of student and parent simultaneously than in series. Yet we have all cringed to hear a bright-eyed, sexually active, noncontracepting patient say, “But they have day care in medical school don’t they?” or “My auntie says I should have my children when I’m young so they can enjoy me.”While armed with only love and the power of positive thinking, Horton was able to hatch a fantastic “elephant-bird,”14 this enigmatic Seussian validation of Lamarkian evolution15 is not apt to be replicated any time soon. Therefore, unless we also take steps to socialize teenagers like those who participated in this study to the idea that teen pregnancy (and by extension the other socially problematic behaviors endemic in their neighborhoods) represents a serious impediment to achieving the desired middle-class lifestyle their fervent demands for educational and job opportunities belie,1 the generation of intervention programs their suggestions will undoubtedly spawn may well be added to the growing litany of failures.9,10Changing attitudes is not as simple as providing teens with additional educational and job opportunities; changing what they believe to be normative, defined here as perceiving adolescent childbearing to not be a threat to one’s future, is the ultimate challenge these research finding pose.In Reply.—I agree with Dr Stevens-Simon that teen pregnancy can impact negatively on a young person’s chance for a successful future.Our team facilitated youth to generate, prioritize, and explain their own ideas regarding what factors influence their chances for reaching a positive future. Indeed, the ninth graders surprised us by omitting pregnancy as a perceived problem. I believe Dr Stevens-Simon is stating that the positive solutions strongly suggested by the teenagers in our study (eg, school and employment opportunities, meaningful connections with adults) will not suffice in the absence of their rejecting pregnancy and other risk behaviors. Her thoughts that we should socialize teenagers to understand that teen pregnancy is an impediment to success are welcome, because young people must see risky behaviors as problems before they are likely to take steps to avoid them.However, socialization efforts must go beyond telling teenagers what not to do, they must create real educational and job opportunities that make the potential of a positive future seem real to youth. Until alternative positive opportunities feel real, why should teenagers feel that pregnancy impedes their future?The teenaged participants in the explanatory focus groups lamented many of the challenges of their environment (violence, drugs, community disrepair, etc). However, there was disagreement over whether to categorize teenage pregnancy as a problem, a neutral pleasant event, or even as a positive solution.1 It is clear from this research, however, that the participants agreed that the solutions to many of their challenges lay in increased opportunity.This was not an outcomes-based study; rather it offered the teen viewpoint. It would be naïve to assume that we should address any social problem with only one optimistic approach. Instead, intervention approaches should be steeped in an understanding of behavioral change and should incorporate multiple layers of intervention. In fact, proponents of the resiliency and youth development models recognize that a strategy of promoting youth development by enhancing protective factors must be joined with efforts to reduce risk factors.2A multilayered approach to reduce teen pregnancy and economic disparity should include efforts to guide teenagers to understand the long-term consequences of early pregnancy. But we must bear in mind what the National Campaign to Prevent Teen Pregnancy has stated: “The definition of what constitutes teen pregnancy prevention is best expanded to include activities that seek to instill teens with confidence and a sense of the future. This speaks to motivation to avoid pregnancy, a critical element in a pregnancy-free adolescence.”3 Further, Joy Dreyfoos stated in Adolescents at Risk: Prevalence and Prevention: “Children who are not engaged in school activities, who have low expectations for school achievement, and hang around with and are easily influenced by friends in similar situations are more prone to early sex Children who perceive that they may have poor prospects for the future and live in communities that are poor, segregated, and lack employment opportunities are more likely to initiate sex at early ages.”4It seems that the youth in our study were quite wise.