Baby Think It Over®: Using Role-Play to Prevent Teen Pregnancy

Adolescence, Fall, 2001 by Jennifer W. Out, Kathryn D. Lafreniere

ABSTRACT

This study examined the effectiveness of Baby Think It Over[R] (BTIO; Jurmaine, 1994), an infant simulation program that seeks to modify attitudes toward teen pregnancy and teen parenting. As in the study by Saltz, Perry, and Cabral (1994), the premise was that teens engage in unprotected sex because of a personal fable concerning pregnancy: "It can't happen to me." It was expected that participation in BTIO, a form of role-play, would encourage teens to acknowledge their own personal vulnerability to an unplanned pregnancy, and provide them with some insight into the experience of adolescent parenting. One hundred fourteen eleventh-grade students participated. After two to three days' experience with BTIO, teens in the intervention group were more likely to accurately assess their personal risk for an unplanned pregnancy than were teens in the comparison group. Qualitative analyses revealed that teens in the intervention group were significantly more likely to produce concrete examples of activities and cons equences related to child-rearing than were teens in the comparison group. Findings of this study are discussed from the perspective of the health belief model (Rosenstock, 1974), and suggestions for further research with BTIO are made.

In the last two decades, health professionals working with adolescents have increased their efforts at both designing and implementing interventions aimed at preventing teen pregnancy. Despite their efforts, the rate of teen pregnancy in Canada has been rising (Wadhera & Millar, 1997). In 1995, the pregnancy rate for Canadian females aged 15 to 19 years was 45.4 per 1,000 (Singh & Darroch, 2000). Further, although there has been a recent downward trend in pregnancy rates among American adolescents, the United States continues to have one of the highest rates of any Western industrialized nation. The 1996 pregnancy rate for American females aged 15 to 19 years was 83.6 per 1,000 (Singh & Darroch, 2000).

Concern over such high pregnancy rates has prompted a renewed interest in the development of effective interventions to reduce teen pregnancy. Most programs designed to prevent adolescent pregnancy focus on one of three approaches: sex education, encouraging sexual abstinence, or increasing the availability of contraception (Saltz, Perry, & Cabral, 1994).

Despite the high hopes of health educators, there is conflicting evidence regarding the efficacy of sex education programs in reducing teen pregnancy rates. In a review of sex education data, Stout and Rivara (1989) concluded that school-based programs had little or no effect on sexual activity, contraceptive use, or teen pregnancy rates.

Programs advocating sexual abstinence also appear to fare poorly. Kirby, Korpi, Barth, and Cagampang (1997) reviewed the Postponing Sexual Involvement Curriculum (PSI), a widely used program in American middle schools that is intended to delay the onset of sexual activity by helping students to identify social pressures that encourage sexual activity and by teaching students specific skills to resist those pressures. A sample of 10,600 youths from schools and community organizations in California participated in the study. The researchers found no significant differences in pregnancy rates or contraceptive use between students who took part in the PSI program and those in the control group.

Kirby, Waszak, and Ziegler (1991) reviewed six American schoolbased clinics that provided a range of medical and counselling services to adolescents. The researchers found that although the school-based clinics had varying effects on contraceptive use, none of their clinics had a significant effect on school-wide pregnancy rates. These findings suggest that the provision of contraceptives alone is not sufficient to decrease pregnancy among sexually active adolescents.

Some researchers have argued that many of the current programs aimed at preventing teen pregnancy are largely ineffective because they fail to take into consideration the developmental characteristics of adolescent thinking. Gordon (1990) suggested that elements of Piaget's stage of formal operational reasoning (Inhelder & Piaget, 1958, 1969) can be used to help understand adolescent contraceptive behavior. During this stage, adolescents not only develop the ability to think in a hypothetico-deductive manner, they also begin to engage in perspective-taking. According to Gordon, problems with perspective-taking may be largely responsible for adolescents' failure to use contraception. Teens who demonstrate difficulty imagining themselves as parents may not consider an unplanned pregnancy to be a potential consequence of unprotected sexual intercourse; nor might they perceive an unplanned pregnancy to be a negative event. Several studies have demonstrated that adolescents often underestimate the demands involved in parenting and tend to perceive minimal negative social consequences associated with a teen pregnancy (Henderson, 1980; Holden, Nelson, Velasquez, & Ritchie, 1993; Redmond, 1985; Smith, Nenney, Weinman, & Mumford, 1982). Hacker, Amare, Strunk, and Horst (2000) found that more than one-third of the female students in their study thought that education about the realities of parenting would help to prevent teen pregnancy. The findings of these studies suggest that interventions that increase perspective-taking skills and provide information about the demands involved in parenting may be more effective than traditional programs in preventing teen pregnancy.