There are a number of good planning models available to help professional communities decide which problems and variables to focus on and also help them understand key elements of the background situation (2). I would like to draw on the interconnectedness between behavior, biology and environment exhibited in the Ecological Model and utilize the Transtheoretical Model or Social Cognitive Theory (SCT) to better frame and tailor a school and community based interventions on preventative health behaviors, focused on condom use to decrease the rate of unintended teen pregnancy among African American and Hispanic teenage girls between ages of 15 and 19 years old who live in East Harlem and go to Public High Schools located in East Harlem.
Theories can be used to guide the search for why people are not following public health regulations/protocols and medical advice or not caring for themselves in healthy ways (2). Utilizing the Transtheoretical Model or Social Cognitive Theory (SCT) can help identify and mobilize key individuals and groups to develop, maintain, or increase accessibility to and de-stigmatize condom use throughout all East Harlem’s Public High Schools via platforms of communications in the school (eg: school newsletters/ student bulletins, letters sent home from principal/teachers, hubs of ‘Student Life’ accessible to students and their peers); via Health Care settings in Public Schools in East Harlem (health curriculum taught in school, student accessibility and relationships with health educators school nurses and school nurse practitioners); via condom distribution targeting students. We would also harness grassroots surveys and conduct semi-structured interviews on students who attend Public High Schools in East Harlem only and who identify themselves as African American or Hispanic teenage girls (between ages of 15 and 19 years old), who live in East Harlem to gather information on unintended teen pregnancy and condom usage amongst them.
In an effort to ensure that our interventions are not perceived as imposing or forced on our participants, we would also partner with the parents/legal guardians of the students and provide them with the option of allowing the student participants to be exposed to this intervention or not. It is important to garner and sustain a consistent, safe and transparent communication environment between our participants, their legal guardians, and the faculty members who work at Public High Schools in East Harlem (classroom teachers, nurses, counselors, peers). Respect for patients’ rights and more participatory, patient-centered communications can lead to improved health outcomes. (2)
Now let’s define our intervention. A preventative health behavior (2) is defined by Kasl and Cobb, as any activity undertaken by an individual who believes himself (or herself) to be healthy, for the purpose of preventing or detecting illness in an asymptomatic state.(2) However, for the sake of this dialogue, we are going to identify condom use as the preventative health behavior (2) undertaken by African American and Hispanic teenage girls and between ages of 15 and 19 years old, who live in East Harlem and go to Public High Schools located in East Harlem.
Observing condom use as a preventative behavior through the monocausal model of disease4, limits condom use as the only preventative health behavior that will produce the favorable outcome of reducing as unintended teen pregnancy rates among African American and Hispanic teenage girls and between ages of 15 and 19 years old, who live in East Harlem and go to Public High Schools located in East Harlem. Taking a multifactorial approach to identifying condom use as a preventative behavior towards teen pregnancy, opens up the opportunities of different variables leading to disease causation, rather than just one cause of disease (3). The condom is typically a latex sheath that fits over the erect penis and prevents sperm from entering a woman’s body (4). It has been identified as a good way for the man to share responsibility for birth control (4). The contraceptive effectiveness of condoms varies from 85 to 98 percent depending on how well they are used. If used correctly for every act of intercourse from start to finish, condoms are 98 percent effective at preventing pregnancy (5).
In order to further examine the phenomenon of unintended teen pregnancy, specifically, among African American and Hispanic teenage girls and who live in East Harlem, I would derive medical data from PRAMS3 and data sets retrieved from the Manhattan Community District 11 (1). Conservative religious groups and political organizations in some parts of the United States have spent considerable energy blocking comprehensive health education in schools and advocating for abstinence-only sex education (4). Many states also experienced a rise in teenage pregnancy after putting in place abstinence-only curricula and later began to reconsider the approach.5 School education programs that make condoms available report fewer students having intercourse and a higher level of safer sex practices among students who are having sex (4).
We are also going to identify healthy participants as African American and Hispanic teenage girls and between ages of 15 and 19 years old, who live in East Harlem and go to Public High Schools located in East Harlem who weren’t pregnant before this intervention. We are lastly going to define ‘the illness’, depicted in the latter part of the definition of Preventative health behavior, as unintended teen births among African American and Hispanic girls between the ages of 15 and 19 years old, who live in East Harlem and go to Public High Schools located in East Harlem.
All teenagers living in Manhattan deserve equal accessibility to and education about condom use, as a preventative measure of teen pregnancy, but that is not always the case, especially in East Harlem where the rate of the teen birth rate is double the Manhattan average (1). Understanding the needs of the community we are planning to work with, helps to understand the different levels and kinds of access and/or resources are available to its members (such as health insurance). In East Harlem, 24% of adults have no health insurance (compared to 15% of adults in Manhattan), 11% of adults went without needed medical care, (compared to 10% of adults in Manhattan).” (1)
I chose to compare my chosen focus group (teenage African American and Hispanic girls between ages of 15 and 19 years old who live in East Harlem and go to Public High Schools located in East Harlem), as a sub group of African American and Hispanic teenage girls between ages of 15 and 19 years old who live and attend Public High Schools in the borough of Manhattan as a whole. Understanding the needs of the community we are planning to implement an intervention on, helps us to understand what the different levels to the problem are such as SES, education and/or Health Literacy. East Harlem has a population of 123,579 people, half of which are identified as Hispanic, 31% are identified as Black, 12% of people are identified as White, and 6% of people are identified as Asian, 2% of people are identified as ‘other’ (1). Poverty level is 31% in East Harlem, compared to 18% in Manhattan as a whole (1). In East Harlem, 31.7% of teens between the ages of 15 years through 19 years, gave birth. 22% of people who live in East Harlem are between the ages of 0 -17 years old (1). In Manhattan, 63% of people have graduated from college, 24% of people have completed a High School, and only 14% of people have not attained high school education (1). In East Harlem, 36% of people have graduated from college, 38% of people have completed a High School and 26% of people have not attained high school education.”(1) Ethnic minorities and those in poverty still experience a disproportionate burden of preventable disease and disability, and the gap persists between disadvantaged and affluent groups in the use of preventative services (2). Clinical prevention and behavioral interventions are often considered cost effective but neither are universally available nor equally accessible across racial and socioeconomic groups (2).
Manhattan Community District 11: EAST HARLEM. (n.d.). Retrieved from https://www1.nyc.gov/assets/doh/downloads/pdf/data/2015chp-mn11.pdf
Glanz, K., Rimer, B. K., & Viswanath, K. Health Behavior and Health Education: Theory, Research, and Practice. 5th Edition. Wiley/Jossey-Bass, San Francisco, CA.
Number and percent of unintended pregnancies among live ... (n.d.). Retrieved from https://www1.nyc.gov/assets/doh/downloads/pdf/ms/PRAMSunintended-2010.pdf
Markt, S. C., Nuttall, E., Turman, C., Sinnott, J., Rimm, E. B., Ecsedy, E., … Mucci, L. A. (2016). Sniffing out significant “Pee values”: genome wide association study of asparagus anosmia. Bmj, i6071. doi: 10.1136/bmj.i6071