Thursday, January 2, 2014

Teen Pregnancy and Parenthood Have Real Costs, but So Does a Flawed Campaign – Lina Jew

Teen Pregnancy in New York City
Even though teen pregnancy rates in the United States have been reduced by one-third since 1990, it is still the highest among comparable countries. In New York City, there was a decline of 98.7 pregnancies per 1,000 females to 69.2 pregnancies per 1,000 females between 2001 and 2011. 87% of these teen pregnancies are unplanned and with unmarried adolescents (1).
The high rate of teen pregnancy is a concern because it is associated with social, economic and physical consequences (2). Adolescent mothers are less likely to graduate from high school and are at a higher risk of living in poverty; and children born to teen parents are more likely to become teen parents themselves. The risk of premature and low birth weight babies is increased in young mothers compared to older mothers; and these children are at a greater risk of future health complications. Research has shown that children of unmarried teen parents are more likely have emotional and behavioral problems and are less likely to do well in school (2). These consequences are likely to keep families in the vicious cycle of poverty.  In 2008, across the nation, teen pregnancy cost taxpayers approximately $10.9 billion annually (2).

The Real Cost of Teen Pregnancy Campaign
In efforts to continue addressing the high pregnancy rate in  New York City, Mayor Michael Bloomberg, Deputy Mayor for Health and Human Services Linda Gibbs and Human Resources Administration Commissioner Robert Doar, launched a citywide campaign in early March 2013 called, “The Real Cost of Teen Pregnancy” (3). The purpose of the campaign was to convey the challenges and negative consequences of becoming teenage parents, with emphasis on the high costs.
The campaign features five ads with hard-hitting statistics about the realities of teen pregnancy and they are displayed on subways and bus shelters across New York City. The strong messages on the ads are conveyed by upset and disgruntled toddlers sayings things like, “Honestly Mom… chance he won’t stay with you. What happens to me?”, “I’m twice as likely not to graduate high school because you had me as a teen” and “Dad, you’ll be paying to support me for the next 20 years” (3). The campaign also includes an interactive texting program that stimulates the real life choices that teen parents face and sporadically send the subscriber facts about teen parenthood. Lastly, there is also a video component that repeats the negative consequences of teen pregnancy.
The campaign has the potential to help further reduce the pregnancy rate in New York City, but its current design impedes this. The message and the facts in the campaign are relatively true and well-intended, but they are not conveyed effectively to its intended audience: adolescents.  To inform teens that they are not ready to be parents, the campaign relied greatly on statistics and addressed them in an authoritative tone.  The messages come as condescending and instill guilt and shame in pregnant teens and teen parents. They reinforce the negative stereotypes of teen parents.

Critique #1: Adolescents and their Belief that they are Invincible Deflect Statistics
The Real Cost to Pregnancy campaign uses the Health Belief Model and assumes that teens are rational and that behavior is planned. The Health Belief Model addresses an individual’s perception of the threats of a health issue (susceptibility and severity) and weighs it against the benefits of avoiding the threat (benefits and barriers) (4)
The campaign relies heavily on asserting facts and statistics about the risks associated with being a teen parent (the threats of teen pregnancy). These explicit statistics are intended to make the challenges of teen parenthood clear to adolescents and hope that teens will perceive the severity of teen pregnancy (the real cost and time), and thus avoid and/or delay parenthood in adolescence. However, research has shown that adolescents do not simply rationally weigh the relative risks and consequences of their actions; their actions are mostly influenced by feelings and social influences (5). A limitation of the Health Belief Model is that it does not include any social factors.
The approach of using facts and statistics to increase the perceived susceptibility of teen pregnancy is a shortcoming of this campaign. According to the Optimistic Bias Theory, people have a tendency to be overly optimistic in their personal risk judgments compared to their judgments about the average person. They overestimate the likelihood of positive events and underestimate the likelihood of negative events that will happen to them. The information that people have about themselves versus others can cause a person to be optimistically bias (6). As a result, this may place people at an increased risk of negative health outcomes (6).
Adolescence is a sensitive period where a young person undergoes not only physical changes, but also psychological and social developmental changes (5). There is significant evidence that show teens engaging in risky behaviors despite knowing and understanding the risks involved (5). Adolescents will read the facts and statistics on the campaign ads and be aware of the risks associated with teen pregnancy, but this awareness will not necessarily cause them to rationally change their behavior (7). They will likely elicit optimistic bias and think that the consequences happen to other people and not them. Adolescents have a belief in personal invulnerability. They believe that they are “bullet proof” and that negative outcomes do not apply to them (8).
Moreover, the danger of eliciting optimistic bias is heightened when the belief that if the negative consequences have not yet occurred, then it is unlikely to occur in the future (9). Teen who have already engaged in (unprotected) sexual activity in the past and did not become pregnant will display stronger optimistic bias and have a false sense of security (10). They will continue to be sexually active and put themselves at greater risk of becoming teen parents. Consequently, simply telling adolescents that “90% of teen parents don’t marry each other” and “kids of teen moms are twice as likely not to graduate than kids whose moms were over age 22” (3) is ineffective when social factors are not considered and when no resources to prevent teen pregnancies are provided.

Critique #2: High Levels of Reactance Hinder Messaging
Another major weakness of this campaign is the poor choice of the messenger and the authoritative tone of the messages. Messages are more effective when they are delivered by a credible and trusted source; those that lack credibility and trust can hinder risk communication efforts and potentially inhibit desired responses (11). The familiarity and similarity of the messenger to the targeted audience also increases the effectiveness of the message because the target audience will find it relevant to them (12). According to the communication theory, the more similar the messenger is to the receiver, the more likely it is that the receiver will listen.
In this campaign, upset toddlers were used to communicate the consequences of teen pregnancy to the target audience of adolescents. On the surface, crying toddlers will attract people’s attention and appeal to their emotions, but it will not lead to any long term behavioral changes. Toddlers are different from adolescents; they do not share similar values, interests and needs. Adolescents will find it difficult to relate to them and are likely going to disregard the messages on the ads.
Not only is there disconnect between the messenger (toddlers) and receiver (teen), but the hard-hitting messages themselves are portrayed in an authoritative tone which invokes reactance. Persuasive messaging in public health campaigns tend to fail because they implicitly or explicitly limit people’s freedom (13). Psychological reactance is invoked when people think their freedom (to form their own opinion, hold different attitudes and do what they want) is being threatened (14). According to the Psychological Reactance Theory, when people feel that their freedom is threated, they become motivated to restore their freedom by derogating the source, perceiving the behavior associated with the threatened freedom to be more attractive and/or by doing what they are told not to (13).
Even though the aim of New York City teen pregnancy campaign is to prevent and/or delay parenthood in adolescence, the strong statements can actually backfire and cause teens to engage in sexual activity to rebel and restore their freedom. Teens can perceive the ads as restricting their options and controlling their future. The statistics used to support the statements are not powerful and do not appeal to adolescents’ core values and causes further reactance.

Critique #3: Guilt and Shame Reinforce Negative Stereotypes
The campaign ads do not only invoke psychological reactance, but also generate guilt and shame. Messages such as, “Honestly Mom… chances are he won’t stay with you. What happens to me?” are condescending and the effect is magnified by the crying toddlers in the ads. The children featured in the ads are of colour – this was probably done on purpose – to  target the groups that have the highest pregnancy rates: Hispanics and African Americans (2). These high risk populations are generally viewed as living in poverty, having little education and becoming pregnant in adolescence.
Frequent stereotypical messages can cause an individual that belongs in that sociocultural group to live up to those stereotypes (15). These ads unintentionally reinforce the stereotypes of people of colour and teen parents: they are often single parents, uneducated and live in poverty (16). By doing so, may inadvertently harm the teens that the campaign is aimed at instead of protecting them. Since the ads are placed across the city, teens will see the ads frequently and identify themselves with the stereotype.
The strong statements in the campaign severely stigmatize teens who are pregnant, or have been pregnant. Stigmatized people are often ostracized, devalued and rejected in their society. Due to the negative nature of the messages in the ads, it creates a negative image of teens that are pregnant or have had children. This has the potential for serious repercussions for teen parents and pregnant teens. They will feel shame and guilt for becoming pregnant and as a result may not seek support. These negative feelings may also cause depression, stress and other issues that will set the teen back.
Children of teen parents will also be susceptible to the stereotype threat. For example, the message that says, “I’m twice as likely not to graduate high school because you had me as a teen,” may cause children of teen parents to underperform in school to reflect the stereotype.

A More Effective Intervention
To address the pitfalls of The Real Cost of Teen Pregnancy campaign, the new campaign will be framed around the positive aspects of delaying teen pregnancy instead of focusing on the negative consequences. Instead of featuring upset toddlers on the ads, popular teen celebrities will be used as the face of the campaign. On the campaign ads, there will be a memorable logo that teens can identify the campaign with. The messages on the ads will be in a more neutral tone and conveyed in a way that invites the target audience to join the movement of delaying parenthood.
There will also be a texting component and a mobile application that provides quick information on sexual health and teen pregnancy prevention resources in the local community. Teens will be able to use the app to locate the nearest clinic and community health center. For those that do not have a mobile device, there will also be a website available with all the information that is on the mobile app. Teens can sign up to join the movement and receive a free package of contraceptives with the campaign logo on it.
            Moreover, there will be a series of short videos that feature popular teen celebrities who are parents and teens who are thinking about becoming sexually active. The videos will show different perspectives of deciding what to do and empower teens to make their own choices. A memorable tune will be played in the videos and the campaign logo will show up at the end of the videos.

Support #1: Powerful Images and Stories Trump Statistics and Facts
The current New York City teen pregnancy prevention campaign uses facts and statistics to support their message. Even though teens will read and comprehend the statistics, they may elicit optimistic bias and believe that the negative consequences will not apply to them. A more effective way to engage teens and to minimize optimistic bias is to support the message of delaying parenthood in adolescence is through compelling stories.
            The series of short videos in the new campaign takes advantage of the Advertising Theory. There are three principles to the Advertising Theory: the promise (benefits), support and core values. The promise is what the target audience receives for doing an action that reflects the purpose of the campaign. What matters is not the validity of the promise, but how the promise is supported. Employing the Advertising Theory is powerful because it effects change at the population level and it is able to do this by supporting the promises with compelling and appealing stories, visual images and music. It assumes that people do not make rational decisions and uses emotional appeal to impact the target audience.
            Adolescence is a time when young people start to develop a degree of emotional, personal and financial independence from their parents (8). Adolescents struggle and strive to establish independence and autonomy. By crafting the promise of independence and freedom, and supporting this promise in the videos with images and music that resonates with adolescents, adolescents will be more likely to listen and buy into delaying pregnancy.

Support #2: Relatable Messenger Increases Likability and Sense of Control
            By using popular teen celebrities instead of toddlers as the messengers of the campaign, the targeted audience will be able to relate to the message better. Teen celebrities are considered ideal messengers for adolescents because they are recognizable, well-liked and perceived as similar to teens (17). Celebrities have a high appeal and often times teens look up to them; they increase likability. People are more likely to do something or change a behavior if they like the person who is making the request (17). This is true even if the person does not personally know the communicator. It has also been shown that similarity between the communicator and target audience minimizes psychological reactance (14). The videos in the new campaign also help minimize reactance because they are explicit in their message, delivered by someone who is familiar and similar and is supported by compelling stories (18).
            Signing up to join the movement of delaying early parenthood and receiving the package of contraceptives will create a sense of association and also increase likability. Teens will be more receptive to the messaging and feel like they are part of something big. By joining the movement, teens will feel a sense of ownership and put more value in the preventing teen pregnancy.
            The new campaign is not telling teens what to do and what not to do. It focuses on the advantages of being an adolescent without the burden of taking a care of a child; and it offers teens options to explore regarding ways to prevent teen pregnancy. The campaign is framed in a way that teens will perceive it as giving them freedom rather than taking their freedom away. This is effective because teens value freedom and independence and believe that they are invincible (8). By framing the issue of teen pregnancy as gaining freedom to do the things teens enjoy doing without the responsibilities of taking care of a child, teens will be more open and responsive to the message.

Support #3: Fostering a Safe Environment
The new campaign does not guilt and shame adolescents for engaging in sexual activities. Instead, it creates a positive environment and provides support to adolescents who do choose to be sexual active. Adolescence is a time for young people to explore their sexuality (8). If this is restricted, then teens may experience some negative health outcomes fueled by lower self-esteem.
By spinning the campaign to reflect the positive consequences of preventing teen pregnancy instead of focusing on the negatives of becoming a teen parent, teens will feel safe and less attacked. The mobile app and website will inform curious teens and will also direct them to available resources when needed. The ads, series of videos and website will help spread the word and the key tune in the videos and logo will allow teens to easily identify the campaign. The positive messaging will spread into communities and help illustrate a more positive image on teen parents and teens in general. Minimizing the stigma associated with being a teen parent will empower teen parents to seek help and prevent future teen pregnancies. The campaign will influence social norms and in turn influence teen behavior in a positive direction.


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