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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