Evaluation of the Sex Knowledge of Pregnant and/or Parenting Females Adolescents
by

Marcy L. Hall, RN, BSN

Submitted in Partial Fulfillment of the Requirements for the
Master of Science in Nursing Degree

Edinboro University of Pennsylvania

Approved by:

jddith Schilling, CRNP, PhD
ittee Chairoerson /

Mary L0i Keller, CRN?, PhD
Committee Member
7

?

Z-€-V 4

Mary Fdhrman, RN, MSN
Committee Member
City of Erie School District

Evaluation of the sex
knowledge of
pregnant and/or parenting
fema Ie
adolescents /by Marcy L.
Hall.
Thesis Nurs. 1999 H17Se
c .2

A 167

Acknowledgments

It is with gratitude that I acknowledge the expertise and guidance given me on this

endeavor. The time spent has been meaningfill and worthwhile for me.
I thank Dr. Judith Schilling for the direction and advice along the way, as
chairperson of my thesis committee. The others of my committee, Dr. Mary Lou Keller

and Mary Fuhrman, also had a great impact on the finished work. Thank you Mary, for
the extra effort on my behalf^ within the Parenting Program. Special thanks to Anita in the
Parenting Program for her assistance through the summer on this research.
My family has been the motivation when I was discouraged, and my strength when

I was tired. Thank you to my wonderfill husband, who has worked with me on every

written project along the way. He was always supportive and caring when I needed it
most. His patience and assistance were even more appreciated on this project. I must
acknowledge the patience of my four children, who over the years have only known a

mom who has a night class to attend. My children were always understanding while I
scoured research, reviewed literature, wrote, rewrote and finally finished this work.

ii

Abstract

Despite a recent decrease in the adolescent pregnancy rate, the United States
continues to lead the industrialized world in this category. The two closest countries are
the United Kingdom and Japan, reporting less than one-half the pregnancy rates of the

United States (Foster, 1997). It has been suggested through research that knowledge of
age-appropriate sexuality and reproductive health may help delay the onset of first coitus,

thereby reducing the occurrence of unplanned adolescent pregnancy (Kirby, 1997).
A descriptive design was utilized to analyze the sex knowledge of pregnant or

parenting adolescents. It was hypothesized that these adolescents lacked general

knowledge of human sexuality and reproductive health. Research subjects were
adolescent females ranging in age from 14 to 20 years. Some of these adolescents were

participants in the Parenting Program offered by the City of Erie School District and some
were clients of the Family Health Council, Inc. in Erie, PA.
Results of this research indicated a high degree of misinformation or lack of

information regarding human sexuality and birth control. Knowledge of general
reproductive health was low, as well as well as accurate information about methods of
birth control. Utilizing Orem’s (1995) theory of self-care, a self-care deficit was

identified.

iii

Table of Contents

Content
Chapter 1: Introduction

1

Background of the Problem.

1

Statement of the Problem

4

Statement of the Purpose

4

Theoretical Framework

4

Assumptions

5

Limitations

5

Summary

6

Chapter II: Review of the Literature

7

Adolescent Pregnancy Statistics

7

Medical Concerns

7

Educational Outcomes

9

Employment Outcomes

9

Cost

10

Female Adolescent Sexual Behavior

10

Role of the Health Care Provider

11

Summary

13

Chapter III: Methodology

Research Design
Hypothesis....

Operational Definitions

Sample....
Informed Consent...

Instrumentation...
iv

Pilot Study

16

Analysis of Data

16

Summary

16

Chapter IV: Results

17

Discussion

17

Serious Conversations

17

Main Source of Sexual Information

17

Venereal Disease

19

Birth Control

20

Abortion

25

Summary

25

General Knowledge.

26
29

Chapter V: Discussion

Conclusions

31

Recommendations

32

References

34

Appendixes

37

38

A. Adolescent Survey

43

B. School District Consent

44

C. Parent Permission

46

D. Letter of Approval

v

List of Tables

Table
1. Serious Sex Conversations.

18

2. Knowledge of Venereal Disease.

19

3. Knowledge of Birth Control

21

4. Knowledge of Abortion

26

5. General Knowledge

21

vi

1

Chapter I

Introduction

Approximately 1 million adolescents become pregnant each year in the United
States. This is 10% of 15 to 19 year old females. About 500,000 give birth, one-third

obtain therapeutic abortions, and the other 14% miscarry (Maynard, 1996).
Eighty-five percent of these teenage pregnancies are unplanned (Fine, 1998). The

purpose of this research was to determine the sex knowledge of pregnant and

parenting adolescent females. Utilizing Orem’s theory of self care (1995), a self-care

deficit is identified.
Background of the Problem
Despite a recent decrease in the adolescent pregnancy rate, the United States

continues to lead the industrialized world in this category. The two closest countries
are the United Kingdom and Japan with less than one-half the number of teenage

pregnancies as are reported in the United States (Foster, 1997). In 1975, Reicheh and
Werley attempted to measure sex knowledge of adolescents who attended a Teen

Center in Chicago, IL. Adolescent females were able to obtain contraceptives at the
Center. Sample subjects of the original study were pretested and posttested using the

Sex Knowledge Questionnaire (Appendix A) developed by Paul A. Reicheh, Ph.D. and
Harriet W. Werley, Ph.D. (1975). Results of that study showed lack of knowledge of

human sexuality and birth control

Knowledge of age appropriate sexuality and reproductive health issues may
help delay the onset of first coitus, thereby reducing the occurrence of unplanned

adolescent pregnancy. Available research indicates that educating adolescents and

preadolescents about ttormd growth and «xud development may deUy the onset of
sexual activity, tmd may also delay a second pregnancy (Kirby, 1997).

2

Adolescence is a time of rapid change, growth, and development: physically,

mentally and sexually (Hardy & Zabin, 1991). Health care providers must address all

aspects of adolescence during brief encounters within the office setting
(Stevens-Simon, 1992). The statistics associated with adolescent pregnancy indicate

that reproductive health and sexuality can no longer be taboo subjects within the scope
of primary care practice (Hardy & Zabin, 1991). With 1 million American adolescents

becoming pregnant each year and 500,000 giving birth, this health crisis continues
(U.S. Department of Health & Human Services, 1998).
According to recent research the United States adolescent pregnancy rate has

shown a slight downward trend since the early 1990s (Stevens-Simon, 1992). Kann et

al. (1998) revealed that 36.4% of females in grades 9 through 12 were currently
sexually active. This rate is higher than those rates recorded in the 1980s, and those
from other developed countries (Foster, 1997). Adolescent pregnancy remains “one

of the country’s most important public health problems” (Stevens-Simon, 1992, p.
295). Due to the serious sequelae of adolescent pregnancy it would appear judicious

for health care providers to continue to attempt to find ways to prevent unwanted teen
pregnancy (Irvine, Bradley, Cuppies, & Boohan, 1997). Adolescent pregnancy is a
major health concern (Irvine et al., 1997). This concern is so great that Healthy People

2000 (U.S. Department of Health and Human Services, 1990) has 14 health objectives

related to reducing the incidence of adolescent sexual behavior. According to Kann et
al. (1997), 48.4% of high schoolers have had sexual intercourse and 43.2% of these

have not used a condom. In fact, on average, teens do not use any birth control until
approximately 14 months after the first sexual intercourse experience ( Hafiher &

Casey, 1986; Ringdahl, 1992). It is apparent that American adolescents are not using
contraception appropriately (SteventeShnon, 1992). These are sigmfic... statistics to

3

consider if we are to reduce the adolescent pregnancy rate. The far reaching
implications of adolescent pregnancy impact all aspects of adolescent life including

psycho-social, educational, medical, and financial for adolescents and society as well
(Kirby, 1997). Adolescents tend to have poorer nutritional habits, may smoke, and

use drugs or alcohol (U.S. Department of Health & Human Services, 1998).
Adolescents are least likely to seek early or regular prenatal care. Adolescent mothers

are at higher risk of preterm labor, anemia, and hypertension (Ringdahl, 1992). Out of
the 12 million cases of sexually transmitted diseases reported annually, approximately

3 million are among adolescents infected with diseases like chlamydia, gonorrhea, and
human papilloma virus (Kirby, 1997).

Adolescent mothers are more likely to drop out of high school There is a
greater possibility they will live in poverty and rely on welfare for income and benefits

(Maynard, 1996). The opportunity to acquire job skills is greatly diminished by
adolescent pregnancy and these young women earn an average of $5,600 annually, less

than one-half the poverty level (Maynard, 1997). Those factors that encouraged
adolescent sexual behavior were found to be curiosity, need for love, and peer

pressure (Cullari & Mikus, 1990). Cullari and Makus also researched correlates of
sexual behavior in adolescents and found that fear of pregnancy and sexually
transmitted diseases were factors that discouraged sexual experimentation. It would

appear that sexual knowledge may further deter risky behavior or, at the very least,
provide much needed information for critical decision making. This age group is often
faced with adult situations and needs accurate and straight forward information to aide

in the process of decision making (Kirby, 1997).
Health care providers, including nurse practitioners and school nurses, must be
a source of information and support for adolescents in the health care setting. It is

4

crucial that we find strategies for the adolescent to use for postponing the age at which

sexual activity begins (Kirby, 1997). The implications are many and impact all areas of

life for the adolescent female. This study addressed the level of sex knowledge among
a group of pregnant and parenting adolescent females.

Statement of the Problem

Adolescent pregnancy and risky sexual behavior continue to be major

concerns of health care providers today (Stevens-Simon, 1992). Lack of sex
knowledge may be a contributing factor to the incidence of a first adolescent

pregnancy and subsequent pregnancies as well.
Statement of the Purpose

A questionnaire was used to evaluate the sex knowledge of pregnant or
parenting female adolescents. The identification of deficits in any area of knowledge

related to sexuality and birth control has implications for health care providers,

especially those involved with adolescents*and preadolescents.
Theoretical Framework
Dorothea Orem’s theory of self-care is the theoretical framework for this study

(1995). Orem’s self-care theory speaks directly to developmental requisites of
humans. Utilizing Orem’s framework, it may be that the pregnant or parenting

adolescent is experiencing a self-care deficit. The adolescent will benefit from
intervention by the health care provider (Comley, 1994), including the provision of

accurate and factual information regarding sexuality. If lack of knowledge is a barrier

to safe health practices regarding sexuality, then it is the responsibility of the health

care provider to aide the adolescent in behavior to regulate the outcomes of decision
making (Comley, 1994). Providing accurate, factual information and follow-up for

adolescents will help them to meet their self-care requisites in regard to sexuality.

5

Orem sees the need for nursing when individuals experience an alteration in their

ability to provide self-care. It is within the scope of nursing practice to recognize a

person’s need for, and ability to provide, self-care. The nurse practitioner is a

professional who is prepared to determine knowledge or self-care deficits. It would
certainly be within the scope of practice to address these needs as they surface and
become apparent. If accurate and factual information can be a deterrent to sexual

intercourse, or delay the onset of sexual experimentation (Kirby, 1997), then it is the

duty of the nurse practitioner to be a source for this information (Irvine et al, 1997;

Kirby, 1997). If assistance is needed in providing self-care, this too is within the nurse
practitioner’s scope of practice (Comley, 1994). Providing much needed knowledge

will aide the adolescent in making wise and healthy sexuality decisions.
Assumptions

This study was based on the following assumptions:
1. Research subjects had access to medical care.
2. Research subjects had instruction on sexuality as offered by the Parenting

Program, Erie, PA., or Family Health Council, Inc., Erie, PA
3. Research subjects understood the explanation and instructions given with

the questionnaire.

4. Research subjects responded honestly to the questionnaire.
Limitations
Limitations of this research study were as follows.
1. The sample was of small size.

2. The sample included only females adolescents.
3. The sample> «•««*-

saml’le

Study findings may not be applicable to other groups.

n°r'hWeS* Pem,SylV,nia

6

4. The research questionnaire was modified by the researcher.

Summary

Adolescent pregnancy is a continuing societal, educational, and medical
concern (Irvine et al., 1997). This phenomenon does not occur without much distress

to adolescents, their parents or caregivers, their educators, and their health care

providers (Hardy & Zabin, 1991; Kaczynski, 1988). The purpose of this research
was to determine the sex knowledge of pregnant and parenting adolescent females.

Orem’s theory of self-care was the theoretical framework used for this research.
Assumptions and limitations of the study were delineated.

7

Chapter II

Review of the Literature
Adolescent pregnancy is a major health concern (Stevens-Simon, 1992).
Society has begun to focus more on the knowledge and sexual behaviors of pregnant
adolescents (Tomlinson, 1982). This chapter reviews the literature concerning

adolescent sexual behavior, and the role of the nurse practitioner/ health care provider.
Adolescent Pregnancy

Adolescent birth rates have declined in all 50 states (U.S. Department of

Health & Human Services, 1998). Despite this decrease, it is estimated that
approximately 1 million adolescents become pregnant each year, and 30,000 of these

are 15 years of age or younger (Ringdahl, 1992; Foster, 1997). Almost 500,000 of
these adolescents give birth (Ringdahl, 1992; U.S. Department of Health & Human

Services, 1998). About one-third of these adolescents have abortions and 14%

miscarry. More than 175,000 of the adolescent mothers were 17 years of age or

younger according to Maynard (1996).
Very young adolescents do not have a high percentage of sexual activity, but

sexual activity does increase with age (Kirby, 1997). By 18 years of age, 52% of

unmarried females have had intercourse (Kirby, 1997). A study by Keller, Duerst, &
Zimmerman (1994) yielded the belief by rural adolescents that sexual intercourse is the

norm in a relationship. Thirty-six percent of high school females reported being
currently sexually active (U.S. Department of Health & Human Services, 1998).

Medical Concerns.
Medical concerns accompany teen pregnancy. Anemia, which is a health

deficit in many adolescent women, can be exacerbated by pregnancy (Hardy & Zabin,
1991). Mother and fetus may end up competing for nutrients with both suffering

8

malnourishment to some degree. The pregnant adolescent may be the biggest loser of
nutrients in this competition. Other complications of pregnancy are also seen more

frequently in adolescents. Hypertension, toxemia, and preterm labor are reasons for
concern in the adolescent pregnancy (Hardy & Zabin, 1991; Irvine et al., 1997;

Maynard, 1996).
Three million adolescents are infected annually with sexually transmitted

diseases. The highest rate of infection from sexually transmitted diseases occurs in

adolescents (Kann et al., 1998; Kirby, 1997). Adolescents have the highest rates of
chlymadia, and adolescent females account for the highest rate of gonorrhea (Kirby,
1997). The National AIDS Policy reported in 1996 that 25% of all new HIV
infections were acquired between the ages of 13 and 21. In 1994, 43% of adolescent

AIDS cases occurred in females. It is estimated that approximately one-half of these
were transmitted through heterosexual sexual behaviors (Kirby, 1997).

Adolescents are less likely to seek early or regular prenatal care, and 50% of
pregnant adolescents receive no prenatal care during the first trimester of the

pregnancy (Ringdahl, 1992). There are several possible reasons for this lack of care,
including denial of the pregnancy, financial difficulty, and even lack of transportation.

This same study indicated that nearly 2.5% receive no prenatal care at all during the
pregnancy. The implications for possible unhealthy outcomes for both the adolescent

mother and her baby are evident.
There is also some evidence of increased mental health disturbance m the

adolescent mother (Cutrona & Troutman, 1986; Irvine et al, 1997). Teens tend to

become socially isolated and may experience the stress of motherhood more severely,

as they are also experiencing the rapid and continuous changes of adolescence.

9

Educational Outcomes
High school drop out rates increase dramatically for the pregnant adolescent

(Maynard, 1996, Witte, 1994). According to Witte, eight out of every 10 pregnant
teens will drop out of high school. Maynard (1996) estimated that only three out of
10 will obtain a high school diploma by the age of 30. Maynard focused on those

adolescent mothers who had babies before the age of 17 years. These adolescent
mothers indicated an interest in completing high school and 70% did return to school,

but one-third dropped out within a year and only 40% who attempted to complete
high school were able to graduate. Cutrona & Troutman (1986) determined that
young women who do not marry, but live at home, are more likely to complete high

school, possibly due to the strong support of immediate family especially with child
care and financial needs. The birth of a second child almost always results in the
mother quitting school

Employment Outcomes
Employment opportunities are diminished by the lack of a high school diploma
and advanced job skills (Maynard, 1996). Lack of sufficient or subsidized child care

is another barrier to employment for adolescent mothers (Hardy & Zabin, 1991). The
younger the mother the greater the need to rely on public assistance (Cutrona &

Troutman, 1986). Single adolescent parents are often forced to rely on public
assistance for income and benefits. Adolescent mothers earn on average $5,600
annually, a sum that is less than one-half that of the poverty level (Maynard, 1996).

Seven out of 10 of these young women will go on welfare. This factor greatly
influences not only the financial stability of the family, but also the dynamics of the

family structure.

10

Among adolescent mothers, there also appears to be a real risk of repeated

pregnancy (Hardy & Zabin, 1991; Rigsby, Macones, & Driscoll, 1998). As many as

60% of these women become pregnant again within 2 years of the first pregnancy

(Hardy & Zabin, 1991).
Cost
The estimated cost of medical care, food stamps, Temporary Assistance to

Needy Families, and other services is greater than $20 billion annually for adolescent
mothers (Ringdahl, 1992). This cost was affected by managed care, pregnancy
complications, hospital care for delivery and termination (Fine, 1998). The average

cost of termination of pregnancy was $460, while hospital care for delivery costs about

$6,059 (Fine, 1998). The birth of a low birth weight infant carried a price tag of
approximately $25,000 (Fine, 1998).

Female Adolescent Sexual Behavior
Much has been written regarding the antecedents of sexual behavior. It has

been concluded that no single variable is responsible for initiating first coitus but,
rather, that a multitude of maturational, developmental, biological, and social forces
are at work (Burke, 1987; Hardy & Zabin, 1991; Ringdahl, 1992). The many

antecedents identified in the literature that influence early sexual behavior include, but
are not limited to, gender, age, age at menarche, poverty, family life, family

disorganization, lack of parental support or supervision, lack of religious affiliation,

drug and alcohol use, poor educational performance, lack of knowledge, low
self-esteem, external locus-of-control, personal values, media, and perceived norms
(Burke, 1987; Fisher, 1991; Foster, 1997; Haffiier, 1996; Hardy & Zabin, 1991;
Keller, Duerst, & Zimmerman, 1994; Kirby, 1997; Kuczjnski,1989; Majnard, 1996;

Reis & Herz, 1987; Ringdahl, 1992, Witte, 1994). Youth at greatest risk of pregnancy

11

had low levels of education, invested less effort in school, experienced high levels of

poverty, lived in families with separation or divorce, had friends whom they believed
to be sexually active, and had low expectations for their own future. These
adolescents often began dating early and females often had a relationship with an older

male (Hardy & Zabin, 1991; Kirby, 1997).

Early sexual activity can be used as a way for an adolescent to show love, be
loved or accepted, or even show independence (Burke, 1987; Ringdahl, 1992). There
are a significant number of adolescent females who are not opposed to becoming

pregnant. In an attempt to discover why adolescents did not use contraception,

Stevens-Simon, Kelly, Singer, & Cox (1996) found that 20% of their particular study
sample “didn’t mind getting pregnant” and 17.5% “wanted to get pregnant.” This
sample consisted of 200 pregnant teens, 13 to 18 years old, who were enrolled in a

program for pregnant teens. These teens were also found to have known the father of
the baby for more than 6 months prior to becoming pregnant. This study showed

evidence of positive attitudes about childbearing, rather than negative attitudes about
contraception.
Role of the Health Care Provider

If the adolescent does not recognize the need for education or guidance m

sexuality and reproductive health, it is the responsibility of the health care provider to
recognize those needs and address them (Hardy & Zabin, 1991). It is generally
accepted that adolescent sexual activity should be postponed until adulthood (Fine,
1998; Haffner, 1996; Hardy & Zabin, 1991; Kuczynski, 1988; Ringdahl, 1992). Witte

(1994) found that while adolescents felt that abstinence was good, there would always

be those who will proceed to having sexual intercourse. Keller et al (1994) also
discovered that if abstinence was being practiced, it would only be a temporary choice.

12

Noncompliance in contraceptive usage is high in the adolescent population (Adame,

1985; Fisher, 1991; Haffiier & Casey, 1986; Hardy & Zabin, 1991; Reis & Herz,
1987; Ringdahl, 1992; Stevens-Simon, 1992; Stout & Kirby, 1993 & Witte, 1994).
This phenomenon may have many causes, and the health care provider will need to

address this very serious lack of action on the part of the adolescent. A study by Frost

& Forrest (1995) indicated that pregnancy prevention programs with education about
sexual and contraceptive behaviors were able to delay the onset of sexual activity
among many teenagers. There was also an increase in the use of contraception among
sexually active teens. Delay of onset of intercourse also tended to be related to use of

contraception with the first encounter. The health care provider is in a unique position
to offer knowledge routinely throughout the life span regarding sexuality (Ringdahl,

1992). The family health care provider has the advantage of knowing the family, and

the adolescent’s social history (Ringdahl, 1992). Well-child visits throughout
childhood afford the health care provider opportunities for age-appropriate assessment

and discussion of sexuality (Kuczynski, 1989; Ringdahl, 1992; Stevens-Simon, 1992).
Attaining healthy sexuality is, indeed, a developmental task of adolescence (Fisher,

1991; Haffiier, 1996; Kusczynski, 1989; Reis & Herz, 1987). Health care providers
must address sexuality just as they address other developmental milestones.

Anticipatory guidance, beginning in preadolescence, will offer children factual

information as needed (Reis & Herz, 1987; Ringdahl, 1992). It is widely accepted
that more knowledge yields better ability to make decisions (Adame, 1985; Fisher,

1991; Haffiier, 1996; Stevens-Simon, 1992). Primary prevention can be the goal of
the health care provider by encouraging abstinence (Ringdahl, 1992; Witte, 1994). As
the adolescent matures and relationships become more sisnificant, it is appropriate for
the health earn provider to discuss sexuahty behavior. Hsher (1991) found that 7S%

13

of parents would be interested in having their physician discuss sexuality with their
adolescents. This same study revealed evidence that just the opposite was actually

happening. Nationwide, discussion of sexuality between health care providers and
teens appeared to be lacking (Hardy & Zabin 1991; Irvine et at, 1997). The work by

Fine (1998) continued to reveal poor provider compliance with recommended
sexuality screening. In order to be most effective for primary prevention, the health

care provider must begin informing and then willingly discussing sexuality at an early
age, ideally before adolescence (Ringdahl, 1992).

Summary
Review of the literature has concerned the many facets of adolescent

pregnancy. There is no evidence that any one single variable is responsible for this
phenomenon but, rather, that many complicated forces are working together.

Knowledge is power. Adame (1985) supported this thinking regarding knowledge

and the ability to make more responsible decisions. Health care providers, including

nurse practitioners and school nurses, are in a unique position to provide accurate,
nonjudgmental sexuality and reproductive health information to adolescents. If a level

of trust exists between health care provider and adolescent, this could be an effective
strategy for the primary prevention of unwanted adolescent pregnancy (Ringdahl,

1992). It is crucial that the health care provider assume this very important role m
adolescent primary care.

14

Chapter HI
Research Methodology
The purpose of this research study was to determine the sex knowledge of

pregnant and/or parenting female adolescents. Included in this chapter are the

research design, sample, and instrumentation. Consent for the research and discussion
of data analysis follow.

Research Design
This research used a nonexperimental design. A descriptive analysis using a
survey approach was utilized.

Hypothesis

Pregnant and parenting female adolescents lack general knowledge of human
sexuality and reproductive health. This lack of knowledge may be one of many factors
associated with unplanned adolescent pregnancy.
Operational Definitions

The following terms were defined as they relate to this research study:
1. Adolescent is a female student participating in the Parenting Program

provided by the City of Erie School District, Erie, PA. or a client of the Family Health
Council, Inc., Erie, PA. Ages range from 14 to 20 years.
2. Sex knowledge is that general knowledge being measured by the

questionnaire used in this study.

Participants in the study consisted of 30 pregnant or parenting female
adolescents utilizing services provided by the Parenting Program in the C'ty

School District, PA. or the Family Health Council, Inc. Students participated in the

15

Parenting Program on a voluntary basis. No ideating information was specified on
the research survey, and participation in this research was voluntary.

Consent to conduct this research was given by the superintendent of the school
district (Appendix B). Parental consent of Erie School District students to participate

in the research was obtained.( Appendix C). Once signed parental permission was
received, Parenting Program participants were notified by telephone that the survey
would be arriving in the mail within the week. Approval to conduct this research was

also obtained from Family Health Council, Inc. (Appendix D). Verbal consent was
given by research subjects recruited at the Family Health Council, Inc. at the time of

on-site survey completion.

Instrumentation
This study used the research tool developed by Reichelt & Werley (1975). For
the current study, the questionnaire was modified by this researcher to address newer

methods of contraception, including depo-provera and norplant.. Statements added

addressed the methods of birth control that were not available at the time of the

original study. The questionnaire was designed to elicit the source of sex knowledge
and the extent of general sex knowledge that subjects possessed. By utilizing True ,
“False”, and “Don’t Know” responses the tool was able to differentiate the uninformed

subject from the misinformed subject.
Initially, 112 parenting program students were informed of the research study

via their homeroom teacher. A flyer was distributed to the homeroom and given to the
student with general information and an attached parental permission form
returned to the students school nurse. Se.en.eeu of these students responded with

written parental permission. These indents were then mailed, to their homes, rhe

16

questionnaire and instructions for completion. Parenting Program participants were

asked to return the questionnaire in the stamped and addressed envelope provided.

Family Council, Inc. clients were given instruction at the time of the questionnaire
completion in the clinic setting. Subjects were instructed not to sign the questionnaire
to preserve anonymity. Family Health Council, Inc. clients questionnaires were

collected the day of the clinic visit.
Pilot Study
A pilot study was done to confirm clarity of the instrument. The researcher
administered the questionnaire to five females who attended a high school that was not
part of the sample surveyed. One of the females was also a single parent. No changes

were necessary as as a result of the pilot study. These volunteers completed the
questionnaire within 15 minutes.
Analysis of Data

This study used descriptive statistics to present a description of the general sex

knowledge of the subjects. Percentages of incorrect responses on each item were

reported. An incorrect response was any response marked incorrectly or T)on t
Know”.

The purpose of this research was to determine the sex knowledge of pregnant
or parenting adolescent females. A sample of 30 subjects volunteered from the

Parenting Program of the City of Erie School District and Family Health Council, Inc.
Subjects completed a questionnaire (Reicbelt & Werley, 1975) which was researcher-

modified. The data were analyzed using descriptive statistic

17

Chapter IV

Results

This chapter provides the results of this study to determine the sex knowledge
of adolescent females who were pregnant or parenting. Data were related to sources

of sex knowledge, information and knowledge of human sexuality.

Discussion
A total of 30 surveys were collected using two methods of data collection.

Seventeen surveys were sent via mail to Parenting Program participants with 11 being
returned. The other 19 surveys were completed by volunteers in a clinic setting. The

clinic offers low cost prenatal care to those who qualify. Females of the survey
population ranged in age from 14 to 20 years old. Sixteen of the adolescents were
pregnant at the time of the survey, 10 had one child but were not currently pregnant,

and one had two children but was not currently pregnant. Four of the pregnant
respondents were experiencing repeat pregnancy.

Serious Sex Conversations
Data in Table 1 reveals that 90% of the subjects had had a serious conversation

about sex with a doctor or nurse, and 87% had had such a conversation with a female

friend. Sixty percent of subjects had a discussion with parents, while 67/o of the
adolescents talked with a male friend. About one-third of subjects had had a serious
conversation about sex with a teacher or counselor.

Main Source of Sexual Information
Figure A shows that 40% of subjects considered IHends to be their ™,n source

of information ebout sex, birth control and pregnancy. Twenty-three percent relied
on books, magazines, newspapers, and movies while ontv 20% reBed on parents. One

respondent indicated that she was her own main source of sexual inf

18

Table 1
Serious Sex Conversations (n=30)
n

%

Parents

18

60

Teacher or Counselor

11

37

1

3

Doctor

27

90

Nurse

27

90

Male Friend

20

67

Female Friend

26

87

Minister or Priest

Note, n Represents the number of yes responses. % Represents the percentage of
those responses.

Other

eacher
1^10%
Fiiends
40%

Boefcs
Z3*

HguxeA. Main Source of Sexual Information

19

Venereal Disease

Table 2 reveals the percentage of incorrect or ‘Don’t Know” responses
regarding venereal disease. The table shows that many of these subjects were unsure

of general information about venereal disease (VD). The researcher suspects this may
have been due in part to the words “venereal disease” versus the currently accepted

term “sexually transmitted disease.” This terminology confusion was not apparent in
the pilot study. Forty percent of subjects felt that once a person had VD he or she
could not get it again. Only 20% thought that if symptoms disappeared no treatment

was necessary, and 30% thought VD was not dangerous to their health.

Table 2
Knowledge of Venereal Disease (VD) (n=30)

Incorrect Responses
n

%

13

43

6

20

12

40

9

30

13

43

Many cases of VD are caught by contact
with toilet seats, drinking fountains,

and swimming pools.

If the symptoms of VD disappear by

themselves, no treatment is needed.
Once you’ve had VD, you can’t get it

again.
Vt) is not really dangerous to your health.
Minors can be treated for VD in Pennsyl­

vania without permission from parents.

20

Birth Control
Table 3 shews mcorrecl responses regarding different methods of birth control

Generally, knowledge regarding any of the listed birth control methods was mimmal
Ninety percent of this group was unaware of the effectiveness of the pill Amos
one-fourth of the sample thought that the pill had to be discontinued every year for
three months. Regarding drug/alcohol use and use of other medications, 67% and
57% respectively,were unsure of pill use.
Subjects in this group had even less knowledge about the IUD. Seventy

percent of respondents were unaware that the IUD is already in place before
intercourse and that the IUD cannot be felt by the man or the woman during

intercourse. More than 90% of subjects were unaware that the IUD works best after a
woman has had a pregnancy. This lack of knowledge may be in part due to the low

popularity of this method of birth control in the last 10 years. The IUD was, in fact,

difficult to obtain.
Lack of knowledge was also evident concerning the diaphragm More than

50% of subjects were incorrect on all responses regarding use of the diaphragm

Spermicide responses also revealed a knowledge deficit. Fifty percent of

subjects were not aware of the need to insert the product right before intercourse, or
that the product is available without prescription. One-third of the respondents were

unsure how the product worked, and 83% were not sure whether or not to wash
douche immediately after intercourse. Most respondents did not make the connection

that the product kills sperm so that it must not be washed out or douche right after
intercourse.
The sections on Depo-Provera

and Norplant yielded a higher level of

knowledge regarding the methods, actions,

and effects. Although all subjects

21

answered incorrectly concerning the length of effectiveness for Norplant, the

researcher believes the subjects did know it was a long-term form of birth control.
The statement used stated 3 years of effect, while in actuality the method is effective

for up to 5 years. Sixty percent of subjects were not aware that Norplant does not

protect against sexually transmitted disease. Only 10% responded incorrectly that
Depo-Provera protects against sexually transmitted disease. It is also difficult to

define the best birth control method. The original survey considered the birth control
pill to be the most effective method of birth control, but now Depo-Provera and

Norplant are available.
Even though condom education seems to be readily available, 60% of this

group thought that condoms break easily. Forty percent were unaware that condoms
should be tested before use.

Table 3
Knowledge of Birth Control (n=30)

Incorrect Responses
n

%

7

23

4

13

17

57

Birth Control Pill
The pill must be stopped every year for three

months
The pill is generally dangerous to use.
The pill may be taken along with other

medications without decreasing its effect.

22

Table 3 cont’d
Knowledge of Birth Control (n=30)

Incorrect Responses

n

%

20

67

14

47

27

90

21

70

21

70

26

87

28

93

The pill may be taken by a girl who uses

alcohol and/or other drugs.
The pill may not be taken if the woman

has a history of certain illnesses.
The pill is the most effective method

of birth control.

IUD
The IUD is inserted before each act of

intercourse.
The IUD cannot be felt by the man or

woman during intercourse.
The IUD is the second most effective
method of birth control

The IUD usually works best if the

uterus (womb) has been stretched
by a previous pregnancy.

23

Table 3 cont’d
Knowledge of Birth Control (n=30)

Incorrect Responses
n

%

16

53

16

53

17

57

14

47

15

50

10

33

8

27

25

83

Diaphragm
The diaphragm must be worn at all times.

A diaphragm should be used only after

having been fitted by a doctor.
The effectiveness of the diaphragm is

increased when used with a cream or jelly.
The diaphragm cannot be felt by either the

man or the woman when properly in place.

Foams, Creams and Jellies

They should be inserted just before each
intercourse.

They work by killing sperm.

When used with a rubber, they are a
highly effective birth control method.

They should be washed out with a
douche immediately after intercourse.

24

Table 3 cont’d
Knowledge of Birth Control (n=30)

Incorrect Responses
n

%

3

10

A rubber should be tested before use.

12

40

Rubbers break easily.

18

60

10

33

7

23

3

10

4

13

3

10

Condom (rubber)
Using a rubber can help prevent
the spread of venereal disease.

The rubber should be held around the

base of the man’s penis when withdrawn.

Depo-Provera
Depo-Provera is an injection (shot) given
every 3 months.

Menstrual flow may decrease or even stop
while using Depo-Provera.

Weight gain is a common side effect of
Depo-Provera.

Depo-Provera does not protect against
sexually transmitted disease.

25

Table 3 cont’d
Knowledge of Birth Control (n=30)

Incorrect Responses
n

%

. under the skin of the upper arm

11

37

Norplant is effective for 3 years

30

100

16

53

18

60

Norplant
The Norplant method of birth control

is six small flexible rods placed just

Menstrual irregularities are common
the first year a woman uses Norplant.

Norplant protects against sexually
transmitted diseases.

Abortion

Referring to Table 4, knowledge regarding abortion was not overwhelming in

any one direction, although 33% of subjects were not aware that it is considered safe
to have an abortion in the first 12 weeks of pregnancy. There were 6% that were

unsure whether or not anyone could tell if a girl had ever had an abortion.
Summary
The data revealed a knowledge deficit regarding human sexuality and birth
control The results of this research indicate that these adolescent females were not

getting or not recalling information on

human sexuality and birth control. Even basic

knowledge about reproductive function was not well known.

26

Table 4
Knowledge of Abortion (n=30)

Incorrect Responses

n

%

10

33

5

17

2

6

An abortion can be done safely and
easily by a doctor during the first 12

weeks of pregnancy.
Having an abortion will make the

woman sterile, (unable to have

children in the future)
Anyone can tell if a girl has had an
abortion.

General Knowledge

Table 5, concerning general knowledge, also shows important results regarding
knowledge deficits about human sexuality. One halfof.be subjects were not aware of

a woman’s fertile time, and 40% did not know what menstruation was. The lack of
basic knowledge is cause for concern, especially since only 23% of respondents felt

that they would like to know more about birth control. Forty percent of subj
not know that rhythm is not a highly effective method of birth control, nor that sperm

can live up to 3 days in the women’s reproductive tract. Twenty-three percent of

those surveyed thought that withdrawal was an effec.we method of both control.

27

Table 5
General Knowledge (n=30)

Incorrect Responses
n

%

7

23

12

40

4

13

2

6

12

40

3

10

7

23

4

13

I don’t know as much as I would
like to know about birth control.

Rhythm is a highly effective method

of birth control.
A girl can get pregnant the first time
she has intercourse, (makes love)

Douching after intercourse is a

highly effective birth control method.
Sperm can live in the female reproductive system for about 72 hours.
If a woman does not have an orgasm

during intercourse, she can’t get
pregnant.

Withdrawal (pulling out) is a highly
effective method of birth control.

Swallowing sperm can make a
woman pregnant.

28

Table 5 cont’d
General Knowledge (n=30)

Incorrect Responses

n

%

12

40

15

50

Menstruation is a clearing of the

uterus (womb) to prepare again
for possible pregnancy.
A woman’s fertile time (when she is most

likely to become pregnant) covers
the middle of the interval between
her menstrual periods.

29

Chapter V

Discussion
This chapter summarizes the results of this research. Conclusions are
discussed and recommendations are made.
The purpose of this research was to assess the sex knowledge of pregnant and

or parenting adolescents. The results of this research were forwarded to the Parenting
Program of the Erie School District and the Family Health Council. It is hoped that

the results will be of use to these agencies in developing future health teaching tools.
A review of the literature included medical concerns, educational outcomes,

employment outcomes, sexual behaviors of adolescent females and the role of the

health care provider in adolescent pregnancy care. Much of the research available
supports health education on an early basis with follow-up using age appropriate
information. It has also been accepted that there is not one best method of teaching
for retention. Issues of sexuality are complex and must be incorporated frequently in

the growing years. School nurses and nurse practitioners can be excellent sources of

accurate and age-appropriate information for these adolescents.
Thirty surveys were distributed to pregnant or parenting adolescents
participating in the Parenting Program of the Erie City School District, Erie, PA. or to

those obtaining services from the Family Health Council, Inc., Erie, PA. Parenting
Program students were mailed the survey and asked to return it in the envelope

provided. Family Health Council clients were given the survey during their pre-natal

visit. Their surveys were then collected and placed in an envelope. Descriptive data
were utilized to assess the survey information.
The survey revealed that while 90% of subjects had had serious conversations

.bout sex with a doctor or nurse. only 60% had had a serious conversation with their

30

parents. Female friends were also a popular choice with 87% of subjects having

indicated this. Sixty-seven percent of this group had had a serious conversation about
sex with a male friend.

The main source of information about sex, birth control, pregnancy, or human
sexuality was friends, with 40% of respondents choosing this selection. Only 20%
chose parents as their main source of information. Twenty-three percent of this group
got most of their information from books, magazines and newspapers. Ten percent of
the research subjects indicated that teachers were their main source of sex information.
General reproductive health knowledge regarding the reason for menstruation,
ovulation, and the length of time sperm can survive in the female body was lacking.

The fact that one-half of the females surveyed did not know when in a woman’s cycle
she is likely to get pregnant, and only 13% of this group indicated a possibility of a girl
getting pregnant the first time she has intercourse, may indicate some sort of denial of

consequence on the part of these adolescent. Birth control knowledge was also

minimal. Ninety percent of the subjects were unaware of the effectiveness of the pill
Less than half of the respondents were familiar with the diaphragm and 60% thought

that condoms break easily. The IUD can be considered to be unknown by this group.

There did seem to be heightened familiarity with Norplant and Depo-Provera.
Thirty-seven percent of subjects were not aware that Norplant is a collection of rods

that remain in the body, but most were aware that it is a long-term type of birth
control Twenty-three percent of subjects were unaware that Depo-Provera is an
injection every 3 months.
Venereal disease knowledge appeared to be minimal according to the

responses to this study. There may have been some terminology confusion regarding
the dated term ‘Venereal disease” instead of the currently accepted “sexually

31

transmitted disease.” More than 25% of respondents felt that venereal disease is not
really dangerous to health. This is most indicative of a knowledge deficit.
Abortion knowledge appears to be based on fact, although there were still

major gaps in basic information. About one-third of the research subjects were

unaware of the safety of abortion in the first 12 weeks of pregnancy and almost 20%
thought that having an abortion would make a woman sterile.
This research did support Orem’s self-care theory of nursing. The pregnant

and parenting adolescents were experiencing self-care deficits. Orem sees the need for

nursing intervention when the individual is incapable of providing self-care. Provision
of accurate, factual information, and follow-up care for adolescents will assist them to
meet self-care requisites in the future. These self-care requisites include putting off

healthy sexual relationships until adulthood and the prevention of unwanted repeat
pregnancies. The nurse practitioner is in a unique position to assess sex knowledge, to

be sensitive to the issues surrounding teen sexuality, and provide the information as it
is needed by the adolescent.

This study supported the data found in the literature. Adolescents are not well
informed about general reproductive health or sexuality issues. There is

misinformation or lack of information in the peer group. The peer group is the main
source of sexual information. Adolescents do not appear to be well informed

regarding birth control.
Conclusions

Results of this research indicated high degree of misinformation or lack of
information regarding human sexuality and birth control Knowledge of general

reproductive health was low, as well as correct information regarding birth control.

32

Lack of reproductive health knowledge and knowledge of basic human

sexuality is shown in this research. Since the major source of sex knowledge was the
peer group, it becomes apparent that there is a need for factual and current

information on a regular basis. School nurses and nurse practitioners are excellent
sources for these data. Health educators, parents, and other adults with adolescent
contacts need to realize the abundance of incorrect information being shared among

teens. Adolescents need an adult whom they trust and can approach with questions
and concerns regarding human sexuality. It would seem practical that the parent

would be the logical choice. Therefore, communication skills become another area of
much needed teaching and enhancement. These are just a few of the unique skills that

the nurse practitioner can utilize during an office visit. All health care providers need

to recognize the impact of adolescent pregnancy. We need to enhance health teaching,
pregnancy prevention through repetitive reproductive health discussions and

encouraging communication between adolescents and a trusting adult. With these
combined efforts and more, it is hoped that adolescent pregnancy continues to decline.

Recoi ■ mW dations
Knowledge is necessary for health and well-being. More research is needed in
the area of how to provide adolescents with needed information, and ways to help

them to internalize the health teaching. Considering the results of this research,
reproductive health teaching must be incorporated into early childhood health

teaching. Early and repetitive health teaching may better aid the adolescent to apply
the concepts as they face adult situations.

Research needs to be expanded to include the male counterpart of the female

adolescent. Limiting research to only female adolescents tells only part of the tale.

33

Larger samples of rural and urban respondents is recommended to aid in

determining reliability and validity. The instrument could be used to determine the
effectiveness of sexuality classes and to help identify adolescents at risk for pregnancy

or sexually transmitted disease.

The tool was modified but this researcher recommends further adjustment.
Although ‘Venereal disease” was the term of popularity when the initial research was
conducted, this researcher found the term to be somewhat confusing to the survey

group. “Sexually transmitted disease” is a better choice in 1999. This alteration may
make the tool more user friendly.

The purpose of this research was to assess the sex knowledge of pregnant and

or parenting adolescents. Lack of reproductive health knowledge and knowledge of
basic human sexuality was shown in this research. The results of this research were

forwarded to the Parenting Program of the Erie School District and the Family Health
Council. It is hoped that the results of this study will be of use to these and other
agencies in developing future health teaching tools.

34

References
Adame, D. D. (1985). On the effects of sex education: A response to those

who would say it promotes teenage pregnancy. Health Education, 16 (5), 8-10.

Burke, P. J. (1987). Adolescents’ motivation for sexual activity and pregnancy
prevention. Issues in Comprehensive Pediatric Nursing, 10, 161-171.
Comley, A. L. (1994). A comparative analysis of Orem’s self-care model and
Peplau’s interpersonal theory. Journal of Advanced Nursing, 20, 755-760.

Cullari, S., & Mikus, R. (1990). Correlates of sexual behavior. Psychology

Report, 66, 1179-1181.
Cutrona, C. E., & Troutman, M. A. (1986). Psychosocial outcomes of
IhTTT
adolescent pregnancy. Seminars
in Adolescent Medicine. 2, 235-237.

Fine, J. (1998). Adolescent pregnancy prevention in managed care. Women’s
Health Issues, 8 (3), 48-58.

Fisher, M. (1991). Adolescent sexuality: Overview and implications for the
pediatrician. Pediatric Annals, 20? 285-289.
Foster, H. W. (1997). The national campaign to prevent teen pregnancy.

Journal of Pediatric Nursing, 12 (20), 120-121.

Frost, J. J., & Forrest, J. D. (1995). Understanding the impact of effective

teenage pregnancy prevention programs. Family Planning Perspectxves>-27. (5),

188-195.
Haflher, D. W. (1996). Sexual health for America’s adolescents. Journal of
School Health, 66 (4), 151-152.

Haffner. D., & Casey, S. (1986). Approaches to adolescent pregnancy
prevention. Seminars in Adolescent Medicme._2_(3), 259-266.

35

Hardy, J. B., & Zabin, L. S. (1991). Adolescent pregnancy in an urban

environment. Washington, DC: Urban Institute Press.
Irvine, HL, Bradley, T., Cuppies, M., & Boohan, M. (1997). British Journal of
General Practice, 47 (418), 323-326.

Kann, L., Kinchen, S. A. ., Williams, B. I., Ross, J. G., Lowry, R., Hill, C.V.,

Grunbaum, J. L., Blumson, P. S. , Collins, J. L, & Kolbe, L. J. (1998). Youth risk
behavior surveillance. Centers for Disease Control Surveillance Studies, 47, 1-89.

Keller, M. L., Duerst, B. L., & Zimmerman, J. (1994). Adolescents’ views of

sexual decision making. IMAGE: The Journal of Nursing Scholarship, 28 (2),

125-130.
Kirby, D. (1997). No easy answers; Research findings on programs to reduce

teen pregnancy. Washington, DC: The National Campaign to prevent teen pregnancy.
Kuczynski, H. J. (1988). An approach to preventing adolescent pregnancy.

Midwives Chronicles and Nursing Notes, 234-237.
Maynard, R. A. (1996). Kids having kids: A Robin Hood Foundation special

report on the costs of adolescent childbearing. New York: The Robin Hood
Foundation.

Orem, D. E. (1995). Nursing: Concepts of practice (5th edition). St. Louis:
Mosby-Year Book, Inc.
Reichelt, P. A., & Werley, H. H. (1975). A sex information program for

sexually active teenagers. The Journal of School Health, 45(2), 100-107.

Reis, I, & Herz, L. (1987). Young adolescents’ contraceptive knowledge and
attitudes: Implications for anticipatory guidance. Journal of Pediatric Health Care, 1,
247-254.

36

Rigsby, D. C., Macones, G. A., & Driscoll, D. A. (1998). Risk factors for
rapid repeat pregnancy among adolescent mothers: A review of the literature. Journal

of Pediatric Adolescent Gynecology. 11 (3), 115-126.

Ringdahl, E. N. (1992). The role of the family physician in preventing teenage
pregnancy: Includes patient information handout. American, Family Physician, 45(5),

2215-2220.
Stevens-Simon, C. (1992). Recent developments in adolescent pregnancy.

Current Problems in Pediatrics, 22 (7), 295-301.
Stevens-Simon, C., Kelly, L., Singer, D., & Cox, A. (1996). Why pregnant

adolescents say they did not use contraceptives prior to conception. Journal of
Adolescent Health, 19, 48-53.

Stout, J., & Kirby, D. (1993). The effects of sexuality education on

adolescent sexual activity. Pediatric Annals, 22(2), 120-126.

Tomlinson M. (1982). Teenage pregnancies. The Journal of Nursing

Care, 15 (4), 8-13.
U.S. Department of Health & Human Services (1990). Healthy People 2000;

National health promotion and disease prevention objectives. Washington, DC: U.S.
Government Printing Office.

U.S. Department of Health & Human Services (1998). Youth Risk Behavior
Surveillance. Morbidity and Mortality Weekly Report, 47, (SS-3).

Witte, K. (1994). Preventing teen pregnancy through persuasive
I
communications: Realities, myths and the hard-fact truths. Journal of Co: hThunity

Health, 22 (2), 137-154.

31

Appendixes

Appendix A

38

Modified from Reichelt, Paul A., and Werley, Harriet H.

SEX KNOWLEDGE QUESTIONNAIRE

Have you ever had serious conversations about sex, birth control, pregnancy, or human
sexuality with: (CIRCLE YES OR NO FOR EACH PART OF THE QUESTION.)

Yes No—Your parents
Yes No—A teacher or school counselor
Yes No—A minister or priest
Yes No-A doctor

Yes No—A nurse
Yes No-A male friend
Yes No—A female friend
Yes No—Other (Write in)
What is the main source of your information about sex, birth control, pregnancy, or human
sexuality? (CHECK ONLY QNLLANSWER)

Friends
Books, magazines, newspapers, movies, etc.
Parents

Teachers or school counselors
_Other (Write in)

The following are all statements concerning human sexuality. For EACH_statement
answer True, False, or Don’t Know by circling the I_or E_or DKm front of the statement.
T F DK I don’t know as much as I would like to know about birth control.

39

T F DK Rhythm is a highly effective method of birth control.
T F DK A girl can get pregnant the first time she has intercourse, (makes love)
T F DK Douching after intercourse is a highly effective birth control method.
T F DK Sperm can live in the female’s reproductive system for about 72 hours (3 days).

T F DK Oral-genital sex (mouth-sex organ contact) is a common practice.
T F DK If a woman does not have an orgasm (climax) during intercourse, she can’t get
pregnant.

T F DK Withdrawal (pulling out) is a highly effective method of birth control.
T F DK Swallowing sperm can make a woman pregnant.

Venereal Disease (VD)
T F DK Many cases of VD are caught by contact with toilet seats, drinking fountains,
and swimming pools.
T F DK If the symptoms of VD disappear by themselves, no treatment is needed.

T F DK Once you’ve had VD, you can’t get it again.
T F DK VD is not really dangerous to your health.

T F DK Minors can be treated for VD in Pennsylvania without permission from thenparents.

Menstruation (monthly period)
T F DK Menstruation is a clearing of the uterus (womb) to prepare again for possible
pregnancy.
T F DK A woman’s fertile time (when she is most likely to become pregnant) covers
the middle of the interval between her menstrual periods.

40

Birth Control Pill
T F DK The pill must be stopped every year for three months.
T F DK The pill is generally dangerous to use.

T F DK The pill may be taken along with other medications without decreasing its
effectiveness.
T F DK The pill may be taken by a girl who uses alcohol and/or drugs.

T F DK The pill may not be taken if the woman has a history of certain illnesses.

T F DK The pill is the most effective method of birth control

The Diaphragm
T F DK The diaphragm must be worn at all times.
T F DK A diaphragm should be used only after having been fitted for it by a doctor.
T F DK The effectiveness of the diaphragm is increased when used with a cream or jelly.
T F DK The diaphragm cannot be felt by either the man or the woman when properly in
place.

The Condom (rubber)
T F DK Using a rubber can help prevent the spread of venereal disease.
T F DK A rubber should be tested before use.

T F DK Rubbers break easily.
T F DK The rubber should be held around the base of the man’s penis when withdrawn.

The I.U.P.. D. (intrauterine device, such as the loop or coil)

T F DK The IUD is inserted before each act of intercourse (making love).

41
T F DK The IUD cannot be felt by the man or woman during intercourse.
T F DK The IUD is the second most effective method of birth control

T F DK The IUD usually works best if the uterus (womb) has been stretched by a
previous pregnancy.

Foams. Creams, and Jellies

T F DK They should be inserted just before each intercourse.
T F DK They work by killing sperm

T F DK They can be bought without a prescription in any drug store.
T F DK When used with a rubber, they are a highly effective birth control method.

T F DK They should be washed out with a douche immediately after intercourse.

Depo-provera
T F DK Depo-provera is an injection (shot) given every 3 months.

T F DK Menstrual flow may decrease or even stop while using Depo-provera.
T F DK Weight gain is a common side effect of Depo-provera.
T F DK Depo-provera does not protect against sexually transmitted diseases.

Norplant

T F DK The Norplant method of birth control is six small flexible rods placed just under
the skin of the upper arm.
T F DK Norplant is effective for 3 years.

T F DK Menstrual irregularities are common the first year a woman uses Norplant.
T F DK Norplant protects against sexually transmitted diseases.

42

Abortion

T F DK An abortion can be done safely and easily by a doctor during the first 12 weeks
of pregnancy.
T F DK Having an abortion will make the woman sterile (unable to have children in the
future).
T F DK Anyone can tell if a girl has had an abortion.

YES NO I am currently pregnant

I have

child (ren)

Appendix B
THE SCHOOL DISTRICT OF THE CITY OF ERIE, PA

43
SAMPLE 3

RESEARCH REQUEST

______ L ,_________

_______ Mai? c y
(First)
sT.

\|AME ____
(Last)
ADDRESS _ lo I

(I

(Middle)

PA .

KJCjQrd

Telephone

&o /

name of college/agency

A

C*

7

s e.

‘irn

Pn -

'request permission to conduct a research project involving pupil records and/or pupils in the School
District of the City of Erie
for the purpose of

rt :

p/~o J r~ - Pft.r. <--n Y
(Name of School/Dep.artment)
S
* V
<7
<
<7 p

Te x

r* pro d

r
If-h

Q-K e/

ua I J •

-n

C\

<2

f2-

If granted permission to do this research, I agree to abide by all the regulations concerning confidentiality
of records. I will supply written parent/student consent as required. I will supply a copy of the completed
'esearch to the Erie School District for its file and use. Before I publish any results from the research, I
;agree that the School District committee will validate my research technique.
, for research to be done in the months of

Presented by August 1,

(Year)

^request an exception to August 1 deadline for the following reasons.

gilding principals, department heads, coordinators will be consulted by the superintendent before
approval is granted.

Pate 4 - f G> -71-

Date

x/ approved
rejected
Building Principal/Department Head/Coordinator
approved
rejected

Su
^ate

fORM: 132-CSD-4-75

rintendent of Schools

approved
rejected
Board of Education

44

Appendix C

Marcy LHail,RN

December 01, 1999

PARENT’S CONSENT FORM

Please check the line which applies.
My daughter may participate in this project. I have read the attached letter, and I
understand that a questionnaire will be administered and will take approximately 15 minutes to
complete this survey. My daughter will not be identified in any way. I also understand that my
daughter can withdraw from the study at any time if she so desires. My daughter’s right to
privacy will be protected at all times. Her name will not be used on any written summaries or
reports of this project. Information given will be used only for the purpose of this study, and any
written summaries of interviews will be destroyed at the conclusion of this study.

I would like more information about this project before I decide to allow my daughter to
participate.
(Please add your phone number below you signature and Mrs. Hall will phone you with
further information.)

No, my daughter may not participate in this project.

(Parent Signature)

(Date)

Please return this permission slip to your school nurse as soon as possible.

Thank you for your help with this research project.

45

Marcy L Hall, RM
101 East Main Street ~ North East, Pa. 16428

Dear Parent,
I am a school nurse in the City of Erie School District. I am also attending courses at Edinboro
University of Pa. in order to complete my Master of Science Degree and Family Nurse
Practitioner. As part of this degree, I am writing a thesis related to adolescent pregnancy.
Your daughter is invited to participate in a research project about the knowledge she possesses
regarding human reproductive health and birth control

If you decide that she may participate, and she is willing, I will be getting information through a
questionnaire. This questionnaire will take approximately 15 minutes to complete, and in no way
will identify your daughter. If your daughter decides to participate the questionnaire will be given
to her to complete. To complete the questionnaire, your daughter will need to answer 52
questions with a True, False or Don’t Know response. The questionnaires will then be collected
and I will analyze the data collected.
Your daughter’s participation in this project is voluntary, and will not affect her school standing.
It is my hope that your daughter will be willing to participate in this research. I think it will aid us
all in better understanding the needs of pregnant and parenting adolescents.

If you or she would like more information about any aspect of this research before you make your
decision, I will be happy to talk with you. Please return the enclosed form to me with your home
phone number and I will contact you to discuss the issue further.
If your daughter is permitted to participate in this research, please read and sign the attached
consent form and send it to school with your daughter. I will then make arrangements to
administer the questionnaire to her.

Thank you for your help.

Sincerely,

Marcy L. Hall, RN, BSN

C Family Health
B Council, Inc.

Apendix D

960 Penn Avenue • Suite 600 • Pittsburgh, PA 15222 • (412) 288-2130 • Fax (412) 288-9036 • www.fhcinc.org

TO:

Marcy L. Hall, RN, BSN

FROM:

Janet Adams, Ph.D7“//| V
Vice President for Applied Research
Coordinator, Researcn Review Panel

DATE:

August 3,1999

RE:

Research Request

The Family Health Council Evaluation Team has reviewed your recent research request for
surveying patients to evaluate the sex knowledge of pregnant and/or parenting adolescents. It has
been:
Approved

X

Approved on the following conditions.

That it does not disrupt the normal patient flow and services of the clinic.

Denied for the following reason(s):
Good luck with your survey. We will be interested in seeing your results.

/rm
cc:

Harold Love

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