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Adolescent Pregnancy in Martin County
Michelle Bittenbender
University of South Florida

Martin County is located on the Atlantic coast of Florida, directly East of Lake
Okeechobee. It is fondly referred to in the Treasure Coast, which refers to the Spanish
Treasure Fleet that was lost in a 1715 hurricane, whose contents washed ashore and
recovered in 1961. In 2010 it’s total area of 753 square miles supported 146,840 people
(Martin County, 2011). The majority of Martin County is considered to be urban,
particularly near the coast, although inlaying areas near Lake Okeechobee are considered
rural. Major employers of Martin County are Martin Memorial Health Systems, Martin
County School District, and the county of Martin County itself (Florida’s Research Coast,
2010). The median household income is $53,210 and only 10.4% of residence lived with
in the national poverty level. Florida on a whole reflects 13.8% Other pertinent
information gathered from
 Percentage of individuals 25 years and over with no high school diploma:
Marin County 13.7 (State average is 14.7)
 Percentage of individuals 5 years and over that speak a language other
than English at home: Martin County 14 (state average is 26.6).

Analyze, interpret and prioritize data
On the whole, Martin County is one of the healthiest counties in Florida, ranking
second out of 67 counties (County Health Rankings, 2013). The three most noteworthy
examples of this are as follows:
 The measure of AIDS cases in Martin County is a mere 7.7 as opposed to
Florida’s state average, which is 18.9.
 The occurrence of enteric disease is low, recorded at 96, compared to the state
average of 11,779.
 Infant mortality, as well, reflects under half the state average. 3.1 in Martin
County versus 6.6 at the state level.
There is, of course, always room for improvement. One of the areas that poses a
more serious threat to the health of the residents of Martin County, is the number of
adults who engage in heavy or binge drinking. According to Martin
County reflects 17.66 versus the state average of 15. This is an important challenge since
the consumption of alcohol is related to numerous ongoing health concerns as well as
increased frequency of driving while under the influence, which can result in devastating
The next area of concern is the ‘Number of Births Per 1,000 Females Ages 10-
14.’ Martin County reports .5 which is above the statewide average of .4. ‘Repeat Births
to Mothers Ages 15-19’ is also a potentially related concern. Martin County is above the
state average here as well, reporting 20.5 versus Florida’s statewide 18.1. These margins
are smaller but still noteworthy. It is important to consider not only the health concerns of
teenage mothers but also the social and economical risks that teenage pregnancy poses.
The combination of these stressors can potentially lead to other educational and social
support deficiencies with in turn can threaten the health and welfare of both the mother
and child for several ongoing years.
Adolescent pregnancy presents a complex situation of life changing events and
outcomes. It is important to remain sensitive to the mother’s experience, due to the
heightened stressors from peer pressure and social stigma. It is with this awareness that I
would like to focus the remainder of this paper on adolescent pregnancy.

Determinants of Health
Public health nurses can draw from a variety of personal, social, economic and
environmental influences that contribute to the health and well being of their patients.
These categories are referred to as Determinants of Health. In the example of adolescent
pregnancy, Social Determinants of Health significantly influence the occurrence and
prevention of pregnancy, which include social expectations, norms, attitudes and support
(Healthy People, 2012). Another Determinant of Health is Biology and Genetics. Age,
sex, and onset of menstruation are examples of biology and genetic inheritance.
Individual Behavior is also a Determinant of Health that directly relates to the likelihood
of health related occurrences. Lastly, the availability and quality of Health Services also
significantly influence one’s health outcomes.

Population Diagnosis
Pregnant Teenagers demonstrating social isolation related to alterations in physical
appearance, perceived unacceptable social behavior, restricted social sphere as
evidenced by possible expressions of aloneness/rejection from others, uncommunicative,
withdrawn, no eye contact and absence of significant other(s).

Primary Prevention
Condom use would be an example of a primary prevention because it decreases
the occurrence of adolescent pregnancy. This intervention operates on an individual
level. Planned Parenthood offers complimentary condoms without inquisition (Planned
Parenthood, 2013). This fosters a welcoming environment for adolescents to obtain birth
control measures without feeling judged by their actions. Complimentary condoms
promote health through education and awareness, in addition to, reducing the risk of
pregnancy when properly used. The role of the public health nurse would be to create an
inviting and educational environment to encourage continued participation. Primary
stakeholders would include condom manufacturers and family planning centers.

Secondary Prevention
Secondary prevention involves early identification and treatment. Pregnancy
screening is an ideal example of a secondary prevention. Early detection of pregnancy is
the gateway to early prenatal care. This measure of prevention is also on the individual
level. Planned Parenthood offers formal pregnancy screening as well as resources on
obtaining health insurance and prenatal care. Text4baby, a program developed through
National Healthy Mothers, Healthy Babies Coalition, is sponsored by Johnson &
Johnson. This program sends free text messages to participants with information
regarding prenatal care, baby health and parenting advice. (National Healthy Mothers,
Healthy Babies Coalition, 2012). Public nurses have a pivotal role in conducting these
screenings and referrals for prenatal care. Providing neutral and correct educational
material is vital to a mother’s decision. Stakeholders in an intervention like this would
include health care companies offering screening tools and prenatal care, major
manufacturers, funding opportunities from companies like Johnson and Johnson, and
community members on a whole.

Tertiary Prevention
Tertiary Prevention supports recovery and enables participants to regain optimal
health (Hunt, 2013). Adolescent pregnancy and newborn support groups exemplify this
facilitation. Support groups are considered to be a public health intervention, which
works on a community level. Support groups are effective in preventing further negative
health impacts as well as helping participants regain a sense of self and develop solidarity
within a group level. Planned Parenthood offers outreach programs entitled ‘Teen
Success Groups.’ Teen Success groups are weekly meetings where pregnant and
parenting teens can meet to talk and learn from peers who share their situation (Planned
Parenthood, 2013). A public nurse would have the role of facilitator in these meetings.
Major stakeholders include healthcare providers, childcare providers and funding

An effective health policy can be a pivotal tool in improving health outcomes and
overall health care. This policy proposal works on a community primary level. This
proposal is modeled after a similar intervention that was formed in the Bronx, NY. The
Bronx is the most poverty stricken area of New York. Adolescents living in high poverty
neighborhoods are three times more likely to become pregnant and are at greater risk of
dropping out of school (U.S. Dept. of Health and Human Services, Office of Adolescent
Health 2013). The Bronx, in effect, has the highest teen pregnancy rate in New York
City. In 2010, the U.S. Department of Health and Human Services Office of Adolescent
Health issued a grant to initiate a project that would engage adolescents from age 12 to 18
to participate in healthy behaviors, learn life skills and develop a sense of purpose in their
lives. This program has demonstrated effective teen pregnancy prevention and has
successfully reduced school suspension and course failure (U.S. Dept. of Health and
Human Services, Office of Adolescent Health 2013). This program encouraged a safe and
supportive environment, which proved to be conducive to learning appropriate behavior
and expectations. It is reported that this program:
• Made participants more likely to use a condom (70%), to use birth control (58%), and
less likely to have sex (47%).
• Helped participants make good choices about their health and well-being (86% of 6

graders and 86% of 9
• Had a positive impact on academics.
77% of 6th graders and 69% of 9th graders said that their participation helped
them get good grades.
90% of 6th graders and 85% of 9th graders said that their participation helped
them think about what they could accomplish in the future
 Greater use of the school based health centers for sexual health services.
Major stakeholders who benefit from a collaboration such as this would be
school systems, healthcare establishments, birth control manufacturers, community
centers, churches. An intervention like this is likely to receive a lot of praise from all the
above-mentioned entities. I don’t foresee any adverse effects of improving the
prevention of adolescent pregnancy. I would present a policy like this to Martin County
School District because of the direct interaction they currently already have with the at-
risk population. Not all children have access to healthcare or attend church regularly but
the majority of children do attend school. A policy of this nature would benefit Martin
County in that it would simultaneously address both the number of births with in the age
group of 10-14 as well as potentially reduce the cases of repeat births to mothers age 15-
19. In the long term, a policy like this could also decrease the number of STD’s, which
was also slightly elevated in Martin County compared to state average. The most
influential aspect of this policy is its ability to instill a sense of purpose in an otherwise
turbulent time period of adolescence. This empowerment could potentially be carried
throughout a participant’s entire life, which could in turn influence a lifetime worth of
health related outcomes.

Hunt, R. (2013). Community-based nursing. Philadelphia, PA: Wolters Kluwer Health.

Martin County Florida. (2011). Martin County Statistics. Retrieved from:,1&_dad=portal&_schema=PO

Florida’s Research Coast. (2010). Major Florida Reasearch Coast Employers Martin
County. Retrieved from:

Florida Charts. (2012). Martin County – County-State Profile. Retrieved from:

County Health Rankings. (2013). Social and Economic Factors. Retrieved from

Healthy People 2020. (2012). Determinants of Health. Retrieved from:

Planned Parenthood. (2013). Info for Teens – Pregnancy. Retrieved from:

National Healthy Mothers, Healthy Babies Coalition. (2012). Text4baby. Retrieved from:

U.S. Dept. of Health and Human Services, Office of Adolescent Health. (2013). Success
Story: Morris Heights Health Center. Retrieved from: