| |

Received: 8 July 2019    Revised: 27 February 2020    Accepted: 28 February 2020

DOI: 10.1111/phn.12726

P O P U L AT I O N S AT R I S K A C R O S S
T H E L I F E S PA N - P O P U L AT I O N S T U D I E S

Teen pregnancy in Chicago: Who is at risk?

Heide R. Cygan DNP, RN, PHNA-BC, Assistant Professor1  | Diane McNaughton PhD,

PHNA-BC, Associate Professor1 | Virginia Reising DNP, RN, PEL-CSN, PHNA-BC, Clinical
Assistant Professor2 | Louis Fogg PhD, Associate Professor1 | Booker Marshall MPH,
Sexual Health Project Manager3 | Jeremiah Simon MPH, YRBS Outreach Coordinator3

1
Community, Systems and Mental Health
Nursing, Rush University College of Nursing, Abstract
Chicago, IL, USA Background: Teenage pregnancy, with its associated health and social consequences
2
Department of Health Systems Science,
for young people and society as a whole, is one of the nation's most important pub-
University of Illinois at Chicago College of
Nursing, Chicago, IL, USA lic health issues. The purpose of this study was to use Youth Risk Behavior Survey
3
Office of Student Health and Wellness, (YRBS) data describe self-reported, pregnancy experiences in 9–12th grade Chicago
Chicago Public Schools, Chicago, IL, USA
Public Schools (CPS) students and identify teens at highest risk based on gender,
Correspondence grade-level, race, ethnicity, and sexual orientation.
Heide R. Cygan, Community, Systems and
Mental Health Nursing, Rush University
Methods: Secondary data analysis of the 2017 CPS high school Youth Risk Behavior
College of Nursing, 600 S. Paulina, Suite Survey was conducted.
1080, Chicago, IL 60612, USA.
Email: Heide_Cygan@rush.edu
Results: The survey response rate was 73% (n  =  1,883). 4.9% (n = 91) of CPS stu-
dents in grades 9 – 12 reported a pregnancy experience, and 1.9% (n = 34) reported
Funding information
BMO Harris Building Healthy Urban
being “unsure” of a pregnancy experience. Statistically significant differences in the
Communities Project likelihood of self-reporting a pregnancy experience were found based on grade level
(p = .000), race (p = .023), and sexual orientation (p = .000).
Conclusion: While risk for a teen pregnancy experience varies across all groups,
public health nurses can use YRBS data to better understand pregnancy risk in the
populations they serve and can leverage core competencies, and robust community
relationships to adapt, implement and evaluate evidence-based teen pregnancy pre-
vention programs for maximum impact on teens at greatest risk.

KEYWORDS

adolescent health, teen pregnancy, Youth Risk Behavior Survey

1 |  I NTRO D U C TI O N
Teenage pregnancy is one of the most important public health issues
facing our nation, presenting health and socioeconomic risks for ad-
olescents, infants, and our society as a whole. Health risks associ-
ated with teen pregnancy include: pre-eclampsia, premature birth,
low birth weight and impaired mental health (Ganchimeg et al., 2014;
SmithBattle & Freed, 2016). Teen pregnancy increases the likelihood
of not completing high school and contributes to increased rates
of poverty for females and males (Dupéré et al., 2015; Manlove &
Lantos, 2018). Further, children born to teen mothers are less likely
to graduate from high school, and more likely to become teen parents
or be unemployed as young adults (Penman-Aguilar, Carter, Snead,
& Kourtis, 2013; Perper, Peterson, & Manlove, 2010). Lower edu-
cational attainment, poverty, and decreased health status resulting
from teen pregnancy have a compounding impact on overall popu-
lation health outcomes and disparities (Centers for Disease Control
[CDC], 2019).

Public Health Nurs. 2020;00:1–10. wileyonlinelibrary.com/journal/phn© 2020 Wiley Periodicals, Inc.     1 |

 |
2       CYGAN et al.
While detailed estimates of teen pregnancy are not available for
the city of Chicago, teen birth rates across the city demonstrate the
need to prevent pregnancy during the teen years. Teen birth rates
in Chicago have dropped in recent years, yet remain higher than the
national average (20.3 per 1,000) at 21.5 per 1,000 (Chicago Health
Atlas, 2018; Martin, Hamilton, Osterman, Driscoll, & Drake, 2018).
Across the 77 Chicago community areas, stark disparities in teen
birthrates are present between communities of low and high eco-
nomic hardship, ranging from 1.2 (Loop) to 58.2 (North Lawndale)
per 1,000 population respectively (Chicago Health Atlas, 2018).
Disparities also exist between racial minority populations. Teen birth
rates for Hispanic/Latino (26.2 per 1,000) and non-Hispanic black
teens (26.6 per 1,000) are drastically higher than rates for non-His-
panic white teens (4.5 per 1,000) (Chicago Health Atlas, 2018).
Although local teen birth rates point to the populations at high-
est risk for teen birth, little is known about teens at highest risk
for pregnancy in Chicago. Without this knowledge it is difficult
for public health nurses to develop, implement and evaluate teen
pregnancy prevention programs that impact highest risk teens. The
purpose of this study was to use Youth Risk Behavior Survey (YRBS)
data describe teen self-reported, pregnancy experiences (history of
being pregnant or getting someone pregnant) in 9th–12th grade
Chicago Public Schools (CPS) students and identify those at high-
est risk based on gender, grade level, race, ethnicity, and sexual
orientation.
2 |  M E TH O DS
2.1 | Design
Researchers conducted a secondary data analysis of the 2017
CPS High School YRBS to describe teen pregnancy experiences in
Chicago. The YRBS is a Centers for Disease Control and Prevention
(CDC) surveillance survey assessing the prevalence of risk behav-
iors and outcomes that contribute to the leading causes of mortal-
ity and morbidity among adolescents in the United States (CDC,
2018a). Teen pregnancy experience was measured with the ques-
tion, “How many times have you been pregnant or gotten some-
one pregnant?” All questions used in this analysis are included in
Figure 1.
The CPS Office of Student Health and Wellness was responsible
for survey planning and administration. During spring 2017, students
voluntarily completed a pencil and paper, self-administered, anony-
mous, 99-item questionnaire. Surveys were administered by school-
based YRBS designees.
Administration and analysis of the 2017 CPS high school YRBS
was approved by the CPS Research Review Board with passive
parental consent. School participation in the YRBS was not man-
datory, but strongly encouraged by the District. Schools were of-
fered a cash incentive to participate. Student participants could
refuse to take the survey at any time and skip questions they did
not want to answer.
2.2 | Setting and sample
Chicago Public Schools is the third largest school district in the
United States and operated 96 regular high schools in 2016–17, serv-
ing 78,214 ninth to twelfth grade students (Chicago Public Schools,
2019a, 2019b). During the 2016–17 school year, CPS served an ad-
ditional 30, 633 ninth to twelfth grade students in nonregular high
schools or alternative educational settings (Chicago Public Schools,
2019a). For the purposes of this paper, regular high schools are defined
as schools that are not charter, alternative, or special education-spe-
cific schools. In alignment, with standard CDC practices, only regular
high schools were included in the CPS sample. Thirty-eight regular high
schools were randomly selected by the CDC for survey administration
in spring 2017. Systematic, equal probability sampling with a random
start was utilized to sample classes from each of the schools to deter-
mine a representative sample of all CPS high school students attending
regular high schools. Data are weighted and therefore generalizable to
all CPS ninth–twelfth grade students attending regular high schools.
2.3 | Statistical analysis
Data from six questions were used in this study (five demographic
variables and one pregnancy experience item) (Figure 1). All analyses
were performed using SPSS. Descriptive statistics were examined
by calculating the frequencies of the demographic descriptors of the
student participants. The likelihood of reporting a pregnancy expe-
rience was examined as both frequencies and as a series of cross
tables with demographic measures. Chi-square statistics were used
to estimate probability values in the paper.
3 | R E S U LT S
The final 2017 YRBS sample included 1,883 students from 37 regu-
lar CPS high schools (Table 1). The survey response rate was 73%.
Based on this representative sample, 4.8% (n = 91) of CPS students
in grades 9–12 reported a pregnancy experience. An additional 1.9%
(n = 34) of students in the sample reported being “unsure” of a preg-
nancy experience (Table 2). Statistically significant differences in
the likelihood of self-reporting a pregnancy experience were found
based on grade level (p = .000), race (p = .023), and sexual orienta-
tion (p = .000) (Table 3). There were no statistically significant dif-
ferences in the likelihood of self-reporting a pregnancy experience
based on gender (p = .114), or ethnicity (p = .903) (Table 3).
Statistically significant differences in the likelihood of self-report-
ing a pregnancy experience were found based on grade level (p = .000).
The rate of self-reported pregnancy experiences for all students,
across grade level, can be found in Table 3; 9th grade: 4.4% (n = 15),
10th grade: 4.2% (n = 23), 11th grade: 5.2% (n = 20), and 12th grade:
6.6% (n = 31). Students in 12th grade were most likely to report one
(4.7%, n  =  22) or two or more pregnancy experiences (1.9%, n = 9),
and 10th grade students were most likely to be unsure of a pregnancy
CYGAN et al.
F I G U R E 1   Youth Risk Behavior
Survey questions used for secondary data
analysis
experience (2.2%, n = 12) when compared to other grades. Students in
12th grade were most likely to report never having a pregnancy expe-
rience (92.2%, n = 428) when compared to other grades.
Statistically significant differences in the likelihood of self-re-
porting a pregnancy experience were also found based on race
(p = .023). The rate of self-reported pregnancy experiences for all
students, across race, can be found in Table 3; American Indian: 2.1%
(n = 3), African American: 7.6% (n = 43), Pacific Islander: 9.8% (n = 5),
white: 3.9% (n = 19), and mixed race: 6.6% (n = 2). Students of Pacific
Island descent were most likely to report one (5.9%, n = 3) or two or
more pregnancy experiences (3.9%, n = 2) and were most likely to
be unsure of a pregnancy experience (3.9%, n = 2) when compared
to other races. Students self-identifying as American Indian were
most likely to report never having a pregnancy experience (95.7%,
n = 132) when compared to other races.
|
      3
Statistically significant differences in the likelihood of self-report-
ing a pregnancy experience were found based on and sexual orienta-
tion (p = .000). The rate of self-reported pregnancy experiences for
all students, across sexual orientation, can be found in Table 3; het-
erosexual: 3.5% (n = 49), gay or lesbian: 16.7% (n = 12), bisexual: 9.3%
(n = 16), and not sure: 12.4% (n = 10). Students who self-identified as
gay or lesbian were more likely to report one pregnancy experience
(15.3%, n = 11) than those who self-identified as heterosexual, bisex-
ual, or unsure. Students who were unsure of their sexual orientation
were more likely to report two or more pregnancies (6.2%, n = 5) than
their heterosexual, gay, lesbian or bisexual peers. Students self-identi-
fying as heterosexual were most likely to report never having a preg-
nancy experience (95.1%, n = 1,401) when compared to other races.
While statistically significant results were not found based
on gender or ethnicity, some differences were found. The rate of
 |
4       CYGAN et al.

TA B L E 1   Demographic characteristics of study participants 4.7% (n  =  41), and for non-Hispanic students was 5.2% (n = 45).
Non-Hispanic students were more likely to report being unsure of
  N(f)
a pregnancy experience (1.9%, n = 16) when compared to Hispanic
Gender  
students. Hispanic students were more likely to report never hav-
Female 963 (51.1%)
ing a pregnancy experience (93.6%, n  =  817) than non-Hispanic
Male 888 (47.2%) students.
Missing 32 (1.7%)
Grade  
9th 366 (19.4%) 4 | D I S CU S S I O N
10th 580 (30.8%)
11th 416 (22.1%) The purpose of this paper was to describe self-reported pregnancy
12th 487 (25.9%) experiences in the 9th–12th grade CPS students and identify those

Missing 25 (0.4%) at highest risk for teen pregnancy through a secondary analysis of
YRBS data. Findings from this study revealed statistically significant
Race  
differences in the likelihood of self-reporting a pregnancy experi-
American-Indian 148 (7.9%)
ence based on grade level, sexual orientation, and race with little
African-American 613 (32.6%)
difference based on gender or ethnicity. Results from this study
Pacific Islander 55 (2.9%)
add to current literature about teen pregnancy as they are based on
White 472 (25.1%)
YRBS data, and identify specific populations at highest risk for teen
Mixed Race 34 (1.8%) pregnancy.
Missing 561 (29.8%)
Ethnicity  
Hispanic 993 (49.7%) 4.1 | The Youth Risk Behavior Survey
Non-Hispanic 908 (48.2%)
Missing 40 (2.1%) The YRBS has been used since 1990, biannually across the U.S to

Sexual orientation   measure adolescent health behaviors and outcomes (CDC, 2018b).
In 2017, 14,765 students across 144 schools completed YRBS
Heterosexual 1,416 (80.8%)
(Kann et al., 2018). With such ubiquitous use of YRBS through-
Gay or lesbian 73 (4.2%)
out the U.S., this data source is readily available yet not used to
Bisexual 178 (10.2%)
its full potential to better understand youth risks and outcomes.
Not sure 85 (4.9%)
Although the YRBS has been used in the literature as a data source
Missing 131 (7.0%)
to describe teen sexual health behaviors (Demissie, Clayton, &
Total 1,883 (100%) Dunville, 2019; Harper, Clayton, Andrzejewski, & Johns, 2018;
Raspberry et al., 2018) it is not used in published literature to
measure teen pregnancy. This study is an example of how this
self-reported pregnancy experience for females was 4.6% (n = 42), widely available data set can be utilized to gain a better under-
and for males was 5.5% (n = 46). Males were more likely to report standing this important youth health outcome and provide insight
being unsure of a pregnancy experience (2.3%, n = 19) when com- to developing effective public health nursing interventions to pre-
pared to females. Females were more likely to report never hav- vent teen pregnancy.
ing a pregnancy experience (94.4%, n = 863) than males. The rate School districts use YRBS data for internal strategic planning
of self-reported pregnancy experience for Hispanic students was (Shelby County Schools, n.d). Government agencies use YRBS data

TA B L E 2   Self-reported pregnancy frequencies

Cumulative
Pregnancy Status Frequency Relative frequency Cumulative frequency relative frequency

Two or more 22 1.2% 22 1.2%

Once 69 3.7% 91 4.9%
Not sure 34 1.8% 125 6.7%
Never 1,645 87.4% 1,770 94.0%
Missing 113 6.0% 1,883 100%
Total 1,883 100%    
CYGAN et al. |
      5

TA B L E 3   Pregnancy comparison table

Gender Never pregnant n/N Once n/N Two or more n/N Unsure n/N

Females (n = 914) 863/914 (94.4%) 34/914 (3.7%) 8/914 (0.9%) 9/914 (1.0%)
Males (n = 829) 764/829 (92.2%) 35/829 (4.2%) 11/829 (1.3%) 19/829 (2.3%)
Chi-square 0.114    
Note: missing (n = 140)

Grade Never pregnant n/N Once n/N Two or more n/N Unsure n/N

9th (n = 342) 320/342 (93.6%) 10/342 (2.9%) 5/342 (1.5%) 7/342 (2.0%)
10th (n = 546) 511/546 (93.6%) 19/546 (3.5%) 4/546 (0.7%) 12/546 (2.2%)
11th (n = 388) 363/388 (93.6%) 17/388 (4.4%) 3/388 (0.8%) 5/388 (1.3%)
12th (n = 464) 428/464 (92.2%) 22/464 (4.7%) 9/464 (1.9%) 5/464 (1.1%)
Chi-square 0.000*      
Note: missing (n = 9)

Race Never pregnant n/N Once n/N Two or more n/N Unsure n/N

American Indian (n = 138) 132/138 (95.7%) 2/138 (1.4%) 1/138 (0.7%) 3/138 (2.2%)
African-American (n = 568) 508/568 (89.4%) 33/568 (5.8%) 10/568 (1.8%) 17/568 (3.0%)
Pacific Islanders (n = 51) 44/51 (86.3%) 3/51 (5.9%) 2/51 (3.9%) 2/51 (3.9%)
White (n = 459) 434/459 (94.6%) 17/459 (3.7%) 2/459 (0.2%) 6/459 (1.3%)
Mixed Race (n = 30) 28/30 (93.3%) 1/30 (3.3%) 1/30 (3.3%) 0/30 (0.0%)
Chi-square p = .023*      
Note: missing (n = 524)

Ethnicity Never pregnant n/N Once n/N Two or more n/N Unsure n/N

Hispanic (n = 873) 817/873 (93.6%) 32/873 (3.7%) 9/873 (1.0%) 15/873 (1.7%)
Non-Hispanic (n = 861) 800/861 (92.9%) 33/861 (3.8%) 12/861 (1.4%) 16/861 (1.9%)
Chi-square 0.903      
Note: missing (n = 149)

Sexual Orientation Never pregnant n/N Once n/N Two or more n/N Unsure n/N

Heterosexual (n = 1,401) 1,332/1,401 (95.1%) 40/1,401 (2.9%) 9/1,401 (0.6%) 20/1,401 (1.4%)
Gay or Lesbian (n = 72) 55/72 (76.4%) 11/72 (15.3%) 1/72 (1.4%) 5/72 (6.9%)
Bisexual (n = 173) 155/173 (89.6%) 11/173 (6.4%) 5/173 (2.9%) 2/173 (1.2%)
Not sure (n = 81) 68/81 (84.0%) 5/81 (6.2%) 5/81 (6.2%) 3/81 (3.7%)
Chi-square 0.000*      
Note: missing (n = 156)
a
p is less than or equal to 0.05.

to identify trends in youth risk behaviors and track progress toward
meeting national health goals (CDC, 2018a). Many professions, in-
cluding law, psychology, nutrition and medicine also use YRBS data
to make practice and policy recommendations (Dawson, 2018;
Hahn, Borton, & Sonneville, 2018; King, Marino, & Barry, 2018;
Meyer, Luo, Wilson, & Stone, 2019). However, the use of YRBS data
in public health nursing research is limited. This is in contrast to
public health nursing competencies which include the analytic skills
necessary to understand data sets and turn the data into evidence
for action (Quad Council Coalition Competency Review Task Force,
2018). Further exploration as to why there is a dearth of public
health nursing-specific research using YRBS is needed.
4.2 | High risk populations
4.2.1 | Teen pregnancy and grade level
Findings from this study showed differences in likelihood of self-
reported pregnancy based on grade level. These results, in many
ways, align with the current literature showing that teen pregnancy
rates and subsequent pregnancy rates increase as age and grade lev-
els increase (Kost, Maddow-Zimet, & Arpaia, 2017; Maravilla, Betts,
Cruz, & Alati, 2017). Our study mirrors these findings with 11th and
12th grade students being more likely to self-report one pregnancy
experience when compared to 9th and 10th grade students, and
 |
6       CYGAN et al.
12th grade students being the most likely to report two or more
pregnancy experiences. However, 9th grade students in this study
were more likely to report two or more pregnancy experiences when
compared to 10th and 11th grade students (Table 3), making them
outliers for this specific outcome.
Considering that 9th grade students in this study frequently re-
ported two or more pregnancy experiences, it is important to ex-
amine risk factors for and teen pregnancy prevention efforts aimed
at young teens. Research on the most effective pregnancy and high
risk sexual behavior (i.e. early onset of sexual intercourse, sex with-
out contraception, sex without condoms and sex with multiple or
anonymous partners) prevention programs for this age group varies
(Lugo-Gil et al., 2018). Ultimately, there is no “one size fits all” ap-
proach to teen pregnancy prevention. A 2019 study by Vasilenko
et al., found that understanding the specific risk and protective
factors of a population may allow for a more nuanced and effec-
tive approach to teen pregnancy prevention, specifically for younger
adolescents. Differences in factors that put young adolescents at
risk for teen pregnancy as compared to older adolescents are not
fully understood but may include increased risk of abuse, and lack of
knowledge and access to contraception (Malabarey, Balayla, Klam,
Shrim, & Abenhaim, 2012).
By better understanding and adapting evidence-based teen
pregnancy prevention programs to meet the unique needs of young
adolescents, public health nurses can have maximum impact. Public
health nurses understand how to use an ecological approach to
develop and implement interventions that meet the needs of pop-
ulations (Quad Council Coalition Competency Review Task Force,
2018). In this instance, using an ecological approach to understand
and address child abuse and lack of knowledge about and access to
contraception, could positively impact this high risk population.
4.2.2 | Teen pregnancy and sexual orientation
Results from this study show that teens identifying as gay, lesbian,
bisexual or not sure were statistically more likely to report a preg-
nancy experience than their heterosexual peers. These findings are
supported by previous literature suggesting that LGBQ youth are
more likely to engage in high risk sexual health behaviors and report
related negative outcomes (i.e. pregnancy, sexually transmitted in-
fections, and trauma) (Charlton et al., 2011; Coble, Silver, & Chhabra,
2017). Studies have consistently found that LGBQ females are at
higher risk of pregnancy than heterosexual peers (Charlton et al.,
2018; Goldberg, Reese, & Halpern, 2016). This study adds to the lim-
ited literature (Lindley & Walsemann, 2015) suggesting that LGBQ
males may also be at higher risk for a teen pregnancy experience.
While there is no literature pointing to the exact reason for in-
creased teen pregnancy rates in LGBQ youth, general sexual health
disparities that impact this population are associated with discrim-
ination, early onset of sexual activity, child maltreatment and bul-
lying, lack of family support, minority stress, and lack of culturally
adapted evidenced-based sexual health prevention and treatment
programs (Charlton et al., 2018; Fisher & Mustanski, 2014; Wood,
Salas-Humara, & Dowshen, 2016). In order to have an optimal im-
pact on teen pregnancy in this population, more evidence-based in-
terventions specifically designed for LGBQ youth are needed. The
evidence-based interventions supported by the United States Office
of Adolescent Health fail to mention the appropriateness of any of
their interventions for LGBQ youth (Office of Adolescent Health,
2017), making it difficult for public health nurses to select the best
program for this population based on these recommendations. The
Augusta Partnership for Children has developed a LGBQ training
designed to prepare teen pregnancy prevention facilitators to bet-
ter meet the needs of this population (Drescher, Eldridge, Wood,
Rossi, & Stepleman, 2018). This training could be used to prepare
public health nurses to adapt existing evidence-based teen preg-
nancy prevention programs to better meet the needs of this high
risk population.
It should be noted that on this YRBS questionnaire, students
were not given the opportunity to identify their transgender status.
Because of this we were unable to describe self-reported pregnancy
risk for transgender youth in this study, leaving a gap in the findings.
Unfortunately, this mirrors much of the current teen pregnancy lit-
erature that focuses on risk for heterosexual, lesbian, gay, and bisex-
ual youth but excludes specific study of transgender teens (Charlton
et al., 2011, 2018; Coble et al., 2017; Goldberg et al., 2016; Lindley &
Walsemann, 2015). Systematic study of pregnancy risk for transgen-
der individuals is urgently needed to meet the unique needs of this
population. Many school districts, including Chicago Public Schools,
included a transgender status question on the 2019 YRBS ques-
tionnaire. This question will allow researchers to better understand
self-reported teen pregnancy risk for this important, yet commonly
overlooked population, and may serve as the first step in developing
evidence-based teen pregnancy prevention programs specifically
designed for transgender youth.
4.2.3 | Teen pregnancy and race
Nationally, racial disparities are seen in teen pregnancy and birth
rates (Office of Adolescent Health, 2019b). These disparities are, in
part, mirrored in our study. In this study, students who identified as
African-American were more likely to report a pregnancy experience
when compared to their white peer. This is reflective of the most re-
cently published (2013) teen pregnancy rates for African-American
teens, which was 76 per 1,000 and higher than that of white teen
(30 per 1,000) (National Campaign to Prevent Teen & Unplanned
Pregnancy, 2020). Unfortunately, the ability to compare our results
against national data stops here as teen pregnancy rates are only
reported nationally for non-Hispanic white, non-Hispanic black and
Hispanic teens (National Campaign to Prevent Teen & Unplanned
Pregnancy, 2020). This lack of detail in reporting teen pregnancy is
a major gap in the literature that leads to a lack of understanding
about teens at highest risk for pregnancy. Further, this gap is surpris-
ing considering detailed information about sexual behaviors such as
CYGAN et al.
onset of sexual activity and number of sexual partners is reported for
all racial groups (National Campaign to Prevent Teen & Unplanned
Pregnancy, 2020). Comprehensive exploration and reporting of teen
pregnancy rates for individual racial groups is urgently needed in
order to truly identify and address disparities.
On the other hand, teen birth rates are reported for all ra-
cial groups (National Campaign to Prevent Teen & Unplanned
Pregnancy, 2020). Although this is not a true comparison, comparing
our results to teen birth rates provides some insight into the overall
public health concern. In our study, Pacific Islanders were the most
likely to report a pregnancy experience. This is in contrast to national
teen birth rates that show this racial group to have the lowest teen
birth rate (7 per 1,000) in the United States (Martin et al., 2018).
Further, in our study American Indian students were the most likely
to report never having a pregnancy experience. This is drastically
different from national teen birth rates for American Indians (24 per
1,000) which place them at high risk for teen birth (Martin et al.,
2018). While the rationale for these differences is unclear, findings
from our study suggest that in Chicago, teens most impacted by teen
pregnancy may be different than those most impacted by teen birth.
This highlights the importance of learning more about all teens that
experience pregnancy, not just those who give birth.
While rates of teen pregnancy and birth have declined across all
racial groups (Office of Adolescent Health, 2019b), awareness of the
unique needs of racial minorities is important when designing and
implementing health promotion activities aimed at reducing teen
pregnancy. Public health nurses are specifically prepared to recog-
nize and respond to the diverse needs of the populations they serve
(Quad Council Coalition Competency Review Task Force, 2018),
placing them in a unique position to develop, implement and eval-
uate programs specifically aimed at the populations at highest risk
for teen pregnancy. The evidence-based interventions aimed at re-
ducing teen pregnancy endorsed by the Office of Adolescent Health
indicate their target population and include information about the
effectiveness in different racial groups (Office of Adolescent Health,
2017). This can be valuable resource for public health nurses when
selecting an appropriate intervention for their population of focus.
4.2.4 | Teen pregnancy and gender
Although researchers in this study did not find a difference in likeli-
hood of self-reporting a pregnancy experience based on gender, it is
an important characteristic to consider in teen pregnancy prevention.
Despite the role males play in teen pregnancy prevention efforts,
there are few evidence-based programs focused on this important
population (CDC, 2018c). Failing to understand and address the
needs of young males leaves a gap in public health nursing practice
and research that must be filled to ensure a comprehensive approach
to teen pregnancy prevention. The U.S. Department of Health and
Human Services (HHS) Office of Adolescent Health (OAH) is currently
funding three pilot programs to fill this gap (CDC, 2018c). Programs
include a computer-assisted motivational interviewing intervention, a
|
      7
father–son dyad intervention, and a community-based, group inter-
vention (CDC, 2018c). Results of these pilot programs could lay the
foundation for evidence-based teen pregnancy prevention programs
so urgently needed for young males. By implementing similar pro-
grams that are specifically designed for males, public health nurses
can fill this gap in practice and research.
4.3 | Public health nurses and teen
pregnancy prevention
Public health nurses are in a unique position to leverage core com-
petencies to impact teen pregnancy for the populations they serve.
This effort must begin with understanding who is at highest risk, and
we suggest the use of the YRBS as an effective tool for collecting and
analyzing relevant data. In our study, use of the YRBS to better under-
stand the population was facilitated by an academic–practice partner-
ship between our academic institution and the local school district.
The academic–practice partnership model offers a framework for
establishing meaningful, trusting relationships between public health
nursing academics and school districts (Lopez-Turley & Stevens,
2015). Academic–practice partnerships are mutually beneficial, col-
laborative relationships between academic institutions and practice
sites (i.e., schools) that are based on a shared vision, mutual goals, and
joint resources (American Association of Colleges of Nursing [AACN],
2019). This model is cost-effective and works toward meeting mu-
tual goals (AACN, 2019; Institute of Medicine, 2010).This model has
been used to successfully address adolescent sexual health needs
(Cygan, McNaughton, Reising, & Reid, 2018) and could be explored as
a framework to specifically address teen pregnancy.
Once aware of those at highest risk, public health nurses can
capitalize on their expert knowledge of the population and commu-
nity to develop, implement and evaluate appropriate teen pregnancy
prevention efforts. Public health nurses often have deep ties with
communities, based on mutual trust and respect (Hassouneh, Alcala-
Moss, & McNeff, 2011; Kulbok, Thatcher, Park, & Meszaros, 2012).
Public health nurses should leverage these robust relationships and
utilize core competencies to adapt teen pregnancy prevention pro-
grams to match the specific needs of those they serve. Stakeholders
are more likely to accept solutions to health concerns when the pro-
posal comes from a trusted source, making the public health nurse
an integral part of the teen pregnancy prevention effort (Hassouneh
et al., 2011; Kulbok et al., 2012).
Public health nurses have the expertise and opportunity to reach
young people in communities, schools and clinics (Quad Council
Coalition Competency Review Task Force, 2018; Santa Maria,
Guilamo-Ramos, Jemmott, Derouin, & Villarruel, 2017). Public
health nurses, working in a variety of settings, have shown success
in preventing teen pregnancy (Hogan, 2018; Marseille et al., 2018;
Schaffer, Jost, Pederson, & Lair, 2008; Serowoky, George, & Yarandi,
2015). These programs can serve as blueprints for future work.
Capitalizing on public health nursing expertise and opportunity is
urgently needed to reach teens at highest risk.
 |
8       CYGAN et al.
5 |  LI M ITATI O N S
One limitation of this study was the exclusion of students who at-
tend charter, alternative, and special education-specific schools.
Studies show that students with who attend alternative schools
or receive special education services may be at higher risk for teen
pregnancy (Barrett, Katsiyannis, Zhang, & Kingree, 2014; Mainella,
2015). While the students included in the YRBS sample are repre-
sentative of regular high school students in the city of Chicago, by
excluding students attending charter, alternative and specific-edu-
cation-specific schools, it is possible that results of this study under-
estimate teen pregnancy rates for all Chicago Public School teens.
Moving forward, including all types of high schools in the sampling
process may result in a more representative sample.
Another limitation of this study is the lack of published research
that uses the YRBS to describe teen pregnancy. The reliability of
youth self-reported health behaviors in research varies (Cabanas-
Sánchez, 2018; Jeong et al., 2018). However, the study of individual
YRBS questions shows high reliability (Brener, Collins, Kann, Warren,
& Williams, 1995; Brener et al., 2002; CDC, 2013; Raghupathy &
Hahn-Smith, 2012). Furthermore, sexual behaviors are likely more
significant to teens than other behaviors such as those related to
physical activity and nutrition, and therefore more reliably recalled
on YRBS (CDC, 2013). Nonetheless further research is needed to de-
termine if YRBS can be accurately used to describe teen pregnancy.
6 |  CO N C LU S I O N
The OAH Teen Pregnancy Prevention Program initiatives, combined
with local efforts by public health nurses, have led to a decrease in
national teen pregnancy and birth rates since 1990 (Martin et al.,
2018). However, teen pregnancy continues to be a public health issue
that impacts young people, families, and communities. Public health
nurses should explore the use of YRBS data to better understand the
populations they serve and leverage core competencies, and deeply
rooted community relationships to develop, implement, and evalu-
ate evidence-based teen pregnancy prevention programs. By doing
so, public health nurses can increase their impact on teen pregnancy
rates through targeted comprehensive sexual health education pro-
grams and other community-based sexual health programs.
AC K N OW L E D G M E N T S
This study is part of the Building Healthy Urban Communities
Project funded by the BMO Harris Bank. The content of this arti-
cle is solely the responsibility of the authors.
ORCID
Heide R. Cygan  https://orcid.org/0000-0003-2811-2170
REFERENCES
American Association of Colleges of Nursing (AACN). (2019). Guiding
principles to academic-practice partnerships. Retrieved from https://
www.aacnn​ursing.org/Acade​mic-Pract​ice-Partn​e rshi​ps/The-Guidi​
ng-Princ​iples
Barrett, D. E., Katsiyannis, A., Zhang, D., & Kingree, J. B. (2014).
Predictors of teen childbearing among delinquent and non-delin-
quent females. Journal of Family and Child Studies, 24(4), 970–978.
https://doi.org/10.1007/s1082​6-014-9907-6
Brener, N. D., Collins, J. L., Kann, L., Warren, C. W., & Williams, B. I. (1995).
Reliability of youth risk behavior survey questionnaire. American
Journal of Epidemiology, 141(6), 575–580. https://doi.org/10.1093/
oxfor​djour​nals.aje.a117473
Brener, N. D., Kann, L., McManus, T., Kinchen, S. A., Sundberg, E. C., &
Ross, J. G. (2002). Reliability of the 1999 youth risk behavior survey
questionnaire. Journal of Adolescent Health, 31, 336–342. https://doi.
org/10.1016/S1054​-139X(02)00339​-7
Cabanas-Sánchez, V., Martínez-Gómez, D., Esteban-Cornejo, I., Castro-
Piñero, J., Conde- Caved, J., & Veiga, O. L. (2018). Reliability and va-
lidity of the Youth Leisure-time Sedentary Behavior Questionnaire
(YLSBQ). Journal of Science and Medicine in Sport, 21(1), 69–74.
https://doi.org/10.1016/j.jsams.2017.10.031
Centers for Disease Control and Prevention (CDC). (2013). Methodology
of the Youth Risk Behavior Surveillance System—2013. MMWR,
62(No.1). Retrieved from https://www.cdc.gov/mmwr/pdf/rr/rr6201.
pdf
Centers for Disease Control and Prevention (CDC). (2018a). Youth risk
behavior surveillance system. Retrieved from https://www.cdc.gov/
healt​hyyou​th/data/yrbs/index.htm
Centers for Disease Control and Prevention (CDC). (2018b). Adolescent
and school health: Overview. Retrieved from https://www.cdc.gov/
healt​hyyou​th/data/yrbs/overv​iew.htm
Centers for Disease Control and Prevention (CDC). (2018c). Effectiveness
of teen pregnancy prevention programs designed specifically for young
males. Retrieved from https://www.cdc.gov/teenp​ regna​ncy/proje​
cts-initi​ative​s/engag​ing-young​-males.html
Centers for Disease Control and Prevention (CDC). (2019). Social deter-
minants and eliminating disparities in teen pregnancy. Retrieved from
https://www.cdc.gov/teenp​r egna​n cy/about ​/socia​l-deter​m inan​t s-
dispa​ritie​s-teen-pregn​ancy.htm
Charlton, B. M., Corliss, H. L., Missmer, S. A., Frazier, A. L., Rosario, M.,
Kahn, J. K., & Austin, S. B. (2011). Reproductive health screening dis-
parities and sexual orientation in a cohort study of U.S. adolescent
and young adult females. Journal of Adolescent Health, 49(5), 505–
510. https://doi.org/10.1016/j.jadoh​ealth.2011.03.013
Charlton, B. M., Roberts, A. L., Rosario, M., Katz-Wise, S. L., Calzo, J.
P., Spiegelman, D., & Austin, S. B. (2018). Teen pregnancy risk fac-
tors among young women of diverse sexual orientations. Pediatrics,
141(4).
Chicago Health Atlas. (2018). Teen Birth Rate. Retrieved from https://
www.chica​gohea​lthat​las.org/indic​ators​/teen-birth​-rate
Chicago Public Schools. (2019a). CPS stats and facts. Retrieved from
https://www.cps.edu/About_CPS/At-a-glanc​e /Pages​/Stats_and_
facts.aspx
Chicago Public Schools. (2019b). School data. Retrieved from https://cps.
edu/Schoo​lData​/Pages​/Schoo​lData.aspx
Coble, C. A., Silver, E. J., & Chhabra, R. (2017). Description of sexual ori-
entation and sexual behaviors among high school girls in New York
City. Journal of Pediatric and Adolescent Gynecology, 30(4), 460–465.
https://doi.org/10.1016/j.jpag.2017.02.007
Cygan, H., McNaughton, D., Reising, V., & Reid, B. (2018). An aca-
demic practice partnership: Building capacity to meet sexual
health education policy requirements of a public school system.
Public Health Nursing, 35(5), 414–419. https://doi.org/10.1111/
phn.12527
Dawson, R. (2018). Adolescent sexual health and education: Where
does the pediatrician's responsibility fall? Pediatric Annals, 47(4),
e136–e139. https://doi.org/10.3928/19382​359-20180​321-01
CYGAN et al.
Demissie, Z., Clayton, H. B., & Dunville, R. L. (2019). Association be-
tween receipt of school- based HIV education and contraceptive use
among sexually active high school students—United States, 2011–
2013. Sex Education, 19(2), 237–246. https://doi.org/10.1080/14681​
811.2018.1501358
Drescher, C. F., Eldridge, E. D., Wood, E., Rossi, A. L., & Stepleman, L.
(2018). Implementing an LGBQ training for teen pregnancy pre-
vention facilitators. Georgia Educational Researcher, 15(1), Article 4.
https://doi.org/10.20429​/ger.2018.15104
Dupéré, V., Leventhal, T., Dion, E., Crosnoe, R., Archambault, I., &
Janosz, M. (2015). Stressors and turning points in high school
and dropout: A stress process, life course framework. Review of
Educational Research, 85, 591–629. https://doi.org/10.3102/00346​
54314​559845
Fisher, C. B., & Mustanski, B. (2014). Reducing health disparities and en-
hancing the responsible conduct of research involving LGBT youth.
Hastings Center Report, 44, S28–S31. https://doi.org/10.1002/
hast.367
Ganchimeg, T., Ota, E., Morisaki, N., Laopaiboon, M., Lumbiganon, P.,
Zhang, J., … Mori, R. (2014). Pregnancy and childbirth outcomes
among adolescent mothers: A World Health Organization multicoun-
try study. British Journal of Obstetrics and Gynaecology, 121(Suppl 1),
40–48. https://doi.org/10.1111/1471-0528.12630
Goldberg, S. K., Reese, B. M., & Halpern, C. T. (2016). Teen pregnancy
among sexual minority women: Results from the national longitudi-
nal study of adolescent to adult health. Journal of Adolescent Health,
59(4), 429–437. https://doi.org/10.1016/j.jadoh​ealth.2016.05.009
Hahn, S. L., Borton, K. A., & Sonneville, K. D. (2018). Cross-sectional asso-
ciations between weight-related health behaviors and weight misper-
ception among U.S. adolescents with overweight/obesity. BMC Public
Health. Retrieved from, https://doi.org/10.1186/s1288​9-018-5394-9
Harper, C. R., Clayton, H. B., Andrzejewski, J., & Johns, M. M. (2018).
Health risks among discordant heterosexual high school students.
Journal of LGTB Youth, 15(3), 149–161. https://doi.org/10.1080/19361​
653.2018.1451802
Hassouneh, D., Alcala-Moss, A., & McNeff, E. (2011). Practical strategies
for promoting full inclusion of individuals with disabilities in commu-
nity-based participatory intervention research. Research in Nursing
and Health, 34, 253–265.
Hogan, J. (2018). Condom access for high school students: The journey
from data to policy. Journal of School Nursing, 33(5), 284–287. https://
doi.org/10.1177/19426​02X18​768075
Institute of Medicine. (2010). The future of nursing: leading change, ad-
vancing health. Retrieved from http://books.nap.edu/openb​ ook.
php?record_id=12956​&page=R1
Jeong, H., Yim, H. W., Lee, S., Lee, H. K., Potenza, M. N., Kwon, J., … Choi,
J. (2018). Discordance between self-report and clinical diagnosis of
Internet gaming disorder adolescents. Scientific Reports, 8, 10084.
Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen,
B., … Ethier, K. A. (2018). Youth risk behavior surveillance —United
States, 2017. MMWR. Morbidity and Mortality Weekly Report, 67(8),
1–114. https://doi.org/10.15585​/mmwr.ss6708a1
King, B. M., Marino, L. E., & Barry, K. R. (2018). Does the Centers for
Disease Control and Prevention's Youth Risk Behavior Survey un-
derreport risky sexual behavior? Sexually Transmitted Diseases, 45(3),
e10–e11.
Kost, K., Maddow-Zimet, I., & Arpaia, A. (2017). Pregnancies, births and
abortions among adolescents and young women in the United States,
2013: National and state trends by age, race and ethnicity, New York:
Guttmacher Institute, 2017. Retrieved from https://www.guttm​
acher.org/repor​t/us-adole​scent​-pregn​ancy-trend​s-2013
Kulbok, P. A., Thatcher, E., Park, E., & Meszaros, P. S. (2012). Evolving
public health nursing roles: Focus on community participatory health
promotion and prevention. The Online Journal of Issues in Nursing, 17,
2. https://doi.org/10.3912/OJIN.Vol17​No02M​an01
|
      9
Lindley, L. L., & Walsemann, K. M. (2015). Sexual orientation and risk
of pregnancy among New York City high-school students. American
Journal of Public Health, 105(7), 1379–1386. https://doi.org/10.2105/
AJPH.2015.302553
Lopez-Turley, R. N., & Stevens, C. (2015). Lessons from a school district–
university research partnership: The Houston education research
consortium. Educational Evaluation and Policy Analysis, 37(1S), 6S–
15S. https://doi.org/10.3102/01623​73715​576074
Lugo-Gil, J., Lee, A., Vohra, D., Harding, J., Ochoa, L., & Goesling, B.
(2018). Updated findings from the HHS Teen Pregnancy Prevention
Evidence Review: August 2015 through October 2016. Retrieved from
https://tppev ​i denc​e revi​e w.aspe.hhs.gov/pdfs/Summa​r y_of_findi​
ngs_2016-2017.pdf
Mainella, A. (2015). Public policy and sexuality education for youth with
disabilities: Impact on sexual behavior and outcomes. International
Journal of Social, Behavioral, Educational, Economic, Business and
Industrial Engineering, 9(2), 458–463.
Malabarey, O. T., Balayla, J., Klam, S. L., Shrim, A., & Abenhaim, H. A. (2012).
Pregnancies in young adolescent mothers: A population-based study
on 37 million births. Journal of Pediatric and Adolescent Gynecology,
25(2), 98–102. https://doi.org/10.1016/j.jpag.2011.09.004
Manlove, J., & Lantos, H. (2018). Data point: Half of 20- to 29-year-old
women who gave birth in their teens have a high school diploma.
Child Trends. Retrieved from https://www.child​trends.org/half-20-
29-year-old-women​-gave-birth​-teens​-high-schoo​l-diploma
Maravilla, J. C., Betts, K. S., Cruz, C. C., & Alati, R. (2017). Factors in-
fluencing repeated teenage pregnancy: A review and meta-analy-
sis. American Journal of Obstetrics and Gynecology, 217(5), 527–545.
https://doi.org/10.1016/j.ajog.2017.04.021
Marseille, E., Mirzazadeh, A., Biggs, M. A., Miller, A. P., Horvath, H.,
Lightfoot, M., … Kahn, J. G. (2018). Effectiveness of school-based
teen pregnancy prevention programs in the USA: A systematic re-
view and meta-analysis. Prevention Science, 19(4), 468–489. https://
doi.org/10.1007/s1112​1-017-0861-6
Martin, J. A., Hamilton, B. E., Osterman, M. J. K., Driscoll, A. K., &
Drake, P. (2018). Births: Final data for 2016. National Vital Statistics
Reports, 67(1). Hyattsville, MD: National Center for Health Statistics.
Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr6​7/
nvsr67_01.pdf
Meyer, I. H., Luo, F., Wilson, B., & Stone, D. M. (2019). Sexual orienta-
tion enumeration in state antibullying statutes in the United States:
associations with bullying, suicidal ideation, and suicide attempts
among youth. LGBT Health, 6(1), 9–14. https://doi.org/10.1089/
lgbt.2018.0194
Office of Adolescent Health. (2017). Evidence- based teen pregnancy pre-
vention programs at a glance. Retrieved from https://www.hhs.gov/
ash/oah/sites​/defau​lt/files​/ebp-chart1.pdf
Office of Adolescent Health. (2019). Teen pregnancy and childbearing
trends. Retrieved from https://www.hhs.gov/ash/oah/adole​ scent​
-devel ​ o pmen​ t /repro ​ d ucti ​ v e-healt ​ h -and-teen-pregn ​ a ncy/teen-
pregn​ancy-and-child​beari​ng/trend​s/index.html
Penman-Aguilar, A., Carter, M., Snead, M. C., & Kourtis, A. P. (2013).
Socioeconomic disadvantage as a social determinant of teen child-
bearing in the U.S. Public Health Reports, 128, S1.
Perper, K., Peterson, K., & Manlove, J. (2010). Diploma attainment
among teen mothers. Child Trends, 2010-01. Retrieved from https://
www.child​t rends.org/wp-conte​n t/uploa​d s/2010/01/child_trend​
s-2010_01_22_FS_diplo​maatt​ainme​nt.pdf
Quad Council Coalition Competency Review Task Force. (2018).
Community/Public Health Nursing Competencies. Retrieved from
http://www.quadc​o unci​l phn.org/wp-conte​n t/uploa​d s/2018/05/
QCC-C-PHN-COMPE ​T ENCI​E S-Appro​ved_2018.05.04_Final​- 002.
pdf
Raghupathy, S., & Hahn-Smith, S. (2012). Reliability of the high school
Youth Risk Behavior Survey when administered online. International
 |
10       CYGAN et al.
Quarterly of Community Health Education, 32(2), 135–148. https://doi.
org/10.2190/IQ.32.2.d
Rasberry, C. N., Lowry, R., Johns, M., Robin, L., Dunville, R., Pampati, S.,
… Balaji, A. (2018). Sexual risk behavior differences among sexual mi-
nority high school students - United States, 2015 and 2017. MMWR.
Morbidity and Mortality Weekly Report, 67(36), 1007–1011. https://
doi.org/10.15585​/mmwr.mm6736a3
Santa Maria, D., Guilamo-Ramos, V., Jemmott, L. S., Derouin, A., &
Villarruel, A. (2017). Nurses on the front lines: Improving adolescent
sexual and reproductive health across health care settings: An evi-
dence-based guide to delivering counseling and services to adoles-
cents and parents. American Journal of Nursing, 117(1), 42–51. https://
doi.org/10.1097/01.NAJ.00005​11566.12446.45
Schaffer, M. A., Jost, R., Pederson, B. J., & Lair, M. (2008). Pregnancy-
free club: A strategy to prevent repeat adolescent preg-
nancy. Public Health Nursing, 25(4), 304–311. https://doi.
org/10.1111/j.1525-1446.2008.00710.x
Serowoky, M. L., George, N., & Yarandi, H. (2015). Using the program
logic model to evaluate ¡Cu´ıdate!: A sexual health program for Latino
adolescents in a school-based health center. Worldviews on Evidence-
Based Nursing, 12(5), 297–305.
Shelby County Schools. (n.d.). Exceptional Children and Health
Services. Retrieved from http://www.scsk12.org/excep​ t iona​l/
yrbs?PID=716
SmithBattle, L., & Freed, P. (2016). Teen mother's mental health.
American Journal of Maternal/Child Nursing, 41(1), 31–36. https://doi.
org/10.1097/NMC.00000​0 0000​0 00198
The National Campaign to Prevent Teen and Unplanned Pregnancy. (2020).
Power to Decide: National Data. Retrieved from https://power​todec​
ide.org/what-we-do/infor​matio​n/natio​nal-state​-data/national
Vasilenko, S. A., Glassman, J. R., Kugler, K. C., Peskin, M. F., Shegog, R.,
Markham, C. S., … Coyle, K. K. (2019). Pregnancy prevention program
by risk profiles: A more nuanced approach to program evaluation.
Journal of Adolescent Health, e-pub, https://doi.org/10.1016/j.jadoh​
ealth.2018.12.003
Wood, S. M., Salas-Humara, C., & Dowshen, N. L. (2016). Human immunode-
ficiency virus, other sexually transmitted infections, and sexual and re-
productive health in lesbian, gay, bisexual, transgender youth. Pediatric
Clinics, 63, 1027–1055. https://doi.org/10.1016/j.pcl.2016.07.006
How to cite this article: Cygan HR, McNaughton D, Reising V,
Fogg L, Marshall B, Simon J. Teen pregnancy in Chicago: Who
is at risk?. Public Health Nurs. 2020;00:1–10. https://doi.
org/10.1111/phn.12726