KFP Final Proposal

Grace Bazinet, Nevaeh Kuhl, Abigail Neeley, Anna Williams, and Candy

Avila College of Social Work, University of South Carolina

SOWK352-001: Social Work & Sci

Inquiry Otis Owens

April 24, 2023

 KFP Final Proposal

Introduction

Teenage pregnancy is defined as any citizen becoming pregnant under the age of 20 and

each year over 200,000 babies are born to teenage women in the US (American Pregnancy

Association, 2021). A big issue in the United States is the lack of adequate sexual education in

the education system. Although the teenage birth rate has shown an overall 2.4% decrease,

southern states have shown to remain tenaciously higher than the rest of the country. Sex

education varies based on different counties and states. Counties in southern states tend to

heavily focus on teaching abstinence to young females.

The understanding of sex and sexuality of an adolescent is dependent on their sexual

education curriculum in school however there are also influences from their household. Their

main influence being their parents' beliefs and what they instruct their children. Abstinence is the

practice of not partaking in sexual behavior. The flaw in this teaching style results in people not

understanding how to have safe sex, which leads to unwanted pregnancy. With adolescents, over

60 percent of these women are living in households considered below the poverty line. This leads

to a continued systemic poverty effect that may lead to poorer living conditions, poor nutrition,

fewer educational opportunities, and other disparities. Within southern states and counties, the

combination of poverty, lack of education, and abstinence-based sex education have caused teen

pregnancy rates to be higher in the Southern United States than the North.

To address this issue, there are several questions that should be clarified. One question

that can be asked is, “Are unwanted teen pregnancies higher because of poverty?” There are

many other questions that can be asked such as, are teenage pregnancy rates highest in

Mississippi due to abstinence only education, religious values, and/or lack of resources? Teenage
pregnancy rates vary by state and the goal is to figure out why. Specifically, in Mississippi, the

teen birth rate is 27.9 percent for 2020, the highest rate in the US (CDC, 2020). This research

will look at how to decrease pregnancy rates in low-income students aged 13 to 18 in the state

of Mississippi.

An intervention to improve the high teen pregnancy rate involves providing workshops

for students, teachers, and parents. Specifically using comprehensive sex education which aims

to provide education about diverse topics about sex and sexuality. To apply better sex education

to students in Mississippi, adolescent participants will be provided with comprehensive sex

education workshops in schools to improve knowledge, awareness, practice, and behaviors about

sexual topics. A second intervention would be to engage parents in a sex-education program that

provides the proper resources and how they will be able to teach proper sex education to their

children. While not all parents want their children to learn about sex-education in school, low-

income areas should increase funding in workshops and programs to better their sex education.

These interventions would decrease unwanted teen pregnancy rates and give students the

knowledge they need to have healthy and safe sex.

After the implementation of our interventions, we hope to decrease the amount of

unintended teenage pregnancies with our comprehensive sex education to adolescents and

parents. We will be able to answer our research question “Does comprehensive sex education

impact the understanding of sex education, parental involvement in sex education, and teen

pregnancy rates in comparison to abstinence teaching?”

Literature Review

Sex education focuses on body development, sex, sexuality, and relationships. This

educates people on safe sex, abstinence, birth control, pregnancy, sexually transmitted infections,
etc. (Planned Parenthood, 2022). By administering sex education, educators can enforce an

understanding and the importance of safe sex habits. This type of education also helps provide

knowledge that can help people throughout their sexual lives. As stated before, in the United

States there are over 200,000 teenage pregnancies a year (American Pregnancy Association,

2021). Mississippi is the state with the highest rates of teenage pregnancy with a rate of 27.9

compared to the lowest of 6.1 in Massachusetts (CDC, 2020). This high percentage of teenage

pregnancy (ages 13-18) in Mississippi can be caused due to the lack of sex education and

resources.

Before 2011, the Mississippi Department of Education was not required to teach any kind

of sexual education in schools. The Mississippi State Legislature passed the House Bill 999 in

2011, which required all school districts in Mississippi to adopt a sex education policy with a

Mississippi Department of Education approved curriculum that only teaches abstinence only or

abstinence plus programs. With the ability for each school district to choose which program they

want to teach; 81 districts choose the “abstinence only” program which would only teach that

abstaining from sexual activity is the only truly effective way to prevent unintended pregnancy.

While 71 districts choose “abstinence plus,” which focuses on delaying the initiation of sexual

activity and recommends the use of contraceptives if a teen is sexually active (Bogan, 2020).

There is substantial evidence that abstinence only programs do not help young adults delay

initiation of sexual intercourse. In fact, research shows that the more the state emphasizes

abstinence only programs, the higher the incidence of adolescent pregnancies and births

(Guttmacher, 2022).

They are less likely to use contraceptives and are at higher risk for HPV and nonmarital

pregnancy. (Guttmacher, 2022). The intervention we are assessing to lower teenage pregnancy in

Mississippi is implementing comprehensive sex education rather than schools teaching

abstinence or abstinence plus education. Alternatively, involving parents within their child's sex

education life will lower teenage pregnancy rates.

Sex Education for Students

To improve young people is right to sex education in Mississippi and further decrease the

Mississippi teen pregnancy rates, curriculums in schools need to stop teaching abstinence

only/plus programs and instead implement Comprehensive Sex Education programs. The

Comprehensive Sex Education (CSE) program focuses on teaching students beginning in early

childhood to 12th grade evidence based, age appropriate, medically accurate information

regarding sexual intercourse, reproductive development, contraception to prevent unintended

pregnancies, as well as how to prevent sexually transmitted infections (ACOG, 2016).

Comprehensive Sex Education places an emphasis on teaching different forms of sexual

expression, healthy sexual and nonsexual relationships, gender identity and sexual

orientation/questioning, communication, recognizing and preventing sexual violence, consent,

and decision making (ACOG, 2016). Programs teach the ramifications of sexual behavior that

happens in person and share information online. Lastly, CSE covers variations in sexual

expression, including vaginal intercourse, oral sex, anal sex, mutual masturbation (ACOG,

2016).

To understand how effective CSE is in efforts to lower teen pregnancy and sexually

transmitted diseases, we need to review evidence that shows that CSE can create positive

outcomes. Eva S Goldfarb, Ph.D., and Lisa D. Lieberman, Ph.D., conducted a systematic

literature review over three decades (starting in 1990) that provided research on how effective

CSE is in school based programs. Researchers began with studying 8,058 articles relevant to the

systematic literature review criteria, 218 met those qualifications. Qualifications for criteria are

searching for

(1) qualitative or quantitative studies evaluating outcomes of school-based, K-12 educational

approaches; (2) both within sex education and across the curriculum; and (3) that were U.S.

based. More than 80% focused solely on pregnancy, disease prevention and were excluded,

leaving 39.
In the next phase, researchers expanded criteria to studies outside the U.S. to identify evidence

reflecting the full range of topic areas. Eighty articles constituted the final review (Eva, 2021).

After the researchers identified all outcomes in each study, they sorted them into four

overarching categories taught within CSE guidelines. Those categories being appreciation of

sexual diversity, dating and intimate partner violence (IPV) prevention, development of healthy

relationships, and prevention of child sex abuse (Eva, 2021).

What this review found is that school-based CSE can lower homophobia and

homophobic- related bullying, can increase understanding of gender and gender norms, can

improve knowledge and skills that support healthy relationships, can build child sex abuse

prevention skills, and can reduce dating and intimate partner violence (Eva, 2021). Furthermore,

it is found that increased funding and teaching of CSE reduced the overall rate of teen births at

the county level by more than 3%. These results thus complement the mixed findings from RCTs

by providing population- level evidence on the causal role played by more comprehensive sex

education (Eva, 2021).

With the onset of the evidence found from the study, we think that if students can avoid

early pregnancy, STIs, sexual abuse, and interpersonal violence and harassment while feeling

safe and supported within their school environment, they are more likely to experience academic

success, and a foundation for future stability.

Sex Education for Parents and Guardians

Parents and guardians play a crucial role in the connection between children and their

relationship with sexual education, including children’s attitudes toward sexual topics and

relationships and as well as the overall effectiveness of sexual education curriculums. With

parental involvement in the curriculum for sexuality education in Mississippi and additionally

talking to their children about sexual health and relationships, parents can feel confident about
what is being taught to their children and thus feel more assured about the program (Brindis et

al., 2020). In a study done in Thailand of 40 parents learning about sex education, the results

showed there was an increase in self-efficacy and communication with children aged 11-13

following comprehensive sex education (Sirilukkananan, 2014). This study also focused on the

learning needs of the parents to improve the overall quality of the sex education and

effectiveness of communication with adolescents.

In states where all sexual education is abstinence-based, such as in Mississippi, for

example, parents can sometimes be the only source of sexual health and education for children.

Children, most commonly adolescents, can also be faced with stigma following sexual questions

or relationships, and open communication with parents about sexual topics can often reduce their

reluctance to express these feelings. In a study completed in 2020, the results showed that over

90 percent of parents in the United States supported comprehensive sexuality education and

believed in “safer sex practices” (Eisenberg, 2021). Additionally, parental involvement in sexual

education curriculums can help to improve programs and reduce backlash about what is being

taught to children (Brindis et al., 2020).

To determine the results of parents discussing sexuality education with their children in

Mississippi, surveys and focus groups can be used to receive input from parents and establish

how confident parents are in talking about certain topics with their children. The same methods

could additionally be used with children before and after parental involvement to assess how

effective open communication about sexuality and education about sexual health can be within

the home. In a study done in 2020, the results found that there was an improvement in child to

parent communication when focus groups or other forms of discussion were available following

comprehensive sex education courses (Edwards et. al., 2020). Focus groups for parents would

also allow parents to express their concerns about where the curriculum needs improvement and
positives about the program, and as well as confide in other parents about which topics they feel

incompetent in.

In a study done by Planned Parenthood in 2021, the results found that 70 percent of

parents felt comfortable discussing how sexual education was taught in the home during focus

groups and 81 percent felt comfortable using anonymous surveys (Kantor & Levitz, 2021). The

study also noted that most parents felt “confident” in their ability to communicate sexual

education standards to their children and were open to sharing their experiences during the focus

groups. For children and adolescents in Mississippi, the surveys could be used before and after

the sexuality education curriculum and parents’ involvement to determine if there was an

increase or decline in knowledge about sexual health and education.

Comparing and Contrasting

Based on what we have learned from the studies, there are multiple ways to approach sex

education in adolescents. When educating adolescents about sexual education there has been

significant research to show that abstinence education does not work and leads to higher rates of

teen pregnancies and STDs. Using comprehensive sex education will target many missing topics

that adolescents may miss when being taught abstinence. Studies have demonstrated how

comprehensive sexual education reduces the rates of sexual activity, sexual risk behaviors, STIs,

and adolescent pregnancy (The American College of Obstetricians and Gynecologists).

There was a difference by political affiliation for two topics, birth control and sexual

orientation. The difference being that republicans had a lower percentage of individuals

compared to democrats that thought those topics should be included in sex education. This is

relevant as Mississippi has reflected to be a republican state. Through this study it shows that a

complete sex education that includes puberty, healthy relationships, abstinence, birth control,
STDs, and sexual orientation is supported by parents and should be implemented in schools.

Using this information, we can conclude that parents would be interested in the alternative

intervention of having parental focus groups to educate parents on sex education and how to talk

to their adolescent.

Deficiencies

When teaching sex education to students in schools it is important to ensure the

information taught is accurate. This information may not be explained properly to students based

on age, gender, sexual orientation, or religious reasons. The other downfall to the education on

sex in grade schools is that it is believed to promote promiscuity among children (Inadequate Sex

Education, 2021). While it is important to teach about safe sex in schools, it is also important to

teach what happens if you or your partner may become pregnant. With the growing number of

states abolishing abortion, Mississippi being one of them, many children and adolescents are

faced with uncertainty if this situation arises.

Giving parents the necessities and education to provide their children with appropriate

and proper sex education is also important but excludes the discomfort with the topic. This topic

continues to be pushed to the back burner between parents and children due to discomfort.

Many parents would much rather than children learn about sex from their school just to avoid

the discomfort. Some parents may also believe that instructing their child about sex condones

sex and promiscuity, which increases their discomfort. While teaching parents about ways to

have these conversations, there is no way to instruct a person not to be uncomfortable with

certain topics (Lukolo & Van Dyk, 2014).

Methods

Research Design
 To collect data to determine how Comprehensive Sex Education Programs affect the

understanding of sex education, parental involvement in sex education, and teen pregnancy rates

the best design to use would be a randomized comparative experiment. This design is when there

is a comparison of the effects of a treatment given to one or more groups and how the lack of the

treatment affects the other group(s) (Berman). The most important part of this design is that it is

completely random, which allows for more flexibility, and it helps us get a cause-effect

relationship between the variables.

When performing this design, we would split the subjects into four different groups: a

group of random parents that receive the program (Group 1), a group of random adolescent aged

students that receive the program (Group 2), a group of random parents that don’t receive the

program (Group 3), and a group of random adolescents that do not receive the program (Group

4). We would then perform a pre and post test to determine their knowledge, self-efficacy, and

likelihood to become pregnant while in their teenage years. The “treatment” for Group 1 and 2 is

the exposure to the Comprehensive Sex Education Program while the control group, Group 3 and

4, receive no experience with the program.

Through our design, we are trying to find out the effects of our program on knowledge,

self-efficacy, the likelihood of speaking with a child about contraceptives, and teenage

pregnancy rates. Since Group 1 and 2 have been exposed to the program, our hope is they will

have more knowledge about sex education, the self-efficacy to talk about sex education, and

will be less likely to become pregnant during their teenage years.

Sample Design
 The study will use a randomized sample design to determine how Comprehensive Sex

Education Programs affect the understanding of sex education, parental involvement in sex

education, and teen pregnancy rates.

The study will survey a randomized sample of 700 teen public-school students living in

Mississippi undergoing Comprehensive Sex education courses as well as their parents of the

respective students in Mississippi. We will compare the results with surveying a randomized

sample of 700 teen public-school students living in Mississippi undergoing abstinence only/plus

courses as well as their parents of the respective students in Mississippi

The sample will be obtained by surveying teenagers undergoing comprehensive sex education vs

those who underwent the abstinence only/plus sex education courses. This sampling method

works best for us because simple random sampling is the best sampling method for ensuring both

internal and external validity. Our research question is focused on individual firsthand

experiences and evaluating efficacy of Comprehensive Sex Education, so simple random

sampling is the best fit.

Data Collection

To collect data, pre and posttests will be given to each group before and after the

comprehensive sex education or normal sex education. Different surveys will be given to the

parent groups and the adolescent groups. The parent groups’ survey will focus on self-efficacy

and knowledge about what to instruct children about sexual health, while the adolescent groups’

survey will focus on knowledge of sexual health and discussions with parents. The surveys will

consist of 20 questions and measure self-efficacy, discussion between child and parent,

knowledge, and pregnancy rate. The surveys will be anonymous, and identifying information

will not be asked in the questions. The pretest will be given prior to the completion of the
comprehensive sex education or normal sex education, and the post test will be given 12 months

following the completion of the pretest and after the completion of either sex education.

The questions in the survey will consist of a combination of both yes and no questions

and scales of 1 to 5 measuring least to greatest. For example, one of the questions for parents

could be “how confident do you feel discussing the risks of STIs and STDs with your child,

with 1 being not confident at all and 5 being very confident?” An example for the adolescent

group could be “how knowledgeable do you feel about how to use contraceptives, with 1 being

not knowledgeable and 5 being very knowledgeable?” By having a pre and post survey, the

results will be measured through if self-efficacy, discussions between child and parent, and

pregnancy rate changed following the comprehensive sex education or normal sex education.

The results of the data collected through the pre, and post surveys will then be compared by

group, comprehensive sex education versus normal sex education, to determine which method

of teaching produced more positive results.

Conclusion

In conclusion, teenage pregnancies can decrease if sex education is properly taught to

students and their parents or guardians. During this literature review, we had the limitation of

only using documents that have come out in ten years or less. At first, we chose five years, but

then chose ten years because it lets us compare how things have changed over the years with

teenage pregnancy. Our group had a tough time with research due to search terms. If we searched

“pregnancy,” the population would be incorrect. The search term “teenage pregnancy” had

extremely broad information, but it helped us narrow down what we needed and were missing.

The group was struggling to find resources that had different information from each other but

changing our search terms helped.

References
ACOG. “Comprehensive Sexuality Education.” ACOG,

2016, https://www.acog.org/clinical/clinical-

guidance/committeeopinion/articles/2016/11/comprehensive-sexuality-education.

Bogan, Danielle R., Aranmolate, Rasaki and Mawson, Anthony R.. "Confronting the impact of

teen pregnancy in Mississippi: the need for after-school programs" International

Journal of Adolescent Medicine and Health, vol. 32, no. 5, 2020, pp. 20170210.

https://doi.org/10.1515/ijamh-2017-0210

Berman, H. B. (n.d.). Experimental Design. StatTrek. Retrieved April 10, 2023,

from https://stattrek.com/experiments/experimental-design#

Brindis, C. D., Decker, M. J., Gutmann-Gonzalez, A., & Berglas, N. F. (2020). Perspectives on

Adolescent Pregnancy Prevention Strategies in the United States: Looking Back, Looking

Forward. Adolescent Health, Medicine and Therapeutics, Volume 11, 135–145.

https://doi.org/10.2147/ahmt.s219949

Centers for Disease Control and Prevention. (2022, February 25). Stats of the state - teen

birth rates. Centers for Disease Control and Prevention. Retrieved February 13, 2023,

from https://www.cdc.gov/nchs/pressroom/sosmap/teen-births/teenbirths.htm

County stats. Teen Health Mississippi. (2022, November 15). Retrieved February 13, 2023,

from https://teenhealthms.org/county-

stats/gclid=CjwKCAiArY2fBhB9EiwAWqHK6hC_Y4M7ZsX2Q6IczhdCiH92GNEKVx

n1b5iN4lg8KydXMKKeLhbQmRoCvZ8QAvD_BwE

Edwards, T., Mkwanazi, N., Mitchell, J., Bland, R. M., & Rochat, T. J. (2020). Empowering

parents for human immunodeficiency virus prevention: Health and sex education at
 home. Southern African Journal of HIV Medicine,

21(1)https://doi.org/10.4102/sajhivmed.v21i1.970

Eva S. Goldfarb, Lisa D. Lieberman, “Three Decades of Research: The Case for Comprehensive

Sex Education.” Journal of Adolescent Health, Volume 68, Issue 1, 2021, Pages 13-27,

ISSN 1054-139X, https://doi.org/10.1016/j.jadohealth.2020.07.036.

Fantaye, A. W., Buh, A. W., Idriss-Wheeler, D., Fournier, K., & Yaya, S. (2020). Effective

educational interventions for the promotion of sexual and reproductive health and rights

for school-age children in low- and middle-income countries: A systematic review

protocol. Systematic Reviews, 9(1). https://doi.org/10.1186/s13643-020-01464-w

Guttmacher. “Federally Funded Abstinence-Only Programs: Harmful and Ineffective.”

Guttmacher Institute, 24 Aug. 2022,

https://www.guttmacher.org/fact-sheet/abstinence- only-programs.

Haselhorst, S. (2022, January 19). Experts say Mississippi's abstinence-based sex ed is failing

teens, second-highest teen birth rate. Clarion Ledger. Retrieved February 13, 2023, from

https://teenhealthms.org/wp-content/uploads/2021/03/Teen-pregnancy_-Mississippi-has-

second-highest-teen-birth-rate-in-U.S_-1.pdf

Kantor, L., & Levitz, N. (2021, July 3). Parents' Views on Sex Education in Schools: How

Confident are Parents? PloS one. Retrieved March 31, 2023, from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5495344/

Lukolo, L. N., & Van Dyk, A. (2014). Parents’ participation in the sexuality education of their

children in rural Namibia: A situational analysis. Global Journal of Health Science, 7(1),

35–45. https://doi.org/10.5539/gjhs.v7n1p35
Mohr, R., Carbajal, J., & Sharma, B. B. (2019). The influence of educational attainment on

teenage pregnancy in low-income countries: A systematic literature review. Journal of

Social Work in the Global Community, 4(1). https://doi.org/10.5590/jswgc.2019.04.1.02

Parenthood, Planned. “Sex Education.” Planned Parenthood Action Fund,

2022, https://www.plannedparenthoodaction.org/issues/sex-

education#:~:text=Sex%20education%2C%20when%20done%20right,sexually%20trans

mitted%20infections%20(STIs).

Regnerus, M., Smith, C., & Fritsch, M. (2002, November 30). Religion in the lives of American

Adolescents: A review of the literature. A research report of the National Study of Youth

and religion. ERIC. Retrieved February 13, 2023, from https://eric.ed.gov/?id=ED473896

Sirilukkananan, K. (2014). Development of a Non-formal Education Program for Parents to

Enhance Communicative Abilities on Sex Education of Their Adolescent Children.

Scholar, 3(2) https://www.proquest.com/scholarly-journals/development-non-

formal- education-program-parents/docview/2384111745/se-2

“Stats of the State - Teen Birth Rates.” Centers for Disease Control and Prevention, Centers

for Disease Control and Prevention, 25 Feb. 2022,

https://www.cdc.gov/nchs/pressroom/sosmap/teen-births/teenbirths.htm.

Teenage pregnancy. American Pregnancy Association. (2021, December 9). Retrieved February

13, 2023, from https://americanpregnancy.org/unplanned-pregnancy/teenage-pregnancy/

The Encyclopedia of World Problems & Human Potential. (2021, April 1). Inadequate sex

education. Inadequate Sex Education. Retrieved April 3, 2023, from

http://encyclopedia.uia.org/en/problem/156055