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Adolescent Perceptions of Teen Births
Judith W. Herrman1
Correspondence Judith W. Herrman, PhD, RN, School of Nursing, University of Delaware, 355 McDowell Hall, Newark, DE 19716. jherrman@udel.edu Keywords Adolescent parenting Adolescent perceptions Qualitative research Teen births Teen pregnancy prevention

ABSTRACT
Objective: To investigate teens perceptions of the costs and rewards of teen births, potential interventions to prevent teen pregnancy, and the presence of someone with whom teens could discuss sexuality. Design: Seventeen focus groups were conducted to solicit individual views, group interactions, and shared meanings. Purposive methods accessed a sample of teens considered at risk of teen pregnancy based on their membership in selected community service and teen groups. Teen parents and nonparents (n = 120), from 12 to 19 years of age, were asked about their lives and stresses and the costs and rewards related to teen births. Results: This study yielded rich data about the consequences of teen births. Data were organized in the domains of Impact on relationships, Impact on vocation, and Impact on self. The data reected the cost and reward themes in each domain. Conclusions: Though teens believed that there were positives of teen births, early childbearing was considered hard in many aspects. These perceptions may be used to guide programs, policies, messages, and curricula with the intent to prevent teen pregnancy. These initiatives may be more effective if informed by teens and guided by their perceptions.

JOGNN, 37, 42-50; 2008. DOI: 10.1111/J.1552-6909.2007.00201.x

Accepted October 2007

1PhD, RN, is an assistant director and assistant professor in the School of Nursing at the University of Delaware, Newark, DE

hile more than 400,000 teen women give birth in the United States each year, it is estimated that

teens perceptions about teen births, their thoughts on prevention, and the presence of role models in their lives. Selected researchers identied teens beliefs about the positive rewards of a teen pregnancy: to achieve independent, adult status; to maintain relationships with the male or partner; to receive love, attention, and recognition; to prove one is capable of having a child; and to become closer to the family or to improve negative family environments (Corcoran, Franklin, & Bell, 1997; Gallup-Black & Weitzan, 2004; Kegler, Bird, Kyle-Moon, et al., 2001; Unger, Molina, & Teran, 2000). In contrast, some studies demonstrated that teens also attribute costs to teen parenting: diminished social life and social isolation; a negative stigma; dealing with multiple demands of school, work, and parenting; lack of opportunity for personal development and focus on career goals; less nancial resources; and parental disapproval (Jewell, Tacchi, & Donovan, 2001; Kegler et al.; National Campaign to Prevent Teen Pregnancy, 1999; Rosengard, Pollok, Weitzen, Meers, Phipps, 2006; Wiemann, Rickert, Berenson,

twice this number of pregnancies occur in the adolescent population. Signicant strides have been made to decrease the teen pregnancy rates in the United States, yet these numbers continue to exceed that of any industrialized nation in the world (National Center for Health Statistics, 2006). Teen births are associated with negative educational, economic, behavioral, health, and juvenile justice costs (National Campaign to Prevent Teen Pregnancy, 2005). There is limited knowledge of adolescents perceptions of the personal and social costs associated with teen births. Determining teen perceptions may assist in designing interventions, messages, and policies based on these insights, increasing the potential effectiveness of initiatives informed by teens. This study investigated teens perceptions of the costs and rewards of teen births, potential interventions to prevent teen pregnancy, and the presence of someone in their lives with whom teens could discuss sexuality.

Background
Though the literature is replete with studies documenting adult perceptions about teen pregnancies and methods for prevention, relatively few studies examine the insights of teens themselves. This review discusses

et al., 2005). Authors soliciting teens thoughts on strategies to prevent teen pregnancy are minimally represented in the literature. Teens suggested providing education about and access to contraception and promoting abstinence

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(Aquilino & Bragadottir, 2000). Other studies reinforced the importance of male and female roles in teen pregnancy prevention and using peer-based interventions (Clifford & Bryczynski, 1997; Corcoran et al., 1997). The family and community has been identied as the forum for counseling about relationships, providing parents with the skills to discuss sexuality with their children, and developing community support for teens who lack the family resources to build sexual decision making (Clifford & Bryczynski; Corcoran et al.; Hacker, Amore, Strunk, et al., 2000). Several studies mentioned teens ideas to have young parents provide education, role modeling, and mentoring to other youth to reinforce the realities and responsibilities of teen parenting (Gallup-Black & Weitzan, 2004; Hacker et al., 2000; National Campaign to Prevent Teen Pregnancy, 1999). The current study views strategies within the context of the consequences of teen births, providing a unique perspective of teens thoughts on teen pregnancy prevention. Few studies report teens perceptions of having an adult in their lives, whether a family member or other role model, with whom they could discuss sexuality and related issues. Teens identied the importance of having adults to provide information and support to teens, whether that be a parent, teacher, coach, or health professional (Aquilino & Bragadottir, 2000). Unfortunately, Hacker et al. (2000) identied that only one third of teens perceived they had a family member or other individual with whom they could easily discuss sexuality, and another one third had never discussed sex with an adult. Many teens discussed sexuality, contraception, and sexual activity with friends and peers. Teens realized that friends may not always be accurate sources of information (National Campaign to Prevent Teen Pregnancy, 1999). Though these studies yield important isolated results, none were found that specically focused on teens perceptions of the costs and rewards of teen births or their perspectives on the impact of a teen birth on their personal lives, warranting the current research. The cost-rewards framework was used to create the research instrument, organize data, and interpret themes. This framework arises out of decision-making theory and is an adaptation of the theory of reasoned action (Adler, Kegeles, Irwin, & Wibbelsman, 1990). Adler et al. used this theory to develop a decision-making framework for adolescent contraceptive use. In this model, the beliefs about the consequences (costs and rewards) are integral in developing a general attitude toward the behavior and is balanced by the perceptions of others and the motivation to comply with the wishes of others. These attitudes and social expectations lead to the intention to engage in a behavior, in this Approval for this study was received from the Institutional Review Board at the local academic institution. Due to the sensitive nature of the material and the vulnerability of youth, careful attention was paid to the recruitment of the teens and to the permission/assent processes. This study was carefully reviewed and suggestions were made regarding participant recruitment, study advertisement, and participant incentives. Participants were recruited only by agency personal, and no contact was allowed with the youth until parental permission and teen assent was obtained. Signs included only agency personnel identities as contacts and ensured condentiality of information. Each teen received a $15 gift card to a local department as an incentive to participate in the focus groups; this amount was deemed as appropriate for 1 hour of participation and was preferable to a cash incentive. The population for this study was the cohort of adolescents at risk for adolescent childbearing in the state of study. It was important to target high-risk youth in order to inform interventions and glean new information about teen perceptions. High-risk youth were considered those at risk for negative behaviors, whether by selfreport, demographics, or referral due to previous highrisk behaviors. Focus group participants were solicited from school-based wellness centers, churches, nonprot teen groups, and adolescent support programs. Agency personnel were responsible for identifying and recruiting study participants based on the teens participation in agency programming, distributing packets, case sexual activity and the intention to become pregnant. Within this scheme, youth perceptions of costs and rewards are at the origin of a deliberate decisionmaking process related to teen sexual behavior and subsequent teen births (Adler et al.).

Relatively few studies examine the insights of teens themselves regarding pregnancy and methods for prevention.

Methods
Qualitative research has gained credibility and trustworthiness in the assessment of adolescent attitudes and health behaviors (Rich & Ginsberg, 1999). Focus groups, as a method of ethnographic studies, provide an optimal means to determine youth perceptions, allow for spontaneous discussion, capitalize upon group interaction, examine shared meanings, and explore the individual insights of youth (Hollis, Openshaw, & Goble, 2002). The complex nature of teen sexual activity, pregnancies, and births warrants the use of research methods that best explore adolescent thoughts, feelings, and reported lifestyles.

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Table 1: Focus Group Questionnaire

1. Tell me something about your life as a teen right now 2. What are some of your concerns as a teen? 3. What do you believe may be the easiest/best/most positive thing about being a teen parent? 4. What do you believe may be hardest/worst/most negative thing about being a teen parent? 5. Why did you choose to/not to become a parent? 6. What was done or could have been done to prevent your becoming a pregnant teen or a teen parent? 7. What programs, services, or policies do you think would be effective in preventing teen pregnancy/parenting? 8. If you could design a program to prevent teen pregnancy, what would it include? 9. Was there an someone in your life who you felt comfortable asking questions about sexuality and pregnancy prevention? 10. Is there anything else you would like to say?

participants perceptions of the impact of teen births on relationships, vocation, and self; their thoughts on prevention efforts; and the presence of a role model or someone with whom they could discuss sexuality in their lives. Questions were developed according to the Adler et al. (1990) adaptation of the theory of reasoned action in which consequences are considered in the decision-making process. Saturation of the data was achieved in the nal interviews, when no new information was solicited.

Results
The study data were reviewed for themes in a recursive, iterative process during each interview. Focus group data were loaded into Ethnograph 5.08 to allow for coding, organization, and thematic analysis. Marginal notes were integrated into the analysis procedures. The works of Camarena, Minor, and Ferrie (1998) and Herrman (2006, 2007) provided the structure for the major data domains, including: Impact on relationships (friends, intimate others, family, and the public), Impact on vocation (education, work, and money), and Impact on self (perceptions of self and current or future parenting). The data were further analyzed and reect the costs and rewards in each domain. Study domains and themes were reviewed and validated by an anthropologist and researcher, known to be an expert in qualitative data analysis, dealing with vulnerable populations, and the impact of poverty on social issues. The data were grouped in domains and are shared here with exemplary quotes to illustrate the study themes within each domain.

and collecting completed assent and consent forms. The nal purposive sample included 120 youth from throughout the state: 72 females and 48 males. The mean age of the participants was 16.1 years, with 68% of the youth identifying themselves as African American, 19% as White, 11% as Hispanic, and 2% as another ethnic origin. Five of the participants were pregnant, 19 of the participants had children, and all but 6 of the students were in school at the time of the study (one had graduated and ve had left school prior to graduation). Seventeen focus groups were conducted over a span of 6 weeks. Each group had 3 to 15 participants and the interviews averaged 40 minutes in length. One focus group included pregnant girls, 1 included teen fathers, 3 had teen mothers, and 12 were made up of nonparenting teens. The nonparenting groups included four female groups, two male groups, and six with boys and girls. Diverse focus groups were selected in order to gain as much information as possible from teens with different lifestyles, concerns, and responsibilities. The focus groups were conducted in private conference rooms and were recorded using a handheld digital recorder and saved to a CD-ROM. The principal investigator conducted all the interviews. Several summary sentences were used at the end of each focus group session to clarify data and to validate interpretations. Each transcription was transcribed verbatim and was checked against the audio recording for accuracy. Marginal notes taken following the focus groups and during subsequent listening and reading of transcripts captured the patterns of nonverbal communication, commented on interactions, noted areas of emphasis, and ensured accurate recall of impressions and observations. The interview tool was designed to ask participants about their lives and stresses and the costs (negative, worst, or hardest things) and rewards (positive, best, or easiest things) related to teen births. Focus group questions are found in Table 1. Probing questions explored

Impact on Relationships
Friends. The participants noted both costs and rewards associated with teen births impacting current friends, past friendships, and social life. Teen parents discussed the loss of friends stating, I lost all my friends after I had a baby and they dont do what I do now. Teen parents noted the need to either access babysitters or having to take my son with me everywhere as additional costs of teen births. Several nonparenting students commented that a birth during the teen years would preclude participating in sports or activities, limit free time, and deny teens of the freedom to choose how to spend time. Changes in social life were perceived as a negative as in, You just cant pick up and go and Your friends know that you dont have the time or money for friends or going out. The teens without children generally agreed that having a child during the teen years negatively affected friends, indicating Some friends just dont want to be with you when you have a kid. In contrast some young parents reported that their experiences had a positive inuence upon their peer

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relations. Young mothers alluded to holding on to true friends, making better choices in friends and activities, developing new friends as a result of the pregnancy or parenting, and receiving support and child care assistance from peers. Young mothers experienced pregnancy along side one another, as reected in this mothers statement: My friend was pregnant with meit brought us closer. Nonparents did not perceive any positives associated with parenting on friends or social life. Intimate Others. Questions about the actual or potential impact of a teen birth on an intimate relationship uncovered largely negative perceptions. Some teens noted that a teen birth may result from an episodic sexual encounter, rather than as part of a relationship, leaving the mother to deal with parenting alone but not necessarily affecting a relationship. The potential stress that this imparted on the young mothers lives was a topic of participants discussion. One teen stated, Having a baby thats you, all day every day. Several respondents indicated that some young mothers may sustain the pregnancy in order to afrm the relationship stating, girls have the baby so they can be with the dad. In contrast, the youth discussed that having a teen pregnancy may cause male partners to leave the relationship or, at the very least, cause a high level of stress on the couple. Respondents noted Guys feel like you are sewing them down if you tell em youre pregnant and they dont like that and You say the p word and its show me the door. In fact, respondents noted that the men often deny their role in parenting: They say you made a mistake, Im not the dad. Young men commented that having a child could have a negative impact on future relationships, reinforcing that girls dont like to go out with fathers. The sample members were adamant about the stress a pregnancy and birth may impose on a relationship. Young parents noted, Having a baby broke us up and I grew up but he didnt. A few of the young parents perceived that a teen birth had a positive impact on their relationship, in which mutual caring for each other and a baby provided a closeness between partners. One father noted that the birth of his baby created a common bond and enhanced the relationship with his girlfriend. A young mother stated, My partner was there for me and my baby. Nonparents conjectured that a baby may positively impact a relationship if both the guy and girl are ready for a baby, but that doesnt always happen. Family. Two apparent cost themes were noted when exploring the impact of a teen birth on family. Many of the teens believed that the teens family life may already be stressed and that a teen birth would just add to the

familys level of turmoil. One participant noted, I dont live with my family . . . theyre all messed up. This individual indicated that being a teen parent would just make life more complicated. Another participant referred to teens seeking out attention and affection from partners as a result of dysfunctional family life stating, Thats why girls go to guys because they cant get what they need from their parents. The second area shared by the teens related to the nancial and emotional burdens placed on the family, the conicts which may arise over how to raise children, and the pressure on the grandparents imposed by a teen birth. A young parent talked about the negative reaction of parents to the announcement of a teen birth stating, my father wont associate with me anymore and They were mad but then they helped me. Nonparenting teens related that an announcement of an impending teen birth to their family would yield negative responses, as in my mom would kill me, theyd be real mad, and my sister had a baby as a teen, my mom would be real mad if I did it too. Young parents shared that having a birth provided a positive force in their family lives. Families became closer, assisted in the childrearing, and experienced positive changes with the birth. One young mother said, Since my baby, my mom and I realize how much we love each other. Teen parents noted that they no longer engaged in negative behaviors or ghting with parents, for example, My mom was there for me and I dont do what we used to ght about. The teen parents attributed changes in their relationships with their families to their maturing and assumption of more adult behaviors as a result of parenting. Public. The teens voiced interesting perspectives re-

lated to how a teen birth is viewed in relation to the public. Several teens expressed negative opinions, contending that teens are unable to be adequate parents or that the type of people that have babies as teens, they dont want to do nothing with their life. Teens noted you get labeled differently, people judge you, and they look at you and your baby, and then ask how old you are. The teens made insightful comments about the inequities associated with teen sexual behavior and gender. They shared that teen women are often considered at fault for pregnancies and that there is signicant negative stigma associated with teen parenting, as in they make it always seem like its the girls fault and put pressure on the girls. A female was thought to be skeevy or a ho if they were known to be sexually active. A girl that carried condoms was considered asking for it. In converse, young men were revered as a pimp if they were sexually active and came prepared by carrying

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condoms. Teens reinforced the need to address both male and female concerns and roles in sexual activity: Theres a double standard . . . boys are supposed to get as much sex as they can, girls arent . . . it means that a lot of guys are having sex with a few girls. Teens without children reected on the public rewards inherent of the teen birth experience in which one may get more attention as a teen mother or father. Young parents considered babies positive forces in their stressed lives. The new life symbolized hope and a brighter future. Young mothers stated, Everyone was nicer to me when I was pregnant and Everyone smiles more because everyone loves babies.

support themselves and their baby and could increase the incentive to work in order to provide for the child now and in the future. Young parents discussed having a more focused goal orientation and a desire for children to experience a better life. They claimed that they no longer participated in negative behaviors, such as partying and hanging out and were more dedicated to apply themselves in school and work. One mother noted I want to work more to have things and to provide for my child. Money. As with education and work, teens were adept at recognizing the impact of a teen birth on money and nances. The youth stated, we all need money . . . without it you are stuck especially with kids. They cited the costs of baby supplies, day care, and babysitting as sources of nancial stress. Young parents listed disposable diapers, formula, clothes, toys, and the whole mess of stuff a baby needs as part of the copious expenses. Many of the youth articulated living in poverty, relating that money was a constant stressor. Having a baby would make money even tighter, as in My mom is a single parent. If I got pregnant, it would be even harder with one more mouth to feed. Teens discussed restrictions on the freedom of where money will go, reecting that I like to spend money on myself, when you have babies it goes to them. They discussed the need for young parents to receive nancial support from adults in their lives as in Most young parents have to depend on somebody for help. Males discussed the need to help nancially when bearing a child and the impact of ongoing child support on future nancial success. One stated, I dont want to pay child support. They take it right out of your pay check before you even see it. The nancial implications were clearly identied by both males and females and appeared to have an impact on their thoughts about teen births, participants reecting I want to be able to provide for a child when I decide to have one and If you are nancially stable, have a kid, not many kids are. Young parents identied selected positive impacts of teen birth on attaining money. As one mother stated, Im all my baby has. I have to make a good life for us. They noted that families and fathers may provide nancial assistance and that parenting may make teens eligible for special programming and government subsidies. Although the teens cited these as positives, they were quick to point out that these incentives did not balance out the nancial stresses incurred from the parenting. One young parent concluded People that have babies as teens have to struggle . . . no time . . . no money . . . no sleep.

Impact on Vocation
Education. The teens in this sample readily discussed the impediments of a teen birth on receiving an education, doing well in school, graduating, and going on to secondary education. Having a baby during the teen years was thought to limit educational options, restrict study time, and pose signicant challenges in juggling school and parenting. One teen noted, Going to school and having a baby . . . thats stress! Others commented on the potential need to drop out due to work responsibilities, the cost of day care during school hours, access to day care settings, difculties with transportation, and the lack of time to meet commitments. One youth stated, High schools supposed to be the best time of your life . . . with a kid there is no time. Young parents shared that sometimes parenting had a positive impact upon educational attainment. An increased emphasis on goals, an appreciation of the need for an education, and a desire to be a positive role model for their children provided the incentive to achieve in school. One mother said Having a child made me more focused on school and doing well in school. Work. Closely aligned with educational impacts are

those associated with current and potential work and careers. The teens agreed that it was difcult to work, parent, and attend school. Young people shared You have to put your dreams on hold if you have a baby, I would still accomplish things but having a baby would slow me down, and If you have a baby now theres no time to get ready for your career. Teens thought it may be difcult to access a job, especially as a pregnant female, and that it may be difcult to keep a job with the demands of parenting. Validating this concept, a teen parent stated, I dont get sleep . . . I go to work, school and take care of my baby . . . its a mess. Despite the challenges associated with working and teen births, respondents noted that they thought having a teen birth could make a person work even harder to

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Impact on Self
Perceptions of Self. Signicant positive impacts of teen parenting were noted in the area of personal characteristics. The nonparenting youth perceived that childbearing during the teen years often resulted in an increased focus on success, more mature judgment skills, better behavior, and a greater sense of responsibility. Youth mothers noted that they developed an increased ability to manage time and learn organizational skills. One mother noted, parenting makes you grow up fast. Teen parents reected that Havin a baby says Im grown, you just jump into maturity, and Im stronger since my baby. Improvements in behavior and refraining from high-risk behaviors was reected in the statements: Ive stopped hanging out and going out and doing the stupid things teens do and Having a baby makes me make better decisions now. One astute teen conjectured that individuals who have children as teens may want to go back and relive their teen years later. He went on to discuss that the behaviors of the teen years were part of growing up and if they didnt come out as a teen, they would later. Current or Future Parenting. The teens shared insight-

are inferior to older mothers stating, Im a better mom than most other ones I know that are older. Its not about how old you are. Last, youth identied that having children early may allow children to be closer to the parents ages, as in Its better to have parenting earlier and be done and you get parenting done and over with when you are young and healthy . . . early in your life when you dont have risk factors.

Presence of Role Models

When asked about the individuals in their lives with whom they could discuss sexuality and other sensitive issues, participants cited a variety of people who had both positive and negative inuences upon their behaviors and attitudes. Those individuals imparting a positive impact on the youth were identied as mothers, fathers, aunts, siblings, other relatives, adult advocates, and some friends. The counselors and adults associated with community programming were noted to be particularly inuential in decision making and represented positive forces in their lives. Respondents indicated that we discuss things here cause I dont go to my family and I dont have anyone in my family, thats why I come here and get answers(both respondents referring to a community-based program). Other participants reected the following related to role models in their lives: I can talk to my mom . . . she had me when she was 16, mom trusted me to give me the information, and I can ask my aunt anything . . . I need information to make decisions. Some role models, especially fellow teens, were noted

ful comments relative to the impact of births during the teen years on parenting. Teens disclosed that being a parent increases the level of responsibilities and stress experienced by the individual. One teen stated, You have to change to be a parent . . . you have to be serious. Another remarked Theres nothing worse than having a baby as a teenager. A child is a blessing, but I dont want to be blessed like that. Teen parents noted the following negative aspects of parenting: my baby follows me to the bathroom, I never get enough sleep, up changing Pampers, feeding, and its not as easy as it looks. They also were able to identify parenting as becoming increasingly difcult as children grew and posed more complex challenges. The positive aspects of parenting across the lifespan were also identied by the teens about adolescent childbearing. Nonparents perceived a potential impetus for teen parenting for young people to have someone to love who loves you back. Teen parents listed that bringing a new life into the world and enjoying watching it grow were positive experiences. Teen parents stated, I like to look at the smile on my babys face, I loved bringing a new life into the world, and I want to have someone that can love me when I want them to love me. They inferred that having a child as a teen assisted to rectify negative personal experiences as in the statement My parents didnt show me what was right. I will show mine. Some teen mothers expressed frustration at the assumption that teen mothers

as having a negative impact on the individuals decision making, as in they encouraged me to have sex, they dont always have the right information, and theres a lot of pressure out there . . . not all of it good. Perhaps most disconcerting were the youth who denied the presence of anyone in their lives to conde in stating, I cant talk to my family, Ill get grounded so I stick to myself, I dont talk to anyone, sex is embarrassing, and Im a private person, I dont have anyone worth talking to.

Thoughts on Prevention
The adolescents identied many strategies which could be effective in preventing births during the teen years. One participant resolutely admitted, I dont think you can prevent teen pregnancy. Teens recommended that adolescents need to be educated and given the tools to make responsible decisions. Individuals cited that Some teen pregnancy is unavoidabletelling kids not to have sex doesnt work and makes them go and do it to be bad, People tell us everyday not to do stuff and we do it, this needs to be different, and Start sex education earlier, at 11 or 12 years. Teens expressed that

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nancy, 2006; Rosengard et al., 2006). Though the par-

Teens expressed the need for role models and information about love, respect, relationships, and caring.
birth control should be more accessible to teens stating, Teens need to learn to prevent pregnancy every time they have sex . . . schools should give out condoms. Teens also commented on the need to have teen parents share their personal stories and the realities of teen pregnancy in order for nonparenting teens to appreciate the impact of a birth on their teen years. Participants noted It cant only be adults . . . wed believe it more if it came from kids our age and have someone around our age . . . thats gonna have more impact than someone older. Others stated, have moms and dudes talk about what it is like with kids . . . and that life is better without a child, Show them a day in the life of a parent, and Include young mothers and fathers that have actually been through it and can say they learned something . . . get someone who went back to school and did it right . . . somebody who learned from their mistakes and can be a positive role model. Respondents frequently cited the need to have someone with whom to communicate and the need for adultyouth conversation about sexuality and pregnancy. One stated, I think all kids should come in the community and get together and hear what other teens have to say . . . maybe that will change their minds. That would make them think about it. Others noted we need someone to talk to, who respects us and listens to us and adults should know we are not as dumb as you think. The participants noted that teens need adults to guide them: You need to put the information in the teens heads . . . people arent thinking of the costs of a baby in the heat of the moment. After school and intramural activities were also identied, young people remarking Adults should think of activities to keep us occupied so we arent thinking of sex and dont have time for it and Make teens proud of themselves, show them something they are good at . . . and have them focus on it.

ticipants were savvy in their information and forthright about beliefs and behaviors, they also displayed a naivet about responsibilities and relationships congruent with their level of adolescent development. Teens appeared rooted in the current reality, unable to consider potential future implications of todays behavior. They were reluctant to consider the global costs associated with childbearing, including utilities, housing, health costs, or meals. Instead, they focused on their personal perspective and the monetary and time costs impacting their daily lives. This nding concurs with several researchers in the literature (Clifford & Bryczynski, 1997; Herrman, 2006; Jewell et al., 2001).

Implications for Nursing

The implications for nursing practice and research are clear in the results and interpretations of these data. Teen perceptions related to the costs and rewards of teen birth, their thoughts on prevention, and the presence of an adult in their lives are key to designing interventions to promote responsible sexual behavior. The results provide a foundation upon which to build programs and policies related to teen pregnancy and the consequences associated with teen births and to generate further inquiry into adolescent perceptions. Nurses may provide the instruction, support, and guidance to implement these programs both with and for adolescents. Using youth-based perceptions to guide curricula, policies, messages, and programs may be more effective than traditional prevention strategies. Teens are open about sex and sexual behaviors. Teens were frank in their recommendations for other teens stating, wrap it up, think about your future before you have sex, plenty of people wait, get your partner tested, and you dont want to catch anything you cant get rid of. Nurses may reinforce the roles of parents and family in guiding adolescents, and in the areas of support, monitoring, education, communication and boundaries were identied as integral. One teen noted, Id love my parents to talk to me about this stuff . . . I would just like to have dinner together. Teens expressed the need for role models and information about love, respect, relationships, and caring: teach us how to have healthy relationships . . . we dont see that and Its not really that you have to love someone to have sex . . . its not like that anymore, is it? A study participant noted, Most boys are too scared to act like they really love somebody, they dont want to show that they really care . . . this generation needs to learn to see sex as love. Further research needs to explore the incorporation of teen perceptions into programs and policies. Assessment of initiatives should include the insights of the teens themselves as important evaluative data to guide

Discussion
These teens demonstrated sincere interest in learning about and sharing their insights related to teen births. The teens reected on the costs and rewards from a personal perspective and through comment on the lives of their peers. Though teens believed some positive aspects may be associated with teen births, the negative aspects carried more weight. These ndings validate other research indicating the teens hold negative conceptions about teen pregnancy (Jaccard, Dode, & Ditue, 2003; National Campaign to Prevent Teen Preg-

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program revision and determination of effectiveness. Additional study may generate quantitative measures to determine adolescent perceptions of teen births with larger groups of youth. This will increase the number of the sample and the generalizability of the data. It may also provide the opportunity to correlate demographic characteristics with group-specic perceptions. The needs of teens from different backgrounds may vary based upon their resources, social support, culture, communities, and perceptions. These cohort-specic data may be used to develop interventions tailored to the needs of teens based on their perspectives and those common to their culture and community. This quantitative survey may be used to evaluate changes in perceptions of teens after specic interventions are employed which are geared toward preventing teen pregnancy. Assessing for changes in the perceptions of the costs and rewards of teen births may be a valuable element in creating effective interventions. Subsequent study may include the correlation of teen perceptions and beliefs with sexual behavior, exploring the translation of attitudes to behavior in the promotion of responsible sexual behavior. A limitation of this study is that the focus groups represented community groups targeting low-income teens and youth considered at risk for teen pregnancy. This nonrandom selection process yielded a skewed sample and, potentially, a biased set of perceptions. The study included a large proportion of African American youth which may skew the results. Characteristics of this group may also be a benet when designing programs and policies which are specic to certain populations of teens. The qualitative nature of this study limits its generalizability to all teens. Focus groups inherently may be limited by the ability of the group members to inuence each others thoughts and disclosures. This may be even more poignant during the adolescent years, when peer pressure and group thinking may be even more powerful. This study does, though, provide a rare glimpse into youth perspectives and a springboard for further research. Adults need to address abstinence, responsible sexual behavior, and healthy relationships on teens own terms and learn to approach topics based on teens levels of knowledge, experience, and perspectives. Interventions must be developmentally based, attend to teen priorities of the costs and rewards of teen births, and consider both intentional and unintentional pregnancies (Gordon, 1996). Sharing these perceptions with teens may open up frank discussions and allow for a discourse about the consequences associated with teen births. Adolescents request honest communications about sexual activity, choices, birth control, and consequences of unsafe sexual behavior, one adolescent deFunded by the Alliance for Adolescent Pregnancy Prevention in contract with the Delaware Division of Public Health. claring: Theres not many things you can do to tell kids not to have sex, but theres a lot you can do to tell them how to safely have sex. As stated by one articulate teen, If you dont want teens to get pregnant, you have to make teens and birth control a priority.

Teens requested honest communications about sexual activity, choices, birth control, and consequences of unsafe sexual behavior.

Acknowledgments

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JOGNN, 37, 42-50; 2008. DOI: 10.1111/j.1552-6909.2007.00201.x

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