According to the United States Census Bureau, the estimated population for Bexar County in San Antonio in 2012 was 1.7 million people (Bexar county quickfacts, 2010). Within the identified zip code of 78207, there was a population of 55,514 people in 2010 with the median age of 30.1 years old. Only 52.7 percent of this population had a high school diploma or higher education (American fact finder, 2010). Median income was $24,197, which according to the US Department of Health and Human services is considered almost poverty level for a family of four (HHS poverty, 2012). Of the population within the zip code of 78207, 92.9% identified as being of Hispanic or Latino origin (American fact finder, 2010). The zip code of 78207 is 7.263 square miles and is the home to 690 businesses (Zip code, 2010).
Within the assessed community of and around zip code 78207, there is an identified problem of elevated rates of teen pregnancy. An assessment of this community was done through multiple venues of research including,data collection, a windshield survey,and a personal interview with Fox Tech High School’s school nurse. Available community resources were evaluated related to the needs in this community. The purpose of this survey is to identify the community barriers to education and healthcare that the students are experiencing to prevent teen pregnancy and implement our community health nursing plan to address the high teen pregnancy rates.
Although the rate of teen pregnancy has declined, it still continues to be an issue of concern here in Texas and San Antonio. With Texas being the fourth highest state related to teenage pregnancy, it brought on our curiosity to see which area of San Antonio has the highest recordings of pregnancy (CDC, 2013). We noted the area in zip code 78207 had high teen pregnancy rates. So we set out to gather our data. We started out with researching high schools in this area. Fox Tech High School is in downtown San Antonio in the zip code 78207. After contacting the school nurse, Sharon Cadena at Fox Tech High School and obtaining information from her, we found out that this year has had the lowest occurrences of pregnancy. She believes this is due to the fact that they are now a magnet school and have down sized in attendance. The school is now becoming a Health and Law Professions Magnet School, which requires students to be accepted. This year’s seniors will be the last graduating class of the formally known Fox Tech High School.This year she has had seven pregnant female students. One of the students had a baby in January 2013 and is now due in December 2013 with her second child. All of the pregnancies are in senior girls, accounting for 1.6% of the student population. Prior to changing to a magnet school, the student population was as high as 1700 students, with as many as 70 students pregnant in a school year. She said this campus will continue to provide day care which is available for any student in the San Antonio Independent School District (SAISD). The daycare will remain there even after the change to the new magnet school. However, it is only available for students who are attending school, meaning, the student must attend class to continue their daycare privileges. Children can stay at the daycare from 6 weeks to 4 years of age (S. Cadena, personal communication, May 16, 2013). When asked about sex education being taught in school, Cadena replied,“sex education is taught more in anatomy and physiology class, and does not focus on contraception” (personal communication, May 16, 2013).
Nurse Cadena provided us with details about the South San Antonio Independent School District/Teenage Parent Program . It has material presented by the Alamo Area Council of Governments. It addresses the needs of pregnant teen parents by preparing them for the expected changes in their lives created by parenthood. The program provides a network of social, transportation, academic and support services designed to help students remain in school and graduate. It also provides essential education for living and life for teen parents. It is conveniently open 8:00am – 3:30pm on weekdays only. This is a free service for the expected parents. The main eligibility requirement is that the student must be enrolled in school, and be between the ages of 14-21 (personal communication, May 16, 2013).
The San Antonio AIDS Foundation also comes to the school campus every year to make a presentation to the freshmen class. Only the students whose parents have signed a consent for them to attend may be involved. Abstinence is what is taught to the students, the presentation implies that if you don’t have sexual intercourse, then you won’t get AIDS or HIV(S. Cadena, personal communication, May 16, 2013).
Our search next brought us to see what clinic facilities are around this area. We located a WellMed Clinic, but thought most teenagers would probably go to a Planned Parenthood if they needed treatment or birth control. Planned Parenthood, located off of W. Ashby was not able to answer our questions when we arrived. We were directed to contact the administrative office. After leaving Planned Parenthood, we began to survey the surrounding area. We found the homes were close together. Some parts of the neighborhood had homes that were well kept, but others looked like they were vacant and were boarded up. Some homes appeared to be falling apart and not safe to live in. We didn’t see any neighborhood hang outs, the Planned Parenthood is right next to San Antonio College, which is located near clubs. There were via bus stops throughout the neighborhoods and main streets. We spotted two HEB’s on our way into this area. One church was located entering into a neighborhood. People were spotted walking around and waiting by via bus stop areas. When leaving the area and heading back to the I-10, we did spot one homeless man under the bridge. No political posters were noticed.
After placing the call to Planned Parenthood we were directed to their website, www.plannedparenthood.org. Reviewing their website, we were able to discover according to their 2011 reports that 95% of the patients that went to Planned Parenthood were receiving preventative healthcare and 5% wanted abortion care. According to the report 10.5% were between the age of 18-19, and 7.5% were 17 or less (Plannedparenthood, 2013).
In 2010, San Antonio residents listed teen pregnancy as a key indicator in the SA2020 Family Well-Being vision area. In 2011, Bexar County recorded nearly 3,000 births to females ages 19 and younger, according to Metro Health data. In 2012, the City of San Antonio conducted a Community Survey among San Antonio residents in all ten City Council Districts and teen pregnancy was ranked the highest concern among 15 community issues. Respondents also felt that teen pregnancy was the most important for the City to address over the next two years (City of San Antonio, 2013).
From 1994 to 2010, the Bexar County teen birth rates dropped by 36%. Yet, in 2010, The Bexar County teen birth rate was still 47% higher than the national teen birth rate. In 2011, there were 2,333 first births (79%) and 619 repeat births (21%) to mothers age 19 and under. San Antonio Independent School District, which is around downtown and includes Fox Tech High School, has the highest incidence of teen pregnancies and births. In 2010, there were 915, from girls ages 15-19, just in that district alone. Looking ahead, in 2016, there will be 134 Kindergarten classes filled with children of teen parents. Teen childbearing costs for Bexar County were $63.9 million, and U.S. taxpayers $9 billion. These costs include health care, child welfare, incarceration and lost revenue (City of San Antonio, 2013).
A snapshot of sexual behavior by high school teens in Bexar County in 2010 is alarming. To begin with, 47% have had sexual intercourse, 7% before the age of 13. At least 16% admit to having 4 or more partners and 52% did not use condoms, with 85% also not using birth control. Race doesn’t play a huge part in statistics seeing that 35% are Non-Hispanic Caucasian, 48% are Africa American and 52% are Hispanic. As expected the numbers gradually increase throughout high school, starting with 31% of freshmen up to 66% of students being sexually active as seniors. With the downtown area appearing to have most of the highest teen birth rates, the 78207 zip is 4 times over the national rate; over 137.2 per 1,000 15-19 year old females (City of San Antonio, 2013).
Teen pregnancy prevention is important to the health and quality of life of young people and communities throughout the United States. It is also one of Centers for Disease Prevention and Promotion (CDC)’s six public health priorities. CDC’s efforts in this critical area include promoting evidence-based programs designed to help teenagers develop protective factors to avoid teen pregnancy and childbirth. Examples of protective factors include; knowledge of sexual health, HIV infection, other sexually transmitted diseases (STDs), and prevention methods of pregnancy, personal values about sex and abstinence, attitudes toward condom use, perception of peer norms and behavior about sex, intent to abstain from sex or limit the number of partners, communication with parents or other adults about sex, condoms, and contraception and avoidance of places and situations that might lead to sex (CDC, 3013).
There are extensive consequences for teen mothers, teen fathers and the child from these relationships. Teen birth moms are more likely to live in poverty, less likely to complete high school, less likely to attend college and more likely to be and remain single parents. For the teen fathers, they are more likely to drop out of school, have poor involvement with their children, have decreased economic stability, income, and occupational attainment, engage in substance abuse and illegal activity and conceive children with multiple women. The children of these teens will have lifetime barriers and effects also. Consequences for the child include that they are more likely to score lower in math and reading into adolescence, drop out of high school, experience abuse/neglect, enter the foster care system, end up in prison, use public insurance, be taken into emergency rooms for care as infants, be unemployed, underemployed as a young adult at then even become a teen parent themselves (City of San Antonio, 2013).
Pregnancy Related Community Resources
Teen pregnancy is an important health concern for San Antonio. May is the National Month to Prevent Teen Pregnancy and hundreds of thousands of teens across the country and in San Antonio are expected to participate in nationwide awareness and prevention activities kicking off on May 1 as the National Day to Prevent Teen Pregnancy. The purpose of the National Day to Prevent Teen Pregnancy is to focus the attention of teens on the importance of avoiding too-early pregnancy and parenthood. The Centers for Disease Control and Prevention (CDC) has listed teen pregnancy as a “winnable battle” if communities implement evidenced-based prevention programs. These are programs that have been researched, evaluated and proven to work (City of San Antonio, 2013).
Project WORTH’s (working on real teen health) mission statement is to “inspire youth and empower parents to prevent teen pregnancy by using evidence-based programs, promoting healthy behaviors, and cultivating community relationships. On May 1, Metro Health’s Project WORTH division hosted The National Day to Prevent Teen Pregnancy: Mapping Our Future to 2020 event at the Central Library Auditorium. Local teens exhibited their collection of posters with best practices to reach the City’s SA2020 goal to reduce the City’s teen birth rate by 20 percent (City of San Antonio, 2013).
“ME NOW… baby later” is a project of the Healthy Futures Alliance, Project WORTH, and Metro Health. The “ME NOW… baby later” campaign is all about giving young girls control over their lives, the goal is to help them realize that they are able to do what they want to do, have fun, and be with friends. This program helps encourage these girls to work for and complete their education, and discovering their personal talents. It hopes to give them time to develop healthy relationships and learn about love along with thinking about goals and dreams and creating a healthy future. “ME NOW… baby later”is also committed to helping these teens avoid early parenthood. It is about giving accurate information, to make healthy choices. Teaching them that babies are wonderful, but they need a lot of attention day and night and they cost money! Many young parents work hard to care for their children. But being a teen parent makes it harder on both the parents and the children. If you are already a parent, it is about avoiding another pregnancy too soon or before you are ready. “ME NOW… baby later” is all about why and how to delay parenthood until it is the right time for you and your family. Now is the time to learn and dream and have fun not to be a parent. (Healthy futures of Texas, 2010). Big Decisions is a project of Healthy Futures of Texas and is an educational tool for schools to provide sex education with a parent session getting them involved as well. This program has been approved for use in the San Antonio School District and teenagers may also access this information from home in an online course (Healthy futures of Texas, 2011).
WIC is the non-emergency Special Supplemental Nutrition Program for Women, Infants, and Children. Those who qualify for WIC, can receive food benefits (redeemable at grocery stores for certain nutritious foods), nutrition education and counseling, breastfeeding support and health care referrals at no cost. WIC services are available to pregnant, postpartum, and breastfeeding women, as well as infants and children younger than 5 years old. Enrolling in a local WIC Program is really simple. Qualified participants can call a local WIC Clinic to make an appointment. There is a local phone number, (210) 207-4905 to call to find convenient clinic locations and general information. When calling the clinic, the staff will set an appointment time, date, and give a list of documents to bring to the first appointment. WIC foods are specifically selected for their high nutritional value as well as for their relatively low cost. These foods include: milk, cereals, eggs, peanut butter, cheese, juices, beans, fruits and vegetables, whole grains (brown rice, whole wheat bread, or corn tortillas), tuna or salmon for breastfeeding women, infant formula, infant cereal, infant fruits and vegetables (baby food). Staff nutritionists guide participants through the importance of good nutrition to the development of a healthy family. This includes individual nutrition counseling, nutrition education, as well as instruction in food preparation. All WIC participants are eligible to receive nutrition education. WIC promotes breastfeeding and healthy nutrition with education classes, nursing bras and nursing pads on limited basis and manual breast pumps. There are 11 WIC clinics around Bexar County, including one at 2315 Buena Vista San Antonio, TX 78207. These clinics provide educational material and additional resources in English and Spanish (City of San Antonio, 2013).
Planned Parenthood provides up-to-date, clear, medically accurate information that helps individuals better understand their sexual health. These clinics have many services, including; birth control, morning after pills, condoms, STD education, abuse resources, body image information, breast exams, pelvic exams, and other safe sex options. There are 6 clinics in San Antonio, with one just 3 miles from the zip code 78207 (Planned parenthood, 2013).
Healthy Community Resources
In the community there are Summer Youth Programs where participants can enjoy eight weeks of recreation-themed activities as well as lunch and a snack. The program is held at Parks and Recreation Department community centers and more than 40 school sites each summer. The program keeps youth active by engaging them in a variety of safe, supervised, age appropriate activities such as traditional sports, craft projects, active games, art exploration, fitness and nutrition, as well as reading and math and science enrichment activities. Swimming opportunities will also be offered for program participants at limited sites this summer (City of San Antonio, 2013).
May is National Bike Month and cycling in San Antonio is on a roll. This year the main event is the MPO’s 17th Annual Walk and Roll Rally. The annual event highlights active transportation including walking, bicycling, carpooling and transit. The Rally features free refreshments, door prizes and informational exhibits. People living or working downtown may celebrate active transportation choices with a short morning walk or bicycle ride to Main Plaza from various starting points to attend the Rally. VIA Metropolitan Transit is again providing free bus transportation for cyclists with bikes on Walk and Roll Rally Day. Active transportation in San Antonio is growing rapidly. Forty-one miles of off-road hike and bike trails built along Leon Creek, Salado Creek and the Medina River as part of the Howard A. Peak Greenways. Another 40 miles are under design or construction. San Antonio conducted a “Get Cyched” Share the Road Public Education Campaign for motorists and cyclists in English and Spanish. San Antonio City Council also passed safe passing and bike light ordinances and adopted a Bike Master Plan Update/Implementation Plan and a Complete Streets Policy. VIA Metropolitan Transit has bike racks on all mainline buses as well as inside Primo Bus Rapid Transit and now includes bicycling in all their planning efforts (City of San Antonio, 2013).
Associated Community Health Problems
A growing number of teens are being diagnosed with sexually transmitted diseases. Compared with older adults, sexually active adolescents aged 15–19 years and young adults aged 20–24 years are at higher risk of acquiring sexually transmitted diseases (STDs) for a combination of behavioral, biological, and cultural reasons. For some STDs, such as C. trachomatis, adolescent females may have increased susceptibility to infection because of increased cervical ectopy. The higher prevalence of STDs among adolescents also may reflect multiple barriers to accessing quality STD prevention services, including lack of health insurance or ability to pay, lack of transportation, discomfort with facilities and services designed for adults, and concerns about confidentiality. Interventions for at-risk adolescents and young adults that address underlying aspects of the social and cultural conditions that affect sexual risk-taking behaviors are needed, as are strategies designed to improve the underlying social conditions themselves (CDC, 2013).
Recent studies conducted in San Antonio from 2002-2010 show an increase in teens, ages 13-19 being diagnosed with STDs. In 2010, 3,654 had Chlamydia which is up over 1000 in the last eight years. Also, 974 were diagnosed with Gonorrhea, up from 601 in 2002. Syphilis went from 16 to 55 in the 8 years and HIV infections also rose from 7 to 16 (City of San Antonio, 2013).
Community Health Nurse Plan
Given all the information that we have obtained including our personal interview, we have developed a plan that the community health nurse can initiate and implement. Most organizations rely on donations to help the community. As the community health nurse we would look towards the contributors for assistance with our plan. We decided to rely strictly on donations and volunteers. We will identify and recognize the high community donors. Our plan as community nurses would be to raise money to assist teenagers with joining organizations, such as cheerleading, athletic sports, band, choir, debate teams and ROTC. Most of these organizations require money to buy uniforms, pay for trips to competitions and other expenses. This money would help parents who are unable to afford to enroll their children in these types of extracurricular activities. We would use volunteers as mentors to the teenagers and encouraging them to stay on the right track.
In developing our plan wewillalso look at states with similar communities whose teenage pregnancy rates are low and evaluate the types of programs they have in place and what has worked for them. We would be able to see if this program is working by initially checking the teen pregnancy statistics prior to implementing the program. Then we could check the statistics quarterly after the program is implemented. We believe this type of program would not only drop pregnancy rates but it will also decrease dropout rates as well as crime rates committed by teenagers. Our program would help provide a means to keeping teenagers busy and off the streets as well as giving them new goals to achieve. This type of program is the key to seeing a decline in teenage pregnancies. If this program becomes successful at a local community level, then we could look towards nationwide programs, such as Planned Parenthood to help fund and promote at a national level. To assist in promoting toward this teen centered plan, we will create a Facebook page, website and smartphone applications for new age access. This will provide the education, resources and support necessary to help promote safe sexual experiences, a healthy life style and healthy future.
In conclusion, the rate of teen pregnancy has slowly declined with appropriate interventions but remain high for San Antonio and Bexar County to include a rate of 47% higher than the national teen pregnancy rate (City of San Antonio, 2013). Effects on the community include high costs to taxpayers, transmission of sexually transmitted diseases, and life altering consequences for the teen mom, dad and new baby. The CDC identified this topic as a winnable battle with the implementation of evidence-based programs. Some of San Antonio’s current programs include, Planned Parenthood, Project WORTH, WIC, Big Decisions, “ME NOW…baby later.” By assisting teens and parents financially, provides a means to be able to participate in their activities of interest. This will hopefully add to a decreasing rate in San Antonio and eventually compared to the national average
Bexar county quickfacts. (2010). Retrieved from http://quickfacts.census.gov/qfd/states/48/48029.html
Centers for disease control and prevention (CDC). (2013). Retrieved from http://www.cdc.gov
City of San Antonio. (2013). Retrieved from http://www.sanantonio.gov
Healthy futures of Texas. (2010). Me now baby later. Retrieved from http://www.menowbabylater.com/
Healthy futures of Texas. (2011). Retrieved from http://www.healthyfuturestx.org
Planned parenthood. (2013). Retrieved from http://www.plannedparenthood.org
Teen births a problem easily solved. (2013, March 4). San Antonio express news. Retrieved from http://www.mysanantonio.com/default/article/Teen-births-a-problem-easily-solved-4327405.php
U.S. department of health and human services (HHS). (2012). HHS poverty guidelines. Retrieved from http://aspe.hhs.gov/poverty/12poverty.shtml