Friday, May 7, 2010

16 and NOT Pregnant: How The Application Of Social Science Theory To The MTV Show Could Improve Teen Pregnancy Prevention – Kristen Kamp

Teen pregnancy has stepped into the media spotlight in recent years. The movies Juno and Knocked Up both released in 2007 have been credited with popularizing the issue. Their release was followed up with the full media disclosure of the pregnancies of Bristol Palin and Jaime Lynn Spears. Concurrently, Massachusetts’ ‘pregnancy pact’ scandal in which a group of high schools girls allegedly made an agreement to attempt to get pregnant captured the nation’s interest.

Birth rates to females age 15-19 have been on the decline since the early 1990s. However, between 2005 and 2006, the rate saw an increase of 4%. (1) The media focus combined with the first increase in pregnancy rates since the early 90s has parents and advocates questioning the scope of the nation’s teen pregnancy issue. In 2009, MTV in association with The National Campaign to End Teen Pregnancy and the It’s Your Sex Life campaign, a public awareness campaign sponsored by the Kaiser Family Foundation and MTV, aired the show 16 and Pregnant.

Each hour long episode of 16 and Pregnant portrays, in documentary-style, the life of an adolescent girl who is pregnant. The show follows the girl as she navigates the challenges of teen pregnancy: marriage, religious dilemmas, adoption, and financial burdens. Although complicated by pregnancy, the show’s subjects encounter the normal host of coming-of-age adolescence issues like parental pressures, need for rebellion, friendship troubles, and teen gossip. The show makes no statement or commentary about the girls’ decisions. However, both The National Campaign and the It’s Your Sex Life Campaign offer follow-up information about pregnancy prevention and safe sex on their websites. These agencies have paired up with MTV to prevent teen pregnancy and promote safe sexual practices among adolescents through the real-life portrayal of teen pregnancy in the media. The show depicts a realist picture of the burdens of teen pregnancy and dispels its glamorous notions.

Critique 1

This public health approach to pregnancy prevention assumes that teens will refrain from engaging in sex or unprotected sex in attempt to prevent the consequences that they see in the show. This line of thought is based in the belief that adolescent behavior regarding sexual decision-making is both reasoned and planned. However, reason is clouded by situational context and social and societal expectations. Decision-making is a dynamic process. Although adolescents are given the tools to make an educated decision about engaging in a behavior, the decision can be overshadowed by deeper motivations and situational context.

This linear model of thinking has its basis in the Theory of Planned Behavior. This theory presumes that behavior is guided by intention. According to this model behavioral intention is influenced by personal attitude toward a behavior as well as the perceived sentiments individuals important to the person.(2) However, it assumes that people carefully weigh their options before acting. Realistically, the intent toward a behavior can be affected by an instantaneous emotion or variation in context. This is especially true of sexual behavior.

In his work A Theory of Human Motivation, Maslow identifies basic needs that drive human behavior. Among these are safety, love, and esteem. In a survey interviewing adolescents about pregnancy prevention 23.9% reported having sex to feel accepted and loved, 39.9% did it because they loved their partner, 34.1% did it for physical pleasure. Only 2.3% of respondents reported having sex to get pregnant or to get someone else pregnant.(3) As these statistics demonstrate, sex is an act that is motivated by the needs identified by Maslow. Maslow’s theory identifies a hierarchy to human needs, recognizing that higher-valued needs trump those of less value. This questions the notion that behavior regarding sexual decision making can be made on a rational plane. Sexual encounters offer fulfillment of core basic needs. In the face of these needs, adolescents are challenged to make rational, reasoned decisions.

Research surrounding adolescent brain development suggests that brain growth occurs throughout adolescence. Prior to and during the time of middle adolescence which spans the ages of 15 to17 (4) studies have indicated that growth and change occur within multiple regions of the prefrontal cortex. The underdevelopment of these parts of the brain affects long-term planning, self-evaluation, and self-regulation.(5) This research indicates that teens are physiologically challenged to perform reasoned decision-making.

Critique 2

The depiction of the hardships faced by pregnant teens in 16 and Pregnant opposes the intrinsically valued traits of adolescents. The show is not successfully promoting a message of abstinence or protected sex because it is not appealing to the core values of adolescence. Freedom, independence, and autonomy, and control (6) are the principles that reign in the adolescent’s world. 16 & Pregnant’s depiction of the challenged life that the adolescent couples enter into upon choosing to carry out their pregnancies counters these idealized notions.

Comprehending the negative consequences of a behavior does not necessarily have the effect of preventing an adolescent from engaging in that behavior. Studies have shown little difference in hypothetical appraisals of risk-taking behavior beyond middle adolescence. However, adolescents demonstrate a much higher risk of engaging in high risk behavior compared to those developmentally ahead of them.(5) Adolescents choose to act out high risk behavior despite knowing the possible consequences of the behaviors. This behavior has been illustrated with condom use and HIV prevention. Surveys have found that although people at high-risk for HIV are knowledgeable about the effectiveness of condoms in preventing transmission, this knowledge does not determine condom-use.(7)

Decision-making is influenced by the pursuit of behaviors that symbolize freedom and autonomy. Adolescence is a time of biological and psychological transformation. During this time teens are forming and attempting to establish their identity.(8) This drive to establish an identity could lead toward behaviors associated with the valued adolescent qualities of freedom and rebellion.(9)

The “Truth Campaign” capitalized on the understanding that youth behavior is dictated by idealized notions of individuality. It successfully reduce rates of adolescent tobacco use. The “Truth Campaign” engaged in months of research and hundreds of interviews and identified motivation for adolescent high-risk behavior:

A youth’s reason for using tobacco had everything to do with emotion and nothing to do with rational decision making. Tobacco was a significant, visible, and readily available way for youth to signal that they were in control. Like piercing an ear or dying hair, using tobacco was a tool of rebellion and all about sending a signal to the world that the user made decisions for themselves.

Critique 3

When watching 16 and Pregnant viewers are dissociated from the risk taking behavior of unprotected sex. Although the consequences are playing out before them, viewers watch the program without the heightened arousal of a situation incited by an sexual act. Viewers are in a state of “cold” cognition. This term refers to thinking processes that occur under states of low emotion.(5)

“Hot” cognition denotes thinking that occurs during conditions of high arousal and strong feelings.(5) Steinberg notes that it is important to consider decision making among adolescents within the context of their emotional state.(5) The state of cognition is accountable for the disparity between adolescents understanding of the consequences of risky behavior and their tendency to engage in such behavior regardless of their comprehension of its consequences.(8)

Adolescents watching 16 and Pregnant are in a cold state of cognition. Under these conditions, the show conveys messages about the consequences of unprotected sex and intends for the adolescent viewer to decide, with the information presented, not to engage in future high-risk situations. However, when adolescents are faced with the actual decision of engaging in unprotected sex they are in a state of heightened emotions, experiencing “hot” cognition. From this state, it is difficult to recall the message that was delivered in a different cognitive environment.

Proposed Intervention

The design of the reworked intervention directed at pregnancy prevention would be grounded in social marketing theory. Social marketing is the application of commercial marketing techniques to the change of social issues.(13)

A redesign of the intervention would begin with an identification of the “product”. The product is teen pregnancy prevention. MTV has a specific target audience: teens. Although they are familiar with a teen audience, their awareness of their target audience is lacking in the context of adolescent risk behavior prevention. The next step would include an in-depth analysis of the target audience with the goal recognizing their core values. This would be done through the collection of both quantitative and qualitative research. Data would be amassed through surveys and observation gathered in focus groups and interviews. Based on the findings and initiatives of the “Truth Campaign” we recognize certain core principles of adolescents that are valuable to a social marketing campaign. These values are individuality, rebellion, emotionalism, and control.(9) A survey assessing teens’ reasons for engaging in sexual intercourse revealed that many teens did it to feel loved and accepted.(3) Accounting for the core teen values of individualism, love, acceptance, rebellion, and emotionalism, a redesign of 16 and Pregnant would portray these qualities as achieved outcomes of safe sex and pregnancy prevention.

The new show would redirect its topic matter from teens dealing with pregnancy to depict teens that have chosen to abstain from sex or practice safe sex. The show would highlight the positive outcomes of the decision to avoid sexual risk taking behavior. The positive outcomes would appeal to the identified teen core values – individuality, love, rebellion, acceptance, and emotionalism. A documentary-style approach would necessitate framing the adolescent experiences to highlight the positive outcomes associated with their healthy behavior.

A fictional show offers more possibility to depict the outcomes of pregnancy prevention associated with core teen values. An important variable in the success of the show is that it provides teens a tool for rebellion. The most obvious means to achieve this is to portray sexuality within the show. The goal of the show is to promote healthy sexual behavior and to discourage sexual risk taking. To do this, the show must portray sexually savvy adolescents who choose to abstain from sex or make sound decisions to use protection. The show would depict other elements of the adolescent life as well as sexual relationships to illustrate that sound decision making has offers rewards in dimensions beyond pregnancy prevention.

Branding is a technique of social marketing. It plays an important role in the creation of youth identity. Association with a brand serves “as a shorthand way for youth to identify themselves to the world”(9). Alluding to the shortcomings of the current show, this show offers the brand “16 and NOT Pregnant”. By associating with the show, teens are rebelling against sexual repression. Regardless of their actual status, teens can identify themselves as someone who is comfortable with their sexuality. In line with the branding of the show, the campaign would distribute condoms in aesthetically-designed packaging with the phrase 16 and NOT Pregnant printed on them. This phrase’s allusion to the failed public health tenets of 16 and Pregnant also appeals to teens’ sense of rebellion.

Defense of Intervention 1

Applying social marketing theory to this intervention directed at teen pregnancy prevention acknowledges that teens are making irrational decisions. Decision making among adolescence is not suited to the Theory of Planned Behavior which assumes that actions are reasoned and planned. The revised intervention acknowledges that adolescent decision making is heavily influenced by emotions, as they relate to core values.

The principles of social marketing theory recognize that human behavior is often dictated by the salience of core values. This theory is the basis of commercial marketing.(13) Health is not the most valued reward that the intervention has to offer.(6) Rather, an appeal to the outcomes of core values will trigger gut-level responses that decision making is often grounded in.

Furthermore, literature surrounding the cognitive development supports the fact that adolescents are not physically equipped to act rationally in regards to decision making. The maturation of the brain continues well through adolescence. Change in structure and function occurring in the brain during adolescence directly affects response inhibition, the measurement of risk and reward, and emotional regulation.(5,8)

Defense of Intervention 2

Rather than focusing on the negative outcomes associated with the lack of adherence to safe sexual practices, the revised campaign highlights the positive effects of safe sexual practices to “sell” healthy behaviors.

Major physiological changes occur during adolescence. This transformative time subjects teens to a process of identity development.(8) Teens are seeking behaviors that define them. The teens portrayed in 16 and Pregnant are faced with relationship, financial, and social challenges. These girls don’t model situations that teens would desire for their own identity development. They, therefore, do not represent an appeal to pregnancy prevention.

In identifying the core values of love, acceptance, individualism, rebellion, and emotionalism held by teens, 16 and NOT Pregnant seeks to offer positive models for behavior. The teens in the show would present the positive aspects of safe sex as defined by these core values. Viewers would experience an emotional response to the outcomes portrayed in show elicited by the appeal to their core values. Viewers would seek to embody the values produced by the behaviors. This notion of wanting to subjectively identify behavior is captured is by the concept of the fundamental attribution error. A study of male and female college students demonstrated that differences in identification of sexual behavior depended on the context in which it occurred.(16) The emotional desire to identify with the values of the show would increase the teens’ association with safe sex practices.

Defense of Intervention 3

Literature suggests the value of delivering a message of pregnancy prevention while adolescents are in a state of “hot” cognition.(5) In depicting situations of sexuality, the show would transport its viewers to this mode of cognition. From this place of heightened emotion, messages about safe sexual practice would be delivered. These messages would promote condom-use or decisions not to engage in intercourse.

By receiving the message during a heightened state of arousal the viewer would internalize the safe sex practice at a level of “hot” cognition. This approach would enable cognitive recall when engaged in a situation of intense emotion where sexual decision making is required. Previous sexual health campaigns have successfully employed the method of creating a hot cognitive state during which to deliver an intervention.(17,15)

The teen core value of rebellion is motivated by the “hot” cognitive state. Rebellion is driven by the pursuit of heightened states of emotion. This emotion is created by the cognitive charge that an adolescent experiences when they refuse dictated behavior. The depiction of sexuality on the show symbolizes rebellion against sexual repression. Creating a “hot” state is vital to both delivering the intervention and to appealing to core teen values.

1. Facts on American Teens' Sexual and Reproducive Health. Guttmacher Institute; 2010.

2. Smedley B, Syme S. Theory at a Glance: Theories and Applications. 2000;

3. Hacker MD KA, Amare PhD Y, Strunk RN N. Listening to Youth: Teen Perspectives on Pregnancy Prevention. Journal of Adolescent Health. 2000;26:279-288.

4. Middle Adolescence (15-17 years old), Child Development - NCBDDD [Internet]. Centers for Disease Control and Prevention: Child Development. [cited 2010 Apr 28];Available from:

5. Steinberg L. Cognitive and affective development in adolescence. TRENDS in Cognitive Sciences. 2005 Feb;9(2):69-74.

6. Seigel M. Marketing social change: An opportunity for the public health practitioner. In: Marketing Public Health Strategies to Promote Social Change. Sudbury, MA: Jones and Bartlett Publishers; 2007. p. 45-71.

7. Cohen, MD, MPH DA, Farley, MD, MPH T, Bedimo-Etame, MD, MSc JR, Scribner, MD, MPH R. Implementation of Condom Social Marketing in Louisiana, 1993 to 1996. American Journal of Public Health. 1999 Feb;89(2):204-208.

8. Berg Kelly K. Promoting adolescent health. Acta Paediatricia. 2007;96:1389-1391.

9. Hicks JJ. The strategy behind Florida's "truth" campaign. Tobacco Control. 2001;10:3-5.

10. Randolph W, Viswanath K. Lessons learned from public health mass media campaigns: marketing health in a crowded media world. Annual Review of Public Health. 2004;25:419-437.

11. Harlam S, Kost K, Darroch Forrest J. Preventing pregnancy, protecting health: A new look at birth control choices in the United States. Journal of Nurse-Midwifery. 1991 Dec;36(6):379-380.

12. Konia-Griffin D, Lesser J, Uman G, Nyamathi A. Teen Pregnancy, Motherhood, and Unprotected Sexual Activity. Research in Nursing & Health. 2002 Oct;26(1):4-19.

13. John Snow, Inc. Social Marketing: Effective Strategies for Dissemination.

14. Commendador MSN, WHNP, PhD K. The relationship between female adolescent self-esteem, decision making, and contraceptive behavior. Journal of the American Academy of Nurse Practitioners. 2007;19:614-623.

15. Fraze J. Applying core principles to the design and evaluation of the 'Take Charge. Take the Test' campaign. What worked and lessons learned. Public Health. 2009 Sep;123:e23-e30.

16. Eshbaugh GG, Wiersma J. Sex for you, but not for me: discontinuity in undergraduate emerging adults' definitions of "having sex". Journal of Sex Res. 2008 Dec;45:329-337.

17. Bull, PhD SS, Posner, PhD SF, Ortiz C, Beaty M.S.P.H. B. POWER for Reproductive Health: Results from a Social Marketing Campaign Promoting Female and Male Condoms. Journal of Adolescent Health. 43:71-78.

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