According to the World Health Organization (WHO), the majority of teenage pregnancy cases take place in low- and middle-income countries (2014). One of the regions that is still challenged with teenage pregnancy is the Caribbean (Azevedo et al., 2012). Within that region, Jamaica holds the fourth highest rank in terms of pregnant adolescents with an 18% prevalence rate (UNFPA, 2013a). Hence, teenage pregnancy continues to be a significant public health concern in Jamaica (UNFPA, 2013b). Prior research has highlighted risk factors affecting adolescent pregnancy, including: high or low self-esteem, resilience, sexual health beliefs and knowledge (Baumgartner, Geary, Tucker, & Wedderburn, 2009; Keddie, 1992; Eggleston, Jackson, & Hardee, 1999; Hutchinson et al., 2007; Wilson-Mitchell, Bennett, & Stennett, 2014), gendered norms (Eggleston et al., 1999) parental control (Kang, Hutchinson, & Waldron, 2013; McGibbon, 2015), intergenerational adolescent pregnancy, lack of a father figure in households (Eggleston et al., 1999; Keddie, 1992; Hutchinson et al., 2007), and media and popular culture (Hutchinson et al., 2007). However, there was a missing link to the broader picture of culture as a determinant of this behavior.

There were three specific phases in the study. First, a theoretical taxonomy of cultural predictors of adolescent pregnancy in Jamaica based on the synthesis of various socio-environmental factors identified in the literature was carried out (McFarlane, Dubey, & Kim, 2017). Second, we examined the applicability and validity of the taxonomy developed based on our own primary data collection with adolescent mothers and mothers-to-be in Jamaica. Third, given that the media environment can be considered important part of culture that influences people’s perceptions and beliefs about adolescent pregnancy, we examined the potential influence of media on the audience members’ attitudes, beliefs and perceptions, utilizing a publicly available United Nation Population Fund (UNFPA) sponsored mini documentary on adolescent pregnancy in Jamaica as a stimuli.

Figure 1: UNFPA mini documentary on adolescent pregnancy in Jamaica

To examine the influence of culture and media on adolescent pregnancy, three focus groups were conducted with Jamaican teenage mothers and mothers-to-be who were enrolled in a government program for adolescent mothers’ continuing education. Additionally, to understand the production of the UNFPA mini-documentaries, an in-depth interview was conducted with a representative from the local organization who had been involved in the development of the mini-documentaries.

The PEN-3 Model (Airhihenbuwa, 1989), a culturally grounded method of developing health programs, was applied in order to analyze and categorize the emergent cultural data from the focus groups. The analysis of media influence on adolescent pregnancy and motherhood utilized a multi-perspectival approach that helps to analyze the impact of media messages by taking into account the content, production and reception of these messages (Kellner, 2011). This analysis consisted of three phases:

1.   Textual analysis of the UNFPA mini-documentary on teenage pregnancy and motherhood in Jamaica

2.   Production analysis to learn about the intended messages behind creating this mini-documentary

3.   Reception analysis that utilized the theory of encoding/decoding (Hall, 1980) to examine whether the adolescent mothers and mothers-to-be interpreted the messages the way they were intended by the producers

Overall, emergent cultural factors identified in the initial literature review were largely confirmed, and, additional factors emerged, such as self-efficacy of the adolescent girls and the key role of the community. The results also showed that the producers and receivers focused on different aspects of the mini-documentary. While the production side believed that this video was created to set the local organization as an example for other countries struggling with adolescent pregnancy, the teenage mothers and mothers-to-be mainly focused on the stories of adolescent mothers that described the hardships of teenage pregnancy and motherhood. These findings demonstrated the importance of utilizing a participatory approach in the evaluation, but also in the creation of an intervention tool designed to intervene teenage pregnancy issues in Jamaica. Additionally, the resilience and positivity of the adolescent mothers and mothers to be can be honed as a part of a participatory intervention that allows the girls themselves to tell their stories and develop a solution for their communities.

The first step in planning any intervention involves carrying out formative research to understand the beliefs, knowledge, perceptions of the target population in order to ensure an

effective and appropriately tailored intervention. Using theory to guide health communication campaigns has been shown to improve intervention outcomes (Tones & Tilford, 1994). Our research therefore demonstrated this principle by utilizing the PEN-3 Model and encoding/decoding model to understand how may culture and media influence adolescent pregnancy in Jamaican girls.

The results from the formative research suggest that future research should collaborate with Jamaican teenage mothers in the design and evaluation of a video-based health intervention that connects theoretical and practical skills in media studies. Use of multimedia, in combination with interpersonal and community-based approaches, has been shown to be more effective than limiting communication channels (Green, Tones, Cross, & Woodall, 2015). To develop the intervention, we suggest a YPAR approach, which aims to involve youth all aspects of a research project and intervention, such as: selecting research questions, recruitment of participants, development of the intervention, delivery of information, data collection, qualitative and quantitative interpretation of findings and dissemination efforts (see Foster-Fishman, Law, Lichty, & Aoun, 2010). In this kind of partnership researchers share their technical knowledge, while community members share their local experiences, to inform the design of an intervention together that addresses health disparities (Chen et al., 2006). For example, in one study researchers created a summer camp for teens to participate in data analysis as a part of a broader research project that targeted teens. Over the course of the camp, researchers used activities and games to engage the teens in the research process and teach them research methods, while at the same time, facilitating the teens analyzing their own data (Foster-Fishman et al., 2010).

We therefore believe that a YPAR approach that includes skills building and self-efficacy for the girls to utilize media as a part of such a campaign, and involves the wider community, would facilitate a process of social change that is culturally appropriate in the Jamaican context.

• United Nation Population Fund (UNFPA) mini documentary

• An online article: http://cuba.miami.edu/health-care/delaying-motherhood-for-childhood/ 

• Airhihenbuwa, C. O. (1989). Perspectives on AIDS in Africa: Strategies for prevention and control. AIDS Education and Prevention, 1: 57-69.

• Azevedo, J. P., Favara, M., Haddock, S. E., López-Calva, L. F., Muller, M., & Perova, E. (2012). Teenage pregnancy and opportunities in Latin America and the Caribbean: On early child bearing, poverty and economic achievement. Washington, DC: The World Bank.

• Baumgartner, J. N., Geary, C. W., Tucker, H., & Wedderburn, M. (2009). The influence of early sexual debut and sexual violence on adolescent pregnancy: A matched case-control study in Jamaica. International Perspectives on Sexual and Reproductive Health, 35(1), 21-28.

• Chen, D. T., Jones, L., & Gelberg, L. (2006). Ethics of clinical research within a community-academic partnered participatory framework. Ethnicity & Disease, 16(1 Suppl. 1), S118-S135.

• Eggleston, E., Jackson, J., & Hardee, K. (1999). Sexual attitudes and behavior among young adolescents in Jamaica. International Family Planning Perspectives, 25(2), 78-91.

• Foster-Fishman, P. G., Law, K. M., Lichty, L. F., & Aoun, C. (2010). Youth ReACT for social change: A method for youth participatory action research. American Journal of Community Psychology, 46(1-2), 67-83.

• Green, J., Tones, K., Cross, R., & Woodall, J. (Eds.). (2015). Health promotion: Planning & strategies (3rd ed.). London: Sage.

• Hutchinson, M. K., Jemmott, L. S., Wood, E. B., Hewitt, H., Kahwa, E., Waldron, N., & Bonaparte, B. (2007). Culture-specific factors contributing to HIV risk among Jamaican adolescents. Journal of the Association of Nurses in AIDS Care, 18(2), 35-47.

• Kang, S. Y., Hutchinson, M. K., & Waldron, N. (2013). Characteristics related to sexual experience and condom use among Jamaican female adolescents. Journal of Health Care for the Poor and Underserved, 24(1), 220-232.

• Keddie, A. M. (1992). Psychosocial factors associated with teenage pregnancy in Jamaica. Adolescence, 27(108), 873-890.

• Kellner, D. (2011). Cultural studies, multiculturalism, and media culture. Gender, race, and class in media: A critical reader (pp. 7-18). Thousand Oaks, CA: Sage.

• McFarlane, S. J., Dubey, S., & Kim, S. (2017, May). Locating cultural influences on adolescent pregnancy in Jamaica. Paper presented at the International Communication Association, San Diego, CA.

• McGibbon, K. A. P. (2015). A correlational study of the intergenerational transmission of teen pregnancy in Jamaica (Doctoral dissertation). Regent University.

• Tones, K., & Tilford, S. (1994). Health education: Effectiveness, efficiency and equity (2nd ed.). London: Chapman and Hall.

• United Nations Population Fund (UNFPA). (2013a, August 23). Jamaica offers a model for preventing adolescent pregnancies while supporting young mothers. Retrieved April 16, 2016 from
  https://www.unfpa.org/news/jamaica-offers-model-preventing-adolescent-pregnancies-while-supporting-young-mothers

• UNFPA. (2013b). State of World Population - Motherhood in Childhood: Facing the challenge of adolescent pregnancy. Retrieved from https://doi.org/10.18356/c8fe40ff-en

• WHO. (2014). Adolescent pregnancy. Retrieved November 1, 2017 from
  http://www.who.int/mediacentre/factsheets/fs364/en/

• Wilson-Mitchell, K., Bennett, J., & Stennett, R. (2014). Psychological health and life experiences of pregnant adolescent mothers in Jamaica. International Journal of Environmental Research and Public Health, 11(5), 4729-4744. doi:10.3390/ijerph110504729