While teenage pregnancy maintains a high profile in the department, faculty focus not only on pregnancy but on the broader issues of adolescent reproductive health. Faculty research on teenage reproductive health extends from the Teen Resource Center in Dalton, Georgia, to the college campuses of Atlanta, to the DeKalb County Board of Health, where this teenager receives a blood pressure screening as part of a preventive medicine program.

n Whitfield County, Georgia, the Board of Health had a problem. They had established a Teen Resource Center, set in a shopping mall for easy access by the urban population around Dalton and the rural populati ons in adjoining Murray County. They had put into place the recommendations suggested by researchers in adolescent health literature. Yet, despite their efforts, Whitfield County reported the highest rates of teen pregnancies in Georgia. "They had all of the resources but no results," says Nancy Thompson, assistant professor of behavioral sciences and health education in the Rollins School of Public Health. Dr. Thompson and her colleague, Associate Professor Kathy Miner, set about trying to determine whether there were barriers to using the Teen Center or any local incentives for pregnancy. In four focus groups, a survey of adolescents who used the center , and ten in-depth interviews with new teen mothers, they began compiling the data that would lead to the answer. From the in-depth interviews, they learned that the majority of the young mothers - seven of ten - expressed excitement or happiness at having a baby. One said the best part is "having somebody who really cares about you - because they don't really kno w you - they just know that you're the person who holds them and cuddles them and plays with them, but they don't know you as a person. They just love you for no reason." When asked about problems associated with motherhood, the young women expressed worries about the loss of their teen years, finances, and their babies. "I would like to have more for her, you know," one young woman said, "more clothes, more different t hings that I would have been able to afford if I was older. Money is a problem. I want to take her to a good doctor and actually pay for it, and maybe have insurance." According to Dr. Thompson, the feelings discussed by these young mothers are not those stressed in adolescent counseling. "When we talk to a teen about not becoming pregnant, these are not the issues we focus on," she says. "Maybe they should be." From the interviews, Dr. Thompson and Dr. Miner gleaned other factors that contributed to the high rate of adolescent pregnancy in Whitfield County. For one thing, two of the women were already pregnant when they moved to Dalton. "The ready availabilit y of work may contribute to the teen pregnancy rate," Dr. Thompson says. Although the carpet mills do not hire high school students, many of the adolescents' partners are high school graduates. Part of the high rate might be attributed to the cultural bac kground of those drawn to the mill area. Many of those who work in the mills descend from an Appalachian heritage, where women may give birth to a first baby in their early teens. By waiting until, say 16, these teens have already delayed pregnancy. In the focus groups and surveys of both men and women, the researchers uncovered other aspects of attitudes toward pregnancy and specifically toward the Teen Resource Center. Those teenagers who had visited the center expressed high satisfaction with t he facility. However, those who had not used the center believed it to be a place solely for pregnancy testing. In reality, it offers a full range of adolescent health services. Because of its association with pregnancy, the center became a source of emba rrassment. As one teen mom explained: "I think more people would go there if it wasn't an embarrassment. You want to try and keep it as confidential as you can. They give you these bags and if your friends are there, they know what's in the bags. I've alw ays wished they'd put something in the bathrooms or something at school. Like my husband, he wouldn't go in no place to get nothing. He's too shy." Based on their research, Drs. Thompson and Miner presented the Northwest Health District with a specific set of recommendations, including the need to emphasize the Teen Center's other services in addition to reproductive health and to staff the center with teens with some personal experience in pregnancy or parenting. In light of those recommendations, the Board of Health has completely revamped the program at the Teen Resource Center. They have added a male staff member to encourage more participatio n among male adolescents. And they held a rock concert in the fall to advertise their full range of services.

Nancy Thompson trains graduate students. In Guatemala City, local workers, trained by Emory and CDC researchers, prepare to conduct interviews for a survey of young adult reproductive health. Demographer Joan Herold

he findings of the Teen Resource Center study illustrate a common trap into which well-meaning public health professionals can fall. By emphasizing pregnancy prevention, the center scared away many who could have benefitted from its services. While teenage pregnancy maintains a high profile in the Department of Behavioral Sciences and Health Education - "It is my highest priority even when I am engaged in other things," says Dr. Miner - faculty focus not onl y on pregnancy but on the whole teen. Their approaches to adolescent health issues derive not from one but many perspectives. "We come from very different disciplines, which complement one another," says Joan Herold, interim chair of the Department. Assistant Professor Ed Maibach approaches his research on teen sexuality from a social learning perspective. A former student of Albert Bandura, who created a landmark social cognitive theory to explain why people develop social habits and why those ha bits are resistant to change, Dr. Maibach adapts his mentor's model to studies of HIV-related behaviors of both adults and adolescents. In one project, for example, he is attempting to change high-risk behaviors by enhancing participants' belief in their power to control their own health. In a similar effort, Dr. Maibach, Dr. Herold, and Dr. Colleen DiIorio, from the School of Nursing, are conducting a longitudinal study on some 2,000 students at six universities in Atlanta. They again will apply a social cognitive model to test HIV-prevention strategies adopted by the young people. Dr. Miner and Dr. Thompson, by contrast, approach their adolescent health projects from their backgrounds as health educator and clinical psychologist, respectively. They have worked together to support school-based health clinics throughout the state of Georgia, developing materials, providing training and guidance, and evaluating services. "While nurses are not allowed to provide contraception devices in the school setting," Dr. Thompson says, "they can develop a relationship with the students, givin g them someone to talk to about health." Dr. Miner, likewise, has brought her expertise to the DeKalb County Teen Pregnancy Task Force, which attacks adolescent pregnancy at a local level. According to the director of that task force, Phyllis Schwartz, the Rollins School of Public Health was "very instrumental in helping the task force frame approaches and in developing teacher training." The group is now "up and running, having taken on a life of its own," according to Dr. Miner. Among other innovative efforts, it sponsors a pregnancy-preven tion program, Diplomas, First!, and hosts a contest for teens to develop videos promoting adolescent pregnancy prevention. From yet another point of view, Dr. Herold brings her skills as a demographer and her experience as a former Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention to adolescent health. With colleagues at the CDC, Dr. H erold conducts Young Adult Reproductive Health Surveys throughout Latin America and the Caribbean, having completed 12 such surveys to date. According to Dr. Herold, in developing countries, teen childbearing is related to greater risks of infant and mate rnal mortality. It leads to increased school drop-out rates and lower job status for teens and may lead to high rates of population growth as well, by increasing the number of children a woman bears in her lifetime and by decreasing the life span of a gen eration in a population. Dr. Herold has implemented adolescent and young adult surveys for Guatemala City and Santiago, Chile, and a national survey for the Dominican Republic. While the prevalence of premarital intercourse and rates of premarital pregnancy vary from one cultu ral setting to another, the most consistent findings have been the adolescents' reasons for why they engage in unprotected sex. Both male and female adolescents say they had unprotected intercourse because it was unplanned and because they lacked knowledg e about contraceptive methods. "Such results have encouraged renewed efforts to increase the availability of contraception to teens and to improve sex education programs in a number of Latin American countries," says Dr. Herold. In recent surveys, Dr. Herold has shifted her focus from asking questions related solely to teenage pregnancy to include queries about AIDS-related knowledge and behavior. "It is very obvious in the Dominican Republic, which has one of the highest HIV rates in Latin America," Dr. Herold says, "that local researchers and practitioners need AIDS-related data as much as they need information on pregnancy and contraception." Like the other faculty in the Department, Dr. Herold believes that the problem of adolescent pregnancy does not exist in isolation. Instead, it is a problem connected to larger issues of adolescent development in the context of the environment. With th e eyes of the social scientist, health educator, psychologist, and demographer, these faculty attack adolescent public health issues from Dalton, Georgia, to Santiago, Chile. With local, national, and international support, they hope to address not only a dolescent pregnancy but the broader issues of adolescent sexuality and reproductive health.