RURAL PARENTS' PERCEPTIONS OF THE BABY THINK IT OVER PROGRAM - A PILOT STUDY.

Abstract: This paper presents results from a survey of rural parents' perceptions of the Baby Think It Over teaching aid. The teaching aid is an electronic baby (infant simulator) used to create an experience that simulates the experience of parenting a young infant. There were no differences in parents `perceptions of the teaching aid based on their child's teen parenting beliefs. Parents (65%) perceived communication between them and their children on parenting and sexuality issues was improved by the intervention. Almost equal numbers of parents found the babies to have a positive effect on family activities (38%) and a disruptive effect (37%) on family activities. Yet, 90% of the parents claimed they would recommend the Baby Think It Over program to a friend.

Prevention of pregnancies in teenagers has been a high priority in the United States for several decades. At the beginning of the 1990s the rate of teenage births was almost twice that of Great Britain, the country with the second highest rate (United Nations, 1991). The U.S. teenage birth rate was more than 4 times the rates of Sweden and Spain and 7 times greater than Denmark and the Netherlands (United Nations, 1991). The 1990s have seen a modest decline in teenage pregnancy rates in the U.S (Centers for Disease Control and Prevention, 1997; Kaufmann, et al. 1998).

The majority (better than 85%) of pregnancies among teenagers are unintended, but almost one-half of the 1 million teenagers who become pregnant each year give birth (Brown & Eisenberg, 1995). Rural adolescents are as likely to become pregnant as teenagers in urban areas. Approximately 12% of all live births in metropolitan counties in the late 1980s were to women younger than 19, compared to 16% of births in nonmetropolitan counties (McManus & Newacheck, 1989).

Adolescents are starting sexual activity at earlier ages and having greater numbers of sexual partners. In the late 1950s, 46% of adolescent females were sexually active by 19 years of age. This rate increased to 53% in the early 1970s, to 66% in the 1980s, and 76% by 1995 (Abma, et al. 1997; Ventura, et al. 1997). This significant increase in sexual activity on the part of adolescents combined with their egocentric view of invulnerability leads many adolescents to use contraceptives sporadically or not at all. Too often, the result is unmarried pregnant teenagers who are not ready for the psychological, social, and financial responsibilities of parenthood.

PARENT-CHILD COMMUNICATION

Many in society would predict that the more parents and teens engage in discussions about sexual issues the more likely the prevention of early initiation of teen sexual activity. Parents can increase teenagers' sexual knowledge by giving factual information. They can also help adolescents explore more subjective and value-laden sexual issues, such as under what circumstances one should engage in sexual intercourse. Such parent-child communications can be an important method for parents to convey their sexual standards to youths. In the absence of such parent-child communication, adolescent peer norms are likely to be the sexual standards for many teens because few schools are likely to teach sexual standards.

A series of recent studies have found that adolescents of both sexes are more likely to discuss sexual issues with their mothers rather than their fathers (Miller, et al., 1998; DiIorio, Kelly, & Hockenberry-Eaton, 1999). Furthermore, the greater the number of topics discussed with their mothers the more likely they were to not have initiated sexual intercourse. Unfortunately, parents and students do not always agree on whether meaningful discussions about sex have occurred (King & Lorusso, 1997). This may be because parent-child sexual communication is most likely to revolve around sexually transmitted diseases and much less likely to include sexual behaviors and contraceptive use.

Research has found that teenagers who report engaging in less parent-teen communication regarding sexual issues were more likely to underestimate their mother's opposition to premarital sex (Jaccard, Dittus, & Gordon, 1998). Yet, other research has not supported the notion of delayed sexual initiation of adolescents as a consequence of positive parent-child relationships. On the contrary, "... we find that the stronger parental desire to maintain a good relationship with their adolescents, the more likely it is that their (adolescents) sexual initiation will be at a younger age" (Taris & Senien, 1997, p. 373).

BABY THINK IT OVER

The purpose of this program is to provide an electronic baby (infant simulator) to create an experience that simulates the experience of parenting a young infant. It is designed as an aid for educators to help young people understand some of the demands of parenting a new child (Baby Think It Over, Inc., 1996). The baby has a microprocessor which tracks the number of times the baby cried for more than one minute, the total number of minutes the baby cried, whether or not the baby's computer system was tampered with, and the number of times the baby was abused.

The baby constantly goes through a repeating cycle of sleep, crying, and being tended to.

The doll has various settings (cranky, normal, and easy) which varies the frequency of the baby crying. The doll cries for a variety of reasons including being put in the wrong position; if handled roughly it cries for 30 seconds, cries when it needs tending (random event), and when it is done being tended and "wants" to be left alone to sleep. When the doll cries the student must insert and gently turn a probe clockwise. The probe must be held in place until the electronic baby is finished crying. Hospital armbands were used to attach the tending probe to the student's wrist. Thus, no one else could take care of the baby if the adolescent wanted to go out with his/her friends.

These infant simulators are becoming extremely popular with schools and a very lucrative business for the manufacturer. Some schools are spending upwards of $30,000 on these teaching aids. Yet, to date there have been no published studies on the success of the Baby Think It Over teaching aid.

The current study is an examination of the relationship between parent-teen communication and having a junior high school child participate in the Baby Think It Over program. More specifically, the following questions were examined: (1) Do parents' perceptions of the infant simulator vary based on the effects of the Baby Think It Over program on their child's beliefs about not being a teen parent?; (2) What did parents perceive was the effect of the infant simulator was on their family?; (3) What did parents think the effect of the infant simulator on their children?; (4) Would parents recommend the Baby Think It Over program to other parents?; (5) How many days should junior high school students "parent" the infant simulator?; and (6) At what grade levels should the program be used?

METHODS

PARTICIPANTS AND PROCEDURES

A brief (one week) teen pregnancy prevention program was completed in three junior high schools in a rural county in Ohio. The central teaching technique for this unit was the Baby Think It Over electronic babies (infant simulators). The students took the babies home for three days over the weekend. A total of 220 students participated in the intervention in 1996-97. The analysis of the effects of the program on the students is reported in another manuscript.

The parents of students who made the greatest gain from pre- to post-test (n = 60) and the parents of students who made little to no progress from pre- to post-test (n = 60) during the Baby Think It Over program were selected as the subjects for this study. These two groups of parents were selected because it was thought that parent-child communication might affect student success in the program. A two-wave mailing procedure was used during the spring of 1997. The parents were mailed a copy of the survey, a hand-signed cover letter describing the purpose of the study, and a stamped preaddressed return envelope. Approximately two weeks following the first mailing, the parents who had not responded received another copy of the survey, a cover letter encouraging the parents to respond, and another stamped preaddressed return envelope. Two weeks after the second mailing, phone calls were made to the parents who had not responded urging them to respond.

The SPSS statistical software package was used for all data analyses. A level of significance was determined a priori at .05 to reduce the likelihood of making a Type I error.

INSTRUMENT DEVELOPMENT

A 14-item survey instrument was developed for the study based on the "Baby Think It Over" program unit. The first section of the instrument assessed parents' perceptions of the program on family activities, their child, parent-child communication, and technical aspects of the program. It consisted of 10 items most of which had from 3 to 7 responses. The second section of the instrument consisted of five demographic questions: family relationship, age, race/ ethnicity, education level, and number of children in the household.

Content and face validity were established by a three member panel of teachers and a nurse who had implemented the Baby Think It Over Program. Stability reliability (test-retest) was established by distributing the confidential survey to 13 parents who were not part of the final sample (n = 120). One week later the parents were distributed a second survey. Cramers V coefficients were calculated on individual items resulting in a mean item reliability score of .85.

RESULTS

Out of the 120 surveys mailed to the parents of the junior high school students, 89 completed surveys were returned, which produced a 74% return rate. Demographic data of the parents indicated that they were most likely to be mothers (61%), White (98%), 40-49 years of age (47%), and had completed high school (45%) (Table 1). These demographics are characteristic of the rural residents in Northern Ohio.

Table 1 Demographics of Respondents 

                                                          N     %

Parental Relationship:    Mother                          54    61
                          Father                           7     8
                          Other                           28    31
Age:                      20-29                            1     1
                          30-39                           39    44
                          40-49                           42    47
                          50-59                            6     7
                          60+                              1     1
Race:                     White                           87    98
                          Hispanic                         2     2
Level of Education:       Did Not Complete High School     4     5
                          Completed High School           40    45
                          Attended College                30    34
                          Graduated From College          14    16

N=89

A series of chi-square analyses for each survey item by whether the parent was a parent of a higher achieving student or a minimally achieving student found no significant differences for any item. Thus, the parent data were aggregated into one group (Table 2). Almost equal numbers of parents found the babies to have a positive effect on family activities (38%) and a disruptive effect (37%) on family activities. A space on the survey after this question asked for specific comments regarding the effects of the program. The following were typical comments from the parents:

"We were all aware of its presence in our house. First she thought it was funny, but as

"time went by, she realized it was not funny at all, it was work!"

"It really showed my son the responsibility of having a baby to tend to."

"It allowed her sisters and brothers and her to see what a pain it is - the doll woke them up in the middle of the night."

"It disrupted our family activities and she had to adapt. It created chaos, which no one liked."

Table 2 Parents Perceptions of the Baby Think It Over Teaching Aid

  Topic                                              N      %

What was the effect of the "Baby Think It Over"
program on family activities?
  Positive Effect                                    33     38
  Disruptive Effect                                  32     37
  No Effect                                          22     25

Do you think the program had an effect on            73     82
your child? (Yes)
  If yes, what effects? (Having a baby is:)
  * lot of responsibility                            76     85
  * time consuming                                   70     79
  * keep them from meeting goals in life             63     71
  * expensive                                        47     53
  * keep them from graduating                        35     39
  * fun                                               5      6
  * easy                                              3      3

Did participation of your child in "Baby Think       58     65
It Over" increase your communication with your
child about sexuality and parenting issues? (Yes)
  If yes, what topics?
  * effects having a baby                            64     72
  * being a parent                                   61     69
  * having sex                                       50     56
  * contraception                                    30     34
  * dating                                           28     32

Your child had the baby for 3 days, was this:
  * just right number days                           56     63
  * not enough days                                  26     29
  * too many days                                     7      8

Schools should use the "Baby Think It Over"
program at what grade levels? (Yes)
  * junior high school grades                        75     84
  * high school grades                               68     76
  * upper elementary grades                          12     13

Would you recommend the "Baby Think It               80     90
Over" program to a friend who was wondering
whether their child should participate in the
program? (Yes)

N = 89

When parents were queried regarding whether they thought the program had an effect on their child they selected their responses by checking any of 7 potential responses that could have applied. The vast majority of parents perceived that the Baby Think It Over program taught their children that "having a baby is a lot of responsibility" (85%), "having a baby is time consuming" (79%), and that "having a baby would keep them from meeting their goals in life" (71%). Parents were also asked if the baby caused increased communication about parenting and sexuality issues with their child and if it did they were requested to identify which of 5 areas were increased. Approximately, two-thirds of the parents claimed the baby had increased communication with their child. More specifically, they perceived that communication increased regarding the effects of having a baby (72%), the effects of being a parent (69%), and having sex (56%). Thus, 90% of the parents claimed they would recommend the Baby Think It Over program to a friend who was wondering whether their child should participate in the program. A space on the survey after this question permitted parents to write additional comments. The following were typical of the parent comments:

"Showed my son that having a baby is exhausting, he was very tired after 3 days."

"She found it hard to do things she wanted to with her friends."

"This program may be a good idea, but the doll is very unrealistic in respect to child care. I was a teen mom. Education is what's needed, not handing out babies in school."

Finally, parents were asked two questions regarding the number of days junior high school students should have the baby and at what grade levels should the baby/ parent teaching unit be used. The majority (63%) of parents believed that 3 days were just the right number of days for students to have the baby on a 24-hour basis. The vast majority of parents (81%) supported using the program during the junior high school years and very few parents (14%) thought the program should be used in the upper elementary grades.

As an aside, it should be noted that when parents were asked whether their child was sexually active only five parents responded affirmatively, while 14 parents thought that their child's best friends were sexually active. When asked if they would be supportive of local high schools having contraceptives available to the students, 43% of the parents responded affirmatively.

DISCUSSION

Based on these results, a number of conclusions can be made about these parents perceptions of the Baby Think It Over program. First, since almost equal numbers of parents found the babies to have positive effects on family activities, and disruptive effects on family activities then to maximize family support for this teaching technique further research needs to be conducted clarifying how school programs could minimize the disruptive effect on families. Schools might want to consider a parent education workshop for parents to give them hints on how to maximize the learning experience for their child while minimizing the negative effects on the family. It should be noted that the vast majority (90%) of parents claimed they would recommend the program to a friend.

Second, the majority of parents perceived that the program had very positive effects on their child (e.g., increased awareness that a baby is a lot of responsibility, is time consuming, and could keep them from meeting their goals in life). Furthermore, two-thirds of the parents claimed the baby had increased communication with their child. Thus, most parents perceived the Baby Think It Over program had its intended effects on their child. Furthermore, if sexual communication was increased between parent and child as this study indicated, some of the more important sexual risk factors, such as contraception and having sex, were not being addressed by many parents. Parents may have had significant discomfort in discussing these sensitive issues with their children. If this is the case then schools should help parents identify resources in the community to communicate with their children or help train parents to be better sex educators for their children. It is unclear whether increased parent-child communication on sexual topics will have the desired effects of later age of onset of sexual activity, fewer sexual partners, or more effective use of contraceptives.

Third, when parents were asked what grade levels should use the program and for how long their children should take care of the babies, the majority of parents were supportive of the program being used in the junior high school but very few wanted the program used in the upper elementary grades. Yet, research indicates that sex education programs do not reduce sexual risk behaviors in students who are already sexually active and 11% of 13 year olds in this county claimed they had had sexual intercourse (Kirby, et. al., 1994; Ohio Department of Education, 1996). This lack of acceptance of an upper elementary education program may be because only 6% of the parents perceived that their children were sexually active. Almost two-thirds of parents perceived that 3 days was just the right number of days for their child to have the baby. Almost one-third of the parents thought that 3 days was not long enough. Parents did not have an opportunity to observe longer or shorter times for their children to parent the electronic babies. Thus, some of these parents might have very different opinions if they had seen their child deal with longer or shorter periods of taking care of the babies.

Prior research has found that the availability of school-based contraceptive services neither initiated intercourse earlier nor increased the frequency of intercourse in sexually active students (Kirby, et al., 1994). Yet, while the parents in the community are very concerned about teen pregnancies few (43%) of them were supportive of school-based contraceptives (Holland, King & Price, 1998). It should be noted that the American Academy of Pediatrics has stated that schools are an appropriate site for condom availability programs (American Academy of Pediatrics, Committee on Adolescence, 1995).

Finally, the limitations of this study need to be examined. A major limitation of this study was that the parents' perceptions of the effects of the program were not confirmed by asking their children. A second limitation involves the small sample size. Thus, the external validity of the results may be limited. A third limitation involves a potential non-respondent bias since one-fourth of the parents did not respond. This represents another threat to the external validity of the results. Further research is warranted to confirm the findings of this pilot study with urban parents and parents of color.

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SJames H. Price, Ph.D., M.P.H., Professor and Associate Dean of Research and Graduate Studies, College of Health and Human Services, University of Toledo, Toledo, Ohio 43606, Phone: [phone]. K. Lynne Robinson, Ph.D., Assistant Professor of Health Education, Department of Health Promotion and Kinesiology, University of North Carolina, Charlotte, North Carolina 28223. Cynthia Thompson, B.S.N., Public Health Nurse, Fulton County Health Department, Wauseon, Ohio 43567. Hans Schmalzried, Ph.D., Fulton County Health Commissioner, Fulton County Health Department, Wauseon, Ohio 43567.