Formally, teen pregnancy is based on a woman who will not reach her 20th birthday by the expected birth of her first child. This definition does not assume marriage, nor if the woman is legally an adult (depending on the country). The idea of marriage and birthing age has, of course, changed based on societal and cultural issues. At one time, when the lifespan was 40, it made sense for a girl to begin her childbearing years as soon as she was able, usually around 12-13. In contemporary U.S. culture, however, the amount of information and professional data that is needed to become a well-rounded citizen is so high that we usually gauge 18 as the very minimum age to begin to have the resources and/or acumen to raise a family. Like many other contemporary issues, though, the impact of diet and artificial hormones in the food supply, combined with advertising and entertainment's push towards sexuality, often pressures younger people to experiment with sex far earlier, regardless of the health or psychological consequences (Linking Teen Pregnancy Prevention to Other Critical Social Issues, 2010). Typically, class does have an effect upon teen pregnency for a variety of reasons. The urban poor tend to have less access to some of the opportunities and activities of middle and upper class girls; they are often alone longer during the day because their mother or grandmother is working; they often do not have access to the same amount of information about birth control and/or abstinance that other children; and they are often so mired in poverty that they are looking for something that they can control, hold onto, and actually be responsible for. Often poor teen mothers feel that having the baby, and the attention they receive as "magic" and, for the first time in their lives, feeling loved and nurtured (Ibid., 7-11). Of course, this "honeymoon" period rarely lasts once the realities of feeding, lack of sleep, and the constancy of care become part of the reality (Valk, 2000)..

Expert Commentary-

Col Jennifer L. Bedick -- Understandably, Col. Bedick sees health related issues in a broader, more epidemiological manner. She is unhappy with the overall statistical nature of Oklahoma's health issues, but of course is primarily concerned with the way her leadership may impact the community at large through the Community Hospital. She does believe there is a synergism between the military base and the community, running both ways, that deals with health related issues; substance abuse, teen pregnancy, etc. For Col. Bedick, education is the single most important aspect of affecting behavior; both through smaller, macro agencies (RNs, community projects, etc.) and macro (e..g. training programs, collateral, integration of information into military issues, etc.).

Barbara Smith RN -- Smith sees community school issues, so is quite familiar with the issue of childhood obesity and type-II diabetes; as well as teen pregnancy and stds. With her focus on children and youth, she too sees that educational programs, greater integration of materials into the classroom. Her biggest issue is that hiding uncomfortable issues will not make them disappear. As adults, and health care professionals, we have the opportunity and obligation to mitigate situations as early as possible within the school system in order to change behaviors later in life.

Dr. Idorenyin L. Aiku -- as a local family physician, Dr. Aiku sees patients from a large variety of ethnic and income groups. Her frustration stems from the regularity of the issues she treats -- I her view, mainly due to not enough appropriate or timely information. Thus, her focus as wll would be on educating the community at large more, possibly in a manner in which there is more engagement, buy-in, and an understanding that small steps at home lead to larger steps within the community.

Each one of the experts, however, did emphasize educational means as a way to mitigate these serious health issues.

Nursing Intervention - Health care providers may be able to help these adolescents and young adults understand their situation during visits by ensuring confidentiality, explain the information clearly, eliciting questions, and emphasizing the success of newly available treatment (National Institutes of Health, 2004). Kirby notes that many adolescents engage in risky sexual behavior, such as sex with multiple partners and sex without the use of condoms. Professionals concerned with the issue have developed school and community programs to reduce adolescent sexual risk-taking behaviors with some deemed effective and some not (Kirby, 2002). The potential for even greater harm is great if behaviors are not changed. In 2001, it was estimated that among students in grades 9 through 12 in the U.S., 46% of students...

Among U.S. high school seniors in 2001, about 22% had had sexual intercourse with four or more sexual partners (Kirby, 2002). The potential for an even higher transmission of HIV thus exists, and changing behavior is a priority. As noted, programs to effect this have been instituted in the community and in schools both, some centering on promoting abstinence, some on promoting the use of condoms and a reduction in other risky behaviors.
This makes me think that education regarding safer sexual strategies needs to be changed and improved. In most cases, it is not that people are not educated and do not understand the principles of safe sex; for some reason, people tend to make poor choices in the heat of the moment. Humans also tend to have the mindset of "it won't happen to me"... Maybe cognitive-behavioral specialists need to be involved in the education and prevention efforts; these specialists are able to understand and analyze the behavior of human beings in a more abstract way.

APPENDIX a

1. How would you describe the health of our community? What population do you think is most effected by the health problems and why?

2. What do you think affects peoples health here? The good things are? The bad things are?

3. What are three things that you would change in our community to help improve people's health?

4. Do you believe with this being a military community, do you think it influences the health care of the people? How do you believe with the influx of soldiers we have had in the past year how do you think that has impacted the local hospitals?

5. Do you know of any policies or procedures that are in place in our community that will help to improve the health problems in Oklahoma?

6. In regards to mental health Oklahoma is ranked 45th in the nation for inadequate facility and/or providers to provide for the mentally ill persons. What do you think we can do as a community to improve the care we provide for these patients? What actions are already in place and what can we do to make them better?

7. Inactivity is on the rise and the lack thereof. Oklahoma is ranked 45th in the nation for obesity among adults and children. The percentage for children is 29.5% in Oklahoma and for the U.S. It is 31.6%. Do you think of any ways we can increase the awareness to the children of our community on of how important exercise is? Are there programs out there that we can educate not only the community but the local schools to help improve physical activity and how diseases can play a role in the lack thereof?

8. Oklahoma is ranked the fifth highest for teen pregnancy, to include an increase in STD's. We live in a military community; do you believe that the younger soldiers have an influence with the teenagers in our community? How can we as a community educate more on how to prevent teen pregnancy and decrease the spread of STD's?

REFERENCES

Key Health Data About Oklahoma. (2011). Trust for America's Health. Retrieved from:

http://healthyamericans.org/states/?stateid=OK

Linking Teen Pregnancy Prevention to Other Critical Social Issues. (2010, March). Retrieved from the Namtional Campaign: http://www.thenationalcampaign.org/why-it-matters/pdf/introduction.pdf

Oklahoma at a Glance. (2011). Oklahoma Department of Commerce. Retrieved from:

http://www.okcommerce.gov/Commerce/Downloads

State Health Report, 2011. (2011). Oklahoma State Government. Summary retrieved from:

http://www.ok.gov/health/pub/boh/state/SOS1011_Summary.pdf

Ferran, L. (February 9, 2010). Michelle Obama: 'Let's Move' Initiative Battles

Childhood Obesity. ABCNews.Com. Cited in;

http://abcnews.go.com/GMA/Health/michelle-obama-childhood-obesity-initiative/story?id=9781473

Fumento, Michael, (1998), the Fat of the Land: The Obesity Epidemic and How Overweight Americans Can Help Themselves, New York. Penguin.

Kirby, D. (2002, December. HIV transmission and prevention in adolescents. HIV InSite,

Cited in: http://hivinsite.ucsf.edu/InSite?page=kb?07&doc=kb"07"04-03.

Slovic, P. e. (2001). Smoking: Risk, Perception, and Policy. New York: Sage.

Stewart, C. (1999). Investigation of Cigarette Smokers Who Quit Without Treatment. Journal of Drug Issues, 29(1), 167+.