15 CHAPTER TWO: LITERATURE REVIEW Introduction There are a wide variety of programs that provide services to prevent unhealthy sexual behavior and teen pregnancies, but more information is needed about program participants’ perspectives about their impact and effectiveness. The need becomes even more crucial during a time when teen pregnancy is escalating. According to Santelli et al., (2009), "after dramatic declines in teen births and pregnancies from 1991 to 2005, teen birth rates in the United States increased in 2006 and 2007" (p. 25). The purpose of this phenomenological case study was to examine the lived experiences of a snowball sample of African-American young women who had become pregnant as teenagers and had participated in a Teen Pregnancy prevention program, in order to evaluate the effectiveness of the program from the women’s point of view. A second purpose was to obtain outcome data pertaining to the women, such as whether they prevented further pregnancies, continued their education, or found employment after participating in the program. The previous chapter of this study introduced the problem of concern, noted the purpose of the study, explained the significance, presented the research questions, and generally described the research design. The purpose of this chapter is to review the literature pertinent to the topic, including the theoretical orientation of the study. The first section below explains the theoretical framework. The second section of the chapter discusses general facts of teen sexual practice and teen pregnancy and defines sex education programs. The third section reviews various teenage pregnancy prevention programs in the United States and discusses factors associated with their success or 16 failure. Included are discussions regarding problems and issues faced by these prevention and education programs. The fourth section reviews Christian views relevant to sexual activity outside of marriage. A summary concludes the chapter. Theoretical Framework The theories guiding this research study are aimed at lowering unhealthy sexual practices of teenage girls who are pregnant or have a child. Numerous interventions have been designed to promote safer premarital behavior amongst young girls. However, relatively few have proven effective, in part due to the lack of development of theoretically based programs and structure (Wright, Abraham, & Scott, 1998). An understanding of the origins and control of inappropriate sexual behavior can be derived from basic social science research. Unless this is applied to the design of behaviorchange programs, the latter are unlikely to target the most important determinants of young people's behavior and are, therefore, unlikely to be effective (Wright et al., 1998). According to Wright et al., (1998), it is imperative that programs whose goal is to deter teen pregnancy comply with the following: • Improve the quality of young people's relationships, particularly in terms of reducing anxiety and regretted sexual behaviors • Reduce the incidence of unsafe sex • Reduce the rate of unwanted pregnancies. The theoretical basis of this study was intentionally eclectic, combining social psychological cognitive models with sociological interpretations, since this researcher was not concerned with advancing a particular theory, but with finding which are most useful in promoting sexual health. First, the social influences on sexual behaviors are 17 considered, followed by the way in which these translate into individual perceptions and beliefs. It is important that educators develop a theoretical understanding of sexual interaction and the social contexts of sexual behavior among teenage girls. Drawing on symbolic interaction, phenomenology and feminist analyses, recent sociological research on young people's sexuality highlights three key issues. First, individuals’ understanding of sexuality is largely learned, and it is learned differently according to one's gender. Because sexuality is socially constructed, it is theoretically open to change. Second, the outcome of heterosexual sexual encounters is shaped by gendered power relationships. Third, the recognition and interpretation of health risks are culturally specific, varying with age, gender, and social class (Wright et al., 1998). Gender relations, power, and risk are all key aspects of the teenager’s sexual world, but no one aspect is absolute. Wright et al., (1998) stated that young people are capable of reflecting on their social and sexual practice, and need to be given the opportunity to do so in a context where they are under no immediate pressure, but where they can come to understand and deal with different points of view. At an individual level social cognition models have sought to identify those cognitions that motivate and regulate health-related behaviors. The most important cognitions relative to sexual practice appear to be the following: • Personal susceptibility to risk • Perceived benefits of and barriers against an action • Social approval • Perceived self-efficacy • Intention formation and context-specific planning. (Wright et al., 1998, p. 18 325) The attributes of the individuals involved and what happens in sexual encounters is largely the result of the interaction that takes place and the context within which the encounter occurs. Relationship education programs