Teaching Proud Choices

CHPIR program helps reduce teen pregnancy rates by focusing on knowledge and healthy behavior.

Genevieve Hunter and Michaela Moore

From left to right, CHPIR's Genevieve Hunter and Michaela Moore, a student at New Bern High School, after a Community Advisory Meeting in May under the Making Proud Choices Program.

By Alicia Banks

Published December 2, 2022, last updated on December 5, 2022 under Around DGHI

When Genevieve Hunter began teaching sexual and reproductive health to teenagers in North Carolina’s Craven County, she quickly realized how much the students didn’t know.

Most didn’t understand the anatomy of their own bodies. Some didn’t know that HIV can lead to AIDS, and many had dangerous misconceptions about how to prevent a pregnancy, says Hunter, a senior program coordinator and principal investigator with DGHI’s Center for Health Policy & Inequalities Research (CHPIR).

Those knowledge gaps were apparent in the county’s high rates of teen pregnancy, which in 2010 ranked 15th among North Carolina’s 100 counties, according to state data. So Hunter and CHPIR decided to try to close them.

“I met with the county health department and started an after-school program,” says Hunter, who has taught sexual and reproductive health to teenagers for more than 30 years. “I’ve always loved working with teenagers.”

Now starting its second decade, the Duke Teen Health Club‘s Making Proud Choices program engages teenagers in frank conversations about topics such as contraception, affirmative consent and signs of healthy relationships. Funded with a grant from the North Carolina Department of Health and Human Services’ Personal Responsibility Education Program, the sessions evolved into being taught as part of a health class for ninth graders, but are now offered through the Boys & Girls Club of the Coastal Plain.

And the program seems to be influencing behavior. Between 2010 and 2020, the teen pregnancy rate in Craven County dropped by more than 50 percent, from 57.7  to 25.8 pregnancies per 1,000 teenagers.

“The course isn’t just about sex; it has helped me and other kids when we need someone to talk to. We have an outlet and learn about things.”

Michaela Moore — Student at New Bern High School

Hunter says the decline adds to the evidence that comprehensive sex education can produce healthy results. Studies have shown, for example, that comprehensive programs that also teach abstinence fare better than abstinence-only approaches in delaying sexual initiation among young people, according to a report from the nonprofit group Advocates for Youth.

“Out of all the students I’ve worked with, no one I knew revealed a pregnancy or had a baby during the program or right after taking it,” Hunter says. “What I would like to measure is how they talk to their friend groups after taking the course, and how that affects their peer’s decision-making process.”

Michaela Moore, a sophomore at New Bern High School who took the course, recalls Hunter discussing signs of abuse. Moore revealed her concern about a friend’s relationship that she didn’t think was healthy, and Hunter assisted the student in getting help. 

“She thought what she was going through was normal, and I was happy for her because the situation could’ve gotten a lot worse,” Moore says. “The course isn’t just about sex; it has helped me and other kids when we need someone to talk to. We have an outlet and learn about things.”

Among the things Moore learned was the fact that untreated HIV can evolve into AIDS, something she had never been taught before the course. “These are things I need to learn as I want to work in healthcare someday,” she says. “[We] need to know the risks, positives and negatives of all things so we can be safe and happy.”

Another student, Jeffery Mitchell, took the course as a sophomore at Havelock High School. Mitchell, who identifies as gay, says it’s important for everyone to know how to be safe with sexual activity.

Jeffery Mitchell

“I’m more knowledgeable now that I’ve taken the course,” he says. “But taking the course makes me feel surer and more confident. It doesn’t matter what your sexuality is, you still have to be cautious of things.”

Hunter notes the program maintains a community advisory council, including county residents as well as agency and nonprofit representatives. The grant funder also requires at least one teen representative and one current or former teen parent representative to be on the council.

She says its longevity is also rooted in its learning strategies, which are to show teenagers why they should choose more positive behaviors and to be proud of the decisions they make.

“How do I feel when someone is proud of me and when I’m proud of myself as opposed to making a mistake?” Hunter asks. She says the positive approach helps students recognize they don’t want to feel bad after making a decision. “This also works because we’re teaching people how to talk to their partners, giving them factual information and making the course non-judgmental.”

The program earned support from not just students, but parents, teachers and two of the county's high school principals. Yet not all county residents are convinced. Citing objections from some parents, the school board voted in August to remove the program from the high school curriculum.

“It was disheartening, and I’m there for the youth,” says Hunter. But she applauds her long-time collaborator, the Boys & Girls Club of the Coastal Plain, for providing the program a fresh start. The program will now be offered at the club’s facilities in New Bern and Havelock. “My only disappointment is that we’re not serving more and all who need it,” Hunter says.  

Mitchell, meanwhile, says people should consider the alternative to teens learning about healthy sexual behavior.

“I hear parents are scared about their kids taking a course like this,” he says. “My parents are more scared of me not knowing what I’m doing when I’m ready to. People want fewer teen pregnancies and more protected sex, but how can we know that if people aren’t willing to teach us?”