The issue of teen pregnancy requires one to dig deeper into the problem in hopes of finding answers to the most difficult and confusing questions. It means examining family relationships, one's upbringing, the media's role, peer pressure, parenting, and abuse as children. The reality is that defining the role of the family in reducing teen pregnancies requires taking a closer look at the knotty problem, and it's at this point in the process that the finger-pointing generally begins. Parents blame schools and media, media professionals throw responsibility back onto the shoulders of parents and schools, and many of those involved hold government ultimately responsible. It's as though probing the elements of this problem is a zero-sum blame game.

The interest in examining the factors behind teen pregnancy is not about assigning blame. Nor is it true that if one factor is found to contribute to the problem, others are therefore absolved. In fact, uncovering the origin of any problem requires examining each of the relevant influences in the wider context of how the factors interrelate. And in this case, they twine into a gnarled mess.

This is well illustrated by a study undertaken by behavioral scientist Anita Chandra and her colleagues at RAND, the independent international research corporation. Published in the November 2008 issue of the journal Pediatrics, it addresses a link between television and teen pregnancy. The researchers found that teens who watched high levels of sexual content on television were twice as likely to become parents within the subsequent three years. As they monitored the study's subjects, the research team measured exposure to sexual content based on very detailed methods of categorizing individual scenes in order to rate the 23 different programs that were selected for the research.

Our results indicate that frequent exposure to sexual content on television predicts early pregnancy, even after accounting for the influence of a variety of other known correlates of each, said the RAND team. In addition, Chandra and her colleagues noted that television shows typically send teens the message that sex carries few risks or responsibilities. What this means for parents should be obvious: although the researchers weren't suggesting a causal link between television viewing and teen pregnancy, the correlation does indicate a need to monitor and restrict what teens watch.

But this may not always be as easy as it sounds. The RAND research also acknowledged other factors that are known to increase pregnancy risk for teens. Living in a single-parent household, low parent education, limited teen educational or career aspirations and ambivalent or positive attitudes toward pregnancy have been identified as critical influences of the timing of sexual initiation and first pregnancy, they said. There is also evidence that teen pregnancy risk is greater among teens with lower grades and those who engage in delinquent behaviors. Previous studies have also uncovered cultural differences in rates of early pregnancy. According to the most recent figures available from the U.S. Centers for Disease Control (CDC), Latino teens have about three times the pregnancy rate of Caucasian teens, while African-American teens have more than twice the rate of Caucasians.

Obviously the variables listed here are so intertwined as to be almost impossible to disentangle. Latino and African American teens are also more likely to live in disadvantaged communities and to have more positive views of early parenthood. They are more likely to live in single-parent homes where the father is the absent parent; and of course, father absence has also been shown to increase the risk of early pregnancy just as it has been shown to increase other risk factors such as low grades and delinquent behavior.

Following the thread of father absence leads to the further acknowledgment that working single mothers are challenged not only when it comes to monitoring the TV habits of their children but also when it comes to their earning potential, especially if they don't have the support of extended family. Stretched and stressed with the sole responsibility for feeding and clothing her children, a single mother's greatest challenge may be to give her children the attention they need.

Another issue is that her daughters tend to enter puberty earlier than their peers. A 2004 study by the University of Chicago's Institute for Mind and Biology was not the first to make the connection between early menarche and absent fathers, but it contributed to the existing research by finding that girls with early menarche and absent fathers showed a significantly higher interest in infants than did their later-maturing peers.

A few months later, the Journal of Adolescent Health published a study by researchers at the University of North Carolina showing a link between early puberty and an earlier interest in viewing sexual content in the media. The trouble is, these early-developing girls were also more likely than their peers to come away from their viewing with the idea that these media messages constituted tacit approval of teen sex.

Given that content analyses have found that the media do tend to portray sexual behavior as normative and risk free, said the researchers, we might expect that all girls would perceive the media as giving them sexual permission. However, in this study the younger earlier maturing girls were the most likely to interpret media content as sexually permissive.

The researchers referred to the mass media as a Sexual super-peer for early-maturing girls. It may be, they speculated, that the earlier maturing girls are looking for information and norms in the media because their real-life peers are not as interested as they are in sex and sexuality.

The contribution of father absence to teen pregnancy doesn't end there. In fact, this thread could actually be one of the longest and stickiest in the web. Absent fathers (or mothers) also leave children vulnerable to sexual abuse in the home, the highest risk of which is from males placed in a caretaking role over children or cohabiting with a single mother.

How child sexual abuse contributes to teen pregnancy goes well beyond the obvious. In a 1999 study published in the journal Adolescence, researchers Nancy D. Kellogg, Thomas J. Hoffman and Elizabeth R. Taylor examined this question among a diverse group of teen mothers enrolled in a school-age parenting program in Texas after finding that more than half of the girls (53 percent) had suffered an unwanted sexual experience prior to their first pregnancy.

For 13 percent of the abused teens, the pregnancy was a direct result of that violation. But there were just as important indirect results among the rest: for instance, the earlier an unwanted sexual experience occurred, the earlier the teen sought an intentional experience. Some responded to the misuse by running away, or by trying to obliterate the experience through self-medicating with alcohol or drugs. All of these behaviors are well known to increase the likelihood that girls will end up further exploited and, eventually, pregnant.

Girls who were sexually abused often endured physical violence as well. Other family dysfunctions such as alcohol and drug abuse often (but not always) coexisted with the sexual abuse. Worse, a large number of the girls (60 percent) went to adults for help, but according to the study, only half of these adults intervened in any way.

Hoffman's research convinces him that any approach to the prevention of teen pregnancy requires addressing foundational family dysfunctions. There would be a relationship between many of these factors: alcohol abuse, substance abuse and sexually acting out, he told Vision. The sexual acting out comes from being sexualized at an earlier age through unwanted sexual experiences. But, says Hoffman, There's a long list of risk factors with regard to sexual abuse that can be conceptualized in terms of family. First and primary would be the presence of a stepfather or other father figure who is not the father. Other factors include mother absence, lack of maternal education (the mother didn't finish high school), presence of an emotionally distant or sexually repressive mother, or presence of a physically distant (unaffectionate) father.

Hoffman explains why physical closeness is a protective factor in father-daughter relationships: A father who is involved in the physical nurturing of the child as an infant in terms of changing diapers, feeding the infant daughter and expressing physical affection is less likely to abuse than a father who doesn't participate in those nurturing activities. To be able to abuse someone, the abuser needs to do a certain amount of objectifying. When the father is engaged in the day-to-day care of his daughter, it's hard to objectify her.

But it isn't only girls who are at risk. Hoffman points out that males who have been sexually abused are also more likely to contribute to the teen pregnancy problem. Either way, he says, Someone who has been abused is more likely to be sexually active earlier.

And then there's the self-esteem factor for girls, beyond the possibility that they may simply be looking for a source of male attention. Unfortunately, this can set a girl up to be vulnerable for a second pregnancy. Then a girl is pregnant she suddenly moves to center stage, says Hoffman. Everyone wants to know how she's doing which is tremendous positive reinforcement for being pregnant. Once she has the baby, of course, the special attention begins to drop off rather quickly. After a while it disappears completely and she wants to recapture it.

Hoffman cautions that this cycle is not universal by any stretch. If young mothers are encouraged to continue their academic education and are also educated about the kind of nurturing care and parenting that infants and toddlers require, they begin to develop the self-esteem they're missing the kind that isn't based on being pregnant or dependent on finding an outside source of attention.

This is precisely the kind of self-esteem that Martin E.P. Seligman, often called the father of positive psychology, says comes from doing well as opposed to just feeling good.

As early as 1967, University of California Davis psychologist Stanley Coopersmith set out to discover what kinds of parenting practices contributed to this kind of self-esteem and published a compilation of his studies on the topic, titled The Antecedents of Self-Esteem. His findings echo Albert's comment about The familiar grandmother rules. While Coopersmith noted that parental acceptance of children was positively associated with high self-esteem, he added that the belief that parents who are accepting are necessarily permissive, democratic, and nonpunitive appears to be an obscuring overgeneralization, and one that has repeatedly been demonstrated to be false.

In contrast, Coopersmith found that children whose parents established well-defined and extensive limits and were consistent about enforcing them with positive techniques had much higher self-esteem than those who had poorly defined limits and experienced greater permissiveness.

Though self-esteem is only one of the many threads to sort out in the teen pregnancy knot, what produces self-esteem would seem to be the same as what protects teens from other threats to their well-being. Few if any of the factors considered here are alcohol and drug abuse, family relationships, delinquency, acting out, etc. are immune to the influence of what Coopersmith summarizes as Parental warmth, clearly defined limits, and respectful treatment.