California State University, Northridge the Impact of the Silent Scream As A
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CALIFORNIA STATE UNIVERSITY, NORTHRIDGE THE IMPACT OF THE SILENT SCREAM AS A HEALTH EDUCATION INTERVENTION A thesis submitted in partial satisfaction of the requirements for the degree of Master of Public Health by Jacqueline M. Changala January, 1987 (\ . The Thesis of Jacqueline M. Changala is approved: Mary C. ~afker, R.N., M.S. i i ©1986 Jacqueline M. Changala All Rights Reserved ; ; i ACKNOWLEDGEMENTS I wish to acknowledge and thank several individuals and organizations that contributed to this research study. I am grateful to the college instructors who permitted me to enter their classrooms to conduct my research; and to the National Right to Life Committee, Washington, DC; American Portrait Films of Anaheim, California, the production company of The Silent Scream; and The Life Education Center of Santa Ana, California, for their time and expertise. A heartfelt thank you goes to James Fleming, Director of the Computer Center, California State University, Northridge for his countless hours of guidance and programming. I am in deep appreciation to my committee members: to Goteti Krishnamurty, a true educator, for his constant support and direction to "discover"; to Mike Kline for his professional and much-respected advice; and to Mitzi Parker, for her uplifting attitude and encour agement. iv TABLE OF CONTENTS ACKNOWLEDGEMENTS iv LIST OF TABLES vi ABSTRACT . • . vii CHAPTER 1 INTRODUCTION • . 1 Background . 1 The Abortion Debate •. 1 The Court Decision 2 Abortion Statistics .. 3 Purpose . 3 Problem Statement .. 3 Null Hypotheses .... 4 Three Student Groups . 4 Comparison of Three Student Groups 4 Review of the Literature ..... 5 Public Opinion of Abortion 5 Factors Affecting Public Opinion 7 Pro-Life Shift in Public Opinion 9 Pro-Life Education Activities .• 14 The Advent of The Silent Scream . 16 Film Content ........ 19 Reactions to the Film .... 21 Use of Film in Health Education 23 Limitations . 24 2 METHODOLOGY . 25 Procedure . • . 25 Instrument .... 27 The Research Design 30 Statistical Analysis 30 3 RESULTS AND DISCUSSION 31 Null Hypothesis 1 31 Null Hypothesis 2 .. 31 Null Hypothesis 3 . 34 Null Hypotheses 4, 5, 6 . 34 Demographic Factors .. 36 Knowledge Item Analysis . 38 Attitude Item Analysis 40 School Attendance and Demographic Factors Affecting Attitude . • . ... 45 Conclusion 46 Summary . 50 REFERENCES . 54 APPENDIX - Student Survey/Survey Answer Key 58 v LIST OF TABLES Table Page 1 Subjects - Demographic Information 28 2 Knowledge Scores by School 32 3 Attitude Scores by School . 33 4 Analysis of Variance Between Schools on Knowledge and Attitude . 35 5 Knowledge Item Analysis ........ 38 6 Attitude Item Analysis - Likert Scale Scores 41 7 Attitude Item Analysis - Percent of Students Agreeing, Holding No Opinion, Disagreeing on Specific Attitude Items .•. , ..•.... 42 8 School and Demographic Factors Affecting Specific Attitude Items . 47 vi ABSTRACT THE IHPACT OF THE SILENT SCREAM AS A HEALTH EDUCATION INTERVENTION by Jacqueline M. Changala Master of Public Health Few issues have surpassed abortion in generating controversy and disagreement among men. An analysis of public opinion indicates that there has been a slight shift to the pro-life or anti-abortion stance, the first since the United States Supreme Court legalized abortion on demand in the Roe v. Wade decision of 1973 (Hume, 1985; Sackett, 1985a). In 1985, a film entitled The Silent Scream, which depicts a real-time ultrasound of a 12-week-old fetus being aborted, increased media exposure of the pro-life movement (Thomas, 1985). The film's intent is to educate the general public on the viability of the unborn child and to change its opinion on the morality of legalized abortion on demand, and thus contribute to the repeal of Roe v. Wade. The purpose of this research study is to determine if the viewing of The Silent Scream affects change in the knowledge and attitude of three Orange County college populations: a public junior college and university, and a private Christian college, and if so, will the affected changes differ among these distinct groups. vii Fifty-one students participated in the research. Before and after viewing the film, the students completed a questionnaire that consisted of 11 knowledge items based upon factual information pre sented in The Silent Scream, and 14 attitude items placed on a 5-point Likert scale. The attitude items were similar to questions used by the National Opinion Research Center from 1972-84, the Gallup polls of 1968-77, and the National Fertility Studies to assess public opinion on abortion. The attitude items were placed on a pro-choice/ pro-life scale. The statistical analysis for this study was completed by using the Statistical Package for the Social Sciences (SPSS). Statistical significance was determined by the student t-test and analysis of variance at the level of significance E < .05. The Silent Scream significantly influenced two schools, the junior college and university, in increasing knowledge regarding the unborn child and abortion. The three schools did not significantly differ in pre-test (baseline) or post-test knowledge scores, nor in knowledge gained. In contrast to knowledge, the film seemed to have influenced the students at all three schools to become more pro-life. There was no significant difference between the three schools in the amount of change in attitude. The schools were not comparable when pre-test (baseline) scores in attitude were considered. Age, sex, ethnicity and religion did not affect these results. This study demonstrates that The Silent Scream influenced two public college populations to gain knowledge and three college pop ulations to change their attitude regarding the unborn child and viii abortion. These results, along with findings by Louis Harris and Associates (1985) for the Planned Parenthood Federation of America, Inc. indicate that the film may be a factor in increasing public support for the pro-life cause. ix CHAPTER 1 INTRODUCTION Background The Abortion Debate Few issues have surpassed abortion in generating controversy and disagreement among men. Abortion affects almost every fiber of society as it revolves around the most fundamental issues of sex, religion and the meaning of life (Sackett, 1985a), and has profound implications in politics, medicine, and the social realm. However, as Noonan (1979) suggests, abortion is 11 an issue that once or twice in a century ... arises so devisive in its nature, so far-reaching in its consequences, and so deep in its foundation that it calls every person to take a stand .. ( p. 1). In debates on abortion, the most vocal activists are usually those who are either for abortion on demand or not for abortion at all. Public opinion, in contrast, is somewhere in the middle. The majority of Americans believe that abortion should remain legal in at least some circumstances, but a slim majority oppose legal abortion in most of the circumstances where it takes place today (Sackett, 1985b). In fact, recent trends indicate that there has been a slight shift to the anti-abortion or pro-life stand (Hume, 1985; Sackett, 1985a). This is apparent in both the political world and in medi cine, and by the increased media exposure of the pro-life movement 1 2 primarily caused by a film entitled The Silent Scream depicting a real-time ultrasound film of a 12-week-old fetus being aborted (Thomas, 1985). This poses a serious social and legal question that has tremendous health implications. The Court Decision As many believe that abortion is only legal in the first tri mester of a pregnancy (Sackett, 1985a), it is important to briefly note the history of the law and how it reads. On January 22, 1973, the United States Supreme Court struck down all state laws regarding abortion, and legalized abortion on a national scale in the infamous case of Roe v. Wade. The law reads, according to Justice Blackmum who delivered the opinion of the Court, as: a) For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgment of the pregnant woman's attending physician. b) For the stage subsequent to approximately the end of the first trimester, the state, in promoting its interest in the health of the mother, may, if it chooses, regulate the abortion procedure in ways that are reasonably related to maternal health. c) For the stage subsequent to viability, the state, in pro moting its interest in the potentiality of human life, may, if it chooses, regulate, and even proscribe, abortion except where it is necessary, in appropriate medical judgment, for the preservation of the life or health of the mother (Roe v. Wade, 1973, p. 49). In a simplified summary of the Court ruling, during the first three months, abortion is available en demand. In the second three months, the state may only enact laws to protect the health of the mother in terms of who performs the abortion and where it occurs. 3 The state may not enact laws to protect the fetus. In the last three months of a pregnancy, the state may enact a law to forbid a woman to have an abortion that is not found necessary to preserve her "life or health" where health is described in broad terms, i.e., social or psychological well-being (Powell, 1981). Abortion Statistics According to a Newsweek poll of 1985, from 1973 to 1985, 15 mil lion legal abortions were performed in the United States. One-fourth of all pregnancies end in abortion, amounting to 4,000 per day. Ninety percent occur before the thirteenth week while one percent are done after the twentieth week of the pregnancies. In New York, the number of live births equals the number of abortions. Seventy-nine percent of abortions are performed on unmarried women, usually in their twenties, for financial or psychological convenience (Sackett, 1985a).