Focus Group Moderators Guide on Teen Pregnancy

Literature Review on Teen Pregnancy Tara Groves Bellevue College HPM375 Zach Snyder 1/12/2024 Literature Review on Teen Pregnancy Abstract The influence of teenage pregnancy on teen well-being is highlighted as this literature review examines the global relevance of adolescent pregnancy in various African contexts. Contextual correlation, factors causing teen pregnancy, and the psychological aftermath are explored in this research, which draws from studies conducted in Eastern Ethiopia, Rural Eastern Uganda, Rwanda, Nigeria, and throughout Africa. Valuable insights are gained through community-based, multi-stakeholder, and scoping review techniques. Reviewing inequalities, cultural norms, restricted access to reproductive health, and sex education services highlights the necessity for a comprehensive approach. Therefore, to enhance the general well-being of teens, it draws attention to the psychological effects, such as stress and stigma, which calls for various interventions such as extensive sex education, access to reproductive health care, and community-based assistance. Introduction Adolescent well-being is significantly influenced by teenage pregnancy, which continues to be a significant public health concern on a global scale. The psychological and emotional effects of teen pregnancy are examined in this study, with a focus on mental health and selfesteem. It explores contextual correlates and variables influencing adolescent pregnancy, drawing various research conducted throughout African areas. The research aims to enhance our understanding of the diverse issues that pregnant teens in Africa experience by examining the extensive interactions between psychological effects and the socio-cultural setting (Mezmur et al., 2021). Therefore, this will provide critical information for developing therapies and support networks specifically designed for these teens. Literature Review A critical investigation of teen pregnancy using a community-based strategy is provided by Mezmur et al. (2021) study conducted in Eastern Ethiopia. Essential to capturing the extensive dynamics of the local context and offering insightful information about the prevalence of teen pregnancy and its contributing variables is the research methodology used. Through active community engagement, the project seeks to identify the diverse issues that young people in Eastern Ethiopia experience, acknowledging the significance of cultural factors that influence the high rate of teen pregnancies in this area. A more profound comprehension of the variables influencing teen pregnancy is made possible by the community-based study approach. It entails working with regional stakeholders to ensure that people’s opinions are heard and that the analysis considers their viewpoints. Therefore, this study adds to the body of knowledge about the prevalence and contributing factors of adolescent pregnancy in Eastern Ethiopia. It also has implications for the development of focused treatments. By customizing approaches to the unique problems this community faces, public health programs can be more successful in improving the health of teens and addressing the underlying causes of adolescent pregnancies in Eastern Ethiopia. The study by Nabugoomu et al. (2020), carried out in rural Eastern Uganda, examines the complicated problem of teen pregnancy from several stakeholders’ standpoints. This strategy is crucial in providing thorough knowledge of the issue by including various views and viewpoints. The research clarifies the different beliefs influencing teen pregnancy in the rural environment by including the opinions of community members, healthcare providers, educators, and other essential stakeholders. Understanding the social, cultural, and economic factors that contribute to the high rates of teen pregnancy in this particular region requires an understanding of the multi- stakeholder viewpoint. The multi-stakeholder approach that the study emphasizes provides the basis for future actions and ways of understanding. Through active stakeholder involvement, the study creates opportunities for cooperation and teamwork in developing comprehensive solutions to fight teen pregnancy. The community, healthcare professionals, educators, and lawmakers must work together to implement successful solutions since this inclusive approach recognizes the interconnection of the problem. Therefore, to mitigate the effects of teen pregnancy in the area, a more comprehensive and long-lasting strategy may be enhanced by the insights gained from this study. As a result, this influences the creation of customized measures that align with teenagers’ particular issues. Through an analysis of the prevalence of teen pregnancy and its contextual implications in Rwanda, Uwizeye et al.’s (2020) study makes a substantial contribution to the understanding of the issue. The study recognizes the socio-cultural and economic elements that may influence teenage reproductive health. In addition to providing insight into the frequency of adolescent pregnancies in Rwanda, the research explores the diverse connection of circumstances that led to these pregnancies. The study’s focus on contextual correlates acknowledged that, in treating teen pregnancy, it is crucial to consider more extensive social, economic, and cultural dimensions. Rwanda’s history, cultural practices, and socioeconomic environment significantly influenced its reproductive health. Uwizeye et al. (2020) hope their analysis will help shape focused initiatives and policies grounded in Rwanda’s unique circumstances. Comprehending the many elements that impact adolescent pregnancy facilitates the creation of more effective approaches to reduce its incidence, advocate for sexual health education, and augment the general welfare of young people around the nation. The results of this study have implications for fighting adolescent pregnancy in East Africa and Rwanda’s public health initiatives. Bewa’s (2021) paper explores the extensive connection between school closings and teen pregnancy, providing insights into the environmental variables that affect teenagers’ reproductive health. The study emphasizes how important it is to comprehend how educational interruption might lead to a higher rate of teen pregnancies. Closing schools for whatever reasons, such as pandemics, disputes, or other reasons, can upset the regular educational resources and support networks that help shape teenagers’ behavior and choice-making. Closing schools affects teen pregnancy and exceeds the short-term disruption to schooling. It may decrease chances for extracurricular activities that support the holistic development of adolescents, social isolation and isolation, and access to knowledge on reproductive health. Bewa (202) study highlights the necessity for comprehensive approaches that consider the various factors influencing the reproductive health of teens at times when school is disrupted. Policymakers and educators may create interventions that draw the academic difficulties caused by school closure and lessen the unforeseen effects on the reproductive health of teenagers by acknowledging the interaction of environmental factors. Therefore, this realization is essential to enhancing a comprehensive approach to teenage well-being. Alukagberie et al.(2023) scoping study on the variables linked to teen pregnancy in Nigeria adds much to the research by offering diverse viewpoints on the problem. The study attempts to cover various factors influencing teen pregnancy in Nigeria using a comprehensive approach. It also explores the dynamics of the nation’s health system and socio-cultural factors, acknowledging these variables’ interdependence in determining teenagers’ reproductive experiences. The scoping review approach makes incorporating varied research and integrating many fields and viewpoints possible. Therefore, this method aids in revealing the diverse connection of variables influencing teen pregnancies in Nigeria. The research examines how societal norms, beliefs, and traditions interact with health system elements, such as education, by considering social-cultural issues. Formulating comprehensive plans and treatments that target the underlying causes of adolescent pregnancies in Nigeria requires this comprehensive understanding. Factors Influencing Teen Pregnancy Teen pregnancy is a complicated problem influenced by several factors. Socioeconomic status is essential since teenagers from lower-income families are more likely to be vulnerable (Alukagberie et al., 2023). Cultural expectations that influence beliefs about gender roles and sexuality may be the cause of early pregnancies. The lack of thorough sex education worsens the problem due to an inadequate understanding of the issue. It is challenging for teens to acquire the resources and assistance they require when they have limited access to reproductive health care. The analyzed research shows how crucial it is to deal with these criteria to develop effective treatment. Adolescent pregnancies are a problem that must be addressed, and initiatives to reduce them must encourage more significant economic opportunity and empowerment of underprivileged populations (Mezmur et al., 2021). Cultural sensitivity is crucial when developing educational initiatives that challenge harmful norms and promote food views on sexuality. Therefore, to offer them the information and abilities needed to make informed decisions, all teens must have access to thorough sex education understanding. Addressing these factors makes a more efficient approach that enhances teen well-being and lowers teen pregnanc y rates. The Effects of Teen Pregnancy Adolescent pregnancies have a significant negative impact on the psychological and emotional health of the young people involved, particularly on their mental and self-worth. Empirical studies have constantly highlighted the distinct difficulties encountered by adolescent mothers, emphasizing the psychological impact of their situations. One significant factor is the widespread stigma attached to teen pregnancies, which frequently results from society’s standards and attitudes. Teens may experience unfavorable attitudes and judgment, worsening feelings of inferiority and humiliation. The general well-being of pregnant teens can be further complicated by this stigma, which can be a significant obstacle to getting the help and treatment they need (Alukagberie et al., 2023). In addition, the difficulties of becoming a parent when still in youth increases stress and emotional strain. Adolescence and parenting provide challenges that young parents must overcome, and they often feel overburdened by their duties. The responsibilities of childcare combine with the developmental needs of adolescence, such as exploring one’s identity and schooling, to create a challenging and emotionally draining scenario. The psychological strains associated with limited financial resources, social distancing, and strained peer connection worsen the mental health issues adolescent parents face. Developing comprehensive therapies that enhance the well-being of pregnant teenagers and lessen the long-term effects of teenage pregnancy on mental health requires acknowledging and treating these psychological and emotional elements (Nabugoomu et al., 2020). Intervention and Prevention Strategies A diversified strategy should be used to treat the mental and emotional effects of teen pregnancy. Adolescents who get comprehensive sex education are better able to make informed choices about their sexual and reproductive health because they have the information and skills. Teens can handle these parts of their lives responsibly if they are given the proper knowledge about healthy relationships, early pregnancy and consequences, and contraception. In addition, another essential element of successful intervention is access to services related to reproductive health (Nabugoomu et al., 2020). Ensuring that youth-friendly, confidential reproductive healthcare is accessible to teens enhances early pregnancy identification and prompt, appropriate assistance. Therefore, this includes getting access to counseling services, safe abortion alternatives, and contraception when they are legal. Equally important is community-based support, which fosters an environment that offers empathy and assistance to young parents. By creating assistance networks and involving the community in awareness efforts, it is possible to lessen the stigma attached to teen pregnancy and create a supportive and understanding environment (Bewa, 2021). Stigma reduction is one of the most important aspects of supporting teen parent’s mental well-being. Due to society’s critical review, young dads and moms may have more emotional difficulties (Bewa, 2021). Therefore, the goal of intervention must be to eliminate social prejudices by creating a welcoming environment that enhances acceptance and open communication. Combining these components enables treatments to address the psychological and emotional consequences of teen pregnancy successfully. Therefore, this enhances adolescents’ general well-being and equips them with the knowledge and skills they need to make wise decisions. Research Question: Examining the psychological and emotional effects of teen pregnancy, especially about self-esteem and mental health. Method Selection Investigating the experiences of teenagers dealing with the mental consequences of teen pregnancy calls for the use of mixed methods research design that combines both qualitative and quantitative methodologies. Focus groups and in-depth interviews are two examples of qualitative approaches that thoroughly evaluate the subject elements of their experiences. By using open-ended questions, researchers may comprehensively understand the psychological impacts on these young people by revealing the aspects of emotions, perspectives, and coping strategies (Mezmur et al., 2021). Quantitative surveys provide numerical data to support qualitative approaches, allowing for a more thorough and organized study. Surveys can offer statistical insights into the frequency of psychological effects by assessing certain variables, such as mental health indicators and self-esteem levels. By combining the two methods, researchers can analyze their data and come to a more comprehensive understanding of the psychological effects of teen pregnancy. Therefore, this thorough strategy enhances the study’s validity and reliability and improves the research findings. Using the mixed method approach, researchers can fully document teenage experiences. As a result, this provides insights into the psychological aspects of teen pregnancy and helps to shape focused interventions for improved outcomes and assistance. Sampling Selection Researchers can use a purposive sampling technique when looking at teen pregnancy since it enables them to choose participants based on factors relevant to the study’s goals. In this instance, the experiences of pregnant teens are significantly shaped by variables including age, socioeconomic status, and location. Researchers may ensure a wide variety of participant inclusion by using purposive sampling, which allows for a more thorough grasp of the dynamic nature of adolescent pregnancy in many circumstances. Therefore, this method adds to the diverse view of the problem by recognizing the individuality of each experience (Mezmur et al., 2021). Age consideration assures representation throughout the adolescent range, recognizing possible differences in demand and difficulties experienced by young vs. older pregnant adolescents. While physical location explains regional variations in cultural norms and services offered, socioeconomic background is crucial for identifying inequalities in access to resources and support networks. The study acquires a rich dataset by choosing a diverse sample, which improves the generalizability of findings and makes it easier to spot trends and differences. Procedure Getting clearance from the appropriate institutional review boards is a crucial first step in ensuring ethical standards in research. In addition, it is essential to have participants informed permission, especially in the study on teen pregnancy and its psychological effects. Therefore, this strategy entails giving participants comprehensive information about the research methods, goals, possible hazards, and advantages so they may decide whether to participate. In addition, standardized psychological tests and semi-structured interviews are advised for data collection collection. In-depth discussions of participants’ viewpoints and experiences are made possible by the interviews, which also provide qualitative insights into the psychological and emotional consequences of teen pregnancy. Standardized psychological tests offer quantitative metrics, like mental health and self-esteem markers, facilitating a more methodical examination (Mezmur et al., 2021). It is essential to consider any confounding variables to improve the validity of the findings. Adolescents who are pregnant might have a substantial impact on their psychological well-being depending on factors like social support. Incorporating these variables into the research design and analysis facilitates the identification of the distinct effects of teen pregnancy on mental health and self-worth, hence enhancing the precision of the conceptual framework. Conclusion In conclusion, this thorough literature analysis highlights the importance of global teen pregnancy, concentrating on various African contexts. The study sheds light on the variables affecting prevalence and outcomes through a comprehensive data analysis. The reviewed studies offer insightful viewpoints using multi-stakeholder techniques, community-based research, and scoping review. Therefore, addressing the challenges of teenage pregnancy and enhancing the comprehensive well-being of teens requires focused solutions. Therefore, this involves an understanding of the socio-cultural aspects, psychological aftermath, and effective treatment, which are essential. References Alukagberie, M. E., Elmusharaf, K., Ibrahim, N., & Poix, S. (2023). Factors associated with adolescent pregnancy and public health interventions to address in Nigeria: a scoping review. Reproductive Health, 20(1), 1-24. https://reproductive-healthjournal.biomedcentral.com/articles/10.1186/s12978-023-01629-5 Bewa, J. M. (2021). School closures and teenage pregnancy. Bull World Health Organ, 99, 6-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924898/ Mezmur, H., Assefa, N., & Alemayehu, T. (2021). Teenage pregnancy and its associated factors in eastern Ethiopia: a community-based study. International Journal of Women’s Health, 267-278. https://www.tandfonline.com/doi/full/10.2147/IJWH.S287715 Nabugoomu, J., Seruwagi, G. K., & Hanning, R. (2020). What can be done to reduce the prevalence of teen pregnancy in rural Eastern Uganda? multi-stakeholder perceptions. Reproductive Health, 17(1), 1-12. https://reproductive-healthjournal.biomedcentral.com/articles/10.1186/s12978-020-00984-x Uwizeye, D., Muhayiteto, R., Kantarama, E., Wiehler, S., & Murangwa, Y. (2020). Prevalence of teenage pregnancy and the associated contextual correlates in Rwanda. Heliyon, 6(10). https://www.cell.com/heliyon/pdf/S2405-8440(20)31880-6.pdf 21 PEW RESEARCH CENTER Appendix A: Moderator guide for focus group discussions As the group is assembling, participants complete a short questionnaire prior to the discussion. Initial introductions and ground rules for discussions included the following: Hello my name is [MODERATOR NAME] and I’ll be your moderator this evening. We’re doing focus group interviews for Princeton Survey Research Associates International, an independent research company based in New Jersey. We are interested in understanding how people in different parts of the country think and feel about some new issues in technology, biology, genetics and medicine. Over the next 1.5 hours or so, we’ll discuss your views and experiences related to some new options being developed to treat people with diseases or medical conditions. Our goal is to think through what our world might be like if, instead of using these options for treatments, they were available and used by healthy people. Scenario 1: Gene-editing for stronger immune system and reduced risk of disease and physical illness Read aloud and hand out to participants: New developments in genetics and genome editing techniques are opening new possibilities that could be used to boost a person’s immune system. Because the immune system is critical to protecting the body from disease and infection, these kinds of changes could potentially allow individuals to live with significantly less disease and illness. These techniques involve changes to the DNA (that is, the genetic material) of specific cells in your body either by injecting material that affects these cells or by first removing these cells from a person’s body, changing the DNA of the cells in the lab, and then replacing these cells back in the person’s body. Currently, geneediting techniques are used to treat people who have an immune system disorder of some kind. In the future, gene-editing techniques could be developed for use by healthy individuals to significantly improve their immune system and dramatically reduce their risk of disease and illness. The idea we want to discuss is what it would be like if gene-editing techniques that improve the immune system were available for HEALTHY individuals, allowing people to live with dramatically reduced risk of disease and illness. QUESTIONS FOR DISCUSSION 1. That’s a lot of pretty technical information and I want to learn more about what you each think. Just a show of hands… www.pewresearch.org 22 PEW RESEARCH CENTER o How many of you would be interested in using these gene-editing techniques FOR YOURSELF to significantly strengthen your immune system and dramatically reduce your risk of disease and illness? And how many of you would NOT be interested in this for yourself? Remembering there are no right or wrong answers here… o How many of you say that doing this is an appropriate use of medical, technical or scientific knowledge? And how many of you say that doing this is NOT an appropriate use of medical, technical or scientific knowledge? 2. Now I’d like to hear more about what you think or feel about the idea of using gene-editing techniques to significantly strengthen the immune system of healthy people and dramatically reduce their risk of disease and illness. On the paper in front of you, I’d like you to write down one advantage and one disadvantage of using these techniques for healthy individuals – for those who have this gene-editing technique done or for society as a whole. (Allow respondents a minute to write their responses. When most seem done, resume discussion.) o o Let’s start first by talking about some the ADVANTAGES gene editing might have for healthy individuals. Now let’s talk about some of the DISADVANTAGES that developing gene editing for healthy individuals might have. 3. Still thinking about possible advantages and disadvantages, what effects do you think using these gene-editing techniques might have on: o Family or other personal relationships o Work – how people do their jobs o Society in general: Between different races or ethnic groups, between different religious groups, between different income groups? 4. Regardless of how you feel about this idea, personally, do you think it is important that everyone should have equal access to use these techniques – perhaps by making sure that insurance will pay or by having rules to make sure these techniques are widely available – or don’t you think it is important to make sure there is equal access to this option? 5. [REQUIRED PROBE] Are there any limitations, safeguards or rules you would like to apply to how gene-editing techniques like this are used to significantly strengthen the immune system of healthy people and dramatically reduce their risk of disease and physical illness? [IF YES, PROBE: What type of rules? Who should be in charge of rules and safeguards?] www.pewresearch.org 23 PEW RESEARCH CENTER 6. When you step back and think about a world where this is possible, do you think people have a moral responsibility to improve their abilities to the extent that medical and technical options like this are available to them? Or do we, perhaps, have a moral responsibility for the opposite – to leave these kinds of options for treatment of disease but nothing else? 7. [REQUIRED PROBE] What would you think about this idea IF the gene editing is done in a way that the genetic modifications could be passed on to future generations if they later have children, and over the long term could change the genetic characteristics of the population? The alternative is when genetic modifications are done on somatic cells and CANNOT be passed on to any children a person later has. How does that distinction change your thinking about this idea, if at all? 8. [REQUIRED PROBE] As we talk, do you think of this idea as fundamentally changing people as human beings? Or, do you, perhaps, see this as similar to other ways humans have tried to improve their abilities over the years with new tools and machines, medicines and education? Tell us a little about your thinking on this. Scenario 2: Brain implant to improve concentration, memory, ability to think and process information Read aloud and hand out to participants: New developments in understanding the brain – in the field of neuroscience — are creating the possibility that doctors will be able to surgically install implants inside the brain that could interact with computers and prosthetic devices. These techniques involve surgically implanting a small computer chip in the brain. Currently, these implanted devices, sometimes called neuroprosthetics, are being developed for use by people with some kind of problem or disability. In the future, these implanted devices could potentially be developed for use by healthy individuals. The idea we want to discuss is what it would be like if these devices were available for HEALTHY individuals, allowing people to function at home, work and in everyday life with a significantly improved concentration, memory, ability to think and process information. QUESTIONS FOR DISCUSSION 1. That’s a lot of pretty technical information and I want to learn more about what you each think. Just a show of hands… www.pewresearch.org 24 PEW RESEARCH CENTER o How many of you would be interested in these types of devices for YOURSELF in order to significantly improve your ability to concentrate and think clearly? And how many of you would NOT be interested in this for yourself? Remembering there are no right or wrong answers here… o How many of you say that doing this is an appropriate use of medical, technical or scientific knowledge? And how many of you say that doing this is NOT an appropriate use of medical, technical or scientific knowledge? 2. Now I’d like to hear more about what you think or feel about the idea of using these implanted devices by healthy people. On the paper in front of you, I’d like you to write down one advantage and one disadvantage of using these implanted devices for healthy individuals – for those getting these devices or for society as a whole. (Allow respondents a minute to write their responses. When most seem done, resume discussion.) o o Let’s start first by talking about some the ADVANTAGES these implanted devices might have for healthy individuals. Now let’s talk about some of the DISADVANTAGES that developing these implanted devices for healthy individuals might have. 3. Still thinking about possible advantages and disadvantages, what effects do you think these implanted devices might have on: o Family or other personal relationships? o Work – how people do their jobs? o Society in general: Between different races or ethnic groups, between different religious groups, between different income groups? 4. Regardless of how you feel about this idea, personally, do you think it is important that everyone should have equal access to these implanted devices – perhaps by making sure that insurance will pay or by having rules to make sure these devices are widely available – or don’t you think it is important to make sure there is equal access to this option? 5. [REQUIRED PROBE] Are there any limitations, safeguards or rules you would like to apply to how implanted devices like this are used to significantly improve healthy people’s concentration, memory, ability to think and process information? [IF YES, PROBE: What type of rules? Who should be in charge of rules and safeguards?] 6. When you step back and think about a world where this is possible, do you think people have a moral responsibility to improve their abilities to the extent that medical and technical options www.pewresearch.org 25 PEW RESEARCH CENTER like this are available to them? Or do we, perhaps, have a moral responsibility for the opposite – to leave these kinds of options for treatment of disease but nothing else? 7. [REQUIRED PROBE] As we talk, do you think of this idea as fundamentally changing people as human beings? Or, do you, perhaps, see this as similar to other ways humans have tried to improve their abilities over the years with new tools and machines, medicines and education? Tell us a little about your thinking on this. Scenario 3: Transfusion of synthetic slood substitutes for physical speed, strength and stamina Read aloud and hand out to participants: New developments in biochemistry are creating the possibility of using synthetic blood substitutes to significantly boost people’s oxygen levels in their blood stream. A higher concentration of oxygen in the blood stream would be carried from the lungs to the muscles and could significantly improve people’s physical speed, strength and stamina. Currently, transfusions with synthetic blood substitutes are being used to treat people who have significant blood loss from an accident or disease when few donors are available to provide blood for a transfusion. In the future, a transfusion with this kind of synthetic blood substitute could be developed for use by healthy people to significantly improve their speed, strength and stamina. That could allow people to function in extreme conditions – at high altitudes, holding their breath underwater, or after hours of exertion – or simply to perform everyday tasks with greater speed, strength and stamina. The idea we want to discuss is what it would be like if a transfusion with this kind of synthetic blood substitute were available for HEALTHY INDIVIDUALS, allowing people to perform all sorts of tasks with significantly improved speed, strength and stamina. QUESTIONS FOR DISCUSSION 1. That’s a lot of pretty technical information and I want to learn more about what you each think. Just a show of hands… o How many of you would be interested in using a transfusion with this kind of synthetic blood substitute FOR YOURSELF to significantly improve your speed, strength and stamina? And how many of you would NOT be interested in this for yourself? Remembering there are no right or wrong answers here… www.pewresearch.org 26 PEW RESEARCH CENTER o How many of you say that doing this is an appropriate use of medical, technical or scientific knowledge? And how many of you say that doing this is NOT an appropriate use of medical, technical or scientific knowledge? 2. Now I’d like to hear more about what you think or feel about the idea of having a transfusion with this kind of synthetic blood to significantly improve healthy people’s speed, strength and stamina. On the paper in front of you, I’d like you to write down one advantage and one disadvantage of using these techniques for healthy individuals – for those who have a transfusion with this kind of synthetic blood substitute or for society as a whole. (Allow respondents a minute to write their responses. When most seem done, resume discussion.) o o Let’s start first by talking about some the ADVANTAGES gene-editing might have for healthy individuals. Now let’s talk about some of the DISADVANTAGES that developing gene-editing for healthy individuals might have. 3. What effects do you think having a transfusion with this kind of synthetic blood substitute might have on: [MODERATOR NOTE: if participants bring up sports/athletic contests, please probe for implications to people working in other aspects of everyday life such as for physically-demanding jobs.] o Family or other personal relationships o Work – how people do their jobs o Society in general: Between different races or ethnic groups, Between different religious groups, Between different income groups? 4. Regardless of how you feel about this idea, personally, do you think it is important that everyone should have equal access to a transfusion with this kind of synthetic blood substitute – perhaps by making sure that insurance will pay or by having rules to make sure these techniques are widely available – or don’t you think it is important to make sure there is equal access to this option? 5. [REQUIRED PROBE] Are there any limitations, safeguards or rules you would like to apply to the option of healthy people having a transfusion with this kind of synthetic blood substitute? [IF YES, PROBE: What type of rules? Who should be in charge of rules and safeguards?] 6. When you step back and think about a world where this is possible, do you think people have a moral responsibility to improve their abilities to the extent that medical and technical options like this are available to them? Or do we, perhaps, have a moral responsibility for the opposite — to leave these kinds of options for treatment of disease but nothing else? www.pewresearch.org 27 PEW RESEARCH CENTER 7. [REQUIRED PROBE] As we talk, do you think of this idea as fundamentally changing people as human beings? Or, do you, perhaps, see this as similar to other ways humans have tried to improve their abilities over the years with new tools and machines, medicines and education? Tell us a little about your thinking on this. III. FINAL QUESTIONS I’d like to take these final few minutes to talk about where you think moral considerations should enter the picture when we think about these kinds of medical, scientific and technical developments as potentially being used to enhance the capacities of healthy individuals.   Do you have a sense of where you’d draw the line between changes to people that would be OK to you because they improve people’s abilities in some way, compared with changes that would make people “fundamentally unnatural” in some way? Do you have any final thoughts on the availability, morality, or regulation of these potential developments being used for healthy people? [OPTIONAL NOTE: Let me remind you that none of the ideas we discussed today are, in fact, available for healthy individuals today. The purpose of our discussion was to better understand whether people think there should be limits to how these kinds of options could be used in the future and what kinds of limits people think are important.] www.pewresearch.org

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