Every week, when Munira Mohamed meets with Robbinsdale Cooper High School students in the Teen Outreach Program, she starts with questions about what's new in their lives.
Mohamed, a facilitator for the program, wants to know if there are signs of any behavior that will affect their future. Sometimes she doesn't like what she hears.
"I see them really not connecting to their school," she said. "I see them not connecting to their classmates. I see them being lost in the shuffle of what is high school, what is being a teenager."
For Mohamed, who is on the front lines of Hennepin County's pregnancy prevention program, those are signs that the teenage boys and girls in the class may be headed in the wrong direction -- sometimes towards unwanted pregnancies.
Sex education is part of the curriculum in every Minnesota high school. But 32 Hennepin County schools are expanding on the effort through the outreach program, known as TOP, which includes frank discussions on the biology of reproduction and also on healthy relationships.
Funded by nearly $17 million federal grant over five years, TOP is offered to schools and teachers willing to participate and this year will reach 2,200 students. Students and their families can opt out of the curriculum but in four years only a handful have.
Its facilitators are not required to be licensed school teachers. However, they and the classroom teachers who work with them are trained in the TOP curriculum developed over the years.
It's an effort that appears to be working. Since 2007, the teen birthrate has declined 40 percent -- faster than nearly anywhere else in Minnesota, and the nation.
In 2007, Hennepin County recorded 1,152 births to girls ages 15 to 19. By 2011, that number had declined to 692 births.
Minnesota's overall teen birth rate has declined 50 percent from 1991, according to the National Campaign to Prevent Teen and Unplanned Pregnancy. There were 3,295 teen births in Minnesota in 2012.
From 2011 to 2012, the national birth rate for teenagers ages 15 to 19 dropped 6 percent to 29.4 per 1,000 -- the lowest rate ever reported for the United States. Rates were down for age groups 15-17 and 18-19, and for nearly all races and Hispanic origin groups. From 2007 to 2011, the national teen birth rate declined 26 percent.
Researchers from the federal department of Health and Human Services' Office of Adolescent Health and from the National Campaign to Prevent Teen and Unplanned Pregnancy say the recession, access to contraception reality TV programs that show the consequences of becoming pregnant contributed to the declining teen pregnancy rates.
Others credit abstinence education, a key component in Minnesota schools.
Still, the United States still has one of the highest teen birth rates among wealthy countries.
"U.S. teens are two and a half times as likely to give birth as compared to teens in Canada, around four times as likely as teens in Germany or Norway, and almost 10 times as likely as teens in Switzerland," noted a 2012 study done for the National Institutes of Health. "Among more developed countries, Russia has the next highest teen birth rate after the United States, but an American teenage girl is still around 25 percent more likely to give birth than her counterpart in Russia. Moreover, these statistics incorporate the almost 40 percent fall in the teen birth rate that the United States has experienced over the past two decades."
Mohamed said many of her students don't talk with their parents about pregnancy prevention or relationships.
Friends, the Internet and popular culture play a bigger role.
"When I ask them those questions they know it's not good to be influenced that easily," Mohamed said. "That conversation then starts going, so at least it's a start."
Such frank conversations play a big role in helping students make healthy decisions, said Kate Faye, another TOPS facilitator. That includes not getting pregnant.
Faye, who graduated from high school in 2001, said the perspective brought by the TOP strategy is very different than when she was in school.
"We had sex ed, but it was brief and nobody talked about what is a healthy relationship," Faye said.
She tackles that subject head-on.
"Cross the line if you believe in love at first sight," Faye recently asked students at Minneapolis Employment Readiness Curriculum, an alternative high school.
Health teacher Becky Clark volunteers to go first.
When Clark was in school she decided to simply tell a boy she had a crush on him.
"He ran in the other direction," Clark recalled, as the students laughed with her. "There was physical running in the other direction."
Discussion about love, romance and crushes would be deemed inappropriate in other classes, but there is room for all those topics in the TOP sessions, Faye said.
"In TOP we have the luxury of being flexible," she said. "So, if our conversation takes us elsewhere where the students need to talk about something, we do it."
Besides classroom discussions about relationships and human sexuality, Hennepin County's pregnancy prevention program includes service learning.
Robbinsdale Cooper High School students help serve breakfast at a downtown Minneapolis homeless shelter for their project. Service learning through the TOP program shows them there's a bigger world outside of school, Mohamed said.
"I feel like TOP comes in and it tries to make sure that they get out of that bubble and really figure out what's around them and who needs help and who are you and how you can fit in this world," she said.