Transcript Public Health Reports Meet the Author! Live Webcast

Public Health Reports
Webinar on
Understanding Sexual Health: Overview
March 12, 2013
1:00 PM - 2:00 PM EDT
Public Health Reports Webinar on
Understanding Sexual Health: Overview
Mary Beth Bigley, Dr.P.H., M.S.N., A.N.P.
Acting Editor, Public Health Reports
Office of the Surgeon General
Public Health Reports Webinar on
Understanding Sexual Health: Overview
John M. Douglas, Jr, M.D..
Chief Medical Officer
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
Sexual Health: Surgeon General’s Call to Action
• Focused on the need to promote sexual
health and responsible sexual behavior
across the lifespan
– Essential component of overall
individual health
– Has major impact on overall health
of communities
– National dialogue at all levels critical
in improving population health
• Primary goal to stimulate respectful,
thoughtful, and mature discussion in
our communities and in our home about
sexuality.
Sexual Health in the U.S.: Why Now?
• High population burden of adverse outcomes related to sexual behavior
– HIV/STD
• Estimated 1.1 million living with HIV, 50,000 new infections/year
• 19.7 million STI each year—almost half among persons 15-24
• 25% adolescent F infected with at least one STD
– Unintended/teen pregnancy
• Nearly 50% of all pregnancies in the U.S. are unintended
• U.S. with one of highest teen birth rates of industrialized nations
– Sexual violence
• Annual estimates: 1. 3 million F raped, 6.7 m F and 6 m M with other sexual violence
victimization
• Health equity/ disparities concern
– African–Americans: HIV rates 8 to 20x Whites
– MSM: 40-50x higher HIV rates than other males
• High economic burden—estimated annual costs
– STD/HIV:
– Teen childbearing:
– Rape/other sexual assault
$17 billion
$11 billion
$12 billion
What is Sexual Health?
• WHO definition (2006)
– state of physical, emotional, mental,
and social well-being related to
sexuality
– not merely absence of disease,
dysfunction, or infirmity.
– requires a positive and respectful
approach to sexual relationships, as
well as possibility of having
pleasurable & safe sexual
experiences, free of coercion,
discrimination, and violence.
– for sexual health to be attained and
maintained, the sexual rights of all
persons must be respected,
protected, and fulfilled.
CDC/HRSA Advisory Committee Definition of
Sexual Health: A Public Health Perspective
• Sexual health is a state of wellbeing in relation to sexuality across the
lifespan that involves physical, emotional, mental, social, and spiritual
dimensions.
• Sexual health is an inextricable element of human health and is based on a
positive, equitable, and respectful approach to sexuality, relationships, and
reproduction, that is free of coercion, fear, discrimination, stigma, shame,
and violence.
• It includes the ability to understand the benefits, risks, and responsibilities
of sexual behavior; the prevention of disease and other adverse outcomes;
and the possibility of fulfilling sexual relationships.
• Sexual health is impacted by socioeconomic and cultural contexts–including
policies, practices, and services–that support healthy outcomes for
individuals, families, and their communities.
Recommended by the CDC-HRSA Advisory Committee on HIV, STD, and Viral Hepatitis Prevention
and Treatment, May 2012 (CHAC Minutes:
http://www.cdc.gov/maso/facm/pdfs/CHACHSPT/20120508_CHAC.pdf)
Douglas JM, Fenton K. Understanding sexual
health and its role in more effective prevention
programs. Public Health Reports 2013
Addressing Sexual Health
• Over past decade, increasing attention to
addressing the concept of sexual health
• Public health premise: sexual health promotion
– great potential to complement traditional disease control
and prevention efforts for a range of conditions (eg, HIV,
STD, viral hepatitis, unintended pregnancy, sexual
violence)
– not to replace traditional efforts but to improve their
acceptance and population impact
Douglas JM, Fenton K. Understanding sexual
health and its role in more effective prevention
programs. Public Health Reports 2013
Sexual Health Framework:
Emphasizing Health Promotion to Enhance Disease Control
and Prevention
Potential Benefits
• Engage new and diverse
partners
• Normalize conversations
• Reduce stigma, fear, and
discrimination
• Enhance the efficiency and
effectiveness of prevention
messaging and services
Ivankovich et al. Considerations for national
public health leadership in advancing sexual
health. Public Health Reports 2013
Sexual Health: A National Priority

2010—National HIV/AIDS Strategy
 “Provides an opportunity for working together to
advance a public health approach to sexual health that
includes HIV prevention as one component”

2011—Healthy People 2020
 “Reproductive and Sexual Health” is a leading health
indicator

2011—National Prevention Strategy
 Vision: Working together to improve health and
quality of life by moving from a focus on sickness and
disease to one based on prevention & wellness
 “Reproductive and Sexual Health” is one of seven
priority areas
Public Health Reports Supplement
on Sexual Health
• Priority topics
– Research
– Surveillance
– Program
– Perspectives
Public Health Reports Supplement on
Sexual Health
• Research
– Susan Kirby: Beginning a conversation on sexual health
• Programs
– Robert Nystrom: Shifting the paradigm in Oregon from
teen pregnancy prevention to youth sexual health
• Perspectives
– Edward Hook: Sexual health education—frame-shifting
and its challenges
Public Health Reports
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A Communication
Framework for Sexual Health
Susan D. Kirby, Dr.PH, MPH
President, Kirby Marketing Solutions
Finding Common Communication Ground
• CDC recognizes the need to work with a
wide variety of partners who hold differing
viewpoints
• Communicating about sexual health may be
difficult when you don’t share same values
• Communication is important and we need
everyone to participate in the conversation
• Finding common communication ground is a
starting place …
Understanding is framebased, not fact-based
Effective communication
can reframe understanding
We typically reject information that
doesn’t fit our frame, not the frame
Mental maps we use
to navigate the world
We fit new information
into our frames
A set of beliefs and values developed
over a lifetime of experiences
Robert Wood Johnson Foundation’s
Social Determinants Research
Democrats’ Frame
Republicans’ Frame
• Complex, interdependent
social systems influence
the health of people
• Life and health are
journeys through
unpredictable paths
• People need opportunity
to make good choices
Your opportunity for health starts long before
you need medical care.
Health starts—long before illness—in our homes,
schools and jobs.
Methodology
• Environmental scan
— Media
• Frame development
— Diverse external and internal
stakeholders
— Developed 4 frames, 30 messages
• Interviews
— 26 diverse community and health
professionals
— Revised messages
• Online surveys
— 240 public
— 70 health professionals
Four Frames & Example Messages
1. Navigating a Journey/Choices
Life is a series of choices, including sexual choices. Throughout their
lives, all people need information and skills to make healthy sexual
choices that reflect their own values and deeply held beliefs.
2. Health Promotion/Wellness
Living a healthy lifestyle is important to good health, and this
includes sexual health, too. It’s time we focused on promoting and
encouraging the behaviors that improve the emotional, social,
spiritual, and physical aspects of sexuality.
3. Working Together
As a society, we have the responsibility to help all Americans make
healthy sexual choices.
4. Fair Chance/Fair Opportunity
All people need to have a fair chance to make informed choices about
their sexual health.
Focus on Framing Results
58%
49%
Public
Health
Promotion/Wellness
21%
28%
Navigating a
Journey/Choices
46%
Fair Chance/Fair
Opportunity
49%
Professionals
31%
40%
0%
20%
40%
Working Together
60%
80%
Most accepted frames by general public and professional respondents
Making Messages Fit a Shared Frame
Journey/Choices Frame Messages
• Public: Throughout life, we all make choices, including sexual
choices. Along the way, all of us need the information, knowledge,
and skills that will help us make sexual choices that protect us from
the risks and dangers of unhealthy sexual activity.
• All Professionals: Throughout life, we all make choices, including
sexual choices. Along the way, Americans need the information,
knowledge, and skills that will help them make sexual choices that
protect their health and future partners.
Wellness Frame Messages
• Moderates, Conservatives, Professionals
• Liberals
Visit the article at Public Health Reports for the full message set on p.50
What’s Next?
• Findings developed in a positive direction,
but there’s more we need to know
• Needs replication in more contexts and in
more real life “campaigns”
• The field needs to know more about how
specific health or social issues interact with
frame preferences
• We need to understand how to use framing
to build broad consensus movements
Public Health Reports
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Shifting the Paradigm in Oregon from Teen
Pregnancy Prevention to Youth Sexual Health
Robert Nystrom
Section Manager
Adolescent, Genetics & Reproductive Health
Oregon Public Health Division
History
• 3rd decade of plans
Oregon Youth Sexual Health Plan
—1994-2002
• Policy & systems
—Minor consent
—Sexuality education
—School-Based Health Centers
• Governor’s directive 2005
• Oregon Youth Sexual Health Partnership
• Plan released in 2009
Plan Development
Community Survey
Youth Action Research
Community Forums
Use of Data
Literature Reviews
Youth Action Research
Schools or Youth Serving
Organizations
Communications
Community Seed Grants
Inform Community
Policy Change
State & Local
Public Health
Youth Action Research Team
Evaluation expertise
Data gathering &
analysis
Adult mentors and
coaches
Five Overarching Goals
•
•
•
•
•
Youth use accurate information and well
developed skills to make thoughtful choices
about relationships
Sexual health inequities are eliminated
Rates of unintended teen pregnancy are
reduced
Rates of sexually transmitted infection are
reduced
Non-consensual sexual behaviors are reduced
Objectives
1.
Infrastructure
2.
3.
4.
5.
6.
7.
8.
Policy
Health Inequities
Youth Development
Education for Youth and Families
Services for Youth and Families
Data
Assurances
Accomplishments - Outputs
• Expansion of clinical services
• Revised/strengthened K-12 comprehensive
sexuality education statute
— Teacher training on LGBTQ inclusiveness
• AMCHP/ASTHO learning collaborative
• Research series on sexual health of disenfranchised youth
• Implemented/expanded community
interventions & programs program
Making it work for Oregon’s youth…
Evidencebased policy,
programs &
strategies
OYSHP Effective
public &
private sector
partnerships
State & local
coordination
Authentic youth &
community
engagement
Data & Science Review
Communitydriven
priorities
Healthy
Youth
Implications - Going Forward
National
• Oregon’s experience serves as a model for other states
to shift from a risk-problem focused framework to a
more PYD framework that promotes sexual health
• Importance of authentic community & youth
engagement and interest-based problem solving
Oregon
• Evaluating plans early efforts
• Expand state capacity to use Youth Action Research
(YAR) or to apply it to other public health topics
• Expand focus on addressing disparities & inclusiveness
Public Health Reports
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Sexual Health Education:
Frame Shifting and Its Challenges
Edward W. Hook III M.D.
Professor of Medicine, Epidemiology, and Microbiology
University of Alabama at Birmingham,
Alabama/North Carolina STD/HIV Prevention Training Center
And Jefferson County Department of Health
Birmingham Alabama
Historical Partners in U.S.
STD Prevention
• American Society for Sanitary and Moral
Prophylaxis (1905) – (Coalition of physicians, social
hygienists, charity groups, moral reformer churches)
• American Social Hygiene Association (1913)
• Armed Forces
• U.S. Public Health Services
Brandt, AM. No Magic Bullet, Oxford Univ Press, 1985.
Conventional Wisdom
Regarding STIs
•
•
•
•
STIs are the result of inappropriate behavior
People with STIs will know they have them
Efforts to control STIs should focus on women
Sex (and STIs) is not an appropriate topic for
conversation
Stigma
Intolerance
Consequences of STI-Related Stigma
Personal (Individual)
• Delays in using or seeking preventative health care
—
—
—
•
•
Condoms
Vaccines
Screening
Delays in seeking care for perceived problems
Ineffective partner notification
Provider
• Hesitancy in seeking relevant information
• Differential testing
• Changes to provider-client interactions
Population
• Guilt by association
• Differential Care
• Profiling
Framing – influenced by context; anticipated to
have selective influence on perception,
encouraging certain interpretation,
discouragement, others (Wikipedia)
A sexual health framework shifts the approach from a
more traditional loss frame approach to a gain frame
• Gain frame – Emphasizes positives, benefits
• Loss frame – Emphasizes risks, potential harm,
potentially fueling shame and stigma
Self-Reflective Questions on Sexual Health
1. Have you ever hesitated to take a sexual history?
2. Have you ever hesitated to test for STIs because
you worry that a client may find it troublesome
or insulting?
3. Have you ever apologized for making a STI
diagnosis?
Loss Frame/Gain Frame Examples
Sexual History
Loss Frame
Gain Frame
Partner Type
Have you ever had
homosexual sex?
Partner Type
Are your partners men,
women or both?
Sites of exposure
Have you had oral or
rectal sex , or just regular
sex?
Sites of exposure
When you have sex, what
sites are exposed- oral,
rectal or genital?
Health Education Opportunities Derived
From a Sexual Health Approach
Patients (Empowering)
• Life Course Perspective
• Reduces Consequences of Perceived Stigma
• Broadly Encourages Preventative Health Care (Women
AND Men)
• Vaccines
• Screening
Providers (Permissive)
• Life Course Perspective
• Reduces Consequences of Perceived Stigma
• Efficiency- Addresses Existing Redundancy
Questions?
Closing
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