Transcript Document

Becoming “Teenwise” 101
May 1, 2014
Teenwise Minnesota 23rd Annual Conference
The source on adolescent sexual health
Presentation Overview
• Pregnancy, birth and STI statistics and trends
• Adolescent sexual behavior trends
• Health disparities
• Evidence-based approaches to promote adolescent
sexual health and prevent pregnancy/STI
• Characteristics of effective programs
• Further information and resources
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The Good News…
• Adolescent pregnancy rates in Minnesota have
decreased 58% from 1990 to 2012
• Adolescent birth rates in Minnesota have
decreased 49% from 1990 to 2012
• Although pregnancy and birth
increased for the first time in
16 years in 2006 and 2007,
rates declined again in 2008
and have continued through
2012
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• What do I mean by “teen”?
– 15-19 year olds
• What’s a birth rate?
– Rates are calculated per 1,000 females
– More accurate statistic than using numbers
– Birth certificate data – includes live births
• What’s a pregnancy rate?
– Rates are calculated per 1,000 females
– More accurate statistics than using numbers
– Includes births, induced abortions and fetal demise over 20
weeks gestation (for which there is a death certificate filed)
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U.S. Adolescent Pregnancy Rates 1972-2008
& Adolescent Birth Rates, 1972-2012
(pregnancies and births per 1,000 females aged 15-19)
120
100
95.1
pregnancy rate
80
60
68
61.7
birth rate
40
29.4
20
0
1972
1976
1980
1984
1988
1992
1996
2000
2004
2008
2012
Kost, K., & Henshaw, S. (2012). U.S. Teenage Pregnancies, Births and Abortions, 2008: National Trends by Age, Race and Ethnicity. Retrieved February 2012,
fromhttp://www.guttmacher.org/pubs/ustptrends08.pdf.
Martin JA, Hamilton BE, Osterman JK, et al. Births: Final data for 2012. National vital statistics reports; vol 62 no 9. Hyattsville, MD: National Center for Health
Statistics. 2013.
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Adolescent Birth Rates
U.S. & Minnesota, 1970-2012
(number of births per 1,000 females aged 15-19)
70
66
60
50
40
30
60
53
56
51
48
42
41
35
31
36
33
30
42 42.5 41.5
26 28
29
20
39
34
27
24 22.4
31.3 29.4
United States
Minnesota
19.3 18.6
10
0
1970 1980 1985 1990 1995 2000 2005 2006 2007 2008 2009 2010 2011 2012
Martin JA, Hamilton BE, Osterman JK, et al. Births: Final data for 2012. National vital statistics reports; vol 62 no 9. Hyattsville, MD: National Center for Health
Statistics. 2013.
Center for Health Statistics, MDH, 2014
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So, everything’s fine, right?
The source on adolescent sexual health
The not so good…
• Every day in Minnesota about 12 adolescents become pregnant;
about 4,500 every year
• There are significant disparities in adolescent pregnancy, birth, and
STI rates
• Chlamydia and gonorrhea rates continue to rise
• Fewer young people report using condoms during their last sexual
encounter
• Societal costs of not investing in youth…
– Adolescent mothers are more likely to drop out of school, receive late or no
prenatal care, rely on public assistance, become single parents and live in
poverty
– Children born to adolescents have higher rates of health, learning, and social
challenges
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Three in ten females get pregnant
at least once before age 20.
Source: National Campaign to Prevent Teen Pregnancy. (April 2010). Briefly:…Teen Pregnancy and Childbearing in the United States: Ten Headlines. Retrieved from
http://www.thenationalcampaign.org/resources/pdf/Briefly_Teen-Pregnancy-and-Childbearing-Ten-Headlines.pdf.
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Adolescent Birth Rates
U.S. vs. Minnesota, 2012
(births per 1,000 females aged 15-19)
70
60
60.4
51.9
50
40
39
34.9
43.9
46.3
27
30
20.5
20
10
0
12.8
9.7
American Indian
Asian/Pacific Islander
Black
Hispanic/Latina
Center for Health Statistics, Minnesota Department of Health, 2014; National Center for Health Statistics, 2013
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White
MN
US
Minnesota Adolescent Birth Rates
2011 vs. 2012
(births per 1,000 females aged 15-19)
80
60
71.6
60.4
48.6
51.9
40.3 39.0
40
29.6
2012
27.0
20
0
2011
13.3 12.8
American Indian
Asian/Pacific Islander
Black
Hispanic/Latina
Center for Health Statistics, Minnesota Department of Health, 2014
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White
Minnesota Adolescent Birth Rates by
Race/Ethnicity, 1995-2012
(number of births per 1,000 females aged 15-19, 3-year clusters)
150
125
Hispanic/
Latina
Black
100
75
50
American
Indian
66.2
Asian/
Pacific Islander
54.3
43.1
25
29.6
13.6
White
0
1995-97
1998-2000
2001-03
2004-06
Center for Health Statistics, Minnesota Department of Health, 2014
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2007-09
2010-2012
Number of Adolescent Births in Minnesota
age 15-19, 2012
2000
1909
1500
1000
581
574
500
212
0
American Indian
325
277
Asian/Pacific
Islander
Black
Hispanic/Latina
Center for Health Statistics, Minnesota Department of Health, 2014
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White
Other/Unknown
Minnesota Adolescent Gonorrhea &
Chlamydia Rates, 2003-2013
(age 15-19 per 100,000 population)
1600
1384
1200
927
968
989
1032 1071
1164 1196
1458
1394
1273
Chlamydia
Gonorrhea
800
400
209
198
213
216
229
214
163
164
158
213
267
0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Center for Health Statistics, Minnesota Department of Health, 2012
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We’re number one…unfortunately.
Netherlands
Switzerland
Japan
Denmark
Sweden
Italy (2006)
Norway
Finland
Germany
France
Greece
Spain
Canada
Australia
Portugal
United Kingdom (2006)
United States
0.0
3.8
4.3
4.9
5.6
6.0
6.9
Adolescent Birth Rate, 2007
9.1
9.2
10.0
10.5
11.2
13.3
14.1
16.0
17.0
26.7
5.0
10.0
15.0
20.0
25.0
41.3
30.0
35.0
40.0
45.0
United Nations Statistics Division. (2010). Millennium Development Goals Indicators. Retrieved from: http://unstats.un.org/unsd/mdg/SeriesDetail.aspx?srid=761
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State Adolescent Birth Rates, 2011
(births per 1,000 females aged 15-19)
Martin, J. A., Hamilton, B. E., Ventura, S. J., & Osterman, M. J. K. (2013). Births: Final data for 2011. Hyattsville, MD: National Center for Health Statistics.
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Trends in Adolescent Sexual Behavior
The source on adolescent sexual health
Nationally, 2/3 of adolescents have had
sex while they are still in high school
100
Percent of High School Students Who Have Had Sex At Least Once
75
50
64
63
38
45
55
43
52
28
25
0
Males
9th grade
Females
10th grade
11th grade
Centers for Disease Control and Prevention. YRBS, 2011. MMWR 2012;61, p. 24
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12th grade
Minnesota Student Survey changes
• The 2013 Minnesota Student Survey was administered
to public school students in Grades 5, 8, 9, and 11
statewide
• Past student surveys were administered to students in
Grades 6, 9 and 12. As a result, trend data is limited to
9th grade only
• Approximately 69% of 9th graders and 62% of 11th
graders participated in the 2013 Minnesota Student
Survey
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Percentage of sexually active adolescents
in Minnesota, 2013
40
38
37
Female
20
Male
17
13
0
9th grade
11th grade
2013 Minnesota Student Survey
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Percentage of sexually active adolescents
in Minnesota, 1992-2013
70
61.2
55.1
50
50
30
47.9
45.9
48.4
50.5
37
29.7
27.6
9th graders
23.3
19
19.7
18.9
2001
2004
2007
20
11th grade
15.0
10
1992
1995
1998
12th graders
-10
2013 Minnesota Student Survey
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2010
2013
Percent that used a condom with
last intercourse, 1992-2013
80
69.8
68.2
70
63.4
63.1
61.5
60.2
60
69.8
70.3
62.9
68.5
61
65
64.0
56.5
12th grade
54
51.1
11th grade
50
40
1992
1995
1998
9th grade
2001
2004
2013 Minnesota Student Survey
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2007
2010
2013
The source on adolescent sexual health
Why do adolescents get pregnant?
The source on adolescent sexual health
What works to prevent teen pregnancy?
The source on adolescent sexual health
We know what works!
• Comprehensive sex and HIV education
• Programs combining sex and HIV education and youth
development approaches
• Clinic interventions with one-on-one counseling
• Access to clinical services/contraception
• Evidence-based strategies!
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How to use
Evidence-Based Approaches
1. Replicate scientifically evaluated programs with fidelity
2. Incorporate the characteristics of scientifically
evaluated programs
3. Develop programs to address risk and protective
factors related to teen pregnancy, and use logic models to
show how interventions affect factors, which in turn
create desired outcomes
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Risk & Protective Factors
• More than 500 factors are known to increase or
decrease the chances that adolescents will engage in
risky sexual behavior
• Both risk and protective factors influence adolescent
sexual behavior
• Programs to prevent adolescent pregnancy and STD
should focus on the factors most strongly related to
sexual behavior, and those that are more amenable to
change
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Risk Factors
Those factors that encourage one or more behaviors that
might lead to pregnancy or sexually transmitted disease,
or discourage behaviors that might prevent pregnancy or
STIs
Alcohol/drug use
 Gang involvement
 Permissive or positive peer attitudes about sex
and childbearing; sexually active peers
 More frequent dating
 New sexual relationship
 Greater number of partners
 Older age of partner

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Protective Factors
Just the opposite- they discourage one or more
behaviors that might lead to pregnancy or STD or
encourage behaviors that might prevent them
Greater family support
 Parental disapproval of teenagers having sex
 Discussing sexual risks with partner
 Greater parent-child communication about sex
 Positive peer norms or support for
contraceptive use
 Peer use of condoms
 Sexual beliefs, attitudes and skills

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17 Characteristics of Effective Programs
Kirby, Laris, Rolleri – ETR Associates
• Researchers conducted a worldwide search for rigorously
evaluated sexuality education and HIV prevention curricula, and
• Determined the common characteristics of effective programs
Three Categories
• Program Development
• Program Content
• Program Implementation
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Characteristics of Effective Programs
• Program Development
– Involved multiple people with different backgrounds to
design curriculum
– Assessed relevant needs and assets of target group
– Used logic model approach
– Designed activities consistent with community values and
resources available (staff time, staff skills, facility space,
and supplies)
– Pilot-tested the program
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Characteristics of Effective Programs
(continued)
• Program Content
– Focused on clear health goals: the prevention of
STI/HIV and/or pregnancy
– Focused narrowly on specific behaviors leading to these
health goals
– Addressed multiple sexual psychosocial risk and protective
factors affecting sexual behaviors
– Created a safe social environment
– Covered topics in a logical sequence
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Characteristics of Effective Programs
(continued)
• Program Content
(continued)
– Included multiple activities to change each of the targeted
risk and protective factors
– Used instructionally sound teaching methods that
• Actively involved the participants
• Helped participants personalize the information, and
• Were designed to change each group of risk and protective
factors
– Used activities, teaching methods and messages
appropriate for youth’s culture, developmental age, and
sexual experience
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Characteristics of Effective Programs
(continued)
• Program Implementation
– Secured at least minimal support from appropriate authorities
– Selected educators with desired characteristics, and then trained
them
– If needed, implemented activities to recruit youth and
overcame barriers to their involvement
– Implemented virtually all activities with reasonable fidelity
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Evidence-Based Interventions (EBIs)
• Emerging Answers
– Published by Doug Kirby in 2007, includes 15 EBIs
• Science and Success
– Published by Advocates for Youth in 2008, includes 26 EBIs
• Mathematica/Office of Adolescent Health
– Published in Spring 2010 (updated April 30, 2012), includes 31 EBIs
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Programs that “work”- what does that mean?
•
•
•
•
Completed or published in 1990 or after
Conducted in the United States
Targeted middle/high school age youth (age <19)
Employed an experimental or quasi-experimental design with
appropriate statistical analyses
• Had a sample size of at least 100 in the combined treatment
and control group
• Low attrition
• Statistically significant impact on sexual behavior over time
– Sexual activity, contraceptive/condom use, STIs, pregnancies & births
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Curriculum-Based Sex and STD/HIV
Education Programs
• Based on written curriculum
• Implemented among groups of young people in school,
clinic, or community settings
• Education programs on both
behavior and risk and protective
factors that mediate behavior
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Effective Sex Ed Curricula
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Effective Sex Ed Curricula
•
Becoming a Responsible
Teen
•
Making Proud Choices!
•
Promoting Health Among
Teens (Abstinence-plus)
•
Be Proud! Be Responsible!
•
¡Cuídate!
•
Reducing the Risk
•
Draw the Line, Respect
the Line
•
Safer Choices
•
Teen Health Project
•
FOCUS
•
It’s Your Game, Keep It
Real
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Youth Development Programs
• Evaluated numerous times and have been consistently
found to be effective at either delaying the initiation of
sex or reducing teen pregnancy
• Have two components: community volunteering and
structured time for preparation and reflection before,
during, and after service
• Often linked to academic
instruction in the classroom
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Effective Youth Development Programs
• Aban Aya Youth Project
• Adult Identity Mentoring: Project AIM
• Children’s Aid Society –
Carrera Program
• Raising Healthy Children
• Reach for Health Community
Youth Service Learning
• Teen Outreach Program
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Clinic Protocols and One-on-One Programs
• Designed to provide teens with reproductive health care
or to improve access to condoms or other
contraceptives
• Four types of clinic-based programs:
–
–
–
–
Family planning services
Advance provision of emergency contraception
Other clinic characteristics and programs
Detailed plans, or protocols, for clinic appointments and
supportive services
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Effective Clinical Interventions
•
•
•
•
•
•
•
•
•
•
HIV Risk Reduction for African American and Latina Teenage Women
Project SAFE
SiHLE: Sistas, Informing, Healing, Living, Empowering
Tailoring Family Planning Services to the Special Needs of Adolescents
TLC: Together Learning Choices
Reproductive Health Counseling for Young Men
Horizons
Safer Sex
Sisters Saving Sisters
What Could You Do?
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Parent-Teen Programs
• Designed to increase parent-child communication,
including programs for:
– parents only
– programs for parents and teens together
– homework assignments in school sex education
classes requiring communication with parents
– video programs with written materials to complete
at home
• Keepin’ It R.E.A.L.!
• Respeto/Proteger
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Interventions for Special Populations
• All4You!
– alternative high schools
• Assisting in Rehabilitating Kids (ARK)
– substance dependent youth in detox facilities
• Be Proud! Be Responsible! Be Protective!
– pregnant and parenting females
• Project TALC
– parents living with HIV & their adolescent children
• Rikers Health Advocacy Program (RHAP)
– drug users & youth in correctional facilities
• Sexual Health and Adolescent Risk Prevention (SHARP)
– youth in juvenile detention facilities
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Abstinence Interventions
• Making a Difference!
• Promoting Health Among Teens
• Heritage Keepers Abstinence Education
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Conclusions
• More work left to do!
• Not just a “girl” thing—involve males & parents
• Disparities must be addressed by concentrating
efforts in high-rate areas
• Programs that tackle both sexual and non-sexual risk
and protective factors can be effective
• We CAN reduce teen pregnancy, birth and STI rates
dramatically
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Resources
•
Advocates for Youth – www.advocatesforyouth.org
•
•
•
•
•
•
Creates programs & advocates for policies that help young people make informed and
responsible decisions about reproductive and sexual health
National Campaign – www.teenpregnancy.org
• Their mission is to promote values, behavior, and policies that reduce both teen pregnancy and
unplanned pregnancy among young adults
Healthy Teen Network – www.healthyteennetwork.org
• A national network of diverse individuals and organizations dedicated to preventing adolescent
sexuality, pregnancy and parenting
ETR Associates – www.etr.org/recapp
• Best practices in pregnancy prevention education, information on evidence-based programs and
current research
Guttmacher Institute – www.guttmacher.org
• Research, policy analysis and public education on abortion, law/public policy, pregnancy, birth,
prevention and contraception, HIV/STIs
SIECUS – www.siecus.org
• SIECUS develops, collects and disseminates information, promotes comprehensive sexuality
education and advocates for the right of individuals to make responsible sexual choices
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Evidence-Based Intervention Resources
• Science and Success
•
www.advocatesforyouth.org/publications/ScienceSuccess.pdf
• Emerging Answers 2007
•
www.thenationalcampaign.org/EA2007
• Mathematica Policy Research EBI Review
•
http://www.hhs.gov/ash/oah/oah-initiatives/tpp/tpp-database.html
• Sex and HIV Programs for Youth: Their Impact and Important
Characteristics
•
www.etr.org/recapp/programs/SexHIVedProgs.pdf
• A Tool to Assess the Characteristics of Effective Sex and HIV Education
Programs
•
www.etr.org/recapp/theories/tac.pdf
• Minnesota Sexuality Education Resource Review Panel (MSERRP)
•
www.teenwisemn.org/resources/curriculum_review.html
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Thank you!
Jill Farris, MPH
Director of Training and Education
Teenwise Minnesota
[email protected]
651-289-1381
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