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May 1, 2014 Teenwise Minnesota 23 rd Annual Conference

Becoming “Teenwise” 101. May 1, 2014 Teenwise Minnesota 23 rd Annual Conference. Presentation Overview. Pregnancy, birth and STI statistics and trends Adolescent sexual behavior trends Health disparities

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May 1, 2014 Teenwise Minnesota 23 rd Annual Conference

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  1. Becoming “Teenwise” 101 May 1, 2014 Teenwise Minnesota 23rd Annual Conference

  2. 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

  3. 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

  4. 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)

  5. U.S. Adolescent Pregnancy Rates 1972-2008 & Adolescent Birth Rates, 1972-2012(pregnancies and births per 1,000 females aged 15-19) pregnancy rate birth rate 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.

  6. Adolescent Birth Rates U.S. & Minnesota, 1970-2012(number of births per 1,000 females aged 15-19) 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

  7. So, everything’s fine, right?

  8. 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

  9. 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.

  10. Adolescent Birth RatesU.S. vs. Minnesota, 2012(births per 1,000 females aged 15-19) Center for Health Statistics, Minnesota Department of Health, 2014; National Center for Health Statistics, 2013

  11. Minnesota Adolescent Birth Rates2011 vs. 2012(births per 1,000 females aged 15-19) Center for Health Statistics, Minnesota Department of Health, 2014

  12. Minnesota Adolescent Birth Rates by Race/Ethnicity, 1995-2012(number of births per 1,000 females aged 15-19, 3-year clusters) Hispanic/Latina Black American Indian 66.2 Asian/Pacific Islander 54.3 43.1 29.6 White 13.6 Center for Health Statistics, Minnesota Department of Health, 2014

  13. Number of Adolescent Births in Minnesotaage 15-19, 2012 Center for Health Statistics, Minnesota Department of Health, 2014

  14. Minnesota Adolescent Gonorrhea & Chlamydia Rates, 2003-2013(age 15-19 per 100,000 population) Center for Health Statistics, Minnesota Department of Health, 2012

  15. We’re number one…unfortunately. United Nations Statistics Division. (2010). Millennium Development Goals Indicators. Retrieved from: http://unstats.un.org/unsd/mdg/SeriesDetail.aspx?srid=761

  16. 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.

  17. Trends in Adolescent Sexual Behavior

  18. Nationally, 2/3 of adolescents have had sex while they are still in high school Percent of High School Students Who Have Had Sex At Least Once Centers for Disease Control and Prevention. YRBS, 2011. MMWR 2012;61, p. 24

  19. 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

  20. Percentage of sexually active adolescents in Minnesota, 2013 2013 Minnesota Student Survey

  21. Percentage of sexually active adolescents in Minnesota, 1992-2013 2013 Minnesota Student Survey

  22. Percent that used a condom with last intercourse, 1992-2013 2013 Minnesota Student Survey

  23. Why do adolescents get pregnant?

  24. What works to prevent teen pregnancy?

  25. 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!

  26. 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

  27. 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

  28. 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

  29. 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

  30. 17 Characteristics of Effective ProgramsKirby, 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

  31. 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

  32. 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

  33. 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

  34. 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

  35. 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

  36. 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

  37. 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

  38. Effective Sex Ed Curricula

  39. Effective Sex Ed Curricula • Becoming a Responsible Teen • Be Proud! Be Responsible! • ¡Cuídate! • Draw the Line, Respect the Line • FOCUS • It’s Your Game, Keep It Real • Making Proud Choices! • Promoting Health Among Teens (Abstinence-plus) • Reducing the Risk • Safer Choices • Teen Health Project

  40. 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

  41. Effective Youth Development Programs • AbanAya 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

  42. 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

  43. 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?

  44. 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

  45. 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

  46. Abstinence Interventions • Making a Difference! • Promoting Health Among Teens • Heritage Keepers Abstinence Education

  47. 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

  48. 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

  49. 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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