1 Becoming Teenwise 101 May 2, 2013 Teenwise Minnesota 22 nd 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 over 49% from 1990 to 2010 Adolescent birth rates in Minnesota have decreased 38.5% from 1990 to 2010 Although pregnancy and birth increased for the first time in 16 years in 2006 and 2007, rates declined again in 2008, 2009 and 2010
4 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 & Adolescent Birth Rates, (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:// Fast Facts: Summary of 2011 Preliminary Birth Data from the National Center for Health Statistics (NCHS),
7 So, everything s fine, right?
8 The not so good Every day in Minnesota about 15 adolescents become pregnant; about 5,400 every year There are significant disparities in adolescent pregnancy, birth, and STI rates More young people are having sexual intercourse 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
10 Adolescent Birth Rates U.S. vs. Minnesota, 2010 (births per 1,000 females aged 15-19) MN US 0 White African American American Indian Asian/Pacific Islander Hispanic/Latina Center for Health Statistics, Minnesota Department of Health, 2012; National Center for Health Statistics, 2011
11 Minnesota Adolescent Birth Rates 2009 vs (births per 1,000 females aged 15-19) White African American American Indian Asian/Pacific Islander Hispanic/Latina Center for Health Statistics, Minnesota Department of Health, 2012
12 Minnesota Adolescent Birth Rates by Race/Ethnicity, (number of births per 1,000 females aged 15-19, 3-year clusters) African American American Indian Hispanic/ Latina Asian/ Pacific Islander White Center for Health Statistics, Minnesota Department of Health, 2012
13 Number of Adolescent Births in Minnesota age 15-19, White African American American Indian Asian/Pacific Islander Hispanic/Latina Other/Unknown Center for Health Statistics, Minnesota Department of Health, 2011
14 Minnesota Adolescent Gonorrhea & Chlamydia Rates, (age per 100,000 population) Chlamydia Rate Gonorrhea Rate 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:
16 State Adolescent Pregnancy Rates, 2005 (pregnancies per 1,000 females aged 15-19) The Alan Guttmacher Institute. (2011). State Data Center. Retrieved from:
17 State Adolescent Birth Rates, 2009 (births per 1,000 females aged 15-19) accessed 4/25/13
21 Why do adolescents get pregnant?
22 Other Trends in the Field
23 Young people are at risk of unintended pregnancy & STIs for a long time! MALE AGE FEMALE The Alan Guttmacher Institute (AGI), In Their Own Right: Addressing the Sexual and Reproductive Health Needs of American Men, New York: AGI, 2002, p. 8.
24 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, MMWR 2012;61, p. 24
25 Percentage of sexually active adolescents in Minnesota, Minnesota Student Survey
26 Percentage of sexually active adolescents in Minnesota, Minnesota Student Survey
27 Percent that used a condom with last intercourse, Minnesota Student Survey
28 Contraceptive Use Always use birth control Never use birth control 2010 Minnesota Student Survey
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30 What works to prevent teen pregnancy?
31 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!
32 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
33 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
34 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
35 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
36 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
37 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
38 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
39 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
40 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
41 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
42 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
43 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
44 Effective Sex Ed Curricula
45 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
46 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
47 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
48 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
49 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?
50 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
51 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
52 Abstinence Interventions Heritage Keepers Abstinence Education Making a Difference! Promoting Health Among Teens (Abstinence-only)
53 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
54 Resources Advocates for Youth Creates programs & advocates for policies that help young people make informed and responsible decisions about reproductive and sexual health National Campaign Their mission is to promote values, behavior, and policies that reduce both teen pregnancy and unplanned pregnancy among young adults Healthy Teen Network A national network of diverse individuals and organizations dedicated to preventing adolescent sexuality, pregnancy and parenting ETR Associates Best practices in pregnancy prevention education, information on evidence-based programs and current research Guttmacher Institute Research, policy analysis and public education on abortion, law/public policy, pregnancy, birth, prevention and contraception, HIV/STIs SIECUS SIECUS develops, collects and disseminates information, promotes comprehensive sexuality education and advocates for the right of individuals to make responsible sexual choices
55 Evidence-Based Intervention Resources Science and Success Emerging Answers Mathematica Policy Research EBI Review Sex and HIV Programs for Youth: Their Impact and Important Characteristics A Tool to Assess the Characteristics of Effective Sex and HIV Education Programs Minnesota Sexuality Education Resource Review Panel (MSERRP)
56 Thank you! Jill Farris, MPH Director of Training and Education