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1 Addressing Adolescent Pregnancy in Guilford County A White Paper May 2009

2 Addressing Adolescent Pregnancy in Guilford County-A A White Paper Robert W. Strack, PhD, MBA Virginia Brown, DrPH Candidate Muhsin Michael Orsini, EdD University of North Carolina Greensboro Department of Public Health Education Making Good Health Happen August 31 st, 2009

3 A son's crime becomes his mother's punishment Greensboro News & Record Sunday, March 15, 2009 By Jeri Rowe Deandre Purvis will be in jail for a long time. He got caught in the vicious cycle we all hear about. No father. A single mother. An impressionable teenager drawn to the glamorous life of a gangster. He committed a string of armed robberies, got popped by the cops and had his mug shot flashed on the 6 o clock news. Monica Purvis thinks about her oldest son every day. Ashley isn t married. She plans to graduate from Smith in June and go to GTCC to study nursing Ashley, her 18-year-old daughter, a senior at Smith High, gave birth three weeks ago to Monica s first grandchild, a girl named Amieria Pierson. Monica had Deandre when she was young. She was 20, unmarried, just a few years out of prison herself. A high school dropout raised by her mother and grandmother Monica didn t know her father, either She had two more children. The fathers were never involved in their lives.

4 Teenage Pregnancy Perpetuates Poverty

5 Outcomes of Teen Pregnancy What are the Baby s Chances? A baby is 9 TIMES more likely to grow up in poverty if his/her mother is: a teenager, unmarried, and does not graduate from high school. SOURCE: The National Campaign to Prevent Teen Pregnancy analysis of Historical Income Tables Households, U.S. Census Bureau, Page 7

6 Costs for the Children of Teen Mothers Children of teen mothers are more likely to: Have decreased educational attainment Earn less money Suffer high rates of child abuse and neglect Grow up poor Live in single-parent households Enter the child-welfare system Become teen mothers themselves

7 Why Care? The Costs of Teen Childbearing

8 Why Care? One in three teens becomes pregnant by age 20. One-quarter of teen parents have a second child before they turn 20. Higher teen pregnancy and birth rates than comparable countries. Recent data show declines in teen birth rates are slowing.

9 We ve Made Progress National Teen Pregnancy Rates, (number of pregnancies per 1,000 girls aged 15-19) After increasing 23 percent between 1972 and 1990 (including 10 percent between 1987 and 1990), the teen pregnancy rate for girls (15-19) decreased 36 percent between 1990 and 2002 to a record low The Alan Guttmacher Institute. (2006). U.S. Teenage Pregnancy Statistics National and State Trends and Trends by Race and Ethnicity. New York, NY: The Alan Guttmacher Institute. 75.4

10 More to Feel Good About National Teen Birth Rates, (number of births per 1,000 girls aged 15-19) From 1940 to 1957, the teen birth rate increased 78% to a record high. The birth rate dropped fairly steadily from the end of the 1950s through the mid-1980s, but then increased 23% between 1986 and Between 1991 and 2005*, the teen birth rate decreased 35% to a record low of 40.4 in *Data for 2005 are preliminary * Ventura, S.J., Mathews, T.J, & Hamilton, B.E. (2001). Births to Teenagers in the United States: National Vital Statistics Reports, 49(10).; Hamilton, B.E., Martin, J.A., & Ventura, S.J. (2006). Preliminary Data for Health E-Stats. Released November 21, 2006.

11 Pregnancy Rate among Females Ages By Race, Guilford County, Guilford County teen pregnancy rates followed national trends and declined have increased from Pregnancy Rate among Females Ages By Race, Guilford County, Rate per 1,000 females ages Whites Other Races Guilford NC Center for Health Informatics and Statistics Page 9

12 2007 Teen Pregnancies in Guilford County for Year Olds 2007 Teen Pregnancies in Guilford County for Year Olds Female Population # of Pregnancies Rate (per 1,000 girls) White 9, African American 7, Hispanic Page 9

13 Abortion Rates among Females Ages By Race, Guilford County,

14 The Costs of Teen Childbearing

15 Costs Included in the Analysis Costs linked to teen moms Public assistance Lost tax revenue Costs linked to the children of teen parents Lost tax revenue Public Health Care Incarceration of sons Child welfare Costs linked to teen fathers Lost tax revenue

16 By The Numbers: The Public Costs of Teen Childbearing Guilford County Costs of Teen Childbearing $13.6 MILLION National Campaign to Prevent Teen Pregnancy By the Numbers: The Public Costs of Teen Childbearing in North Carolina, National Campaign to Prevent Teen Pregnancy, Washington, DC

17 Public and Moses Cone Costs Social Costs for adolescent childbearing in 2004 (3, 4) The United States - $9.1 billion North Carolina - $312 million Guilford County -$13.6 million In 2008 the average cost for an uncomplicated birth at Women s Hospital was $3, per case. $13.6 million in taxpayer cost for Guilford County based on 593 births to adolescents in $54 million for public health care (Medicaid and SCHIP); $36 million for child welfare; $61 million for incarceration of the sons of teen parents; $105 million in lost tax revenue due to decreased earnings and spending. Women s Hospital of Greensboro incurred $537,775 in unreimbursed costs for women 19 and under that gave birth in FY 2008 (1). Page 7,8

18 Costs to School System Teen parenthood and educational disadvantage: Children of teen moms are 50% more likely to repeat a grade less likely to complete high school delayed in independent reading and early writing skills score lower on school readiness, cognition, language, communication and interpersonal skill measures. For teen moms - adolescent childbearing is leading cause of school dropout for girls Page 8

19 Number of Classrooms filled* in 2009 with Children born to Adolescent Moms from in Guilford County Number of Classrooms filled in 2009 with Children born to Adolescent Moms from in Guilford County: mtotal = 323 Classrooms Number of Classrooms Filled N K 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th Grade Level (DPI Avg Class Sizes: K-3rd = 21; 4th-9th = 26; 10th-12th = 29) * For illustration should adolescents stay in Guilford County and enrolled in school.

20 Epidemiological Data of Note

21 Epidemiological Data of Note The North Carolina, as in Guilford County, pregnancy rates for girls in 2007 were three times higher for Hispanic girls and two times higher for African American girls than the rate for white girls. In Guilford County in % of the births (207 of 649 births) among year olds were repeat births. If repeat births were eliminated for 2007 Guilford County would have experienced a 32% decline in births to year olds in Population estimates for Guilford County show an expected growth in the number of adolescents through Because the Latino population is a much younger population there are higher concentrations that are in or will reach their childbearing years in the near future.

22 Guilford County Resident Births for 2007 By Age of Mother and Birth Order For All Women Repeat Births for 2007 Number of Births th or more th th th th th rd nd st Age of Mother Appendix A

23 Population Estimates Guilford County Female Population Projections 25,000 20,000 15,000 10,000 5,000 Appendix F ,656 15,555 15,017 18,073 19, ,888 15,714 15,304 18,083 19, ,086 15,752 15,625 18,005 20, ,282 15,732 15,980 18,150 20, ,483 15,839 16,201 18,213 20, ,645 15,914 16,519 18,249 20, ,810 16,127 16,621 18,528 21, ,962 16,336 16,629 18,809 20, ,875 17,488 16,905 19,545 21, ,400 19,283 18,746 21,263 22,905

24 National Reviews of Adolescent Pregnancy Programs

25 National Reviews of Adolescent Pregnancy Programs Common themes across reviews 1. the research provides clear evidence that programs designed to teach young people about sex do not increase sexual activity; 2. programs based on an abstinence only approach have not shown to have an impact on teen sexual behavior; 3. comprehensive approaches which specifically target proximal sexual behaviors have the best likelihood of impacting adolescent behavior and outcomes; and 4. program effectiveness varies across populations and settings and no one program provides a complete solution. Page 13

26 Summary of Dr Doug Kirby s Emerging Answers 2007 Review Sexual behaviors and risk/protective factors leading to pregnancy and STD/STI Page 11

27 Summary of Dr Doug Kirby s Emerging Answers 2007 Review Sexual behaviors and risk/protective factors leading to pregnancy and STD/STI In order to effectively reduce teen pregnancy and STDs/HIV programs should specifically target one or more of the known key behaviors/factors. The conclusion by Dr. Kirby is that there is growing evidence that various community programs can and do influence sexual attitudes and behaviors leading to delayed sexual activity, improved contraceptive use among sexually active teens and reducing or preventing adolescent pregnancy and childbearing. Page 11

28 Rates for key sexual behavior [1] determinates in Guilford County Percent Reporting Risky Behavior 2003 Percent Reporting Risky Behavior 2008 Guilford County North Carolina Guilford County North Carolina Ever Had Sexual Intercourse Age at first intercourse prior to Number of Sexual Intercourse Partners in lifetime more than one Number of Sexual Intercourse Partners Past Three Months more than one Use of Condom during most recent sexual intercourse Percentages Of Sexually Active Reporting Using A Pregnancy Prevention Method During Most Recent Sexual Intercourse NA* Page 22

29 Characteristics of Effective Programs Page Page 17-19

30 History of Foundation Funding

31 History of Foundation Funding MCWLCHF APP Funding $292,395 $311,535 $325, $227,279 $240,149$238,763 $241, $141, $50, $3,803 $15,192 $10,906 $20,287 $0 $ MCWLCHF APP Funds $3,803 $15,192 $10,906 $0 $0 $20,287 $227,27 $240,14 $238,76 $292,39 $241,62 $311,53 $325,54 $141,13 $50,158 MCWLCHF APP Funds Page 27

32 IOM Prevention Circles within Circles Selected Subgroups Universal Populations Indicated Individuals

33 Intensity Versus Degree of Risk High Intensity of Intervention Moderate Low Universal Selected Indicated Low Moderate High Degree of Risk

34 Foundation Funding by Universal, Selected and Indicated criteria Universal Selected Indicated Family Life Council: Jóvenes Sabias 210 Family Life Council: Jóvenes Sabios 250 Family Life Council: The Next Level 489 Family Life Council: Wise Guys Family Life Council: Wise Guys Mentors Program 116 Greensboro Cerebral Palsy, Inc.: Addressing Sexuality Issues of the Disabled NA Greensboro Pregnancy Care Center: Clinical Services NA Guilford County Department of Public Health: Smart Girls Planned Parenthood: East Greensboro Outreach Center NA Planned Parenthood: Teens Taking Action YWCA Greensboro: Teen Parent Mentor Program 250 YWCA High Point: Teen Mom Program 15 Total Numbers Served Page 25

35 Lessons learned from The California Wellness Foundation s Teenage Pregnancy Prevention Initiative

36 Lessons learned from The California Wellness Foundation s Teenage Pregnancy Prevention Initiative The Significance of Dosage On Building Capacity Expect Change The Contribution of Strategic Media The Power of Peers Focus on Learning Page 20-21

37 Recommendations

38 All Adolescents need Reproductive Health Knowledge The vast majority of adolescents (77%) will have a sexual encounter before they reach the age of % of Americans will have sex prior to being married

39 Recommendations for foundation action to address adolescent pregnancy Targeting interventions Implementing effective curriculum-based programs Considerations for community-wide approach and the Coalition Tracking efforts Recommendations by Setting/Agent Page 28-32

40 Recommendations by Setting/Agent Setting / Agent Potential Courses of Action Schools Work with and advocating for effective family life education program which includes use of an evidence based comprehensive sex education curriculum. Strategize the means/process needed for improving the reach and saturation of sexual education/pregnancy prevention programming with the student population. Because there are natural partners within the community for providing sexual education, strong consideration should be given to supporting and expanding the capacity of community experts on sexual education within the school system. Establish system for collecting data to determine the quality and reach of sex education curriculum within the current school population to ensure Universal coverage. Family Planning Clinics / Health Providers / Medical Community Ensure adolescents have access to contraception. Use the coalition to measure, monitor and advocate for increased coverage and saturation. Increased one on one reproductive health and contraceptive counseling for adolescents within clinic settings. Increase the use of long acting reversible contraception among adolescents. To achieve this aim, consideration might be given to study the capacity of health providers to educate, fund and prescribe long acting reversible contraceptive options which would increase our understanding of this capacity within the community. This might be carried out by the coalition, university, or health department. Community Based Organizations Program Providers Continue to fund local programs that follow 17 characteristics of effective programs. Work more closely with the GC health department and the GC School system to ensure selected populations are being accurately identified. The coalition could serve as an advocate and steward of this process. Fund capacity building activities. This strategy is supported by the findings of the California Wellness Foundation s study of their Teenage Pregnancy Prevention Initiative that concluded these activities are worthwhile investments: Fund technical support efforts for selecting/modifying effective programming, grant writing, program planning and evaluation, tool development. Sponsor grantee conferences, or regular meetings, to provide learning/skills based workshops and foster group learning. Intended Result Increase implementation of effective sex ed. curricula Longer term and sustainable plan for meeting schools sex education requirements Assurance of Universal coverage for all GC Adolescents Improve contraceptive access. Increase adolescent contraceptive compliance Understanding of barriers to and increasing use of, the most effective contraceptive options. Improved sexual health of universal and selected populations. More effective targeting of selected interventions. Improvement of program efficacy and increased capacity for external funding. Capacity Building Universal Selected Indicated X X X X X X X X X X X X X X X X Fund capacity building activities. This strategy is supported by the findings of the California Wellness Foundation s study of their Teenage Pregnancy Prevention Initiative that concluded these activities are worthwhile investments: Fund technical support efforts for selecting/modifying effective programming, grant writing, program planning and evaluation, tool development. Sponsor grantee conferences, or regular meetings, to provide learning/skills based workshops and foster group learning. Health Department The Guilford County Department of Public Health (GCDPH) has a number of services that directly influence the reproductive health of adolescents within our community from direct clinic services, to community health out reach, to school nursing, to health education and direct programming. A needs assessment of the health department s services that are reaching and impacting the reproductive health of adolescents would illuminate strengths and gaps in service. Support and utilize the Health Surveillance & Analysis Unit of the health department as a means for more effectively targeting selected programming. Promote the collaboration of the GC health department and GC school system with the goal of creating a coordinated sexual education and services safety net for the county s adolescent population. Higher Education / Universities Fund universities to provide technical assistance. Promote and/or fund opportunities for elementary education teachers to get CEUs for more effective teaching of a sexual education curriculum. Promote through funding or academic matching the placement of students within community programs. Provide opportunities through the coalition and university structures to match community partners with academic researchers who have the potential to secure larger external funding. Coalition / APP Community Champion Use the coalition as a base for building a long term plan for growing a community collaborative approach. Some specific duties coalition should adopt include, but are not limited to, the following suggestions: collaborate with the GC Dept. of Public Health to identify reproductive health needs using existing and new data, support an annual/regular assessment of reproductive health services within the community, maintain a directory of adolescent pregnancy prevention programs, create and support a referral system for programs to direct youth Improvement of program efficacy and increased capacity for external funding. Identification of strengths and limitations of currently available services. More effective targeting of selected interventions. Identification of potential synergy given each organization s mission. Improvement of program efficacy/ increased capacity for external funding. Improve capacity of current teachers of sexual education. Provide additional support to community programs while strengthening the knowledge base of future practitioners. Provide opportunity for pairing of interests and increased funding. Provide direction and coordination for issue within community. Build capacity and increase likelihood of synergistic opportunities. X X X X X X X X X X X X X X X Health Department The Guilford County Department of Public Health (GCDPH) has a number of services that directly influence the reproductive health of adolescents within Identification of strengths and limitations of currently X Page 31-32

41 Key Recommendations Work with the school system Directed energies to improving the reach and saturation of sexual education/pregnancy prevention programming. Advocating for effective comprehensive sexual education curriculum. Enlist other community partners (funders, advocacy groups, university, etc) in working with school system. Build on currently successful programs Support existing APP program efforts. Provide technical assistance to currently funded programs to enhance their integration of the Kirby s 17 characteristics of effective programs. Continue to fund rigorous evaluation. Continue supporting GCAPP as the community champion for community wide efforts Assess the specific duties/services the coalition can/should orchestrate. Improve contraception access through a review of local clinics Assess coverage, counseling protocols, contraceptive costs/barriers, etc. Focus on Learning & Capacity Building Work with Guilford County Health Department and local Universities to collect & analyze local data, improve program efficacy & capacity and secure larger external funding opportunities.

42 Letters of Peer Review for the Guilford County APP White Paper Sandra Welch Boren, Program Officer Moses Cone ~ Wesley Long Community Health Foundation 1200 North Elm Street Greensboro, NC Dear Ms. Boren: May 20, 2009 On behalf of The National Campaign to Prevent Teen and Unplanned Pregnancy, I am pleased to express my support for the ideas laid out in your terrific white paper entitled, Addressing Adolescent Pregnancy in Guilford County. For more than a decade, the nation has made great progress on reducing its teen pregnancy rate a decline of more than one-third since the early 1990s. The state of North Carolina has shared in this success, experiencing a decline of more than 20 percent in its teen pregnancy rate since the early 1990s. This enormously impressive decline is good news for our country and communities, and is in no small part due to the efforts of community leaders like you who are working on the front lines every day to build better futures for children and families. Despite this progress, it is still the case that three in ten teen girls in this country become pregnant, and some communities have not experienced this same level of success as we see nationwide. Teen pregnancy and birth rates for young women of color are disproportionately high; in fact, Latina and African American teen girls are more likely than not to become pregnant before turning twenty. In addition, recent data suggest that we cannot afford to become complacent: the teen birth rate increased five percent between 2005 and 2007 after 14 straight years of decline. A sustained investment in preventing teen pregnancy is integral to maintaining the progress that has been made over the last decade in North Carolina and in Guilford County. There is now strong evidence that a number of programs can help teens delay sex, increase contraceptive use, and/or actually prevent teen pregnancy. From state and local governments to private foundations and philanthropists, communities should be investing in these models and using interventions that have been shown through strong science to change risky behavior in adolescents and to reduce teen pregnancy. While the evidence on what works is growing, an investment in continued research, testing, and innovation is necessary to continue to expand the list of effective programs and strategies available at the local level. Investment in programs that have been proven effective in changing teen sexual behavior is now more important than ever, given the recent rise in the teen birth rate in the United States and in North Carolina. However, as is so aptly described in the white paper, programs alone are not the only solution to this crisis. Addressing teen pregnancy requires a commitment from all sectors affected by this issue health care providers, the business community, the workforce, education as well as broader efforts to influence social norms, values, and popular culture by involving parents, families, faith communities, and the media. There is good reason to believe that providing support for community efforts to raise awareness bring people together who care about this issue, and increase advocacy efforts is an appropriate and necessary way to advance this work in Guilford County. We would be happy to share examples of successful community efforts from around the country at your request. All of us at the National Campaign hope that support continues for the critical work of preventing teen pregnancy in your community. If you need additional assistance or if we can help in your efforts, please do not hesitate to contact my colleague Jennifer Drake at (202) or by at jdrake@thenc.org. Sincerely, Sarah S. Brown

43 Discussion / Addressing Adolescent Pregnancy in Guilford County A White Paper Questions? White Paper available on the Moses Cone ~ Wesley Long Community Health Foundation website: May 2009 Robert W. Strack, PhD, MBA Virginia Brown, DrPH Candidate Muhsin Michael Orsini, EdD University of North Carolina Greensboro Department of Public Health Education Commissioned by the

44 Addressing Adolescent Pregnancy in Guilford County-A A White Paper Robert W. Strack, PhD, MBA Virginia Brown, DrPH Candidate Muhsin Michael Orsini, EdD University of North Carolina Greensboro Department of Public Health Education Questions / Discussion

45 Extra Slides

46 Teen Births per 1,000 Teen Girls aged in the United States, * (*2006 data preliminary) Sources: Ventura, S.J., Mathews, T.J., & Hamilton, B.E. (2001). Births to Teenagers in the United States, National Vital Statistics Reports, 49(10).; Hamilton, B.E., Sutton, P.D., & Ventura, S.J. (2003). Revised Birth and Fertility Rates for the 1990s and New Rates for Hispanic Populations, 2000 and 2001: United States. National Vital Statistics Reports 51(12).; Hamilton, B.E., Martin, J.A., & Ventura, S.J. (2007). Births: Preliminary Data for National Vital Statistics Report, 56(7).

47 Teen Births per 1,000 Teen Girls aged in the United States, * (*2006 data preliminary) Estimate of annual illegal abortions in 50 s & 60 s: 200,000 to 1.2 million States began to legalize abortions during 60 s 1973: Roe V. Wade invalidates state laws against abortion 1991: Magic Johnson announces he has HIV 1960: Birth Control Pill approved for marketing 1981: First reported AIDS case 1986: Surgeon General Koop releases The Surgeon General's Report on AIDS Sources: Ventura, S.J., Mathews, T.J., & Hamilton, B.E. (2001). Births to Teenagers in the United States, National Vital Statistics Reports, 49(10).; Hamilton, B.E., Sutton, P.D., & Ventura, S.J. (2003). Revised Birth and Fertility Rates for the 1990s and New Rates for Hispanic Populations, 2000 and 2001: United States. National Vital Statistics Reports 51(12).; Hamilton, B.E., Martin, J.A., & Ventura, S.J. (2007). Births: Preliminary Data for National Vital Statistics Report, 56(7).

48 Birth Rate among Females Ages By Race, Guilford County, Birth Rate among Female Ages by Race, Guilford County, Whites Other Races Guilford Whites Other Races Guilford