Protecting America’s Youth: Schools and Communities Tackle Youth Sexual Risk Behaviors

1. Protecting America’s Youth: Schools and Communities Tackle Youth Sexual Risk Behaviors Monday, October 17, 2005 2:00 p.m. EDT Please wait. The Web conference will begin shortly. Thank you.

2. Protecting America’s Youth: Schools and Communities Tackle Youth Sexual Risk Behaviors Lynne Flynn, Web conference moderator Director of Health Policy, The Council of State Governments

3. CSG’s Healthy States Initiative • CSG’s Partners: • National Black Caucus of State Legislators-- www.nbcsl.com • National Hispanic Caucus of State Legislators-- www.nhcsl.com • Complete information on Healthy States: www.healthystates.csg.org • Click on the Healthy States link on lower left and other resources listed • Supported by the Centers for Disease Control and Prevention (CDC)

4. Upcoming Web conferences • 1 more planned for 2005: • Colorectal Cancer Prevention in Minority Communities on October 26th • 7 archived on Web site: • Immunization Disparities, Vaccine Safety • Heart Disease & Stroke prevention • Oral Health, Anti-smoking, and School Health programs • Diabetes prevention in the Hispanic Community

5. Technical Problems? • For problems connecting to the Web, call 1.866.767.6902 • If you have any difficulty with audio or Web connections, press *0 for operator assistance

6. Please Complete Evaluation at End of Web Conference • We need your help! • Please complete the evaluation poll at the end of the Web conference

7. Today’s Speakers • Jennifer Galbraith, PhD, Behavioral Scientist, Prevention Research Branch, HIV/AIDS Prevention, CDC • Laurie Bechhofer, HIV/STD Education Consultant, Michigan Dept. of Education • Washington State Representative Shay Schual-Berke, MD

8. Jennifer Galbraith, Ph.D. • Background in anthropology, community and public health • Behavioral Scientist, Prevention Research Branch, HIV/AIDS Prevention, CDC • Formerly researcher on sexual risk behaviors, Division for Adolescent and School Health, CDC • An original developer of the “Focus on Kids” • evidenced based HIV prevention program for urban African-American adolescents & parents

9. Impact of Sexual Behaviors • About 880,000 teenage pregnancies every year • Approximately 470,000 live births to teens in 2000 • 3 million sexually transmitted diseases occur each year among 13-19 year olds

10. Impact of Sexual Behaviors, cont’d • Cumulative through 2003, an estimated 38,490 young people in the United States received a diagnosis of AIDS • African-Americans were the largest group of young people affected by HIV accounting for 56% of all HIV infections ever reported among those aged 13-24 • Young men who have sex with men (MSM) were at high risk for HIV infection.

11. Trends in Sex Risks Ever Sex Condom Use Alc/Drug before Sex Multiple Partners National Youth Risk Behavior Survey, 1991-2003

12. Approaches to prevention education: What’s in a name? • Abstinence-based • Abstinence-plus • Abstinence-until-marriage • Abstinence only • A-H Abstinence criteria

13. Approaches to prevention education: what we know • Beware of easy labels--know the program, understand the results • One size does not fit all • Ten characteristics of effective HIV education programs • Limitations of school programs and alternatives • After school/community programs • Parent education • We don’t know the answers to the easy questions; let’s ask the tough questions

14. How CDC assists states • Identify and monitor critical health risk behaviors and school health policies and programs to reduce health problems among youth • Synthesize and apply research to increase the effectiveness of school health policies and programs • Enable constituents to plan and implement effective policies or interventions • Evaluate to assess and improve the effectiveness of school health policies and programs and evaluate the impact of interventions

15. www.cdc.gov/yrbs

17. Enable Constituents to Prevent HIV: SEAs/LEAs Baltimore Broward Cty Chicago Dade Cty Dallas District of Columbia Hillsborough Cty Los Angeles Memphis Milwaukee New York City Orange Cty Palm Beach Philadelphia San Bernadino San Diego San Francisco Seattle

18. NGOs Funded for HIV Prevention • Enable relevant national nongovernmental organizations to help local agencies that serve youth to implement effective HIV prevention programs • Current funding supports: • Youth in High-Risk Situations • Postsecondary Programs • School Based Programs • Abstinence Programs

19. How can state legislators promote what successful communities are doing? • Programs based on the needs of your state and local communities • Surveillance data • Community values and norms • Programs based on science and research

20. Laurie Bechhofer • HIV/STD Consultant with the Michigan DOE since 1996 • collaborated with schools, parents, and communities to promote HIV/STD education programs for youth consistent with student needs, community norms, the law, and research and best practice • In 2004, worked with legislators and stakeholders to help ensure that the new sex education laws met the needs of multiple constituencies • Worked with the Governor’s office in the development of the Talk Early & Talk Often program for parents of middle school students • Presented at national and state conferences: • National Academy of Pediatrics Expert Panel, developing National Guidelines for Sexuality and Reproductive Health in Schools • CDC-sponsored national summit for leaders in HIV prevention • Currently the Associate Chair of the Sexuality Education and Reproductive Health Council, American School Health Association

21. Michigan LawsHIV/STD and Sex Education • HIV/AIDS is required, sex education is allowed • For sex education, certain content is • Prescribed • Prohibited • Allowed • Must be age appropriate • Cannot be medically inaccurate • Must emphasize abstinence Summary: Law provides parameters. Local district has flexibility within those parameters.

22. Model HIV/AIDS Curriculum • Michigan one of the only states with model curriculum; developed by state departments of education and health • Skills-based • Curriculum is optional for local school districts-can adopt, adapt or disregard

23. Survey of Michigan School DistrictsStatus of HIV/STD and Sex Education • November 2004 through March 2005 • 502 of 552 school districts returned survey (91%) • Key results: • Implementation of non-mandated sex education • Opt in/opt out policies • Abstinence focus at middle and high school levels • Integration of HIV/STD and sex education • Typical length of unit of study

24. Advisory Boards and Curriculum Approval Process • Required local sex education advisory boards • Set goals and objectives • Reviews and recommends materials and methods to local board • Advisory board composition • At least half parents • Must include five constituencies: parents, educators, students, community health professionals, and clergy • Curriculum changes must go through advisory board and two public hearings prior to school board approval and district adoption Summary: Curricula determined at district rather than building or classroom levels

25. Parent/Guardian Rights • Be notified in advance of instruction • Preview materials in advance • Observe instruction • Excuse child without penalty

26. Challenges and Opportunities • Finding common ground with multiple constituencies with recent sex education legislation (PA 165 and 166 of 2004) • Assumptions about parent support and community norms • Less school attention on HIV/STD and health education with focus on NCLB and core academic subjects

27. Evidence that Program is Working Student Behavioral and Health Outcomes • Percentage of high school students who have had sex is going down (49% in 1997, 42% in 2005) • Pregnancy rates for 15-19 year olds are going down (90% in 1993, 56% in 2003) Program Implementation and Parental Support • Most school districts are choosing to teach sex education • Most parents want sex education taught in school

28. Rep. Shay Schual-Berke • Fourth term representative; member of Healthcare, Appropriations, and Capitol Budget Committees • Retired cardiologist, who chose to spend more time with her family and serve her community • Strong supporter of legislation to protect women's reproductive health and maintain Medicaid funding for contraceptive services • Sponsored legislation requiring medically-accurate information in sex-education courses and providing emergency contraception to sexual assault victims • Board memberships: • Current: Wesley Homes and Washington Council for the Prevention of Child Abuse and Neglect • Past: Highline School Board, State School Directors Association, King County Oversight Panel on Teen Health Clinics, National Council of State Legislatures' Forum for Health Policy

29. What prompted the development of the “Guidelines for Sexual Health and Disease Prevention?” 79.2% of all births to teens in Washington aged 12-17 are paid for by Medicaid. Some STD’s like Chlamydia in teens are on the rise.

30. Proven close to home… BRITISH COLUMBIA WASHINGTON STATE Teen birthrate 12 births per 1,000 teenaged women Comprehensive sexual health education 36 births per 1,000 teenaged women Different school to school; HIV/AIDS prevention is the only state mandate in the State of Washington Sex education program

31. WA State Dept. of Health Office of the Superintendent of Public Instruction Governor’s Advisory Council on HIV/AIDS WA State Medical Association American Academy of Pediatrics, WA Chapter WA State Parent Teacher Association Association of WA School Principals WA Association of School Administrators School Nurse Association of WA WA Association of Social Workers American Civil Liberties Union of WA League of Women Voters of WA People of Color Against AIDS Network Lifelong AIDS Alliance American Association of University Women, WA Chapter WA Education Association WA Association of Local Public Health Associations Planned Parenthood Affiliates of Washington Spokane AIDS Network NW Women’s Law Center Okanogan Family Planning The Guidelines were developed by the state departments of health and education and were supported by:

32. The Washington State Experience • Looked at what was successful and research-based • Developed Guidelines for Sexual Health Information and Disease Prevention, available at: / http://www.k12.wa.us/curriculumInstruct/healthfitness/pubdocs/SexEdGuidelines011005.doc • The Healthy Youth Act – 2005 legislation • Implementation

33. How can state legislators promote what successful communities are doing? Research says the comprehensive approach is effective. Protection Media Love Gender roles Growth &Development Sexualhealth Peer pressure Relationship Skills Abstinence Abstinence is the foundation

34. Important Components: Guidelines for Sexual Health Information and Disease Prevention • GOAL: delayed onset sexual activity, reduced numbers of partners and increased contraceptive use in those sexually active. • Developed in response to a legislative request. • Provide a voluntary framework for effective sex education and are a tool for educators, policy-makers and others to evaluate existing or new programs, curricula or policies. • Uses information and materials that are medically and scientifically accurate about the prevention of pregnancy, STDs, HIV and sexual abuse, age and culturally appropriate • Stresses that abstinence from sexual activity is the only certain way to avoid pregnancy and reduce risk of STD’s, including HIV, but meets needs of all sexually active youth • Encourages communicationwith parents/guardians or other trusted adults and development of personal skills such as values, decision-making, communication and negotiation.

35. Recommendations for Legislators • State assessment of where you are • Broad education of legislators • Develop a nonpartisan/bipartisan coalition of stakeholders • Legislation should meet needs of all constituencies, be flexible, evidence-based • Expect incremental progress

36. Q & A Session Instructions • Submit questions either way: • Email: Use the question box on the bottom right portion of the web page • Phone: Press *1 and let the operator know you have a question. The operator will un-mute your line so you can ask your question directly to the panelists.

37. State and National Resources American Social Health Association • http://www.ashastd.org/ ETR's Resource Center for Adolescent Pregnancy Prevention • http://www.etr.org/recapp/ Kaiser Family Foundations • http://www.kff.org/hivaids/index.cfm National Campaign to Prevention Teen Pregnancy • http://www.teenpregnancy.org/ National Association of State Boards of Education • http://www.nasbe.org/healthy_schools/healthy_schools.htm Youth Risk Behavior Survey Surveillance System • http://www.cdc.gov/HealthyYouth/yrbs/index.htm OSPI Guidelines for Sexual Health Information and Disease Prevention • http://www.k12.wa.us/currEdGuidelines011005.pdf HB 1282, the Healthy Youth Act  • http://www.leg.wa.gov/wsladm/billinfo1/dspBillSummary.cfm?billnumber=1282&year=2005

38. Sexual Risk Behavior Panelists Dr. Jennifer Galbraith, CDC Behavioral Scientist Laurie Bechhofer, HIV/STD Education Consultant, Michigan Representative Shay Schual-Berke, Washington State

39. This Concludes the Web Conference • Please complete the evaluation poll which will pop up on your screen • Go to www.healthystates.csg.orgfor complete information on Healthy States Initiative • Thanks for attending!