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Adolescent Reproductive Health Data

Adolescent Reproductive Health Data. Objectives. By the end of this presentation, participants will be able to: Discuss trends in adolescent sexuality and reproductive health Characterize patterns in adolescent contraceptive use

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Adolescent Reproductive Health Data

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  1. Adolescent Reproductive Health Data

  2. Objectives By the end of this presentation, participants will be able to: Discuss trends in adolescent sexuality and reproductive health Characterize patterns in adolescent contraceptive use Assess study and data quality in response to “Practice-Based Learning and Improvement” core competency

  3. Adolescent Demographics • Racial and ethnic diversity • Prevalence of sexual minority youth • Health insurance • Home, education, and employment demographics

  4. The Growing Diversity of the Adolescent Population

  5. Prevalence of Gay, Lesbian, and Bisexual Teens Data not readily available. Research indicates 2 - 4.5% of high school students self-identify as gay, lesbian, or bisexual Believed to be underestimates

  6. 2007 Vermont Youth Risk Behavior Survey

  7. Sexual Orientation & Adolescents: Growing Up Today Study (97-03) N= 7750 N=5700 Corliss H, et al Arch Pediatr Adolesc Med. 2008;162(11):1071-1078.

  8. Sexual Orientation: MN HS Student Sample Ramefedi GJ. Pediatrics 1992;89:714-721.

  9. Adolescents and Insurance • 3 million adolescents (12%) ages 12-17 lack health insurance • 8 million youths (28%) ages 18-24 are uninsured • The risk of being uninsured doubles when a teen turns 19

  10. US Children, Home Demographics: 2007 • 33% live with families where no parent has full-time, year-round employment • 31% live in single-parent households • 18% live in poverty • 17% of 18-24 year olds live in poverty

  11. Education and Employment • In 2007, of U.S. 8th graders: • 30% scored below basic math level • 27% scored below basic reading level • 8% did not attend school and did not work • In 2006, 15% of persons ages 18-24 • did not attend school, • did not work, and • had only a high school degree

  12. Sexual Development and Activity

  13. Teen Sexual Experience,NSFG 2002 Percent of males and females ages 15-19 who have ever had sexual intercourse

  14. Percent of High School Students Who Have Ever Had Sexual Intercourse 2007 Youth Risk Behavior Survey

  15. Percent of HS Students Who Have Had Sexual Intercourse, Race and Grade YRBS 2007 W B H 9th 10th 11th 12th

  16. Male Adolescents and Sexual Experience Percentage of Young Men Who Have Had Intercourse, NSFG 2002 Ages

  17. Percent of Males and Females Ages 15-19 Having Had Oral Sex NSFG 2002 *With partner of the opposite sex

  18. Males Ages 15-19: Rates of Vaginal vs. Oral Sex NSFG 2002

  19. Females Ages 15-19: Rates of Vaginal vs. Oral Sex

  20. Sexual Behavior of Adolescents NSFG 2002 *With a partner of the opposite sex

  21. Contraceptive Use

  22. Contraceptive Use at Last Intercourse Other 7% NSFG 2002 No Method 9% Hormonal Only 13% Condom Only 47% Dual Use 30% Female Male

  23. Female Contraceptive Use at 1st Sex by Year of 1st Sex 2002 National Survey of Family Growth

  24. Male Contraceptive Use at 1st Sex by Year of 1st Sex 2002 National Survey of Family Growth

  25. Contraceptive Use at Last Intercourse YRBS 2007 *This data only reflects oral contraceptives and not rates of injectable contraceptives use

  26. Condom Use at Last Intercourse 2007 Youth Risk Behavior Survey

  27. Adolescent Pregnancy, Abortion, and STI Data

  28. Epidemiology of STIs and Young People • 19 million new cases/ year • ½ occur in people ages15–24 • Most asymptomatic and undiagnosed • New research: 1 in 4 teen has an STI • 2006: 1/3 of new infections were among people age 13-29 (may be as high as 50%) • Economic costs ~ $6.5 billion/year

  29. Chlamydia Rates, Ages15-19: 1996-2006

  30. Chlamydia: Age & Sex Specific, 2006 Rate (per 100,000 population)

  31. Disparities in Chlamydia Rates

  32. Gonorrhea Rates, Ages 15-19 1996-2006 Rate (per 100,000 population)

  33. Gonorrhea: Age and Sex-Specific, 2006 Rate (per 100,000 population)

  34. Syphilis: Age & Sex Specific Rates, 2006 Rate (per 100,000 population)

  35. US Teen Pregnancy Rates Decline

  36. Disparities in Pregnancy Rates

  37. Teen Pregnancy Outcomes: 2004 Rates per 1,000

  38. Pregnancy, Birth and Abortion, Ages 15-19 Rate per 1000

  39. Teen Pregnancy Outcomes, 1990 and 2002 Rates per 1,000 women, ages 15-19 116.3 Hispanic All Races White Black

  40. Abortion Rates, Ages 15-19, 1989-2002

  41. Teen Pregnancy Rates Worldwide, 2000 Per 1000

  42. Understanding the Data: Epidemiology 101 • Study Design • Relative Risk • Odds Ratio

  43. Study Design: Randomized Controlled Trial • 2 groups: a treatment and control group • Treatment group receives the treatment under investigation • Control group receives either no treatment or some standard default treatment • Patients are randomly assigned to all groups

  44. Randomized Controlled Trial • Advantages • Reduces risk of bias and increases the probability that differences between groups can be attributed to the treatment • Disadvantages • Study takes along time to complete • Researchers need to recruit 2 study populations: treatment and control • Costly

  45. Cohort Study • Patients who presently have a certain condition and/or receive a particular treatment are followed over time and compared with another group who are not affected by the condition.

  46. Cohort Study • Disadvantages • Not as reliable • All variables not controlled • Can take a long time—have to wait until conditions of interest develop • Advantages • More flexible re: ethical considerations • Valuable for studying diseases that take years to manifest

  47. Study Design • Prospective Cohort Study • Identifies the original population at the beginning of the study • Accompanies subjects concurrently until disease develops or does not develop • Retrospective Cohort Study • Use historical data to telescope the frame of calendar time for the study and obtain their results sooner

  48. Study Design • Case Control Studies • Patients who already have a certain condition are compared with patients who do not • Advantages • Can be done quickly • Researchers do not use special methods • Disadvantages • Less reliable • No control groups • Issues of association vs. causation

  49. Relative Risk = Risk of developing STI in exposed population Risk of developing STI in non-exposed population Relative Risk Disease Develops Disease Does Not Develop Incidence Rates of Disease Totals __a__ a + b __c__ c + d

  50. Relative Risk: What Does It Mean? • If RR = 1 • No evidence exists for any increased risk in exposed individuals or for any association of the disease with the exposure. • If RR is greater than 1 • The risk in the exposed person is greater than the risk in the non-exposed person. • If the RR is less than 1 • The risk in the exposed person is less than the risk in the non-exposed person.

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