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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

  4. The Growing Diversity of the Adolescent Population • Most minority populations are growing faster than white populations. By 2050, it is projected that: • Percentage of adolescent non-Hispanic whites will fall from 75.7% in 1990 to 52.7% • Non-Hispanic blacks will increase from 11.8% to 15%. • Asians will increase 3% to 10%. • Hispanics* will increase from 9% to 21.1%. • Indigenous groups will remain constant at about 1%. • Asian/Pacific Islanders, though small in number, are growing at the fastest rate. • The American Indian/Alaska Native population is projected to remain largely unchanged.

  5. Prevalence of Gay, Lesbian, Bisexual, and Youth: 2005 Vermont YRBS • Of 8,636 9th to 12th graders: • 1% of students described themselves gay or lesbian • 3% described themselves as bisexual • 3% are not sure • 2% reported having had same-sex intercourse

  6. Adolescents and Insurance • 3.3 million (1 in 8) adolescents ages 12-17 lack health insurance • 8 million (1 in 4) youths ages 18-24 are uninsured • The risk of being uninsured doubles when a teen turns 19

  7. U.S. Children: Home Demographics, 2004 • 33% live with families where no parent has full-time, year-round employment • 31% live in single-parent households • 18% live in poverty • 21% of 18-24 year olds live in poverty

  8. U.S. Teenagers:Education and Employment • In 2005, of U.S. 8th graders: • 32% scored below basic math level • 29% scored below basic reading level • In 2004: • 9% did not attend school and did not work • 15% ages 18-24 did not attend school, did not work, and had only a high school degree

  9. Sexual Development and Activity

  10. Adolescent Sexual ExperienceNSFG 2002 Percent of males and females ages 15-19 who have ever had sexual intercourse

  11. Percent of High School Students Who Have Ever Had Sexual Intercourse, 2005 YRBS After declining in the 1990s, sexual experience appears to be leveling out.

  12. Percentage of HS Students Who Have Had Sexual Intercourse By Race and Grade, 2005 YRBS 9th 10th 11th 12th W B H O

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

  14. Adolescent Sexual Behaviors:2005 YRBS

  15. Percentage of Males and Females Ages 15-19 Reporting Ever Having Had Oral Sex: 2002 NSFG *With partner of the opposite sex

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

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

  18. Contraceptive Use

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

  20. Female Contraceptive Use at First Intercourse by Year of First Premarital Intercourse,NSFG, 2002

  21. Male Contraceptive Use at First Intercourse by Year of First Premarital Intercourse, NSFG, 2002

  22. Contraceptive Use at Last Intercourse, High SchoolYRBS 2005

  23. Percent of High School Students Who Used a Condom at Last Intercourse,2005 YRBS

  24. Adolescent Pregnancy, Abortion, and STI Data

  25. Scope of Sexually Transmitted Infections • 18.9 million new cases of STIs each year • half of which occur in people ages 15-24 • Most are asymptomatic and remain undiagnosed • By age 25, at least one in two sexually active people will have contracted an STI • Economic costs of treatment ~ $6.5 billion/ year

  26. Age and Sex-Specific Chlamydia Rates: United States, 2006 Rate (per 100,000 population)

  27. Chlamydia Rates 15-19 Year Olds: 1996-2006

  28. Gonorrhea: Age and Sex-Specific Rates, United States, 2006 Rate (per 100,000 population)

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

  30. Syphilis: Age and Sex-Specific Rates, United States, 2004 Rate (per 100,000 population)

  31. Declining Teenage Pregnancy Rates Guttmacher Institute, 2005

  32. Disparities Persist Between Racial Minorities and Whites Pregnancies per 1,000 women aged 15-19, 2002

  33. Pregnancy Outcomes for Teenagers 15-19 Years by Race and Hispanic Origin, 1990 and 2002 Rates per 1,000 women 223.8 134.2 169.1 131.5 116.3 98.8 75.4 65.0 Hispanic All Races White Black

  34. Abortion Rates: 15-19 Year Oldsper 1,000

  35. Sexuality Education

  36. Americans Opinions Regarding Sexuality Education Public opinion Guttmacher Institute, 2004

  37. Students’ Opinions Regarding Sexuality Education Guttmacher Institute, 2004

  38. Teachers’ Opinions of Sexuality Education Guttmacher Institute, 2004

  39. Abstinence-Only Education Programs Evaluated • Few studies on abstinence-only programs • Evaluation of four federally funded programs found: • Slight improvements in attitudes regarding abstinence • Ineffective at improving communication with parents or intentions to remain abstinent • Majority of other studies had methodological limitations • Measuring short-term behaviors • Small sample sizes

  40. The Content of Federally Funded Abstinence-Only Programs • 80% of curricula contain false, misleading, or distorted information, including: • False information about effectiveness of contraception • False information about the risks of abortion • Blur religion and science • Treat gender stereotypes as scientific facts • Contain other scientific errors

  41. Virginity Pledge Data • Pledgers: • Delayed onset of intercourse for up to 18 months (not until marriage) • 1/3 less likely to use contraception at eventual intercourse • Had same STIs rates as non-pledgers • 88% had intercourse before marriage • Pledge neither significantly decreased nor increased the chances of pregnancy

  42. Follow-Up Virginity Pledge Data • Pledgers vs. Non-pledgers: Sexual Debut • Pledgers had sexual intercourse later • 61% of pledgers and 79% of inconsistent pledgers had sex before marriage • Pledgers vs. Non-pledgers: Condom Use • Less likely to use condoms at most recent intercourse • Pledgers and STI Rates: • Did not differ from non-pledgers • Were less aware of STI status • Pledgers and Oral and Anal Sex: • More likely to have oral/anal sex but no vaginal sex

  43. Comprehensive Sex Education • Review of 28 well designed experimental studies found most programs do not adversely affect • Initiation or frequency of sexual activity • Number of partners • Many programs shown to: • Significantly improve condom use and other contraceptive methods

  44. Institute of Medicine’s Findings • IOM study investigated the ability of sexuality education programs to prevent STIs, including HIV. • Findings included: • Comprehensive sexuality education programs can be effective in reducing high-risk behavior and do not increase sexual activity. • There is insufficient evidence to support abstinence-only-until-marriage programs.

  45. Understanding the Data: Epidemiology 101

  46. The “PRACTICE-BASED LEARNING AND IMPROVEMENT” Core Competency • Residents must be able to: • Investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices • Analyze practice experience and perform practice-based improvement activities using a systematic methodology • Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems

  47. Residents must be able to: • Obtain and use information about their own population of patients and the larger population from which their patients are drawn • Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness • Use information technology to manage information, access online medical information, and support their own education • Facilitate the learning of students and other healthcare professionals

  48. Study Design • Randomized Controlled Study • There are two groups: a treatment and control group • The treatment group receives the treatment under investigation, and the control group receives either no treatment or some standard default treatment • Patients are randomly assigned to all groups • Advantages • Assigning patients at random reduces risk of bias and increases the probability that differences between groups can be attributed to the treatment • Disadvantages • Study takes a long time to complete • Researchers need to recruit two study populations: treatment and control • Costly

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

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