Reducing Teen Pregnancy in the United States

Reducing Teen Pregnancy in the United States


>>>GOOD AFTERNOON.
IT’S 1:00. LET’S BEGIN WITH THE GRAND
ROUNDS. SO TODAY WE’RE TALKING ABOUT THE
REDUCING TEEN PREGNANCY RATES IN THE UNITED STATES.
I DO WANT TO BRING YOUR ATTENTION TO A COUPLE OF
UPCOMING TOPICS BEFORE WE MOVE TO THE TOPIC OF THE DAY.
AND THOSE ARE IMMUNIZATIONS, HYPERTENSION AND CANCER
SCREENING. ALL COMING TO YOU IN THE NEXT
FEW MONTHS. AS ALWAYS, FOR THOSE OF YOU WHO
MIGHT, FOR WHATEVER REASON, BE NEW TO THE GRAND ROUNDS, AND I
CERTAINLY HOPE NOBODY IS NEW, HERE ARE THE RESOURCES WHERE YOU
CAN GET THE CONTINUING EDUCATION CREDITS, WHERE YOU CAN VIEW THE
GRAND ROUNDS IN THE ARCHIVED MODE, WHERE YOU CAN
TWITTER, FACEBOOK, FRIEND US OR WHATEVER ELSE YOU WOULD LIKE.
AS ALWAYS, WE TRY TO BE TRENDY AND KEEP UP WITH THE REST OF THE
WORLD. IN THIS CASE, WE ARE PROVIDING
ARTICLES THAT RELATE TO THE TOPICS OF THE GRAND ROUNDS FOR
THE PERIODS OF SELECTION MADE BY NAOMI PEPPER, LEE WARNER AND
ANNA BRITAIN. THOSE ARE THE ONES THAT EVER
THAT ARE APPEARING IN THIS WEEK’S SCIENCE CLIPS.
NOW, AS YOU KNOW, SOME OF YOU, I HOPE, WHO ATTEND THE GRAND
ROUNDS, WE LIKE TO KEEP UP WITH — NOT WITH THE
KARDASHIANS, WHICH IS WHAT YOU THOUGHT, BUT KEEP UP WITH THE
GLOBAL EVENTS. AND YOU MAY RECALL A COUPLE OF
MONTHS AGO WE HAD THE GOLDEN GLOBE AWARDS AND WE HAD THE
OSCARS. SO WE HAD SOME OF OUR FAVORITE
MOVIE STARS GIVING TALKS. AND WHAT WAS THE BIGGEST EVENT
THIS MONTH IN THE WORLD THAT WAS CONSTANTLY ON TV AND EVERYBODY
WAS WATCHING WHAT IS GOING TO HAPPEN?
THE WORLD HAS A NEW POPE. AND THE GRAND ROUNDS IS NOT
GOING TO BE RUN OVER BY THAT, SO WE HAVE OUR OWN FIRST TIME —
REVEREND MILLICENT WEST. SO SHE IS VERY WELCOME TO THIS
GRAND ROUNDS. I DO HAVE TO SAY THAT THIS HAS
BEEN AN OUTSTANDING EXPERIENCE. EVERY TIME JOHN AND I WORK ON
ONE OF THESE GRAND ROUNDS, WE’RE DELIGHTED WITH THE WAY OUR
SPEAKERS WORK WITH US AND TOLERATE ALL OF THE ORDER GIVING
EVERYTHING ELSE THEY ENDURE. BUT THIS GROUP HAS BEEN REALLY
ESPECIALLY SENSATIONAL AND I HAVE NAMED THEM THE FABULOUS
FIVE. I DO HAVE TO SAY, BECAUSE IT’S
FOUR OF THEM, I HAVE KIND OF SNUCK IN MYSELF AS THE FIFTH ONE
IN THERE. I ALSO HAVE TO SAY THAT A
SPECIAL THANKS GOES TO LEE WARNER.
THIS IS THE HAIRY VERSION OF LEE WARNER ON THE PICTURE FOR
ALL THE WORK AND CONTRIBUTIONS HE HAS DONE IN COORDINATING THE
WORK FOR THIS EVENT. AND WITH THAT, I AM GOING TO —
WE’RE GOING TO TURN IT TO SEVERAL COMMENTS THAT
DR. FRIEDEN HAS TAPED FOR THIS OCCASION BECAUSE HE’S NOT ABLE
TO JOIN US IN PERSON.>>ABOUT 1,000 TEENS GIVE BIRTH
IN THIS COUNTRY EVERY DAY. ALTHOUGH RATES HAVE DELINED
IN RECENT YEARS, WE STILL HAVE MUCH
FURTHER TO GO. OUR RATES ARE MANY TIMES HIGHER
THAN THOSE OF OTHER HIGH-INCOME COUNTRIES. AND THERE ARE LARGE
DISCREPANCIES BETWEEN TEEN PREGNANCY RATES AMONG
DIFFERENT RACIAL,ETHNIC AND SOCIOECONOMIC GROUPS. TEEN PREGNANCY ALL TOO OFTEN
RESULTS IN INTERGENERATIONAL TRANSMISSION OF POVERTY. TEEN PREGNANCY CAN BE
PREVENTED– BY ENCOURAGING TEENS TO
DELAY SEXUAL INTERCOURSE, SUPPORTING PARENT-CHILD
COMMUNICATION ABOUT SEX, AND INCREASING THE PROPORTION
OF SEXUALLY ACTIVE KIDS WHO USE EFFECTIVE CONTRACEPTION,
INCLUDING LONG ACTING REVERSIBLE CONTRACEPTIVES SUCH
AS THE IUD AND IMPLANTS. PUBLIC HEALTH PROGRAMS CAN
REDUCE TEEN PREGNANCY BY INCREASING AWARENESS OF
TEEN PREGNANCY AND ITS CONSEQUENCES, ENCOURAGING KIDS TO DELAY ONSET
OF SEXUAL INTERCOURSE, DISPELLING MYTHS AND
MISCONCEPTIONS ABOUT CONTRACEPTIONS, ENGAGING PARENTS AND OTHER
ADULTS LEADERS IN EFFORTS TO PREVENT
TEEN PREGNANCY. WE NEED TO TRAIN HEALTH CARE AND
PUBLIC HEALTH PROFESSIONALS ABOUT THE SAFETY AND
EFFECTIVENESS OF LONG ACTING REVERSIBLE CONTRACEPTION
FOR TEENS. WE’RE SEEING IMPORTANT PROGRESS
AND TODAY’S PUBLIC HEALTH GRAND ROUNDS OUTLINES SOME OF THAT PROGRESS. ALL OVER THE WORLD, RATES OF
TEEN PREGNANCY ARE FALLING. AND IN DIVERSE COMMUNITIES
THROUGHOUT THE U.S., WE’RE ALSO SEEING IMPORTANT PROGRESS.
MUCH MORE CAN BE DONE AND FOR THOSE OF US IN PUBLIC HEALTH,
REDUCING TEEN PREGNANCY IS ONE OF THE MOST IMPORTANT THINGS WE
CAN DO TO ADDRESS THE SOCIAL DETERMINANTS OF HEALTH.>>LET’S MOVE ON TO — TO
OUR FIRST SPEAKER.>>>GOOD AFTERNOON.
I’M NAOMI TEPPER FROM CDC’S DIVISION OF REPRODUCTIVE HEALTH.
I WILL PROVIDE AN OVERVIEW OF TEEN PREGNANCY IN THE UNITED
STATES AND DESCRIBE SOME OF CDC’S EFFORTS TO REDUCE RATES OF
TEEN PREGNANCY. TEEN PREGNANCY HAS SEVERAL
HEALTH, ECONOMIC AND SOCIAL CONSEQUENCES.
FOR EXAMPLE, TEEN MOTHERS MAY HAVE LOWER EDUCATIONAL
ATTAINMENT AND EARNINGS. THEY MAY HAVE HIGHER RATES OF
PRETERM BIRTH, LOW BIRTH WEIGHT AND INFANT DEATH.
THEIR CHILDREN MAY BE MORE LIKELY TO BE ABUSED AND
NEGLECTED AND TO HAVE EARLY DEVELOPMENTAL PROBLEMS.
THE SONS MAY BE AT HIGHER RISK FOR INCARCERATION LATER IN LIFE.
THE DAUGHTERS MAY BE MORE LIKELY TO BECOME TEEN MOWERS
THEMSELVES, THUS PERPETUATING THE CYCLE.
HOW COMMON IS TEEN PREGNANCY? THREE IN TEN TEEN GIRLS IN THE
UNITED STATES WILL BECOME PREGNANT BY AGE 20.
THIS AMOUNTS TO ALMOST 750,000 TEEN PREGNANCIES PER YEAR.
AMONG AFRICAN-AMERICAN AND LATINO TEEN GIRLS, ALMOST FIVE
IN TEN WILL BECOME PREGNANT BY AGE 20.
THE RATES OF TEEN BIRTHS HAVE ACTUALLY BEEN DECLINING AND WE
HAVE EXPERIENCED A 50% DECLINE IN THE PAST 20 YEARS.
THE COST OF TEEN BIRTHS IN THE UNITED STATES WAS OVER $10
BILLION IN 2008. MOST OF THIS IS DUE TO INCREASED
COSTS FOR HEALTH CARE, FOSTER CARE, INCARCERATION AND LOST TAX
REVENUE. RATES OF TEEN BIRTHS ARE STILL
HIGH, HOWEVER, AND THE UNITED STATES, IN FACT, HAS A HIGHER
BIRTH RATE THAN MANY COUNTRIES OF SIMILAR ECONOMIC STATUS.
HERE IS A BRIEF OVERVIEW OF HHS EFFORTS TO REDUCE TEEN
PREGNANCY RATES. THE OFFICE OF THE ASSISTANT
SECRETARY FOR HEALTH HAS TWO MAJOR INITIATIVES.
THE PREGNANCY ASSISTANCE FUND AND THE TEEN PREGNANCY
PREVENTION INITIATIVE. THIS PROGRAM IS A TWO-TIERED
INITIATIVE. THE FIRST IS FOCUSED ON PROGRAM
FOUND TO REDUCE TEEN PREGNANCY. THE SECOND SUPPORTS
COMMUNITY-WIDE INITIATIVES, SOME OF WHICH ARE IN COLLABORATION
WITH CDC. I WILL TALK ABOUT THESE IN
FURTHER DETAILS. THE ADMINISTRATION FOR FAMILIES
HAS TWO MAJOR RESPONSIBILITIES, THE PERSONAL RESPONSIBILITY AND
EDUCATION PROGRAM ESTABLISHED BY THE AFFORDABLE CARE ACT IN 2010
AND STATE TITLE V ABSTINENCE GRANTS.
CDC’S APPROACH TO REDUCING TEEN PREGNANCY RATES IS BASED ON THIS
CONCEPTUAL FRAMEWORK FOR IDENTIFICATION OF PRIORITY
ACTIONS. BRIEFLY, THE EFFORTS AT EACH
LEVEL HAVE AN INCREASINGLY LARGER POPULATION IMPACT.
DR. BARFIELD WILL DISCUSS THIS HEALTH PYRAMID IN GREATER DEPTH
LATER IN THE SESSION. I WILL FOCUS ON ASPECTS OF CDC’S
WORK WHICH CUT ACROSS SEVERAL LEVELS OF PARENTING. THE
FIRST ARE THE COMMUNITY-WIDE INITIATIVES AND THE SECOND IS
THE DEVELOPMENT OF EVIDENCE BASED GUIDANCE FOR CONTRACEPTIVE
USE. THE COMMUNITY-WIDE INITIATIVES
ARE A PARTNERSHIP BETWEEN CDC AND THE OFFICE OF THE ASSISTANT
SECRETARY FOR HEALTH. THE GOAL OF THESE INITIATIVES IS
TO REDUCE RATES OF TEEN PREGNANCY AND IS BIRTH IN
COMMUNITIES WITH THE HIGHEST RATES.
WITH A FOCUS ON AFRICAN-AMERICAN AND LATINO TEENS.
TEN COMMUNITY BASED ORGANIZATIONS IN NINE STATES
FROM 2010 TO 2015. REVEREND WEST WILL PROVIDE MORE
INFORMATION ABOUT THE INITIATIVE IN GEORGIA LATER IN THE SESSION.
THERE ARE FIVE CRITICAL COMPONENTS FOR SUCCESS OF THE
INITIATIVE. COMMUNITY MOBILIZATION, ACCESS
TO YOUTH FRIENDLY CLINICAL SERVICES, EDUCATION OF KEY
STAKEHOLDERS, WORKING WITH DIVERSE COMMUNITIES AND ACCESS
TO EVIDENCE BASED PROGRAMS. I WILL FURTHER DISCUSS THE
IMPORTANCE OF EVIDENCE-BASED PROGRAMS.
COMMUNITIES ARE EXPECTED TO USE ONE OR MORE OF 31 AVAILABLE
EVIDENCE-BASED PROGRAMS. A FEW ARE LISTED HERE AND A FULL
LISTING IS AVAILABLE ON THE ASSISTANT SECRETARY FOR HEALTH
WEBSITE. SEVERAL OF THE EVIDENCE-BASED
PROGRAMS ARE IMPLEMENTED IN SCHOOL SETTINGS.
THIS IS CRITICAL BECAUSE FROM OUR COMMUNITY-WIDE INITIATIVES,
WE HAVE LEARNED THAT THE VAST MAJORITY OF TEENS AGREE THAT
HIGH SCHOOL EDUCATION SHOULD INCLUDE TOPICS ON SAFE SEX AND
HEALTHY RELATIONSHIPS. THE BRONX TEEN CONNECTION IS ONE
OF OUR COMMUNITY-WIDE INITIATIVES.
TO REACH A SCHOOL, THE PROGRAM AMES TO IMPLEMENT AN
EVIDENCE-BASED PROGRAM IN HIGH SCHOOL AND TO LINK HIGH SCHOOLS
AND YOUTH ORGANIZATIONS TO QUALITY REPRODUCTIVE HEALTH
SERVICES. THE BRONX TEAM’S CONNECTION IS
USING A PROGRAM CALLED REDUCING THE RISK, WHICH IS A HIGH SCHOOL
BASED INTERVENTION. IT INCLUDED 16 CLASSES FOCUSED
ON THE DEVELOPMENT OF SKILLS TO HELP TEENS AVOID PREGNANCY AND
SEXUALLY TRANSMITTED IN SECTIONS.
EARLY SUCCESSES INCLUDE COLLABORATION WITH THE DEBATE OF
EDUCATION AND 11 HIGH SCHOOLS IN THE SOUTH BRONX TO IMPLEMENT THE
REDUCING THE RISK PROGRAM. THEY HAVE ALSO ESTABLISHED 16
LINKAGES BETWEEN HIGH SCHOOLS AND CLINICS TO PROVIDE DIRECT
REFERRALS FOR SEXUAL AND REPRODUCTIVE SERVICES.
THEY HAVE REACHED OVER 700 TEENS AND IT IS PROJECTED THAT THEY
WILL REACH OVER 7,000 TEENS OVER THE FIVE YEARS OF THE
INITIATIVE. ANOTHER ACTIVITY IN THIS PROGRAM
WAS A 2012 PUBLIC AWARENESS CAMPAIGN TO PROMOTE USE OF
CONTRA SESSION PLUS CONDOM TOES PREVENT PREGNANCY AND SEXUALLY
TRANSMITTED INFECTIONS, ALSO KNOWN AS DUAL CONTRACEPTIONS.
I WILL NOW TALK ABOUT WHY CONTRACEPTIVE USE IS IMPORTANT
IN THIS CONTEXT. THE MAJORITY OF THE DECLINE IN
TEEN PREGNANCY IS ATTRIBUTABLE TO INCREASED USE OF
CONTRACEPTION CONTRACEPTION.
HOWEVER, AMONG TEENS WHO BECOME PREGNANT, ABOUT HALF ARE DUE TO
NONUSE OF CONTRACEPTIONS AND HALF ARE DUE TO CONTRACEPTIVE
FAILURE. SO EVEN IF THE TEEN IS USING
CONTRACEPTION, SHE MAY EXPERIENCE FAILURE OF THE METHOD
ITSELF OR MORE LIKELY SHE MAY NOT BE USING THE METHOD
CORRECTLY AND IS CONSISTENTLY. FOR EXAMPLE, FORGETTING TO TAKE
HER PILL OR NOT USING A CONDOM. THE MOST EFFECTIVE REVERSIBLE
CONTRACEPTIVE METHOD INCLUDE IMPLANTS OR INTRA-UNITERINE
DEVICES OR IUDs. THEIR EFFECTIVENESS IS LESS THAN
ONE PREGNANCY PER 100 WOMEN PER YEAR.
IMPLANTS AND IUDs ARE KNOWN AS LONG ACTING REVERSIBLE
CONTRACEPTIVES, OR LARCs. MODERATELY EFFECTIVE METHODS
INCLUDE PILLS, THE PATCH, RING AND DIAPHRAGM.
IT RANGES FROM 6 TO 12 PREGNANCIES PER 100 WOMEN PER
YEAR. THE LEAST EFFECTIVE METHODS
INCLUDE CONDOMS, WITHDRAW, SPONGE, SPERMICIDE.
18 PREGNANCIES PER 100 WOMEN PER YEAR.
TO RETURN TO THE LARC METHODS THE TYPICAL EFFECTIVENESS OF THESE METHODS IS SO HIGH BECAUSE THEY ARE NOT
DEPENDENT ON USER ADHERENCE. SEVERAL PROFESSIONAL
ORGANIZATIONS, INCLUDING THE AMERICAN COLLEGE OF
OBSTETRICIANS AND GYNECOLOGISTS RECOMMEND THAT LARC SHOULD BE
FIRST LINE RECOMMENDATIONS FOR ALL ADOLESCENTS.
DESPITE INCREASING RECOMMENDATIONS THAT TEENS
SHOULD CONSIDER USING LARC, MOST TEENS ARE STILL USING THE PILL
OR CONDOM. LESS THAN 4% OF TEENS ARE USING
IUDs AND LESS THAN 1% ARE USING IMPLANTS.
THE MAIN BARRIERS TO TEENS USING LARCs ARE COST, KNOWLEDGE OF THE
METHODS AND ACCESSIBILITY. SOME EARLY RESULTS FROM SURVEYS
IN OUR COMMUNITY-WIDE INITIATIVE REVEALED THAT THE MAJORITY OF
TEENS HAD NOT HEARD OF METHODS OTHER THAN PILLS OR CONDOMS.
OTHER BARRIERS INCLUDED CONCERNS ABOUT CONFIDENTIALITY,
UNFAVORABLE CLINIC HOURS AND LACK OF TRANSPORTATION.
THE MAIN REASONS PROVIDERS DON’T OFFER LARCs TO TEENS ARE PATIENT
PREFERS, CONCERNS ABOUT SAFETY, LACK OF TRAINING OR NOT HAVING
THE METHODS AVAILABLE. OUR COMMUNITY-WIDE INITIATIVE
SHOWED THAT 70% OF PROVIDERS HAD NEVER OR NOT OFTEN PROVIDED AN
IUD TO TEENS FOR THESE REASONS. LATER IN THE SESSION, DR. SECURA
WILL DESCRIBE HOW THESE BARRIERS TO USE CAN BE REMOVED.
ONE OF CDC’S ANTERIOR EFFORTS IS DEVELOPING GUIDELINES FOR SAFE
AND EFFECTIVE CONTRACEPTIVE USE. THESE ARE THE FIRST EDITIONS
ADAPTED BY THE WORLD HEALTH ORGANIZATION.
THEY ARE TO HELP PROVIDERS WHEN THEY COUNSEL PATIENT ABOUT
CONTRACEPTIVE CHOICE AND USE. THE U.S. MEDICAL ELIGIBILITY
CRITERIA FOR CONTRACEPTIVE USE, OR MEC, PROVIDES EVIDENCE-BASED
GUIDELINES FOR WHICH CONTRACEPTIVE METHOD CAN BE USED
SAFELY BY WOMEN WITH CERTAIN CHARACTERISTICS AND MEDICAL
CONDITIONS. IT INCLUDED GUIDANCE FOR 17
CONTRACEPTIVE METHODS AND OVER 120 MEDICAL CONDITIONS.
THE MEC PROVIDES GUIDANCE FOR WOMEN OF DIFFERENT AGES AND
STATES TEENS CAN USE OTHER METHODS OF CONTRACEPTION,
INCLUDING IUDs. IT PROVIDES GUIDANCE FOR A
NUMBER OF IMPORTANT CONDITIONS AND CHARACTERISTICS THAT ARE
INCREASINGLY COMMON AMONG TEENS. CDC IS NOW FINALIZING THE DATES
FOR CONTRACEPTIVE USE AND SPR WHICH IS EVIDENCE-BASED
PROVIDERS AND COMPLEX MANAGEMENT OF CONTRACEPTIONS.
THE FDR GUIDANCE APPLIES TO WOMEN ALL OF AGES AND MAY BE
PARTICULARLY HELPFUL TO TEENS WHO FACE BARRIERS FOR STARTING
CONTRACEPTIONS. IT WILL ADDRESS GUIDANCE AROUND
WHICH EXAMS OR TESTS ARE NEEDED BEFORE STARTING CONTRACEPTION.
ACCORDING TO THE WORLD HEALTH ORGANIZATION, SPR, VERY FEW
EXAMS OR TESTS ARE NEEDED IF ANY BEFORE INITIATING MOST METHODS.
SINCE THE 2010 RELEASE OF THE MEC, WE HAVE ISSUED TWO INTERIM
UPDATES, ALONG WITH KEY PARTNERS WE HAVE DISSEMINATED THE
GUIDANCE TO THOUSANDS OF HEALTH CARE PROVIDERS.
IT HAS BEEN INCORPORATED INTO NATIONAL STANDARDS AND PROTOCOLS
FOR FAMILY PLANNING AND REPRINTED IN SEVERAL TEXTBOOKS.
WE HAVE DEVELOPED VARIOUS TOOLS FOR HEALTH CARE PROVIDERS,
INCLUDING SUMMARY CHARTS IN ENGLISH AND SPANISH, A
SMARTPHONE APP. WE PLAN TO IMPLEMENT SIMILAR
ACTIVITIES WHEN THE SPR IS RELEASED THIS SPRING.
ALL OF THIS GUIDANCE AND TOOLS CAN BE FOUND ON CDC’S WEBSITE.
IN SUMMARY, WHILE THE TEEN PREGNANCY RATE IN THE U.S. IS
DECLINING, IT IS SO HIGH AND IS AMONG THE HIGHEST OF COUNTRIES
WITH SIMILAR. MOST TEEN PREGNANCIES ARE DUE TO
NON USE OR INCONSISTENT USE OF CONTRACEPTION.
THOSE USING CONTRACEPTION ARE NOT USING THE MOST EFFECTIVE
METHOD. THESE METHODS ARE SAFE FOR WOMEN
OF ALL AGES, INCLUDING TEENS. CDC’S EVIDENCE-BASED
CONTRACEPTIVE GUIDANCE CAN HELP PROVIDERS AS THEY WORK WITH
THEIR TEEN PATIENTS TO USE CONTRACEPTION SAFELY AND
EFFECTIVELY. THANK YOU AND I WOULD NOW
LIKE TO INTRODUCE REVEREND MILLICENT WEST.>>GOOD AFTERNOON. I AM MILLICENT WEST AND I WILL
TALK ABOUT THE COMMUNITY MOBILIZATION FOR TEEN PREGNANCY
PREVENTION. I WILL BEGIN BY SHARING SOME
BACKGROUND INFORMATION ON RICHMOND COUNTY WHERE THERE ARE
APPROXIMATELY 16,000 TEENS LIVING.
THE TEEN BIRTH RATE IN 2008 FOR A 15 TO 19-YEAR-OLD WAS 63
BIRTHS FOR EVERY 1,000 TEEN GIRLS.
IN ADDITION, AS OF 2008, THE COST OF TEEN CHILD BEARING IN
RICHMOND COUNTY WAS $10 MILLION PER YEAR.
THE GEORGIA CAMPAIGN WAS ESTABLISHED IN 1995.
IT WAS FUNDED BY CDC TO IMPLEMENT A COMMUNITY-WIDE
INITIATIVE TO REDUCE PREGNANCY AND BIRTH AMONG TEENAGERS IN
RICHMOND COUNTY. G-CAP BROUGHT TOGETHER DIVERSE
COMMUNITY PARTNERS REPRESENTING MULTIPLE SECTORS IN RICHMOND
COUNTY PERFORM THE WE ARE CHANGE RICHMOND COUNTY FOR A BRIGHTER
FUTURE INITIATIVE. WE ARE CHANGED CONSISTS OF CIVIC
LEADERS, LOCAL ORGANIZATIONS, PARENTS, AND YOUTHS UNITED TO
HELP LEAD PLANNING AND IMPLEMENTATION OF THIS EFFORT.
WE THEN WORKED TO IDENTIFY A BROADER GROUP OF PARTNERS THAT
WORK WITH YOUTH AND CARE ABOUT THE HEALTH AND THE DEVELOPMENTS
OF THE YOUTH. THE DIVERSITY OF OUR EFFORTS
WE WILL DISCUSS TODAY. WE HAVE 12 PARTNERS IMPLEMENTING
EVIDENCE-BASED PROGRAMS FOR USE AND FIVE CLINIC PARTNERS.
WE ALSO HAVE A DIVERSE GROUP OF PARTNER AGENCIES SERVING YOUTH
IN A RANGE OF SETTINGS FROM JUVENILE JUSTICE TO AREA
CHURCHES TO COMMUNITY ENRICHMENT PROGRAMS.
ADDITIONALLY, PARENTS PLAY AN INTEGRAL ROLE IN SUPPORTING THIS
INITIATIVE. MANY OF THESE PARTNERS ARE
STAFFED BY PARENTS THEMSELVES, THROUGH THEIR INVOLVEMENT WE
HAVE GAINED SUPPORT OF AND ACCESS TO RICHMOND COUNTY YOUTH.
ONE OF OUR KEY PRIORITIES IS AN EXAMPLE OF PROGRESS.
ALL PROGRAM PARTNERS HAVE REVIEWED AND SELECTED AN
EVIDENCE-BASED PROGRAM SHOWN THROUGH RIGOROUS EVALUATION TO
HAVE REDUCED TEEN PREGNANCY OR RELATED SEXUAL RISK BEHAVIORS.
WITHIN THE FIRST SIX MONTHS OF IMPLEMENTATION, 450 YOUTHS HAVE
PARTICIPATED IN SUCH PROGRAMS. ANOTHER KEY PRIORITY TO THE
INITIATIVES IS TO ESTABLISH LINKAGES TO SEVERAL THE
AT-RISK YOUTH. THAT GIVES US THE ABILITY TO GET NEEDED RESOURCES AND INFORMATION
IN THE HANDS OF YOUTH AND THEIR PARENTS.
IT ALSO STRENGTHENS THE EFFECTIVENESS OF REFERRALS FOR
YOUTH WHO ARE ENGAGED IN RISKY SEXUAL BEHAVIOR.
LINKING THE YOUTH TO CLINICAL SERVICES ENSURES A POSITIVE
EXPERIENCE FOR THEM ONCE THEY GET THERE, INCLUDING PROVIDING
TEEN FRIENDLY CULTURALLY COMPETENT SERVICES AND
INCREASING ACCESS FOR ALL COMMUNITY YOUTH.
HERE ARE TWO EXAMPLES OF VIEWS OF STANDARDIZED EVIDENCE
INFORMED BEST PRACTICE PROVIDED BY CDC AND NATIONAL PARTNERS
THAT OUR CLINIC PARTNERS HAVE ADOPTED AND THAT ARE NOW USED TO
MONITOR AND EVALUATE PROGRESS TOWARDS INCREASING YOUTH ACCESS.
SOME CLINICS HAVE EXTENDED HOURS TO ACCOMMODATE THE YOUTH
SCHEDULE AND ALL PARTNERS HAVE INITIATED THE QUICK START METHOD
THAT DR. TEPPER MENTIONED. PARENTAL INVOLVEMENT IS KEY IN
ALL ASPECTS OF THE INITIATIVE. FOR LESS — MONTHS IN OCTOBER,
WE HAVE HOLDING OPEN HOUSE FOR THE RICHMOND COUNTY HEALTH
DEPARTMENT FOREVER PARENTS AND TEENS TO PROVIDE HOW TO IMPROVE
COMMUNICATION BETWEEN PARENTS AND TEENS ON THESE I AND TO
EXPOSE BOTH PARENTS AND TEENS TO THE SERVICES AVAILABLE AT THE
HEALTH DEPARTMENT. WE ALSO HAVE TO BE VERY CREATIVE
IN OUR APPROACH. THE CENTRAL ASPECT OF TEENS
SERVICES WILL BE — PROVIDING AT LOW OR NO COST.
ONE CLINICAL PARTNER FOUND A WAY TO LEVERAGE FUNDS FROM A PRIVATE
DONOR TO COVER 11 100% OF THE COSTS.
THE BENEFITS OF THIS ARE A BOOST TO THE INITIATIVE.
1100% COVERAGE WAS INITIATED IN OCTOBER 2012.
SHOWN HERE IS THE PERCENTAGE OF ADOLESCENT PATIENTS RECEIVING
LARC THAT INCREASED FROM 2.7% IN YEAR TWO TO THE FIRST QUARTER OF
YEAR THREE. WE HAVE EXPERIENCED CHALLENGES
IN WORKING WITH COMMUNITY GROUPS.
WE HAVE SOUGHT TO RAISE AWARENESS AND BUILD SUPPORT FOR
THE INITIATIVE AMONG THE FAITH COMMUNITY.
PASTORS HAVE BEEN VERY RECEPTIVE TO ADDRESSING TEEN PREGNANCY
WITH EVIDENCE-BASED PROGRAMS. HOWEVER, YOUTH LEADERS HAVE
RESISTED OUR EFFORTS DUE TO FEAR, ASSUMPTIONS, AND THEIR
BELIEF THAT PROVIDING THIS INFORMATION TO YOU MIGHT BE
VIEWED AS INAPPROPRIATE. WE HAVE ENGAGING FAITH-BASED
LEADERS, INCLUDING PLANNING A FAITH-BASED COMMUNITY SUMMIT
LATER THIS SPRING. SIMILAR CHALLENGES SURFACED
EARLY ON WITHIN THE JUVENILE JUSTICE SYSTEM WITH LOCAL
JUSTICE SUPPORTING THE CONCEPT OF TEEN PREGNANCY PREVENTION,
HOWEVER, IT INCLUDED CONDOM DEMONSTRATION.
WE HAVE INTEGRATED TEEN PREGNANCY PREVENTION THROUGH
EVENTS. A FUN-FILLED INTEGRATION RICH
WELLNESS JAM IS BEING INTEGRATED INTO A LONG STANDING AUGUSTA
MUSIC FESTIVAL MAY 5th. THIS WILL GIVE OUR COMMUNITY
PARTNERS PLATFORM WITH A TEEN PREGNANCY PREVENTION MESSAGE TO
GIVE YOUTH, THEIR PARENTS AND FAMILY A FAMILY-FRIENDLY
ENVIRONMENT. THE ORGANIZERS ARE HOPING AND
INTEGRATING INTO ALL FUTURE MAY 5th FESTIVALS.
THE MORE ACCURATE POSITIVE INFORMATION THERE IS IN THE
COMMUNITY, THE BETTER THE INITIATIVE WILL FARE IN REACHING
POPULATIONS AND AFFECTING CHANGE.
THE LESSONS LEARNED CAN BE SUMMARIZED IN THREE KEY
MESSAGES. FIRST, IT IS EXTREMELY IMPORTANT
THAT WE REACH OUT DIRECTLY TO TEENS WHO HAVE EFFORTS AND
THEREBY ENSURE THE SUCCESS OF THE INITIATIVE.
SECOND, MUCH OF OUR SUCCESS IS DEPENDENT ON PARENTAL
ENVIRONMENT. AND KEY TO THE YOUTH
PARTICIPATION AND THEY SPEAK TO OTHERS ABOUT THEIR POSITIVE OR
NEGATIVE EXPERIENCES WITH THE INITIATIVE.
THEY CAN BE OUR LOUDEST CHEERLEADERS OR OUR FIERCEST
ENEMIES IN THE COMMUNITY. FINALLY, BUILDING RELATIONSHIPS
BETWEEN YOUTH SERVING ORGANIZATIONS AND CLINIC
PARTNERS IS KEY IN PROMOTING SUSTAINABILITY AND ENSURING THAT
YOUTH RECEIVE THE ACCESS TO REPRODUCTIVE HEALTH SERVICES
THEY NEED TO HELP THEM MAKE PROUD CHOICES THAT WILL BRIGHTEN
THEIR FUTURE. THANK YOU. AND OUR NEXT SPEAKER IS
DR. GINA SECURA.>>GOOD AFTERNOON. I’M GINA SECURA, PROJECT
DIRECTOR FOR THE CONTRACEPTIVE CHOICE PROJECT.
IT’S GREAT TO BE BACK AT THE CDC.
LET ME BEGIN BY DESCRIBING WHAT TEEN PREGNANCY LOOKS LIKE IN
ST. LOUIS WHEN WE LAUNCHED THE CHOICE PROJECT.
IN 2008, WE EXPERIENCED LARGE DISPARITIES IN TEEN PREGNANCY
AND BIRTH RATES IN TERMS OF WHERE TEENS LIVE AND BY RACE.
THE ST. LOUIS REGION HAS TWO DISTINCT AREAS.
A SMALL, URBAN CITY AND A SPRAWLING COUNTY WHERE 71% ARE
WHITE. PREGNANCY AND BIRTH RATES AMONG
TEENS WHO LIVE IN THE CITY ARE TWO TIMES THE RATES OF TEENS WHO
LIVE IN THE COUNTY. CITY TEENS HAVE HIGHER RATES
THAN THE NATIONAL RATE. PREGNANCY AND BIRTH RATES AMONG
BLACK TEENS ARE FIVE TIMES GREATER THAN THE RATES IN WHITE
TEENS. THE CHOICE PROJECT IS FOUNDED BY
THE SUSAN T. BUFFETT FOUNDATION. WE DESIGNED THE STUDY IN
PARTNERSHIP WITH COMMUNITY CLINICS THAT PROVIDE
REPRODUCTIVE HEALTH SERVICES. IN ADDITION TO PROVIDING FREE
BIRTH CONTROL TO THEIR PATIENTS, WE SEE THE CLINICS FOR
COLLECTIVE CLINICAL SERVICES THEY PROVIDED TO STUDY
PARTICIPANTS. THE STUDY WAS DEVELOPED BETWEEN
JANUARY AND JULY OF 2007 AND RECRUITMENT JAN ON AUGUST 1st.
OUR KEY QUESTION WAS TO INVESTIGATE WHETHER PROVIDING
FREE CONTRACEPTION WOULD REDUCE ABORTION AND TEEN PREGNANCY
RATES IN THE ST. LOUIS REGION. TODAY’S TALK FOCUSES ON
PREVENTING OR REDUCING TEEN PREGNANCY.
WE FOCUSED ON THE PROMOTION OF THE MOST EFFECTIVE BIRTH CONTROL
METHODS THAT YOU JUST LEARNED ABOUT, KNOWN AS LARC, BECAUSE SO
FEW WOMEN WERE USING THESE METHODS, DESPITE THEIR LEVEL OF
EFFECTIVENESS. OUR SPECIFIC GOAL WAS TO
ELIMINATE THREE MAIN BARRIER TOES LARC.
WE GREATED WOMEN ABOUT ALL CONTRACEPTIVE METHODS, INCLUDING
LARK. OUR LONGITUDINAL COHORT STUDIES
INCLUDED NEARLY 10,000 ST. LOUIS AREA WOMEN AGES 14 TO 45 WHO ARE
FOLLOWED FOR TWO TO THREE YEARS. AMONG THEM, 1400 ARE TEENS.
AGES 14 TO 19. THEY WERE RECRUITED AT OUR
UNIVERSITY RESEARCH CLINIC. IT’S AN AIDS COMMUNITY-BASED
CLINIC INCLUDING ONE ABORTION PROVIDER AND ONE TEEN-FOCUSSED
CLINIC. ELIGIBLE WOMEN UNDERWENT A
COUNSELING PROM WE PROVIDED FOR THE PROJECTS.
THE METHODS ARE INTRODUCED IN A MORE EFFECTIVE ORDER, MOST TO
LEAST. WE DELIVERED A STANDARDIZED
SCRIPT THAT WE DEVELOPED. THE TYPICAL SESSION LASTED 13
MINUTES. THIS IS AN EXAMPLE OF OUR PEER
COUNSELING APPROACH. WE USE THIS LAMINATED TOOL,
CALLED OUR MENU OF OPTIONS TO GUIDE THE COUNSELING SESSION.
ONCE SHE CHOSE HER METHOD, SHE WAS THEN CONSENTED FOR THE
RESEARCH PROJECT. WE ENROLLED 200 WOMEN PER MONTH
FOR FOUR YEARS. WOMEN WERE INTERVIEWED VIA
TELEPHONE AND OFFER STI SCREENING ANNUALLY.
DURING INTERVIEWS, WE OBTAINED DATA ON USE, CONTINUATION,
SATISFACTION, SEXUAL BEHAVIOR AND PREGNANCY.
TO DATE, 80% OF THE COHORT HAS GRADUATED THE PROJECT.
>>HERE IS A SCHEMATIC OF THE PROJECT TIMELINES THAT I JUST
DESCRIBED. WE ARE PARTICULARLY PROUD THAT
WE CONTINUE TO MAINTAIN HIGH FOLLOW-UP RATES, ABOVE 80%, AT
12, 24 AND 36 MONTHS. OVERALL, 75% OF STUDY
PARTICIPANTS CHOSE A LARC METHOD OF STEADY ENROLLMENT.
LARC UPTAKE WAS HIGH AMONG TEENS AT 72%.
THIS IS QUITE IMPRESSIVE WHEN COMPARED TO THE NATIONAL
ESTIMATE OF LARC USE IN TEENS OF 4.5%.
TEENS ARE MORE LIKELY TO CHOOSE THE IMPLANTS THAN AN IUD,
WHEREAS WOMEN 20 AND OLDER ARE MORE LIKELY TO CHOOSE AN
IMPLANT RATHER THAN THAT TRADITIONAL.
>>IT IS IMPORTANT TO NOTE THAT TEENS ARE MUCH MORE LIKELY TO
DISCONTINUE NON-LARC METHODS, WHICH INCLUDE THE PIM, PATCH,
RING AND THE SHOT. IN FACT, ONLY 48% OF TEENS WERE
STILL USING ONE OF THESE METHODS AT 12 MONTHS.
OUR STUDY HAS SHOWN THAT LARC METHODS OVER 20 TIMES MORE
EFFECTIVE IN UNINTENDED PREGNANCY COMPARED TO THE PILL,
PATCH OR RING. THIS GRASS SHOWS THE PROBABILITY
OF UNINTENDED PREGNANCY OVER TIME BY METHOD AND STRATIFIED BY
AGE. LARC METHODS ARE VERY EFFECTIVE
AT PREVENTING PREGNANCY REGARDLESS OF AGE AS SHOWN BY
THE NEARLY IDENTICAL RED AND BLUE LINES T TOP OF THIS GRASS.
THE YELLOW AND GREEN LINE SHOW THAT PEOPLE HAVE A LOWER CHANCE
OF PREVENTING UNINTENDED PREGNANCY.
WOMEN UNDER 21 USING 2 PILL, PATCH OR A RING ARE TWICE AS
LIKELY TO EXPERIENCE UNINTENDED PREGNANCY AS WOMEN 21 AND OLDER
USING THESE SAME METHODS. HERE IS A COMPARISON OF THE
NATIONAL DATA REPRESENTING ALL TEENS WITH A CHOICE THREE YEAR
AVERAGE ANNUAL RATE FOR THREE OUTCOMES.
THE NATIONAL RATES REPRESENT BOTH SEXUALLY EXPERIENCED TEENS
AND TEENS WHO HAVE NEVER HAD SEX.
WE HAVE OBSERVED A REDUCTION OF OVER 50% AMONG CHOICE TEENS
COMPARED TO THE NATIONAL ESTIMATE.
WE HAVE ALSO OBSERVED A REDUCTION OF DEAN BIRTHS OF MORE
THAN HALF COMPARED TO THE 2008 NATIONAL TEEN BIRTH RATE.
IF WE COMPARE THE CHOICE RATE TO THE MOST RECENT 2010 TEEN BIRTH
RATE OF 334.43, WE STILL OBVIOUSLY OBVIOUS THE REDUCTION.
FINALLY, THE O PORTION RATE OF BOY TEENS WAS ALMOST HALF THAT
OF THE NATIONAL RATE. WE ARE CURRENTLY BUILDING AN
ONLINE RESOURCE CENTER TO CATALOG ALL OF THE MATERIALS
DEVELOPED AND THE LESSONS LEARNED DURING THE PROJECT.
MANY MATERIALS ARE SHOWN HERE AND WILL BE AVAILABLE ON THE
SITE. WE WILL CONTINUE TO PROVIDE
TECHNICAL ASSISTANCE TO INDIVIDUALS AND ORGANIZATIONS
WHO WANT TO USE AND ADAPT OUR CHOICE MATERIALS.
AND WE WANT TO VAULT HOW THE MATERIALS ARE USED AND THE
FACILITATORS AND SUCCESSFUL IMPLEMENTATION INTO CLINICAL
CARE. THE EVALUATION FINDINGS WILL BE
INCORPORATED INTO THE RESEARCH CENTER FOR FURTHER EXAMINATION.
MARY ALEXANDER OF HEALTHY START, INDIANAPOLIS, USING OUR
CONTRACEPTIVE TOOL AND UPDATED IT FOR USE IN HER HEALTH START
PROGRAM. AND HER CONTACT INFORMATION AND
SHE IS GOOD TO HAVE. THESE ARE CREATIVE IDEAS THAT
COST VERY LITTLE MONEY AND WE ARE EXCITED THAT OTHERS
INCORPORATE WHAT WE’VE LEARNED INTO THEIR OWN ORGANIZATION.
WE HAVE OFTEN ASKED WHAT WOULD HAPPEN IF A CHOICE MODEL WAS
ROLLED OUT NATIONALLY? HOW CAN TEEN OUTCOMES WOULD WE
POTENTIALLY AVERT INSPECT THIS SLIDE FOCUSES ON PREGNANCY AND
OUTCOMES NATIONALLY. WE BELIEVE THIS IS AN
APPROPRIATE COMPARISON GIVEN ALL THE TEENS IN CHOICE WERE
SEXUALLY ACTIVE AND ALL PREGNANCIES AND OUTCOMES
OCCURRING IN SEXUALLY ACTIVE TEENS.
IF WE APPLY THE REDUCTION PERCENTAGES SEEN IN THE CHOICE
PROJECT, WE COULD POTENTIALLY AVERT 590,000 TEEN PREGNANCIES A
YEAR. WE COULD AVERT TEEN BIRTHS.
FINALLY, WE COULD POTENTIALLY AVERT NEARLY 140,000 TEEN
ABORTIONS. OVER THE COURSE OF THE PROJECT,
WE HAVE IDENTIFIED A FEW COMMON BARRIER TOES SUCCESSFUL
IMPLEMENTATION OF THE CHOICE MODEL AS WELL AS CREATIVE
SOLUTIONS IN OUR THREE KEY AREAS OF EDUCATION, ACCESS AND COST.
LET ME POINT OUT WHAT’S AVAILABLE ON THE RESOURCE
CENTER. NOT ENOUGH TIME TO COUNSEL, USE
THE CHOICE MODEL WHERE YOU TRAIN A NON-CLINICIAN TO HEALTH.
PROVIDE LARC IN YOUR CLINIC BECAUSE INSURANCE WON’T PAY FOR
THEM. WE HAVE HEARD FROM ORGANIZATIONS
WHO HAVE IDENTIFIED WAY TOES MANAGE THE COST.
I WOULD LIKE TO LEAVE YOU WITH A FEW KEY MESSAGES.
LARC IS HIGHLY EFFECTIVE AT PREVENTING PREGNANCIES,
INCLUDING AMONG TEENS. TEENS OVERWHELMINGLY CHOOSE LARC
AND ARE MORE LIKELY. SUCCESSFUL LARC PROMOTION AND
USE AMONG TEENS DEPENDS ON EDUCATING TEENS ABOUT LARC’S
METHODS SO THEY CONSIDER THEM AS FIRST LINE OPTIONS, PROVIDING
ACCESS TO TRAINED PROVIDERS WHO ARE PROPONENTS OF LARC FOR
TEENS. AND REMOVING COST BARRIERS AND
HELPING TEENS NAVIGATE INSURANCE ISSUES.
FINALLY, PREVENTING 20% OF TEENS WERE REFERRED TO BY
A FAMILY MEMBER. THANK YOU OUR NEXT SPEAKER,
DR. WANDA BARFIELD.>>>GOOD AFTERNOON.
WE HAVE HEARD THREE PRESENTATIONS TODAY THAT
DESCRIBE THE PUBLIC HEALTH TRIUMPH AND CHALLENGES OF TEEN
PREGNANCY IN THE UNITED STATES. I WOULD LIKE TO FURTHER
SUMMARIZE SOME OF THE KEY SUCCESSES, CHALLENGES AND
OPPORTUNITIES FOR FURTHER PROGRESS.
TEEN PREGNANCY PREVENTION IS ONE OF CDC’S PRIORITIES OR WINNABLE
BATTLES. FOR THIS WINNABLE BATTLE, CDC’S
DIVISION OF REPRODUCTIVE HEALTH MODIFIED THE ORIGINAL CDC IMPACT
PYRAMID SHOWN HERE. FACTORS THAT AFFECT HEALTH
INCLUDE COUNSELING AND EDUCATION, CLINICAL
INTERVENTION, LONG LASTING PROTECTIVE INTERVENTION,
CHANGING THE CONTEXT OF HEALTH DECISIONS AND SOCIOECONOMIC
FACTORS. THIS MODIFIED PYRAMID SHOWN
EARLIER BY DR. TEPPER HIGHLIGHTS APPROACHES MOST LIKELY TO
ACHIEVE PUBLIC HEALTH IMPACTS IN TEEN PREGNANCY CONVENTION.
THOSE ARE THE TOP OF THE PYRAMID SEXUAL HEALTH EDUCATION IS AN IMPORTANT TEEN PREGNANCY
PREVENTION TOOL. WE HAVE MANY EDUCATION BASED
PROGRAMS ACROSS THE COUNTRY. THE EFFORTS OF THE OFFICE OF
ADOLESCENT HEALTH. THERE IS NATIONAL ATTENTION FOR
EVIDENCE-BASED PREVENTION. HOWEVER, EDUCATION ABOUT BIRTH
CONTROL METHODS LAG BEHIND OTHER HEALTH EDUCATION AREAS.
MORE THAN 96% OF YOUTH RECEIVE SOME TYPE OF SEXUAL HEALTH
EDUCATION BEFORE AGE 18, BUT ONLY 70% OF TEEN FEMALES RECEIVE
INSTRUCTIONS ON METHODS OF BIRTH CONTROL.
WE STILL FACE MANY CHALLENGES TRANSLATING AND SCALING UP
EVIDENCE-BASED PREVENTION PROGRAMS, EFFECTIVELY.
IN ORDER TO MAKE MORE PROGRESS IN THIS AREA, WE NEED TO EDUCATE
STATE AND LOCAL EDUCATION OFFICIALS ABOUT THE BENEFITS OF
SEXUAL HEALTH EDUCATION AND FACILITATE THEIR USE.
THESE EFFORTS MIGHT BE ACCOMPANIED BY ACTION TO
INCREASE PARENT-CHILD COMMUNICATION ABOUT RESPONSIBLE
DECISION MAKING. SEXUAL HEALTH EDUCATION SHOULD
BE EXPANDED TO OTHER SYSTEMS, PARTICULARLY TOT THAT SEVERAL
AT-RISK YOUTH. OUR PRESENTERS TODAY TOUCHED ON
THE NEED TO STRENGTHEN EFFECTIVE CLINICAL SERVICES AND PROMOTE
LARCS. DR. SECURA DESCRIBED A VERY
EXCITING RESEARCH CONDUCTED BY THE CHOICE PROJECT SHOWING
ENORMOUS IMPACT ON U.S. TEEN UNINTENDED PREGNANCY IF WE REMOVE BARRIERS TO LARC. WE HAVE EVIDENCE-BASED GUIDANCE
FOR PROVIDING CONTRACEPTIVES SAFEFULLY AND EFFECTIVELY. DR. TEPPER SUMMARIZED CDC EFFORTS TO STRENGTHEN CLINICAL SERVICES. HOWEVER, WE STILL HAVE
CHALLENGES. MANY USERS ARE POORLY EDUCATED
ABOUT CONTRACEPTIVES AND HAVE POOR FACTS ABOUT SAFETY AND SIDE
EFFECTS. IN FACT, TOO MANY PROVIDERS HAVE
MISCONCEPTIONS ABOUT WHICH CONTRACEPTIVE METHODS ARE
SAFE AND APPROPRIATE FOR TEENS. WE ALSO NEED TO EDUCATE PEOPLE
THAT TODAY’S LARC IS A BATTLE OF GENERATION.
THERE ARE MANY BARRIERS THAT ARE STILL PROMISE OPPORTUNITY.
CDC IS REMOVING CHARACTERS TO BOOST.
RECENTLY, SOUTH CAROLINA PROVIDED INFORMATION TO MEDICAID
FOR PROVIDERS TO CODE AND REIMBURSE IUDs INSERTED IN THE
IMMEDIATE POSTPARTUM PERIOD. WE’RE WORKING WITH ORGANIZATIONS
SUCH AS THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS
TO IMPROVE PROVIDER PATIENT IN THE SAFETY AND EFFECTIVENESS OF
LARC SO THAT THEY CAN BERTH EDUCATION BEEN THEY HIGHLIGHTED
THE IMPORTANCE OF COMMUNITY TO ADDRESS A KEY PUBLIC HEALTH
CHALLENGE. CDC’S COMMUNITY DEMONSTRATION
PROJECTS EXPLORE NOVEL WAYS TO CREATE MORE SUPPORTIVE
ATMOSPHERES FOR YOUTH TO RECEIVE PREGNANCY BASED PREVENTION AND
ACCESS CLINICAL SERVICES. LESSONS LEARNED FROM THESE TEN
COMMUNITIES CAN BE REPLICATED BY OTHER COMMUNITIES AND MAY HAVE
IMPLICATION FOR NATIONAL PROGRAMS.
FOR EXAMPLE, SEVERAL COMMUNITIES HAVE DEVELOPED WAY TOES INCREASE
AND FOSTER YOUTH ACCESS TO CLINICAL SERVICES.
AND TO EDUCATE FOSTER PARENTS ABOUT THE NEED FOR YOU TO
RECEIVE THOSE SERVICES. COLLABORATION FOR CHILDREN AND
FAMILIES BOTH PROMISE TO SCALE UP COMMUNITY PRACTICES
NATIONWIDE. ADDRESSING SOCIOECONOMIC FACTORS
INCLUDES EDUCATION, POSITIVE YOUTH DEVELOPMENT, REDUCING
POVERTY AND DECREASING DISPARITY.
WE KNOW HOW IMPORTANT SOCIAL DETERMINANTS ARE TO TEEN
PREGNANCY. FROM THE VERY BEGINNING TO SET
YOUTH ON A MORE HEALTHY TRAJECTORY THROUGHOUT LIFE.
A RECENT CDC VIEW OF POSITIVE YOUTH DEVELOPMENT SHOWED THAT
HELPING KIDS THROUGH ELEMENTARY, MIDDLE AND HIGH SCHOOL CAN
SUSTAIN THAT POSITIVE TRAJECTORY.
WE ALL HAVE A VERY IMPORTANT ROLE TO PLAY IN REDUCING TEEN
PREGNANCY. I’D LIKE TO THANK YOU ALL.
>>THIS ENDS OUR GRAND ROUND SESSION.
NOW WE HAVE TIME FOR QUESTIONS. I THINK THAT THE AUDIENCE IS
WARMING UP, I’D LIKE TO JUST ASK A FEW QUESTIONS OF OUR PANEL
SPEAKERS AND ALSO IF IN THE AUDIENCE YOU HAVE A QUESTION,
PLEASE PRESS THE GREEN BUTTON AT YOUR DESK AND STAND AND
COMPLETION ASK A QUESTION RATHER THAN MAKING A STATEMENT.
>>REVEREND WEST, HOW DO YOU THINK WE COULD BERTH INVOLVED
ORGANIZATIONS INTO THE PREVENTION OF TEEN PREGNANCY?
>>I BELIEVE THAT WE — IT’S VERY IMPORTANT THAT WE CONTINUE
TO KNOCK ON THE DOORS, THAT WE CONTINUE TO ENGAGE THEM IN
CONVERSATIONS ABOUT THE TOPIC. WE HAVE FOUND THAT THEY ARE VERY
OPEN TO RECEIVING THE INFORMATION, BUT THE PROBLEM
COMES IN WHEN WE GET TO THE DOOR KEEPERS.
AND THAT IS THOSE PEOPLE AT THE CHURCHES WHO MAY HAVE THEIR OWN
VIEW OF THE TEEN PREGNANCY INITIATIVE OR THE INFORMATION WE
ARE TRYING TO SHARE WITH THE YOUNG PEOPLE.
SO AS WE CONTINUE TO EDUCATE THE FAITH-BASED LEADERS AND THEIR
CONGREGATIONS AND THE LEADERS AND THEIR CHURCHES, I THINK THAT
WILL BETTER HELP US REACH THE CHILDREN WHO ARE IN THE
CONGREGATION AND THEIR PARENTS.>>WE HAVE A QUESTION.
>>YES. FROM OUR TWITTER AUDIENCES, LONG
ACTIVE REVERSIBLE CONTRACEPTION IS THE MOST EFFECTIVE, BUT DOES
IT AFFECT CONDOM USE AND RISK OF STDs?
>>THANK YOU FOR THE QUESTION. I THINK IT’S A REALLY IMPORTANT
ISSUE BECAUSE WE KNOW THAT CONDOMS ARE NOT THE MOST
EFFECTIVE CONTRACEPTIVES, BUT THEY ARE ONE OF THE MOST
EFFECTIVE WAYS TO PREVENT SEXUALLY TRANSMITTED INFECTIONS,
INCLUDING HIVs. SO THERE ARE SOME STUDIES
LOOKING INTO HOW USE OF OUR CONTRACEPTIVE METHODS AFFECT
CONDOM USE. THERE MAY BE SOME EFFECTS, BUT I
THINK THE IMPORTANT EFFORTS WE DO ARE TO ENCOURAGE DUAL
PROTECTION WHICH IS TRANSLATING TO ONE OF THE WAYS TO DO THAT IS
TO DO A CONTINUE DUAL CONTRACEPTION USE.
LIKE AN IUD OR AN IMPLANT AND WE USED CONDOMS.
>>FROM OUR TWITTER FOLLOWERS, HOW DO WE CREATE PREGNANCY
PREVENTION MESSAGES THAT ENCOURAGE TEEN TOES PLAN
LONG-TERM AND MAKE HEALTHY CHOICES WITHOUT SHAME OR
EMBARRASSMENT?>>WHO WOULD LIKE TO ADDRESS
THAT FROM THE PANEL?>>SO THAT’S A GREAT QUESTION.
I THINK WHAT WE TRY TO DO WITH THE CHOICE PROJECT WAS WE
APPROACHED THIS AS A CONVERSATION AROUND
CONTRACEPTION, REGARDLESS OF WHAT YOU LOOK LIKE, HOW OLD YOU
WERE, WHAT YOUR BACKGROUND WAS AND WE WANTED TO INFORM HER SO
THAT SHE COULD MAKE THE BEST DECISION.
I THINK OUR APPROACH OF A PEER-BASED COUNSELING SESSION
WHERE SHE WASN’T UNDRESSED ON THE TABLE TALKING TO A
CLINICIAN MADE IT MORE APPROACHABLE AND THAT
DIALOGUE IS IMPORTANT. WE HEAR THAT OFTEN FROM A LOT OF
OUR PARTICIPANTS, THAT IT WAS THE FIRST TIME SOMEBODY SAT DOWN
WITH HER AND TOLD HER ABOUT IT.>>I THINK THAT IS AN
IMPORTANT ISSUE. CAN YOU TALK MORE ABOUT THE
ENVIRONMENT OF THE CLINICAL SETTING AND HOW THAT MIGHT HAVE
BEEN YOUTH FRIENDLY?>>YES.
WE ARE FORTUNATE THAT WE COULD CREATE IT FROM THE START.
AND SO WE CREATED A PLACE WHERE WOMEN AND TEENS WANTED TO GO.
SO OUR FRONT DESK STAFF WAS WARM AND WELCOMING.
AS SOON AS SHE CAME IN, WE OFFERED HER WATER, HOT
CHOCOLATE, WHATEVER SHE WANTED, HER SIBLINGS.
WE ASKED IF THE PARENT WAS WITH HER, WE OFFERED THEM WATER.
AND IT WAS MUCH MORE COMFORTING, I THINK, AND IT ALLOWED HER TO
FEEL AIF AND OUR HOURS, WE RAN EVENT HOURS FOR TEENS, WE RAN
SATURDAY FOR TEENS. SO SHE COULD MAKE THOSE APPOINTS
WITHOUT SOMETHING OR BEING FOUND OUT.
>>I’M INVOLVED IN A PROJECT WITH ASPI, THE ASSISTANT
SECRETARY FOR PLANNING AND EVALUATION AROUND ISSUES OF
SCALING UP, A BIG CHALLENGE, THROUGHOUT HHS.
AND THE CHOICE PROJECT, YOU HAD SOME BEAUTIFUL RESULTS.
AND ALSO EXTENDED WHAT THEY COULD POSSIBLY DO IF THEY WERE
REPLICATED NATIONWIDE. THERE IS A BIG SCALE OF ISSUE
AND I’D BE INTERESTED IN HEARING BOTH FROM YOUR PERSPECTIVE AND
CDC PERSPECTIVE WHAT ARE THE SUCCESSES AND CHALLENGES IN
SCALING UP?>>SO I THINK THAT IS A REALLY
IMPORTANT ISSUE. THAT’S WA WE’RE TRYING TO DO IS
SCALE UP. AND ONE EXAMPLE IS IN TERMS OF
INVITING DR. SECURA HERE IS WE’RE WELCOMING ALL KINDS OF
IDEAS AND PROJECTS SO LEARN MORE THING ABOUT THEM AND THE WAY WE
OWE YOU. AND WE’RE LEARNING AS WE GO TO
MAKE SURE THAT WE HAVE THE OPPORTUNITY TO THINK ABOUT THE
SPECIFIC FACTORS. AND I THINK IT WAS ALLUDED TO
HERE TODAY THAT SOME OF THOSE FACTORS MAY ACTUALLY INVOLVE A
BROADER CONTEXT IN TERMS OF, YOU KNOW, A YOUTH FRIENDLY
ENVIRONMENT, CONVEYING RESPECT, AND ALSO I THINK SOME OF THE
OTHER FACTORS IN TERMS OF MAYBE EXHIBITING OR EFFECTIVE METHODS
FIRST COMPARED TO LAST. I WAS JUST LOOKING AT A WEB PAGE
TODAY AND NOTICED THAT THE LEAST EFFECTIVENESS WERE ACTUALLY
LISTED FIRST. SO THERE MAY BE A LOT OF SUBTLE
THINGS THAT WE CAN DO TO SORT OF CHANGE IN TERMS OF GETTING THE
MESSAGES OUT AND CHANGING CONTEXT.
ARE THERE ANY OTHER COMMENTS?>>I THINK FOR US, WE HAVE
RECEIVED A TIME OF CALLS NATIONAL
NATIONALLY ASKING WHAT THEY CAN DO WITHIN THEIR CLINIC.
PART OF THAT IS BUILDING THE RESOURCE CENTER.
WE HAVE TAPED OUR COUNSELING SESSION SO THAT IF YOU DON’T
HAVE A COUNSELOR AVAILABLE OR A HEALTH EDUCATOR IN THE CLINIC,
WE NOW HAVE A DVD THAT COULD BE PLAYING IN THE WAITING ROOM AND
WE HAVE A NUMBER OF CLINICS WHO ARE TRYING THAT OUT.
I THINK ISSUES AROUND, YOU KNOW, TRYING TO GET PEOPLE GEARED UP
WITH THE MEDICAL ELIGIBILITY AND PRACTICING EVIDENCE-BASED
MEDICINE, IS THEY ARE STARTING FOR THAT.
WHEN WE PUT IN THE FACTORS OF COST EDUCATION, WHEN I HAVE
CONVERSATIONS WITH PEOPLE AND PUT KNIT THREE BUCKETS, THE
WHEELS START TURNING AND IT’S, OKAY, I CAN DID ON TWEAK THIS, I
CAN DO THAT, I CAN START TO PRESENT LARC FIRST.
THAT I CAN DO. AND PEOPLE ARE STARTING TO GET
ON BOARD. COST WILL ALWAYS BE THE BIGGEST
CHALLENGE, BUT HOPEFULLY WITH THE ACA AND PEOPLE ARE STARTING
TO IDENTIFY PRIVATE DONORS WHO WILL MAKE LARC AVAILABLE ON THAT
DAY. I THINK JUST STARTING TO HAVE
THESE CONVERSATIONS IS REALLY, REALLY HELPFUL.
SO CALL US. WE’RE HAPPY TO TALK TO ANYBODY,
HAPPY TO HELP YOU REDESIGN WHATEVER YOU HAVE AND THE
LIMITATIONS YOU HAVE.>>I WAS GOING TO ADD ONE THING,
WHICH YOU TOUCHED ON, EDUCATION OF PROVIDERS, AS WELL, AND OUR
PARTNERS HAVE BEEN REALLY HELPFUL, INSTRUMENTAL IN THESE
EFFORTS. YOU MENTIONED THE GUIDANCE AND,
YOU KNOW, OUR WORK WITH AMERICAN COLLEGE OF OB/GYNs AND AMERICAN
ACADEMY OF PEDIATRICS AND THE AMERICAN ACADEMY OF FAMILY
PHYSICIANS. YOU KNOW, THEY HAVE BEEN REALLY
MOTIVATED AND PROACTIVE ABOUT GETTING OUT TO THEIR MEMBERSHIP
TO EDUCATE PROVIDERS SO THAT PROVIDERS HEAR THE MESSAGES FROM
THE ORGANIZATIONS THAT THEY REALLY TRUST.
ANY OTHER QUESTIONS?>>WE HAVE SEVERAL COMING IN BY
TWITTER. CAN YOU TALK MORE ABOUT THE
RELATIONSHIP BETWEEN PARENTAL COMMUNICATION AND QUALITY TIME
AND TEEN PREGNANCY? HOW CAN ASSOCIATE PROMOTE THIS?
IN MY AREA, THERE ARE NO SPORTS AFTER 5:00 P.M., FOR EXAMPLE.
>>REVEREND WEST, WOULD YOU LIKE TO ADDRESS THIS QUESTION?
>>THANK YOU FOR THE QUESTION. ONE OF THE THINGS THAT WE HAVE
FOUND IN THE COMMUNITY IS THAT PARENTS HAVE TO BE EDUCATED, AS
WELL. AND THE QUALITY TIME COMES WITH
MORE TIME AND WE ALL KNOW THAT IN OUR SOCIETY NOW, A LOT OF
THAT TIME IS TAKEN UP BECAUSE A LOT OF OUR YOUNG PEOPLE WHO ARE
BECOMING PREGNANT ARE IN SINGLE PARENT HOMES.
AND THAT MOTHER OR FATHER MAY BE THE ONLY PROVIDER AND SO THEY
DON’T HAVE A LOT OF TIME WITH THEM.
IT’S VERY IMPORTANT THAT WE FIND OTHER PEOPLE WHO HELP MENTOR THE
CHILDREN, THE YOUNG PEOPLE, THE TEENAGERS SO THAT THEY CAN GET
THAT TYPE OF QUALITY TIME, WHETHER IT BE BY THEIR
BIOLOGICAL PARENT OR BY A SURROGATE PARENT.
AND SO WE SEE IN OUR COMMUNITY ORGANIZATIONS SOME OF THE
ORGANIZATIONS, FOR EXAMPLE, THE 100 BLACK WOMEN OF AUGUSTA WHO IS ONE OF OUR PARTNERS HELPED PROVIDE SOME OF THAT MENTORING. AND SO WE FIND THAT MENTORING ARE VERY IMPORTANT. SO THAT WHEN THEY ARE IN SITUATIONS WHERE THEY DON’T HAVE
THE QUALITY TIME TO HELP PROVIDE A PLATFORM TO HAVE THE
DISCUSSION THAT THERE ARE OTHERS IN THE COMMUNITY THAT YOUTH
CAN GO TO AND STILL HAVE A TYPE OF QUALITY TIME THAT WILL HELP
GIVE THEM THE INFORMATION THAT THEY NEED IN A SAFE ENVIRONMENT
AND WITH SOMEONE THAT THEY TRUST.>>UNFORTUNATELY WE’RE
OUT OF TIME. BUT WE WANTED TO, AGAIN, THANK THE SPEAKERS FOR THEIR GREAT
PRESENTATIONS AND THANK THE AUDIENCE FOR ATTENDING.
THANK YOU.

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