Minnesota Title V MCH Needs Assessment Fact Sheets

Children and Adolescents

Preventing Teen Pregnancy and Sexually Transmitted Infections

September 2004

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Size of the Problem

Nationally, teen pregnancy rates have declined 27 percent between 1990 and 2000 and teen birth rates have declined 30 percent between 1991 and 2003 [1]. Declines have taken place in all 50 states and among all racial and ethnic groups. Despite these declines, the U.S. still has the highest rates of teen pregnancy among other industrialized countries [2].

For the years 1999-2001, Minnesota’s overall teen pregnancy rate for young women aged 15 – 19 was 41 per 1000 [3]. In 2002, there were 5,150 births to young women aged 19 years and younger [4].

While Minnesota’s teen pregnancy rate continues to be one of the lowest in the nation, there are significant disparities among Minnesota’s youth of color [5].

Sexually transmitted infections or STIs (also referred to as Sexually Transmitted Diseases) refers to more than 25 infectious organisms that are transmitted through sexual activity and the dozens of clinical syndromes that they cause. STIs are almost always spread from person to person by sexual intercourse, most commonly by anal or vaginal intercourse. STIs are less often spread through oral sex. Some STIs, such as hepatitis B or HIV infection, are also transmitted through the sharing of needles or equipment to inject drugs, body pierce or tattoo. Pregnant women with some STIs may pass their infections to infants during pregnancy, birth or breast-feeding [6].

There are two bacterial STIs (chlamydia and gonorrhea) reported to the Minnesota Department of Health that disproportionately impact adolescents and young adults (ages 15 – 24). During 2003, 7,509 cases of chlamydia and 1,818 cases of gonorrhea in adolescents and young adults were reported. Between 2001 and 2002 in Minnesota, the chlamydia rate increased by 21% and the gonorrhea rate increased by 13% with an additional five to six percent increase between 2002 and 2003. While STI rates are highest in Minneapolis and St. Paul, cases of chlamydia were reported in all but one Minnesota county during 2003 [7].

Seriousness

Consequences
Teenage childbearing is associated with unfavorable outcomes for young parents, their children, and society. Teen mothers have higher rates of birth complications [8, 9], a greater likelihood of experiencing psychological problems related to higher levels of stress, despair, depression, feelings of helplessness, low self-esteem, and a sense of personal failure [10]. Teen mothers are more likely to contemplate and attempt suicide, and experience reduced educational attainment and occupational achievement than older mothers [11].

Teenage males also face reproductive health decisions with fewer resources and male-specific counseling/clinic services than their female partners. Men make up only 2 percent of clients in the federally funded Title X Family Planning programs [12].

Up to 85% of females and 40% of males have no symptoms of chlamydia infection. Because such a high percentage of individuals do not know they have an infection, they are more likely to transmit disease. Also, up to 40% of females with untreated chlamydia will develop pelvic inflammatory disease (PID). Of those with PID, 20% will become infertile, 18% will experience debilitating, chronic pelvic pain and 9% will have a life threatening tubal pregnancy [13]. Gonorrhea infection has similar consequences [14].

Disparities in Teen Pregnancy
While overall Minnesota has low adolescent pregnancy rates compare to other states, when examined by race and ethnicity we see some startling facts. For Minnesota’s youth of color, teen pregnancy rates are two to four times higher than white teens, with African American and Latina/Hispanic young women most likely to experience a pregnancy [15].

Pregnancy rates among women aged 15 –19 years for 1999-2001:

  • White: 32.1 per 1,000
  • African American: 131.7 per 1,000
  • American Indian: 112.2 per 1,000
  • Asian: 71.3 per 1,000
  • Hispanic/Latino: 119.1 per 1,000 [16]

The teen pregnancy rate also varies dramatically by county. The lowest 1997 birth rate was in Stevens County — 6.2 per 1,000. This is just a fifth of overall state rate. The highest teen birth rate was in Watonwan County where 106.1 teen girls per 1,000 or one in ten gave birth. This is over three times the state rate [17].

Disparities in STIs
According to the 2003 STD Surveillance data [18]:

  • Adolescents and young adults are disproportionately impacted by STIs. In Minnesota 70% of reported chlamydia cases and 57% of gonorrhea cases were diagnosed in people between 15 and 24 years old.
  • Females are also disproportionately impacted by these two STIs. In Minnesota 73% of reported chlamydia cases and 56% of reported gonorrhea cases are female. (It is unknown how much of this disparity is related to higher screening rates among females.)
  • The most significant disparities are found in communities of color, especially when combined with other disparities. For example, the 2002 rates of chlamydia for females, 15 – 19 years old, living in the Minneapolis zip code 55411, analyzed by race/ethnicity are:

    American Indian = 17,857 per 100,000
    Black = 14,932 per 100,000
    White = 5,556 per 100,000
    Hispanic = 4,054 per 100,000
    Asian/Pacific Islanders = 3,436 per 100,000

Economic Loss
In December 2001, $13.3 million of the $24.2 million spent on MFIP in Minnesota was received by families who started with a birth to a teen [19].

In 2000, the estimated cost to diagnose and treat Chlamydia was $73 and the diagnosis and treatment of Gonorrhea was $69 [20].

In 2000, the estimated costs per case of PID (because of delayed treatment of Chlamydia or Gonorrhea), including those associated with acute PID, chronic pelvic pain, ectopic pregnancy and treated infertility, ranged from $1,060 to $3,626 [21].

Interventions

Effective teen pregnancy prevention efforts have been identified: (1) comprehensive sexuality education, (2) access to contraceptives and reproductive health care, and (3) the promotion of youth development, particularly the expansion of adolescent skills and life options, and (4) service learning programs. These four strategies have been related to delayed initiation of intercourse, contraception use, and fewer sexual partners [22, 23].

Research has shown that comprehensive sexuality education is proven to delay first intercourse and empower teens to better protect themselves once they do decide to become sexually active [24].

New research indicates that both less sexual activity and increased contraceptive use have made nearly equal contributions to the decline in teen pregnancy rates between 1991 and 2001, attributing 53 percent of the decline in pregnancy rates for youth aged 15-17 to decreased sexual experience and 47 percent to improved contraceptive use [25]. Teen pregnancy prevention efforts should continue to focus on both delay in initiation of sexual intercourse and effective contraception for teens who are already having sex [26].

An evaluation of the service-learning program, Teen Outreach Program (TOPS), showed that TOP teens had a reduced likelihood of teen pregnancy, school suspension, and course failure while in the program [27].

Two types of interventions have the potential to impact STD transmission; interventions designed to change behavior and STI screening intended to diagnose and treat asymptomatic infections.

Behavioral Change Interventions
CDC has studied eight programs around the country for effectiveness with one or more of the outcomes listed below:

  • Significantly less likely to initiate sexual intercourse than those in the comparison condition;
  • More frequent use of condoms;
  • Fewer sex partners than adolescents in the comparison condition.

The effective interventions can be found at http://www.cdc.gov/hiv/pubs/hivcompendium/hivcompendium.htm. [Attn: Non-MDH Link] Although the interventions were designed for HIV prevention in youth, behavior that prevents HIV also decreases the likelihood of STI transmission.

STI Screening
CDC recommends the routine screening of all sexually active women aged <25 years to find asymptomatic disease. Once tested and treated, the person is no longer at risk for PID and infertility, and is not transmitting infection to a partner or partners. According to the U.S. Preventive Services Task Force, “The strongest evidence supporting screening is a well-designed randomized trial demonstrating that screening women at risk (prevalence of infection 7%) reduced the incidence of PID from 28 per 1000 woman-years to 13 per 1000 woman-years. The prevalence of chlamydial infection has declined in populations that have been targeted by screening programs (primarily women attending family planning and other publicly funded clinics)” [28].

In 2001, the STD and HIV Section of the Minnesota Department of Health conducted a study designed to determine the prevalence of STIs in female adolescents. Testing for chlamydia and gonorrhea was done at nine urban school-based clinics (SBCs), a suburban juvenile detention center (JDC), and an urban organization serving homeless youth (OSH). The study sample included a total of 1,997 participant visits. For all sites combined, 9.7% of participant tests were positive for chlamydia [29].

Involving young men in family planning and reproductive health has the following benefits.

  • Reducing the rate of unintended pregnancy and HIV [30].
  • Improving communication between young men and women, helping them make more informed, shared decisions around family planning and reproductive health [31].

Status

In recent years, the federal government has put an increased emphasis on abstinence education by funding it at the level of $102 million. Abstinence education emphasizes the importance of abstaining from sexual intercourse until marriage [32].

The economic and political climate of Minnesota may have an impact on the teen pregnancy rate. Many resources for pregnant and parenting teens and preventative efforts have been eliminated in the past legislative session. These include the TANF Youth Risk Behavior and MN ENABL funds (3 million), the Youth Risk Behavior prevention money (4.4 million) and a 1.2 million dollar decrease in family planning dollars. Minnesota has recently received approval for implementation of the 1115 Family Planning Waiver, which has the potential to expand services to teenagers 15 and older as well as low-income women under 200 percent of federal poverty guidelines. Implementation is slated for January 2006.

In 2001, the Minnesota Legislature created the Eliminating Health Disparities Initiative to reduce disparities and improve the health of populations of color and American Indians in the state. The Minnesota Department of Health administers this funding through community and tribal grants. One of the priority health areas is healthy youth development with the intent of reducing teen pregnancies.

In a national survey, the overwhelming majority of adults and teens believe that school-aged teens should not be sexually active but those who are should have access to contraception. The survey also found that a large majority of adults and teens also believe that advocating abstinence while also providing teens with information about contraception is not a “mixed message” [33].

Current Minnesota law (Statute 121A.23) requires each school district to develop and implement a comprehensive program to prevent and reduce the risk of sexually transmitted infections and diseases, including but not exclusive to human immune deficiency virus and Human Papilloma Virus. A comprehensive approach includes student and personnel receiving STI/HIV education (including helping students to abstain from sexual activity until marriage) and working together with parents, community agencies and voluntary service organizations. Each program will focus on policy, curriculum/instructions, reaching high-risk students and community education/ networking.

According to the 2001 Minnesota Student Survey, 48% of 12th grade males and 50% of 12th grade females have had sexual intercourse. Of those, 24% of the males, and 33% of the females have rarely or never used a condom [34].

In a report published by the Kaiser Family Foundation, more than 25% of teens surveyed did not know that oral contraceptives offer no protection against STIs [35]. In another report by the Kaiser Foundation, more than three-quarters of adolescents and young adults surveyed expressed a need for more information about sexual health topics. They are especially concerned with how to recognize STDs and HIV infection, what STD and HIV testing involves, and where they can go to get tested. One-quarter of those surveyed said they need more information on how to use condoms [36].

In a national study published in 2002, the authors surveyed 7,300 physicians with 4,226 responding. Less than one third routinely screened men or women for STIs [37].

According to an analysis of the national 1999 Youth Risk Behavior Survey, among high school students who had received a routine check-up during the previous year only 57% of the females and 74% of the males had discussed STDs with their health care provider [38].

References

1. Center for Disease Control and Prevention. (2003). Births: Final Data for 2002. National Vital Statistics Reports, 52(10).
2. Singh, S. & Darroch, JE. (2000). Adolescent pregnancy and childbearing: Levels and trends in developed countries. Family Planning Perspectives, 32(1): 14-23.
3. DATA SOURCE: Minnesota Department of Health, Center for Health Statistics.
4. DATA SOURCE: Minnesota Department of Health, Center for Health Statistics.
5. DATA SOURCE: Minnesota Department of Health, Center for Health Statistics.
6. Minnesota Department of Health. Sexually transmitted diseases. Online resource: www.health.state.mn.us/divs/idepc/dtopics/stds/index.html
7. ibid
8. Hayes, C. (1987). Risking the future: Adolescent sexuality, pregnancy and childbearing (Vol. 10). Washington, DC: National Academy Press.
9. Jorgensen, S. R. (1993). Pregnancy and parenting. In T. P. Gullota, G. R. Adams, and R. Montemayer (Eds.), Advances in adolescent development (Vol. 5) (pp. 103–140). Newbury Park, CA: Sage.
10. Jorgensen, S. R. (1993). Pregnancy and parenting. In T. P. Gullota, G. R. Adams, and R. Montemayer (Eds.), Advances in adolescent development (Vol. 5) (pp. 103–140). Newbury Park, CA: Sage.
11. Hayes, C. (1987). Risking the future: Adolescent sexuality, pregnancy and childbearing (Vol. 10). Washington, DC: National Academy Press.
12. 2002 National Directory- A Resource Guide to Male Reproductive Health Programs. Chivers-Grant Institute of Morehouse College. 2002.
13. Centers for Disease Control and Prevention. Fact Sheet: Chlamydia. Online resource:
www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm [Attn: Non-MDH Link]
14. Centers for Disease Control and Prevention. Fact Sheet: Gonorrhea. Online resource: www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm [Attn: Non-MDH Link]
15. DATA SOURCE: Minnesota Department of Health, Center for Health Statistics.
16. DATA SOURCE: Minnesota Department of Health, Center for Health Statistics.
17. Minnesota Department of Health. (1998). 1997 teen births by county. [Online]. Available: www.health.state.mn.us/divs/chs/data/adolec.htm
18. Minnesota Department of Health. Sexually transmitted diseases. Online resource: www.health.state.mn.us/divs/idepc/dtopics/stds/index.html
19. Minnesota Department of Human Service, Division of Reports and Forecasts; 2001 data prepared by Paul Farseth as reported in Minnesota Organization of Adolescent Pregnancy, Prevention and Parenting (2003). Minnesota state adolescent sexual health report: 2003.
20. Chesson, H., Blandford, J., Gift, T., Tao, G., Irwin, K. (2004). The estimated direct medical cost of sexually transmitted diseases among American youth, 2000. Perspectives on Sexual and Reproductive Health, 36:11-19.
21. ibid
22. Kirby, D. (2001). Emerging answers: Research findings on programs to reduce teen pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy.
23. Manlove, J, Franzetta, K, McKinney, K, Papillo, AR, & Terry-Humen, E. (2004). A good time: After-school programs to reduce teen pregnancy.
24. Manlove, J, Franzetta, K, McKinney, K, Papillo, AR, & Terry-Humen, E. (2004). A good time: After-school programs to reduce teen pregnancy.
25. Santelli, JS, Abma, J, Ventura, S, Lindberg, L, Morrow, B, Anderson, JE, Lyss, S, & Hamilton, B. (2004). Can changes in sexual behaviors among high school students explain the decline in teen pregnancy rates in th 1990s?. Journal of Adolescent Health, 35:80-90.
26. Santelli, JS, Abma, J, Ventura, S, Lindberg, L, Morrow, B, Anderson, JE, Lyss, S, & Hamilton, B. (2004). Can changes in sexual behaviors among high school students explain the decline in teen pregnancy rates in th 1990s?. Journal of Adolescent Health, 35:80-90.
27. Manlove, J, Franzetta, K, McKinney, K, Papillo, AR, & Terry-Humen, E. (2004). A good time: After-school programs to reduce teen pregnancy.
28. Agency for Health Care Research and Quality. New recommendations issued for preventive services. Online resource: www.ahrq.gov/clinic/ajpmsuppl/#note [Attn: Non-MDH Link]
29. Minnesota Department of Health. Sexually transmitted diseases. Online resource: www.health.state.mn.us/divs/idepc/dtopics/stds/index.html
30. Drennan M. (1998). Reproductive health: New perspectives on men’s participation. Population Reports. 46.
31. Becker R. Male involvement and adolescent Pregnancy prevention. Resource Center for Adolescent Pregnancy Prevention. Accessed 6-14-04
32. Republican Study Committee (2002). Federal Sex-Ed/Contraception vs. Abstinence Funding. http://www.house.gov/burton/RSC/Abstinence4.PDF [Attn: Non-MDH Link]
33. The National Campaign to Prevent Teen Pregnancy. (2003). With one voice 2003: America’s adults and teens sound off about teen pregnancy. Washington: Author.
34. Minnesota Departments of Education and Human Services. 2001 Minnesota student survey. Online resource: www.mnschoolhealth.com/resources.html?ac=data [Attn: Non-MDH Link
35. ibid
36. Kaiser Family Foundation. (2003). Sexual health knowledge, attitudes and experiences (#3218). Washington D.C.
37. Lawrence, J., Montano, D., Kasprzyk, D., Phillips, W., Armstrong, K., & Leichliter, J. (2002). STD screening, testing, case reporting, and clinical and partner notification practices: A national survey of US physicians. American Journal of Public Health, 92: 1784-1788.
38. Burnstein, G. (2000, December). STD or pregnancy prevention counseling during check-ups. Paper presented at the National STD Conference, Milwaukee, WI.