Learn about upcoming funding for teen pregnancy prevention programs as well as a discussion on how to develop a teen pregnancy prevention program for your community.

1. Preventing Teen Pregnancy
• We prevent teen and unplanned pregnancy in San
We prevent teen and unplanned pregnancy in San
Antonio and Texas by:
bringing the best of science‐based approaches
to empower parents, teens, and young adults;
developing a common‐ground approach that the
Janet P. Realini, MD, MPH community can support
JRealini@HealthyFuturesTX.org
www.HealthyFuturesTX.org 1 2
Many Different Stories
Why Care about Teen Pregnancy?
• Higher risks for
– Mom (dropout, welfare, single parenthood)
– Baby (low birth weight, infant mortality, abuse,
foster care, incarceration, teen parenthood)
foster care incarceration teen parenthood)
– Dad (less education, lower income)
• Healthier for mom, baby, family to wait
Bexar County Tax
Costs:
3
$70 million/year
U.S. Birth Rates for Females 15‐19
Teen Sex, Pregnancy, and STDs & Percent of Births to Unmarried
100 100
• 1 in 2: 54% of Texas HS students have had sex1 80 80
60 60
• 1 in 5: 18‐19% under 15 has had sex2
40 40
• 1 in 3: 31% of US females get pregnant before age 201
20 20
• 1 in 2: For Latinas and Blacks, it is over 50%2
0 0
• 1 in 4: 26% of U.S. Females 14‐19 have an STI3
0
4
8
2
6
0
4
8
2
6
0
4
8
2
6
0
4
194
194
194
195
195
196
196
196
197
197
198
198
198
199
199
200
200
Birth Rate % Unmarried
1. Eaton DK, et al. Youth Risk Behavior Surveillance—United States, 2007. In Surveillance Summaries,
June 5, 2008. MMWR 2008; 57 (No. SS04).
2. 14 and younger: The sexual behavior of young adolescents. National Campaign to Prevent Teen
Pregnancy, 2003. Note: Adapted from: National Vital Statistics Reports
3. CDC Press Release, 3/11/08 2001;49(10); 2006; 55 (1 & 11); 2009; 57 (7,12).
5

2. U.S. Teen Pregnancy Rates U.S. Teen Pregnancy Rates
by Race/Ethnicity 1986‐2006
Pregnancies per 1000 Females 15‐19, 1986‐2006
Births per 1000 Females 15‐19
120
250
100
200
80
150
60
100
40
50
20
0
0
6
0
4
8
2
6
TOTAL Non-Hispanic White Black Hispanic
1 98
1 99
1 99
1 99
2 00
2 00
Data from: Kost K, Henshaw S, Carlin L. U.S. Teenage Pregnancies, Births and Abortions: Data from: Kost K, Henshaw S, Carlin L. U.S. Teenage Pregnancies, Births and Abortions:
Naitonal and State Trends and Trends by Race and Ethnicity. New York: Guttmacher Naitonal and State Trends and Trends by Race and Ethnicity. New York: Guttmacher
Institutes 2010. www.gutttmacher.org/pubs/USTPTrends.pdf Institutes 2010. www.gutttmacher.org/pubs/USTPTrends.pdf
Youth Risk Behavior Surveillance
U.S. High School Students 1991‐2007 Teen Pregnancy in Texas
• 3rd HIGHEST teen birth rate:
– 63.1 per thousand females 15‐19 (2006)
– 51,180 teen births in 2005
• HIGHEST percent repeat teen births:
– 23% in 2006
Eaton DK, et al. Youth Risk Behavior Surveillance—United States, 2007.
In Surveillance Summaries, June 5, 2008. MMWR 2008; 57 (No. SS04).
9 10
Making Progress in San Antonio
Teen Pregnancy in Texas
70 Bexar School‐Age Birth Rates down 34%…
58.9 57.1
Births per 10 females 15-17
57.1
60 53.3
51.1 50.2 49.3
50 44.5 43.5
40.4 41.8 39
37.2 35.5
40 33.3 31.4
29.9 28.2
26.9
000
30 24.7 23.2
22.4 22.1 21 4 22
21.4 22.2
20
10 … but still 82% higher than the national rate
0
1994 1996 1998 2000 2002 2004* 2006
Bexar U.S.
….and the National Rate is now increasing…
Minimal estimate: $1 billion/year in tax costs
Sources: Texas Department of State Health Services;
National Vital Statistics Reports 2009;57(12)
11 12

3. Bexar County Birth Rates Many Teen Births in San Antonio
for Females 15‐17
by Zip Code, 2005 3763 Bexar teen births in 2007:
171 Kindergarten Classes
Over 4 times the N i
O i h National Rate:
lR
over 85.6 per thousand
3 to 4 times the National Rate:
64.3 to 85.6 per thousand
2 to 3 times the National Rate:
Bexar County Tax Costs:
42.9 to 64.2 per thousand
1 to 2 times the National Rate:
$70 million/year
21.5 to 42.8 per thousand
Less than or equal to the 2005
National Rate: 21.4 per thousand
13 14
What Prevents Teen Pregnancy?
What Causes Teen Pregnancy?
• Effective sex education, plus
• Access to contraception
• A complex issue
• It’s not just about sex • Especially when combined with
• It s not just about girls
It’s not just about girls Positive Youth Development
P iti Y th D l t
• A symptom of youth taking risks
Teen pregnancy is related
to low expectations:
not having a stake in the future
15
What Works?
Types of Sex/HIV
Effective Sex Education Programs
Education Programs
Abstinence‐Only Abstinence‐Plus
Abstinence‐Only Comprehensive • No strong evidence • 2/3 have positive effects
• No discussion of • Support both they delay sex – delayed sex and/or increase
birth control or abstinence and use protection
condoms—except of condoms and birth • None increase sexual activity
failure rates control
“Abstinence‐Plus”
•CDC Task Force on Community Preventive Services, 2009.
•Kohler PK et al. J Adol Health 2008; 42: 344‐351.
•Underhill K, et al. Cochrane Database of Systematic Reviews 2008.
•Underhill K, et al. Cochrane Database of Systematic Reviews 2007.
17 •Gilliam ML, et al. Obstet Gynecol 2010; 115:171‐172. 18

4. Abstinence-Plus Most Parents Want
MORE than Abstinence
Abstinence-Plus Recommended by:
• American Medical Association • Overwhelming support for Abstinence‐Plus
• Texas Medical Association Sex Education1‐3
• American Academy of Pediatrics – Over 80% support teaching birth control
• American College of Obstetricians and – About 50% oppose Abstinence‐Only
Gynecologists – Support among conservatives too
• Society for Adolescent Medicine
• Bexar County Parents:
– 80% want Abstinence‐Plus4
1. NPR/KFF/Kennedy School of Govt. Sex Education in America, 2004
2. KFF. survey of parents of 7‐
2. KFF. survey of parents of 7‐12 graders: Sex Education in America, 2000
3. Bleakley A, et al. Arch Pediatr Adolesc Med 2006;160:1151‐
3. Bleakley A, et al. Arch Pediatr Adolesc Med 2006;160:1151‐1156.
19 4. Realini, Herriott, Katerndahl. SA Medicine 59(3), March 2006. 20
Abstinence‐Plus does not increase sexual activity
Numerous Studies are Consistent & Reassuring
Abstinence‐Plus Education
does not increase sexual activity No comprehensive sex ed program increased sexual activity (1)
Comprehensive programs did not increase sexual activity (or STDs) (2)
• This is not a “mixed message” Of 29 evaluations, none increased sexual activity (3)
• Abstinence‐Plus does not increase sexual “No evidence … to support concerns regarding the potential for
Comprehensive Risk Reduction (CRR) interventions to result in an
activity by any measure increase in sexual activity. To the contrary, the evidence indicated
that CRR interventions reduce both prevalence of sexual activity and
frequency of sexual activity” (4)
1. Kirby D. Emerging Answers 2007, pp 15‐16
2. Kohler et al, J Adol Health, April 2008
3. Underhill K, et al. Cochrane Database of Systematic Reviews
2008, Issue 1; CD 007006
4. CDC. Community Guide to Risk Reduction, 11/09
21 22
Federal Abstinence-Only: Federal Abstinence-Only:
Funding Requirements Funding Requirements
A. Exclusive purpose: the social, psychological, & health gains to E. Sexual activity outside the context of marriage is likely to
be realized by abstaining from sexual activity. have harmful psychological and physical effects.
B.
B Abstinence from se al acti it o tside of marriage is the
sexual activity outside F. Bearing children out-of-wedlock is likely to have harmful
expected standard for all school-age children. consequences for the child, the child’s parents, and society.
C. Abstinence from sexual activity is the only certain way to avoid
out-of-wedlock pregnancy and sexually transmitted diseases, G. How to reject sexual advances and how alcohol and drug use
and other associated health problems. increases vulnerability to sexual advances.
D. A mutually faithful monogamous relationship in the context of H. Importance of attaining self-sufficiency before engaging in
marriage is the expected standard of human sexual activity. sexual activity.
Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Pub. L. No. 104-193 (1996).
Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Pub. L. No. 104-193 (1996).
23 24

5. Texas Schools Texas Schools
Texas Education Code §28.004 Texas Education Code §28.004
Requirements: NOT the same as Federal Requirements:
May include positive information
• Abstinence from sexual activity the preferred behavior about condoms/contraceptives
• More attention to abstinence than any other behavior • If there is instruction on contraception/condoms,
teach human use reality rates, not theoretical rates
rates
• Abstinence is the only method that is 100% effective in
preventing pregnancy, STDs, HIV/AIDS, & the emotional • May not distribute condoms with classroom instruction
trauma associated with adolescent sexual activity
• May separate sexes
• Direct adolescents to a standard of behavior in which • School Health Advisory Council
abstinence before marriage is the most effective way
to prevent pregnancy, STDs, HIV/AIDS • Materials available for reasonable public inspection
25 26
Strong Evidence of Positive Impact on Behavior, What Works to Prevent the
Pregnancy, or STD rates
Second Pregnancy?
Service‐Learning:
Sex/HIV Education:
• Teen Outreach Program
• The Olds Model1,2 (Nurse‐Family Partnership)
• Becoming a Responsible Teen* – Intensive nurse home visiting
• Reach for Health*
• ¡Cuidate!
– Prenatal & for 2 years
• Draw the Line/Respect the Line* Multi‐Component, with Intensive
• Making Proud Choices Sexuality & Youth Development: – Reduced pregnancies, child abuse
• Reducing the Risk* •Aban Aya • Intervention in well‐child clinic3
• Safer Choices •Children’s Aid Society—Carrera*
– Link Family Planning to Well‐Child Care
• SiHLE: Sistas, Informing, Healing, Community Program with
Living, Empowering Multiple Components: • Intensive school‐based intervention4
• It’s Your Game: Keep it Real* •HIV Prevention for Adolescents in
low‐income Housing
1. Olds DL, et al. JAMA 1997;278:637‐43.
*Shown to delay sexual debut 2. Kitzman H, et al. JAMA 1997;278:644‐52.
3. O’Sullivan AL, Jacobsen BS. Nursing Research 1992;41:210‐5.
NONE Increase Sexual Activity 4. Key JD, et al. J Adol Health 2008;42: 394‐400.
In addition to Sex Education and access to
contraception, Young People need: Parents
Teens say parents most influence them sex1
Search‐Institute.org Adults underestimate their influence1
• 40 Developmental “Assets”
• Lots of caring adults Parent‐child connectedness is important
• Emotional “connections” It is more than one “Big Talk” 2
Repetition improves closeness, perception of openness
• Positive messages and “norms”
• Programs for parents and their teens may change
• Lots of healthy activities
behavior
• Feeling of worth—able to contribute – Especially increasing condom use
• Feeling they have a bright future
1. National Campaign to Prevent Teen & Unplanned Pregnancy. With One Voice (lite ) 2009.
2. Martino SC et al. Pediatrics 2008;121:612‐618.
3. Kirby D. Emerging Answers 2007.
Service-Learning is particularly effective
29 30

6. Contraceptives:
What about Clinics? Use can Reduce Pregnancy Rates
• Brief Clinic Protocols
– One‐on‐one; Clear messages
– Increase use of condoms, contraceptives
– No increase sexual activity
• S h l b d Cli i /C d
School‐based Clinic /Condom Programs
P
– None increase sexual activity
– Some increase condom/contraceptive use
– A few school clinics may have reduced pregnancies
– One condom program: LESS likely to have sex; more likely
to use condoms if sexually active
Kirby D. Emerging Answers 2007
31 32
Long‐Acting Contraceptives Condoms Work!
can reduce user failures
• Good physical barrier: no “pores”
• Failure mostly due to not using them
• Breakage (0.4% ‐ 2.3%); slippage (0.6% ‐ 1.3%)
g ( ); pp g ( )
• 85% effective in pregnancy prevention
• STDs: Good Evidence that condoms prevent:
– HIV
– Gonorrhea, Chlamydia, Trichomonas, PID
– Herpes, Syphilis, Chancroid
– HPV: Infection, Warts, Dysplasia & Cancer
33 34
•Abstinence‐Plus education
for 7th to 12th grades Preventing Teen Pregnancy
•Compatible with Texas
Law , §28.004
•Used in 11 Texas School
Districts
•“Promising”
Download FREE at Janet P. Realini, MD, MPH
JRealini@HealthyFuturesTX.org
www.BIGDECISIONS.org
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www.HealthyFuturesTX.org 36