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Adolescent Reproductive and Sexual Health Data

Adolescent Reproductive and Sexual 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 and Sexual Health Data

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  1. Adolescent Reproductive and Sexual 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. GLBT Prevalence in Vermont YRBS Survey, 2009

  7. Sexual Orientation & Adolescents: Growing Up Today Study 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 Lack Insurance • 75,040 children under the age of 18 lack health insurance • 29,313 youths ages 18-24 are uninsured • The risk of being uninsured historically doubled when a teen turned 19 • Affordable Care Act allows young adults to stay on parent’s health care plan until age 26

  10. Lack of Insurance = Lack of Care • Insured adolescents visit a physician’s office twice as often as uninsured teens • In a 1997 survey of adolescent girls: • 50% of uninsured girls reported foregoing needed care • More than 2xs the rate of insured girls

  11. Home Demographics of US Children, 2009 • 31% live with families where no parent has full-time, year-round employment • 34% live in single-parent households • 20% live in poverty • 24% of 18-24 year olds live in poverty

  12. Adolescents’ Education and Employment • In 2009, of U.S. eighth-graders: • 29% scored below basic math level • 26% scored below basic reading level • Since 2008: • 9% of teens not attending school and not working • 14% of 18-24 year olds not attending school, not working, a high school degree

  13. Sexual Development and Activity

  14. Teen Sexual Experience,NSFG 2006-8 Percent of males and females ages 15-19 who have ever had sexual intercourse by age

  15. Percent of US Students Who Have Ever Had Sexual Intercourse Youth Risk Behavior Survey 2009

  16. Percent of Students Who Have Had Intercourse, By Race and Grade 2009 Youth Risk Behavior Survey 9th 10th 11th 12th W B H

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

  18. Males Ages 15-19: Rates of Vaginal vs. Oral Sex 2002 National Survey of Family Growth

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

  20. Sexual Behavior of Adolescents 2002 National Survey of Family Growth *With a partner of the opposite sex

  21. Contraceptive Use

  22. Female Contraceptive Use at 1st Intercourse by Year of 1st Intercourse 2006-2008 National Survey of Family Growth

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

  24. Contraceptive Use, YRBS 2009 Percent of US High School Students Reporting Use of a Contraceptive Method at Last Intercourse 8.9% of students reported using both a condom and either birth control pills or injectable contraception

  25. Trends in Condom Use, YRBS 2009 Percent of US High School Students Reporting Condom Use at Last Intercourse

  26. Adolescent Sexually Transmitted Infections, Pregnancy and Abortion

  27. 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

  28. Chlamydia Rates, Ages15-19: 1996-2009 Reported Chlamydia Rate (per 100,000 population)

  29. Chlamydia: Age & Sex Specific, 2009 Reported Chlamydia Rate (per 100,000 population)

  30. Disparities in Adolescent Chlamydia Rates Reported Chlamydia Rate (per 100,000 population)

  31. Gonorrhea Rates, Ages 15-19 Over Time Gonorrhea rate (per 100,000 population)

  32. 2009 Gonorrhea Rates by Age and Sex Gonorrhea rate (per 100,000 population)

  33. 2009 Syphilis Rates By Age and Sex Syphilis rate (per 100,000 population)

  34. Teen Pregnancies Declined Over Time

  35. Teen Births Declined Over Time *Data is preliminary for 2007-2008

  36. Recent Changes in US Teen Births

  37. Disparities in Pregnancy Rates Remain Over Time

  38. Disparities in Teen Pregnancy Outcomes, 2004 Rates per 1,000 population

  39. International Comparison of Pregnancy, Birth and Abortion Rates per 1000 Women 15-19

  40. Comparing Teen Pregnancy Outcomes Over Time Rates per 1,000 women, ages 15-19 All Races White Black Hispanic

  41. Abortion Rates, Ages 15-19, 1989-2006

  42. Teen Pregnancy Rates Worldwide Pregnancy Rate Per 1000 Women Ages 15-19

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

  44. 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

  45. 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

  46. 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.

  47. Cohort Study • 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

  48. 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

  49. 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

  50. 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

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