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Adolescent Risk Behaviors. Lesley Cottrell, PhD West Virginia University, Department of Pediatrics Section Chief: Epidemiological, Psychosocial, & Behavioral Research. Rationale for Prevention among Youth. Adolescence is a time… of new-found freedom and exploration

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Adolescent risk behaviors

Adolescent Risk Behaviors

Lesley Cottrell, PhD

West Virginia University,

Department of Pediatrics

Section Chief: Epidemiological, Psychosocial, & Behavioral Research


Rationale for prevention among youth
Rationale for Prevention among Youth

  • Adolescence is a time…

    • of new-found freedom and exploration

    • when behaviors are established that have both an immediate and long-lasting health impact.

    • to provide prevention messages as patterns of health behaviors are being established.


Overview
Overview

  • Epidemiology

  • Current State of Science

    • Intervention Research

  • Emerging Issues

  • Interventions in the pipeline



Ever Had Sexual Intercourse, by Gender and Race/Ethnicity

National Youth Risk Behavior Survey, 2005

* B > H > W


Ever had sexual intercourse 1991 2005
Ever Had Sexual Intercourse, 1991 – 2005

National Youth Risk Behavior Surveys, 1991 – 2005

1 Significant linear decrease, P < .05


Had first sexual intercourse before age 13 years by gender and race ethnicity
Had First Sexual Intercourse Before Age 13 Years, by Gender and Race/Ethnicity

* M > F

** B > H > W

National Youth Risk Behavior Survey, 2005


Had first sexual intercourse before age 13 years 1991 2005
Had First Sexual Intercourse Before Age 13 Years, 1991 – 2005

National Youth Risk Behavior Surveys, 1991 – 2005

1 Significant linear decrease, P < .05


Had sexual intercourse with 4 persons during their life by gender and race ethnicity
Had Sexual Intercourse with >4 Persons During their Life, by Gender* and Race/Ethnicity,**

* M > F** B > H > W

National Youth Risk Behavior Survey, 2005


Had sexual intercourse with 4 persons during their life 1991 2005
Had Gender* and Race/Ethnicity,**Sexual Intercourse with >4 Persons During their Life, 1991 – 2005

National Youth Risk Behavior Surveys, 1991 – 2005

1 Significant linear decrease, P < .05


Currently sexually active by gender and race ethnicity
Currently Sexually Active,* by Gender and Race/Ethnicity,** Gender* and Race/Ethnicity,**

* Had sexual intercourse with ≥ 1 persons during the 3 months preceding the survey

** B > W, H


Currently sexually active 1991 2005
Currently Sexually Active,* 1991 – 2005 Gender* and Race/Ethnicity,**

* Had sexual intercourse with ≥ 1 persons during the 3 months preceding the survey

1 Significant linear decrease, P < .05


Hiv sti and pregnancy among youth
HIV, STI, and Pregnancy Among Youth Gender* and Race/Ethnicity,**

  • Of the 19 million new STIs that occur in US each year, 48% are among young people ages 15 – 24.

  • 15% to 30% of new HIV cases occur among individuals under 25 years of age.

  • There were 757,000 pregnancies in 2002 among 15-19 year olds.

  • African American and Hispanic/Latino youth are disproportionately affected by these outcomes.


Sexually transmitted disease
Sexually Transmitted Disease Gender* and Race/Ethnicity,**

  • 15 – 24 year-olds acquire nearly 50% of all new STDs.

  • 9.1 million cases of STDs occur among 15-24 year olds each year.

  • Increased rates of some STDs, primarily because of improved screening.


Chlamydia age and gender specific rates united states 2004

10-14 Gender* and Race/Ethnicity,**

15-19

20-24

25-29

30-34

35-39

40-44

45-54

55-64

65+

Total

Chlamydia — Age- and Gender-Specific Rates: United States, 2004

Rate (per 100,000 population)

Men

Women

3,000

2,400

1,800

1,200

600

0

0

600

1,200

1,800

2,400

3,000

Age

132.0

10.8

2,761.5

458.3

2,630.7

744.7

402.9

1,039.5

364.8

185.2

99.3

148.3

56.1

62.6

23.0

22.4

7.4

6.2

2.2

2.0

147.5

486.2

(STD Surveillance 2004, CDC, Sept. 2005)


Gonorrhea age and gender specific rates united states 2004

750 Gender* and Race/Ethnicity,**

600

450

300

150

0

0

150

300

450

600

750

Gonorrhea — Age- and Gender-Specific Rates: United States, 2004

Rate (per 100,000 population)

Men

Women

Age

5.8

10-14

36.9

15-19

252.9

610.9

20-24

430.6

569.1

25-29

302.1

269.7

114.2

30-34

178.6

35-39

124.5

60.3

40-44

89.6

32.9

11.7

45-54

48.1

55-64

17.0

2.5

65+

4.1

0.6

116.7

Total

110.2

(STD Surveillance 2004, CDC, Sept. 2005)


STDs Gender* and Race/Ethnicity,**

  • Greater risk for STDs than people in other age groups.

  • Female youth and youth of color are disproportionately affected.

  • African Americans have the highest rates of sexually transmitted diseases (STDs).

    • In 2005, compared to Whites, African Americans were about:

      • 18 times as likely to have gonorrhea

      • 7 times as likely to have Chlamydia

      • 5 times as likely to have syphilis.

  • The presence of certain STDs can increase one’s chances of contracting HIV 3- to 5-fold.


Adolescent pregnancy
Adolescent Pregnancy Gender* and Race/Ethnicity,**

  • Decrease in rates of pregnancy overall

    • smaller decreases in ethnic minority youth;

    • most recent data suggest rates are not continuing to decrease and in most states have remained level.

  • 831,000 pregnancies occur each year among 15-19 year olds.


Racial ethnic disparities in teen birth rates
Racial/Ethnic Disparities Gender* and Race/Ethnicity,**in Teen Birth Rates

% Decline

33%

38%

47%

21%

1991

61.8

43.4

118.2

104.6

2004

41.1

26.7

63.1

82.6

All races

Non Hispanic White

Non-Hispanic Black

Hispanic

Rates per 1,000 females aged 15-19


Birth rates among females aged 15 19 years by state united states 2004
Birth Rates* Among Females Aged 15--19 Years, Gender* and Race/Ethnicity,**by State --- United States, 2004


HIV/AIDS Among Adolescents Gender* and Race/Ethnicity,**


Critical issues affecting disparities
Critical Issues Affecting Disparities Gender* and Race/Ethnicity,**

  • Behavioral Factors

    • Early sexual debut

    • Multiple sex partners

    • High risk sexual behavior

  • Contextual Factors

    • Cultural beliefs about sexuality

    • Gender roles

    • Access to health care services

  • Structural Factors

    • Social, economic and race based inequality

  • Social Networks

    • Black young adults at high risk even when their behaviors are normative

    • Factors other than individual risk behaviors and covariates appear to account for racial disparities


Current state of science intervention research

Current State of Science – Gender* and Race/Ethnicity,**Intervention Research


Moving Research into Practice Gender* and Race/Ethnicity,**

DEBI: Diffusion of Effective Behavioral Interventions

Adaptation

www.effectiveinterventions.org

http://www.cdc.gov/hiv/projects/rep/default.htm

http://www.cdc.gov/hiv/topics/research/prs/index.htm


Identifying effective interventions prevention research synthesis prs project
Identifying Effective Interventions: Gender* and Race/Ethnicity,**Prevention Research Synthesis (PRS) Project

  • Goal:

    • Review and synthesize cumulative body of evidence from the scientific research literature to help inform policy decisions, programmatic efforts, and future research

    • Identify evidence-based behavioral interventions

  • Results:

    • 31 interventions identified as “best evidence”

    • 7 were for youth

  • Ongoing review for earlier and later years


Prs project website
PRS Project Website Gender* and Race/Ethnicity,**

Fact Sheet:

  • Target population

  • Intervention

  • Research study

  • Key findings


Interventions identified by prs for youth n 15
Interventions Identified by PRS for Youth (n=15) Gender* and Race/Ethnicity,**

  • Best Evidence (n=7)

    • Becoming a Responsible Teen (BART) (St. Lawrence, 1995)

    • Be Proud! Be Responsible! (Jemmott, 1992)

    • Focus on Kids (FOK) + Informed Parents and Children Together (ImPACT) (Wu, Stanton, 2003)

    • Sistas, Informing, Healing, Living and Empowering (SiHLE) (DiClemente, 2004)

    • Sisters saving Sisters (Jemmott, 2005)

    • Choosing Life: Empowerment, Actions, Results (CLEAR-in person) Rotheram-Borus, 2004)

    • ¡Cuídate! (Take Care of Yourself) (Villarruel, 2006)


Interventions identified by prs for youth
Interventions Identified by PRS for Youth Gender* and Race/Ethnicity,**

Promising Evidence (5)

  • Safer Sex– (Shrier, 2001)

  • Focus on Kids (FOK) (Stanton, 1996)

  • Intensive AIDS Education (Magura, 1994)

  • Street Smart (Rotheram-Borus, 2003)

  • Together Learning Choices—(Rotheram-Borus, 2001)

    Compendium (3)

  • AIDS Community Demonstration Projects (Community PROMISE) (ACDP, 1999)

  • Reducing the Risk (School based)

  • Get Real about AIDS 1992 (School based)


Debi youth interventions
DEBI Youth Interventions Gender* and Race/Ethnicity,**


Common intervention messages
Common Intervention Messages Gender* and Race/Ethnicity,**

  • peer opinion leaders to assist in program delivery

  • active social learning methods, involving role plays, behavioral rehearsal, and group discussion

  • inclusion of parents through homework and other activities

  • the same risk and protective factors may predict various problems

  • risk and protective factors may be found in the environment as well as in the individual

  • developmental needs, processes, and tasks should be taken into account


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