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  1. Adolescent Risk Behaviors Lesley Cottrell, PhD West Virginia University, Department of Pediatrics Section Chief: Epidemiological, Psychosocial, & Behavioral Research

  2. 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.

  3. Overview • Epidemiology • Current State of Science • Intervention Research • Emerging Issues • Interventions in the pipeline

  4. Epidemiology

  5. Ever Had Sexual Intercourse, by Gender and Race/Ethnicity National Youth Risk Behavior Survey, 2005 * B > H > W

  6. Ever Had Sexual Intercourse, 1991 – 2005 National Youth Risk Behavior Surveys, 1991 – 2005 1 Significant linear decrease, P < .05

  7. Had First Sexual Intercourse Before Age 13 Years, by Gender and Race/Ethnicity * M > F ** B > H > W National Youth Risk Behavior Survey, 2005

  8. Had First Sexual Intercourse Before Age 13 Years, 1991 – 2005 National Youth Risk Behavior Surveys, 1991 – 2005 1 Significant linear decrease, P < .05

  9. 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

  10. Had Sexual Intercourse with >4 Persons During their Life, 1991 – 2005 National Youth Risk Behavior Surveys, 1991 – 2005 1 Significant linear decrease, P < .05

  11. Currently Sexually Active,* by Gender and Race/Ethnicity,** * Had sexual intercourse with ≥ 1 persons during the 3 months preceding the survey ** B > W, H

  12. Currently Sexually Active,* 1991 – 2005 * Had sexual intercourse with ≥ 1 persons during the 3 months preceding the survey 1 Significant linear decrease, P < .05

  13. HIV, STI, and Pregnancy Among Youth • 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.

  14. Sexually Transmitted Disease • 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.

  15. 10-14 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)

  16. 750 600 450 300 150 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)

  17. STDs • 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.

  18. Adolescent Pregnancy • 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.

  19. Racial/Ethnic Disparitiesin 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

  20. Birth Rates* Among Females Aged 15--19 Years, by State --- United States, 2004

  21. HIV/AIDS Among Adolescents

  22. Critical Issues Affecting Disparities • 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

  23. Current State of Science – Intervention Research

  24. Moving Research into Practice 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

  25. Identifying Effective Interventions: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

  26. PRS Project Website Fact Sheet: • Target population • Intervention • Research study • Key findings

  27. Interventions Identified by PRS for Youth (n=15) • 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)

  28. Interventions Identified by PRS for Youth 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)

  29. DEBI Youth Interventions

  30. Common Intervention Messages • 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