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Public Health Reports Webinar on Understanding Sexual Health: Overview. March 12, 2013 1:00 PM - 2:00 PM EDT. Public Health Reports Webinar on Understanding Sexual Health: Overview. Mary Beth Bigley, Dr.P.H ., M.S.N., A.N.P.

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public health reports webinar on understanding sexual health overview

Public Health Reports Webinar on Understanding Sexual Health: Overview

March 12, 2013

1:00 PM - 2:00 PM EDT


Public Health Reports Webinar on Understanding Sexual Health: Overview

Mary Beth Bigley, Dr.P.H., M.S.N., A.N.P.

Acting Editor, Public Health Reports Office of the Surgeon General


Public Health Reports Webinar on Understanding Sexual Health: Overview

John M. Douglas, Jr, M.D..

Chief Medical Officer

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

Centers for Disease Control and Prevention

sexual health surgeon general s call to action
Sexual Health: Surgeon General’s Call to Action
  • Focused on the need to promote sexual health and responsible sexual behavior across the lifespan
    • Essential component of overall individual health
    • Has major impact on overall health of communities
    • National dialogue at all levels critical in improving population health
  • Primary goal to stimulate respectful, thoughtful, and mature discussion in our communities and in our home about sexuality.
sexual health in the u s why now
Sexual Health in the U.S.: Why Now?
  • High population burden of adverse outcomes related to sexual behavior
    • HIV/STD
      • Estimated 1.1 million living with HIV, 50,000 new infections/year
      • 19.7 million STI each year—almost half among persons 15-24
      • 25% adolescent F infected with at least one STD
    • Unintended/teen pregnancy
      • Nearly 50% of all pregnancies in the U.S. are unintended
      • U.S. with one of highest teen birth rates of industrialized nations
    • Sexual violence
      • Annual estimates: 1. 3 million F raped, 6.7 m F and 6 m M with other sexual violence victimization
  • Health equity/ disparities concern
    • African–Americans: HIV rates 8 to 20x Whites
    • MSM: 40-50x higher HIV rates than other males
  • High economic burden—estimated annual costs
    • STD/HIV: $17 billion
    • Teen childbearing: $11 billion
    • Rape/other sexual assault $12 billion
what is sexual health
What is Sexual Health?
  • WHO definition (2006)
    • state of physical, emotional, mental, and social well-being related to sexuality
    • not merely absence of disease, dysfunction, or infirmity.
    • requires a positive and respectful approach to sexual relationships, as well as possibility of having pleasurable & safe sexual experiences, free of coercion, discrimination, and violence.
    • for sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled.
cdc hrsa advisory committee definition of sexual health a public health perspective
CDC/HRSA Advisory Committee Definition of Sexual Health: A Public Health Perspective

Douglas JM, Fenton K. Understanding sexual health and its role in more effective prevention programs. Public Health Reports 2013

Recommended by the CDC-HRSA Advisory Committee on HIV, STD, and Viral Hepatitis Prevention and Treatment, May 2012 (CHAC Minutes:

  • Sexual health is a state of wellbeing in relation to sexuality across the lifespan that involves physical, emotional, mental, social, and spiritual dimensions.
  • Sexual health is an inextricable element of human health and is based on a positive, equitable, and respectful approach to sexuality, relationships, and reproduction, that is free of coercion, fear, discrimination, stigma, shame, and violence. 
  • It includes the ability to understand the benefits, risks, and responsibilities of sexual behavior; the prevention of disease and other adverse outcomes; and the possibility of fulfilling sexual relationships. 
  • Sexual health is impacted by socioeconomic and cultural contexts–including policies, practices, and services–that support healthy outcomes for individuals, families, and their communities.
addressing sexual health
Addressing Sexual Health

Douglas JM, Fenton K. Understanding sexual health and its role in more effective prevention programs. Public Health Reports 2013

  • Over past decade, increasing attention to addressing the concept of sexual health
  • Public health premise: sexual health promotion
    • great potential to complement traditional disease control and prevention efforts for a range of conditions (eg, HIV, STD, viral hepatitis, unintended pregnancy, sexual violence)
    • not to replace traditional efforts but to improve their acceptance and population impact
sexual health framework emphasizing health promotion to enhance disease control and prevention
Sexual Health Framework: Emphasizing Health Promotion to Enhance Disease Control and Prevention

Potential Benefits

  • Engage new and diverse partners
  • Normalize conversations
  • Reduce stigma, fear, and discrimination
  • Enhance the efficiency and effectiveness of prevention messaging and services

Ivankovich et al. Considerations for national public health leadership in advancing sexual health. Public Health Reports 2013

sexual health a national priority
Sexual Health: A National Priority
  • 2010—National HIV/AIDS Strategy
    • “Provides an opportunity for working together to advance a public health approach to sexual health that includes HIV prevention as one component”
  • 2011—Healthy People 2020
    • “Reproductive and Sexual Health” is a leading health indicator
  • 2011—National Prevention Strategy
    • Vision: Working together to improve health and quality of life by moving from a focus on sickness and disease to one based on prevention & wellness
    • “Reproductive and Sexual Health” is one of seven priority areas
public health reports supplement on sexual health
Public Health Reports Supplement on Sexual Health
  • Priority topics
    • Research
    • Surveillance
    • Program
    • Perspectives
public health reports supplement on sexual health1
Public Health Reports Supplement on Sexual Health
  • Research
    • Susan Kirby: Beginning a conversation on sexual health
  • Programs
    • Robert Nystrom: Shifting the paradigm in Oregon from teen pregnancy prevention to youth sexual health
  • Perspectives
    • Edward Hook: Sexual health education—frame-shifting and its challenges
public health reports meet the author live webcast
Public Health ReportsMeet the Author! Live Webcast

A Communication

Framework for Sexual Health

Susan D. Kirby, Dr.PH, MPH

President, Kirby Marketing Solutions

finding common communication ground
Finding Common Communication Ground

CDC recognizes the need to work with a wide variety of partners who hold differing viewpoints

Communicating about sexual health may be difficult when you don’t share same values

Communication is important and we need everyone to participate in the conversation

Finding common communication ground is a starting place …


A set of beliefs and values developed

over a lifetime of experiences

Mental maps we use

to navigate the world

We fit new information

into our frames

We typically reject information that doesn’t fit our frame, not the frame

Understanding is frame-based, not fact-based

Effective communication can reframe understanding

robert wood johnson foundation s social determinants research
Robert Wood Johnson Foundation’sSocial Determinants Research

Republicans’ Frame

  • Life and health are journeys through unpredictable paths
  • People need opportunity to make good choices

Your opportunity for health starts long before

you need medical care.

Health starts—long before illness—in our homes,

schools and jobs.

Democrats’ Frame

Complex, interdependent social systems influence the health of people

  • Environmental scan
    • Media
  • Frame development
    • Diverse external and internal stakeholders
    • Developed 4 frames, 30 messages
  • Interviews
    • 26 diverse community and health professionals
    • Revised messages
  • Online surveys
    • 240 public
    • 70 health professionals
four frames example messages
Four Frames & Example Messages
  • Navigating a Journey/Choices

Life is a series of choices, including sexual choices. Throughout their lives, all people need information and skills to make healthy sexual choices that reflect their own values and deeply held beliefs.

  • Health Promotion/Wellness

Living a healthy lifestyle is important to good health, and this includes sexual health, too. It’s time we focused on promoting and encouraging the behaviors that improve the emotional, social, spiritual, and physical aspects of sexuality.

  • Working Together

As a society, we have the responsibility to help all Americans make healthy sexual choices.

  • Fair Chance/Fair Opportunity

All people need to have a fair chance to make informed choices about their sexual health.

focus on framing results
Focus on Framing Results


Most accepted frames by general public and professional respondents

making messages fit a shared frame
Making Messages Fit a Shared Frame

Wellness Frame Messages

  • Moderates, Conservatives, Professionals
  • Liberals
    • Visit the article at Public Health Reports for the full message set on p.50

Journey/Choices Frame Messages

  • Public: Throughout life, we all make choices, including sexual choices. Along the way, all of us need the information, knowledge, and skills that will help us make sexual choices that protect us from the risks and dangers of unhealthy sexual activity.
  • All Professionals: Throughout life, we all make choices, including sexual choices. Along the way, Americans need the information, knowledge, and skills that will help them make sexual choices that protect their health and future partners.
what s next
What’s Next?
  • Findings developed in a positive direction, but there’s more we need to know
  • Needs replication in more contexts and in more real life “campaigns”
  • The field needs to know more about how specific health or social issues interact with frame preferences
  • We need to understand how to use framing to build broad consensus movements
public health reports meet the author live webcast1
Public Health ReportsMeet the Author! Live Webcast

Shifting the Paradigm in Oregon from Teen Pregnancy Prevention to Youth Sexual Health

Robert Nystrom

Section Manager

Adolescent, Genetics & Reproductive Health

Oregon Public Health Division



Oregon Youth Sexual Health Plan

  • 3rd decade of plans
    • 1994-2002
  • Policy & systems
    • Minor consent
    • Sexuality education
    • School-Based Health Centers
  • Governor’s directive 2005
  • Oregon Youth Sexual Health Partnership
  • Plan released in 2009

Plan Development

Community Survey

Youth Action Research

Community Forums

Use of Data

Literature Reviews

youth action research
Youth Action Research

Youth Action Research Team

five overarching goals
Five Overarching Goals
  • Youth use accurate information and well developed skills to make thoughtful choices about relationships
  • Sexual health inequities are eliminated
  • Rates of unintended teen pregnancy are reduced
  • Rates of sexually transmitted infection are reduced
  • Non-consensual sexual behaviors are reduced


1. Infrastructure

2. Policy

3. Health Inequities

4. Youth Development

5. Education for Youth and Families

6. Services for Youth and Families

7. Data

8. Assurances

accomplishments outputs
Accomplishments - Outputs
  • Expansion of clinical services
  • Revised/strengthened K-12 comprehensive

sexuality education statute

    • Teacher training on LGBTQ inclusiveness
  • AMCHP/ASTHO learning collaborative
  • Research series on sexual health of disenfranchised youth
  • Implemented/expanded community

interventions & programs program

implications going forward
Implications - Going Forward


Oregon’s experience serves as a model for other states to shift from a risk-problem focused framework to a more PYD framework that promotes sexual health

Importance of authentic community & youth engagement and interest-based problem solving


Evaluating plans early efforts

Expand state capacity to use Youth Action Research (YAR) or to apply it to other public health topics

Expand focus on addressing disparities & inclusiveness


Public Health ReportsMeet the Author! Live Webcast

Sexual Health Education:

Frame Shifting and Its Challenges

Edward W. Hook III M.D.

Professor of Medicine, Epidemiology, and Microbiology

University of Alabama at Birmingham,

Alabama/North Carolina STD/HIV Prevention Training Center

And Jefferson County Department of Health

Birmingham Alabama

historical partners in u s std prevention
Historical Partners in U.S. STD Prevention

Brandt, AM. No Magic Bullet, Oxford Univ Press, 1985.

American Society for Sanitary and Moral Prophylaxis (1905) – (Coalition of physicians, social hygienists, charity groups, moral reformer churches)

American Social Hygiene Association (1913)

Armed Forces

U.S. Public Health Services

conventional wisdom regarding stis
Conventional Wisdom Regarding STIs

STIs are the result of inappropriate behavior

People with STIs will know they have them

Efforts to control STIs should focus on women

Sex (and STIs) is not an appropriate topic for conversation




consequences of sti related stigma
Consequences of STI-Related Stigma

Personal (Individual)

  • Delays in using or seeking preventative health care
    • Condoms
    • Vaccines
    • Screening
  • Delays in seeking care for perceived problems
  • Ineffective partner notification


  • Hesitancy in seeking relevant information
  • Differential testing
  • Changes to provider-client interactions


  • Guilt by association
  • Differential Care
  • Profiling

Framing – influenced by context; anticipated to have selective influence on perception, encouraging certain interpretation, discouragement, others (Wikipedia)

A sexual health framework shifts the approach from a more traditional loss frame approach to a gain frame

  • Gain frame – Emphasizes positives, benefits
  • Loss frame – Emphasizes risks, potential harm, potentially fueling shame and stigma
self reflective questions on sexual health
Self-Reflective Questions on Sexual Health
  • Have you ever hesitated to take a sexual history?
  • Have you ever hesitated to test for STIs because you worry that a client may find it troublesome or insulting?
  • Have you ever apologized for making a STI diagnosis?
loss frame gain frame examples sexual history
Loss Frame/Gain Frame ExamplesSexual History

Loss Frame

Partner Type

Have you ever had homosexual sex?

Sites of exposure

Have you had oral or rectal sex , or just regular sex?

Gain Frame

Partner Type

Are your partners men, women or both?

Sites of exposure

When you have sex, what sites are exposed- oral, rectal or genital?

health education opportunities derived from a sexual health approach
Health Education Opportunities Derived From a Sexual Health Approach

Patients (Empowering)

Life Course Perspective

Reduces Consequences of Perceived Stigma

Broadly Encourages Preventative Health Care (Women AND Men)



Providers (Permissive)

Life Course Perspective

Reduces Consequences of Perceived Stigma

Efficiency- Addresses Existing Redundancy



For more information about PHR: