Pursuing a Lifespan Women’s Health Perspective: Needs and Opportunities in the Adolescent Years

1. Pursuing a Lifespan Women’s Health Perspective: Needs and Opportunities in the Adolescent Years AMCHP Web conferenceSeptember 27, 2007

2. Epidemiology of Women and Chronic Disease • Prevalence Rate Increases 1996-2002 for Women 18-44 Years – Asthma, Diabetes, Hypertension,Heart Disease • In 2002 12.1% of women reported activity limitation related to depression • Will add bullet point about infertility • Overweight and obesity increasing over past 25 years and has risen each year. • Obese women at increased risk for maternal morbidity and mortality -- Gestational diabetes,Preeclampsia

3. System Challenges “Too little, too late, too fragmented”

4. To reiterate….. Behaviors in Adolescence Can Have Life-long Consequences Adolescence as a Key Time for Shaping Health Behaviors

6. Multiple Determinants of Health (Evans & Stoddart 1990) • Distal Risk Factors • Genetic • Physical environment • Social environment • Proximal Risk Factors • Biomedical responses • Behavioral responses • Access to health care

7. Intervention Strategy Options • Information strategies • Administrative strategies • Financing strategies • Provider strategies • Non-governmental strategies • Environmental

8. H. Grason. Applying a Lifespan Approach to Safe Motherhood Interventions. Presented at “Expecting Something Better” Jacobs Institute conference. Washington, DC. May 2005.

9. H. Grason. Applying a Lifespan Approach to Safe Motherhood Interventions. Presented at “Expecting Something Better” Jacobs Institute conference. Washington, DC. May 2005.

10. Obesity-Related Strategies by Life Stage: Little Girls • Environmental strategy – make neighborhoods safe and amenable for physical activity. • Provider strategy – increase pediatrician practice of taking family histories. • Administrative strategy – focus on food policies and education in day care and preschool settings.

11. Obesity-Related Strategies by Life Stage: Adolescent Girls • Provider Strategies • Need to begin to focus on woman-centered information transfer approach. • Pediatric histories need to be relayed to family practice and internal medicine physicians and reproductive health providers. • School settings • Include peer support groups. • Breastfeeding education. Different influences on behavior and different activities and places where spend time.

12. Obesity-Related Strategies by Life Stage: Young Women in their 20s • Might expand provider base for health interventions to include coaches, athletic club/gym staff. • Assuring information transfer across providers and over time continues to be important. • Young women change providers often. • Use multiple providers at once. • Tailoring chronic disease management to pregnancy.

13. New Territories ? • Which adolescents are MCH reaching and how…schools, after school & social programs, family planning,pregnant women < 24 yrs • Who is MCH not reaching….those where FP clinics have insufficient capacity or reach, or those women who don’t use family planning • ?? College Students: 44% of all women (adolescents) ages 18-24 are enrolled in college; about 14.4 million • !! 28% of women (adolescents) 18-24 reported no usual source of health care in 2003

14. Health, and Adolescents in College • Reported unprotected sex after drinking • - 15.6% males; 12.5% females* • Multiple Sexual Partners* • - 2+ 11%; 3+ 5.7%; 4+ 7.6% • 50% report ‘always use a condom”* • 32% are obese or overweight* * Source: Fall 2006 NCHA Data, 4 year Colleges

15. Healthy Campus 2010 Priorities • Injuries • Tobacco, alcohol, illicit drugs • Sexual behavior • Dietary patterns • Physical activity

16. Conclusions • Lifespan approach demands attention to consistency and continuity with respect to health information and health care. • Patient-based approaches complemented by population-based approaches to reach women across life course are critical.