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Dissemination of an Evidence-Based Pregnancy, STD, and HIV Prevention Program in Middle Schools in Texas
 

Dissemination of an Evidence-Based Pregnancy, STD, and HIV Prevention Program in Middle Schools in Texas

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  • Nationally, about 48% of high school students have had sex in their lifetime. In Texas more high school students are sexually experienced than students nationally and as you can see some cities such as Dallas have a much higher proportion of high school students who are sexually active
  • More infections of HIV occur among adolescents and young adults (13-29 years) than any other age group
  • Abstinence-plus– emphasizes abstinence and includes medically accurate information on PREGNANCY AND DISEASE PREVENTION, including contraception
  • It’s Your Game, Keep It Real. By game, we mean it’s your life. By real, we mean telling it like it is, being respectful, healthy and happy.So, the question becomes, how do you keep your game real? Well, we believe it’s by respecting yourself and others, as well as playing by your rules.
  • Iris peer pressure: Grade 7 Lesson 3Marvin’s story: Grade 8 Lesson 5
  • While attitudes toward SHE are favorable, there remain other barriers . . .

Dissemination of an Evidence-Based Pregnancy, STD, and HIV Prevention Program in Middle Schools in Texas Dissemination of an Evidence-Based Pregnancy, STD, and HIV Prevention Program in Middle Schools in Texas Presentation Transcript

  • Dissemination of an Evidence-based Pregnancy, STD, and HIV Prevention Program in Middle Schools in Houston, TX
    Belinda Flores, MPH, CHES, Melissa Peskin, PhD, Christine Markham, PhD, Ross Shegog, PhD, Shellie Tyrrell, MA, MSW, Kimberly Johnson, MPH, Robert Addy, MA, Susan Tortolero, PhD
    Center for Health Promotion and Prevention Research
    University of Texas School of Public Health
    Funded by the City of Houston Department of Health and Human Services and the Centers for Disease Control and Prevention
    May 26, 2010
  • Overview of the prevalence of sexual behaviors and HIV/AIDS/STIs among adolescents
    What is prevention
    Current Study and overview of “It’s Your Game… Keep It Real”
    Findings: Perspectives from school personnel
    Conclusions
    Overview
  • Students in Texas are more likely to be sexually experienced compared to the national average
    Percent of High School Students Reporting to Have Ever Had Sex (2007)
    Texas
    U.S.
    Source: Centers for Disease Control and Prevention. (2007). YRBSS: Youth Online Comprehensive Results. Retrieved June 4,2008 from http://apps.nccd.cdc.gov/yrbss/
  • Students begin having sex at early ages
    About 1 in 10 sixth grade students have had sex
    Source: Shanklin, S.L., Brener, N., McManus, T., Kinchen, S., Kann, L. (2007). 2005 Middle School Youth Risk Behavior Survey. Atlanta, G.A.: Centers for Disease Control and Prevention.
  • 8.0%
    Oral
    6.5%
    Anal
    14.4%
    Any
    12.2%
    Vaginal
    Students engage in different types of sex
    Sexual behaviors among 7th grade students in 2004
    Source: Markham, C.M., Peskin, M.F., Addy, R.C., Baumler, E.R., Tortolero, S. Patterns of vaginal, oral, and anal sexual intercourse in an urban seventh grade population. Journal of School Health. 79:193-200, 2009.
  • 2006
    8.0%
    Oral
    6.5%
    Anal
    2004
    14.4%
    Any
    12.2%
    Vaginal
    15.9%
    Any
    13.0%
    Vaginal
    8.7%
    Oral
    6.8%
    Anal
    7th grade sexual behavior has increased over a two year period
  • Therefore… in Texas with over 2 million students in 6-12 grade, the estimated total number of students having sex in any given year
    826,644
    Source: Shanklin, S.L., Brener, N., McManus, T., Kinchen, S., Kann, L. (2007). 2005 Middle School Youth Risk Behavior Survey. Atlanta, G.A.: Centers for Disease Control and Prevention. YRBS Results YRBSS: Youth Online Comprehensive Results. Retrieved June 4,2008 from http://apps.nccd.cdc.gov/yrbss/
    Source for TX student numbers: Enrollment in TX Public Schools, 2007-2008. Available at: http://ritter.tea.state.tx.us/research/pdfs/enrollment_2007-08.pdf
  • Sexually Transmitted Infections
    In the U.S., nearly half of all new STI cases occur among 15-24 year olds
    But many STIs go undetected
    • Teen rates of gonorrhea and syphilis have recently increased (2004-2006)
    Sources: Weinstock, 2004; National Office of AIDs Policy. Youth and HIV/AIDS 2000; Gavin (2009). Forhan S.E., Gottlieb, S.L., Sternberg, M.R., Xu, F., S. Datta, S.D., Berman, S., Markowitz, L.E. (2008). Prevalence of Sexually Transmitted Infections and Bacterial Vaginosis among Female Adolescents in the United States: Data from the National Health and Nutritional Examination Survey (NHANES) 2003-2000, Presented at the National STD Conference, Chicago, IL,.
  • Chlamydia and Gonorrhea Rate among 15-19 year olds (2008)
    U.S.
    Texas
    U.S.
    Source:  US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for HIV, STD and TB Prevention (NCHSTP), Division of STD/HIV Prevention, Sexually Transmitted Disease Morbidity for selected STDs by age, race/ethnicity and gender 1996-2008, CDC WONDER On-line Database, November 2009. Accessed at http://wonder.cdc.gov/std-std-v2008-race-age.html on Apr 26, 2010
  • Estimated New HIV Infections in the U.S. by Age
    Source:  CDC. Estimates of new HIV infections in the United States. CDC HIV/AIDS Facts. 2008.
  • In TX, over half of all HIV cases among youth occur among African Americans.
    Source: Texas Department of State Health Services. (2008). Texas HIV/AIDS Quarterly Report. Accessed March 4, from http://www.dshs.state.tx.us/HIVSTD/stats/pdf/HARSQ22008.pdf.
  • In TX, over one fourth of all HIV cases among youth occur among Hispanics.
    Source: Texas Department of State Health Services. (2008). Texas HIV/AIDS Quarterly Report. Accessed March 4, from http://www.dshs.state.tx.us/HIVSTD/stats/pdf/HARSQ22008.pdf.
  • Percent of parents who are very concerned about their child becoming infected with HIV
    Sources: Kaiser Family Foundation
  • Total direct medical cost for new STI infections among 15-24 year olds.
    $6,500,000,000
    Source: Chesson, H., Blandford, J.M., Gift, T.L., Tao, G., Irwin, K.L. (2004). The estimated direct medical cost of sexually transmitted diseases among american youth. Perspectives on Sexual and Reproductive Health, 36(1): 11-19.
  • Prevention
    Consistent and clear prevention messages
    Societal support for young people
    Access to contraceptive
    Comprehensive sexual health education
    and
    reproductive health services
  • Prevention
    Most Texas school districts (N=990) implement programs that are NOT evidence-based
    • Emphasizes abstinence
    • Includes medically accurate information
    • Mentions contraception
    • Teaches abstinence as the only healthy and morally correct option
    Source: Wiley, D., & Wilson, K. (2009). Just Say Don’t Know: Sexuality education in Texas public schools. Texas Freedom Network Education Fund.
  • One in three teens do not get formal education about birth control
    46% of males and 38% of females received no instruction about birth control methods prior to first sex
    Barriers to implementation: concerns about negative community reaction, unclear policies, lack of teacher skills
    Focus: Comprehensive sexual health education in schools
    Sources:Texas Freedom Education Network, 2009; Abma, J.C., Martinez, G.M., Mosher, W.D., Dawson, B.S. (2004). Teenagers in the United States: Sexual activity, contraceptive use, and childbearing 2002. Vital and Health Statistics, Series 23, No. 24.. Landry, 1999; Schaalma, 2004, Levesque, 2000
  • IYG Program Goals
    • Delay sexual initiation
    • Reduce risk among students that are sexually active
  • IYG Outcomes
  • Scope & Sequence
    7th Grade
    8th Grade
  • It’s Your Game…Keep It Real Curriculum:www.itsyourgame.org
  • It’s Your Game…Keep It Real
  • Information transfer
    Information transfer
    Skills / practice
    Activities
    Peer modeling
    Real-life serial - modeling
    Skills / practice
  • Methods: Recruitment and data collection
    All middle schools from large school district in SE Texas invited to participate; 33 agreed to participate
    Letters of information about the study were distributed via email, as well as in individuals’ school mailboxes
    school administrators, physical education/health teachers, nurses, counselors, and to random sample of non health/PE teachers at each school
    Within each email, a unique hyperlink of the self-administered survey was embedded
    Emails reminding school staff of the survey were distributed approximately every three weeks beginning two weeks after the initial email
  • Methods (cont.)
    Paper surveys in manila envelopes were distributed to non-responders after three email reminders
    Upon completion of the web-based survey or receipt of paper surveys, participants were emailed a $5 gift certificate
    315 school staff completed surveys
    84.3% of the surveys were web-based and 15.7% were paper
  • Results: Demographics
  • 92.7% agree/strongly agree that sexual health education (SHE) should be taught in middle schools
    91.7% agree/strongly agree that PE/health teachers can play an important role in informing students about the risks associated with sex
    87.3% are in favor of including SHE in the middle school PE/health curriculum at their middle schools
    Attitudes
  • 18.3% agree/strongly agree that their school has too many other priorities
    23.9% agree/strongly agree that a SHE curriculum that teaches about contraceptives would be difficult to implement in their schools
    Barriers: School-level
  • 44.4% are not aware/slightly aware of curricula which address SHE
    50.2% do not know/slightly know where to find a SHE curricula
    50.2% are not aware/slightly aware of district policy towards SHE
    Barriers: Knowledge
  • 63.9% agree/strongly agree that they can talk comfortably about sexuality in the classroom
    61.2% agree/strongly agree that they can discuss contraceptive practices in the classroom
    51.8% agree/strongly agree that they can get students to do an assignment that involves them talking with parents about sexual topics
    Barriers: Self-Efficacy
  • 36.9% agree/strongly agree that administrators support teachers who teach about SHE in the classroom
    20.3% agree/strongly agree that administrators support teachers who teach about condoms and other contraceptives
    Barriers: Support
  • 84% think that PE or health teachers support comprehensive SHE
    73.1% think that other teachers support comprehensive SHE
    52.4% think that community leaders support comprehensive SHE
    43% think that parents support comprehensive SHE
    Other Support for Comprehensive SHE
  • Teachers and other school officials want to teach SHE
    But, they lack knowledge of programs & policies, self-efficacy, and perceived support
    They need support to overcome these barriers
    Survey Conclusions
  • Implications for dissemination of effective SHE in middle school
    Dissemination strategies should:
    Provide administrators and policy makers with pertinent data and advocacy materials and stress the importance of effective programs
    Inform other staff about policies and effective programs
    Provide trainings to school staff on how to adapt and use effective programs
    Determine staff for teaching SHE
    Make schools aware of strong parental and community support for SHE in schools
  • Questions?
    Belinda Flores
    Belinda.Flores@uth.tmc.edu