Your SlideShare is downloading. ×
0
Division of Reproductive Health
Office of the Director
Teenage Pregnancy Prevention
in the United States:
Using CDC’s Heal...
Objectives
 Describe why teen pregnancy is a public
health problem in the United States
 Describe why preventing teen pr...
Teen Pregnancy is a Public Health Problem
Teen Mother
• Educational
attainment
• Earnings
Pregnancy
• Preterm birth
• Low ...
Teen Pregnancy in the United States
3in 10teen girls
will become pregnant before age 20
750,000 teen pregnancies every yea...
Teen Pregnancy in the United States
5in 10African American and Latina teen girls
will become pregnant before age 20
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Rateper1,000womenaged15-...
Teen Birth Rates in High-income
Countries, 2010
34
27
18
15
15
13
11
10
9
8
6
5
5
4
0 5 10 15 20 25 30 35 40
United States...
The Cost of Teen Births


 Reflects the steady decline of the teen birth rate in recent
years
 Decrease in programmati...
US Department of Health and Human Services
U.S. Department of Health and Human Services
 Pregnancy Assistance Fund
 Teen Pregnancy Prevention Initiative
Replicati...
CDC’s Winnable Battles
Healthcare-
Associated
Infections
HIV
Motor
Vehicle
Injuries
Nutrition, Physical
Activity, Obesity
...
Clinical
Interventions
Long-lasting
Protective
Interventions
Changing the Context
to make individual’s default
decisions h...
Teen Pregnancy and the Health Impact Pyramid
Factors that Affect Health
Sexual
health
education
Strengthen
effective clini...
Sexual
health
education
Strengthen
effective clinical
interventions
Promote long-lasting
preventive interventions
(LARC)
I...
Sexual Health Education
 Challenges
– Most teens receive sex education
• Not always before the first time they have sex
–...
Sexual
health
education
Strengthen
effective clinical
interventions
Promote long-lasting
preventive interventions
(LARC)
I...
Strengthen Effective Clinical Interventions
and Promote Use of LARC Interventions
 Challenges
– Youth are poorly educated...
Strengthen Effective Clinical Interventions
and Promote Use of LARC Interventions
 Opportunities
– CDC is working with
• ...
Sexual
health
education
Strengthen effective
clinical interventions
Promote long-lasting
preventive interventions
(LARC)
I...
Improve the Context to Encourage
Healthy Decisions
• Challenges and opportunities
– Community mobilization
• CDC’s communi...
Sexual
health
education
Strengthen
effective clinical
interventions
Promote long-lasting
preventive interventions
(LARC)
I...
Address Socioeconomic Factors
 Challenges and opportunities
Social determinants of health are important to
reducing teen...
CDC’S EFFORTS TO PREVENT
TEEN PREGNANCY
Integrating Services, Programs, and Strategies
Through Community-wide Initiatives
 Partnership between CDC and the Office...
CDC’s Teen Pregnancy Prevention
Community-Wide Initiatives
2010 – 2015 Grantees
• AL - Alabama Department of Public Health...
5 Keys to Success of Community-wide Initiatives
Strong teens
Strong communities
Youth are able to
access and use youth-
fr...
For a full list of evidence based programs visit: http://www.hhs.gov/ash/oah/oah-initiatives/tpp/tpp-database.html
Teen Pregnancy and Contraception






•
•
Santelli JS, et al. Persp Sex Reprod Health 2006;38:106-11
Key Domains of the Elements of
Youth Friendly Reproductive
Health Services
 Confidentiality
 Privacy
 Consent
 Accessi...
Infographic of Teen-Friendly
Reproductive Health Visit
http://www.cdc.gov/TeenPregnancy/TeenFriendlyHealthVisit.html
Effectiveness of family planning methods
http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/Contraception.htm
Tier ...
Typical Effectiveness of
Contraceptive Methods
 Most effective: <1 pregnancy per 100
women/year
– Single rod progesterone...
Typical Effectiveness of
Contraceptive Methods
 Moderately effective: 6–12 pregnancies
per 100 women/year
– Contain estro...
Typical Effectiveness of
Contraceptive Methods
 Least effective: >18 pregnancies per
100 women/year
– Male condom
– Femal...
Long Acting Reversible Contraception
(LARC)
 High typical effectiveness
– Not dependent on adherence
 Should be first-li...
Contraceptive Method Use among
54.1
22.8
9.4
3.6 0.5
9.6
0
10
20
30
40
50
60
70
80
90
100
Pill Condom DMPA IUD Implant,
Lu...
Teens and LARCs
 Why teens do not use LARCs
Cost
Knowledge
Accessibility



Teens and LARCs
 Why providers do not offer LARCs
Patient preference
Concerns about safety
Not trained in IUD insertio...

 Evidence-based guidelines for which contraceptive
methods can be used safely by women with certain
characteristics and...
U.S. MEC for Contraceptive Use:
Recommendations for
 can safely use all methods of
contraception
Including implants and ...
U.S. Selected Practice Recommendations
for Contraceptive Use (SPR)





 What exams and tests are needed before star...
CDC Contraceptive Guidance
Healthcare Provider tools
http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/USMEC.htm
Quality Family Planning (QFP)
Recommendations
New CDC-OPA* recommendations, Providing
Quality Family Planning Services (QF...
 Provide quality contraceptive counseling
 Offer confidential services and observe all relevant state
laws and any legal...
Dissemination
 Increase awareness among providers
 Develop & disseminate provider training
materials
 Evaluate use of g...
Summary
 pregnancy rate in the U.S. is declining, but still high
 Most pregnancies are due to non-use
or inconsistent us...
For more information please contact Centers for Disease Control and
Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Tel...
The findings and conclusions in this presentation have not
been formally disseminated by the Centers for Disease
Control a...
Upcoming SlideShare
Loading in...5
×

Prevención de Embarazo Adolescente Usando la Pirámide de Impacto en Salud. Dra. Lisa Romero, CDC.

408

Published on

Published in: Health & Medicine, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
408
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
17
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Good morning. I am Lisa Romero from CDC’s Division of Reproductive Health. Today I will provide an overview of teen pregnancy in the United States and describe some of CDC’s efforts to preventteen pregnancy.
  • This presentation will [list objectives]
  • Teen pregnancy has health, economic and social consequences. For example:[CLICK]Teen mothers may have lower educational attainment and earnings.[CLICK]They may have higher rates of preterm birth, low birthweight, and infant death.[CLICK]Their children may be more likely to be abused and neglected and to have early developmental problems.The sons may be at higher risk for incarceration later in life. Daughters may be more likely to become teenmothers themselves, thus perpetuating cycle.
  • How common is teenpregnancy?3 in 10 teen girls in U.S. will become pregnant by age 20.This amounts to almost 750,000 teenpregnancies per year.
  • Among African Americanand Latinateen girls, almost 5 in 10 will become pregnant by age 20.
  • The rates of teen births have actually been declining and we have experienced over a 50% decline in the past 20 years (peak in 1991 (61.8)). However, this still accounts for OVER 300,000 births to teens age 15-19 in 2012.
  • Nonetheless, rates are still high and the United States, in fact, has a higher teen birth rate than many countries of similar economic status.
  • In 2010, teen births cost the United States 9.4 billion dollars. Most of this is due to increased costs for health care, foster care, incarceration, and lost tax revenue.This reflects the steady decline of the teen birth rate in recent years.In 2008 the costs were estimated to be 10.9 billion dollars. The reduction of 1.5 billion in 2 years was due to the decrease in programmatic costs associated with each participant in publicly funded programs.
  • In the United States, there are many efforts to reduce teen pregnancy.Here is an organizational chart of the US Department of Health and Human Services. [CLICK]I have highlighted in red the Office of Associate Secretary for Health, the Centers for Disease Control and Prevention (CDC) and the Administration for Children and Families (ACF), all of which support efforts to reduce teen pregnancy in the U.S.
  • Here is a briefoverview of HHS efforts to reduce teen pregnancy rates:The Office of the Assistant Secretary for Health has 2 major initiatives:The Pregnancy Assistance Fund and the Teen Pregnancy Prevention Initiative. This program is a 2 a two-tiered initiative. The 1st tieris focused on replication of evidence-based programs already found to reduce teen pregnancy.The 2nd tiersupports communitywide initiatives, some of which are in collaboration with CDC.The Administration for Children and Families has 2 major initiatives:The Personal Responsibility and Education Program established by the Affordable Care Act in 2010State Title V Abstinence Grants(Background info if needed)Pregnancy Assistance Fund (a $25 million competitive grant program). Provides expectant and parenting teens, women, fathers, and their families with a seamless network of supportive services to help them complete high school or postsecondary degrees and gain access to health care, child care, family housing, and other critical supports. The funds are also used to improve services for pregnant women who are victims of domestic violence, sexual violence, sexual assault, and stalking. The Teen Pregnancy Prevention (TPP) Program ($105 million discretionary grant program). The TPP program works to prevent teen pregnancy by supporting the replication of evidence-based programs and the implementation of demonstration programs to develop and test new models and innovative strategies.Three grant programs funded through the TPP Program include:•TPP Replication of Evidence-Based Programs•TPP Research and Demonstration Programs•TPP Communitywide Initiative (CDC)The Personal Responsibility Education Program (PREP) (as part of the Affordable Care Act of 2010 (healthcare reform), Congress authorized $75 million per year for five years (2010-2014). Of that, $55 million is allocated to states and $10 million is allocated to fund innovative strategies. The remainder is for tribal communities, program evaluation, and support). The first federal funding stream for programs that teach about abstinence and contraception for the prevention of pregnancy and sexually transmitted infections (STIs). PREP-funded programs must also cover at least three adult preparation subjects, such as healthy relationships, adolescent development, financial literacy, educational and career success, and healthy life skills. State Title V Abstinence Grants (In FY 2013, $36.9 million was granted to 39 States and Territories). The Title V State Abstinence Education Grant Program provides funding to States and Territories for abstinence education, and where appropriate, mentoring, counseling and adult supervision to promote abstinence from sexual activity.
  • For this Winnable Battle, CDC’s Division of Reproductive Health modified the original CDC health impact pyramid, developed by our CDC Director Dr. Frieden. The CDC Health Impact Pyramid is a 5-tier pyramid that best describes the impact of different types of public health interventions and provides a framework to improve health. At the base of this pyramid, indicating interventions with the greatest potential impact, are efforts to address socioeconomic determinants of health. In ascending order are interventions that change the context to make individuals&apos; default decisions healthy, clinical interventions that require limited contact but confer long-term protection, ongoing direct clinical care, and health education and counseling.Interventions focusing on lower levels of the pyramid tend to be more effective because they reach broader segments of society and require less individual effort. Implementing interventions at each of the levels can achieve the maximum possible sustained public health benefit.
  • Presented here is a modified pyramid thathighlights approaches most likely to achieve public health impactin teen pregnancy prevention. Factors at the top of the pyramid affect individuals while those at the bottom affect populations. Although important, factors at the top may have smaller impacts compared to factors at the bottom with larger impacts.
  • I am now going to go thru the levels of the pyramid and highlight some of the challenges and opportunities:Sexual health education is an important teen pregnancy prevention tool. We have many education-based programs across the country and most teens receive some type of sexual health education before age 18. The efforts of the Office of Adolecent Health, under the President’s Teen Pregnancy Prevention Initiative has brought national attention to the need for evidence-based prevention programs.
  • However, for the vast majority of sexually experienced teens, formal sex education does not precede their first sexual experience. This represents a missed opportunity to introduce medically accurate information on both abstinence and effective contraceptive usefor the vast majority of sexually experienced teens.Education about birth control methods lags behind other health education areas such as HIV and STDs; More than 96% of youth in the U.S. receive some type of sexual health education before age 18, but only about 70% of teen females receive education on methods of birth control And we still face many challenges translating and scaling up evidence-based prevention programs efficiently and with fidelity. In order to make more progress in this area, we need to educate state and local education officials about the benefits of sexual health education and facilitate their use. These efforts mustbe accompanied by action to increase parent-child communication about responsible sexual decision-making.Adolescents need the necessary knowledge, skills and encouragement to make healthy decisions and engage in healthy behaviors. Continued efforts to prevent teen childbearing among this group should include developmentally-appropriate, evidence-based approaches to continue delay of sexual debut and introduce the most effective methods of contraception for those who are sexually active.
  • Highlighting the next two levels of the pyramid,There is a strong need to strengthen effective clinical services and promote long acting reversible contraceptives or LARCs (IUD and Contraceptive Implant).Current research has shown enormous impact on U.S.teen and unintended pregnancy if we remove barriers to LARCs. CDC has developed evidence-based guidance for providingcontraception safely and effectively and CDC continues its efforts to strengthen clinical services.
  • However, we still have challenges. Many youth are still not educated about contraception and do not have facts about safety and side effects. In fact too many PROVIDERS have misconceptions about which contraceptive methods are safe and appropriate for teens. They also need education that today’s LARCs are not the same as a prior generation. In addition, there are many barriers related to teens’ utilization of LARCs, includingcost knowledge and accessibility.
  • Yet there are promising opportunities. CDC is working with states and other government agencies (i.e., CMS/Medicaid) to remove logistical barriers to contraceptive use. Recently, South Carolina provided information to Medicaid providers to effectively code and reimburse IUDs inserted in the immediate postpartum period.We are also working with clinical organizations such as ACOG and AAP to improve provider education on the safety and effectiveness of LARCs so that they can better educate teens and parents.
  • The next level of the pyramid is Improving the context to encourage healthy decision-making among teens, which includes access to contraception, parent-child communication, and social norms, all very critical for large impact.
  • CDC understands the importance of community mobilization to address a key public health challenge facing our youth.CDC’s community-wide initiatives, which I will describe in more detail shortly but briefly are 10 communities funded throughout the U.S to reduce rates of teen pregnancy, create more supportive environments for youth to receive evidence-based pregnancy prevention and obtainaccess to contraceptive and reproductive healthservices. Lessons learned in these 10 communities can be replicated by other communities, and may have implications for national programs. For example, all 10 communities have developed innovative ways to link youth receiving an evidence-based prevention program to youth friendly clinical services, thus increasing youth’s access to utilization of contraceptive and reproductive health servicesIn addition, collaboration with other federal agencies, including the OAH and ACF,hold promise to scale up community practices nationwide.
  • The final level of the pyramid is addressing socio-economic factors This includes education, positive youth development, reducing poverty, and decreasing disparities.
  • We know how important addressing social determinants are to reduce teen pregnancy. The community-wide initiatives are addressing disparities by adopting and implementing strategies guided by best practice. Examples of these strategies include:Raising awareness about the link between teen pregnancy and social determinants of health with community partners;Identifying social determinants of health that impact teen pregnancy in their community and that are feasible to change;Identifying, reaching, and serving youth that are hard to reach, marginalized, and from diverse communities into teen pregnancy prevention programs and services;Providing evidence-based programs that meet the needs of youth from diverse communities and retain youth in those programs;Ensuring that clinical providers and program facilitators and their staff have the necessary skills and knowledge to provide culturally competent teen pregnancy prevention programs and adolescent friendly clinical reproductive health services; andIn addition, the President of the United States has highlighted the importance of taking care of our youth, starting at an early age– to set them on a more healthy trajectory through life. A recent CDC review of positive youth development showed that Programs (i.e., early childhood education) can set youth on a more healthy trajectory through life Helping kids throughout the elementary, middle, and high school years can sustain that positive trajectory
  • Next I will highlight CDC’s efforts to prevent teen pregnancy
  • The Community-wide initiatives are a partnership between the CDC and the Office of the Assistant Secretary for Health.The goal of these initiatives is to reduce rates of teen pregnancy and births in communities with the highest rates of teen pregnancy with afocus on African American and Latino teens.Each community-wide initiative (10 communities funded in throughout the U.S.) utilizes a five component model that addresses all of the factors associated with the Health Impact Pyramid.
  • Here is a map of the 10 communities funded throughout the United States
  • There are 5 critical components for success of the community-wide initiatives: [CLICK] community mobilization[CLICK] access to youth friendly clinical services[CLICK] education of key stakeholders[CLICK] working with diverse communities [CLICK] and access to evidence-based programs. Background if needed:Community Mobilization: This component focuses on engaging all sectors of the population in a community-wide effort to address teen pregnancy. Grantees have formed 3 partnership groups, including the core partner group, community advisory group and youth leadership teams. These groups participate and provide feedback on the development of the community wide plans.  Evidence Based Programs: This component focuses on exposing teens to evidence-based teen pregnancy prevention programs, including youth development and curriculum-based programs that reduce risk factors associated with teen pregnancy. Each of our grantees is required to partner with at least 10 youth serving organizations to provide T&amp;TA on the implementation of evidence based programs.  Clinical Services: This component focuses on establishing linkages between teen pregnancy prevention program partners and clinics that serve at risk youth from the target community, including mechanisms for active referral to quality reproductive health care services; and ensuring clinical partners are providing teen friendly culturally competent reproductive health care services that are available and easily accessible to all youth in the community.  Stakeholder Education: This component focuses on educating policy makers and other community stakeholders about relevant evidence-based strategies to reduce teen pregnancy and data on needs and resources in target communities; it alsoincludes support for local community policy, procedure, and practice changes to reduce barriers for youth.  Working with Diverse Communities: This component supports the other components and focuses on reaching youth that are most in need using culturally competent strategies.
  • As an example of the key component that supports increasing access to evidence-based programsCommunities are expected to use one or more of 31 available evidence-based programs – a few are listed here and a full listing is available on the Assistant Secretary for Health web site.
  • Next, I will talk about why contraceptive use is important in teen pregnancy prevention efforts.The majority of the decline in teen pregnancy in the US is attributable to increased use of contraception.However, among teens who become pregnant, about half are due to non-use of contraception and half are due to contraceptive failure. So even if the teenis using contraception, she may experience failure of the method itself, or more likely, she may not be using the method correctly and consistently, for example forgetting to take her pill or not using a condom.
  • A secondexample of a key component of the community-wide initiatives, the component that focuses on increasing access to youth friendly clinical servicesEnsures that all clinical partners are providing teen friendly culturally competent reproductive health care services that are available and easily accessible to all youth in the community. Changes at the health care delivery systems’ level that focus on ensuring health center provision of accessible, affordable, and evidence-based contraceptive and reproductive health care for adolescents are necessary to improve rates of contraceptive and reproductive health service utilization by adolescents. Here are the broad domains of the elements of Youth Friendly Reproductive Health Services[list them]For a full list of the elements of Youth-Friendly Contraceptive and Reproductive Health Services see CDC website: http://www.cdc.gov/TeenPregnancy/TeenFriendlyHealthVisit.html(Background if needed)ConfidentialityTeens receive clear information about their state’s laws governing the rights of adolescent patients to confidentiality and to consent to care or treatment. A teen’s health information cannot be shared with anyone—including parents or guardians—without the teen’s written permission, unless required by law or if the health care provider is concerned the teen might harm him or herself or someone else. Health information disclosed or discussed during a visit is confidential, consistent with state laws and regulations. Billing procedures maintain teen’s confidentiality. If this is not possible, the provider or billing staff advises the teen about the potential breach of confidentiality and provides options. For example, the patient might want to pay out of pocket, or sensitive lab services like pregnancy and STD tests may be indicated on the bill as “routine screening.” However, some health plans might not reimburse unless a service is fully itemized.Privacy The provider has a counseling area to discuss sensitive topics with teens that provides visual and auditory privacy. For example, other health care staff or clients cannot hear the conversation or see who is participating.The health center has an examination room that provides visual and auditory privacy.At every visit, each teen patient has time alone with a provider to discuss or ask questions about contraceptive and reproductive health concerns, regardless of whether the visit is urgent or preventive.Staff members do not discuss teens’ information in common office spaces.Medical records are kept secure and are accessible only to select health care staff, such as through the use of locked files, or password-protected electronic medical records. ConsentTeens receive clear information about informed consent—their right to complete and understandable information about their care and medical procedures, and to give permission to receive medical care related to contraceptive and reproductive health.Teens receive clear information that confidential contraceptive and reproductive health services are available without the need for parent or caregiver consent, consistent with state laws and regulations.AccessibilityThe health center provides services during hours and days convenient for teens, such as weekends, after school hours, or same day service.Contraceptive and reproductive health care services are provided for free or at low cost.Cultural and Linguistic AppropriatenessThe health center environment and staff leave teen patients feeling respected and engaged in their health care. Culturally competent care is provided, meaning all care is sensitive to and respectful of each teen’s culture, ethnicity, community values, religion, language, educational level, sex, gender, and sexual orientation.The care provided addresses the unique biologic, cognitive, and psychosocial needs of adolescents.Conversations between teens and providers are two-way, where teens feel respected and not judged. Comprehensive ServicesTeens are informed of all contraceptive and reproductive health services available at the specific health center; a referral is provided for any contraceptive or reproductive health services that are not available at the specific health center. Teens’ contraceptive and reproductive health needs are assessed at every visit.Counseling is provided on all methods to prevent pregnancy, in order of effectiveness, starting with the most effective.A wide range of contraception is available via prescription or dispensed on site, including IUDs, hormonal implants, hormonal contraceptive pills, the patch, and ring.The provider promotes “Dual-protection”: using a condom for STI/HIV prevention and a highly effective birth control method for pregnancy prevention at the same time.Quick Start methods are used for initiation of hormonal contraception and IUDs, such as starting the pill or inserting the IUD on any day of the month.Emergency contraception is available to male and female adolescents, either by prescription, dispensed on site, or prescribed for future use.Female teens can receive hormonal contraception without prerequisite exams or testing, such as Pap test, pelvic exam, breast exam, or STD testing.Teens receive STD/HIV counseling, testing, and treatment without having an exam.Human Papillomavirus (HPV) vaccine is available and offered when appropriate.Mental health, substance use, violence, and other health concerns are assessed and appropriate referrals are made.Parent/Guardian InvolvementEach teen has an opportunity for examination and counseling without parents or guardians present, and the teen’s privacy is respected.Parents and guardians are informed of the health center’s standard procedure for the provider to spend time alone with teen patients to discuss their comprehensive health and wellness. The provider encourages the teen to involve parents or guardians in the teen’s health care decisions.Parents receive clear information on their teen’s right to confidentiality, privacy, and informed consent.Parents receive medically accurate information and resources on contraceptive and reproductive health, as needed or as requested.Parents receive resources on parent-teen communication and adolescent health and development.
  • This is an Infographic of a Teen-friendly Reproductive Health Visit in English and Spanish that was developed for the Community-wide Initiative. It can be found and downloaded on the CDC website listed.
  • In addition to focusing on ensuring health center provision of accessible, affordable, and evidence-based reproductive health care for adolescents, it is critical that adolescents are counseled on the effectiveness of all contraceptive methods when making a choice of contraceptive options.This figure shows currently available contraceptive methods, ranked by typical effectiveness, meaning how effective is the methodat preventing pregnancy with real-world use.Incorrect or inconsistent use can impact the effectiveness of the contraceptive method. [CLICK]Highlighted in orange are the most commonly used methods among teens, the pill and the condom, are listed in the second and third tier, respectively.
  • As previously mentioned, most teen pregnancies are due to non-use or inconsistent use of contraception. Those using contraception are not using the most effective methods. The most effective (tier 1) reversible contraceptive methods include implants and intrauterine devices or IUDs.Their typical effectiveness, meaning how effective they are at preventing pregnancy with real-world use, are &lt;1 pregnancy per 100 women per year.[CLICK]Implants and IUDs are also known as long acting reversible contraceptives or LARCs.
  • Moderately effective (tier 2) methods include the injectable, pill, patch, ring, and diaphragm. Their typical effectiveness ranges from 6-12 pregnancies per 100 women per year.
  • The least effective (tier 3)methods include condoms, withdrawal, sponge, spermicide, and fertility awareness based methods.The typical effectiveness of these methods is 18 or more pregnancies per 100 women per year.
  • To return to the LARC methods, the typical effectiveness of these methods is so high because they are not dependent on user adherence.Consequently, use of LARC methods has been increasingly encouraged among all women, including young women.In fact, several professional organizations including the American College of Obstetricians and Gynecologists, recommend that LARCs should be first-line recommendations for all adolescents.
  • Despite increasing recommendations that teens should consider using LARCs, most teens are still using the pill or condoms.[CLICK]Please note that less than 4% of teens are using IUDs and &lt;1% are using implants.
  • The main barriers to teens using LARCs are cost, knowledge of the methods, and accessibility.[CLICK] Some early results from surveys in our community-wide initiatives revealed that the majority of teens had not heard of methods other than pills and condoms. Other barriers included concerns about confidentiality, unfavorable clinic hours, and lack of transportation.
  • The main reasons providers don’t offer LARCs to teens are patient preference, concerns about safety, lack of training, or not having the methods available.[CLICK] Our community-wide initiatives showed that 70% of providers had “never” or “not often” prescribed an IUD to teens for these reasons.
  • In addition to the community-wide initiatives, CDC’s other key efforts to reduce rates of teen pregnancy involves developing evidence-basedguidelines for safe and effective contraceptive use.These landmark guidelines are the first U.S. editions, adapted from the WHO. They are intended to assist healthcare providers when they counsel patients about contraceptive method choice and use.They are evidence-based guidelines for which contraceptive methods can be used safely by women with certain characteristics and medical conditions17 contraceptive methods and &gt;120 medical conditions
  • The U.S. Medical Eligibility Criteria (MEC) states that teens without other medical conditions can safely use all methods of contraception, including implants and IUDs.It also provides guidance for a number of important conditions and characteristics that are increasingly common among teens, including obesity, smoking, diabetes, sexually transmitted diseases and HIV.
  • CDC has also published the U.S. Selected Practice Recommendations (SPR) for Contraceptive Use.This is evidence-based guidance for healthcare providers on common, yet complex issues in management of contraception.The SPR guidance applies to women of all ages and may be particularly helpful for teens who face barriers to starting contraception. For example:The SPR provides guidance around starting a woman on contraception on the same day as her visit regardless of where she is in her menstrual cycle, also known as “quick start”.It also addresses guidance around which exams or tests are needed before starting contraception. According to the SPR, very few exams or tests, if any, are needed before initiating most methods.
  • CDC has developed various tools for healthcare providers, including summary charts in English and Spanish, a smartphone app, and a pocket-size wheel. All of our contraceptive guidance and tools can be found on CDC’s website.
  • Finally, this spring (2014) the CDC-OPA (Office of Population Affairs) will be releasing new recommendations on Providing Quality Family Planning Services.These recommendations will:Define what services should be offered in a family planning visit, and describe how to do soSupport consistent application of quality care across settings and provider typesTranslate research into practice, so the most evidence-based approaches are used
  • The QFP recommendations for providers when they are working with teen clients includes:Provide quality contraceptive counseling. Work with the client interactively to select the most effective and appropriate contraceptive method for him or her. Providers are encouraged to present information on potential reversible methods of contraception using a tiered approach (i.e., presenting information on the most effective methods first, before presenting information on less effective methods). This information should include an explanation that LARC methods are safe and effective for women who have never given birth, including adolescents.2. Offer confidential services.There is substantial evidence showing that confidentiality is critical for adolescents and can greatly influence their willingness to access and use services. Further, multiple professional medical associations have emphasized the importance of providing confidential services to adolescents. Recognizing this, QFP recommends that providers offer confidential services to adolescents. It also notes the need to observe all relevant state laws and any legal obligations, such as notification or reporting of child abuse, child molestation, sexual abuse, rape, or incest, as well as human trafficking.3. Provide comprehensive information about how to prevent pregnancy.QFP recommends that providers give comprehensive information to adolescent clients about how to prevent pregnancy. This information should clarify that avoiding sex (i.e., abstinence) is the most effective way to prevent pregnancy and STDs. If the adolescent indicates that she or he is not or will not be abstinent, providers should give information about contraception and help her or him to choose a method that best meets her or his individual needs, Information about contraceptive options should be provided in a tiered manner, with the most effective methods described first. Adolescents should be informed LARCs are safe and effective contraceptive options for many adolescents, including those who have not been pregnant or given birth. Condoms should be encouragedto reduce the risk of STDs. 4. Encourage and promote communication between the adolescent and his/her parent(s) or guardian(s).There is strong evidence showing that parent-child communication about sexual health is associated with reduced sexual risk behavior, and numerous studies have demonstrated the ability of behavioral interventions to both improve parent-child communication and reduce adolescent sexual risk behavior. As a result, providers are encouraged to promote communication between the adolescent and his or her parent(s) or guardian(s) about sexual and reproductive health (on a voluntary basis and in a manner that preserves the adolescent’s confidentiality). For example, educational materials and programs can be provided to parents or guardians who help them talk about sex and share their values with their child in the clinic setting, or they can be referred to community-based programs. 5. Educate pregnant adolescents about contraceptive options post-pregnancy.In a given year, approximately 20% of births to adolescents represent repeat births. So educating pregnant adolescents about contraceptive options for the post-pregnancy period, and including a discussion about the benefits of immediate postpartum insertion of LARC is an important priority. In addition to providing postpartum contraception, QFP encourages providers to refer pregnant and parenting adolescents to home visiting and other programs that have been shown to provide needed support and reduce rates of repeat teen pregnancy.
  • CDC is taking a number of steps to increase widespread awareness of the MEC, SPR and the upcoming QFP recommendations. E.g., hosting a webinar and other events for a wide range of key stakeholders, disseminate at conference and in various print media, we are seeking endorsement of key opinion leaders/organizations. We also have (MEC and SPR) and will develop (QFP) an extensive set of provider training materials that will equip primary care providers with the skills and knowledge needed to implement the recommendations, as well as patient education materials, job aids, and suggestions for health systems change that will facilitate their use. And finally we have/will be evaluating the use of the MEC, SPR and QFP recommendations through several means, including a survey of providers and publicly-funded clinics that is in the field now.
  • In summary, while the teen pregnancy rate in the U.S. is declining, it is still high and is among the highest of the developed countries.Most teen pregnancies are due to non-use or inconsistent use of contraception. Those using contraception are not using the most effective methods, such as the long-acting reversible contraceptives. These methods are safe for women of all ages, including teens.As a demonstration project, lessons learned in CDC’s community-wide initiatives will provide useful information on prevention efforts using the 5 component model.And finally,CDC’sevidence-based guidance can help providers to manage contraception U.S. Medical Eligibility Criteria for Contraceptive UseU.S. Selected Practice Recommendations for Contraceptive UseU.S. CDC and OPA Quality Family Planning RecommendationsThank you.
  • Thank you
  • Transcript of "Prevención de Embarazo Adolescente Usando la Pirámide de Impacto en Salud. Dra. Lisa Romero, CDC."

    1. 1. Division of Reproductive Health Office of the Director Teenage Pregnancy Prevention in the United States: Using CDC’s Health Impact Pyramid to Frame Teen Pregnancy Prevention Efforts PAHO/WHO International Interagency Meeting on Current Evidence, Lessons Learned, and Best Practices in Adolescent Pregnancy Prevention in Latin America and the Caribbean March 17, 2014 Lisa M. Romero, DrPH, MPH Health Scientist
    2. 2. Objectives  Describe why teen pregnancy is a public health problem in the United States  Describe why preventing teen pregnancy is a CDC “Winnable Battle”  Describe CDC’s efforts to prevent teen pregnancy
    3. 3. Teen Pregnancy is a Public Health Problem Teen Mother • Educational attainment • Earnings Pregnancy • Preterm birth • Low birthweight infant • Infant death Child • Abuse and neglect • Early development problems • Sons: Incarceration • Daughters: Teen pregnancy Hoffman S, et al. Washington, DC: The Urban Institute Press, 2008
    4. 4. Teen Pregnancy in the United States 3in 10teen girls will become pregnant before age 20 750,000 teen pregnancies every year Kost K, et al. Guttmacher Institute, 2012, http://www.guttmacher.org/pubs/USTPtrends08.pdf
    5. 5. Teen Pregnancy in the United States 5in 10African American and Latina teen girls will become pregnant before age 20
    6. 6. 0 10 20 30 40 50 60 70 80 90 100 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Rateper1,000womenaged15-19years 17.8 29.4 Teen pregnancy1, induced abortion1, and birth rates1,2,3, United States, 2000–2012* 69.8 Teen pregnancy rate Teen birth rate Teen abortion rate 1. Pregnancy, abortion and birth rates 2000-2008: Ventura SJ, Curtin SC, Abma JC. Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990–2008. National Vital Statistics Reports, 2012;60(7). Table 2. 2. Birth rates 2009: Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2010. National Vital Statistics Reports, 2011;60(2). Table S-2. 3. Birth rates 2010–2011: Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2011. National Vital Statistics Reports, 2012;61(5). Table 2.
    7. 7. Teen Birth Rates in High-income Countries, 2010 34 27 18 15 15 13 11 10 9 8 6 5 5 4 0 5 10 15 20 25 30 35 40 United States Russia Hungary Australia Ireland Israel Spain Austria Germany Norway Sweden Japan Netherlands Switzerland –
    8. 8. The Cost of Teen Births    Reflects the steady decline of the teen birth rate in recent years  Decrease in programmatic costs associated with each participant in publicly funded programs
    9. 9. US Department of Health and Human Services
    10. 10. U.S. Department of Health and Human Services  Pregnancy Assistance Fund  Teen Pregnancy Prevention Initiative Replication of Evidence-based Programs Research and Demonstration Projects • Untested and innovative strategies (with ACF) • Multi-component community-wide initiatives (with CDC)  
    11. 11. CDC’s Winnable Battles Healthcare- Associated Infections HIV Motor Vehicle Injuries Nutrition, Physical Activity, Obesity and Food Safety Teen Pregnancy Tobacco
    12. 12. Clinical Interventions Long-lasting Protective Interventions Changing the Context to make individual’s default decisions healthier Socio-economic Factors Smallest impact Largest impact Thomas R. Frieden. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595. doi: 10.2105/AJPH.2009.185652 Counseling and Education
    13. 13. Teen Pregnancy and the Health Impact Pyramid Factors that Affect Health Sexual health education Strengthen effective clinical interventions Promote long-lasting preventive interventions (LARC) Improve the context to encourage healthy decisions: Access to contraception, parent child communication, social norms Address socioeconomic factors: Improve educational achievement, promote PYD, reduce poverty, decrease disparities Smallest impact Largest impact Adapted from Thomas R. Frieden. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595. doi: 10.2105/AJPH.2009.185652
    14. 14. Sexual health education Strengthen effective clinical interventions Promote long-lasting preventive interventions (LARC) Improve the context to encourage healthy decisions: Access to contraception, parent child communication, social norms Address socioeconomic factors: Improve educational achievement, promote PYD, reduce poverty, decrease disparities Smallest impact Largest impact Teen Pregnancy and the Health Impact Pyramid Factors that Affect Health Adapted from Thomas R. Frieden. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595. doi: 10.2105/AJPH.2009.185652
    15. 15. Sexual Health Education  Challenges – Most teens receive sex education • Not always before the first time they have sex – Education about birth control methods lags behind other health education areas such as HIV and STDs  Opportunities – There is a need to educate state and local education officials about the benefits of sexual health education – Parents/guardians need to talk to their teens about responsible decision-making in regards to sexual issues
    16. 16. Sexual health education Strengthen effective clinical interventions Promote long-lasting preventive interventions (LARC) Improve the context to encourage healthy decisions: Access to contraception, parent child communication, social norms Address socioeconomic factors: improve educational achievement, promote PYD, reduce poverty, decrease disparities Smallest impact Largest impact Teen Pregnancy and the Health Impact Pyramid Factors that Affect Health Adapted from Thomas R. Frieden. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595. doi: 10.2105/AJPH.2009.185652
    17. 17. Strengthen Effective Clinical Interventions and Promote Use of LARC Interventions  Challenges – Youth are poorly educated about contraception including safety and side effects • Many providers have misconceptions about which contraceptive methods are safe and appropriate for teens – Barriers to low utilization (2-4%) of LARCs among adolescents • Cost, knowledge, and accessibility
    18. 18. Strengthen Effective Clinical Interventions and Promote Use of LARC Interventions  Opportunities – CDC is working with • States and other government agencies to remove logistical barriers to contraceptive use • Partners to improve provider education on the LARC safety and effectiveness for better education of teens and parents – American College of Obstetricians and Gynecologists – American Academy of Pediatrics
    19. 19. Sexual health education Strengthen effective clinical interventions Promote long-lasting preventive interventions (LARC) Improve the context to encourage healthy decisions: Access to contraception, parent child communication, social norms Address socioeconomic factors: Improve educational achievement, promote PYD, reduce poverty, decrease disparities Smallest impact Largest impact Teen Pregnancy and the Health Impact Pyramid Factors that Affect Health Adapted from Thomas R. Frieden. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595. doi: 10.2105/AJPH.2009.185652
    20. 20. Improve the Context to Encourage Healthy Decisions • Challenges and opportunities – Community mobilization • CDC’s community-wide initiatives create supportive environment for youth  Receive evidence-based prevention programs  Obtain access to contraceptives and reproductive health services – Collaboration with the other government agencies to scale-up community practices nationwide
    21. 21. Sexual health education Strengthen effective clinical interventions Promote long-lasting preventive interventions (LARC) Improve the context to encourage healthy decisions: Access to contraception, parent child communication, social norms Address socioeconomic factors: Improve educational achievement, promote PYD, reduce poverty, decrease disparities Smallest impact Largest impact Teen Pregnancy and the Health Impact Pyramid Factors that Affect Health Adapted from Thomas R. Frieden. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595. doi: 10.2105/AJPH.2009.185652
    22. 22. Address Socioeconomic Factors  Challenges and opportunities Social determinants of health are important to reducing teen pregnancy Positive youth development can set youth on a more healthy trajectory through life
    23. 23. CDC’S EFFORTS TO PREVENT TEEN PREGNANCY
    24. 24. Integrating Services, Programs, and Strategies Through Community-wide Initiatives  Partnership between CDC and the Office of the Assistant Secretary for Health Innovative, multi-component, community-wide initiatives in reducing teen pregnancy/birth African American and Latino teens aged 15–19 http://
    25. 25. CDC’s Teen Pregnancy Prevention Community-Wide Initiatives 2010 – 2015 Grantees • AL - Alabama Department of Public Health • CT - City of Hartford, Department of Health and Human Services • GA - Georgia Campaign for Adolescent Pregnancy Prevention • MA - The Massachusetts Alliance on Teen Pregnancy • NC - Adolescent Pregnancy Prevention Campaign of North Carolina • NY - The Fund for Public Health in New York, Inc. • PA - Family Planning Council of Southeastern Pennsylvania • SC - South Carolina Campaign to Prevent Teen Pregnancy • TX - The University of Texas Health Science Center at San Antonio
    26. 26. 5 Keys to Success of Community-wide Initiatives Strong teens Strong communities Youth are able to access and use youth- friendly, culturally competent family planning services Stakeholders are informed about, and supportive of teen pregnancy prevention efforts Diverse communities, priorit y populations are effectively reached Evidenced-based programs educate and motivate youth Community is mobilized, teen pregnancy prevention initiative sustained
    27. 27. For a full list of evidence based programs visit: http://www.hhs.gov/ash/oah/oah-initiatives/tpp/tpp-database.html
    28. 28. Teen Pregnancy and Contraception       • • Santelli JS, et al. Persp Sex Reprod Health 2006;38:106-11
    29. 29. Key Domains of the Elements of Youth Friendly Reproductive Health Services  Confidentiality  Privacy  Consent  Accessibility  Comprehensive Services  Cultural & Linguistic Appropriateness  Parent/Guardian Involvement http://www.cdc.gov/TeenPregnancy/TeenFriendlyHealthVisit.html
    30. 30. Infographic of Teen-Friendly Reproductive Health Visit http://www.cdc.gov/TeenPregnancy/TeenFriendlyHealthVisit.html
    31. 31. Effectiveness of family planning methods http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/Contraception.htm Tier 1 Tier 2 Tier 3
    32. 32. Typical Effectiveness of Contraceptive Methods  Most effective: <1 pregnancy per 100 women/year – Single rod progesterone implant • Effective 3 years – Intrauterine device (IUD) • Copper IUD: Effective 10 years • Two LNG-IUDs: Effective 3 or 5 years Long acting reversible contraceptives (LARCs) Trussell J. Contraception 2011;83:397-404 LNG, Levonorgestrel
    33. 33. Typical Effectiveness of Contraceptive Methods  Moderately effective: 6–12 pregnancies per 100 women/year – Contain estrogen and progestins or progestin alone • Injectable • Pill • Patch • Ring – Barrier: Diaphragm Trussell J. Contraception 2011;83:397-404
    34. 34. Typical Effectiveness of Contraceptive Methods  Least effective: >18 pregnancies per 100 women/year – Male condom – Female condom – Withdrawal – Sponge – Spermicide – Fertility-awareness based methods: Standard days method, two days method, ovulation method, and sympto- thermal method Trussell J. Contraception 2011;83:397-404
    35. 35. Long Acting Reversible Contraception (LARC)  High typical effectiveness – Not dependent on adherence  Should be first-line recommendations for all adolescents (American College of Obstetricians and Gynecologists, 2012) ACOG. Obstet Gynecol 2012;120:983-8
    36. 36. Contraceptive Method Use among 54.1 22.8 9.4 3.6 0.5 9.6 0 10 20 30 40 50 60 70 80 90 100 Pill Condom DMPA IUD Implant, Lunelle or patch Other
    37. 37. Teens and LARCs  Why teens do not use LARCs Cost Knowledge Accessibility   
    38. 38. Teens and LARCs  Why providers do not offer LARCs Patient preference Concerns about safety Not trained in IUD insertion IUDs not available Community-wide Initiatives 70% of providers had “never” or “not often” prescribed an IUD to teens for these reasons
    39. 39.   Evidence-based guidelines for which contraceptive methods can be used safely by women with certain characteristics and medical conditions  17 contraceptive methods and >120 medical conditions U.S. Medical Eligibility Criteria for Contraceptive Use (MEC)
    40. 40. U.S. MEC for Contraceptive Use: Recommendations for  can safely use all methods of contraception Including implants and IUDs Teens with medical conditions and characteristics Obesity Smoking Diabetes Sexually transmitted infections HIV
    41. 41. U.S. Selected Practice Recommendations for Contraceptive Use (SPR)       What exams and tests are needed before starting contraception  SPR: Guidance on the few exams or tests needed before starting contraception
    42. 42. CDC Contraceptive Guidance Healthcare Provider tools http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/USMEC.htm
    43. 43. Quality Family Planning (QFP) Recommendations New CDC-OPA* recommendations, Providing Quality Family Planning Services (QFP)  Define what services should be offered in a family planning visit, and describe how to do so  Support consistent application of quality care across settings and provider types  Translate research into practice, so the most evidence-based approaches are used Office of Population Affairs (OPA) *Expected release date Spring 2014
    44. 44.  Provide quality contraceptive counseling  Offer confidential services and observe all relevant state laws and any legal obligations  Provide comprehensive information about how to prevent pregnancy  Encourage communication between the adolescent and his or her parent(s) or guardian(s) about sexual and reproductive health  Educate pregnant adolescents about contraceptive options for the post-pregnancy period, including benefits of immediate postpartum insertion of LARC QFP Recommendations for Teens
    45. 45. Dissemination  Increase awareness among providers  Develop & disseminate provider training materials  Evaluate use of guidance documents
    46. 46. Summary  pregnancy rate in the U.S. is declining, but still high  Most pregnancies are due to non-use or inconsistent use of contraception  As a demonstration project, CDC’s community-wide initiatives will provide useful information on prevention efforts using the 5 component model  CDC’s evidence-based guidance can help providers to manage contraception
    47. 47. For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health, Office of the Director www.cdc.gov/teenpregnancy
    48. 48. The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×