Dissemination of an Evidence-based Pregnancy, STD, and HIV Prevention Program in Middle Schools in Houston, TX<br />Belind...
Overview of the prevalence of sexual behaviors and HIV/AIDS/STIs among adolescents<br />What is prevention<br />Current St...
Students in Texas are more likely to be sexually experienced compared to the national average<br />Percent of High School ...
Students begin having sex at early ages<br />About 1 in 10 sixth grade students have had sex<br />Source: Shanklin, S.L., ...
8.0%<br />Oral<br />6.5%<br />Anal<br />14.4%<br />Any<br />12.2%<br />Vaginal<br />Students engage in different types of ...
2006<br />8.0%<br />Oral<br />6.5%<br />Anal<br />2004<br />14.4%<br />Any<br />12.2%<br />Vaginal<br />15.9%<br />Any<br ...
Therefore… in Texas with  over 2 million students in 6-12 grade, the estimated total number of students having sex in any ...
Sexually Transmitted Infections<br />In the U.S., nearly half of all new STI cases occur among 15-24 year olds<br />But ma...
Chlamydia and Gonorrhea Rate among 15-19 year olds (2008)<br />U.S.<br />Texas<br />U.S.<br />Source:  US Department of He...
Estimated New HIV Infections in the U.S. by Age<br />Source:  CDC. Estimates of new HIV infections in the United States. C...
In TX, over half of all HIV cases among youth occur among African Americans. <br />Source: Texas Department of State Healt...
In TX, over one fourth of all HIV cases among youth occur among Hispanics. <br />Source: Texas Department of State Health ...
Percent of parents who are very concerned about their child becoming infected with HIV <br />Sources: Kaiser Family Founda...
Total direct medical cost for new STI infections among 15-24 year olds.<br />$6,500,000,000<br />Source:  Chesson, H., Bla...
Prevention<br />Consistent and clear prevention messages<br />Societal support for             young           people<br /...
Prevention<br />Most Texas school districts (N=990) implement programs that are NOT evidence-based<br /><ul><li>Emphasizes...
Includes medically accurate information
Mentions contraception
Teaches abstinence as the only healthy and morally correct option</li></ul>Source: Wiley, D., & Wilson, K. (2009). Just Sa...
One in three teens do not get formal education about birth control<br />46% of males and 38% of females received no instru...
IYG Program Goals<br /><ul><li> Delay sexual initiation
 Reduce risk among students that are  	sexually active</li></li></ul><li>IYG Outcomes<br />
Scope & Sequence<br />7th Grade<br />8th Grade<br />
It’s Your Game…Keep It Real Curriculum:www.itsyourgame.org<br />
It’s Your Game…Keep It Real<br />
   Information transfer<br />   Information transfer<br />    Skills / practice<br />Activities<br />Peer modeling<br />Re...
Methods: Recruitment and data collection<br />All middle schools from large school district in SE Texas invited to partici...
Methods (cont.)<br />Paper surveys in manila envelopes were distributed to non-responders after three email reminders<br /...
Results: Demographics<br />
92.7% agree/strongly agree that sexual health education (SHE) should be taught in middle schools<br />91.7% agree/strongly...
18.3% agree/strongly agree that their school has too many other priorities<br />23.9% agree/strongly agree that a SHE curr...
44.4% are not aware/slightly aware of curricula which address SHE<br />50.2% do not know/slightly know where to find a SHE...
63.9% agree/strongly agree that they can talk comfortably about sexuality in the classroom<br />61.2% agree/strongly agree...
36.9% agree/strongly agree that administrators support teachers who teach about SHE in the classroom<br />20.3% agree/stro...
84% think that PE or health teachers support comprehensive SHE<br />73.1% think that other teachers support comprehensive ...
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Dissemination of an Evidence-Based Pregnancy, STD, and HIV Prevention Program in Middle Schools in Texas

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

  1. 1. Dissemination of an Evidence-based Pregnancy, STD, and HIV Prevention Program in Middle Schools in Houston, TX<br />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<br />Center for Health Promotion and Prevention Research<br />University of Texas School of Public Health<br />Funded by the City of Houston Department of Health and Human Services and the Centers for Disease Control and Prevention<br />May 26, 2010<br />
  2. 2. Overview of the prevalence of sexual behaviors and HIV/AIDS/STIs among adolescents<br />What is prevention<br />Current Study and overview of “It’s Your Game… Keep It Real”<br />Findings: Perspectives from school personnel<br />Conclusions<br />Overview<br />
  3. 3. Students in Texas are more likely to be sexually experienced compared to the national average<br />Percent of High School Students Reporting to Have Ever Had Sex (2007)<br />Texas<br />U.S.<br />Source: Centers for Disease Control and Prevention. (2007). YRBSS: Youth Online Comprehensive Results. Retrieved June 4,2008 from http://apps.nccd.cdc.gov/yrbss/<br />
  4. 4. Students begin having sex at early ages<br />About 1 in 10 sixth grade students have had sex<br />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.<br />
  5. 5. 8.0%<br />Oral<br />6.5%<br />Anal<br />14.4%<br />Any<br />12.2%<br />Vaginal<br />Students engage in different types of sex<br />Sexual behaviors among 7th grade students in 2004<br />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.<br />
  6. 6. 2006<br />8.0%<br />Oral<br />6.5%<br />Anal<br />2004<br />14.4%<br />Any<br />12.2%<br />Vaginal<br />15.9%<br />Any<br />13.0%<br />Vaginal<br />8.7%<br />Oral<br />6.8%<br />Anal<br />7th grade sexual behavior has increased over a two year period<br />
  7. 7. Therefore… in Texas with over 2 million students in 6-12 grade, the estimated total number of students having sex in any given year <br />826,644<br />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/<br />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<br />
  8. 8. Sexually Transmitted Infections<br />In the U.S., nearly half of all new STI cases occur among 15-24 year olds<br />But many STIs go undetected<br /><ul><li>Teen rates of gonorrhea and syphilis have recently increased (2004-2006)</li></ul>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,.<br />
  9. 9.
  10. 10. Chlamydia and Gonorrhea Rate among 15-19 year olds (2008)<br />U.S.<br />Texas<br />U.S.<br />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<br />
  11. 11. Estimated New HIV Infections in the U.S. by Age<br />Source:  CDC. Estimates of new HIV infections in the United States. CDC HIV/AIDS Facts. 2008.<br />
  12. 12. In TX, over half of all HIV cases among youth occur among African Americans. <br />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.<br />
  13. 13. In TX, over one fourth of all HIV cases among youth occur among Hispanics. <br />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.<br />
  14. 14. Percent of parents who are very concerned about their child becoming infected with HIV <br />Sources: Kaiser Family Foundation<br />
  15. 15. Total direct medical cost for new STI infections among 15-24 year olds.<br />$6,500,000,000<br />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. <br />
  16. 16. Prevention<br />Consistent and clear prevention messages<br />Societal support for young people<br />Access to contraceptive<br />Comprehensive sexual health education<br />and<br />reproductive health services<br />
  17. 17. Prevention<br />Most Texas school districts (N=990) implement programs that are NOT evidence-based<br /><ul><li>Emphasizes abstinence
  18. 18. Includes medically accurate information
  19. 19. Mentions contraception
  20. 20. Teaches abstinence as the only healthy and morally correct option</li></ul>Source: Wiley, D., & Wilson, K. (2009). Just Say Don’t Know: Sexuality education in Texas public schools. Texas Freedom Network Education Fund.<br />
  21. 21. One in three teens do not get formal education about birth control<br />46% of males and 38% of females received no instruction about birth control methods prior to first sex<br />Barriers to implementation: concerns about negative community reaction, unclear policies, lack of teacher skills<br />Focus: Comprehensive sexual health education in schools<br />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<br />
  22. 22.
  23. 23. IYG Program Goals<br /><ul><li> Delay sexual initiation
  24. 24. Reduce risk among students that are sexually active</li></li></ul><li>IYG Outcomes<br />
  25. 25. Scope & Sequence<br />7th Grade<br />8th Grade<br />
  26. 26. It’s Your Game…Keep It Real Curriculum:www.itsyourgame.org<br />
  27. 27. It’s Your Game…Keep It Real<br />
  28. 28. Information transfer<br /> Information transfer<br /> Skills / practice<br />Activities<br />Peer modeling<br />Real-life serial - modeling<br /> Skills / practice<br />
  29. 29. Methods: Recruitment and data collection<br />All middle schools from large school district in SE Texas invited to participate; 33 agreed to participate<br />Letters of information about the study were distributed via email, as well as in individuals’ school mailboxes <br /> school administrators, physical education/health teachers, nurses, counselors, and to random sample of non health/PE teachers at each school<br />Within each email, a unique hyperlink of the self-administered survey was embedded<br />Emails reminding school staff of the survey were distributed approximately every three weeks beginning two weeks after the initial email<br />
  30. 30. Methods (cont.)<br />Paper surveys in manila envelopes were distributed to non-responders after three email reminders<br />Upon completion of the web-based survey or receipt of paper surveys, participants were emailed a $5 gift certificate <br />315 school staff completed surveys<br />84.3% of the surveys were web-based and 15.7% were paper<br />
  31. 31. Results: Demographics<br />
  32. 32. 92.7% agree/strongly agree that sexual health education (SHE) should be taught in middle schools<br />91.7% agree/strongly agree that PE/health teachers can play an important role in informing students about the risks associated with sex<br />87.3% are in favor of including SHE in the middle school PE/health curriculum at their middle schools<br />Attitudes<br />
  33. 33. 18.3% agree/strongly agree that their school has too many other priorities<br />23.9% agree/strongly agree that a SHE curriculum that teaches about contraceptives would be difficult to implement in their schools<br />Barriers: School-level<br />
  34. 34. 44.4% are not aware/slightly aware of curricula which address SHE<br />50.2% do not know/slightly know where to find a SHE curricula<br />50.2% are not aware/slightly aware of district policy towards SHE<br />Barriers: Knowledge<br />
  35. 35. 63.9% agree/strongly agree that they can talk comfortably about sexuality in the classroom<br />61.2% agree/strongly agree that they can discuss contraceptive practices in the classroom<br />51.8% agree/strongly agree that they can get students to do an assignment that involves them talking with parents about sexual topics<br />Barriers: Self-Efficacy<br />
  36. 36. 36.9% agree/strongly agree that administrators support teachers who teach about SHE in the classroom<br />20.3% agree/strongly agree that administrators support teachers who teach about condoms and other contraceptives<br />Barriers: Support<br />
  37. 37. 84% think that PE or health teachers support comprehensive SHE<br />73.1% think that other teachers support comprehensive SHE<br />52.4% think that community leaders support comprehensive SHE<br />43% think that parents support comprehensive SHE<br />Other Support for Comprehensive SHE<br />
  38. 38. Teachers and other school officials want to teach SHE<br />But, they lack knowledge of programs & policies, self-efficacy, and perceived support<br />They need support to overcome these barriers <br />Survey Conclusions<br />
  39. 39. Implications for dissemination of effective SHE in middle school<br />Dissemination strategies should:<br />Provide administrators and policy makers with pertinent data and advocacy materials and stress the importance of effective programs<br />Inform other staff about policies and effective programs<br />Provide trainings to school staff on how to adapt and use effective programs<br />Determine staff for teaching SHE<br />Make schools aware of strong parental and community support for SHE in schools<br />
  40. 40. Questions?<br />Belinda Flores<br />Belinda.Flores@uth.tmc.edu<br />

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