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Tx dshs std hiv focus groups final

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The presentation will discuss use of focus groups to obtain data to tailor sexual health program approaches. We conducted 4 focus groups of middle and high school-aged youth in our program areas to identify prevalent sexual beliefs, attitudes and behaviors of Hispanic border community adolescents Each focus group comprised 8-12 participants. Such data were used to tailor the sexual heath education program implementation and evaluation and make them relevant to our program populations.

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Tx dshs std hiv focus groups final

  1. 1. Best Practices for Developing Appropriate Sexual Health Programs for Border Hispanic Adolescents in Texas Sheetal Malhotra, MBBS, MS Rebecca Palacios, PhD Katherine Hendricks, MD, MPH&TM
  2. 2. Objectives <ul><li>Based on the information obtained about Hispanic adolescents in border communities in Texas: </li></ul><ul><li>Describe prevalent sexual beliefs, attitudes and behaviors </li></ul><ul><li>Describe best practices for conducting STD interventions </li></ul><ul><li>Describe best practices for STD program leadership and evaluation </li></ul>
  3. 3. Background <ul><li>Minority communities are disproportionately affected by sexual health problems </li></ul><ul><li>Two predominantly Hispanic border communities in Texas </li></ul><ul><ul><li>demonstrate high teen pregnancy rates </li></ul></ul><ul><ul><li>most live below the poverty line </li></ul></ul>
  4. 4. Birthrates for 15- to 19-Year-Olds <ul><li>US 65/1000 </li></ul><ul><li>TX 77/1000 </li></ul><ul><li>El Paso County 89/1000 </li></ul><ul><li>San Elizario & Fabens ISDs 190/1000 </li></ul><ul><li>~ 70% of county births are to teen mothers </li></ul>Source: DSHS Office of Border Health
  5. 5. Background <ul><li>Two towns in El Paso County </li></ul><ul><li>Fabens </li></ul><ul><ul><li>~ 8000 residents </li></ul></ul><ul><ul><li>predominantly Hispanic (96%) </li></ul></ul><ul><ul><li>~ 40% of the population <18 </li></ul></ul><ul><li>San Elizario </li></ul><ul><ul><li>~ 11,000 residents, </li></ul></ul><ul><ul><li>~ 98% Hispanic </li></ul></ul><ul><ul><li>~ 50% of the population<18 yrs </li></ul></ul>
  6. 7. Methods <ul><li>4 focus groups in communities in May 2007 </li></ul><ul><ul><li>high school boys (11; 15-18 yo) </li></ul></ul><ul><ul><li>high school girls (11; 15-18 yo) </li></ul></ul><ul><ul><li>middle school boys (12; 11-15 yo) </li></ul></ul><ul><ul><li>middle school girls (7; 12-14 yo) </li></ul></ul><ul><li>Diverse groups </li></ul>
  7. 8. Methods <ul><li>Participants were asked to discuss </li></ul><ul><ul><li>life goals </li></ul></ul><ul><ul><li>sexual activity </li></ul></ul><ul><ul><li>pregnancy </li></ul></ul><ul><ul><li>reasons for having sex </li></ul></ul><ul><ul><li>parent-child communication on sex </li></ul></ul><ul><ul><li>other risk behaviors ie, alcohol, drugs </li></ul></ul>
  8. 9. Results: General <ul><li>Most aspired to go to college </li></ul><ul><li>Media/friends/family were sources of information on sex </li></ul><ul><li>Communication with parents about sex </li></ul><ul><ul><li>embarrassment </li></ul></ul><ul><ul><li>expectation of abstinence </li></ul></ul><ul><ul><li>some parental monitoring </li></ul></ul><ul><li>Alcohol and drug use </li></ul><ul><ul><li>most teens had tried alcohol; >1/2 had used drugs </li></ul></ul><ul><ul><li>started between 12-16 years </li></ul></ul>
  9. 10. Results: General <ul><li>Reasons for having sex </li></ul><ul><ul><li>“ to fit in”/ “everyone is doing it” </li></ul></ul><ul><ul><li>peer pressure </li></ul></ul><ul><ul><li>curiosity </li></ul></ul><ul><ul><li>“ physical needs”/ “it just happens” </li></ul></ul><ul><ul><li>pressure from boy/girlfriend </li></ul></ul><ul><ul><li>competition/ “dares” </li></ul></ul><ul><ul><li>alcohol/drug use/gang activity </li></ul></ul><ul><ul><li>porn/media </li></ul></ul><ul><ul><li>problems at home </li></ul></ul>
  10. 11. Results: General <ul><li>Reasons to not have sex </li></ul><ul><ul><li>to prevent disease (STDs) or pregnancy </li></ul></ul><ul><ul><li>waiting until marriage </li></ul></ul><ul><ul><li>parental/family disapproval </li></ul></ul><ul><ul><li>pregnant/parenting teens who are struggling </li></ul></ul><ul><ul><li>saying no feels powerful </li></ul></ul><ul><ul><li>future goals like careers </li></ul></ul><ul><ul><li>extracurricular activities </li></ul></ul><ul><ul><li>religion (for some) </li></ul></ul>
  11. 12. Results: Middle School Boys <ul><li>Start “messing around” at 10-11 years; >1/2 have “messed around” </li></ul><ul><li>Petting/fondling/necking at 12-13 years </li></ul><ul><li>Oral sex started at 15-16 years; few teens their age had engaged in oral sex </li></ul><ul><li>Vaginal sex started at 13-14 years; most knew someone who had engaged in vaginal sex </li></ul><ul><li>Girls often encourage the boys to have sex </li></ul>
  12. 13. Results: Middle School Boys Parent knowledge on sex is “expired!”
  13. 14. Results: Middle School Girls <ul><li>Start “messing around” at 12-14 years; >1/2 have “messed around” </li></ul><ul><li>Petting/fondling/necking at 12-13 years </li></ul><ul><li>Oral sex started at 14-15 years; few teens had engaged in oral sex </li></ul><ul><li>Vaginal sex started at 14-15 years; a few teens had engaged in vaginal sex </li></ul><ul><li>Boys start sexual activity earlier; usually not planned </li></ul>
  14. 15. Results: Middle School Girls Teens we know are in a hurry to experience sex.
  15. 16. Results: Middle School <ul><li>Felt it was okay for teens their age to have sex </li></ul><ul><li>Couples waited about 3 months before having sex </li></ul><ul><li>Important for a girl to be a virgin before marriage; not so much for boys </li></ul><ul><li>Parents disapprove of sex; even with “protection” </li></ul><ul><li>Less likely to have sex if parents talked to them about sex </li></ul>
  16. 17. Results: High School Boys <ul><li>Start “messing around” at 10-11 years; most have “messed around” </li></ul><ul><li>Petting/fondling/necking at 13-14 years </li></ul><ul><li>Oral sex started at 15-16 years; ≤1/2 have had oral sex </li></ul><ul><li>Vaginal sex started at 15-16 years; ~80% teens had engaged in vaginal sex; before oral/anal sex </li></ul><ul><li>Usually not planned; only ~1/2 use condoms </li></ul>
  17. 18. Results: High School Boys <ul><li>Felt it was okay for teens their age to have sex </li></ul><ul><li>Couples waited about 5-9 months before having sex </li></ul><ul><li>Important for a girl to be a virgin before marriage; however, most girls were not virgins </li></ul><ul><li>Not important for boys to be virgins; girls may want “experienced” boys </li></ul><ul><li>Pregnant girls are “easy;” girls sometimes get pregnant to keep/get boyfriend </li></ul><ul><li>Teen parents not attractive as partners </li></ul>
  18. 19. Results: High School Boys If you don’t do it, other kids will laugh at you.
  19. 20. Results: High School Girls <ul><li>Start “messing around” at 10-11 years; most have “messed around” </li></ul><ul><li>Petting/fondling/necking at 13-14 years </li></ul><ul><li>Vaginal sex started at 12-13 years; most had already engaged in vaginal sex; usually unplanned </li></ul><ul><li>Oral sex started at 15 years; most teens their age had engaged in oral sex; occurred after vaginal sex </li></ul><ul><li>≥ 1/2 had tried anal sex; started between 14-16 years </li></ul><ul><li>Experimentation with oral & anal sex </li></ul>
  20. 21. Results: High School Girls <ul><li>Felt it was okay for teens their age to have sex to meet physical “needs” </li></ul><ul><li>Casual hook-ups at parties are common </li></ul><ul><li>Couples waited about 4 months before having sex </li></ul><ul><li>Important for a girl to be a virgin before marriage; not important for boys to be virgins </li></ul><ul><li>Boyfriends asked girls to “prove” love by experimenting with oral/anal sex </li></ul><ul><li>Girls sometimes get pregnant to keep/get boyfriend; pregnant girls get a lot of attention and help </li></ul>
  21. 22. Results: High School Girls If you want some, you get some!
  22. 23. Implications for Public Health Program Planning <ul><li>Sexual health information should be administered as early as possible in middle school </li></ul><ul><li>Programs should focus on </li></ul><ul><ul><li>enhancing teen self esteem </li></ul></ul><ul><ul><li>helping teens establish goals for their future </li></ul></ul><ul><ul><li>promoting the advantages of abstinence </li></ul></ul><ul><ul><li>enhancing teen-parent communication and monitoring </li></ul></ul><ul><ul><li>identifying characteristics of healthy relationships </li></ul></ul><ul><ul><li>presenting actual norms to counter the idea that everybody is doing it </li></ul></ul>
  23. 24. Implications for Building Program Evaluation <ul><li>Relevant information on beliefs, attitudes and behaviors of target population should be obtained </li></ul><ul><li>Information obtained should be incorporated into program and evaluation instrument </li></ul><ul><li>Acknowledge unique cultural beliefs & behaviors </li></ul><ul><li>Appropriate language and phrasing </li></ul><ul><li>Evaluation instrument feedback – focus groups & piloting </li></ul>
  24. 25. Tailoring Program Evaluation to Target Population <ul><li>Information from focus groups in our program used to draft evaluation instrument items on </li></ul><ul><li>Life goals </li></ul><ul><li>Peer norms </li></ul><ul><li>Pregnancy </li></ul><ul><li>Sexual behaviors </li></ul><ul><li>Reasons for having sex </li></ul><ul><li>Desirable qualities in partner </li></ul><ul><li>Parental expectations, communication & monitoring </li></ul>
  25. 26. Tailoring Program Evaluation to Target Population: Examples <ul><li>By the time I am 25, I plan to </li></ul><ul><li>□ Have finished high school </li></ul><ul><li>□ Have gone to college </li></ul><ul><li>□ Have a good job </li></ul><ul><li>□ Be a professional athlete </li></ul><ul><li>□ Be rich </li></ul><ul><li>□ Have a nice or a “cool” car </li></ul><ul><li>□ Have my own place to live </li></ul>
  26. 27. Tailoring Program Evaluation to Target Population: Examples <ul><li>Please check if you agree or disagree with the following: </li></ul><ul><li>Sexual urges (“hormones”) can be controlled </li></ul><ul><li>It’s OK to for people my age to go to a party and have sex with someone they just met </li></ul><ul><li>If a girl gets pregnant, it’s likely that her boyfriend will stay with her </li></ul>
  27. 28. Tailoring Program Evaluation to Target Population: Examples <ul><li>Which reasons would you choose for having sex at this point in your life? </li></ul><ul><li>□ Curiosity </li></ul><ul><li>□ To fit in/peer pressure </li></ul><ul><li>□ To be more popular </li></ul><ul><li>□ To prove love </li></ul><ul><li>□ To keep from breaking up </li></ul><ul><li>□ To feel more &quot;grown-up&quot; </li></ul><ul><li>□ It feels good </li></ul><ul><li>□ It’s a need </li></ul><ul><li>□ It just happens </li></ul>
  28. 29. Tailoring Program Evaluation to Target Population: Examples <ul><li>Which reasons would you choose for NOT having sex at this point in your life? </li></ul><ul><li>□ Pregnancy </li></ul><ul><li>□ It’s wrong </li></ul><ul><li>□ Bad reputation </li></ul><ul><li>□ Boyfriend/girlfriend might lose respect for me </li></ul><ul><li>□ Would disappoint parents </li></ul><ul><li>□ Bad experience of others </li></ul><ul><li>□ It’s empowering to wait </li></ul><ul><li>□ Don’t have money to support baby </li></ul>
  29. 30. Tailoring Program Evaluation to Target Population: Examples <ul><li>What are some characteristics you want in a potential marriage partner? </li></ul><ul><li>□ Honest </li></ul><ul><li>□ “ Hot” </li></ul><ul><li>□ Has goals </li></ul><ul><li>□ Flexible </li></ul><ul><li>□ Willing to express their point of view </li></ul><ul><li>□ Funny </li></ul><ul><li>□ Emotionally mature </li></ul>
  30. 31. Study Limitations <ul><li>May not be representative of entire student population </li></ul><ul><li>Presence of adults during focus groups </li></ul><ul><li>Sensitive topic of discussion </li></ul><ul><li>Small and shy group of middle school girls </li></ul><ul><li>Some had just completed a sex ed program </li></ul><ul><li>Need for Spanish-English translation may have hampered flow of discussion </li></ul><ul><li>Use of slang terms for discussion/surveys </li></ul>
  31. 32. Conclusion <ul><li>Focus groups are an important strategy for obtaining culturally relevant belief, attitude, and behavior information to develop appropriate sexual health programs and evaluations. </li></ul>
  32. 33. Funding for the Study <ul><li>This study was supported by grant # 90AE0147 from the Administration of Children and Families (ACF). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the ACF, the Department of Health and Human Services or the U.S. government. </li></ul>
  33. 34. Thank You! <ul><li>For more information contact </li></ul><ul><li>Sheetal Malhotra, MBBS, MS </li></ul><ul><li>[email_address] </li></ul><ul><li>512-328-6268 ext 206 </li></ul>

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