Date of Defense:
April 28, 2017
Introduction: Data on the sexual health disparities of adolescents and young adults is well documented. For example, adolescents and young adults (15-24) in the United States (US) are disproportionately burdened by sexually transmitted infections (STIs) and according to the Centers for Disease Control and Prevention (CDC), make up 50% of the 20 million new STI cases (April 2013). Although birth rates for adolescents and young adults have continued to decline in the United States and in Minnesota, they remain the highest among comparable countries (Guttmacher Institute, 2014a). The Guttmacher Institute (2014a) reported that 82% of teen pregnancy is unintended in the US. It is important to note that rates of STIs and unintended pregnancy do not provide a complete picture of adolescent sexual health, and the absence or presence of disease alone does not define health. Rather, they are part of the core indicators used by Healthy People 2020 to assess health status (Office of Disease Prevention and Health Promotion [ODPHP], 2017a).
One public health approach to address the sexual health disparities experienced by adolescents is offering medically accurate and age-appropriate sex education in schools as identified by the Healthy People 2020 objective under Educational and Community-Based Programs (ECBP-2.7) (ODPHP, 2017b). Schools are the ideal place for such instruction as they have access to 95% of young people aged 17 and below (School Health Policies and Practices Study [SHPPS], 2013, p.1). Furthermore, an intervention of sex education at the public-school level is important because changing “…behaviors during childhood is easier and more effective than trying to change unhealthy behaviors during adulthood” (SHPPS, 2013, p.1). Even though ECBP-2.7 is a national objective, there are no set standards for providing sex education and is therefore left up to each state’s discretion. In 2014, Minnesota was one of 20 states that mandated sex education to be provided in school (Guttmacher Institute, 2014b). Minnesota statute 121.23A does not specify whether the instruction needs to be medically accurate or age-appropriate, however it does specify that the instruction given must help students abstain from sexual activity until marriage (Minnesota Statutes 2016). With little direction from the state, school districts and teachers are left with little assistance on how to fulfill this mandate, therefore creating inconsistencies statewide.
Experience: As the Adolescent Sexual Health Data Intern for Teenwise Minnesota (MN), my first learning objective was to apply knowledge of statistics and data synthesis in order to assist the organization in disseminating current, evidence-based information to the public and policy-makers on adolescent sexual health (e.g., teen pregnancy, STIs) , through web-based and print resources. My second objective was to explore various strategies to connect research to policy development; and my third objective was to participate in program evaluation and assessment activities. I completed these objectives by assisting in the composition of the 2014 Minnesota Adolescent Sexual Health Report (ASHR), including 87 individual county reports, as well as the creation of a supplemental information piece about chlamydia and adolescents in Minnesota titled “Chlamydia among Minnesota Youth”. Other activities to fulfill the learning objectives included attending the 2014 Teenwise Minnesota Annual Conference and various training seminars led by Teenwise MN, in addition to updating the Teenwise MN website to engage stakeholders and inform constituents.
Organization: Teenwise MN was a small non-profit dedicated to advancing the sexual health and development of adolescents of Minnesota. At the time of my field experience, Teenwise MN was considered one of the main sources on adolescent health in Minnesota. Teenwise MN worked to address the gap in sex education standards in Minnesota by providing training and program evaluation of various evidence-based interventions (EBIs) to professionals and community members working with youth, such as teachers, nurses, and group facilitators at juvenile justice centers. In addition, the organization worked to engage the community by organizing an annual conference, advocating for policies that improved adolescent health, hosting workshops for parents on how to talk to their kids about sex, and releasing an annual report on the state of adolescent health in Minnesota. In November of 2015, Teenwise MN officially closed after working in the field for 25 years.
Results: For the purposes of this paper, results will be limited to the main findings we reported on from statistics provided by the Minnesota Department of Health’s (MDH) Center of Health Statistics and the STD & HIV/AIDS Surveillance Systems. Consistent with national trends, birth and pregnancy rates among those aged 15-19 in Minnesota continued to decline. Using birth data from 2012, we calculated that “approximately 12 adolescents become pregnant and 9 gave birth in Minnesota” (Fujii & Farris, 2014, p.2). The top ten counties with the highest birth rates were all in greater Minnesota (MDH, 2012). Also consistent with national trends, adolescents in Minnesota are disproportionately affected by STIs. While adolescents “…account for only 7% of the population in Minnesota, adolescents aged 15-19 accounted for 27% of the chlamydia cases and 25% of the gonorrhea cases in 2013” (Fujii & Farris, 2014, p.3; MDH, 2014b). Racial disparities continued to persist in Black, American Indian, and Hispanic/Latina youth as their pregnancy rate was more than three times greater than that of White youth (MDH, 2012). Black youth, followed by American Indian youth experienced the highest rates of gonorrhea and chlamydia. In 2013, trend data was limited to 9th graders for the Minnesota Study Survey because they changed the grades that were administered the survey. We found a 25% decrease among 9th graders reporting ever having sex from 2010 to 2013 (MDH, 2014a).
Lessons Learned: Prior to being the Adolescent Sexual Health Data Intern, I had never worked with a complex spreadsheet such as the one used to develop the report, and because my preceptor was often working out of the office, I was left to learn most of it by myself. Data interpretation was also challenging for me as I had only just started taking the required biostatistics graduate course. After completing my field experience, I had more confidence in my understanding of data digestion, analysis, and the power of data. This helped me appreciate the MDH’s response to the chlamydia rates in young people when they selected Teenwise MN to develop a supplemental piece to include in their annual report. By doing so, the MDH acknowledged how influential Teenwise MN’s annual report was in disseminating information to community members, stakeholders and policy-makers who care about adolescent health. Lastly, I learned to shift my perspective on parental involvement in sex education. I had previously considered parents as a potential barrier. However, Teenwise MN viewed parents as potential allies, and hosted workshops on how to talk to their child about sex. Parents’ impact on decision-making was reinforced when adolescents listed their parents’ objection as one of their top five reasons for abstaining from sexual activity (MDH, 2014a).
Recommendations: To address this issue on the national level, I would recommend Teenwise MN ask Congress to support for the Real Education for Healthy Youth Act (REHYA) bill as it would secure funding for programs offering comprehensive sex education that is aimed at helping young people make informed decisions regarding their sexual health. For Minnesota, I would recommend Teenwise MN advocate for the Responsible Family Life and Sexuality Education Programs or SF-1468/HF-1759 which has been introduced to the state legislature for several years without successfully being passed (Minnesota State Legislature, 2017a & 2017b). The bill outlines curriculum standards, definitions, and requirements as well as parental consent. Even though this bill continues to be unclear on how to carry out the statute, it raises the current standards and ensures the instruction given to students will be age-appropriate and medically accurate. Besides advocacy on legislation, I would like the organization to work with the MDH on developing new questions and modifications for the Minnesota Student Survey. Since Teenwise MN was dedicated to being the source on adolescent health and analyzing data on that population, they could identify areas of interest yet to be addressed. Lastly, I would recommend Teenwise MN continue to reach out to organizations working with youth disproportionately impacted by sexual health disparities, such as Comunidades Latinas Unidas En Servicio (CLUES), Neighborhood House, and American Indian Family Center.
Conclusion: The evidence-based interventions provided by Teenwise MN have been proven to have a positive effect on adolescent sexual behavior. These EBIs and data on adolescent sexual health, such as Teenwise MN’s Adolescent Sexual Health Report, can assist in the development of comprehensive sex education in Minnesota. The guidelines should include mandating that the curriculum be medically accurate and age-appropriate. Providing evidence-based sex education in schools enable young people to make informed decisions about their health
Centers for Disease Control and Prevention. (2013, April). Sexually transmitted infections among young Americans. Retrieved from: https://www.cdc.gov/std/products/youth-sti-infographic.pdf
Fujii, A. & Farris, J. (2014). 2014 Minnesota Adolescent Sexual Health Report. Teenwise Minnesota, April 2014. St. Paul, MN.
Guttmacher Institute. (2014a, May). In Brief: Facts on American Teens’ Sexual and Reproductive Health, 2013. www.guttmacher.org/pubs/FB-ATSRH.pdf.
Guttmacher Institute. (2014b). State Policies in Brief, Sex and STD/HIV Education. Retrieved from http://www.guttmacher.org/statecenter/spibs/spib_SE.pdf
Office of Disease Prevention and Health Promotion. (2017a). Adolescent Health. In Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/Adolescent-Health/objectives
Office of Disease Prevention and Health Promotion. (2017b). Educational and Community-Based Programs. In Healthy People 2020. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/educational-and-community-based-programs/objectives
Minnesota Department of Health. (2012). Center for Health Statistics, 2012 Birth Data.
Minnesota Department of Health. (2014a). Center for Health Statistics, 2013 Minnesota Student Survey.
Minnesota Department of Health. (2014b). Sexually Transmitted Disease (STD) and HIV/AIDS Surveillance Systems. Surveillance Statistics 2013.
Minnesota State Legislature. (2017a). House Floor Bill 1759. Retrieved from https://www.revisor.mn.gov/bills/text.php?number=HF1759&version=0&session=ls90&session_year=2017&session_number=0
Minnesota State Legislature. (2017b). Senate Floor Bill 1468. Retrieved from https://www.revisor.mn.gov/bills/text.php?number=SF1468&version=0&session=ls90&session_year=2017&session_number=0
Minnesota Statutes 2016. (2016). Section 121A.23, subdivision 1. Retrieved from https://www.revisor.mn.gov/statutes/?id=121A.23
School Health Policies and Practices Study. (2013). Background and introduction: School health policies and practices study 2012. In Results from the School Health Policies and Practices Study (Chapter 1). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/healthyyouth/shpps/2012/pdf/shpps-results_2012.pdf