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Teen Pregnancy and STIs | Overview
 
   
Teen Pregnancy & Sexually Transmitted Infections
 
This is Chapter 3, Outcome Area 5 of California's adolescent health strategic plan. To view the full plan, click here.

Involving young people in the policy process is a critical step toward the creation of public policy that supports adolescent health. Young people have firsthand knowledge of their school, family, and community environments which should form the basis of policies that impact youth. They can conduct youth outreach and collect data in ways that adults cannot. Moreover, youth often provide pragmatic and fresh perspectives that challenge and expand traditional thinking. Their desire to look beyond conventional parameters and their ability to give a firsthand account of the issues make youth effective in attracting the attention of policymakers and the media.

  
     
 

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Although sexual development is an integral part of adolescence, early sexual activity can have a number of negative consequences. The vast majority of adolescents who become pregnant indicate that their pregnancies were unplanned, unintended, or mistimed.106 Adolescents who have children, as well as the children themselves, suffer educational and economic disadvantages that persist into adult-hood.107,108,109 For both biological and behavioral reasons, adolescents are at greater risk for STIs than older people.110 Untreated STIs can cause pelvic inflammatory disease, ectopic pregnancies, infertility, genital cancers, and death from AIDS. There is growing concern that HIV infection may be spreading in this age group despite education, prevention, and treatment programs.		  
     
  Data snapshot  
     
  Teen Births  
 

Figure 3.12

Figure 3.13
In 1998, there were 59,207 births to California residents under the age of 20, 10,000 fewer than in 1991. This represents a 27% drop in the 15 to 19 teen birth rate from 72.9 per 1000 in 1991 to 53.2 per 1000 in 1998 (Figure 3.12). There are pronounced ethnic disparities in teen birth rates with rates among Latinos almost five times those of whites or Asian/Pacific Islanders (Figure 3.13). In 1998, birth rates per 1000 teens ages 15 to 19 were: white 25.2, African American 68.1, Latino 97.0, Asian/Pacific Islander 19.8, and American Indian/Aleut/ Eskimo 64.7. Whereas teen birth rates among Latinos and African Americans were comparable in 1990, birth rates among African Americans dropped sharply during the 1990s such that the rate is now 25% lower than among Latinos. There are also geographic and income disparities in teen birth rates. Teen birth rates are particularly high in major population centers, including Los Angeles County, San Diego County, the San Francisco Bay Area, and much of the Central Valley.111 Teen births are more prevalent among populations of lower socio-economic status. Factors related to reductions in teen birth rates include increased numbers of teens who are delaying sexual activity; increased use of traditional contraception; increased use of long lasting methods of contraception such as Norplant and Depo-Provera; and health education, social service supports and media campaigns.112,113		  
     
  Sexually Transmitted Infections  
 

Figure 3.14

Figure 3.15
Rates of gonorrhea and syphilis have been brought to historic lows. Between 1985 and 1999, gonorrhea rates for 15 to 19 year olds dropped by 73% among females and by 88% among males (Figure 3.14). Syphilis rates fell 96% between 1985 and 1999. On the other hand, between 1990 and 1999, Chlamydia rates in California increased 45% among youth ages 15 to 19. The vast majority of cases occur in the 15 to 25 year old age group (Figure 3.15). An estimated 5% to 10% of sexually active adolescent girls are infected. Rates among African American and Latino teens are at least three times the rate among whites.114		  
     
  Although the number of actual AIDS cases among teens is low, HIV infection during these years is significant. Sixteen percent of AIDS cases occur among young adults, ages 20 to 29. Given the average 10 to 12 year latency period between HIV infection and the onset of symptoms, many of these individuals were infected during their teenage years. Nationally, of all youth diagnosed with AIDS, more than 50% are African American or Latino.115  
     
  Sexual Behavior  
 

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Table 3.4
The 1999 California Youth Risk Behavior Survey (YRBS) indicates that a substantial percentage of high school students are sexually active (40%), and a smaller but significant percentage have had multiple sexual partners (12%) (Table 3.4). Males are more likely to report sexual activity and multiple partners than are females, and there are significant ethnic disparities in sexual behavior (Table 3.4). Eighty-four percent of California high school students protect themselves from sexually transmitted infections (STIs) and unplanned pregnancy through abstinence or use of condoms. Sixty percent of sexually active students in grades 10 to 12 reported using a condom the last time they had sexual intercourse.73 Although there are no trend data for California, national data indicate that condom use increased from 46% to 58% between 1991 and 1999.116 However for some teens, embarrassment, cost, and lack of knowledge continue to be obstacles to condom use. Among older teens, condom use decreases as their use of non-barrier methods increases. While oral contraceptives, Depo-Provera and Norplant are highly effective at preventing pregnancy, they leave many teens vulnerable to STIs. 		 
     
  Examples of current efforts  
     
 
  • For over 20 years, the Office of Family Planning, within the Department of Health Services (DHS) has funded the Information and Education program, providing $2 million to 32 community-based organizations to conduct reproductive health education in the schools. In recent years, the emphasis has been to target alternative, continuing education and other non-traditional schools. This program is well accepted by many districts.
  • The Male Involvement Program (MIP) aims to reduce teen pregnancy by promoting primary prevention skills and motivation in adolescent boys and young men. Funded by DHS at $2 million, MIP funds 25 grantees to implement programs using a variety of strategies involving schools, recreation programs, and job training programs.
  • The Maternal and Child Health Branch of DHS administers 47 local Adolescent Family Life Program (AFLP) projects providing case management services to pregnant or parenting teenagers and their siblings. The goal of AFLP is to prevent or delay subsequent pregnancies and to keep parenting teens in school. AFLP works in close coordination with the CalLearn Program. Administered by the California Department of Social Services, CalLearn includes financial benefits to pregnant and parenting teens for staying in school and for maintaining a certain level of academic performance.

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    The California Department of Health Service’s Partnership for Responsible Parenthood is a multi-pronged parenting initiative that includes a major media campaign and the Community Challenge Grant Program (CCG). Grants have been made to 134 local agencies to develop local solutions to the problem of teenage pregnancy. CCG stresses the delay of sexual activity, community-based youth development activities, and expanded roles for males in both pregnancy prevention and child-rearing.

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    Legislation supports quality sex education in California. Section 51553 of the Education Code prevents schools from withholding information about contra-ception by requiring that it be covered if sex education is offered. AB 246, passed in 1999, requires that factual information presented in course materials and instruction for sex education courses be medically accurate and free of racial, ethnic, and gender biases. However, there is no requirement that sex education be offered.
  • The Teenage Pregnancy Prevention Grant Program (SB 1170), administered by the California Department of Education, funds 37 local education agencies to implement school-based interventions using school-based strategies previously shown to be effective.
  • The California Wellness Foundation has funded a 10 year, $60 million Teen Pregnancy Prevention Initiative that supports a public education campaign (Get Real), community action programs, policy projects, and leadership development.
  • Positively Speaking is a statewide program that trains individuals affected by HIV to give classroom presentations. Positively Speaking grew out of a collaboration between the STD Control Branch within the California DHS and the Healthy Kids Resource Center to further incorporate STI education into ongoing HIV prevention received by students in grades 7 through 12.
  • The Family Planning, Access, Care and Treatment Program (Family PACT), under the auspices of the California Office of Family Planning, enables teens with family incomes under 200% of the federal poverty level to access comprehensive clinical family planning services and primary care when they are unable to use services through Medi-Cal or Healthy Families. All Medi-Cal providers may enroll to provide and be reimbursed for these services under the program. There are currently over 2,800 providers participating in the Family PACT program.
  • TeenSMART provides enhanced reproductive health counseling for pregnancy prevention and STI risk reduction to sexually active adolescents enrolled in Family PACT clinics.
  • The California Chlamydia Action Forum, sponsored by DHS and the California Healthcare Foundation took place in October of 1998. The Forum resulted in a five year public and private Chlamydia prevention and control strategy for California. Governor Davis has allocated $1.3 million to the Chlamydia Awareness Grant to be used to hire regional health educators and to conduct outreach and awareness activities.
  • To establish the point prevalence of Chlamydia in teens and young adults, the “Get Tested” Campaign was launched by the STD Control Branch within DHS in the beginning of 2000. This campaign will provide resources for screening adolescents for Chlamydia in a variety of settings, such as health clinics, school-based health centers, and youth-serving organizations.
  
     
  Strategies to reduce teen pregnancy and STIs  
     
  1. Provide teens with the information, skills, and support they need to practice safe sexual behavior, including abstinence.  
 
  • Offer family life education to youth that is age appropriate, culturally sensitive, teaches sexual and reproductive options, and emphasizes the benefits of abstinence. Build on current knowledge of best practices by emphasizing communication, skill-building activities, and role-playing.
  • Educate teenagers about the risks of sexually transmitted diseases, including HIV/AIDS, and the need for prompt treatment. Integrate Chlamydia messages into existing HIV and teen pregnancy prevention campaigns and family life education modules.
  • Establish and reinforce community norms that value healthy adolescent sexuality but do not sanction pregnancies and high risk behavior.
  • Change the perception of teen pregnancy as an individual/family problem and recognize the role of the social environment.
  • Incorporate promising strategies into comprehensive pregnancy prevention programs including: individual and peer education, counseling, case management, after school activities, and building support systems and relationships with caring adults.
 
     
  2. Increase access to reproductive health care.  
 
  • Encourage all health care providers who provide care to youth to include comprehensive, age-appropriate information on sexual health issues, including prevention of unintended pregnancies and STIs.
  • Make confidential STI screening and treatment services easily accessible to teenagers along with culturally sensitive counseling and education regarding the use of available protective measures.
 
     
  3. Increase the role males play in preventing adolescent pregnancy.  
 
  • Educate males at an early age to identify and understand the legal, financial, and emotional roles and responsibilities of parenthood.
  • Involve males in teen pregnancy prevention efforts, make programs comfortable for males, and conduct outreach to young men who are not using services for which they are eligible.
  • Enforce statutory rape laws against adult men involved with girls who are minors.
  
     
  4. Decrease glamorization of irresponsible sexual behavior in the media.  
 
  • Add more educational content to regular programming which provides realistic and positive portrayals of life and reduces the glamorization of premarital and extramarital sex and teenage parenthood.
  • Portray characters in situations where they demonstrate responsible sexual behavior and are shown facing and discussing abstinence as well as the consequences of sexual relations, including unintended pregnancy, sexually transmitted diseases, AIDS, and early parenting.
  
     
  Additional resources  
     
  Complex Terrain: Charting a Course of Action to Prevent Adolescent Pregnancy. Brindis, C., Peterson S.A., Brown, S., and Snider, S. Center for Reproductive Health Policy Research, Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, 1997.  
     
  Linking Pregnancy Prevention to Youth Development. Brindis, C., and Davis, L. Advocates for Youth Series, Vol. 5, 1998.  
     
  Get Organized: A Guide to Preventing Teen Pregnancy. National Campaign to Prevent Teen Pregnancy. http://www.teenpregnancy.org  
     
  Challenges and Opportunities: Action Agenda for Chlamydia Prevention and Control in California. A Five Year Plan. Recommendations for Action from the California Chlamydia Action Forum. California HealthCare Foundation. January, 1999.  
     
  California HIV/AIDS Update. Vol. 10, No. 1, January, 1997.  
     
  Solutions: Getting Real About Teen Pregnancy. Get Real Campaign. http://www.letsgetreal.org  
     
  Findings in Brief: A Look at Californian’s Views on Teen Pregnancy. Get Real Campaign. http://www.letsgetreal.org  
     
  Adolescent Pregnancy and Parenting in California: A Strategic Plan for Action. Brindis, C., and Jeremy, R. Center for Population and Reproductive Health Policy, Institute for Health Policy Studies, School of Medicine, University of California San Francisco, 1988.  
  Click here to view references  
 
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