Adolescent Health Project
Why Our Community Needs To Start Talking About Sexual Health
BY SHERRY THOMPSON
It’s been 10 years since sexually transmitted diseases (STDs) were declared an epidemic in Douglas County, and rates remain significantly higher than national and state rates. Collaborators on the new Adolescent Health Project hope that refocusing on the issues and implementing best and promising practices will reduce the high STD rates, as well as teen pregnancies.
“The Adolescent Health Project is rooted in research, and research is the cornerstone of our mission at the Women’s Fund,” says Michelle Zych, Women’s Fund executive director. “Sexual literacy, teen pregnancy and STDs have consistently ranked among the top issues facing girls in our community. Because of that, we’ve invested nearly $170,000 in programs that help young girls increase their knowledge of sexual health and well-being. But even with that commitment, and the commitment of the nonprofits that provide access to education and preventive health care, we still have high rates of STDs and incredible racial disparities when it comes to teen pregnancy.”
The Adolescent Health Project stems from a conversation among providers about how these issues could be approached differently. “Having partners like the Sherwood Foundation, the Nebraska Department of Education, Methodist Health System, Douglas County Health Department and the UNMC College of Public Health make it possible for us to be more thoughtful and inclusive in our approach,” Zych says. “It gives us the opportunity to think differently about how we provide solutions to these issues to help improve the lives of girls and women in our community.”
“I am very excited about this initiative because it has brought new partners around the table and it has energized us to approach this issue again at many different levels,” says Adi Pour, Ph.D., health director for the Douglas County Health Department.
The project is based on research. Melissa Tibbits, Ph.D., assistant professor for UNMC in Health Promotion, Social and Behavioral Health, identified best practices nationally to prevent STDs and teen pregnancy and then met with community stakeholders and those providing services to adolescents to find out what was available locally.
“There are quite a few programs focused on preventing teen pregnancy and STDs, but most of these programs serve only 10 to 15 youth at a time,” she says. “So, there is a lot going on, but there is more that needs to be done, particularly since these issues are relevant to all youth.”
A third part of the research involved interviews with teens. Christopher Fisher, Ph.D., also of UNMC, asked the youth about how big they thought the problem was and how they think it should be addressed.
Additionally, focus groups with youth gauged their understanding of STDs and testing, as well as where they received their information. Overall, the vast majority of the students said they got their information on STDs from the Internet, and about half were unsure if STDs were curable.
It’s a known fact that a significant number of youth will have sex before they graduate from high school, says Tibbits, whose background is in preventing risky behavior in adolescents.
“What the research confirmed for me was, the young people felt their sexual health education should be provided in the schools,” Pour says. “We also hear this in the Youth Risk Behavior Survey.”
The youth interviews provided good insights for the project, Zych says. “Teens know that STDs exist and that they should get tested, but they are terrified of the results. This reaction was surprising to us, but is rooted in the idea that having an STD is incredibly isolating. It’s something that is seen as shameful, but we do not allow a space for teens to talk about what they see on television and hear in music. We expect them to know the rules, but are uncomfortable having the conversation.”
“What I hear in the community is we have increased the awareness of the high STD rate in Douglas County,” Pour says. “Where we have not been successful is changing the risky behavior in our youth.” Behaviors that will lead to a reduction in STD rates include delaying sex, taking precautions such as using condoms, making sure a partner is tested and is negative, and having one partner instead of several, she says.
Much of the problem with the high rates of STDs in Douglas County has to do with the conservative nature of the community, Pour says. “People do not talk openly about STDs. We need to make this more of a dialogue so everyone feels comfortable.”
While STD rates are higher in some areas of the city, it’s a problem in all geographical areas. “This is across Douglas County,” Pour says. “We have STDs in every ZIP code.”
The primary STD seen in Douglas County is chlamydia, with 3,205 cases in 2013. During the past decade, the numbers have gone down and then back up, with some of the change due to increased screening. Testing has become more accessible in the community, with locations such as libraries serving as test sites. On the positive side, Pour says, there has been a decrease in cases for youth 15 to 19 years old. However, cases have increased for the 20- to 24-age group.
“What does that mean? In my mind, the education that has been done in the community has changed some of the behavior of the younger people, but less so of the older ones,” she says.
Testing is important, as chlamydia has no symptoms in females. “You only really know if it is an STD if you get tested,” Pour says. And, it can have long-term impact on girls, such as infertility or pelvic inflammatory disease.
“The message for our young people is that choices they make when they are adolescents can lead to disease that can affect them later in life, and chlamydia is one of them,” she says.
Research shows that comprehensive sexual education is effective in preventing STDs and teen pregnancy, according to Tibbits. Research also has identified that ethnic differences in pregnancy and STD rates are tied to risk factors, such as poverty.
“We know that individual behavior, including individual sexual behavior, is influenced by a lot of different things, including family situation, peers, schools, community characteristics and also the broader community’s attitude and norms about these issues,” Tibbits says.
“Intervening to reduce these broader risk factors is what will really have an impact on youth sexual behavior,” she adds.
The Adolescent Health Project seeks to equip adolescents with the knowledge and skills to enable them to make healthy choices, with the ultimate goals of decreasing the number of adolescents engaging in risky sexual behavior, decreasing the number of teen pregnancies and decreasing the number of teens with STDs, Zych says.
A comprehensive approach is needed to reduce teen pregnancy and STDs in Douglas County, Tibbits says. This includes strategies targeted at all youth, as well as additional strategies for youth with greater risk factors and those who are pregnant, parenting or have STDs.
“Implementing evidence-based strategies across the intervention spectrum to address youth with diverse needs holds the most promise for reducing the burden of teen pregnancy and STDs in Douglas County,” Tibbits wrote in the report Teen Pregnancy and Sexually Transmitted Infections: Research Findings and Implications for Douglas County.
The report also says that, in addition to prevention, treatment is vital for pregnant teens and youth with STDs. “Teens who receive prenatal care have better birth outcomes, so ensuring adequate access to care should be a priority.” And, in many cases, treatment for STDs is simple and effective.
Douglas County can learn from the successes of other communities that have applied innovative strategies to address these issues. “Communities that have been successful at reducing teen pregnancy and STDs share the common characteristic of focusing on implementing evidence-based interventions across the intervention spectrum in community-appropriate ways. Further, they all are long-term, collaborative efforts with diverse stakeholders and funders,” the report states.
The project will be measured and evaluated to make sure it’s a success, Zych says. “In identifying best and promising practices, we are able to determine where our community should be. The environmental scan shows us where our community is. The youth focus groups give us the insight to ensure that we aren’t developing solutions that won’t actually reach them. Our goal is to build the capacity of our community to bridge the gap between where we are and where we should be.”
Pour is optimistic that these new efforts will lead to positive change. “It is achievable for our community if we put all of our organizations together and try to impact this from every angle we can.”
“The biggest issue is we need to change the risky behaviors of our young people,” she says. “Until that happens, the rate is not going to change.”
Want to know more? The reports mentioned in this article are available on the Women’s Fund website (www.omahawomensfund.org), under Identifying Issues. Information on STD rates in Douglas County and testing sites is available at www.douglascountyhealth.com.