Tuesday, December 06, 2011

Chicago study

This report is presented by Northwestern University, Center for Healthcare Equity – Institute for Healthcare Studies, in collaboration with Chicago State University and The Chicago Department of Public Health. The report was made possible with support from the Aetna Foundation and Aetna, Inc.

Teen Pregnancy Prevention Initiatives in Chicago

1. Chicago Department of Public Health

Currently, CDPH does not have any specific initiatives focused on reducing teen pregnancy. However, teen pregnancy prevention education is integrated into its existing STI/HIV/AIDS prevention programs and partnerships with Chicago Public Schools and other community based organizations. CDPH clinics also offer family planning clinical services and education for low-income women of child-bearing age.

Adolescent Health Program

The Adolescent Health Program (AHP) is a services unit under the Community-Based Services Section of the Division of STI/HIV/AIDS within the Chicago Department of Public Health. The primary goal of the AHP is to reduce the rates of STI/HIV/AIDS disease among Chicago adolescents ages 12–24 through education, health screening, and treatment. The program targets youth in high morbidity areas for STI/HIV/AIDS, communities with a large reentry population, and other settings where adolescents are engaged in high-risk sexual behavior, such as juvenile incarceration facilities. AHP provides education, training, and technical assistance to a variety of youth-serving organizations on various STI/HIV/AIDS prevention strategies, including: (1) condom use and negotiation skills, (2) abstinence, (3) postponement of sexual activity, and (4) peer training. AHP also offers STI/HIV/AIDS education and testing at CDPH's specialty clinics. AHP has established partnerships with Chicago Public Schools, Cook County Juvenile Temporary Detention Youth Center of Chicago, and various youth-focused coalitions such as the Better Boys Foundation, Illinois Youth Center, Connect 2 Protect, and the YMCA.

Family Planning Program

Since 1965, CDPH has been providing family planning clinical and education outreach services for low-income women of child-bearing age who are residents of the city. CDPH targets economically challenged community areas that have high rates of teen births, infant morbidity and mortality, and STIs. Clinical services include physical examinations, laboratory tests, health education/counseling, STI/HIV screening and treatment, and prescription of birth control methods. Clients receive services regardless of their ability to pay. During the calendar year 2009, CDPH provided 11,999 family planning service visits to 6,621 clients. Of these, 2,384 (36%) were new to the program, and 4,237 (64%) were continuing clients. One hundred and eighteen (2%) of the clients were adolescents age 17 years and younger.

Family Planning Program staff provides community outreach education on topics such as: substance abuse; anatomy and physiology of the male and female reproductive systems; STI/HIV prevention; birth control methods; and the recognition and prevention of sexual coercion. During 2009 the staff provided 31 community outreach sessions to 1,532 participants in public schools and community agencies and to family case management staff.

The participants who completed the customer satisfaction surveys reported an average of 96% satisfaction with these presentations.

CDPH/Chicago Public Schools STI Collaboration

This collaborative effort began in fall 2009 under an intergovernmental agreement between CDPH and CPS and in partnership with the CPS, School-Based Health Centers (SBHC), and other community partners. The purpose of CDPH/CPS STI project is to reduce the spread of sexually transmitted infections among teens and adolescents in Chicago by establishing a voluntary, expanded STI education and screening project for all 11th and 12th grade students in selected CPS high schools. The group conducts STI prevention and screening in CPS high schools, including alternative and charter schools.

The project consists of health education, voluntary screening for chlamydia and gonorrhea, provision of test results, and assurance of timely treatment and follow-up.

The project has been implemented successfully in three Westside high schools. Four hundred students were educated, and almost 280 received STI screening and counseling services. Of these students, 10–12% tested positive for an STI and 100% of these were successfully treated. These students also received an HIV test through the school-based health centers. The partners plan to expand the education, counseling and screening activities to other Chicago schools with special emphasis on schools that have high youth morbidity rates from gonorrhea and chlamydia.

2. Chicago Public Schools

Although sex education is optional in Illinois schools and abstinence-only-until-marriage programs are the standard, Chicago public schools have been providing "age-appropriate and comprehensive" sex education (abstinence, contraception, and the prevention of sexually transmitted diseases) since 2006. Starting in fifth grade, students are educated on health topics including sexually transmitted infections and pregnancy.

In October 2010, Chicago Public Schools (CPS) were awarded more than $3.9 million in federal funding through the national Teen Pregnancy Prevention Initiative (TPPI).[16] TPPI favors implementation of evidence-based programs and programs providing medically accurate and age-appropriate comprehensive sex education over abstinence-only programs. Chicago Public Schools will implement the Chicago Teen Pregnancy Prevention Initiative using the Teen Outreach Program (TOP) model, reaching approximately 9,000 ninth grade students enrolled in almost 40 target schools per year. The overarching goal of this initiative is to reduce teen pregnancy by improving Chicago youth's life skills, healthy behaviors, and community engagement.

The program includes plans for a condom availability program, a teen health hotline, community service programming, a youth advisory committee, and a social media campaign. The project also includes an independently conducted rigorous evaluation, with half of the students randomized into a control condition. Illinois Caucus for Adolescent Health and Planned Parenthood are subcontractors under the Chicago Public Schools grant.

3. Community-Level Programs

Teen Pregnancy Prevention Primary Program TP4^[17]

Methodist Youth Services (MYS) is a nonprofit, nonsectarian child welfare agency that serves otherwise homeless abused and neglected or delinquent youth under the direction of the Illinois Department of Children and Family Services or the Department of Corrections. MYS is licensed by the State of Illinois and certified as a provider of Medicaid eligible services. The agency provides clinical and case management services to at-risk youth and families in each of its programs.

In collaboration with the Illinois Department of Human Services, MYS has initiated TP4, a teen pregnancy prevention program in the Pilsen community working in local area elementary and secondary schools. This innovative educational program is designed to engage young men and young women while strengthening the knowledge and communication skills of their parents. The male involvement and service learning curricula includes traditional elements of health education in which students receive positive messages of abstinence and safe sex practices.

Elev8 Chicago^[18]

Elev8 Chicago (formerly Integrated Services in Schools) is a community-based initiative that seeks to transform the educational achievement and life outcomes of disadvantaged students in five Chicago middle schools: Ames, Marquette, Orozco, Perspectives-Calumet, and Reavis. Elev8 Chicago establishes networks of relationships among school and community partners to implement extended-day learning (e.g., after-school, Saturday, and summer programs); comprehensive on-site, school-based health services; and mentoring. The initiative also facilitates family access to a variety of income and social supports such as tax credits and healthcare coverage. Elev8 Chicago partnerships are shown in Table 4.

A primary objective of the Elev8 program is to provide adolescent-centered health services and education in school-based health centers. The health centers are part of a larger plan to address obstacles to academic success that are prevalent in low-income neighborhoods, including poor eating and health habits, depression, and risk-taking behaviors. Educational programs and on-site services are designed to encompass all aspects of health (e.g., physical and mental), with an emphasis on prevention.

Atlantic Philanthropies, an international foundation supporting the Elev8 program, has made comprehensive, age-appropriate sex education a requirement for funding. By doing so, the expectation is that all Elev8 students will know how to prevent pregnancy and sexually transmitted diseases, and have the ability to apply responsible decision-making skills with regard to their personal health by the time they graduate. Schools use a variety of approaches to provide sex education. For example, Perspectives-Calumet Middle School in Auburn Gresham offers comprehensive and age-appropriate sex education in seventh and eighth grades as part of its Healthy Lifestyles course. Teachers and health center staff co-teach the curriculum to students. Families are also provided with materials to help them talk with their children about sexuality in the media and are engaged in the schools' sex education program through a parent seminar. Ames Middle School in Logan Square hired an external provider, the Chicago Women's Health Center, to provide sex education to its students rather than assign it to a health or science teacher.

Other community-based programs and initiatives to reduce teen pregnancy in Chicago are found in Appendix 6.

Community Perceptions

To understand how communities view teen pregnancy, we conducted key informant interviews with multiple stakeholders from four community areas (Albany Park, Chicago Lawn, South Lawndale, and Auburn Gresham). Questions were designed to elicit stakeholder perceptions regarding the frequency and impact of teen pregnancy, and the types of resources and assets available to combat teen pregnancy. Key informants included aldermen, school administrators, community health center directors, faith-based leaders, and directors of other community-based organizations. Between three and six interviews per community area were completed.

Albany Park

All interviewees agreed that teen pregnancy is very common in Albany Park. However, when asked to describe the impact of teen pregnancy on the community, responses were mixed. Individuals who stated that teen pregnancy has a major impact described its effect on the level of education attained (high rate of school drop outs) and income level (teens who become pregnant end up on welfare). Teen pregnancy prevention education and adolescent reproductive health services in the community are provided primarily by the public schools and one teen health clinic. When asked what resources are needed to reduce the prevalence of unintended pregnancy among teens in Albany Park, one respondent suggested offering more after-school programs, or "something to keep them busy."

Auburn Gresham

Perceptions about the prevalence of teen pregnancy were mixed, ranging from unsure to very common. One respondent who stated that teen pregnancy is somewhat common described the economic impact that it has on the community— teen mothers are less likely to stay in school and more likely require some sort of income subsidy. When asked about community-based initiatives or programs focused on preventing teen pregnancy, respondents mentioned Family Focus, ACCESS Community Health Center at Perspectives–Calumet Middle School, and Community Youth Development Institute, an alternative high school for at risk youth and high school dropouts between the ages of 16 and 21.

Chicago Lawn

All interviewees perceive teen pregnancy in Chicago Lawn as common, citing the high number of teens seeking prenatal care at the local clinics and the number of pregnant teens attending Gage Park High School. Metropolitan Family Services and Chicago Family Health Center were mentioned as the primary organizations that provide pregnancy prevention education and reproductive health services to teens in the community.

Teen pregnancy is also perceived to have a moderate to major impact on the community, particularly its effect on the high school dropout rate. One of the major barriers to completing high school after becoming pregnant is a lack of child care services. To prevent teens from dropping out of school after becoming pregnant, one respondent suggested that the community offer services like day care and mentoring to teen mothers, but only if they remain in school. Another respondent stated that the way in which certain income subsidies are structured potentially incentivizes teens to become pregnant: "It's almost like the system is built [so] that the more children you have, the more money you get on the LINK card, so that's how they look at it: 'If I have a baby, then I can have a house.'"

South Lawndale

Teen pregnancy is perceived to be very common in South Lawndale. Statements such as "There are a lot of young girls pushing baby strollers" and "Teen pregnancy is through the roof here" were made by respondents when describing the magnitude of the issue. A lack of comprehensive sex education in schools was cited as a major barrier to reducing teen pregnancy. Parental resistance to discussing the topic of sex with their children is another barrier. According to one respondent, "The hardest thing is getting a mom talking to her son about pregnancy, getting the dad talking to his daughter about sex. I mean, they just don't do it." Respondents mentioned Alivio Medical Center on the Little Village Lawndale High School campus and the Jorge Prieto Clinic as providers of reproductive health services and education for teens. Information about pregnancy prevention is also provided at community health fairs.

Overview

The Impact of Teen Pregnancy

The adverse effects of teen births on both teen parents and their children are well documented. Teen mothers have less education, are more likely to be in poor health, and are more likely to rely on public assistance.[1] Only about 50% of teen mothers receive a high school diploma by age 22, compared with nearly 90% of women who do not give birth during adolescence.[2] Births to teenagers are at higher risk of low birth weight and preterm birth, as well as death in infancy, compared with babies born to women in their 20s and older.[3] Children of unwanted conception have a greater risk of being born at low birth weight, of dying in the first year of life, of being abused, and of having developmental disabilities than children of wanted conception.

Children who are born to teen mothers also experience a wide range of problems.[4] They are more likely to grow up in less supportive and stimulating home environments, have impaired cognitive development, more behavioral problems, less education, and higher rates of both incarceration (for boys) and unintended teen pregnancies.

Teen pregnancy and childbirth cost U.S. taxpayers an estimated $9 billion per year because of increased healthcare and foster care costs, increased incarceration rates among the children of teen parents, and lost tax revenue from teen mothers who earn less money because they have less e0ducation.[5]

Teen Pregnancy in the United States^[6]

Teen pregnancy and birth rates in the United States are substantially higher than those in other Western industrialized nations—more than 1 million American teenagers become pregnant each year, and more than 400,000 give birth. Nearly two-thirds of births to females younger than age 18 and more than half of those to females ages 18–19 years are unintended.

With the exception of a two-year increase between 2005 and 2007, teenage birth rates have declined each year since 1991. Data for 2008 and 2009 indicate that this downward trend continues. In 2009, a total of 409,840 infants were born to females ages 15–19 years, for a live birth rate of 39.1 per 1,000 females in this age group.

Non- Hispanic/Latino black youth, Hispanic/Latino youth, American Indian/Alaska Native youth, and socioeconomically disadvantaged youth of any race or ethnicity experience the highest rates of teen pregnancy and childbirth. Together, black and Hispanic/Latino youth comprise nearly 60% of U.S. teen births in 2009, although they represent only 35% of the total population of 15- to 19-year-old females.

Teen Pregnancy in Chicago

From 2000 to 2008, there was a 25% decline in the birth rate for Chicago's teens ages 15–19 (fig. 1). However, Chicago's teen birth rate has consistently exceeded the statewide and national rates during the past eight years. In 2008, the Chicago rate was 57% higher than the U.S. rate.

Trends by Age. Older teens (ages 18–19) have higher birth rates compared with younger teens (ages 15–17). The 2008 birth rate among 18- to 19-year-olds is 2.8 times the rate among 15- to 17-year-olds (87.8 vs. 38.8 per 1,000 teens) (table 1). From 2000 to 2008, live birth rates declined 29% among 15- to 17-year-olds and 24% among 18- to 19-year-olds.

Trends by Race/Ethnicity. The declining trend masks huge racial and ethnic disparities (fig. 2). In 2007 (the most recent year Chicago birth statistics are available for by race/ethnicity), the live birth rate among Black and Hispanic/Latino teens ages 15–19 years are 6.9 and 6.1 times higher than among Whites. Over 95% of Chicago's teen births in 2007 occurred among Black and Hispanic/Latina females.

Trends by Health System Planning Region. There are also large disparities in teen birth rates by geographic location. In 2007, the southwest and west regions of the city had the highest teen birth rates (fig. 3). The live birth rate in the southwest is four times that in the north region (92.4 vs. 22.8 per 1,000 teens).

Repeat Births^[7]

Repeated childbearing during adolescence reduces the likelihood that teen mothers will graduate high school, increases public costs associated with child welfare, increases criminal justice system involvement, and increases the likelihood of long-term poverty.

One-quarter of U.S. teenagers giving birth will bear another child within two years. Repeated births within 24 months of an index birth occur more commonly among African American (23%) and Hispanic/Latina (22%) girls than White adolescent mothers (17%).

In 2007, nearly one-fifth of U.S. teen births were repeat births.[8] Of the more than 400,000 births to females ages 15–19 in 2007, 88,059 (19.8%) were to teen females who already had given birth at least once.

In 2007, 31.3% of Chicago teen births were repeat births compared with 19.8% nationally. Older teens had a higher proportion of repeat births (38.8%) compared with younger teens (18.5%). As shown in Table 2, repeat births were highest among 15-to 19-year-old Black and Hispanic/Latino teens (33.4% and 28.5%, respectively). The proportion of previous births was highest among teens living in communities on the North Side, Far South East Side, and South Side (fig. 4).

Sexual Behavior among Chicago Public High School Students: Youth Risk Behavior Survey, 2009

Youth who engage in sexual activity are at risk of contracting sexually transmitted infections (STIs) and becoming pregnant. In 2009, 46 percent of U.S. high school students reported ever having had sexual intercourse.[9] In the same year, among those reporting having had sexual intercourse during the past three months, 22.9% reported the use of birth control pills to prevent pregnancy before the last sexual intercourse and 61% reported use of a condom during the last sexual intercourse.

The Youth Risk Behavior Surveillance System (YRBSS)[10] monitors priority health-risk behaviors and the prevalence of obesity and asthma among youth and young adults. YRBSS includes school-based national, state, and local Youth Risk Behavior Surveys (YRBS) conducted among representative samples of students in grades 9–12. It is a self-administered, anonymous questionnaire completed by a representative sample of public high school students. The Youth Risk Behavior Survey (YRBS) is conducted every two years.

2009 Chicago YRBS results are summarized below.

Sexual initiation

Among Chicago public high school students, 53.6% are sexually experienced, that is to say, have had sexual intercourse. The proportion is lower for females (45.3%) than males (61.9%). Among female students, 46.3% of Blacks and 52.5% of Hispanic/Latinas have had sexual intercourse. Among male students, the proportions are 74.9% and 56.2% among Blacks and Hispanic/Latinos, respectively.

Among sexually experienced students, 19.4% of females and 47.2% of males first had intercourse at age 13 or earlier. 45.2% of Blacks and 21% of Hispanic/Latinos first had intercourse at age 13 or earlier.

Sexual activity

Regarding current activity, 78.1% of sexually experienced females were sexually active (had sex in the past three months), compared with 68.7% among males. Among sexually experienced students, 23.9% had more than one partner in the past three months. The proportion is lower for females (15.4%) than males (30.3%).

Contraceptive use among sexually active students

Among sexually active students, 82.8% used a condom or other method of protection at last intercourse. Only 5.9% of females and 4.0% of males used a condom and another method of protection (e.g., the birth control pill or Depo-Provera) at their last intercourse.

Among those who were currently sexually active, 89% had not used birth control pills and 95.8% had not used Depo-Provera prior to the last sexual intercourse. Ninety-five percent did not use both a condom and either birth control pills or Depo-Provera before the last sexual intercourse.

Forced sex

13.0% of sexually experienced students reported being forced to have sex. The proportion is slightly higher among females (14.4%) than males (12.1%).

Prenatal Care and Pregnancy Outcomes

There is substantial evidence to indicate that women who receive insufficient, late, or no prenatal care have increased risks of poor pregnancy outcome. Women, especially adolescents, who do not want a child tend to delay or never receive prenatal care.[11] Because pregnant teens are less likely to receive adequate prenatal care,[12] their babies are more likely to be low birth weight (defined as less than 2,500 grams or 5 lb 8 oz). In 2007, the low birth weight rate among 15- to 19-year-olds was 20% higher compared with the rate for all ages (9.8% vs. 8.2%, respectively).[13] Infants born to teenage mothers also have a higher infant mortality rate.[14]

In 2008, the Agency for Healthcare Research and Quality's National Health Disparities Report Card showed that large racial disparities remain in access to prenatal care.[15] American Indian/Alaskan Native women and Hispanic/Latino women were twice as likely to lack prenatal care as White women. Black women are 1.6 times as likely as White women to lack prenatal care.

In Chicago, the percentage of teen mothers receiving prenatal care during their first trimester increased from 61.2% in 2000 to 69.6% in 2007, a 13.7% increase (fig. 5). The Healthy People 2010 prenatal goal is to increase the percent of infants born to pregnant women receiving prenatal care beginning in the first trimester to 90.0%.

Table 3 shows characteristics of teen mothers receiving prenatal care during the first trimester. Hispanic/Latino mothers had slightly higher levels of first trimester prenatal care compared with other racial/ethnic groups.

Tuesday's Daily Brief

Arianna Huffington: GOP Is Now a Three-Man Race: Romney vs. Gingrich vs. Gingrich

Tuesday, December 6, 2011

Arianna Huffington: GOP Is Now a Three-Man Race: Romney vs. Gingrich vs. Gingrich

Arianna Huffington: Now that Herman Cain has "suspended his campaign," the race is down to three people: Newt Gingrich, Mitt Romney, and Newt Gingrich. At this point, the question isn't so much whether Gingrich can beat Romney (he can), but whether Gingrich will beat Gingrich. This task is complicated by the fact that there isn't just one Gingrich. He's a very Walt Whitmanesque candidate -- he celebrates himself, he sings of himself, he is large, and he contains multitudes. And while both men are serial flip-floppers, the differentiating variable between them isn't consistency; it's conviction. Whereas Romney tries to reconcile his flip-flops with lawyerly logic, Newt has the ability to seemingly believe each of his contradictory positions with absolute conviction. And for better or worse -- usually worse -- the natural selection of our political process strongly favors that trait.

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