Division of Reproductive Health
Office of the Director
Teenage Pregnancy Prevention
in the United States:
Using CDC’s Heal...
Objectives
 Describe why teen pregnancy is a public
health problem in the United States
 Describe why preventing teen pr...
Teen Pregnancy is a Public Health Problem
Teen Mother
• Educational
attainment
• Earnings
Pregnancy
• Preterm birth
• Low ...
Teen Pregnancy in the United States
3in 10teen girls
will become pregnant before age 20
750,000 teen pregnancies every yea...
Teen Pregnancy in the United States
5in 10African American and Latina teen girls
will become pregnant before age 20
0
10
20
30
40
50
60
70
80
90
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Rateper1,000womenaged15-...
Teen Birth Rates in High-income
Countries, 2010
34
27
18
15
15
13
11
10
9
8
6
5
5
4
0 5 10 15 20 25 30 35 40
United States...
The Cost of Teen Births


 Reflects the steady decline of the teen birth rate in recent
years
 Decrease in programmati...
US Department of Health and Human Services
U.S. Department of Health and Human Services
 Pregnancy Assistance Fund
 Teen Pregnancy Prevention Initiative
Replicati...
CDC’s Winnable Battles
Healthcare-
Associated
Infections
HIV
Motor
Vehicle
Injuries
Nutrition, Physical
Activity, Obesity
...
Clinical
Interventions
Long-lasting
Protective
Interventions
Changing the Context
to make individual’s default
decisions h...
Teen Pregnancy and the Health Impact Pyramid
Factors that Affect Health
Sexual
health
education
Strengthen
effective clini...
Sexual
health
education
Strengthen
effective clinical
interventions
Promote long-lasting
preventive interventions
(LARC)
I...
Sexual Health Education
 Challenges
– Most teens receive sex education
• Not always before the first time they have sex
–...
Sexual
health
education
Strengthen
effective clinical
interventions
Promote long-lasting
preventive interventions
(LARC)
I...
Strengthen Effective Clinical Interventions
and Promote Use of LARC Interventions
 Challenges
– Youth are poorly educated...
Strengthen Effective Clinical Interventions
and Promote Use of LARC Interventions
 Opportunities
– CDC is working with
• ...
Sexual
health
education
Strengthen effective
clinical interventions
Promote long-lasting
preventive interventions
(LARC)
I...
Improve the Context to Encourage
Healthy Decisions
• Challenges and opportunities
– Community mobilization
• CDC’s communi...
Sexual
health
education
Strengthen
effective clinical
interventions
Promote long-lasting
preventive interventions
(LARC)
I...
Address Socioeconomic Factors
 Challenges and opportunities
Social determinants of health are important to
reducing teen...
CDC’S EFFORTS TO PREVENT
TEEN PREGNANCY
Integrating Services, Programs, and Strategies
Through Community-wide Initiatives
 Partnership between CDC and the Office...
CDC’s Teen Pregnancy Prevention
Community-Wide Initiatives
2010 – 2015 Grantees
• AL - Alabama Department of Public Health...
5 Keys to Success of Community-wide Initiatives
Strong teens
Strong communities
Youth are able to
access and use youth-
fr...
For a full list of evidence based programs visit: http://www.hhs.gov/ash/oah/oah-initiatives/tpp/tpp-database.html
Teen Pregnancy and Contraception






•
•
Santelli JS, et al. Persp Sex Reprod Health 2006;38:106-11
Key Domains of the Elements of
Youth Friendly Reproductive
Health Services
 Confidentiality
 Privacy
 Consent
 Accessi...
Infographic of Teen-Friendly
Reproductive Health Visit
http://www.cdc.gov/TeenPregnancy/TeenFriendlyHealthVisit.html
Effectiveness of family planning methods
http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/Contraception.htm
Tier ...
Typical Effectiveness of
Contraceptive Methods
 Most effective: <1 pregnancy per 100
women/year
– Single rod progesterone...
Typical Effectiveness of
Contraceptive Methods
 Moderately effective: 6–12 pregnancies
per 100 women/year
– Contain estro...
Typical Effectiveness of
Contraceptive Methods
 Least effective: >18 pregnancies per
100 women/year
– Male condom
– Femal...
Long Acting Reversible Contraception
(LARC)
 High typical effectiveness
– Not dependent on adherence
 Should be first-li...
Contraceptive Method Use among
54.1
22.8
9.4
3.6 0.5
9.6
0
10
20
30
40
50
60
70
80
90
100
Pill Condom DMPA IUD Implant,
Lu...
Teens and LARCs
 Why teens do not use LARCs
Cost
Knowledge
Accessibility



Teens and LARCs
 Why providers do not offer LARCs
Patient preference
Concerns about safety
Not trained in IUD insertio...

 Evidence-based guidelines for which contraceptive
methods can be used safely by women with certain
characteristics and...
U.S. MEC for Contraceptive Use:
Recommendations for
 can safely use all methods of
contraception
Including implants and ...
U.S. Selected Practice Recommendations
for Contraceptive Use (SPR)





 What exams and tests are needed before star...
CDC Contraceptive Guidance
Healthcare Provider tools
http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/USMEC.htm
Quality Family Planning (QFP)
Recommendations
New CDC-OPA* recommendations, Providing
Quality Family Planning Services (QF...
 Provide quality contraceptive counseling
 Offer confidential services and observe all relevant state
laws and any legal...
Dissemination
 Increase awareness among providers
 Develop & disseminate provider training
materials
 Evaluate use of g...
Summary
 pregnancy rate in the U.S. is declining, but still high
 Most pregnancies are due to non-use
or inconsistent us...
For more information please contact Centers for Disease Control and
Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Tel...
The findings and conclusions in this presentation have not
been formally disseminated by the Centers for Disease
Control a...
of 48

Prevención de Embarazo Adolescente Usando la Pirámide de Impacto en Salud. Dra. Lisa Romero, CDC.

Published on: Mar 4, 2016
Published in: Health & Medicine      Education      
Source: www.slideshare.net


Transcripts - Prevención de Embarazo Adolescente Usando la Pirámide de Impacto en Salud. Dra. Lisa Romero, CDC.

  • 1. Division of Reproductive Health Office of the Director Teenage Pregnancy Prevention in the United States: Using CDC’s Health Impact Pyramid to Frame Teen Pregnancy Prevention Efforts PAHO/WHO International Interagency Meeting on Current Evidence, Lessons Learned, and Best Practices in Adolescent Pregnancy Prevention in Latin America and the Caribbean March 17, 2014 Lisa M. Romero, DrPH, MPH Health Scientist
  • 2. Objectives  Describe why teen pregnancy is a public health problem in the United States  Describe why preventing teen pregnancy is a CDC “Winnable Battle”  Describe CDC’s efforts to prevent teen pregnancy
  • 3. Teen Pregnancy is a Public Health Problem Teen Mother • Educational attainment • Earnings Pregnancy • Preterm birth • Low birthweight infant • Infant death Child • Abuse and neglect • Early development problems • Sons: Incarceration • Daughters: Teen pregnancy Hoffman S, et al. Washington, DC: The Urban Institute Press, 2008
  • 4. Teen Pregnancy in the United States 3in 10teen girls will become pregnant before age 20 750,000 teen pregnancies every year Kost K, et al. Guttmacher Institute, 2012, http://www.guttmacher.org/pubs/USTPtrends08.pdf
  • 5. Teen Pregnancy in the United States 5in 10African American and Latina teen girls will become pregnant before age 20
  • 6. 0 10 20 30 40 50 60 70 80 90 100 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Rateper1,000womenaged15-19years 17.8 29.4 Teen pregnancy1, induced abortion1, and birth rates1,2,3, United States, 2000–2012* 69.8 Teen pregnancy rate Teen birth rate Teen abortion rate 1. Pregnancy, abortion and birth rates 2000-2008: Ventura SJ, Curtin SC, Abma JC. Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990–2008. National Vital Statistics Reports, 2012;60(7). Table 2. 2. Birth rates 2009: Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2010. National Vital Statistics Reports, 2011;60(2). Table S-2. 3. Birth rates 2010–2011: Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2011. National Vital Statistics Reports, 2012;61(5). Table 2.
  • 7. Teen Birth Rates in High-income Countries, 2010 34 27 18 15 15 13 11 10 9 8 6 5 5 4 0 5 10 15 20 25 30 35 40 United States Russia Hungary Australia Ireland Israel Spain Austria Germany Norway Sweden Japan Netherlands Switzerland –
  • 8. The Cost of Teen Births    Reflects the steady decline of the teen birth rate in recent years  Decrease in programmatic costs associated with each participant in publicly funded programs
  • 9. US Department of Health and Human Services
  • 10. U.S. Department of Health and Human Services  Pregnancy Assistance Fund  Teen Pregnancy Prevention Initiative Replication of Evidence-based Programs Research and Demonstration Projects • Untested and innovative strategies (with ACF) • Multi-component community-wide initiatives (with CDC)  
  • 11. CDC’s Winnable Battles Healthcare- Associated Infections HIV Motor Vehicle Injuries Nutrition, Physical Activity, Obesity and Food Safety Teen Pregnancy Tobacco
  • 12. Clinical Interventions Long-lasting Protective Interventions Changing the Context to make individual’s default decisions healthier Socio-economic Factors Smallest impact Largest impact Thomas R. Frieden. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595. doi: 10.2105/AJPH.2009.185652 Counseling and Education
  • 13. Teen Pregnancy and the Health Impact Pyramid Factors that Affect Health Sexual health education Strengthen effective clinical interventions Promote long-lasting preventive interventions (LARC) Improve the context to encourage healthy decisions: Access to contraception, parent child communication, social norms Address socioeconomic factors: Improve educational achievement, promote PYD, reduce poverty, decrease disparities Smallest impact Largest impact Adapted from Thomas R. Frieden. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595. doi: 10.2105/AJPH.2009.185652
  • 14. Sexual health education Strengthen effective clinical interventions Promote long-lasting preventive interventions (LARC) Improve the context to encourage healthy decisions: Access to contraception, parent child communication, social norms Address socioeconomic factors: Improve educational achievement, promote PYD, reduce poverty, decrease disparities Smallest impact Largest impact Teen Pregnancy and the Health Impact Pyramid Factors that Affect Health Adapted from Thomas R. Frieden. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595. doi: 10.2105/AJPH.2009.185652
  • 15. Sexual Health Education  Challenges – Most teens receive sex education • Not always before the first time they have sex – Education about birth control methods lags behind other health education areas such as HIV and STDs  Opportunities – There is a need to educate state and local education officials about the benefits of sexual health education – Parents/guardians need to talk to their teens about responsible decision-making in regards to sexual issues
  • 16. Sexual health education Strengthen effective clinical interventions Promote long-lasting preventive interventions (LARC) Improve the context to encourage healthy decisions: Access to contraception, parent child communication, social norms Address socioeconomic factors: improve educational achievement, promote PYD, reduce poverty, decrease disparities Smallest impact Largest impact Teen Pregnancy and the Health Impact Pyramid Factors that Affect Health Adapted from Thomas R. Frieden. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595. doi: 10.2105/AJPH.2009.185652
  • 17. Strengthen Effective Clinical Interventions and Promote Use of LARC Interventions  Challenges – Youth are poorly educated about contraception including safety and side effects • Many providers have misconceptions about which contraceptive methods are safe and appropriate for teens – Barriers to low utilization (2-4%) of LARCs among adolescents • Cost, knowledge, and accessibility
  • 18. Strengthen Effective Clinical Interventions and Promote Use of LARC Interventions  Opportunities – CDC is working with • States and other government agencies to remove logistical barriers to contraceptive use • Partners to improve provider education on the LARC safety and effectiveness for better education of teens and parents – American College of Obstetricians and Gynecologists – American Academy of Pediatrics
  • 19. Sexual health education Strengthen effective clinical interventions Promote long-lasting preventive interventions (LARC) Improve the context to encourage healthy decisions: Access to contraception, parent child communication, social norms Address socioeconomic factors: Improve educational achievement, promote PYD, reduce poverty, decrease disparities Smallest impact Largest impact Teen Pregnancy and the Health Impact Pyramid Factors that Affect Health Adapted from Thomas R. Frieden. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595. doi: 10.2105/AJPH.2009.185652
  • 20. Improve the Context to Encourage Healthy Decisions • Challenges and opportunities – Community mobilization • CDC’s community-wide initiatives create supportive environment for youth  Receive evidence-based prevention programs  Obtain access to contraceptives and reproductive health services – Collaboration with the other government agencies to scale-up community practices nationwide
  • 21. Sexual health education Strengthen effective clinical interventions Promote long-lasting preventive interventions (LARC) Improve the context to encourage healthy decisions: Access to contraception, parent child communication, social norms Address socioeconomic factors: Improve educational achievement, promote PYD, reduce poverty, decrease disparities Smallest impact Largest impact Teen Pregnancy and the Health Impact Pyramid Factors that Affect Health Adapted from Thomas R. Frieden. A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health: April 2010, Vol. 100, No. 4, pp. 590-595. doi: 10.2105/AJPH.2009.185652
  • 22. Address Socioeconomic Factors  Challenges and opportunities Social determinants of health are important to reducing teen pregnancy Positive youth development can set youth on a more healthy trajectory through life
  • 23. CDC’S EFFORTS TO PREVENT TEEN PREGNANCY
  • 24. Integrating Services, Programs, and Strategies Through Community-wide Initiatives  Partnership between CDC and the Office of the Assistant Secretary for Health Innovative, multi-component, community-wide initiatives in reducing teen pregnancy/birth African American and Latino teens aged 15–19 http://
  • 25. CDC’s Teen Pregnancy Prevention Community-Wide Initiatives 2010 – 2015 Grantees • AL - Alabama Department of Public Health • CT - City of Hartford, Department of Health and Human Services • GA - Georgia Campaign for Adolescent Pregnancy Prevention • MA - The Massachusetts Alliance on Teen Pregnancy • NC - Adolescent Pregnancy Prevention Campaign of North Carolina • NY - The Fund for Public Health in New York, Inc. • PA - Family Planning Council of Southeastern Pennsylvania • SC - South Carolina Campaign to Prevent Teen Pregnancy • TX - The University of Texas Health Science Center at San Antonio
  • 26. 5 Keys to Success of Community-wide Initiatives Strong teens Strong communities Youth are able to access and use youth- friendly, culturally competent family planning services Stakeholders are informed about, and supportive of teen pregnancy prevention efforts Diverse communities, priorit y populations are effectively reached Evidenced-based programs educate and motivate youth Community is mobilized, teen pregnancy prevention initiative sustained
  • 27. For a full list of evidence based programs visit: http://www.hhs.gov/ash/oah/oah-initiatives/tpp/tpp-database.html
  • 28. Teen Pregnancy and Contraception       • • Santelli JS, et al. Persp Sex Reprod Health 2006;38:106-11
  • 29. Key Domains of the Elements of Youth Friendly Reproductive Health Services  Confidentiality  Privacy  Consent  Accessibility  Comprehensive Services  Cultural & Linguistic Appropriateness  Parent/Guardian Involvement http://www.cdc.gov/TeenPregnancy/TeenFriendlyHealthVisit.html
  • 30. Infographic of Teen-Friendly Reproductive Health Visit http://www.cdc.gov/TeenPregnancy/TeenFriendlyHealthVisit.html
  • 31. Effectiveness of family planning methods http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/Contraception.htm Tier 1 Tier 2 Tier 3
  • 32. Typical Effectiveness of Contraceptive Methods  Most effective: <1 pregnancy per 100 women/year – Single rod progesterone implant • Effective 3 years – Intrauterine device (IUD) • Copper IUD: Effective 10 years • Two LNG-IUDs: Effective 3 or 5 years Long acting reversible contraceptives (LARCs) Trussell J. Contraception 2011;83:397-404 LNG, Levonorgestrel
  • 33. Typical Effectiveness of Contraceptive Methods  Moderately effective: 6–12 pregnancies per 100 women/year – Contain estrogen and progestins or progestin alone • Injectable • Pill • Patch • Ring – Barrier: Diaphragm Trussell J. Contraception 2011;83:397-404
  • 34. Typical Effectiveness of Contraceptive Methods  Least effective: >18 pregnancies per 100 women/year – Male condom – Female condom – Withdrawal – Sponge – Spermicide – Fertility-awareness based methods: Standard days method, two days method, ovulation method, and sympto- thermal method Trussell J. Contraception 2011;83:397-404
  • 35. Long Acting Reversible Contraception (LARC)  High typical effectiveness – Not dependent on adherence  Should be first-line recommendations for all adolescents (American College of Obstetricians and Gynecologists, 2012) ACOG. Obstet Gynecol 2012;120:983-8
  • 36. Contraceptive Method Use among 54.1 22.8 9.4 3.6 0.5 9.6 0 10 20 30 40 50 60 70 80 90 100 Pill Condom DMPA IUD Implant, Lunelle or patch Other
  • 37. Teens and LARCs  Why teens do not use LARCs Cost Knowledge Accessibility   
  • 38. Teens and LARCs  Why providers do not offer LARCs Patient preference Concerns about safety Not trained in IUD insertion IUDs not available Community-wide Initiatives 70% of providers had “never” or “not often” prescribed an IUD to teens for these reasons
  • 39.   Evidence-based guidelines for which contraceptive methods can be used safely by women with certain characteristics and medical conditions  17 contraceptive methods and >120 medical conditions U.S. Medical Eligibility Criteria for Contraceptive Use (MEC)
  • 40. U.S. MEC for Contraceptive Use: Recommendations for  can safely use all methods of contraception Including implants and IUDs Teens with medical conditions and characteristics Obesity Smoking Diabetes Sexually transmitted infections HIV
  • 41. U.S. Selected Practice Recommendations for Contraceptive Use (SPR)       What exams and tests are needed before starting contraception  SPR: Guidance on the few exams or tests needed before starting contraception
  • 42. CDC Contraceptive Guidance Healthcare Provider tools http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/USMEC.htm
  • 43. Quality Family Planning (QFP) Recommendations New CDC-OPA* recommendations, Providing Quality Family Planning Services (QFP)  Define what services should be offered in a family planning visit, and describe how to do so  Support consistent application of quality care across settings and provider types  Translate research into practice, so the most evidence-based approaches are used Office of Population Affairs (OPA) *Expected release date Spring 2014
  • 44.  Provide quality contraceptive counseling  Offer confidential services and observe all relevant state laws and any legal obligations  Provide comprehensive information about how to prevent pregnancy  Encourage communication between the adolescent and his or her parent(s) or guardian(s) about sexual and reproductive health  Educate pregnant adolescents about contraceptive options for the post-pregnancy period, including benefits of immediate postpartum insertion of LARC QFP Recommendations for Teens
  • 45. Dissemination  Increase awareness among providers  Develop & disseminate provider training materials  Evaluate use of guidance documents
  • 46. Summary  pregnancy rate in the U.S. is declining, but still high  Most pregnancies are due to non-use or inconsistent use of contraception  As a demonstration project, CDC’s community-wide initiatives will provide useful information on prevention efforts using the 5 component model  CDC’s evidence-based guidance can help providers to manage contraception
  • 47. For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division of Reproductive Health, Office of the Director www.cdc.gov/teenpregnancy
  • 48. The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

Related Documents