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N 144 Community Assessment Presentation

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Amber McRostie

on 25 April 2013

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Transcript of N 144 Community Assessment Presentation

presented by Danielle Burrows,
Amber McRostie, Cathy Zaguirre
and Inessa Zhernokleyev Teenage
Pregnancy in
Sacramento County Incidence & Prevalence in Sacramento County Statistical Data Biophysical,
Psychological and
Physical Environmental Considerations Socio-cultural,
and Health System Considerations Why is the teenage pregnancy rate of Sacramento County higher than that of California and Los Angeles County? And why is the teenage pregnancy rate so high in Sacramento County?

What contributes to this problem?

Why has the overall incidence decreased 50% since 1995?

Why is the incidence of teenage pregnancy so much higher among African American and Hispanic/Latina teens than compared to their white counterparts? Analysis Increased risk of teen pregnancies among the Hispanic population in Sacramento County possibly related to lack of awareness and education as evidenced by data from Sacramento County.

Increased risk of teen pregnancies among 13-19 year olds in Sacramento County related to accessibility barriers (transportation, lack of knowledge of available resources, language) and lack of knowledge as evidenced by data from Sacramento County.

Increased risk of teen pregnancies among teens in Sacramento county related to stigma on society related to sex, contraceptives, and pregnancy related to lack of communication and support in the community as demonstrated in protests at clinics such as planned parenthood, under-reporting of sexual activity in surveys of teens not having sex, etc... Community
Diagnoses 1. Implement a sexual education/family planning teaching program like that in L.A. County. Potential
Solutions As of 2010, there are 28 live births per 1000 teenagers ages 15-19 in Sacramento.
In 1995 it was 61 live births per 1000.
Teen birth numbers have decreased more than 50% since 1995. (Children’s Report Card) Teen Births 1995-2010 Incidence & Prevalence in Sacramento County 2010: LA County 27.3 births /1000, Sacramento County 28.7 births/1000 2010: Sacramento falls between LA County and California State Sacramento County Teenage Pregnancy Rate Compared to Los Angeles County Sacramento Teenage Pregnancy Rate compared to LA County and California 52 births per 1000 of teen pregnancies in Sacramento are born to teens ages 18 and 19.
12.6 births are born to ages 15-17. Demographics:
Age Demographics:
Race/Ethnicity 2010 About 80% of teen parents come from poor and low-income families.

Teens make up 85% of unmarried parents [source:California Dept of Education].

Less than 40% of teenagers who
become pregnant before the age
of 18, ever earn a high school
diploma [source:teenshelter.org]. Demographics continued.. Latinos have highest teen birth rate, and are at least 50% less likely to use contraception than their peers.Fertility?

African Americans are second highest to be pregnant as teens.

Males have sex earlier than females, have more partners and are less likely to use reproductive health services
[source: cdph.ca.gov] Genetic Predisposition Youth with chronic conditions are more likely to be abused sexually.

Early puberty has been found to be
associated with early age of alcohol use and sexual activity, which in turn
results in early pregnancy
[source: Journal of American
Academy of Pediatrics]. Physiologic conditions that increase the risk Stress could include peer pressure to have sex earlier or with a specific partner, or stress from the sexual partner to become intimate.

Stressors in other parts of the young person’s life could potentially cause them to seek comfort in their significant other, leading to intimacy prematurely.

Sex could also be used as an “acting out” tool for the teen to rebel against someone or something causing stress in their lives.
[source: Middlebrooks, J. S., and Audage, N. C. (2008)]

The effects of childhood stress on health across the lifespan. Project Report. National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention. [source: The Minority Health and Health Equity Archive. http://health-equity.pitt.edu/932/] Does exposure to stress increase risk of the problem? Adds stress to the mother
Cultural/social stigma causes stress due to societies judgment/misunderstanding of pregnancy in teens
Teens looked down upon by parents/family members
Lack of support by family/significant other
Young age and lack of education and job experience
Need for welfare/assistance arises What are the psychological effects of the problem? “Infants of teen mothers are at higher risk for physical, social, and emotional challenges than infants of mothers in their 20s and early 30s. Teen mothers are more likely to become welfare dependent than other teens, and teen parenthood for both mothers and fathers is associated with lower educational attainment and lower income levels. Fiscal hardship can be compounded by the fact that teen mothers are less likely to be married or stay married, which may mean covering family expenses on their own.”
“Research estimates that teen births cost society at least $10.9 billion annually, most of which is associated with negative outcomes for the children of teen parents, including increased costs for health care, foster care, incarceration, lost productivity, and tax revenue.” Kidsdata.org More clinics have opened over time to address problem, such as Planned Parenthood.

There has been adaptation by society but not on an individual level. What is the extent of adaptation to the problem? Yes, indirectly...

Usually the cultural and family environment affects the rate of teen pregnancy.

Children born to teens are more likely to enter the foster care system and to become teen parents themselves than children born to older mothers.

According to the data in the graph on the next slide, the Sacramento percent of teens NOT having sex is currently higher than both the California and LA county rates.   Does the environment contribute to the problem? Data Source: UCLA Center for Health Policy Research, California Health Interview Survey. Accessed online at http://www.chis.ucla.edu/ (March 2011). Percent of teens NOT
having sex In 2009...
California: 80.8%
Los Angeles county: 84.2%
Sacramento county: 72.7%

What do you think of these numbers?

What might effect teen’s answers to this question? Teens NOT having sex The National Campaign to Prevent Teen and Unwanted Pregnancy. (2011). Counting it up: The public costs of teen childbearing. Retrieved from: http://www.thenationalcampaign.org/costs/default.aspx Yes, the prevalence of the problem necessitates changes in teaching, especially to the Hispanic/Latina group.
The Hispanic/Latina groups high prevalence rates could be affected by a religious aspect/Catholicism. Teaching could be done in such a way that it does not counteract the beliefs of the church.
Pre-existing clinics could provide teaching and readily-available contraceptives in high Latino/African American neighborhoods. Does the problem necessitate environmental changes? Very controversial. What
are your thoughts??? Social attitudes...

"Teen pregnancy is bound to happen to a young Hispanic or African-American woman."

"Irresponsible teens." Socio-cultural Considerations Teens in poverty are more likely to get pregnant because of teachings and attitudes about sex and access to contraception.

Socioeconomic standing, proper education about, and access to contraception can reduce the chances of teen pregnancy.
Cultural nuances may include such issues as behavior “patterning”.

Health officials note that many teens of color that have babies at a young age were themselves born to teen mothers. AB 499 –New Law Increases Access to Preventive STD Care for California Youth

Bill that increases youth access to critical preventive care.
Will allow youth age 12 and older to consent to medical care related to prevention of STDs.
California law – allows minors 12 and older to consent diagnosis and treatment of STDs.

[Source: teenhealthlaw.org] Laws The Federal Title X Family Planning Program: Privacy and Access Rules for Adolescents

Makes family planning and related health services available at free or at low cost to eligible individuals, including adolescents, in every state.
Consent and confidentiality rules designed to reduce barriers that limit adolescents' access to care and to protect the privacy of those who choose to receive services

[Source: teenhealthlaw.org]
A young person may be eligible for a special kind of Medi-Cal called “sensitive services” or “minor consent services” if he or she is:

At least 12 years old and not over 20
Living at home or temporarily away such as in school.
Seeking care for sexually transmitted diseases, family planning, prenatal care, abortion, sexual assault,substance abuse treatment or outpatient mental health treatment.

[Source: www.cdph.ca.gov] Medi-Cal may not contact the parents and the parents' income is not considered in determining eligibility; only the teen's own income is counted.

It is available to young people in all immigration categories, including undocumented; a social security number is not required.

[Source: www.cdph.ca.gov] Family’s attitude about sex and contraception can affect the teen’s likelihood of becoming pregnant and how pregnancy is dealt with.

If sex is something that is taboo in you family or your teen does not understand, she could be at risk for becoming pregnant.

Self-esteem issues.

Prioritizing your own body and health. Behavioral Considerations Socioeconomic Status Influence
on Teen Pregnancy Cultural Beliefs & Behaviors More on policies related to
teenage pregnancy... Sensitive Services More on Medi-Cal... The rate of teen births in Sacramento County has decreased over the past 10 years but it is still significantly higher than other areas of California. We’re moving in the right direction but we still have a ways to go. Do health system factors contribute to the problem? This pregnancy resource guide provides a lot of information for provides to help them make referrals for:

Birthing Centers
Childbirth Classes
Children’s Services
Family Planning
Family Support Services
Health Insurance (Free and Low Cost)
Housing Assistance
Prenatal Care
Teen Program and Services
Translation Services
Transportation Provider Resource Guide for Sacramento County
[Source: http://www.dhhs.saccounty.net] What resources are available to the public and to providers? Family Planning Resources available to Sacramento County Free/Low Cost Health Insurance Somewhat…

Many of facilities that provide free care are only open during weekdays and during business hours

There is some help with transportation available, however transportation may still be a barrier.

[source: http://www.dhhs.saccounty.net] Are these preventative services accessible? There are barriers…
Lack of transportation
Unable to use services during hours services are available
Lack of knowledge of available resources
Little or no access to internet or phone
Limited understanding of English Services are being utilized but… Some birth control methods may not be culturally appropriate or religiously acceptable to certain members of the population.

Also depending on the individuals culture, parents and beliefs, teen girls may need to be very proactive in acquiring birth control. Is the available care culturally relevant to the population of Sacramento County? There are over 50 locations in
the Sacramento Area to get birth

4 of these are Planned Parenthood

Locations open weekdays during business hours, walk-ins are ok but appointment is preferred Available Preventative Measures Pregnancy tests are widely available and free many places. Access to these resources may be dependent on availability of transportation.

Teens may be more likely to be diagnosed at later date than general public. Diagnosis of Pregnancy [source: http://www.dhhs.saccounty.net] [source: http://www.dhhs.saccounty.net] [source: kidsdata.org] [source: kidsdata.org] [source: kidsdata.org] [source: kidsdata.org] [source: bedsider.org] Why is the Teen Pregnancy Rate Lower in LA County Than Sacramento County? Breaking the Cycle LA County provides teaching at the middle school level and in high school that is facilitated by Planned Parenthood. These teaching sessions provide students with information regarding sex, STIs, family planning, etc. The individuals teaching these sessions are highly trained. Over 900 presentations take place a year. Planned Parenthood also provides a parent sex-ed/family planning teaching session for the parents of teens.
[source: plannedparenthood.org]

In Sacramento the sex-ed and family planning teaching received in school by teens is limited and varied... Teens of color that have babies at a young age were themselves born to teen mothers. Teens of color that have babies at a young age were themselves born to teen mothers.

This relates to the behavior of “patterning” where young people choose a path similar to the one they grew up in because it is a familiar way of life. 2. Implement a Planned Parenthood "Parent Teaching Program" like that in LA County. 3. Implement a Teen-Mom lead teaching program. 4. Condom Billboard Campaign. Decrease of Teen Pregnancy Rates Over the Last Decade In Sacramento County Increased resources and education available to teens over the years.
Increased laws and regulations, such as access to birth control and medical care for minors without needing parental consent. Planned Parenthood would provide teaching at the Junior High and High School Level. Teaching would be performed by individuals employed and trained by Planned Parenthood. Planned Parenthood would provide teaching to parents of Junior High, Middle School and High School Students. This teaching would provide parents with the resources and knowledge to have "the talk" with their child regarding safe sex decisions. Create and implement a teaching program that would involve teen-moms speaking to their high-school peers regarding the reality of teen-pregnancy and teen-parenting. Billboards that would display the benefits of using and risks of not using a condom.
Ex: Billboard with picture of a condom with the price bellow it on one side, picture of a baby with the cost of raising a child on the other side. 5. Advocate for change in condom packaging Encourage condom companies to package condoms in a way that would be more feminine, more appealing to women. Ideally
this would increase the percentage of teen girls
willing to use them. Condom success rate at preventing pregnancy 98%
Birth control success rate at preventing pregnancy 92-98%
Success rate ONLY if used as prescribed, which is usually daily, success rate drastically goes down when not taken regularly
Sacramento is also the third highest STI rates in the state
Possibly due to the use of oral contraceptives? They do not prevent STIs and the teen is more likely not to use them as prescribed
oral contraceptives with irregular use=STIs and teen pregnancies???

[source: http://www.newsreview.com/sacramento/sacramento-needs-more-sex-ed/content?oid=1900515] Why high rates of pregnancy in Sacramento? Why is the pregnancy rate higher African American and Latina teens? Higher rate may be due to increased poverty among these minority groups.

Additionally the lower use of birth control use among Latina teens may be due to religious, familial and cultural influences.

Also, the lack of awareness of resources by the teens and their families. Cost of raising a
child: $266,770 & up Cost of a condom:
about $1 Facilities that offer free services are only open during the weekdays, business hours .

More risky teenage behaviors occur during the later hours of the day and more on the weekends. Where can I go on the weekends?
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