Teen Topics: What's the state of teen reproductive health?
What's the state of teen reproductive health?
By Melanie Gold, DO
Clinical Associate Professor of Pediatrics
University of Pittsburgh School of Medicine
Staff Physician
University of Pittsburgh Student Health Service
and Kaiyti Duffy, MPH
Assistant Director of Medical Education
Physicians for Reproductive Choice
New York City
In July 2009, data from the National Vital Statistics System were published presenting a snapshot of the sexual and reproductive health of young people aged 10-24 between 2002 and 2007. The report suggests that recent progress in adolescent reproductive health outcomes might be slowing, and certain negative sexual health outcomes are increasing.1
One of the most worrisome findings is that teen birth rates are on the rise, reversing previous positive trends. After having steadily decreased between 1991 and 2005, birth rates among adolescents ages 15-19 increased from 40.5 live births per 1,000 females in 2005 to 42.5 in 2007 (preliminary data). Other disturbing findings concern increases in the rates of HIV/AIDS and other sexually transmitted infections (STIs). The report specifies that the annual rate of AIDS diagnoses reported among males ages 15-19 nearly doubled in the past 10 years, from 1.3 cases per 100,000 population in 1997 to 2.5 cases in 2006. Similarly, after decreasing for more than 20 years, gonorrhea infection rates among adolescents and young adults have leveled off or had modest fluctuations, and rates for syphilis have been increasing. Also distressing is that rates of chlamydia among males and females ages 15-24 have steadily increased without ever experiencing declines between 1997 and 2006.
In addition, disparities persist among racial and ethnic minorities. Hispanic and non-Hispanic black adolescents ages 15-19 continue to experience significantly higher rates of teen pregnancy than their white counterparts (132.8 per 1,000 vs. 45.2 per 1,000 population). Additionally, young non-Hispanic black female adolescents ages 15-19 are four times more likely to be living with AIDS than their Hispanic peers and almost 20 times more likely than their white peers. In 2006, among young persons aged 10-24 years, rates for chlamydia, gonorrhea, and syphilis were highest among non-Hispanic blacks for all age groups.1
What are the antecedents of these trend reversals? A small, qualitative study published in the April 2009 Journal of Pediatric and Adolescent Gynecology postulated that young African-American adolescents often possess an unwillingness to use hormonal contraception.2 For some of the adolescents in the study, concerns about side effects, privacy, and compliance outweighed their concerns about pregnancy. The study participants also reported a number of barriers to correct and consistent use of condoms and emergency contraception (EC).
What can be done about these disturbing trends? Researchers from the Centers for Disease Control and Prevention (CDC) suggest that interventions integrating contraceptive care and STD/HIV testing and treatment services can help address negative reproductive health outcomes. In an analysis of the 2002 National Survey of Family Growth published in the August 2009 American Journal of Obstetrics and Gynecology, 35% of 15-24 year olds seeking contraceptive care did not receive any concomitant STD/HIV care.3 The authors stipulate that these are lost opportunities for intervention.
Based on results from the qualitative study in the Journal of Pediatric and Adolescent Gynecology, the authors advised that efforts to reduce early, unintended pregnancy among African-American youth should focus on addressing adolescents' hormonal contraception-related concerns, improving access to EC, and helping female adolescents effectively negotiate condom use. Additional qualitative research published in the September 2009 Journal of Adolescent Health suggests that increased provider education about adolescents' apprehensions related to efficacious methods of contraception, particularly the ring and the patch, may lead to increased use.4
Another approach that has been suggested for decreasing rates STIs, especially chlamydia and gonorrhea, is expedited partner therapy (EPT). EPT involves treating sex partners without requiring a clinical evaluation. Citing randomized trials demonstrating EPT's effectiveness in reducing rates of persistent or recurrent gonorrhea or chlamydia, the Society for Adolescent Medicine (SAM) issued a position paper in the September 2009 Journal of Adolescent Health endorsing EPT.5
Specifically, SAM recommends that providers "use EPT as an option for STI care among chlamydia- or gonorrhea-infected heterosexual males and females who are unlikely or unable to otherwise receive treatment; through SAM and American Academy of Pediatrics chapters, collaborate with policy-makers to remove EPT legal barriers and facilitate reimbursement; and collaborate with health departments for implementation assistance."5 Clinicians may obtain more information regarding the laws affecting expedited partner therapy in individual states by visiting the CDC web site at www.cdc.gov/std/ept/legal.
References
- Gavin L, MacKay AP, Brown K, et al. Sexual and reproductive health of persons aged 10-24 years — United States, 2002-2007. MMWR Surveill Summ 2009; 58:1-58.
- Gilliam ML, Davis SD, Neustadt AB, et al. Contraceptive attitudes among inner-city African-American female adolescents: Barriers to effective hormonal contraceptive use. J Pediatr Adolesc Gynecol 2009; 22:97-104.
- Farr SL, Kraft JM, Warner L, et al. The integration of STD/HIV services with contraceptive services for young women in the United States. Am J Obstet Gynecol 2009; 201:142.e1-8.
- Raine TR, Epstein LB, Harper CC, et al. Attitudes toward the vaginal ring and transdermal patch among adolescents and young women. J Adolesc Health 2009; 45:262-267.
- Burstein GR, Eliscu A, Ford K, et al. Expedited partner therapy for adolescents diagnosed with chlamydia or gonorrhea: A position paper of the Society for Adolescent Medicine. J Adolesc Health 2009; 45:303-309.
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