2019 Public Health Ethics Forum: Ethical Dilemmas in Child and Adolescent Health – Part 3 of 6



good afternoon everyone so just to make sure you're in the session that you think you should be in to this afternoon's session is on adolescent access to sexual health education and services so I'll go ahead and introduce both speakers in the order that they will be speaking our first speaker is dr. Kathleen Ethier dr. Ethier is the director of the division of adolescent and school health in the National Center for hiv/aids viral hepatitis STD and TD and TB prevention prior to her appointment as director of – she served in a variety of capacities across the agency including as the director of the program performance and evaluation office in the CDC office of the director dr. Ethier's research has included psychosocial behavioural organizational and clinical factors related to women's health maternal health and adolescent sexual and reproductive health she has authored or co-authored numerous articles and book chapters for peer-reviewed publications dr. Ethier earned her PhD in social psychology from the graduates from the Graduate Center of the City University of New York welcome our second speaker is dr. Jessica sails and dr. cells is an associate professor in the department of behavioral sciences and health education at the Rollins School of Public Health at Emory University she is also a researcher in the Emory Center for AIDS research and a scholar scientists in the Center for translational and prevention science at the University of Georgia interesting dr. sells research has focused on the development and evaluation of sexual health interventions tailored for adolescents as well as clinical practice improvements as a way to improve patient's sexual health outcomes welcome also dr. sells our first speaker not the Ethier thank you good afternoon how's everybody doing it's post-lunch as you heard i'm from the division of adolescent in school health here at cdc we do three things in the division of adolescent in school health we do surveillance on youth behaviors and experiences among high school students and school-based policies and practices we run school district based programs for HIV STD and teen pregnancy prevention and then we do research and evaluation around those issues today I'm going to talk to you about both sexual risk and protective behaviors trends that we've been seeing in the last ten years in those factors and disparities that we're currently seeing as well as some of the data that we've been seeing across the country on school-based practices to prevent sexual risk behaviors and to promote health we focus on HIV STD and pregnancy prevention among youth because half of all new STDs are among 15 to 24 year olds chlamydia cases among 13 to 19 year olds they take up they account for 26% of all chlamydia cases there have been increases among adolescents in in gonorrhea and syphilis one in five new HIV diagnoses occur in young people and although we have seen significant declines in teen births we are still one of the highest the our rates are still one of the highest among developing nations we also know that schools can really play a critical role in promoting the health and health and safety of adolescents so there are roughly 26 million students in middle schools and high schools around the country 95 percent of school-aged youth attend school they spend at least six hours a day in school and there are numerous protective factors like school connectedness and parent engagement that can prevent prevent a whole wide variety of risk behaviors but stepping back from that in order to address those health outcomes we first and associated disparities first we have to understand them and so we run the youth risk behavior surveillance system for the country the YRBS as it's commonly known focuses on behaviors and experiences that cause the most health problems among youth and we also assess how those behaviors and experiences change over time this is a high school based survey it's conducted every other year and it is anonymous and self administered so that we really are able to maintain a high level of confidentiality and that's important when you start to look at kind of some of the results that we have versus some other surveys which are not confidential or are done over the telephone or in people's homes we collect date we collect nationally representative data which is the data that I'm going to talk to you about today but we also collect data at the state and local levels which which states and and jurisdictions are then able to use to talk to really kind of plan for themselves and draw attention to what's happening in their own communities last year so we collect the data every other year and it's released kind of the following summer after after we're done collecting it so the 2017 data was released last June and when we did that we produced a special report we call our data summary and trend report for us in terms of HIV STD and pregnancy prevention and those behaviors and experiences with common school-based protective factors we focused on four sets of behaviors and experienced sexual behavior high-risk substance use violence victimization and mental health and suicide and we present to ten-year trends and we also included data on sexual minority youth I'm going today to really only focus on kind of two sets of those data one on sexual risk behavior so those sexual behaviors and experience of sexual violence that put youth at risk for HIV STD and n teen pregnancy and then sexual protective behaviors so those behaviors like condom use and and and birth control use that that protect against those outcomes overall as you can see we've seen improvements over the last ten years in the proportion of students who experience sexual risk behaviors we've seen improvements in some of those protective favourite protective behaviors and and lack of improvement or decline in in other protective behaviors like condom use and so I'm going to spend a little bit of time kind of teasing those apart and looking at some of the breakdowns by gender and by race ethnicity so first let's focus on sexual risk behaviors and experiences in 2017 almost forty percent of youth overall had ever had sex and those rates are higher among males compared to females and among black youth compared to other racial and ethnic groups but as you can see we saw declines over ten years among both genders and significant declines among all racial and ethnic groups and one thing to note here that in 2007 there were can pretty dramatic differences among groups and that and the gap between those groups really seems to have closed over time we're doing some additional analyses to understand whether those gaps have closed significantly when you look at it it looks like it has but we're really going to do some more in-depth analyses to understand kind of whether we're seeing kind of more increasingly changes that are happening faster among some groups versus others it looks like we've seen the greatest declines among black youth similarly for whether or not youth have had form or lifetime sexual partners this is risk for youth who have had more sexual partners are just more likely to have had exposure to STDs or to HIV and so it poses a risk factor for those outcomes and as you'll see again in 2017 males and black youth were most likely to have had four or more partners but again as you'll see there have been significant declines over the last ten years for both genders and really significant declines for all racial and ethnic groups but particularly for black group for black youth so I wanna stop for a minute and talk about sexual violence and why sexual violence poses risk for HIV STD and teen pregnancy first as you'll see here eleven percent of female high school students have reported that they have been physically forced to have sex when they did not want to young women who and and there is a significant difference there between females who experience this and males who experience this so much lower rates of males have experienced forced sex there is no significant difference by race ethnicity in terms of the proportion of youth this is for all youth but then if you also look among females specifically there are no racial and ethnic differences youth who are forced to have sex don't have choices about condom use may or may not already be on effective birth control methods and so and so forth sex while also being incredibly traumatic and potentially physically harmful in term it also poses direct risk for HIV STD in teen pregnancy and so that's one of the reasons why we look at it in relation to those outcomes we find it incredibly disheartening that 11 percent of high school females have experienced rape this has not changed in the last 10 years so for the last 10 years roughly between 10 and 11 percent of high school females have reported that they have been physically forced to have sex sexual dating violence which we look at among youth who have said that they had a dating partner in the last year so this is a smaller portion of the sample but you see similarly that a higher proportion of female students say that they have experienced sexual dating violence in the last year and a higher proportion of white and Hispanic students also say that they have experienced sexual dating violence compared to black students so I'm going to talk now about protective behaviors these sexual behaviors D actually decrease risk for HIV STD and unintended pregnancy so in terms of condom uses you may remember from an earlier slide we have seen declines in condom use over time over the last 10 years males are more likely to report than females that they used a condom the last time they had sex and there are there are no differences among racial and ethnic groups and the proportion of youth who used a condom the last time they had sex and you'll see that those declines have been primarily particular have been particularly since 2013 so there's if you look at the kind of quadratic you'll see things have been pretty pretty stable between 2007 and 2013 and then we've started to see declines again we see declines in the prep the proportion of black youth and white youth who have used a condom we do not see those same significant declines among Hispanic youth and so we've you know started to explore why we're seeing these declines and so the next set of slides I'm going to show you is what we think the answer is which is that we've seen increases over the last 10 years in the use of effective hormonal birth control so here you'll see this is for 2017 you'll see that these more females than males say they used hormone effective hormonal birth control the last time they had sex more white students compared to Hispanic students and black students compared to Hispanic students also said in 2017 that they use effective hormonal birth control the last time they had sex and so here you'll also see that we've seen steady increases among white students and black students but not those same deep increases among Hispanic students so what we really think is going on here with with condom use is that people are method switching and so the decline in condom use is in direct proportion to the increase in effective hormonal birth control and it's among the same groups so I think as youth have had more access to highly effective forms of birth control they are using them as we as more youth have had access to health insurance they then have more access to clinical services and they have more access to highly effective methods of birth control while that is while that's great news for unintended pregnancy prevention it's not great news for STD and HIV prevention and I think the increases that we're seeing in STDs while we're seeing decreases in teen pregnancy probably are intertwined with these findings I want to focus for a moment on condom use among male sexual minority youth because we spend a great deal of time in our school-based work with messages for young men who have sex with men for HIV prevention and STD prevention in terms of condom use and here what we're seeing this is a slide that shows the proportion who said they did not use a condom the last time they had sex and so what is of concern to us is that young men who and this is all among men among young men young men who identify as gay and young men who only have same sex partners are most likely to say that they did not use a condom the last time they had sex so we clearly need to do more work in this area at the same time our messages around HIV testing seem to be getting through so those same groups young men who identify as gay and young men who have only same sex partners are least likely to say that they have never been tested for HIV and I apologize for the double negative there so I'm gonna switch now so I could go on and on and on about data we've got a ton of it and so if you have any more questions about any particular aspect of the data you're welcome to go to our website our youth online allows you to not only see our data summary in ternary port in all of the different breakdowns that I didn't show you today but also will can allow you to do some of your own analyses you can look at state-based data there's a whole way a whole variety of ways in which you can look at this data both in terms of the data that I showed you today and the other 120 variables that we didn't we didn't talk about but I want to spend some time kind of as the counterpoint to where we are in terms of the sexual health of adolescents in this country to talk about what we provide for them in schools so the data that I'm going to share with you is from our school health profile system and this is a system of surveys that we conduct in schools in the alternate years to the YRBS so in the odd-numbered years we collect the YRBS data in the even number years we collect our school health profiles data it assesses school health policies and practices in public middle schools and high schools and covers a wide variety of topics for educational services and health school health based services that we know are important to prevent the the exact behaviors and experiences that I just prevent it presented to you on it's self reported data from principals and health education teachers and so here you'll see let's starting with quality sex education you you will see here that most schools across the country are not providing quality health education so this is the percentage of secondary schools which are middle of school and high schools that taught 11 key HIV STD and pregnancy prevention topics in middle schools and high schools and what you want to see is you want to see all states in the darkest blue colors and that's 75 to 100 percent of schools in that state provide that kind of education and here what you'll see is that the majority of states are nowhere near that's seventy-five to a hundred percent one of the key ways in which we know that health education becomes quality health education is to make sure that the teachers provide are receiving professional development and so this slide is on the shows the percentage of secondary schools where the lead health education teacher got professional development in the prior two years to the survey on teaching students with different sexual orientations or gender identities which we know is key to making sure that those youth feel included and are really able to take in the education that's provided to them and if you think back to the slide on condom use among males who identify as gay or who have same-sex partners you can see where this if that's the source of their health education the fact that the professionals teaching those courses are not getting professional development and how to provide that for them is really problematic so again here what you would want to see is you would want to see all states in the darkest color blue and clearly that's not happening we also know that in order again for around the same issues in order to really fully prevent HIV and STD and pregnancies among youth LGBTQ youth really need to receive information that is relevant to them so that includes information around condom use that includes information about HIV testing the percent of secondary schools that what we're showing here is the percentage of secondary schools that provide curricular supplementary materials that include HIV STD or pregnancy information that is relevant to LGBTQ youth and here again you would want to see all the states in that seventy five to a hundred percent range and we're not there clearly so the next set of slides I'm going to show you use the data that we have on whether schools have systems that are set up to refer youth to sexual health services either in school-based health centers connected to their schools or in their communities and here what you see is that most schools do not link students to needed health services so again this is the percent of secondary schools that provide on-site services or refer to community sources of health care for seven sexual health services and again most of the states are in that zero to twenty four percent range not not even above the 50% range and again you're not finding a high enough proportion of schools that facilitate access to providers who have experience in providing services to LGBTQ providers so to sum up we have seen improvements in some sexual risk behaviors but there is clearly more work to be done so we need to grapple with as we try to encourage youth to take on protective behaviors for pregnancy prevention which is incredibly important that they're also protecting themselves from STDs and HIV we clearly need to message better two young men who identify as gay or who have who have same-sex partners around the importance of not just HIV testing but also condom use we need to do more particularly from our schools in both protecting young women against forced sex and sexual violence but also then helping them with the trauma associated with that experience we know that schools play a critical role in reducing adolescent risk for HIV other STDs and pregnancy but clearly what we're finding is that that's not happening consistently across the country so if you look at those maps you will often see that there are places in the country that are doing just fine but the but the bulk of states are not we know that there are three things that can improve sexual behavior and experiences in schools that is quality health education connecting youth to health services and school environments that support them and help them feel safe and connected in our own work with school districts we find that when schools do the this set of things we see improvements over time in those behavioral outcomes and those experiential outcomes so we know that that's those are the most important things that schools can do to improve these areas but we're clearly not seeing those improvements at this point across the country and so for us I think that is a that is a really difficult issue we fund school districts and so the places where we fund we do see those improvements in all of these issues the the main problem is that we reach about 8 percent of the of the youth in the country with our programs and so that means there's 92 percent of youth who are not who are not recipients of that so I'm gonna leave that there if you have any questions I'd be happy to answer them and look forward to hearing the discussion thanks dr. Aafia dr. cells and if it's ok I'd like to hold questions into the end for both speakers great ok good afternoon and thank you for inviting me to come in and share some information about the type of work that I do in relationship to a sexual health promotion with young people and over the course of my work time working in this this field which is a been about 15 years now I've experienced a journey with hope how I personally also approached engaging youth and sexual health promotion and so I'm going to share some findings and in a new approach that that I've been engaging youth in a different way to to sort of be more empowered regarding their sexual health promotion so adolescents experience as we've just learned multiple sexual health disparities that are impact numerous health outcomes so we know that young people are still acquiring HIV at some of the highest rates when we look at HIV new diagnosis by age groups and although teen pregnancy is going down we know that we still have higher rates of teen pregnancy in this country than in other comparatively high-income nations and then also we are seeing upward trends in terms of STI diagnosis in this in the United States so we know that these young people are are bearing the burden of a lot of these health disparities but they are often only only superficially if at all engaged by Adolescent Health researchers in the research process itself so community-based participatory research approaches are grounded in a belief that community engagement and social action can bridge the gap between science and practice to increase health equity CBPR approaches emphasized that key stakeholders in the community so in this session these stakeholders would be adolescents suggests that they should be fully involved in each stage of the research process from conception all the way through dissemination of their results and by partnering with individuals who are typically seen as the subjects of research the cbpr study is more likely to uncover important factors that are contribute to the real-world problems that are of importance to their community that's being engaged in the research so also by partnering with individuals who are often marginalized without power and resources like adolescents the cbpr process can also build community capacity which can be empowering to the individuals that participate in this the cbpr approach but can also contribute to a sense of agency and self control over their own lives for those participants but also in communities that embrace are involved in this approach as such cbpr can meaningfully engage adolescents in youth driven research if we choose to adopt these types of strategies as adolescent health researchers and as a developmental psychologist I'm particularly excited and interested in how engaging in using community-based participatory research or cbpr with adolescents may also function as a positive youth development program so positive youth development programs aim to meet the developmental needs of youth as well while doing so build the core set of youth assets that are oftentimes referred to as the five C's and these are things such as building confidence competence their contribution to their community as well as character and caring and finally meaningfully engaging and through meaningful participation in the process of health focused research there's some suggestion that in being involved in this process may also enhance trust in medical research among communities that for historical reasons have high levels of medical mistrust so I'm going to share with you for the rest of the time today how with some funding from the patient-centered outcomes Research Institute we set out to conduct a CBPR program with metro Atlanta after african-american youth to support their identifying and then conducting research project focused on an adolescent health issue of their choosing that they determined was impacting their community as well as we wanted to evaluate this program to see if participation in the cbpr process increased the youth assets the five C's that I just mentioned prior as well as increase their trust in medical research and health outcomes from that medical research so through an application process that was disseminated to high schools across the metro area we recruited 12 African American high school students we also engaged in recruited six adult professionals in Atlanta and we were specifically looking to engage adults who had experience working with adolescents in some capacity to serve as a support and advisory board to the youth so these individuals would support and provide feedback advice to youth as solicited now most of the individuals the students that were involved were in the tenth grade or the eleventh grade with a mean age of fifteen and a half seven youth attended schools in Cobb County three in Fulton County one in Fayette and one in Henry County respectively and more than half of our sample qualified for the National School Lunch Program in which they received free and reduced lunches so I'm not going to go into this slide and I apologize for even throwing it up here but it's just to show you that we had a very intentional process by which we wanted to make sure that as the Emery team that we wanted to be able to impart skills through a series of training to these young people so that they could be empowered to select the research that they wanted to focus on and then conduct that research interpret it's finding and disseminate it to their communities that they felt most needed to hear the information so this is just to show you some of the topics and the process by which we went through this after the youth did decide on their health topic they which they did focus on sexual health is the priority area that they wanted to explore further they then were supported by our Emery team as well as the adult advisory board in terms of giving them feedback on the methods and the tools that they were going to be using to collect their data as well as on the analysis of results and the presentation and sharing of the findings in their community so I'm going to share some slides now that came from a presentation that was actually created and developed by the youth that served that were part of the and they named themselves the Atlanta research coalition and so this is the young people that were involved in this and this presentation that they were invited to give at the Adolescent Medicine symposium at Shoah this this spring so they labeled their presentation Smith's education now through their review of the literature that was one of the things that we were trying to get them familiar with how they can find out information about a topic that they're interested in under their community so we gave them exposure to n training on how to conduct literature searches how to identify available publicly available data sets like the YRBS data and finding places where they can find statistics as well as use publicly available State Health databases to search health outcomes like STI rates teen birth and HIV they did a comparison of all the metro Atlanta counties and they through this process identified Fulton County as the place where they wanted to focus their needs assessment because they found that Fulton County experienced specially high teen birth rates as well as STI and HIV rates compared to the other counties for youth and those in those age ranges experiencing these events compared to the other counties in the metro area they were particularly surprised by the number of youth who are recently being diagnosed with HIV particularly in the southern US and specifically in Georgia they also then found through aides view that shows data on HIV rates by at the by age and by the county level in Georgia that Fulton County also disproportionately diagnoses more youth than other areas in the metro Atlanta area so they also began to think about what sexual health education resources are available in communities and they examined the sexual health education requirements for the state of Georgia to the extent possible they wanted to look in and see what the sexual education requirements were by county in the metro area they found that sexual education is legally required in Georgia however it is not required to be medically accurate culturally appropriate age-appropriate unbiased nor unfavorite of religion and when they uncovered this I can't tell you how upset they were and how it raised a lot of concern about the education that they were receiving in other areas in their school system so through this process based on their review of the public health literature in conversations that these findings stimulated them to have with members of their community as well as feedback from the adult board they felt that comprehensive sex education can indeed combat high teen pregnancy STD and HIV rates in Fulton County Georgia so they set out to conduct a community assessment to identify the sexual health education needs among adolescents aged 14 and 19 residing in Fulton County what they did was they they did everything they wanted to do a mixed-methods assessment because they determined that a combination of surveys and qualitative data collection would probably yield the best and most high-quality information they conducted seven key informant interviews with adolescent health specialists principals school board members and a state representative that represents Fulton County they conducted two focus groups with students in Fulton County and the PERT they predominantly focused on South Fulton County because some of the more granular data that they could ascertain on HIV rates we're showing that more diagnoses were being made in South Fulton than in North Fulton County they then also conducted a hundred and eleven surveys among high school students in Fulton County they did everything they created their tools they did the data collection they did it all within the span of four months so impressively what they found then the analysis part takes a little longer to put all this together but what they found in what they concluded when they triangulated use all their data pieces together that some prominent themes emerged they found that there were content gaps in what education was being offered to that to students in Fulton County they found that a lot of young people had no clue where they could go in their community to access sexual health services or even to get more information about sex education or more sex education they I don't know why the font thought really big there but they valued their they value this information they wanted to learn more about this information and they wanted to have it but they wanted the information to be of high quality and they felt like that the education that they were exposed to because a lot of them noted being exposed to sex education in school was not delivered with quality so they reported a lot of concern about the capability of their sex education instructor to actually be qualified to teach the topic they desired improvements a lot of improvements in the delivery of sex education in their school and they also noted that there were a lot of of perceived risk so that young people actually were concerned and felt like that they were at risk for for some of these health outcomes so there was some noting of perception of risk in their community among and we asked let's see they asked the extent to which they felt like they were at risk for unintended pregnancy STI HIV as well as dating violence and the numbers were high across all groups they also noted and a prominent theme of stigma they felt that that from multiple sources that they were hearing that the sex education that is delivered in Fulton County is stigmatizing it's particularly stigmatizing to the LGBTQ community and the students felt like that that this sort of made it so a lot of people tuned out because they felt like the message was not given appropriately so some key takeaways that they really focused in on where that adolescents are interested in sexual health and they want to learn more about this information so we should honor that wish and we should be able to create spaces where they can have access and be able to learn about their sexual health however they desired improvements for this this education and they wanted overall improvement in their sexual education that were being offered in school they also noted that less than fifty percent reported learning about gender identity community sexual health resources learning about partner communication about sex sexual orientation less than 50 percent learned about consent or dating violence and then like I noted the majority of students receive sexual health education that contains stigmatizing messages to minority sexual identity youth in their settings so they walked away and they provided some key recommendations the one and the first one is that a comprehensive medically accurate sex education curriculum that is inclusive of all identities and free of judgment should be implemented in Fulton County Schools and that teachers should be trained to follow this curriculum with fidelity and provide and they also wanted this to provide students and parents access to hands up handout and resources regarding where they could get sexual health care in their communities as well so I think it just beautifully shows that they fall very much in line from young people's perspective research done by young people who are not experts in this area who really don't follow closely sorry the CDC's recommendations but they came up and came upon this information and these conclusions based upon their own data with young people in the community and when I tell you what when you get a group of young people who feel empowered and passionate about a topic they were able to write a final report which they we shared back with picori and shared at several conferences they prepared an article for Vox ATL I think some Vox folks were here this morning they prepared an article and they put it on their website they were invited to speak and share their findings at a PTA meeting not in Fulton County but in Gwinnett County where there was a group of parents they used the same type of sex education curriculum and Gwinnett as in Fulton and when they heard that they had these findings suggesting for a change in the curriculum they were invited by this group to come share their findings to advocate for why young people want to have better indifferent sexual education they also gave that presentation that I just showed you their slides from at adolescent medicine symposium at Choa and they created an infographic to be shared with youth online and on social media so these are some of the individuals while they were doing the presentation at the symposium of the adolescent medicine symposium so on our side what the Emory team did we we talked about how we wanted to make sure that we we were hypothesizing that being going through this process would serve as sort of a positive youth enhancement for participants as well as in increase their trust in medical research so we asked young people to participate in a quantitative survey that was conducted before they started working with us on the Atlanta research youth research coalition and then we also conducted we did that pre and post and then we also did qualitative interviews with the each of the young members after they were done participating in our 18-month program and through the surveys we were able to assess and use the trust in medical research scale where higher scores indicate greater trust in medical research and then through the interviews we were able to ascertain the extent to which the experience increased positive youth outcomes so here are the qualitative findings first and we'll see and some that I want to highlight more specifically are in relationship to confidence so here we see that young the youth board members reported that they gain confidence talking to adults in conducting research and expression expressing their opinions and beliefs here's a quote that shows this example I feel like my confidence went up I learned how to communicate better and share my ideas I'm not afraid to share them now another area where we were excited to see growth was in the area of character youth board members expressed that their participation in this process informed how they will practice ethical research and treat others in their daily lives outside of the program so one individual stated I knew about ethics before but I never experienced like asking myself if what we're doing is ethical I guess it made me try to be more aware of other people's feelings and well-being of another area growth was in caring and youth board members empathized a lot with the adolescents who are not receiving adequate sexual health education and realized that this not only affected individuals but also their communities and one person wrote our noted I feel bad that adolescence education is being determined by someone else and that they're missing out on what I feel like everyone should be learning about because it's not just about sex but where you're learning about your body and then why it does certain things and how to keep yourself healthy and finally the area of contribution we also saw was developed in these young members and they noted things like that participating was rewarding because it allowed them to feel like they were effecting change in their community so they said the project opened my eyes to a lot of things that I didn't know was going on in the world today and I feel like that I can help other people in the future by us doing this project that can change the environment I feel like I can change the environment and importantly overall we saw overall just general sense of positive youth development from participants where youth board members were excited to be involved in the research process and felt empowered by their roles as key stakeholders driving the agenda they noted that the adult advisory board helped us instead of only letting us help them a lot of time kids only get to help adults do things this program gives me a voice in my opinion matters I think that's important especially at this stage in life and related to our findings from pre to post in terms of increases in trust in medical research we saw a significant increase in these young individuals trust in the medical research and the outcomes of that research after participating in the program so some conclusions and takeaways that we've had or that these findings suggest that a cbpr approach the one that we took with these young people had a strong positive impact on the youth that were involved and that the youth board experienced overall greater trust in medical research and positive changes in pretty much all aspects of positive youth development after participating in the a YRC program our findings highlight how meaningfully engaging youth and research can strengthen their own developmental assets of those participating but that they are also contributing then to meaningful changes in improving Adolescent Health and their communities and that when youth do this and they want to share their findings people want to listen so that's my presentation here are our wonderful team come some more photos of them in action so I'm happy to take questions [Applause] thanks dr. cells we're gonna go ahead and open up the forum for questions sure Mike Underwood can you guys see me Mike Underwood division of adolescent and school health um thanks both of you for your presentation they were really really interesting um Oh dr. cells I was really interested in the youth board and I can't recall now but I don't think we're any of the students from winnette so I found it interesting that Gannett was the one willing to listen to them what was the reaction from Fulton cob where the students came within they were able to identify a couple of opportunities to participate to share their finding but by the end of their program there were no more so what they're hoping now and they're still interested in being present but they submitted their their report to they're still trying to to to get the message out and still actively involved even though they haven't really been required to be involved um and sharing findings okay I have a question here Jo Valentine from the division of STD prevention and they you the presentations were really wonderful I'm sort of interested especially in this sort of notion about the declining and you know evidence of declining sexual practice sexual behavior among very high-risk populations we think of characteristically as high-risk populations and recently I had read an article that was I think in The Washington Post that talked about basically in the u.s. sexual behavior is declining and one of the striking categories where it was declining the most was among young men 18 to 29 and some like okay but the STD rates keep rising so something's going on here why if we're having less sex apparently we're having more unhealthy sex so I was thinking in terms of the issue of trying to design or think about what the prevention messages and intervention efforts should be in both of you can speak to this question given that you have less sexual behavior actually happening what then do we need to talk about in terms of the content of our messages because it won't make much sense to keep talking about condom use if people aren't even having sex and I think we're all getting to the realization that there's probably a lot of unhealthy sexual activity going on with the realization of more everything from the Boy Scouts to the Catholic Church and all this evidence of forced sex that's been happening for decades in our in our society we haven't ever really addressed so what does that mean what are our ethical obligations and in terms of designing programs that we we end up still sort of into focusing on that individuals risk behavior but I'm wondering how much resonance is that going to have with populations that apparently are having less sex so we've seen declines in sexual behavior we've seen declines in numbers of partners I don't think that translates into kids aren't having sex still 40% of all high school students have ever had sex and they're still a proportion who have had four or more partners and so I think that that we still have some ethical obligations to provide education for those youth are having sex I think the you know I think we've hit up against an ethical question around the do you focus on HIV STD prevention do you focus on pregnancy prevention they're not mutually exclusive necessarily and I we do we do promote kind of dual protection so both highly effective hormonal birth control as well as condom use but it's very difficult to get adolescents to use one method let alone two and so we we're at about 8% of dual use in YRBS data and that has stayed the same for the last number of cycles so I'm not sure how we promote how what we do to to promote that dual protection I think you know a little bit I do want to get back to something that came up in in doctor sales talk in that this idea that sex education is about promoting a method of HIV or STD or pregnancy prevention but a lot of what it's doing is is teaching youth about their bodies so I will say just for disclosure say that at one point I was doing some I was helping out in a Fulton County school who asked me to come really pretty much every semester and do the sex education portion of their health class because there was a lot of things that the teacher was restricted from saying that a guest speaker could come and say and so I did that for a number of years in one particular school in Fulton County and what I found was that I couldn't even get to prevention methods I couldn't get to some of those protective behaviors because I spent so much time just describing how bodies work and so I think you know from an ethical standpoint when we don't do that we can't even get to and in whether or not you're having sex you need to know you need that information and schools are really the last time we have everybody in one place where we can provide that before they move on to wherever they're gonna go from there so I think I don't know job this is I don't know that this is necessarily answering your question but I do think that you deserve to be taught basic information about how their bodies work and then from there to go on to what's going to happen if you don't take care of your body and here are the implications for that and then the other thing I think is that I think you know from what we heard youth are starting to figure out for themselves that adults are not always telling them what they need to know adults are not can't always be trusted to tell youth I'll give youth all of the information and that's really detrimental to relation to our relationships between youth and adults if they don't feel like they can rely on us to give them what they need then we're in trouble so I don't know if you yeah yes Kent I would completely agree with everything you just said and then also note that you know the the way in which sex education typically happens it's sort of a one-time event and in the one year of school for most individuals and that you're so rushed to get so much in when you especially when you realize that the the knowledge the basic knowledge which a lot of the curriculum is even built on hasn't even been built so you have to sort of start from even before to get them to a place to understand the curriculum that that sort of speaks to me that we should consider ways in which we can integrate this material in a regular basis and maybe an in different ways across as you know other sex education experts have been recommending for a long time to infuse this into a life course sort of approach to addressing sexual health that starts in kindergarten and ends in twelfth grade right never ends in our lives but also then it's um it's then making sure that where there are deficiencies or where we're placing a lot of importance on schools to deliver this when there might not be support to have the education be quality that we are also giving people access and and it's our ethical obligation to share where in the community they can engage this information and where they can find and turn to for resources when and if they determine that they need them when they become you know when they become relevant regardless of if that's now our in ten years from now so I think that's something we heard a lot from also that came out was as really strong interest of young people and that participate in this study was having their parents they really wanted also their parents to get some of this information because they actually felt really comfortable and they wanted to talk to their parents and they wanted their parents to be able to talk with them about it and so I think that's another element to where oftentimes thinking about how to it to engage and ethically engage families in these conversations as well because sometimes families are great spaces for some people but might not be safe spaces especially we know for sexual minority youth in terms of their conversations or questions about sex thank you okay we're right at time so I want to thank dr. sails and dr. Ethier again for their excellent presentations you

Leave a Reply

Your email address will not be published. Required fields are marked *