Emergency Contraception

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					Adolescent Reproductive
      Health Data
            Adolescent Reproductive Health Data


                                         Objectives
 By the end of this presentation,
  participants will be able to:
   Discuss trends in adolescent sexuality and
    reproductive health
   Characterize patterns in adolescent
    contraceptive use
   Assess study and data quality in response to
    “Practice-Based Learning and Improvement”
    core competency

                                                  PRCH 2009
          Adolescent Reproductive Health Data

                                     Adolescent
                                   Demographics

   Racial and ethnic diversity
   Prevalence of sexual minority youth
   Health insurance
   Home, education, and employment
    demographics



                                                PRCH 2009
Adolescent Reproductive Health Data

  The Growing Diversity of
the Adolescent Population




                                      PRCH 2009
            Adolescent Reproductive Health Data

             Prevalence of Gay, Lesbian,
                     and Bisexual Teens

 Data not readily available.

 Research indicates 2 - 4.5% of high school
  students self-identify as gay, lesbian, or
  bisexual

 Believed to be underestimates



                                                  PRCH 2009
Adolescent Reproductive Health Data

2007 Vermont Youth Risk
        Behavior Survey




                                              6
                                      PRCH 2009
                Adolescent Reproductive Health Data

              Sexual Orientation & Adolescents:
                Growing Up Today Study (97-03


                N=5700                                               N= 7750




                                                                                7
Corliss H, et al Arch Pediatr Adolesc Med. 2008;162(11):1071-1078.      PRCH 2009
                   Adolescent Reproductive Health Data

                       Sexual Orientation: MN HS
                                 Student Sample

                                                           Increase in
    35,000 12-18 yr olds surveyed in                      homosexual
              Minnesota:                                  attraction w/
                                                         increased age


                 1.1%: bisexual
    88.2%:                                                2.2% age 12;
                       or               10.7%:
predominantly                                             5.9% age 16;
                 predominantly         “unsure”
 heterosexual                                             6.4% age 18
                  homosexual




       Ramefedi GJ. Pediatrics 1992;89:714-721.                    PRCH 2009
         Adolescent Reproductive Health Data

                          Adolescents and
                                Insurance
 3 million adolescents (12%) ages
 12-17 lack health insurance
 8 million youths (28%) ages 18-
 24 are uninsured
  The risk of being uninsured
  doubles when a teen turns 19
                                               PRCH 2009
     Adolescent Reproductive Health Data

            US Children, Home
          Demographics: 2007
 33% live with families where no
  parent has full-time, year-round
  employment
 31% live in single-parent
  households
 18% live in poverty
 17% of 18-24 year olds live in
  poverty
                                           PRCH 2009
           Adolescent Reproductive Health Data

                                  Education and
                                   Employment
 In 2007, of U.S. 8th graders:
   30% scored below basic math level
   27% scored below basic reading level
   8% did not attend school and did not work
 In 2006, 15% of persons ages 18-24
      did not attend school,
      did not work, and
      had only a high school degree


                                                 PRCH 2009
Adolescent Reproductive Health Data

        Sexual Development
                and Activity




                                      PRCH 2009
    Adolescent Reproductive Health Data

     Teen Sexual Experience,
                  NSFG 2002
Percent of males and females ages 15-19
 who have ever had sexual intercourse




                                          PRCH 2009
   Adolescent Reproductive Health Data

   Percent of High School Students Who
      Have Ever Had Sexual Intercourse

2007 Youth Risk Behavior Survey




                                         PRCH 2009
    Adolescent Reproductive Health Data

   Percent of HS Students Who Have Had
     Sexual Intercourse, Race and Grade

               YRBS 2007




9th 10th 11th 12th                W       B   H
                                                  PRCH 2009
       Adolescent Reproductive Health Data

            Male Adolescents and
               Sexual Experience
Percentage of Young Men Who Have Had Intercourse,
                    NSFG 2002




                      Ages                          PRCH 2009
                       Adolescent Reproductive Health Data

                          Percent of Males and Females
                        Ages 15-19 Having Had Oral Sex
                                    NSFG 2002




*With partner of the opposite sex                            PRCH 2009
Adolescent Reproductive Health Data

Males Ages 15-19: Rates
 of Vaginal vs. Oral Sex
             NSFG 2002




                                      PRCH 2009
Adolescent Reproductive Health Data

Females Ages 15-19: Rates
   of Vaginal vs. Oral Sex




                                      PRCH 2009
               Adolescent Reproductive Health Data




                             NSFG 2002




*With a partner of the opposite sex                  PRCH 2009
Adolescent Reproductive Health Data




                                      PRCH 2009
    Adolescent Reproductive Health Data

          Contraceptive Use at
              Last Intercourse
                                     Other
               NSFG 2002
                                      7%

                                           No
                                          Method
                                           9%

                                             Condom
                                              Only
                          Dual Use             47%
                            30%



Female                                Male
                                                   PRCH 2009
  Adolescent Reproductive Health Data

     Female Contraceptive Use at
       1st Sex by Year of 1st Sex

2002 National Survey of Family Growth




                                        PRCH 2009
 Adolescent Reproductive Health Data

  Male Contraceptive Use at
  1st Sex by Year of 1st Sex
2002 National Survey of Family Growth




                                        PRCH 2009
          Adolescent Reproductive Health Data

                  Contraceptive Use at
                      Last Intercourse
                         YRBS 2007




*This data only reflects oral contraceptives and not rates of
injectable contraceptives use                                   PRCH 2009
    Adolescent Reproductive Health Data

             Condom Use at Last
                    Intercourse
2007 Youth Risk Behavior Survey




                                          PRCH 2009
Adolescent Reproductive Health Data

  Adolescent Pregnancy,
  Abortion, and STI Data




                                      PRCH 2009
                 Adolescent Reproductive Health Data

                              Epidemiology of
                       STIs and Young People
19 million new cases/
year
   • ½ occur in people
   ages15–24                                   New research: 1 in 4
   •Most                                       teen   has an STI
   asymptomatic and
   undiagnosed
                                              2006: 1/3 of new
                                              infections were among
        Economic                              people age 13-29
        costs ~ $6.5                          (may be as high as
        billion/year                          50%)
                                                             PRCH 2009
Adolescent Reproductive Health Data

  Chlamydia Rates, Ages
       15-19: 1996-2006




                                      PRCH 2009
Adolescent Reproductive Health Data

       Chlamydia: Age & Sex
             Specific, 2006
    Rate (per 100,000 population)




                                      PRCH 2009
Adolescent Reproductive Health Data

Disparities in Chlamydia
                   Rates




                                      PRCH 2009
Adolescent Reproductive Health Data

  Gonorrhea Rates, Ages
        15-19 1996-2006
      Rate (per 100,000 population)




                                      PRCH 2009
Adolescent Reproductive Health Data

          Gonorrhea: Age and
           Sex-Specific, 2006
       Rate (per 100,000 population)




                                       PRCH 2009
Adolescent Reproductive Health Data

         Syphilis: Age & Sex
        Specific Rates, 2006
       Rate (per 100,000 population)




                                       PRCH 2009
Adolescent Reproductive Health Data

          US Teen Pregnancy
               Rates Decline




                                      PRCH 2009
Adolescent Reproductive Health Data

Disparities in Pregnancy
                   Rates




                                      PRCH 2009
Adolescent Reproductive Health Data

                  Teen Pregnancy
                  Outcomes: 2004




      Rates per 1,000
                                      PRCH 2009
Adolescent Reproductive Health Data

       Pregnancy, Birth and
       Abortion, Ages 15-19
           Rate per 1000




                                      PRCH 2009
                                   Adolescent Reproductive Health Data

                                  Teen Pregnancy Outcomes,
                                             1990 and 2002
Rates per 1,000 women,
      ages 15-19




                         116.3




                             All Races       White           Black       Hispanic 2009
                                                                              PRCH
Adolescent Reproductive Health Data

       Abortion Rates, Ages
          15-19, 1989-2002




                                      PRCH 2009
Adolescent Reproductive Health Data

   Teen Pregnancy Rates
        Worldwide, 2000


                                      Per 1000




                                                 PRCH 2009
Adolescent Reproductive Health Data

Understanding the Data:
      Epidemiology 101



     Study Design
     Relative Risk
     Odds Ratio




                                      PRCH 2009
            Adolescent Reproductive Health Data


             Study Design: Randomized
                       Controlled Trial
 2 groups: a treatment and control group
   Treatment group receives the treatment under
    investigation
   Control group receives either no treatment or
    some standard default treatment
 Patients are randomly assigned to all
  groups


                                                  PRCH 2009
           Adolescent Reproductive Health Data

             Randomized Controlled
                             Trial

 Advantages              Disadvantages
   Reduces risk of bias
                             Study takes along
                               time to complete
    and increases the
    probability that
                             Researchers need to
                                       recruit 2 study
   differences between
                                       populations:
   groups can be
                                       treatment and
   attributed to the
                                       control
   treatment
                                      Costly


                                                         PRCH 2009
           Adolescent Reproductive Health Data


                                     Cohort Study


 Patients who presently have a certain
  condition and/or receive a particular
  treatment are followed over time and
  compared with another group who are not
  affected by the condition.




                                                 PRCH 2009
              Adolescent Reproductive Health Data


                                        Cohort Study

 Advantages                    Disadvantages
                                     Not as reliable
   More flexible re:
    ethical considerations           All variables not
   Valuable for studying
                                      controlled
    diseases that take               Can take a long
    years to manifest                   time—have to wait
                                        until conditions of
                                        interest develop


                                                      PRCH 2009
            Adolescent Reproductive Health Data


                                      Study Design

 Prospective Cohort Study
   Identifies the original population at the
    beginning of the study
   Accompanies subjects concurrently until
    disease develops or does not develop
 Retrospective Cohort Study
   Use historical data to telescope the frame of
    calendar time for the study and obtain their
    results sooner

                                                  PRCH 2009
            Adolescent Reproductive Health Data


                                      Study Design


 Case Control Studies
   Patients who already have a certain condition
    are compared with patients who do not
   Advantages                    
                            Disadvantages
     Can be done quickly              Less reliable
     Researchers do not               No control groups
      use special methods              Issues of association
                                      vs. causation


                                                         PRCH 2009
                Adolescent Reproductive Health Data


                                          Relative Risk
 Relative Risk =
   Risk of developing STI in exposed population
    Risk of developing STI in non-exposed population
                      Disease      Disease               Incidence
                      Develops     Does Not     Totals      Rates
                                   Develop
                                                         of Disease
       Exposed           a           b         a+b         __a__
                                                            a+b

       Not               c           d         c+d          __c__
       exposed                                              c+d

                                                               PRCH 2009
          Adolescent Reproductive Health Data

                     Relative Risk: What
                          Does It Mean?
 If RR = 1
   No evidence exists for any increased risk
    in exposed individuals or for any
    association of the disease with the
    exposure.
 If RR is greater than 1
   The risk in the exposed person is greater
    than the risk in the non-exposed person.
 If the RR is less than 1
   The risk in the exposed person is less than
    the risk in the non-exposed person.      PRCH 2009
            Adolescent Reproductive Health Data



                                       Odds Ratio
 Odds Ratio in a Cohort Study
   Probability that exposed person develops STI
    Probability that non-exposed person develops STI

            Develops                 Does Not
            Disease                 Develop Disease
 Exposed
                      a                      b
 Not
 Exposed              c                      d

                                                      PRCH 2009
           Adolescent Reproductive Health Data



                                      Odds Ratio
 Odds Ratio in a Case-Control Study
   Odds that a case was exposed
    Odds that a control was exposed
              Cases                Controls
          (With Disease)      (Without Disease)
History
of                   a                       b
Exposure

No History           c                       d
of
Exposure
                                                  PRCH 2009
           Adolescent Reproductive Health Data

              Odds Ratio: What Does
                           It Mean?

 If exposure is not related to the disease,
  the OR = 1.0
 If exposure is positively related to the
  disease, the OR > 1.0
 If exposure is negatively related to the
  disease, the OR < 1.0



                                                 PRCH 2009
           Adolescent Reproductive Health Data

               Condom Use: Relative
                Risk and Odds Ratio
 If condom users have = risk for STI as
  non-condom users, the RR or OR = 1
 If the RR and OR < 1.0 -> association is
  “protective”
   Condom users had a lower risk of STIs
 If the RR or OR >1.0 -> “harmful” effect
   Condom users had a higher risk of STI than
    non-users

                                                 PRCH 2009
           Adolescent Reproductive Health Data


            Statistical Significance
 Refers to the likelihood that the observed
  associations were due to chance alone.
 Tests of significance are often reported
  using p-values or confidence intervals.
 A p-value of 0.05 is often used as a cutoff
  point for statistical significance.
 A p-value of less than 0.05 means that the
  likelihood that the observed association is
  due to chance alone is less than 5%.
                                                 PRCH 2009
           Adolescent Reproductive Health Data


            Confidence Interval (CI)

 Quantifies the uncertainty in measurement
 Usually reported as 95% CI
    Range of values within in which we can be
     95% sure that the true value for the whole
     population lies
 Consists of values of the RR or OR consistent
  with the data a particular level of confidence
 Interval that includes 1.0 is not statistically
  significant - it is consistent with an RR=1.0 (no
  effect)
                                                 PRCH 2009
Adolescent Reproductive Health Data

                 Please Complete
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                                      PRCH 2009

				
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