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The Impact of Condom Distribution Programs on Teen Chlamydia and Gonorrhea Rates in Philadelphia, 2010-2014 Anjani Parikh, MPH Centers for Disease Control.

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Presentation on theme: "The Impact of Condom Distribution Programs on Teen Chlamydia and Gonorrhea Rates in Philadelphia, 2010-2014 Anjani Parikh, MPH Centers for Disease Control."— Presentation transcript:

1 The Impact of Condom Distribution Programs on Teen Chlamydia and Gonorrhea Rates in Philadelphia, 2010-2014 Anjani Parikh, MPH Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support Nicole Zaleski, MA, MPH Public Health Associate Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention 2015 Class PHAP Summer Seminar May 16, 2016 Public Health Associate Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention

2 BACKGROUND & SIGNIFICANCE

3 Background & Significance  In 2010, chlamydia (CT) and gonorrhea (GC) rates among Philadelphia teens (15-19 years old) were 3 and 3.5 times the national average, respectively  Condom distribution interventions that increase availability and accessibility are effective in increasing condom use and reducing the incidence of sexually transmitted infections (STIs)  More effective when combined with other community-level interventions Philadelphia Department of Public Health, 2011; Charania et al., 2011; CDC, 2015.

4 Programming  2003 – Philadelphia High School Sexually Transmitted Disease (STD) Screening and Education Program is launched  Chlamydia/gonorrhea education and screening implemented in all public high schools in partnership with Philadelphia School District  Condoms distributed during educational presentations (starting 2007)  2011 – “Take Control Philly” initiative launched  Condom mailing program targeting teens  Adolescents ages 13-19 can order free condoms online  Social media presence and community events  2013 – Condom dispensers installed in high schools  Free condoms available in all public high schools and some charter and alternative schools through nurse’s offices and health resource centers

5 RESEARCH QUESTIONS & METHODS

6 Research Questions  What impact has condom distribution had on teen chlamydia and gonorrhea rates in Philadelphia?  What geographic differences exist within the city?  47 zip codes served by Philadelphia Department of Public Health  Chlamydia/gonorrhea rates  Condom distribution rates  Has condom distribution programming targeted high morbidity zip codes of the city?  What zip codes in Philadelphia require further intervention?

7 Methods  Calculated rates of teen chlamydia/gonorrhea by zip code for years 2010-2014  Rate = number of cases/1,000 teens  Calculated rates of condom distribution by zip code for years 2011-2014, individually and cumulatively  Rate = number of condoms/1,000 teens  Calculated percent change in chlamydia/gonorrhea rates between 2010 and 2014  Used ArcGIS© to map chlamydia/gonorrhea rates, condom distribution rates, and percent change by zip code  Visual comparison of maps to identify trends

8 RESULTS

9 2010 (Baseline) CT/GC Rates by Philadelphia Zip Code (191XX) Philadelphia Department of Public Health (2016); U.S. Census Bureau (2010) 0 – 20 cases 21 – 40 cases 41 – 75 cases 76 – 100 cases 101+ cases LEGEND Rate = CT/GC cases/1,000 teens

10 2011 CT/GC Rates and Condom Distribution Rates by Philadelphia Zip Code Philadelphia Department of Public Health (2016); U.S. Census Bureau (2010) 0 – 20 cases 21 – 40 cases 41 – 75 cases 76 – 100 cases 101+ cases LEGEND Rate = CT/GC cases/1,000 teens 0 – 250 condoms 251 – 500 condoms 501 – 750 condoms 751 – 1000 condoms 1,001+ condoms LEGEND Rate = Number of condoms distributed/1,000 teens 2011 CT/GC Rates 2011 Condom Distribution Rates

11 2012 CT/GC Rates and Condom Distribution Rates by Philadelphia Zip Code Philadelphia Department of Public Health (2016); U.S. Census Bureau (2010) 0 – 20 cases 21 – 40 cases 41 – 75 cases 76 – 100 cases 101+ cases LEGEND 0 – 250 condoms 251 – 500 condoms 501 – 750 condoms 751 – 1000 condoms 1,001+ condoms LEGEND 2012 CT/GC Rates 2012 Condom Distribution Rates Rate = CT/GC cases/1,000 teens Rate = Number of condoms distributed/1,000 teens

12 2013 CT/GC Rates and Condom Distribution Rates by Philadelphia Zip Code Philadelphia Department of Public Health (2016); U.S. Census Bureau (2010) 0 – 20 cases 21 – 40 cases 41 – 75 cases 76 – 100 cases 101+ cases LEGEND 0 – 250 condoms 251 – 500 condoms 501 – 750 condoms 751 – 1000 condoms 1,001+ condoms LEGEND 2013 CT/GC Rates 2013 Condom Distribution Rates Rate = CT/GC cases/1,000 teens Rate = Number of condoms distributed/1,000 teens

13 2014 CT/GC Rates and Condom Distribution by Philadelphia Zip Code Philadelphia Department of Public Health (2016); U.S. Census Bureau (2010) 0 – 20 cases 21 – 40 cases 41 – 75 cases 76 – 100 cases 101+ cases LEGEND 0 – 250 condoms 251 – 500 condoms 501 – 750 condoms 751 – 1000 condoms 1,001+ condoms LEGEND 2014 CT/GC Rates 2014 Condom Distribution Rates Rate = CT/GC cases/1,000 teens Rate = Number of condoms distributed/1,000 teens

14 2010 and 2014 CT/GC Rates by Philadelphia Zip Code Philadelphia Department of Public Health (2016); U.S. Census Bureau (2010) 2014 CT/GC Rates2010 CT/GC Rates 0 – 20 cases 21 – 40 cases 41 – 75 cases 76 – 100 cases 101+ cases LEGEND Rate = CT/GC cases/1,000 teens 0 – 20 cases 21 – 40 cases 41 – 75 cases 76 – 100 cases 101+ cases LEGEND Rate = CT/GC cases/1,000 teens

15 Percent Change of CT/GC Rates and Cumulative Condom Distribution Rates by Philadelphia Zip Code Philadelphia Department of Public Health (2016); U.S. Census Bureau (2010) Percent Change in CT/GC Rates 2010-2014 Cumulative Condom Distribution Rates 2011-2014 -56.25% – -30.00% -29.99% – -25.00% -24.99% – -5.00% -4.99% – 5.00% 5.01% – 84.21% LEGEND Percent change = CT/GC rate increase/decrease in zip between 2010 - 2014 0 – 1000 condoms 1001 – 2000 condoms 2001 – 3000 condoms 3001 – 4000 condoms 4,001+ condoms Rate = Cumulative total of condoms distributed/1,000 teens in zip from 2011 - 2014 LEGEND

16 Percent Change of CT/GC Rates Philadelphia Department of Public Health (2016); U.S. Census Bureau (2010) Percent Change in CT/GC Rates 2010-2014 RegionZip Code 2010 Rate 2014 Rate PCT Change Condom Rate NW1912955.835.6-36.2%4514.0 19132193.3131.9-31.8%4092.1 19140147.7110.0-25.5%4616.0 19141142.481.5-42.8%8492.5 NE1911144.029.3-33.5%4121.2 191169.34.4-52.9%5940.8 SE1914843.218.9-56.3%7400.5 Annual Rate = # cases/1000 teens Condom Rate = # condoms distributed/ 1000 teens, cumulative 2011 - 2014 Zip code-specific impact of condom distribution on CT/GC rates -56.25% – -30.00% -29.99% – -25.00% -24.99% – -5.00% -4.99% – 5.00% 5.01% – 84.21% LEGEND Percent change = CT/GC rate increase/decrease in zip between 2010 - 2014

17 Results  Philadelphia saw a 26.4% citywide decrease in the teen chlamydia/gonorrhea rate between 2010 and 2014  Rate changes within zip codes ranged from a 56.2% decrease to a 84.2% increase Increases occurred in less populated zip codes with small numbers of baseline cases  Visual comparison of maps reveals that chlamydia/gonorrhea rate decreases occurred in zip codes with high condom distribution (Northwest, Northeast, and Southeast)  Condom distribution efforts target high morbidity areas  More intervention needed in Southwest and North

18 DISCUSSION & IMPLICATIONS

19 Discussion & Implications  The STD Control Program at the Philadelphia Department of Public Health (PDPH) is making an impact on teen chlamydia and gonorrhea rates and we are part of it!  Programming links teens with PDPH services and resources High school program educates ~30,000 Philadelphia teens annually about STI prevention, risk reduction, and PDPH condom mailing service High school program identifies and treats hundreds of teen chlamydia and gonorrhea cases annually  Our contribution  This project helps demonstrate the impact of condom distribution programs and identify areas where further intervention is needed  We support condom distribution, STI screening, and education through our involvement with the high school program  We identified and addressed the language barrier among ESOL students by creating a one-pager that is translated into 8 languages

20 References Centers for Disease Control & Prevention. (2015). Condom Distribution as a Structural Level Intervention. http://www.cdc.gov/hiv/programresources/guidance/condoms/index.html. http://www.cdc.gov/hiv/programresources/guidance/condoms/index.html Charania, M.R., Crepaz, N., Guenther-Gray, C., Henny, K., Liau, A., Willis, L.A., Lyles, C.M. (2011). Efficacy of Structural-Level Condom Distribution Interventions: A Meta- Analysis of U.S. and International Studies, 1998-2007. AIDS and Behavior, 15(7), 1283- 1297. DOI: 10.1007/s10461-010-9812-y. Philadelphia Department of Public Health. (2011). Philadelphia Youth in Crisis. http://www.phila.gov/health/pdfs/Adolescents%20and%20STIs.pdf. http://www.phila.gov/health/pdfs/Adolescents%20and%20STIs.pdf Philadelphia Department of Public Health. (2016). STD Control Program Surveillance Data. United States Census Bureau. (2010). 2010 U.S. Census Data. http://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml. http://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml

21 For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://www.cdc.gov/stltpublichealth The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Special Thanks to PDPH STD Control Program staff! Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support Robbie Madera, MPH STD Epidemiologist STD Control Program Philadelphia Department of Public Health Greta Anschuetz, MPH Assistant Program Manager/Screening & Surveillance STD Control Program Philadelphia Department of Public Health

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