Presentation on theme: "Public Health Reports Webinar on Understanding Sexual Health: Overview March 12, 2013 1:00 PM - 2:00 PM EDT."— Presentation transcript:
Public Health Reports Webinar on Understanding Sexual Health: Overview March 12, 2013 1:00 PM - 2:00 PM EDT
Mary Beth Bigley, Dr.P.H., M.S.N., A.N.P. Acting Editor, Public Health Reports Office of the Surgeon General Public Health Reports Webinar on Understanding Sexual Health: Overview
John M. Douglas, Jr, M.D.. Chief Medical Officer National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention Public Health Reports Webinar on Understanding Sexual Health: Overview
Sexual Health: Surgeon Generals Call to Action Focused on the need to promote sexual health and responsible sexual behavior across the lifespan – Essential component of overall individual health – Has major impact on overall health of communities – National dialogue at all levels critical in improving population health Primary goal to stimulate respectful, thoughtful, and mature discussion in our communities and in our home about sexuality.
Sexual Health in the U.S.: Why Now? High population burden of adverse outcomes related to sexual behavior – HIV/STD Estimated 1.1 million living with HIV, 50,000 new infections/year 19.7 million STI each yearalmost half among persons 15-24 25% adolescent F infected with at least one STD – Unintended/teen pregnancy Nearly 50% of all pregnancies in the U.S. are unintended U.S. with one of highest teen birth rates of industrialized nations – Sexual violence Annual estimates: 1. 3 million F raped, 6.7 m F and 6 m M with other sexual violence victimization Health equity/ disparities concern – African–Americans: HIV rates 8 to 20x Whites – MSM: 40-50x higher HIV rates than other males High economic burdenestimated annual costs – STD/HIV: $17 billion – Teen childbearing: $11 billion – Rape/other sexual assault$12 billion
What is Sexual Health? WHO definition (2006) – state of physical, emotional, mental, and social well-being related to sexuality – not merely absence of disease, dysfunction, or infirmity. – requires a positive and respectful approach to sexual relationships, as well as possibility of having pleasurable & safe sexual experiences, free of coercion, discrimination, and violence. – for sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled.
CDC/HRSA Advisory Committee Definition of Sexual Health: A Public Health Perspective Sexual health is a state of wellbeing in relation to sexuality across the lifespan that involves physical, emotional, mental, social, and spiritual dimensions. Sexual health is an inextricable element of human health and is based on a positive, equitable, and respectful approach to sexuality, relationships, and reproduction, that is free of coercion, fear, discrimination, stigma, shame, and violence. It includes the ability to understand the benefits, risks, and responsibilities of sexual behavior; the prevention of disease and other adverse outcomes; and the possibility of fulfilling sexual relationships. Sexual health is impacted by socioeconomic and cultural contexts–including policies, practices, and services–that support healthy outcomes for individuals, families, and their communities. Recommended by the CDC-HRSA Advisory Committee on HIV, STD, and Viral Hepatitis Prevention and Treatment, May 2012 (CHAC Minutes: http://www.cdc.gov/maso/facm/pdfs/CHACHSPT/20120508_CHAC.pdf) http://www.cdc.gov/maso/facm/pdfs/CHACHSPT/20120508_CHAC.pdf Douglas JM, Fenton K. Understanding sexual health and its role in more effective prevention programs. Public Health Reports 2013
Addressing Sexual Health Over past decade, increasing attention to addressing the concept of sexual health Public health premise: sexual health promotion – great potential to complement traditional disease control and prevention efforts for a range of conditions (eg, HIV, STD, viral hepatitis, unintended pregnancy, sexual violence) – not to replace traditional efforts but to improve their acceptance and population impact Douglas JM, Fenton K. Understanding sexual health and its role in more effective prevention programs. Public Health Reports 2013
Sexual Health Framework: Emphasizing Health Promotion to Enhance Disease Control and Prevention Potential Benefits Engage new and diverse partners Normalize conversations Reduce stigma, fear, and discrimination Enhance the efficiency and effectiveness of prevention messaging and services Ivankovich et al. Considerations for national public health leadership in advancing sexual health. Public Health Reports 2013
Sexual Health: A National Priority 2010National HIV/AIDS Strategy Provides an opportunity for working together to advance a public health approach to sexual health that includes HIV prevention as one component 2011Healthy People 2020 Reproductive and Sexual Health is a leading health indicator 2011National Prevention Strategy Vision: Working together to improve health and quality of life by moving from a focus on sickness and disease to one based on prevention & wellness Reproductive and Sexual Health is one of seven priority areas
Public Health Reports Supplement on Sexual Health Priority topics – Research – Surveillance – Program – Perspectives
Research – Susan Kirby: Beginning a conversation on sexual health Programs – Robert Nystrom: Shifting the paradigm in Oregon from teen pregnancy prevention to youth sexual health Perspectives – Edward Hook: Sexual health educationframe-shifting and its challenges Public Health Reports Supplement on Sexual Health
Public Health Reports Meet the Author! Live Webcast A Communication Framework for Sexual Health Susan D. Kirby, Dr.PH, MPH President, Kirby Marketing Solutions
Finding Common Communication Ground CDC recognizes the need to work with a wide variety of partners who hold differing viewpoints Communicating about sexual health may be difficult when you dont share same values Communication is important and we need everyone to participate in the conversation Finding common communication ground is a starting place …
Mental maps we use to navigate the world We fit new information into our frames We typically reject information that doesnt fit our frame, not the frame Understanding is frame- based, not fact-based Effective communication can reframe understanding A set of beliefs and values developed over a lifetime of experiences
Robert Wood Johnson Foundations Social Determinants Research Democrats Frame Complex, interdependent social systems influence the health of people Republicans Frame Life and health are journeys through unpredictable paths People need opportunity to make good choices Your opportunity for health starts long before you need medical care. Health startslong before illnessin our homes, schools and jobs.
Methodology Environmental scan Media Frame development Diverse external and internal stakeholders Developed 4 frames, 30 messages Interviews 26 diverse community and health professionals Revised messages Online surveys 240 public 70 health professionals
Four Frames & Example Messages 1.Navigating a Journey/Choices Life is a series of choices, including sexual choices. Throughout their lives, all people need information and skills to make healthy sexual choices that reflect their own values and deeply held beliefs. 2.Health Promotion/Wellness Living a healthy lifestyle is important to good health, and this includes sexual health, too. Its time we focused on promoting and encouraging the behaviors that improve the emotional, social, spiritual, and physical aspects of sexuality. 3.Working Together As a society, we have the responsibility to help all Americans make healthy sexual choices. 4.Fair Chance/Fair Opportunity All people need to have a fair chance to make informed choices about their sexual health.
Focus on Framing Results Most accepted frames by general public and professional respondents 46%
Making Messages Fit a Shared Frame Journey/Choices Frame Messages Public: Throughout life, we all make choices, including sexual choices. Along the way, all of us need the information, knowledge, and skills that will help us make sexual choices that protect us from the risks and dangers of unhealthy sexual activity. All Professionals: Throughout life, we all make choices, including sexual choices. Along the way, Americans need the information, knowledge, and skills that will help them make sexual choices that protect their health and future partners. Wellness Frame Messages Moderates, Conservatives, Professionals Liberals Visit the article at Public Health Reports for the full message set on p.50Public Health Reports
Whats Next? Findings developed in a positive direction, but theres more we need to know Needs replication in more contexts and in more real life campaigns The field needs to know more about how specific health or social issues interact with frame preferences We need to understand how to use framing to build broad consensus movements
Shifting the Paradigm in Oregon from Teen Pregnancy Prevention to Youth Sexual Health Robert Nystrom Section Manager Adolescent, Genetics & Reproductive Health Oregon Public Health Division Public Health Reports Meet the Author! Live Webcast
History Oregon Youth Sexual Health Plan 3rd decade of plans 1994-2002 Policy & systems Minor consent Sexuality education School-Based Health Centers Governors directive 2005 Oregon Youth Sexual Health Partnership Plan released in 2009
Community Survey Youth Action Research Plan Development Community Forums Literature Reviews Use of Data
Youth Action Research Schools or Youth Serving Organizations Community Seed Grants State & Local Public Health Adult mentors and coaches Evaluation expertise Data gathering & analysis Communications Inform Community Policy Change Youth Action Research Team
Five Overarching Goals Youth use accurate information and well developed skills to make thoughtful choices about relationships Sexual health inequities are eliminated Rates of unintended teen pregnancy are reduced Rates of sexually transmitted infection are reduced Non-consensual sexual behaviors are reduced
1.Infrastructure 2.Policy 3.Health Inequities 4.Youth Development 5.Education for Youth and Families 6.Services for Youth and Families 7.Data 8.Assurances Objectives
Accomplishments - Outputs Expansion of clinical services Revised/strengthened K-12 comprehensive sexuality education statute Teacher training on LGBTQ inclusiveness AMCHP/ASTHO learning collaborative Research series on sexual health of disenfranchised youth Implemented/expanded community interventions & programs program
Authentic youth & community engagement - Data & Science Review OYSHP - Effective public & private sector partnerships Evidence- based policy, programs & strategies State & local coordination Community- driven priorities Healthy Youth Making it work for Oregons youth…
Implications - Going Forward National Oregons experience serves as a model for other states to shift from a risk-problem focused framework to a more PYD framework that promotes sexual health Importance of authentic community & youth engagement and interest-based problem solving Oregon Evaluating plans early efforts Expand state capacity to use Youth Action Research (YAR) or to apply it to other public health topics Expand focus on addressing disparities & inclusiveness
Sexual Health Education: Frame Shifting and Its Challenges Edward W. Hook III M.D. Professor of Medicine, Epidemiology, and Microbiology University of Alabama at Birmingham, Alabama/North Carolina STD/HIV Prevention Training Center And Jefferson County Department of Health Birmingham Alabama Public Health Reports Meet the Author! Live Webcast
Historical Partners in U.S. STD Prevention American Society for Sanitary and Moral Prophylaxis (1905) – (Coalition of physicians, social hygienists, charity groups, moral reformer churches) American Social Hygiene Association (1913) Armed Forces U.S. Public Health Services Brandt, AM. No Magic Bullet, Oxford Univ Press, 1985.
Conventional Wisdom Regarding STIs STIs are the result of inappropriate behavior People with STIs will know they have them Efforts to control STIs should focus on women Sex (and STIs) is not an appropriate topic for conversation
Consequences of STI-Related Stigma Personal (Individual) Delays in using or seeking preventative health care Condoms Vaccines Screening Delays in seeking care for perceived problems Ineffective partner notification Provider Hesitancy in seeking relevant information Differential testing Changes to provider-client interactions Population Guilt by association Differential Care Profiling
Framing – influenced by context; anticipated to have selective influence on perception, encouraging certain interpretation, discouragement, others (Wikipedia) A sexual health framework shifts the approach from a more traditional loss frame approach to a gain frame Gain frame – Emphasizes positives, benefits Loss frame – Emphasizes risks, potential harm, potentially fueling shame and stigma
Self-Reflective Questions on Sexual Health 1.Have you ever hesitated to take a sexual history? 2.Have you ever hesitated to test for STIs because you worry that a client may find it troublesome or insulting? 3.Have you ever apologized for making a STI diagnosis?
Loss Frame/Gain Frame Examples Sexual History Loss Frame Partner Type Have you ever had homosexual sex? Sites of exposure Have you had oral or rectal sex, or just regular sex? Gain Frame Partner Type Are your partners men, women or both? Sites of exposure When you have sex, what sites are exposed- oral, rectal or genital?
Health Education Opportunities Derived From a Sexual Health Approach Patients (Empowering) Life Course Perspective Reduces Consequences of Perceived Stigma Broadly Encourages Preventative Health Care (Women AND Men) Vaccines Screening Providers (Permissive) Life Course Perspective Reduces Consequences of Perceived Stigma Efficiency- Addresses Existing Redundancy