1. Adolescent STD Prevention: Assembling the Pieces into Practical Approaches to Prevention
Lisa M. Henry-Reid, MD
Chair, Division of Adolescent and Young Adult Medicine
Department of Pediatrics, Stroger Hospital

2. & Normal Adolescent Development Peer Influence
Parental Involvement
Brain Development
& Normal Adolescent Development
Peer Influence
Knowledge deficits
RISK OF STIs
Access to Caring and Available Care
Mental health/substance use
Early Pubertal Onset
Non-Consensual Sex
Media
Abstinence Only

3. Recent STI Risk Indicators
Over 1 million cases of reported CT infections
5.6% increase from 2005
Teen birth rate – first increase since 1991
3% increase among years
4% increase among years
5% AA
4% American Indians
3% Whites
2% Hispanics
Approximately 50% all STIs in year olds

4. HIV Estimated 40-45,000 new HIV infections in 2005 Sexually active
13.8% ages 15-24
Sexually active
Inconsistent condom use
Older age partners
Lack of Confidential and
Affordable Health Care
Lack of Education
Myth of Invulnerability
Fear of disclosure

5. Percentage of High School Students Who Were Tested for HIV infection, by Sex* and Race/Ethnicity,** 2005
Nationwide in 2005, 11.9% of high school students had been tested for human immunodeficiency virus (HIV) infection. Overall, the prevalence of HIV testing was higher among female than male students and higher among black than white and Hispanic students.
* F > M ** B > W, H
National Youth Risk Behavior Survey, 2005

6. Percentage of High School Students Who Were Currently Sexually Active,
Percentage of High School Students Who Were Currently Sexually Active,* by Sex and Race/Ethnicity,** 2005
46.8% have ever had sex
Median age first intercourse 16.5, but in Mathmatica study of several abstinence only programs targeting late elementary and middle school students, those who became sexually active made their debut at a mean age of 14.9 years
Nationwide in 2005, 33.9% of high school students had had sexual intercourse with one or more persons during the three months preceding the survey (i.e., currently sexually active). Overall, the prevalence of being currently sexually active was higher among black than white and Hispanic students.
* Had sexual intercourse with ≥ 1 persons during the 3 months preceding the survey
** B > W, H
National Youth Risk Behavior Survey, 2005

7. Percentage of High School Students Who Used a Condom During Last Sexual Intercourse,* by Sex** and Race/Ethnicity,*** 2005
Among the 33.9% of high school students nationwide in 2005 who had had sexual intercourse with one or more persons during the 3 months preceding the survey, 62.8% reported that either they or their partner had used a condom during last sexual intercourse. Overall, the prevalence of having used a condom during last sexual intercourse was higher among male than female students, higher among black than white and Hispanic students, and higher among white than Hispanic students.
* Among the 33.9% of students nationwide who had sexual intercourse with one or more persons during the 3 months preceding the survey
** M > F *** B > W > H
National Youth Risk Behavior Survey, 2005

8. & Normal Adolescent Development Peer Influence
Parental Involvement
Brain Development
& Normal Adolescent Development
Peer Influence
Knowledge deficits
RISK OF STIs
Access to Caring and Available Care
Mental health/substance use
Knowledge deficits occur when parents, medical providers, school health education counselors fail to provide honest and accurate information about STIs and the risk factors associated with their acquisition and teens piece together a tapestry with lots of holes from information garnered from their peers, the media, or adults who espouse their opinion(s) as fact(s)
from not knowing signs and symptoms of STIs or that oral sex and anal sex place one in harm’s way of acquiring STIs, to not having discussions about reproductive health with teens who have physical/developmental disabilities or chronic medical conditions, to assuming sexuality by asking a male if he has a girlfriend or a girl whether she has a boyfriend.
Early Pubertal Onset
Non-Consensual Sex
Media
Abstinence Only

9. Percentage of High School Students Who Drank Alcohol or Used Drugs Before Last Sexual Intercourse,* by Sex** and Race/Ethnicity,*** 2005
Among the 33.9% of high school students nationwide in 2005 who had had sexual intercourse with one or more persons during the three months preceding the survey, 23.3% had drunk alcohol or used drugs before last sexual intercourse. Overall, the prevalence of having drunk alcohol or used drugs before last sexual intercourse was higher among male than female students and higher among white and Hispanic than black students.
* Among the 33.9% of students nationwide who had sexual intercourse with one or more persons during the three months preceding the survey
** M > F *** W, H > B
National Youth Risk Behavior Survey, 2005

10. Percentage of High School Students Who Reported Current Alcohol Use,
Percentage of High School Students Who Reported Current Alcohol Use,* by Sex and Race/Ethnicity,** 2005
Nationwide in 2005, 43.3% of high school students had had at least one drink of alcohol on one or more of the 30 days preceding the survey (i.e., current alcohol use). Overall, the prevalence of current alcohol use was higher among white and Hispanic than black students.
* Had at least one drink of alcohol on  1 of the 30 days preceding the survey
** W, H > B
National Youth Risk Behavior Survey, 2005

11. Percentage of High School Students Who Felt Sad or Hopeless,. by Sex
Percentage of High School Students Who Felt Sad or Hopeless,* by Sex** and Race/Ethnicity,*** 2005
During the 12 months preceding the survey, 28.5% of high school students nationwide in 2005 had felt so sad or hopeless almost every day for two or more weeks in a row that they stopped doing some usual activities. Overall, the prevalence of having felt sad or hopeless almost every day for at least two weeks was higher among female than male students, and higher among Hispanic than white and black students.
* Almost every day for > 2 weeks in a row that they stopped doing some usual activities during the 12 months preceding the survey
** F > M
*** H > W, B
National Youth Risk Behavior Survey, 2005

12. Early Female Pubertal Onset
Onset Puberty
Onset Menarche
High School
“Adult” Brain Development
7 years
9 years
15 years
21-25 years
11 years
13 years

13. & Normal Adolescent Development Peer Influence
Parental Involvement
Brain Development
& Normal Adolescent Development
Peer Influence
Knowledge deficits
RISK OF STIs
Access to Caring and Available Care
Mental health/substance use
Early Pubertal Onset
Non-Consensual Sex
Media
Abstinence Only

14. Adolescent Issues “I’m invincible” “I don’t know where to go”
Access to Care (Legal and policy issues)
“I don’t know how to talk with my partner”
“I read that condoms don’t really protect you”
“I’m not sexually active…I just have sex”
“I just don’t want my parent(s) to know”
“But my friends say it’s okay”
“I wanted the benefits”
Need to assure health care for youth
Need to educate parents…let parents talk
Peers can be an ally if they aren’t having sex

15. STI Prevention
Part of brain youth need most to develop good judgment and decision making develops last
Knowledge + Practice
Employ the mantra = Educate & remediate
Connecting behavior(s) to the present, not the future
More focus on males

16. Some of our STI Prevention Strategies
Bringing STI/HIV information and testing into the community
Parent-Peer Educator program
Education for Middle School populations
Incorporating Role-Plays into health education
“Miller Time”
“Home Alone”
“Parent Trap”
Team approach
Frequent visits

17. STI Prevention Focus on ALL adolescents
High risk Low Risk
Imperative to understand adolescent culture
Adult models aren’t portable to youth
Abstinence Only
No evidence of successful long term effects
Informed decision-making requires providing comprehensive information
Small changes in behavior can make a difference

18. The Climb to Safer Sexual Activity
Acceptance of sexual identities
The Climb to Safer Sexual Activity
Early identification of mental/psychosocial health issues
Involved Adults
Self Esteem
Informed Decision-making
Policies that “embrace” youth
After school programs, job opportunities, vocational training programs…things to give young people a future orientation that has promise of success, tougher laws on adults having sex with minors.
“Emotions Rule” – must be factored into the intervention
Available, Confidential Health Care

19. STI Prevention
Let’s S “State”
T “Teens”
ARE
I “Important”