1. Using Qualitative Data to Contextualize Chlamydia and Birth Rates Joyce Lisbin EdD, Anna Groskin MHS, Rhonda Kropp RN MPH, Virginia Loo ABD, Julie Lifshay MPH, Gail Bolan MD STD Control Branch, CA DHS

2. Need for Qualitative Data Case-based disease surveillance system –provides overview of disease trends –identifies emerging problems in specific geographic areas and demographic groups Qualitative data –places disease trends within a social and behavioral context –provides opportunity to engage community in defining the problem and solution –allows for community-specific understanding and action –provides data not available in case reports (behavioral and attitudinal)

3. Background High chlamydia (CT) and birth rates among females ages 15-19 in California, 1994-98 Alameda County has some of the highest rates in the state among youth 15-19 yrs. old: - Birth rate: 4080/100,000 (1998) - CT rate: 2,941.4/100,000 (1998)

4. Purpose To explore potential factors contributing to high rates of CT and births: Community Norms –relationships (formation, number, expectations) –acceptable sexual behaviors Community Resources –supportive adult relationships –health care access

5. Purpose II  Individual attitudes, behaviors, and knowledge: – Experiencing or contributing to a pregnancy – Contracting an STD – Sexual behaviors and relationships – Gender specific roles and acceptable behavior – Knowledge of chlamydia symptoms, complications, treatment and reinfection risks – Contraceptive practice

6. Methods Identify 2 areas for project implementation using zip-code level analysis Partner with 2 local clinics: located within targeted zip codes staff commitment to participate in data collection and client-driven intervention Conduct 11 focus groups: 6 female, 3 male, 2 co-ed conducted a guided discussion for consistency administered quantitative questionnaires incorporated information on sexual health

7. Methods II Participant Characteristics: convenience sample age 15-19, resident of Alameda Co. recruited through clinic, friend, flier and staff referral Analysis of Data: AnSWR qualitative software Link focus group data to quantitative data from survey

8. Progress Partnered with local family planning clinic Met with clinic staff Completed 6 focus groups with 34 teens Beginning data analysis with AnSWR Meeting with staff to disseminate findings Negotiating with second clinic and area high school

9. Preliminary Results Community Norms Future-oriented youth Sexual violence Community Resources Communication with parents Influence of Church Individual Attitudes, Behavior and Knowledge Lack of knowledge about CT and treatment Attitudes on abortion, oral sex, STDs and pregnancy Relationships and gender differences Condom-use

10. Plans for Utilizing Results Using epidemiological and contextual data, young adults will design and implement intervention to: Increase awareness about STDs and associate risks Increase healthy behaviors and use of barrier contraceptives Improve communication and decision making skills Increase health care seeking behaviors

11. Qualitative results will strengthen surveillance and prevention efforts by: Informing quantitative data Implement more informed intervention Establishing community partnerships Empowering youth to change individual behavior and community norms Engaging community members to design and implement intervention Future Applications