Teen Pregnancy, Infant Mortality, and STIs: A Profile of Critical Health Inequities in Missouri
TPPP has introduced a comprehensive new report, Health Disparities and Inequities Among Youth in Missouri using key data sources to illustrate the current sexual health crisis and the urgent need for action. This report supports our critical mission of promoting adolescent sexual health and preventing teen pregnancy. We have collated a wide range of local, national and international public health data to highlight disparate outcomes in teen pregnancy, infant mortality, STIs, and HIV rates. We compare Missouri with other U.S. states and identify the most vulnerable populations within our state.
Looking at data from Flourish STL and the Missouri Foundation for Health, the report points to what Flourish describes as a “crisis in our region,” where Black babies are four times more likely to die from SIDS than White babies, regardless of the mother’s level of education, a disparity linked to racism-induced maternal stress. It also highlights the need for increased access to healthcare and medically accurate sexual health education (MASHE). Currently, 18 Missouri counties do not have access to a single publicly funded clinic that provides contraceptive health services, which makes these counties “contraceptive deserts.” Young adults aged 13-24 account for 30% of the 500 new HIV infections that occur each year in Missouri--an infection that is preventable through correct use of barrier methods and, once again, access to affordable youth-friendly healthcare.
Finally, our new report outlines a series of promising actions put forth by Health and Social Services to reduce health disparities nationally.
This report is only an initial step in understanding how disparities impact young people. We expect that there is much to learn from conversations with young people and community members with lived experience, as well as local data.
Through the participatory efforts of our tireless and dynamic community partners, we have already seen dramatic reductions in the rate of unplanned teen pregnancies. By providing a robust picture of the remaining challenges impacting adolescent sexual health and a platform of solutions, we are hopeful our report supports stakeholders in identifying areas for collaborative action to improve health equity for all in the state of Missouri.
Authored by TPPP Public Health Intern, Jessica Winker
Sexual harassment and sexual violence are significant problems in the United States. 1 in 3 women and 1 in 6 men will experience sexual violence involving physical contact during their lifetime.1 Sexual violence and harassment can lead to lasting and harmful effects on the victims, victims’ family and friends, and the community. However, teaching what sexual consent is can prevent sexual violence from occurring and increase awareness and understanding of this public health issue.
In the United States there are just 24 states and Washington, D.C. that require sexual education to be taught in public schools, and Missouri is unfortunately not one of those states. Currently, sexual education in Missouri is optional; the school districts who do provide sexual education can decide which curriculum to use (if any). In July, Gov. Mike Parsons signed a bill which amends Missouri State Statute 170.015, the statute that regulates sexuality education in public schools. Starting in August of 2018, sexual consent, sexual harassment, and sexual violence were all added as topics that should be covered if a school provides sexual health education. The following definitions were included in the newly signed amendment:
Sexual consent- is a freely given agreement to the conduct at issue by a competent person. An expression of lack of consent through words or conduct means there is no consent. Lack of verbal or physical resistance or submission resulting from the use of force, threat of force, or placing another person in fear does not constitute consent. A current or previous dating or social or sexual relationship by itself or the manner of dress of the person involved with the accused in the conduct at issue shall not constitute consent.
Sexual harassment- is any uninvited and unwelcome verbal or physical behavior of a sexual nature, especially by a person in authority toward a subordinate as mean causing or attempting to cause another to engage involuntarily in any sexual act by force, threat of force, duress, or without that person's consent.
Sexual violence- is causing or attempting to cause another to engage involuntarily in any sexual act by force, threat of force, duress, or without that person's consent.
It is important to teach about sexual consent and healthy relationships and these changes to the state statute encourage schools to include these sexual health topics in their curriculum. According to a study of 1,300 middle school children, 43% of the students surveyed reported being victims of sexual harassment.2 In addition, 1 in 3 female rape victims experienced rape between the ages of 11-17.3 With many children and teenagers experiencing sexual harassment or violence, it is essential to start sexual health education and prevention programs as early as possible to stop harm before it starts. The CDC has published guidance and technical support, entitled STOP SV, for this reason. This online resource details necessary strategies to prevent sexual violence.4 Requiring schools to include consent, sexual harassment, and sexual violence in their curriculum can lead to fewer sex-related crimes by increasing awareness and understanding of the issue at an early age. The new amendment to Missouri State Statute 170.015 will lead to positive health changes in Missouri by highlighting the importance of sexual consent and healthy relationships to adolescents as part of their health education.
This is exactly why the Associated Students of the University of Missouri (ASUM), a student run advocacy group that lobbies in Jefferson City on behalf of the roughly 72,000 students in the University of Missouri System (Missouri S&T, UMSL, UMKC, and Mizzou), proposed this amendment to the state statute. Each year, the ASUM Board of Directors sets the legislative agenda for the year and then lobbies for legislation in Jefferson City.
Being on a college campus, it is difficult to ignore the problem of sexual assault or harassment because it is so prevalent. As student leaders began looking further into the issue, they noticed some alarming statistics that pointed to this being, not only a college campus issue, but a national issue as well. One of the most alarming college statistics dealt with the “Red Zone” (the time between the start of school and Thanksgiving break when about 1 in 5 women will experience assault or attempted assault). While colleges are making an effort to educate their students, it often comes too little and too late. The changes to Missouri State Statute 170.015 aim to provide consent education during high school. This not only helps educate students before they get to college, but it also helps educate those who do not attend college. ASUM is hopeful this legislation will better educate students about consent and reduce the number of incidents of sexual harassment and sexual violence across the state.
Agencies and advocates from across the state joined ASUM in supporting the revisions to the state statute. As the change goes into effect in August, Teen Pregnancy & Prevention Partnership continues to partner with educators and school districts to ensure that high quality lesson plans and additional resources are available for teachers and students. Below is a list with links to these resources:
Advocates for Youth offers a free comprehensive curriculum, Rights, Respect and Responsibility, that can be downloaded at their website AdvocatesForYouth.org. Here are some examples of the lesson plans that you can get from Advocates for Youth related to consent, sexual harassment and sexual violence:
Lesson 3: My Space, Your Space- Kindergarten
Lesson 3: Understanding Boundaries- Grade 6
Lesson 7: Warning Signs: Understanding Sexual Abuse and Assault- Grade 8
Lesson 3: It Wasn't My Fault- Grade 9
Lesson 2: My Boundaries- Grade 11
In addition, TPPP has created fact sheets which can be downloaded and shared to ensure schools, teachers and parents understand the changes to the state statute and the impact of those changes. You can download them here or contact TPPP for electronic copies.
References:(1) Centers for Disease Control and Prevention [CDC] (2018). Sexual Violence Prevention. Retreieved from, https://www.cdc.gov/features/sexualviolence/index.html(2) Espelage, D.L. (2016). Sexual harassment common among middle school children, study finds. Retrieved from, https://phys.org/news/2016-12-sexual-common-middle-school-children.html#jCp(3) Smith SG, Chen J, Basile KC, Gilbert LK, Merrick MT, Patel N, Walling M, Jain A. (2017). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010-2012 State Report. Atlanta, GA: National Center for Injury Prevention and Control, Centersfor Disease Control and Prevention.(4) Centers for Disease Control and Prevention [CDC] (2018). Sexual Violence. Retrieved from, https://www.cdc.gov/violenceprevention/pdf/SV-Prevention-Technical-Package.pdf
Every May brings reflection as it has traditionally been Teen Pregnancy Prevention Month. Thanks to dedicated volunteers and data from state and national sources, we are proud to present a new report on teen pregnancy/birth and adolescent sexual health in Missouri.
Even as teen births have declined in recent years, there continue to be areas of Missouri where rates remain high. Rates of sexually transmitted infections (STIs) have not seen the same downward trend and other health and community outcomes vary widely between Missouri counties. In the report Teen Pregnancy and Adolescent Sexual Health in Missouri: Factors, Trends, and Impact (which can be downloaded at the bottom of this page), data is combined in multiple ways to highlight counties and regions of our state where the health of young people is being impacted. This report is intended to provide an overview of existing resources and trends that draws stakeholders together to explore local data, gather additional input from young people, and create programs that will promote adolescent sexual health.
We hope this report is only the beginning of more discussion and local partnership to support young people in creating the future they want for themselves and their community. It is also being released at a critical time as the Department of Health and Human Services recently announced the federal funding opportunity for the Teenage Pregnancy Prevention Program. For more information related to the report or for ideas on how the Teen Pregnancy & Prevention Partnership can support your community in promoting adolescent sexual health, please contact TPPP.
On Friday January 19th TPPP members gathered for the first 2018 Professional Development event, Technology Trends & Tools. This event was held at the Thomas Dunn Learning Center (3113 Gasconade Street St Louis, MO 63118) which will be the location for all bi-monthly professional development events in 2018.
Technology Trends & Tools was facilitated by Meg Boyko, and featured a webinar from Answer, a Rutgers agency which provides information about teen health and sexuality in a variety of media forms. Answer’s award-winning website and magazine Sex, Etc. is created by teens for teens. Their website features a state by state breakdown of laws regarding adolescent sexuality, FAQ where teens answer submitted questions, trivia games to test your knowledge on birth control methods, and more.
Attendees discussed how digital media affects young adults and teens in relation to the National Sexuality Education Standards. Some of the pros of digital media included; easily accessed sexuality information through internet access, LGBTQIAA students being able to reach out and find community through technology, and facts about birth control methods being readily available. Cons discussed were; the rise in cyber bullying, body negativity based on impossible beauty standards featured on venues such as Instagram, and the possibility of young people not being capable of distinguishing medically-accurate websites from non-evidence-based (or even misleading) websites.
Technology trends were shared throughout the event, including data on what mobile apps teens are using most often. The most popular app in 2017 among young people ages 12 to 24, with a 79% use rate, was Snapchat. This was followed closely by Facebook at 76% and Instagram at 73%. Attendees broke into small groups and explored other apps including WhatsApp, Omegle, and Musical.ly. The groups considered the possible benefits and drawbacks of each of these apps for teens.
Apps can also be used for sexual health and personal safety. Attendees looked at the Bedsider Birth Control App, Eve, and Circle of Six and considered their features and utility. Several attendees noted that the Bedsider Birth Control App and Eve featured gendered language that may not be inclusive to all users. An alternative, which does not appear gendered in its design or language, is Clue.
TPPP members and partners are also encouraged to explore sexual health resource websites and evaluate them for quality of information. Three suggestions for further exploration are Amaze, Common Sense Media, and Planned Parenthood. Attendees contributed other ideas for resource websites, including Scarleteen which features a Sex and Disability section, and Adventures in Sex City which is a game for young adults to build knowledge in a fun interactive way.
On October 13, members of Teen Pregnancy & Prevention Partnership and sexual health educators from across the St. Louis region met for a networking and information-sharing event. More than 15 organizations were represented along with individuals working in the community. The group provided valuable feedback to TPPP about the barriers they face providing sexual health education in the St. Louis region, as well as, information about what professional development topics they need to be supported in their work. You can download a summary of the feedback below.
At the end of the event, TPPP previewed a new youth-friendly service directory.
By Desiree Young, TPPP Volunteer Blogger
The month of April was dedicated to the awareness of Sexual transmitted Infections (STIs) and sexually transmitted diseases (STDS), so we wanted to make sure you start May up to date!
What is an STI?
According to the American Sexual Health Association, sexually transmitted infections are infections caused by a transmitted virus or bacteria that can be spread through sexual contact. STIs were previously referred to as STDs, but were changed to STIs due to the term "disease" indicating an apparent medical problem that has no obvious symptoms; and most STIs do not show signs until they reach a critical stage, then it is classified as a STD. Both STIs and STDs can be passed through sexual contact. Last year, the World Health Organization (WHO) reported that chlamydia, gonorrhea and syphilis are starting to become resistance to the antibiotics used to treat the infections. The 2015 Missouri Youth Risk Behavior Survey showed that high school students who report having sexual intercourse declined from 46.7 percent to 37.7 percent from 2005 to 2015, and the number of high school students who report using a condom during sex decreased from 67.2 to 56.4. The Centers for Disease Control and Prevention (CDC) reported that there were 19538 chlamydia cases in Missouri for people who were between the ages 15-24 and there were 4477 Gonorrhea cases. In 2016, the Saint Louis Dispatch reported that the St. Louis region ranked 8th for gonorrhea and 17th for chlamydia. While the current statistics may be discouraging, we must continue to spread awareness and positive prevention messaging to prevent the rates from increasing. To find out the current STD rates in Missouri by county, click here.
Preventing STIs/STDs first starts with education. Parents, educators, community members and peers can join the fight against STIs/STDs by educating one another and by having honest conversations about STIs/STDs. Abstinence is an safe and effective option for STIs/STDs prevention, but there are others, including barrier methods. When condoms are used correctly (perfect use), there is a 98% percent success rate. For more information on how to properly use condoms, click here.
Resources & Useful Links
Many organizations throughout the state are dedicated to ensuring that teens receive medically-accurate information about STIs/STDs and preventing STIs/STDs. Health Departments often provide information on free condom distribution locations. In St. Louis, visit stlcondoms.com and in Kansas City, visit http://igotmineinkc.org/
Thank you to everyone for your support in our second “non-event”, Not Another Trivia Night – Anniversary Edition. We appreciate your participation and donations in support of our mission. If you missed it, we hope you can join us next time! You can keep up with our events by following our social media pages: (www.facebook.com/TPPPMO) or Twitter (@TPPPMO). If you want to browse this year’s trivia questions, we’ve put them here for you or they are still posted our social media pages. Are you having trouble finding the answers? Don't worry; there’s a link that directs you to the sources!
Time Turner Round
What was the average price of one gallon of gas in the United States in 1997?
Find the answer at: http://bit.ly/2m4qhxV
Which iconic leader had more than 2 billion people across the world tune in to watch their funeral in 1997?
Find the answer at: http://bit.ly/2lkx1KT
After 146 years, which renowned news outlet published its first ever front-page color photograph?
Find the answer at: http://nyti.ms/2lFThL8
That's A Fact Round
What was the Missouri teen birth rate in 1997?
Find the answer at: http://bit.ly/2mkujVh
What was the Missouri teen birth rate in 2015?
Find the answer at: http://bit.ly/2mkjv9V
The U.S. Department of Health and Human Services Office of Adolescent Health (OAH) maintains a database of programs that have had an impact on behaviors that prevent teen pregnancy and meet criteria to be considered an HHS evidence-based program. In 2016, how many programs did OAH add to that list?
Find the answer at : http://bit.ly/2lFTaiM
Service & Social Justice Round
Which international organization' founding preamble states that "universal and lasting peace can be established only if it’s based upon social justice?"
Find the answer at: http://bit.ly/1gjeDtB
Gustavo Gutierrez wrote a famous book outlining this form of social justice theology?
Answer: Liberation Theology http://bit.ly/1bLlqLO
Which group is credited with initiating movement to address the HIV/AIDS epidemic in the US?
Find the answer at: http://bit.ly/1Ls1vAw
Through the Years Round
In what year were the National Sexuality Education Standards released?
Find the answer at: http://bit.ly/1eZmEQI
In what year did the HPV vaccine receive FDA approval?
Find the answer at: http://bit.ly/2myOv6j
In what year was Missouri State Statute 170.015 enacted? (Missouri State Statute 170.015 governs sexual health education in Missouri.)
Find the answer at: http://on.mo.gov/2mMjWHe
Livin' in the 90's Lunch Round
In a 1997 episode of their self-titled sitcom, what iconic TV star became the first person to publicly come out as gay on television?
Find the answer at: http://bit.ly/1HUJYOh
What musical artist released their last single, which would go on to posthumously reach #1 on the Billboard Hot 100 chart, just a week before their untimely death in 1997? (Also the tie-breaker this year!)
Find the answer at : http://bit.ly/2mRZjbI
Which popular video game-turned-television show premiered in 1997, and returned to the pop culture zeitgeist in a new form last year?
Find the answer at: http://bit.ly/2lkxo88
What record-breaking American Olympic athlete will be celebrating their 20th birthday on March 14th of this year?
Find the answer at: http://bit.ly/29AQjSS
In June 1997, Bloomsbury Publishing released what novel by an unknown author that would go on to sell 107 million copies?
Find the answer at: http://bit.ly/2m1X0Ux
May is Teen Pregnancy Prevention Month, which means TPPP and our members have been busy sharing the good news about teen birth rates and learning together to better support young people. As of 2014, the Missouri teen birth rate was 27.2 births per 1,000 teen girls from 15 to 19. Since 1991, the teen birth rate has declined by 58%. In the past year alone, the decline was 9%, according to The National Campaign to Prevent Teen and Unplanned Pregnancy. The CDC released data showing declines in teen birth across the country and a reduction in disparities as well.
Our May Professional Development Meeting on May 13th covered the topic of Supporting Pregnant and Parenting Teens in Developing Healthy Relationships. Guided by Kimberly Broadnax and William Scott from Parents as Teachers National Center, TPPP members discussed the importance of healthy relationships for parenting teens for their own health and for the development of their children. A key message from our presenters was that teens need the opportunity to learn how to navigate relationships on their own terms and they need supportive adults to teach - not preach. Participants were encouraged to think of how to encourage teens as they worked through relationship conflicts by asking questions and listening, rather than providing answers based on personal experience. To further our understanding, we worked through a small group activity where TPPP members considered the challenges relationships with various stakeholders in a teen's life might bring, how to help teens recognize the status of a relationships (supportive/nurturing vs negative/destructive) and how to support teens with any issues they identify in their relationships.
On May 20th, TPPP members gathered for a legislative update and policy forum. We looked at policies at the federal, state and local levels that impact adolescent health. During the time before the Presidential election in November, we do not expect changes at the federal level. However, there is a bill, the Real Education for Healthy Youth Act – REHYA, that has been introduced which would greatly expand comprehensive sexual health education for adolescents by providing grants and training to implement it. At the state level, there were a variety of bills that would have impacted adolescent sexual health, but only one was passed. House Bill 2011 created a budget without $8 million in federal Medicaid funding for federally subsidized family planning services. Instead, Missouri legislators created an entirely new, state-run women’s health program using general revenue funding to circumvent federal Medicaid law and deny a patient’s right to choose Planned Parenthood for their health care. Gov. Jay Nixon vetoed the bill in part, but did not veto the section in question. The implementation of this new women’s health program could impact family planning services to older teens who are eligible for the family planning waiver. At the local level, TPPP works within the current Missouri statute on sexual health education to assist school districts providing medically-accurate sexual ed. This spring the Parkway School District School Board voted 4 to 3 to adopt a new sexuality education framework. TPPP worked with parent and student advocates, as well as the district, to ensure they had materials and resources to meet the needs of Parkway students. This was the conclusion of a 2 year review and revision process by the district. Moving forward, TPPP will continue to work with Missouri districts and advocate improvements to the state statute.
TPPP and other organizations across the country have engaged in dialogue around teen pregnancy prevention and adolescent sexual health on social media throughout the month. If you missed the #Youth360: Moving Beyond Prevention to Holistic Adolescent Sexual & Reproductive Health chat hosted by @HealthyTeen on May 19th, you can view the Storify. You can continue the conversation this month and throughout the year by liking and following TPPP on Facebook and Twitter.
Relationship Status: It’s Complicated Presented by Kaleigh Cornelison-Stanovsky, LCSW
TPPP Members gathered on March 11th for our second professional development program of the year in our Healthy Adolescent Relationships series. Kaleigh Cornelison-Stanovsky lead the group in an interactive presentation on technology and how teens use it in their relationships. The group started off by discussing current social media platforms and apps that young people are using including: Twitter, Instagram, Tumblr and Kik.
Kaleigh encouraged TPPP members to remember, and even highlight, the positive aspects of technology usage. We watched this short video entitled “Look Up” as an example of how adult educators often think of technology. However, teens are using technology to create many positive interactions and we can acknowledge that while helping them assess the risks and decide when/how to protect themselves.
Some examples of teens creating their own space in the virtual world include:
While all teens can have positive online experiences and relationships, some teens benefit from connecting with people outside of their home/community because they may feel isolated, misunderstood or even threatened. The group created a list that included rural teens, LGBTQ+ individuals and those with chronic illnesses or disabilities.
Kaleigh presented information from the Missouri Statutes on including technology in sexuality education classes and data from a 2015 Pew Research Survey. She also provided examples of videos that could be used with young people to discuss issues they may face when using technology. Below are links to some of those videos.
One of the take-aways from this professional development meeting was that we can all incorporate positives and negatives of technology into our programs so that they are relatable to teens. We can also help teens build their critical-thinking and decision-making skills so that they have safe and healthy online relationships. Program participants discussed several scenarios where teens faced serious challenges due to technology use, including sexting, bullying and online harassment. Staying as neutral as possible, acknowledging the real consequences of online actions and addressing both the physical safety and mental health of teens in these scenarios were all important concepts that came out of the discussions.