Do Latino Youth Really Want to Get Pregnant?

Genevieve Martínez García

Genevieve Martínez García

While teen births rates are rapidly dropping, the disparity between Latino girls and their White and Black peers is still noticeable. This disparity has led researchers and program administrators alike to ask themselves…how much of Latino teen pregnancies are intended? It is not an unusual question since the number of unintended pregnancies is quite high. It is estimated that in 31 out of 50 states, more than half of pregnancies are unintended, about half of which resulted in actual births (Kost, 2013).

Pregnancy intentions have been measured in multiple ways, assessing pregnancy intentions during conception, level of happiness with pregnancy at birth, or number of years between actual and planned conception. These measurements have resulted in multiple variables: unintended, unwanted, or mistimed pregnancies. However, these measurements are exclusively asked to pregnant or parenting mothers. My curiosity was to find out if girls and boys have a secrete desire to get pregnant, and what are the environmental conditions that may lead a teen to think a pregnancy can be a good thing in their lives.

Through extensive formative research (interviews, focus-groups and key stakeholders’ consultation), I developed a scale to assess pregnancy intentions among Latino youth in one Maryland county. The “Pregnancy Wantedness Scale” (PWS) asked respondents to rate on a 5-point Likert scale their level of agreement on 20 statements that described positive and negative consequences of an immediate pregnancy. High scores on the PWS indicate higher levels of positive attitudes towards and pregnancy. These attitudinal items stated for example “Having a baby right now would make me happy” or “If I have a baby right now my partner would stay with me.” We built a linear regression model to explore the impact socio-demographic and cultural attributes have on the level on pregnancy wantedness. We included indicators of income, family education, household composition, religion, acculturation, age, and contraception use. I also wanted to isolate the results by gender and level of sexual experience, so we split our sample of 794 Latino youth ages 14-19 into four groups. (For a full description of the methods, data tables, strengths, and limitations please see the full text article here)[1].

The sample was slightly more male (57%) with a mean age of 16.9 years. Forty-two percent (42%) were born outside the U.S., and 43% immigrated as children under 13. Many of the youth immigrated from El Salvador, Honduras, or Guatemala (36%) and most (70%) lived with their mother, or with mother and father. Their mothers’ level of education was pretty low. About half (50.6%) had less than high school degree, and only 14.7% had some college degree which is consistent with education levels of Central American immigrants nationwide (Pew Hispanic, 2014). Half of the respondents considered themselves Catholic (50.5%) and reported that religion was very important or important (38.1%) in influencing their decisions about sexuality and contraception.

Most of the sample (60.8%) reported having had vaginal sex at least once in their lifetime. Of these, 43% of the males first had sex by age 13 and 20% of the females at 14 years. Although 68.5% and 52.7% of sexually active male and female respondents respectively used a condom during their last sexual intercourse, 23.8% reported using no method or using withdrawal. Fourteen percent of sexually active males and 25.5% of sexually active females had experienced a pregnancy.

We found that teens in general did not intend to get pregnant. However, their overall score on the PWS scale hovered just below the midpoint. This means that their intentions to NOT get pregnant were not very strong either. Surprisingly this ambivalence is precisely what places them at risk of a pregnancy. Previous studies that examined ambivalence found that female youth who are ambivalent towards becoming pregnant are less likely to use contraception (Stevens-Simon, Sheeder Beach, & Harter, 2005; Kavanaugh & Schwarz, 2009; Frost, Singh, & Finer, 2007), more likely to have an abortion (Rosengard, Phipps, Adler, & Ellen, 2004), and more likely to get pregnant (Zabin, Astone, & Emerson 1993) than female youth with negative or even positive attitudes about pregnancy.

How did the four subsamples compare to each other in terms of their levels of pregnancy wantedness? The sexually experienced sample had a significantly higher level of pregnancy wantedness PWS mean of 50.5 compared to 47.1 of the abstinent sample. Females had significantly lower scores than males (mean= 46.5 versus 48.8 respectively), and abstinent females had lower scores than their sexually active peers (44.1 versus 48.8 respectively). Differences in pregnancy wantedness levels between sexually experienced and abstinent males were not significant.

So what are the factors that may cause this ambivalence? We discovered that for all four groups, living with their mother, and living with their mother AND father was a protective factor that decreased their pregnancy wantedness. However, each group had different factors that impacted their attitudes towards a teen pregnancy. For those with no sexual experience, their mother’s education (having at least completed high school completion or having some college education) decreased their PWS scores. Males were influenced by their religious views. Those who considered religion important in their sexual behavior decisions had higher pregnant wantedness scores, suggesting that traditional religious views encourage familism. One interesting finding is the effect of acculturation in females’ attitudes towards a pregnancy. For abstinent females, greater levels of language acculturation—meaning they spoke more English than Spanish—translated into lower PWS score. For sexually experienced females having been born outside the U.S. decreased their pregnancy wantedness. Another surprising finding is that only hormonal contraception use at last sexual intercourse was found significant in decreasing pregnancy wantedness among sexually active females, but condom use was not significant in any group.

How do social determinants affect pregnancy wantedness?

The table below lists the social determinants found significant in reducing (-) or increasing (+) the PWS score, or pregnancy wantedness among Latino teens.

2014_09_table_pregnancy wantednessWhat’s the take home message?

We found that Latino youth do not want to get pregnant in most cases. However, their ambivalent attitudes towards a pregnancy might place them at risk by not actively seeking effective ways to prevent a pregnancy. As sexual health educators, we need to shift our lens and think beyond the classroom, the contraception, and the curriculum we teach. Where Latino youth live, learn, and play matters! And this is evidenced by the familial, social, and cultural environment that helps shape their views towards a pregnancy and towards actively seeking pregnancy protection. This study suggests that the family environment (who lives with the youth and their level of education), their beliefs (religion), their acculturation level (language use and place of birth), and use of hormonal contraception play an important role in youth’s sexual and reproductive health decisions. Condom use, the desired behavioral outcome of evidence-based teen pregnancy prevention programs, appears irrelevant to pregnancy desire. It would be interesting to explore more in-depth the acculturation dynamics that impact sexually abstinent girls differently and the religious views males hold. Teen pregnancy prevention efforts must expand the scope of their targeted outcomes, and consider social determinants of health from social, economic and cultural contexts in which Latino youth live, work, and play to promote healthy sexuality for all.

[1] Martínez-García, G. Carter-Pokras, O., Atkinson, N., Portnoy, B. & Lee, S. (2014). Do Latino youth really want to get pregnant?: Assessing pregnancy wantedness. American Journal of Sexuality Education, 9:3, 329-346. http://dx.doi.org/10.1080/15546128.2014.944735

 

References

Kost, K., Henshaw, S., & Carlin, L. (2010). US teenage pregnancies, births and abortions: National and state trends and trends by race and ethnicity.

Pew Hispanic (2014). 2011 Hispanic Origin Profiles. Retrieved on September 20, 2014 from http://www.pewhispanic.org/.

Stevens-Simon, C., Sheeder, J., Beach, R., & Harter, S. (2005). Adolescent

pregnancy: do expectations affect intentions?. Journal of Adolescent Health,37(3), 243-e15.

Kavanaugh, M. L., & Schwarz, E. B. (2009). Prospective Assessment of Pregnancy Intentions Using a Single‐Versus a Multi‐Item Measure.

Perspectives on sexual and reproductive health, 41(4), 238-243.

Frost, J. J., & Darroch, J. E. (2008). Factors associated with contraceptive choice and inconsistent method use, United States, 2004. Perspectives on sexual and reproductive health, 40(2), 94-104.

Rosengard, C., Phipps, M. G., Adler, N. E., & Ellen, J. M. (2004).

Adolescent pregnancy intentions and pregnancy outcomes: A longitudinal examination.Journal of Adolescent Health, 35(6), 453-461.

Zabin, L. S., Astone, N. M., & Emerson, M. R. (1993). Do adolescents want babies? The relationship between attitudes and behavior. Journal of Research on Adolescence, 3(1), 67-86.

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How & Where Healthy Teens Live, Learn, & Play: A 360° Approach

Gina Desiderio

Gina Desiderio

When researching the effective characteristics of sexuality education programs, Dr. Douglas Kirby noted that while programs addressing individual knowledge, attitudes, and skills are important, they are not sufficient in reaching positive health outcomes: “Communities should not rely solely on these programs to address problems of HIV, other STIs, and pregnancy but should view them as an important component in a larger initiative that can reduce sexual risk-taking behavior to some degree.”

Evidence-based programs are but one piece of a larger approach to creating a national community where all adolescents and young adults, including teen parents, are supported and empowered to lead healthy sexual, reproductive, and family lives. To reach this vision—Healthy Teen Network’s vision that drives our mission—we must support a comprehensive, 360° approach to adolescent sexual and reproductive health.

How and where we live, learn, and play affect every one of us—our health and well-being, even our life span. These factors are referred to as social determinants of health. Examples include access to quality education and healthcare, life goals and hopes for the future, or healthy relationships with peers, family, and educators

The 360° approach is best represented by looking at the interrelated spheres of individual, relationships, community, and society, to understand how determinants in each sphere can influence individual behavior. The Social-Ecological Health Promotion frame illustrates the overlapping nature of the spheres.

Healthy Teen Network uses this frame as our theoretical approach to better understand the complex factors and spheres, and to increase our impact. The Youth 360° Fact Sheet, How & Where Healthy Teens Live, Learn, & Play is the first in our new series of resources focused on the Social-Ecological Health Promotion frame and social determinants of health.

How have you found that how and where we live, learn, and play plays a role in health outcomes?

How do you work to incorporate the social determinants of health into your work?

Gina Desiderio is the Director of Marketing and Communications at Healthy Teen Network.

Applauding AAP’s Policy Statement on Condom Use by Adolescents

Pat Paluzzi, DrPH

Pat Paluzzi, CNM, DrPH

Healthy Teen Network applauds the American Academy of Pediatric’ s recently released policy statement on Condom Use Among Adolescents. The policy statement offers a thorough background and description of condom use in the United States and provides relevant recommendations for the field.

Healthy Teen Network is particularly pleased to see the ecological approach to promoting condom use endorsed within this statement. The recognition of parents, schools, and peer networks supports our belief in the social ecological health promotion frame as the best approach to create sustained healthy behaviors among young people.

Within this statement, AAP once again dispels the myth that making condoms available increases sexual behavior, and the AAP provides even more compelling support for sexuality education. Condoms are an important part of healthy sexual activity among all age groups, and given the rates of unintended pregnancies and STIs among young people, they are a critical component of promoting healthy choices among this age group.

Pat Paluzzi, CNM, DrPH, is President/CEO of Healthy Teen Network.

Lessons from Global Public Health

Mousumi Banikya-Leaseburg

Mousumi Banikya-Leaseburg

Recently I attended a meeting of a few Baltimore City health professionals to talk about ways to enhance the youth-friendliness of Baltimore City clinics that provide sexual and reproductive health services to adolescents and young adults. During the course of our brainstorming session, we came up with a number of innovative strategies and approaches, many of which we knew to have been successfully implemented in developing countries, in low-resource settings, with positive outcomes. The realization that Baltimore as a city­—and the United States as nation—are lagging behind many countries with weaker health infrastructure and poorer economic support, in terms of finding and implementing innovative, sensible, and cost-effective solutions for a vast number of public health challenges was paramount on my mind as I made my way back home from the meeting. I began to think, “What are some lessons that the United States can learn from global public health?”

Having worked as a physician, researcher, and public health practitioner in both international and domestic low resource settings for many years, I have always viewed health as a basic human right that every man, woman, and child is entitled to—regardless of who they are, where they come from, or where they are headed—and not as a privilege. In my opinion, the politicized nature of health in the United States is the single most important factor that has prevented us from adopting more real-life, innovative, and sensible solutions that can reduce the burden of health disparities on the American population. If health could only be viewed as what it truly is, without all the baggage of politics, policies, religion, privilege, money, etc., I imagine there would not be so many obstacles in achieving it. I think other countries do a much better job of viewing health through a more objective lens, providing an excellent lesson for us to learn. I know this might sound like a simplistic approach, but sometimes the most groundbreaking solutions are the most simple.

“Reverse Innovation” is a term used to describe innovation that begins as a practical solution to meet the needs of populations in developing countries, and then “trickles up” to developed countries where the same practical solution which was born out of necessity and constraints is essentially repackaged as an innovative, low-cost solution for the populations of developed countries. There are many such reverse innovation solutions in the field of health that the United States might be able to adopt to solve contemporary health system challenges particularly those in the field of adolescent sexual and reproductive health. Here are just three examples:

  1. Modified Service Delivery Models: To combat the chronic shortage of skilled health care workers, developing countries are promoting novel approaches and introducing specialized worker education and training. Many developing countries are training mid-level workers to perform emergency procedures. This approach has improved health access through task-shifting. Such workforce substitution has most recently been implemented with great success by the Contraceptive CHOICE research project where non-clinical, lay, frontline staff were trained to provide contraceptive counseling to overcome the barrier of clinicians not having enough time to provide full contraceptive options counseling to patients. Similarly, community health workers (CHWs) and peer health workers can be mobilized following the example of countries such as India and Pakistan to increase positive health outcomes in communities across the United States.
    .
  2. mHealth and Telehealth: Despite the widespread availability of mobile health (or mHealth) and telehealth technology, the United States seems to be hesitant about fully embracing and taking advantage of such innovation that has the potential to drastically decrease existing health disparities in the country. Countries such as Kenya, Uganda, South Africa, Rwanda, and India have jumped to the forefront of mHealth innovation using new technology to transform healthcare through improved data collection, disease surveillance, post-discharge surveillance, health promotion, diagnostic support, disaster response, and remote patient monitoring. Both mHealth and telehealth can be used in the field of adolescent sexual and reproductive health (ASRH) to deliver health education to disadvantaged communities and to increase access to sexual health services for adolescents and young adults.
    .
  3. Leadership and Governance: Visionary leadership is required to successfully implement and sustain public health initiatives. Such leadership can kindle community optimism which is important for community support of any initiative. Despite leadership development being a top priority for health leaders, underdeveloped leadership and management skills coupled with a high rate of turnover in key positions plague most health systems in the United States. The State of Ceará, in Brazil, mandates that public servants receive leadership training to apply for management positions. By doing so, the state has been able to strengthen leadership and management of public sector employees. Over time, this has contributed to improved health system performances. Between 2000 and 2004, 25 (out of 37) municipalities in Ceará reduced infant mortality–some by as much as 50%. The United States can certainly learn from the success story of Ceará.

We need to be more creative in our approach to public health in the United States and embrace innovation and change with open arms. Although traditional approaches may be tried and tested, the reality is that these tried and tested approaches have not been able to eradicate the vast disparities that exist in health indices in the United States among different groups of people, particularly in the field of ASRH. Perhaps for some, a sense of urgency has still not arisen. Maybe that is why they are still content with the status quo. I, on the other hand, am not satisfied with how things are and shall continue to advocate for more integration of successful lessons from global public health.

What are some other lessons the United States can learn from global public health? What hurdles have you faced when attempting to introduce new and innovative strategies in your own work?

Mousumi Banikya-Leaseburg, MD, MPH, CPH is a Program Manager at Healthy Teen Network.

Additional reference: http://www.globalizationandhealth.com/content/8/1/17#B48

Road Map for the Future of Adolescent Sexual and Reproductive Health

Pat Paluzzi, DrPH

Pat Paluzzi, DrPH

It has taken over a year much thinking, talking, and revising, but Healthy Teen Network is extremely excited to present our 2013-2016 Strategic Plan, Road Map for the Future of Adolescent Sexual and Reproductive Health to the field.

This three-year plan is a result of conversations with adolescent, reproductive health, and social justice professionals, state leaders, researchers, funders, and high level officials—in other words, some of the field’s best thinkers. It is comprehensive, forward-thinking, and based in reality. It challenges our thinking and approaches and uses data to make the case for adding to what we know about evidence-based interventions with new research-based, science-based, innovative approaches, so all youth are included in our messages. The social-ecological health promotion frame changes our way of thinking about what we do and what young people need to thrive, such as addressing issues of housing, food, education, employment and more, as these social determinants impact the health and well-being of young people. And finally, this plan recognizes that those of us who make it our business (and life’s work) to address these issues, need to think about how we can create sustainable efforts, even when those in power are not supportive of our approaches.

Please view the Prezi below, read our plan, ask questions, challenge our thinking, and above all else, put our plan to use if it resonates with you. As one of our interviewees said, we cannot continue to do the ‘same old’ and expect better results; we have to be creative and innovative.


Pat Paluzzi, DrPH, is the President/CEO of Healthy Teen Network.

Healthy People 2020 & Adolescent Health

Christine Runion

Christine Runion

For the past 30 years, the U.S. Department of Health and Human Services (HHS) has been publishing a framework for public health in attempt to improve our nation’s health. As the field progresses, we have all become aware that the key to teen pregnancy and HIV prevention encompasses more than just sexual education: it includes bullying prevention, access to health care, positive relationship reinforcement, and more… it includes all aspects of healthy teens!

And that’s why we’re so excited that, for the first time ever, the Healthy People Initiative, Healthy People 2020 (HP2020), released a little more than a year ago, includes the topic Adolescent Health. HHS highlights adolescent issues such as sexually transmitted infections (including HIV) and teen and unplanned pregnancies.

Is anyone else thinking “RAISE THE ROOF?” or “Totally awesome?” ….Wait, what are kids saying these days?

No matter what exclamatory phrase you choose, I think we can all agree that it’s about time! Adolescents (ages 10-19) and young adults (ages 20-24) make up a whopping 21 percent of the population. That’s one in five people! And we all know that habits and lifestyle choices made in our brain-shaping and sometimes awkward, confusing, and crazy youth can shape us for life. So let’s support teens to make them good ones.

And how can we ensure that these lifestyle choices are beneficial to the teens making them? By getting involved with HP2020, of course! Whether you are in the field, in the classroom, looking to make an impact in your community, or even within your own family, there are many ways in which you can incorporate the HHS adolescent health objectives:

  • Use the objectives to see where your population stands in relation to the nation.
  • Use the objectives to help inform your organization’s strategic plan.
  • Use the objectives to help inform resource allocation within your organization.
  • Develop collaborative partnerships across the six topic areas to maximize your access to funding and your impact on your population.
  • Use the objectives to help determine if your organization’s activities, ranging from programming to education to advocacy, are meeting all of your population’s needs.

Many organizations used HP2010’s Critical Health Objectives (CHOs) to inform their work and boast remarkable results:

“We are a multi-issue organization and the CHOs really validated a holistic approach to adolescent health.” – The California Adolescent Health Collaborative

“We are using the CHOs to break down barriers between these segregated adolescent health issues. It is helpful that there is a national initiative like HP2010 and the CHOs that also take this approach.” – Alabama Campaign to Prevent Teen Pregnancy

To read more about success stories related to HP2010, check out Healthy Teen Network’s Healthy People 2020 and Adolescent Health: A Primer.

How to Get/Stay Involved

Organizations (and individuals) can use the same tactics for getting involved with HP2020 as others did for HP2010. The HHS publishes tools and resources useful for those wishing to utilize the HHS’s objectives—and keep adolescent health on the list of topics for decades to come!

Visit the Healthy People Initiative website for updates and more information.

A full list of the objectives for Adolescents is available online.

To get more ideas on how to implement these objectives in your organization, click here.

You can access the resource Improving the Health of Adolescents and Young Adults, another comprehensive CDC resource for adolescent health.

Christine Runion is a Marketing and Communications Associate at Healthy Teen Network.

The Stakes Remain High

Pat Paluzzi

Alexandra Eisler

The social networks have been a flutter with facts, opinions, and rumors since the release of three additional curricula to the Health and Human Services list of effective programs – Safer Choices, Respeto/Proteger, and Heritage Keepers Abstinence Education. Initially, Healthy Teen Network found research that appeared to call into question the efficacy of Heritage Keepers Abstinence Education. The “Life Skills” component that was referenced in our previous post refers to add-on sessions to the curriculum that were not found to impact the program’s outcomes. We have since located the unpublished manuscript that was used to assess this program, and we will review it to learn more about its findings.

Regardless, Healthy Teen Network remains concerned about any program that promotes abstinence only until marriage. This framework for teaching young people about their sexual health excludes a variety of populations including LGBTQ youth and people who choose not to marry. We believe that youth deserve unbiased information about their sexual health that allows them to think critically about their relationships and community. Healthy Teen Network welcomes the opportunity to examine this curriculum further; however, at this time Heritage Services indicated that they could not share a copy of their curriculum.

We will continue to inquire about the findings associated with this program, and provide updates as we learn more.  We invite you to share any knowledge and/or experience you have had with any of these three newly approved programs.

Pat Paluzzi is the President/CEO and Alex Eisler is the Training and TA Coordinator at Healthy Teen Network.

High Stakes. Big Mistake?

Pat Paluzzi

Alexandra Eisler

Please note that as of 05/03/2012, an update to this post, regarding the evaluation of the Heritage Keepers program, has been posted here.

To be clear: this time of evaluating and expanding the public health field to support young people in making healthy decisions about their sexual health is a time to celebrate. This is a time when those with money, power, and sway hold a unique responsibility to back programming that promotes the well-being of all youth and provides them with accurate information that promotes healthy decision-making. The President’s Teen Pregnancy Prevention Initiative and the Department of Health and Human Services (HHS) have played a central role in disseminating effective programs that promote these goals and have stood firm in approaching this work so that it values all young people and their families.

However, with that said, Healthy Teen Network was concerned to find that the expansion of the current list of HHS-vetted programs included Heritage Keepers Abstinence Only Education. HHS itself noted in 2007 that this program not only demonstrated “little or no impact on sexual abstinence or activity” but that its evaluation lacked rigor to determine if the collected behavioral data indicated actual behavior change among participants.[1]*

Looking to other programs on this list, they are rigorously evaluated with their results published in peer-reviewed journals providing a layer of quality control that ensures youth receive high-quality interventions that can save their lives. This program, Heritage Keepers Abstinence Education, has failed to be published. We, as public health professionals, should take pause at this shortcoming. Certainly, there are many quality programs available that have not been published, but those programs are not on this list and therefore not a part of this massive funding stream of tax dollars.

The program’s outcomes appear to be largely based on middle school students’ support of abstinence and expectation to remain abstinent.* Intentions to remain abstinent are a weak proxy to promote the health of our adolescents, and intentions do not necessarily result in a change in sexual-risk taking behaviors. Just look at the research on virginity pledges (82% of those who pledge deny having ever pledged).[2] In fact, the 2007 Mathematica report on this program—submitted to HHS—indicates the following:

  • Youth in the [Heritage Keepers program] and control groups reported similar rates of sexual abstinence. (p. 40)[3]
  • Youth in the [Heritage Keepers program] and control groups did not differ in reported age at first sex. (p. 41)[3]*

The stakes here are incredibly high and we should ask why a program like this would be included in the ranks of effective programs.

Evaluation aside, couching this program in the context of marriage and traditional gender roles flies in the face of championing the health of all communities. Narrowly focused messages like those espoused in this curriculum are at best ignorant of the needs of many youth, in particular LGBTQ youth, and at worst prejudicial and homophobic. Adolescents have the right to learn about their sexual health and determine what is right for them and their families without being bombarded with divisive ideology. For more information on some of the potentially damaging curriculum content, see this review.

As advocates for our young people, we have a responsibility to ensure that they get accurate information that allows them to build the lives that they themselves choose. The inclusion of a program like this in our most notable list of resources reflects poorly not only on the President’s Teen Pregnancy Prevention Initiative, it reflects poorly on all of us. As an organization with young people’s health first and foremost in mind, Healthy Teen Network is outraged and saddened that work of this caliber represents the sexual health profession. This is a time to hold our leaders accountable for promoting programming that places the lives of our youth and our families at risk.

Pat Paluzzi is the President/CEO and Alex Eisler is the Training and TA Coordinator at Healthy Teen Network.


[3] http://aspe.hhs.gov/hsp/abstinence07/HK/report.pdf

*This post has been updated.  These statements regarding evaluation relate to a 2007 review, but these do not appear to be the same evaluation results used in the 2011 review.  See our updated post here.

HP 2020: What the New Indicators Mean for Our Work

Pat Paluzzi

October 31st at the American Public Health Association (APHA) Annual Meeting, Dr. Howard Koh, Assistant Secretary for Health at Department of Health and Human Services (DHHS), announced the leading health indicators for the next decade. Healthy People 2020 indicators provide national focus on a set of health issues affecting the United States, which will receive heavy emphasis within the public health sector over the next 10 years.

These issues are:

  • access to health services;
  • clinical preventive services, environmental quality;
  • injury and violence;
  • maternal, infant, and child health;
  • mental health;
  • nutrition,
  • physical activity and obesity;
  • oral health (which made this list for the first time);
  • reproductive and sexual health;
  • social determinants (a theme that Koh said has galvanized decision-makers);
  • substance abuse;
  • and tobacco.

Many of these indicators are directly related to our work and present great opportunity for moving our work forward in new ways. The combination of reproductive and sexual health with social determinants can mean new/renewed attention on what those of us who work with young people know—that social determinants heavily impact any success we may have in reducing risky behaviors associated with teen pregnancy, STIs and HIV, and/or supporting teen parents and their children.

At APHA, session presenter Gail Christopher, Vice President for Programs at the W.K. Kellogg Foundation, noted that education and closing graduation disparity gaps will be a critical focus as work moves forward. This is also very good news for those of us focused on pregnant and parenting teens. We know that education attainment among teen parents can alter a life course and provide a way out of poverty for teen parents and their children.

How will these indicators play into the work you do?

Pat Paluzzi is President/CEO of Healthy Teen Network.

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