After reading the topics and text for this module, provide a one-page position statement on a health indicator of your choice for a specific population. Your health indicator should be a priority issue derived from the health statistics for your own county on the County Health Rankings website. In your post, provide us with the zip code and the top health problem in your county. As you write your position statement, consider…How can you demonstrate the seriousness of this issue? What does the literature suggest as best practices in improving outcomes for this problem? Are there any specific barriers you see based on your knowledge of this county?

Before writing your position statement, review a few from your professional organizations to get an idea of what should be addressed

Post your initial response by Wednesday at 11:59 PM EST. Respond to two students by Saturday at 11:59 PM EST. The initial discussion post and discussion responses occur on three different calendar days of each electronic week. All responses should be a minimum of 300 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor), and referenced.  A minimum of 2 references are required (other than the course textbook). These are not the complete guidelines for participating in discussions. Please refer to the Grading Rubric for Online Discussion found in the Course Resources module. 

Pregnancy Prevention in Adolescents

Background: Bradford county (zip code 18840), is located in northeast Pennsylvania along the New York state border. The county is predominantly Caucasian, with a total population of 60,221, and over 72% of the area is considered rural (County Health Rankings & Roadmaps, 2023). It is among the healthiest counties in Pennsylvania ranked 14 of 67, with higher than middle range for health factors related to quality and length of life (County Health Rankings & Roadmaps, 2023). While the crime rate is low and the air quality is good, the teen pregnancy rate is still concerning at 28 births per 1,000 girls, compared to the state rate of 15, and national rate of 19 (County Health Rankings & Roadmaps, 2023).                             

Problem: Although teen pregnancy rates (maternal age 15-19 years) have declined over the past few decades, this continues to be a public health concern for adolescents, their families, and communities as a whole. More effective contraceptive use may have a role in decreasing teen pregnancy rates. Rural communities struggle with higher rates of teen pregnancy, and are slower to see a decline in teenage pregnancies due to limited availability of reproductive health services and lower utilization of the services that are available (Baney et al., 2022). Contributing factors to teenage pregnancy include irresponsible sexual behavior, use of drugs and alcohol, lack of knowledge regarding the consequences of sexual activity, and peer pressure. There are substantial health, economic, and social costs associated with teen pregnancies creating immediate and long term effects on the parents, their babies, and the entire community. The financial burden for society showed a savings of $145 million in 2020 due to declining teen births (Power To Decide, 2023). For example, approximately 50% of teen mothers earn a high school diploma, whereas,  90% of females who do not give birth during adolescence will graduate from high school (Center for Disease Control and Prevention [CDC], 2021). Additionally, children of teenage mothers are more likely to drop out of high school, have more health problems, be incarcerated during adolescence, give birth as a teenager, and struggle with unemployment as a young adult (CDC, 2021). 

Intervention: To help reduce the rates of teen pregnancies, a collaborative approach among teenagers, parents and teachers, health care providers, and community members, utilizing science based approaches should be adopted and initiated. Essential key components will include implementation of evidence based teen pregnancy prevention (TPP) interventions, enhancing quality of and access to youth friendly reproductive health services, educating stakeholders about TPP, working with youth in communities most at risk for teen pregnancy, and mobilizing the community to garner support (Mueller et al., 2017). Effective scientific strategies to reduce teen pregnancies include sexual health education which provides information regarding abstinence, various forms of contraception, and opportunities to address peer pressure (County Health Rankings & Roadmaps, 2023). Stakeholders, including community leaders, parents, and local officials should be invested in this endeavor. Engaging their support with this initiative may be accomplished by educating the stakeholders about relevant evidence based strategies and communication of data on community needs and resources (Finely et al., 2018). Lawmakers should increase support for development and evaluation of scientific evidence based programs to promote adolescent sexual and reproductive health, including school based interventions, media efforts, and clinic based interventions ( Santelli et al., 2017).

Barriers: Bradford county includes many residents of low socioeconomic status, making funding difficult. Lack of parental and community support to implement such a plan is also challenging. Additionally, because this is a rural area which lacks the convenience of public transportation, access to reproductive health services is limited. 

References

Baney, L., Greene, A., Sherwood-Laughlin, C., Beckmeyer, J., Crawford, B.L., Jackson, F., Greathouse, L., Sangmo, D., Ward, M., & Kavaya, S. (2022). “It was just really hard to be pregnant in a smaller town…” Pregnant and parenting teenagers’ perspectives of social support in their rural communities. International Journal of Environmental Research and Public Health, 19 (24). https://doi.org/10.3390/ijerph19246906

Center for Disease Control and Prevention (CDC). (2021). Reproductive health: teen pregnancy.https://www.cdc.gov/teenpregnancy/about/index.htm

County Health Rankings & Roadmaps (2023). Bradford, PA. https://www.countyhealthrankings.org/explore-health-rankings/pennsylvania/bradford?year=2022

Finley, C., Suellentrop, K., Griesse, R., House, L.D., & Brittain, A. (2018). Stakeholder education for community wide health initiatives: a focus on teen pregnancy prevention. Health Promotion Practice, 19(1), 38-50. doi: 10.1177/1524839917734521

Mueller, T., Tevendale, H.D., Fuller, T.R., House, L.D., Romero, L.M., Brittain, A., & Varanasi, B. (2017). Teen pregnancy prevention: implementation of a multicomponent community wide approach. Journal of Adolescent Health, 60(3), 9-17. Doi:10.1016/j.jadohealth.2016.11.002

Power To Decide. (2023). Pennsylvania data. https://powertodecide.org/what-we-do/information/national-state-data/pennsylvania

Santelli, J.S., Grilo, S.A., Lindberg, L.D., Speizer, I.S., Schalet, A., Heitel, J., Kantor, L.M., McGovern, T., Ott, M.A., Lyon, M.E., Rogers, J., Heck, C.J., & Mason-Jones, A.J. (2017). Abstinence only until marriage policies and programs: an updated position paper of the society for adolescent health and medicine. Journal of Adolescent Health, 61(3), 400-403. http://dx.doi.org/10.1016/j.jadohealth.2017.06.001

I lived in Saint Charles County, Maryland, with a zip code of 20602. Our county ranks in the 25^th -50th percentile in terms of health outcomes and health factors. However, one specific health factor that stands out in our county is the high rate of sexually transmitted infections (STIs). In fact, our STI rate is significantly higher than both the state and national averages, with the state rated at 624.9 and the national average at 551.0. In 2009, the STI rate in Saint Charles County was 401, which was comparatively lower. However, over the years, the STI rate has been steadily increasing, reaching its highest spike in 2019 at 697.1.

To address this pressing issue, the Charles County Department of Health has been actively working on implementing interventions at the individual, group, and community levels. These interventions include providing education, assistance, and instruction that can help to impact societal attitudes regarding HIV and other STIs as well as the use of mass media (Charles County Department of Health). They also promote the benefits of vaccination and offer efforts to support vaccine series completion, as well as provide free condoms in the community and schools. These strategies have been effective, as evidence has shown the increased number of patients getting tested for STIs.

As a healthcare provider, I recognize the seriousness of this issue, as it is a preventable disease. According to the literature, behavioral counseling interventions have been shown to decrease the chance of acquiring STIs in sexually active adolescents and adults with higher risk of acquiring STIs (Krist et al., 2020). It is crucial to establish collaborative partnerships among healthcare providers, communities, and other entities such as schools, religious organizations, and local colleges in a manner that respects cultural sensitivity (Valentine et al., 2022). By working together at all levels, we hope to see a positive change in our STI rates and overall health outcomes.

References

Charles County Department of Health. (n.d.). To promote, protect and improve health of our community! Retrieved February 22, 2023, from https://www.charlescountyhealth.org/

Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., Donahue, K., Doubeni, C. A., Epling, J. W., Kubik, M., Ogedegbe, G., Pbert, L., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2020). Behavioral counseling interventions to prevent sexually transmitted infections. JAMA, 324(7), 674. https://doi.org/10.1001/jama.2020.13095

Valentine, J. A., Delgado, L. F., Haderxhanaj, L. T., & Hogben, M. (2022). Improving sexual health in u.s. rural communities: reducing the impact of stigma. AIDS and behavior, 26(Suppl 1), 90–99. https://doi.org/10.1007/s10461-021-03416-4

The Bronx has a history of having a high number of STD cases. Since the advent of HIV/AIDS, the Bronx has consistently had the most people infected with HIV/AIDS and the most deaths related to HIV/AIDS in all boroughs of New York City (NYC Health, 2023). The problem is that STDs are high in the Bronx. Records as far back as 2007 until now show the rates of STDs in the Bronx (1,289.0) are more than double the state (640.6) and national rates (555.1 [County Health Rankings, 2023]). A challenge is there is only one treatment available for gonorrhea, and some strains have already shown resistance to this treatment. One more challenge is shame and stigma related to STDs prevent people from getting tested and disclosing being infected (Scheinfeld, 2021).

Position

The paper’s position is that the STDs in the Bronx need attention as seriously as the COVID-19 pandemic. All medical professionals and workers need education about STDs, prevention efforts, and how to talk with patients about them.

A safe sex campaign with information in English and Spanish highlighting that using condoms and dental dams needs to be seen with the same seriousness as wearing masks during the COVID-19 pandemic. Hospitals, clinics, and community health centers should saturate the local community with these campaigns.

Citizens need education about STDs, particularly chlamydia, genital herpes, gonorrhea, HPV, and syphilis. Stories about STDs should air on the local news station that emphasizes the importance of being tested. People also need to know that there is only one treatment available for gonorrhea, which some strains are already resistant to in some countries.             

Discussion about shame and stigma regarding STDs needs to happen in the community on the local level. These discussions can happen at churches, hospitals, employee meeting rooms, clubs, or anywhere there is space where people gather. People with HIV who may feel okay with having unsafe sex because the undetectable equals the untransmutable need to be made aware that safe sex is still necessary when having sex with new or multiple partners.

References

Centers for Disease Control and Prevention. (2022, September 21). Gonococcal infections  among adolescents and adults. https://www.cdc.gov/std/treatment-guidelines/gonorrhea-             adults.htm

County Health Rankings. (2023). New York Data and Resources. https://www.countyhealth   rankings.org/explore-health-rankings/new-york/data-and-resources

NYC Health (2023). HIV in NYC: Statistics and reports. https://www.nyc.gov/site/doh/data/data-      sets/hiv-aids-surveillance-and-epidemiology-reports.page

Scheinfeld E.  (2021). Shame and STIs: An exploration of emerging adult students’ felt shame    and stigma towards getting tested for and disclosing sexually transmitted infections.     International Journal of Environmental Research and Public Health, 18(13), 7179.
LAU, T. (2022, December 8). The fight to end New York’s HIV epidemic continues on World     AIDS Day. Amsterdam News. https://amsterdamnews.com/news/2022/12/08/the-fight-to-           end-new-yorks-hiv-epidemic-continues-on-world-aids-day-2022/