Data-Informed: Maximizing Adolescent Sexual and ...surveygizmolibrary.s3.amazonaws.com/.../DataInformedASRHProgram… · ... Child and Adolescent Health Division ... and Program Development

Mary Campa, Ph.D. and Zhiwei Yu, MPH

California Department of Public Health

Center for Family Health

Maternal, Child and Adolescent Health Division

Epidemiology, Assessment, and Program Development Branch

September 17, 2014

Data-Informed: Maximizing Adolescent Sexual and

Reproductive Health Program Capacity in California

Objectives

At the conclusion of this presentation, participants will be able to…

1. describe successes and challenges in adolescent sexual health

in California;

2. identify at least 3 resources for obtaining local data about

adolescent sexual health; and,

3. identify steps for integrating local data into program planning.

Adolescent Sexual and Reproductive

Health at MCAH

• MCAH Program Standards

– Adolescent Family Life Program (AFLP) / AFLP – PYD

– Information and Education Program (I&E)

– Personal Responsibility and Education Program (CA PREP)

• MCAH Epidemiology, Assessment and Program Development

– Population surveillance

– Program monitoring

– Program evaluation

• Title V 5-Year Needs Assessment related to children and

adolescents

Reframing Adolescent Sexual Health

• National push to reframe adolescent sexual health (ASH) to be:

– youth-positive

– inclusive

– socially responsible

– holistic

• A youth-positive model of ASH aligns with MCAH’s priorities on

positive-youth development, recognition of the social determinants

of health, and focus on life course development.

Adolescent Health In California, 2012

• Approximately 5.6 million adolescents in California

– 12 percent of the nation’s adolescent population

• Nearly 3 million California children live in areas of concentrated

poverty; roughly 32.3% of total California children

• The majority of adolescents in California are Latino (Hispanic)

Percentage

0% 25% 50% 75% 100%

Adolescent Health In California, 2012

• Approximately 13.1% of adolescents dropped out of high

school

• Almost 30,000 children were in foster care

• 128 adolescents committed suicide

• Many youth report high levels of connection to adults in

their community

• Few youth who are in a relationship report dating violence

• Almost 300,000 youth received FPACT services

46.7

43.9

40.9 39.4 39.0 38.6

40.2 40.1 38.3

35.4

31.5

28.0

25.7

47.7

45.0

42.6 41.1 40.5 39.7

41.1 41.5 40.2

37.9

34.2

31.3 29.4

10

20

30

40

50

60

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Bir

ths p

er

1,0

00 f

em

ale

s i

n s

pecif

ied

gro

up

Year

California

U.S.

Birth Rates, Ages 15 – 19, 2000 – 2012,

California and U.S.

California data sources: Births: 2000-2012, Birth Statistical Master File, California Department of Public Health, Center for Health Statistics and

Informatics. Population: 2000-2009, State of California, Department of Finance, Race/Hispanics Population with Age and Gender Detail, 2000–2010.

Sacramento, California, September 2012. 2010-2012, State of California, Department of Finance, Report P-3: State and County Population

Projections by Race/Ethnicity, Detailed Age, and Gender, 2010-2060. Sacramento, California, January 2013. U.S. data sources: 2000-2011, Martin

JA, Hamilton BE, Ventura SJ, Osterman MJK, and Mathews TJ. Births: Final data for 2011. NVSR 62(1). Hyattsville, MD: National Center for Health

Statistics, 2013. *Preliminary data for 2012, Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2012. NVSR 62(3). Hyattsville, MD:

National Center for Health Statistics, 2013. Note: The California birth rates presented here differ from rates computed on the basis of other population

estimates such as those published by the National Center for Health Statistics. Further, these rates should not be compared to rates CDPH published

prior to 2013, wherein the population was based on the California Department of Finance population projections as of July, 2007.

*

The birth rate among

California females

ages 15 – 19

declined 45%

between 2000 and

2012. Between 2011

and 2012, the rate

declined 8%.

This decline is similar

to that observed in

the overall U.S. birth

rate among females

ages 15 – 19.

In 2012, the birth rate

among females ages

18 – 19 was 3.3

times that of those

ages 15 – 17.

Between 2000 and

2012, the birth rate

among females ages

18 – 19 decreased by

34 births per 1,000.

During the same time

period, the birth rate

among females ages

15 – 17 fell 51%.

Birth Rates by Age Group, 2000 – 2012,

California

Data sources: Births: 2000-2012, Birth Statistical Master File, California Department of Public Health, Center for Health Statistics and Informatics.

Population: 2000-2009, State of California, Department of Finance, Race/Hispanics Population with Age and Gender Detail, 2000–2010. Sacramento,

California, September 2012. 2010-2012, State of California, Department of Finance, Report P-3: State and County Population Projections by

Race/Ethnicity, Detailed Age, and Gender, 2010-2060. Sacramento, California, January 2013. Note: The rates should not be compared to rates

CDPH published prior to 2013, wherein the population was based on the California Department of Finance population projections as of July, 2007.

26.5 23.8

22.6 21.6 21.3 21.6 21.7 21.8 20.8 19.2

16.4 14.8

13.1

77.1

74.1

68.6 66.2

65.1 63.9

68.3 68.4

65.3

59.2

53.1

46.7

43.1

10

20

30

40

50

60

70

80

90

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Bir

ths p

er

1,0

00 f

em

ale

s i

n s

pecif

ied

gro

up

Year

Ages 15-17

Ages18-19

Number of Births to Females Under Age 20 by Age

Group, 2000, 2006, 2012, California

Data source: 2000, 2006, 2012 Birth Statistical Master File, California Department of Public Health, Center for Health Statistics and Informatics.

895

18,887

36,486

681

17,208

35,562

360

10,359

24,562

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

<15 15 - 17 18-19

Nu

mb

er

of

bir

ths

Age Group

2000 2006 2012

In 2012, over 10,000

children were born to

California mothers

ages 15 – 17; an

additional 360 were

born to mothers

under age 15.

Birth Rates by Race and Hispanic Ethnicity,

Ages 15 – 19, 2000, 2006, 2012, California

Data sources: Births: 2000, 2006, 2012, Birth Statistical Master File, California Department of Public Health, Center for Health Statistics and

Informatics. Population: 2000, 2006, State of California, Department of Finance, Race/Hispanics Population with Age and Gender Detail, 2000–2010.

Sacramento, California, September 2012. 2012, State of California, Department of Finance, Report P-3: State and County Population Projections by

Race/Ethnicity, Detailed Age, and Gender, 2010-2060. Sacramento, California, January 2013. Note: The rates should not be compared to rates CDPH

published prior to 2013, wherein the population was based on the California Department of Finance population projections as of July, 2007. Births to

mothers identified as “other” or “unknown” race are excluded from the analysis; they comprised <1% per year in 2000 and 2006, and 1.5% in 2012.

77.3

22.3

59.1

27.7

15.0

45.7

40.6

66.9

15.8

45.1

22.4

9.7

40.1

32.7

38.9

10.2

30.8

17.9

5.0

31.0

19.8

10

20

30

40

50

60

70

80

90

Hispanic White(non-Hispanic)

African American(non-Hispanic)

Multiple Race(non-Hispanic)

Asian(non-Hispanic)

American Indian(non-Hispanic)

Pacific Islander(non-Hispanic)

Bir

ths p

er

1,0

00 f

em

ale

s i

n s

pecif

ied

gro

up

Race/Ethnicity

2000 2006 2012

The birth rate among

California females

ages 15 – 19

declined across all

racial/ethnic groups.

Hispanic females had

the greatest absolute

decline in birth rate

between 2000 and

2012, declining a full

38 births per 1,000

females ages 15-19.

Substantial

geographic variation

exists in adolescent

childbearing across

California counties.

The county with the

highest 3-year

aggregated birth rate

has a rate 5.3 times

greater than the

county with the

lowest 3-year

aggregated birth rate.

Aggregated Birth Rate, Ranked by County,

Ages 15 – 19, 2010 – 2012, California

0 10 20 30 40 50 60

Tulare

Kings

Del Norte

Kern

Imperial

Madera

Fresno

Monterey

Yuba

Merced

Glenn

Lake

Tehama

Trinity

Colusa

San Bernardino

Stanislaus

San Joaquin

Siskiyou

Mendocino

Modoc

Lassen

Inyo

Sutter

Santa Barbara

Los Angeles

Riverside

Shasta

California

Sacramento

Ventura

San Diego

Plumas

San Benito

Solano

Mariposa

Santa Cruz

Humboldt

Butte

Orange

Napa

Calaveras

Alameda

Santa Clara

Sonoma

Mono

Contra Costa

Amador

Tuolumne

San Mateo

Yolo

San Luis Obispo

El Dorado

Nevada

San Francisco

Placer

Marin

Births per 1,000 females in specified group

Data sources: Births: 2010-2012, Birth Statistical Master File, California Department of Public Health, Center for Health Statistics and Informatics.

Population: 2010-2012, California Department of Finance, Report P-3: State and County Population Projections by Race/Ethnicity, Detailed Age, and

Gender, 2010-2060. Sacramento, CA, January 2013.

Small Group Discussion

How do you describe local youth sexual

health in your community?

What data do you use? What data

would you like to use that is missing?

MCAH Adolescent Health Data Website

http://www.cdph.ca.gov/data/statistics/Pages/AdolescentHealthData.aspx

TBR Press Release and FAQ

The Local and State Populations

County County

N % N % Ranking11N % N % Ranking11

Total Population1 848,839 100.0 37,570,307 100.0 11 Adolescent Population1 140,294 100.0 5,376,295 100.0 11

Aged 10 - 14 years 68,100 8.0 2,556,893 6.8 8 Hispanic 83,896 59.8 2,661,266 49.5 11

Aged 15 - 17 years 42,443 5.0 1,646,388 4.4 7 African American 7,576 5.4 327,954 6.1 12

Aged 18 - 19 years 29,751 3.5 1,173,014 3.1 7 Asian 4,630 3.3 575,264 10.7 28

Uninsured2 171,416 21.2 6,694,764 18.2 15 White 39,563 28.2 1,564,502 29.1 41

Public Health Insurance2 293,077 36.3 10,611,883 28.8 8 Male 72,251 51.5 2,758,039 51.3 8

Single Head-of-Household2 37,864 15.0 1,244,103 10.0 22 Female 68,043 48.5 2,618,256 48.7 45

Population Living in Poverty2 183,684 22.8 5,676,189 15.5 7 Living in Foster Care4866 0.6 27874 0.5 25

Children Living in Poverty2 80,481 32.2 1,971,754 21.6 6 Family PACT Providers5 53 2.4 2,190 100.0 7

Unemployment Rate2 14.3 -- 12.1 -- 21 Teen Family PACT Clients5 6,957 19.0 291,325 16.0 10

Rural MSSAs3 10 71.4 227 41.8 10 High School Dropout Rate616.8 -- 13.1 -- 9

Adolescent Sexual and Reproductive HealthKern County, 2011

Adolescence is the developmental period from ages 10 to 19. During adolescence and into early adulthood, the brain undergoes the

last major period of growth and reorganization, resulting in an increased need for stimulation and changes in social and emotional

information processing. Adolescence is a time for youth to explore their identity and values. Often this occurs in the context of peer

relationships though parents and other adult figures remain influential. Although the morbidity and mortality rates increase sharply

from childhood through adolescence, most youth fare well. Adolescence is a critical time for establishing patterns for a positive

adulthood - including an active role in one's reproductive and sexual health.

California

Notes: 1 Adolescent Population aged 10 - 19. State of California, Department of Finance, Report P-3: State and County Population Projections by Race/Ethnicity, Detailed Age, and Gender, 2010-2060. Sacramento, California,

January 2013. 2Estimated number of population with no health insurance coverage, public health insurance; Estimated number of households with male/female householder, no wife/husband present; estimated total persons

and children under age 18 below federal poverty level in past 12 months; unemployment rate percentage: 2010-2012, U.S. Census Bureau, American Community Survey (3-year estimates) retrieved from

http://factfinder2.census.gov/. 3Total rural and frontier MSSAs: Office of Statewide Health Planning & Development, Medical Study Service Areas, retrieved from: http://www.oshpd.ca.gov/hwdd/MSSA/. 4 PIT estimate, July

1, 2011, youth ages 0-17; University of California at Berkeley, California Child Welfare Indicators Project (CCWIP) retrieved from: http://cssr.berkeley.edu/ucb_childwelfare/PIT.aspx. 5Family Pact: 2011-2012, Bixby Center for

Global Reproductive Health and University of California San Francisco, Family PACT Program Report. Sacramento, CA. 2013. Retrieved from: http://bixbycenter.ucsf.edu/publications/files/Family%20PACT%20AR_2011-12.pdf. 6High School Cohort Drop Out Rate: 2010-2011. California Department of Education, retrieved from: http://dq.cde.ca.gov/dataquest/. 7Rate per 1,000 females, 2011; Percent of repeat births is percent of births to females

aged 15 – 19 with 1-7 previous lives births. Birth Statistical Master File, California Department of Public Health, Center for Health Statistics and Informatics. 8Rate per 100,000 youth. 2012. California Department of Public

Health, STD Control Branch, rates by race, age and juridiction, retrieved from http://www.cdph.ca.gov/data/statistics/Pages/STDLHJData.aspx. 9Rate per 100,000 youth, 2011. California Department of Justice, Office of the

Attorney General, California Arrests Data File, retrieved from: http://oag.ca.gov/crime/cjsc/stats/arrests. 10 Percent 9th graders rated with high level of caring adult in community; percent 9th graders with boyfriend or

girlfriend who report dating violence; percent of 9th graders reporting depression-related feelings in past year: 2009-2011. WestEd Health and Human Development Department for California Department of Education,

retrieved from: http://chks.wested.org/resources/. 11County rankings determined by assigning rank of one to the largest value among counties and rank of 58 to smallest value.

Kern KernCalifornia

Adolescent Sexual and Reproductive

Health, County Profiles

County

Local State Ranking11 Female Male Hispanic Asian White

Adolescent Behaviors and Outcomes

Adolescent birth rate (aged 15-19)1,7 52.7 28.0 2 -- -- 64.2 -- 31.9

Percent of repeat adolescent births (aged 15-19)7 18.6 17.4 9 -- -- 19.4 -- 17.1

Chlamydia rate (aged 15 - 19)8 2239.7 1402.8 2 3505.7 1056.1 2380.2 1245.6 1714.0

Gonorrhea rate (aged 15 - 19)8 277.6 159.3 3 436.3 262.1 465.4 159.9 231.2

Juvenile arrest rate (aged 10 - 19)9 994.9 361.0 18 177.8 665.9 358.7 -- 351.4

Have caring adult in community10 64.0 63.0 25 -- -- 62.0 61.0 74.0

32.0 31.0 25 39.0 23.5 30.8 27.2 31.1

5.0 6.0 25 5.4 5.3 4.9 3.1 6.8

Kern County Adolescent Birth Rate by Age Group1,7

, 2001 - 2011

Adolescent Sexual and Reproductive HealthKern County, 2011

African American

7.2Experienced dating violence in past year10

Depression-related feelings10 27.3

70.0

2070.8

Geography Gender Race and Ethnicity

75.1

16.0

8037.6

2394.0

• 1,486 adolescent births occurred in Kern County in 2011, representing 4.7% of adolescent births in the State that year. 2.5% of CA females ages 15-19 lived in Kern County in 2011.

• The adolescent birth rate has decreased 25.1 percent since the high in 2008; the State has seen a similar decrease in that time, dropping 26.8 percent.

• 67.3% of adolescent births in Kern County in 2011 were to women aged 18-19. The State average was 69.1%.

• 71.4% of adolescent births in Kern County in 2011 were to mothers who reported a Hispanic ethnicity. The State average was 73.8%.

• 15.6% of teen births in Kern County in 2011 were to foreign-born mothers. The State average was 19.7%.

Adolescent Births In Kern County1,7

Adole

scent

Birth

Rate

, per

1,0

00 f

em

ale

s

Updated MSSA Report

MCAH Program Data

Environmental Scan of ASRH Efforts

Maternal Infant Health Assessment

(MIHA) Snapshots

Data Informed Program Targeting

• In an environment of limited funds, it is critical to reach

the most high-need youth

• Targeting can occur based on

– Means-Testing

– Category

• Population group

• Geography

23

Small Group Discussion & Activity

How do you determine your program

service area?

How do you determine who is most in

need of services in your community?

Geographical Program Targeting

Based on Need

• Geographical targeting can

– reduce administrative costs;

– limit type 2 errors of over service; and,

– increase services to youth with most need.

• Requires

– Small area geography

– Defined need criteria

Geographical Program Targeting

Based on Need

• Three step process

– Step 1: Identify locations of high-need youth

– Step 2: Identify locations of unmet need

– Step 3: Review program data; reflect and

refine

Considerable

variation in early

childbearing exists

within California

counties.

The average

difference in birth

rates among

adolescents across

MSSAs within

counties is over 36

births per 1,000.

Geographic Distribution of 2010 – 2012 Aggregated

Birth Rate+ by MSSA, Ages 15 – 19, California

Data sources: Teen Births: Years 2010-2012 Birth Statistical Master File, California Department of Public Health, Health Information and Research

Section. Teen population: MCAH calculation of the MSSA population using California, Department of Finance, Report P-3: State and County

Population Projections by Race/Ethnicity, Detailed Age, and Gender, 2010-2060. Sacramento, California, January 2013 and Census 2010 population

by census tract http://factfinder2.census.gov/faces/nav/jsf/pages/index.xhtml

California Adolescent Sexual Health

Needs Index (CASHNI)

• Developed at MSSA level to allow for localized, need-based program

targeting of primary and secondary pregnancy prevention programs.

• Accounts for overall community risk based on:

• Adolescent birth rate

• Percentage of repeat births

• Gonorrhea incidence rate

• Percentage of youth living in concentrated areas of poverty

• Percentage of youth living in racially isolated areas of African

Americans, Hispanics or American Indian / Alaskan Natives

• High school drop out rates

• Accounts for community need for sexual health programing based on

number of adolescent births and community rural and urban status.

California Adolescent Sexual Health

Needs Index (CASHNI)

Wrap Up

3

0

• Understanding adolescent sexual and

reproductive health in California

• Maximizing data – informed programming

• Reflect, revise and improve

Thank you!

• Acknowledgements: – Mark Damesyn, Dr.P.H.

– Marina Chabot, MSc

– Maggie Tufts, MPH

– MCAH ASRH Program Staff (PREP, AFLP, I&E)

– UCSF Evaluation Partners

• Contact Information:

Mary Campa, Ph.D. Zhiwei Yu, MPH

[email protected] [email protected]

3

1