Negative Social Determinants of Health; How Can We Make an Impact?

By Samantha Lowe

At-risk youth have strong negative Social Determinants of Health (SDoH), which include conditions in which you are born, grow, live, work and age.  SDoH include biology and genetics, individual behavior, social environment, physical environment, and access of health services.

Supporting at-risk youth is of the utmost importance as they are less likely to have access to health care, health education, and formal sex education. Educating and equipping youth with personal safety, nutrition, and relationship skills, in a comfortable environment could be life changing, as at-risk youth are also more at risk for sexual violence.

A recent study conducted in Central Texas of youth enrolled in the Risk-Reduction Education about Abstinence, Contraception, and Health, or the REACH project (Wilson et al., 2018). 76 youth between the ages of 15-21 years, who were homeless, current or former foster youth, or youth who left high school prior to graduation made up the sample population (Wilson et al., 2018).

Across all groups (male, female, heterosexual and non-heterosexual), the most common topic that youth were interested in learning was Healthy Relationships and Personal Safety (Wilson et al., 2018).  Overall, youth reported wanting to learn about these topics from a nurse/doctor or a teacher, reporting that it is difficult to learn about these topics from a family member (Wilson et al., 2018). The least preferred type of educators across all groups was a Faith Based Worker, while the mode of learning across all groups was the same, youth preferred to learn in a small group class setting (Wilson et al., 2018). In a surprising result, the least preferred mode of sexuality education was learning over technology, this included apps and text messaging (Wilson et al., 2018).

Supporting at-risk youth includes listening to their educational preferences, developing innovative programs and creating new ways to engage youth within the process. This does not stop or begin with sex education, it begins with supporting the child and the community. Keeping at risk students active, engaged in community activities, and informed on health risks and supports can begin in the classroom but needs to be continued once the students leave school. For example, relationships can be a difficult topic to cover in classroom and most learning opportunities about the topic are environmental, making out of school community supports a key factor (Wilson et al., 2018).

Triple Play delivers on the belief that whole child health fosters young people’s ability to gain diverse knowledge, skills, and protective factors that enable them to overcome barriers to wellness and positively impact their future health. Triple Play provides health promotion, which encompasses health education, health literacy and a range of social and environmental interventions designed to benefit and protect health and quality of life.
— Boys and Girls Clubs of America

An organization who has been working to help at risk student populations is the Boys and Girls Clubs of America, they have been implementing a program titled, TRIPLE PLAY: GAME PLAN FOR MIND, BODY AND SOUL, a program designed to support youth who are raised in areas with poor SDoH.

The Boys and Girls Clubs of America continue to run research on how well the program is working, more information on the program along with statistics and research findings can be found at the link below!

https://www.prnewswire.com/news-releases/boys--girls-clubs-of-america-and-anthem-foundation-improve-health--wellness-factors-among-todays-youth-to-create-healthier-future-generations-300661679.html

Citations:

Wilson, K., Maness, S., Thompson, E., Rosen, B., McDonald, S., & Wiley, D. (2018). Examining Sexuality Education Preferences Among Youth at Risk for Poor Sexual Health Outcomes Based on Social Determinants of Health Factors. American Journal Of Sexuality Education, 1-14. doi: 10.1080/15546128.2018.1447414

An Argument for Media Literacy within Middle School Sex Education

By Samantha Lowe

Media literacy refers to the ability to check if your source is creditable and ensure the information you are reading is accurate and based in science. And, it’s becoming increasingly more important. The skill of media literacy should be applied to all information you read on the internet but often people tend to believe whatever they read, credible or not. We often address “fake” news/information in adult populations, but what about adolescents? Young teens and teens are even less aware of the need to check the credibility of the information they are receiving.

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I recently read the article “Why Can’t We Just Have Sex?”: An Analysis of Anonymous Questions About Sex Asked by Ninth Graders, this article focused on urban 9th grade students of mostly Latino and African American decent (N=645). Students were asked to write down any question about sex they would like to have answered during their sex education course. While this article shined light on what adolescent students want to learn during a comprehensive sex education course, it had some important and shocking unintentional results (Pariera and McCormack, 2017). For example,
- The number of young people who claiming to have learned about birth control has DECREASED in recent years (Pariera and McCormack, 2017);
- One third of all educators with the task of teaching sex education do not receive any special training (Pariera and McCormack, 2017);
- Less than half of the young people say they learned how to use a condom or information on where to get birth control (Pariera and McCormack, 2017); and
- 37% of all questions asked indicated some form of misinformation (Pariera and McCormack, 2017).

A 2004 report found that 11 of the 13 common used sex education curricula were inaccurate, containing falsehoods about HIV, abortion and birth control (Pariera and McCormack, 2017). Students are leaving sex education courses with no skills applicable to real life scenarios, they are often also not able to differentiate between real and false information and have no functional skills.

Youth in the United States are expected to wade through countless encounters with false information and come out with all the right information. That seems unreasonable when modern adults are not able to accomplish the same task. With recent studies showing that sex education curriculum problems are impeding student access to accurate and practical information that could be beneficial to them (Pariera and McCormack, 2017). It is time to begin equipping students with the ability to differentiate between factual and false information, it also time to begin funding specialized training for educators who will be teaching sex education courses. Equipping educators with media literacy skills and the ability to address and correct misconceptions from students.

Source:
Pariera, K. and McCormack, T. (2017). “Why Can't We Just Have Sex?”: An Analysis of Anonymous Questions About Sex Asked by Ninth Graders. American Journal of Sexuality Education, 12(3), pp.277-296.

Supporting K-12 Schools to #TeachThem in a Time of #MeToo

By Liz Thorne

The #MeToo movement has shown the extent to which acts of rape, sexual violence and sexual misconduct permeate the lives of countless women, as well the people and institutions that allow it to perpetuate like an “open secret”. Last month, the news of allegations of sexual misconduct against Asis Ansari added a new dimension to the #MeToo discourse. There was a debate about whether the actions of Asis belonged in the same conversation as the actions of Harvey Weinstein or Larry Nassar. But folks working in the field of sexuality education knew that it did.

While I was consuming all of this in my news feed, I just kept thinking to myself, “This is why we need more comprehensive sexuality education in every school in every town starting from preschool through higher education!” According to the Guttmacher Institute, fewer than half the states require schools to include the topic of “avoiding coercion” as part of a sexuality education program and similarly, a majority don’t require discussion of healthy relationships. But teaching young people about healthy relationships is the primary prevention for sexual violence because it’s centered on breaking down gender stereotypes, setting healthy boundaries, communication, and that consent is more than just “not hearing no”.

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There are states and school districts that are using this as an opportunity to strengthen laws and policies around sexuality education. The Sexuality Information and Education Council of the United States (SIECUS) has developed a toolkit to support educators to advocate for policies that support comprehensive sexuality education. They also created the partner #TeachThem movement to build on the awareness that #MeToo has brought to the need for stronger comprehensive sexuality education. But even states with strong policies struggle with implementation due to a lack of funding for professional development for teachers and administrators.

This is why I’m so proud to be supporting a school district with funding from Advocates for Youth to develop a sexuality education plan of instruction K-12 inclusive of policy, scope and sequence and training/professional development. Earlier this month we held a meeting with folks representing: education, public health and child welfare at the state level; school administrators; district staff; county public health; community based organizations that provide culturally specific sexuality education; university; LGTBQ rights; and sexual assault/violence prevention.  The group came together to critique the first draft of a district sexuality education policy. We envisioned a policy that codifies instruction that is not just developmentally appropriate and science-based, but inclusive and trauma-informed. A policy where school level data are used to guide instruction, and teachers are enthusiastic and equipped to teach sexuality education through strong professional development and support from an incredible network of community partners. There is so much more work to do, but I left this meeting filled with energy and hope.   

I salute these and other professionals, sexuality educators, young people, teachers, administrators and advocates across the country working to strengthen sexuality education. Our work has never been more important or needed.

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An Article Review: "We Talked About Sex." "No, We Didn't": Exploring Adolescent and Parent Agreement About Sexuality Communication

By Samantha Lowe

Adolescent perceptions of parental interactions do not get as much attention as they deserve, gone are the days of the common "because I said so" parent reasoning, it is now time for open, honest, and factual conversations about sex and contraception.  Speaking with your adolescents about sexual encounters is important, currently over 40% of adolescents report they had sex before any conversation with their parents about contraception  (Grossman et al., 2017).  Research has shown that having a conversation with your child in early adolescence can post-pone sexual activity along with reducing risky sexual behaviors (Grossman et al., 2017). 

Recently, an article was published in November of 2017, using qualitative and quantitative data to compare thoughts and feeling of 27 parent and adolescent dyads in relation to a discussion about sexual topics.  Agreement between the dyad was analyzed and then given a low, medium, or high agreement rating. Adolescents and parents who had high agreement were more likely to report positive parental approaches to sexuality communication and awareness of parental perspectives (Grossman et al., 2017). 

What were the authors trying to get them to agree on? Basically… if the conversation happened. Nine topics were outlined, and adolescents and parents were presented with open and closed ended questions, these topics included; puberty, the biology of pregnancy, when it's okay to date, avoiding STI's, condoms, when it is okay to have sex, religious beliefs and sex, adolescent pregnancy, and LGBTQ issues (Grossman et al., 2017). Interview questions also addressed perceptions of parental messages about sex, comfort talking with a parent about sex, and perceptions of parental rules for dating and sexual behavior (Grossman et al., 2017). Dyads were divided into high-(6-9), medium-(3-5), and low-(0-2) match groups based on agreement of the nine outlined topics and the adolescents’ perceptions of the quality of the conversation (Grossman et al., 2017).

Demographics: Dyads consisted mostly of mothers and adolescent children, keeping the psychological trend of the "not likely to participate in the study" father alive. Out of 27 dyads, 25 included the mother while the remaining 2 included the father. Twelve dyads (44%) included adolescent females, with an adolescent mean age of 12 years, 19% of the adolescents reported already having sexual intercourse.  52% of dyads self-reported as African American, reporting a moderate level of religious importance  (Grossman et al., 2017).

While dyads were analyzed results focused on the adolescents perception of the conversation, it is the adolescents perceptions, not the parents, that are going to shape their experiences and behaviors (Grossman et al., 2017). Even if a parent believes they are communicating effectively, the perception of the adolescent can be completely different. Focusing on the adolescents perception is key, if they do not feel like the communication was effective then the positive consequences from the discussion (delayed sexual involvement and lowered risky sexual behaviors) could never manifest.

Results: No dyad reported agreement of having discussed all nice topics, the highest level of dyad agreement on if a topic was discussed was for puberty (74%), followed by dating and LGBTQ issues (56%). Lower levels of agreement included religious beliefs about sex (15%), readiness for sex and teen pregnancy (33%) (Grossman et al., 2017). The fact that 56% of dyads had discussed LBTQ issues and only 15% had discussed religious beliefs about sex was amazingly shocking to me, I would like to see how these results changed in an a strictly Appalachian sample. I would predict that the numbers would be reversed, with more conversations about religion and less about LGBTQ culture.  Based off the research I conducted in graduate school I suspect this percentage would be MUCH lower as about 25% of my Appalachian participants did not know how to identify their own sexuality and struggled with the difference between "Asexual" and "Heterosexual". Further research needs to be done within specific sub-populations.

Three main themes became apparent from adolescent responses related to their experience with sexuality communication with their parent: Comfort with sexuality communication, Responses to parents viewpoints, and Awareness of parental perspectives (Grossman et al., 2017). Results when on to show that dyads in the high match group expressed a more positive parental approach, agreed with their parents viewpoints, and could explain why their parent held their viewpoints. Parents were open, honest, and practiced good listening skills (Grossman et al., 2017).

Adolescent quotes from the high match group included:

  • "My Mom is just like all out and makes sure I know everything"
  • "I am very comfortable because she has all the information"
  • "She tells me what happened and why it happened, because it happened to her"
  • "I think it is smart of her, she doesn’t want me to get the wrong information"
  • "My Mom is overreactive because she got pregnant at a young age and she does not want me to do the same and miss out on educational opportunities"

Low match groups exhibited poor listening skills and adolescents felt like parents did not give adolescents enough credit for their understanding of the topic, and their uncomfortableness of speaking about the topic was obvious to the adolescent (Grossman et al., 2017).

Low match adolescent quotes included:

  • "Because she makes jokes about everything"
  • "They talk about it like it is a bad word, like you shouldn’t talk about it and you shouldn’t be doing it"
  • "They talked to me in kiddie talk and say it like I am a little kid"
  • "I don’t think they know about STI's, they only know about the simple ones"
  • "My Mom doesn’t know much about condoms because I don’t think she has used one"
  • "They are too overprotective, I don’t think that they know that I do understand and want to make the right decision"

Topics of dating and puberty seemed to be easier for parents to discuss with their adolescents while topics of pregnancy and contraception seemed to cause some uneasiness in the parent (Grossman et al., 2017). Results in this study show that uncomfortableness, inability to explain why they hold their views and ineffective listening on the parents’ end can doom the conversation. These findings support sex education courses that include both parents and adolescents with in the middle school setting. These programs can provide support for topics of potential discomfort and encourage the parent to be open despite their hesitancies. These courses also open the floor for more than one conversation about sexual topics, as following up about what was heard in the conversation can reduce gaps in communication (Grossman et al., 2017).

The study needs to be replicated with a larger N than 27 so the results are more generalizable. It would be interesting to compare cross cultural agreement and topics between dyads. From previous research we understand some cultural differences, for example in the Netherlands romance and consent are two highly discussed topics between adolescent and parent dyads, which is a stark difference from the typical abstinence, STI, and pregnancy topics covered in American dyads (Grossman et al., 2017).)

The sample was a convenience sample which comes with its own problems, but I don’t believe they need to be discussed. However dyads were thrown out of the study when the parental figure identified as another adult family member. In my opinion, this should not have made a difference as they are still the person who is likely to have this conversation with the adolescent. Future studies should include these dyads as modern families are not likely fit the cookie-cutter mold of the typical nuclear family.

Citations:

Grossman, J., Sarwar, P., Richer, A. and Erkut, S. (2017). “We Talked About Sex.” “No, We Didn't”: Exploring Adolescent and Parent Agreement About Sexuality Communication. American Journal of Sexuality Education, 12(4), pp.343-357.

What Do We Value?

By Liz Thorne

I have always worked in a job dedicated to service to others that is mission-driven. Here at Cairn Guidance, our mission is to create places of health and well-being where all youth are healthy, connected, educated and reaching their full potential. I’m willing to bet most people would agree this is a shared value. But how we get there is where we see so much divergence.

The recent decision by the Administration to cut $213 million dollars in programs and research to prevent teen pregnancy is a recent example of a policy that is not based in evidence or reason, and moves in the opposite direction of what we know works in preventing teen pregnancies. Here’s what we know.

Most young people will have sex before they are married. Regardless of whether you talk about it or not, young people will have sex before they graduate high school. Nearly half (41%) of high schoolers in the US have had sex.[1]

The teen pregnancy rate has been dropping for years. While rates of sexual activity have been stable, the teen birth rate has dropped precipitously for years. So what has changed? Studies point to increased use of contraception, including more effective methods like long acting reversible contraceptives (LARCs).[2] The American Academy of Pediatrics put out a policy statement in 2014 recommending LARCs as the first line contraceptive choice for youth who choose not to be abstinent. Another policy support- the Affordable Care Act required that insurance companies cover contraceptives like LARCs to make them more accessible and lessen the burden on publicly funded family planning programs.

Learning to navigate relationships, intimacy and romance is part of growing into an adult. Being in a healthy relationship takes skills and skills take practice. Plus, too many young people find themselves in unhealthy relationships that can derail their potential. Many of the programs funded through the Office of Adolescent Health focused on helping young people identify healthy relationships, including consent and how to make healthy choices aligned with their values.  Quality comprehensive sexuality education covers healthy relationships (including consent and how to get help if you are in an unhealthy relationship); abstinence as a healthy choice for our young people, contraception and building skills (like communication and negotiation). However, many young people in schools across our country do not have access to comprehensive sexuality education.

We have too far to go to head in the opposite direction. Even as teen pregnancy rates declined for all populations, there are still differences based on race and class that must be addressed. At least 1 in 5 women are sexually assaulted while in college. Young people must have access to information, health services, and opportunities to develop skills to keep themselves safe, healthy and able to learn.

[1] Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System, 2015.

[2] Lindberg L, Santelli J, Desai S. Understanding the decline in adolescent fertility in the United States 2007-2012. Journal of Adolescent Health http://www.jahonline.org/article/S1054-139X(16)30172-0/pdf

College Student Creative Expression of Reproductive Topics, Including Abortion

By Samantha Lowe

During my graduate studies at Morehead State I was given the opportunity to further my research and analyze student's perceptions of birth control (birth control was not defined and included all forms of contraceptives) and abortion. This further analysis was presented at the Wilma Grote Symposium for the Advancement of Women at Morehead State University.

With recent political events, such as the magnificent Global Women's March, I felt it was time to revisit this subsection of my research.  What are young Appalachians' views on women's reproductive health? And does holding a politically conservative or liberal point of view influence opinions?

Metaphors for the selected reproductive health items: “Having an abortion is like” and “Taking birth control is like” were coded for use of negative, neutral or positive language. Negative language included violent imagery, while positive language included normalizing the event. Stimuli coded by 6 independent undergraduate students was checked for agreement by inter-rater reliability statistics.

Surprisingly, holding a conservative or liberal perspective had no effect on the amount of violent imagery used to respond to our abortion stimuli. While this may seem shocking as the two parties appear as opposites on this issue; it is the regions lacking sex education programs that lead young adults to see abortions as inherently violent, rather than the medical procedure that they are. The vast majority of participants responded with “murder” to our “having an abortion is like” stimuli, taking this into consideration it is possible that for the Appalachian region the word “murder” could potentially be classified as a Frozen Metaphor (Frozen Metaphor: has been so imbedded in common language that it now viewed as literal language). Below is a table of student responses.