sexual health

Public health officials call on HHS to restore grant funding for preventing teen pregnancies

kkrisberg — Tue, 22 Aug 2017 16:19:42 +0000

Public health officials call on HHS to restore grant funding for preventing teen pregnancies

In July, public health departments across the country got a letter from the Trump administration abruptly cutting off funding for teen pregnancy prevention efforts in the middle of the program’s grant cycle. The move means that many teens will miss out on receiving an education that could — quite literally — change the trajectory of their lives.

The abrupt funding cut — which came down without reason or explanation, according to grantees — also cuts off research efforts right at the evaluation stage. That’s the stage when public health practitioners rigorously assess a program’s outcomes, gather evidence of its effectiveness, and determine what works and what doesn’t. That’s exactly what we should want from our public investments — evidence, not anecdotes — and it’s exactly how you tackle a problem as complex and as costly as teen pregnancy. Teasing out the evidence is how we sort the aspirational from the effectual.

And determining what works to prevent and reduce teen pregnancy is a worthy endeavor. According to the Centers for Disease Control and Prevention, while the U.S. teen birth rate recently hit a record low — the birth rate among young women ages 15 to 19 dropped 8 percent between 2014 and 2015 — the U.S. is still home to one of the highest teen pregnancy rates in the industrialized world. And that rate comes with impacts, including upping the risk that teen girls won’t graduate from high school, which has a generational domino effect in and of itself, as well as racking up billions in societal costs related to health care, foster care and lost tax revenue. Plus, nearly all teen pregnancies are unplanned, which makes investing in their prevention sound public policy.

At a news conference held earlier this month and hosted by the Big Cities Health Coalition (BCHC), health officials from cities on opposite coasts — Baltimore and Seattle — spoke about the importance of preventing teen pregnancy in their communities and the on-the-ground impact of abruptly losing federal funding that had already been awarded and appropriated. Both the Baltimore City Health Department as well as Public Health — Seattle & King County are among the 81 grantees who received a letter from the U.S. Department of Health and Human Services (HHS) in July saying the five-year grant they’d already been awarded through the agency’s Teen Pregnancy Prevention Program would be ending two years early, in 2018 instead of 2020.

Both Leana Wen, Baltimore’s health commissioner, and Patty Hayes, director of Public Health — Seattle & King County, said there was no dialogue, discussion or explanation for the funding cut. The announcement didn’t even come in a special notice. Instead, both health officials found out about the cut when they received their usual, yearly notice-of-award letter in which the end date had been pushed up by two years. Hayes said Seattle’s program manager quickly reached out to HHS for an explanation and was basically told the agency was moving on to implement the cuts.

“It’s just an arbitrary decision that we’re trying to appeal,” Hayes said during the BCHC news conference.

Hayes and Wen are among 20 public health officials from around the country who signed onto a BCHC letter to HHS Secretary Tom Price asking him to reconsider the cuts. Also, in July, Democratic senators wrote to Price asking him to explain his plan to “unilaterally” cut the teen pregnancy prevention grants short. The letter states:

Since the start of the grant projects and prior to the recent notification of early termination, (the HHS Office of Adolescent Health) has ensured the program includes high quality implementation, rigorous evaluation, innovation and learning from results. The pace of progress has accelerated dramatically since the federal investments in evidence-based teen pregnancy prevention began. Since 2010, pregnancy rates among 15- to 19-year-olds has declined by 41 percent nationwide — more than double the decline in any other six-year period since rates peaked in 1991 — and is at a historic low. Seventy-five percent of pregnancies among this population remain unintended. The (Teen Pregnancy Prevention) Program has been proven to support young people in delaying sexual initiation and adopting sexual health behaviors that help them avoid unintended pregnancy.

In Baltimore, the grant termination means a cut of $3.5 million, which means 20,000 students in grades seven through nine will lose access to comprehensive reproductive health education, Wen said. The funding cut also means the agency won’t have the resources to continue training teachers or members of a local youth advisory council that does peer-to-peer education.

Wen said Baltimore has made huge progress in reducing its teen birth rate — it fell by 44 percent between 2009 and 2015. She’s worried that losing any ground on that front will only lead to fewer educational and economic opportunities for Baltimore youth, fewer young women graduating from high school and greater public costs to the community.

“We should be doing everything we can to empower youth to succeed and thrive,” Wen said during the BCHC news conference. “We see the impact in our cities, and we urge the federal government and HHS to reconsider this drastic cut, taking into account the future of all of our youth across the country.”

In Seattle and King County, where teen pregnancy rates have gone down by more than half since 2008, public health officials were using their $5 million Teen Pregnancy Prevention grant to evaluate the effectiveness of a sexual health curriculum they recently updated called FLASH, which includes a variety of strategies to help reduce teen pregnancy, sexually transmitted diseases and sexual violence. During the BCHC news conference, Hayes said FLASH has been used all over the U.S. and the world, with about 80,000 FLASH lessons downloaded in the span of just one year. She noted that the curriculum is designed to be inclusive of LGBT students and is just as relevant for young people who decide to abstain from sex as it is for those who don’t.

However, Public Health — Seattle & King County hadn’t had the chance to rigorously evaluate the curriculum to tease out its exact impacts, such as whether it increased the number of students who delay sex or the number of young people who practice safe sex. That’s what it was using its HHS grant funding for – to measure the effectiveness of the curriculum. The public health agency had already recruited more than two-dozen schools in multiple states to take part in the evaluation; thousands of students participated in the FLASH curriculum and an independent evaluator was hired to analyze the outcomes.

But now that HHS has shut down the grant funding early, that data will be lost. Hayes said she believed there was a “good chance” the evaluation would have shown that FLASH does, indeed, make a positive difference in young people’s lives. Without such evidence, however, it may become more difficult to persuade schools to adopt the curriculum. Hayes said her agency has filed an administrative appeal with the HHS Office of Adolescent Health in the hopes of getting the funding restored.

Hayes said she believes the funding cut is due to both across-the-board budget cuts, but also to an ideological shift on how to address teen pregnancy.

Beyond the particular efforts that the HHS grants were supporting, the abrupt funding cuts also impact both agencies’ overall capacity to prevent teen pregnancy in their communities. In Baltimore, Wen said the funding gap will “create a huge hole in our ability to deliver services.” At Public Health — Seattle & King County, Hayes said the grant supported a significant portion of the agency’s teen pregnancy prevention efforts.

“It does shrink our program,” Hayes said, “and so it’s not without great implications.”

Visit CDC to learn more about the benefits of investing in teen pregnancy prevention.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

kkrisberg Tue, 08/22/2017 - 12:19

CDC: Rates of sexually transmitted diseases going up in the U.S.

kkrisberg — Tue, 17 Nov 2015 16:55:10 +0000

CDC: Rates of sexually transmitted diseases going up in the U.S.

For the first time since 2006, cases of chlamydia, gonorrhea and syphilis are on the rise, according to new data from the Centers for Disease Control and Prevention. The agency reports that while the sexually transmitted diseases continue to impact young people and women most severely, the recent increases were driven by rising disease rates among men.

Released just today as part of CDC’s Sexually Transmitted Disease Surveillance 2014 report, the data finds that chlamydia cases are up 2.8 percent since 2013; primary and secondary syphilis (the most infectious stages of the disease) are up 15.1 percent since 2013; and gonorrhea is up 5.1 percent since 2013. It’s important to note that these numbers are based on reported cases, whereas many cases go unreported and other types of STDs, such as herpes and human papillomavirus, aren’t regularly reported to CDC. STDs cost the U.S. $16 billion in health care costs every year and are often preventable.

“America’s worsening STD epidemic is a clear call for better diagnosis, treatment and prevention,” said Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and Tuberculosis Prevention, in an agency press release. “STDs affect people in all walks of life, particularly young women and men, but these data suggest an increasing burden among gay and bisexual men.”

Digger deeper into the new surveillance data, CDC reports that cases of chlamydia and gonorrhea are highest among young people ages 15 to 24. However, young women face more serious long-term effects from such infections, with researchers estimating that undiagnosed STDs result in more than 20,000 women becoming infertile each year. Rates of syphilis have gone up among both men and women, however men account for more than 90 percent of primary and secondary syphilis cases. Syphilis rates are significantly higher among gay and bisexual men. And more than half of men who have sex with men who were diagnosed with syphilis in 2014 were also living with HIV — a data point that’s particularly concerning as syphilis can make it easier to transmit and become infected with HIV.

However, CDC reports that young people remain at highest risk for acquiring an STD, particularly chlamydia and gonorrhea. In fact, young people ages 15 to 24 accounted for almost two-thirds of all reported cases of chlamydia and gonorrhea in 2014. CDC experts say that despite recommendations that sexually active youth be regularly screened for STDs, far too few young people are actually getting tested.

In response to the new data, the National Coalition of STD Directors noted that proposed federal budget cuts now in Congress “would likely end CDC’s ability to fund all state health departments for STD prevention and control.” Earlier this year, for example, a funding bill that got through the Senate Appropriations Committee included a 20 percent cut to CDC’s Division of STD Prevention. Public health departments play a critical role in STD prevention and control, providing confidential screening services and referrals, education, contact tracing and disease surveillance. In fact, health department-run clinics are often able to reach a community’s most vulnerable residents and those who might otherwise go without testing and care.

"These shocking and ever-increasing STD rates are a real clarion call for action," stated William Smith, executive director of the National Coalition of STD Directors. "This is a time when the health care delivery system needs public health leadership and additional investments in this work are required to ensure this leadership. Cuts to our public health system at the federal, state, and local levels have eviscerated its capacity and this diminished capacity of the public health system simply cannot adequately address STD increases of this magnitude."

Visit CDC for a full copy of Sexually Transmitted Disease Surveillance 2014.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

kkrisberg Tue, 11/17/2015 - 11:55

The causal elephant in the room: Global warming.

All hail, school sex ed.!

See Noevo, for once, you're right. When young people have no chance to learn safe sex practices, then we really shouldn't be surprised when rates of STDs go up.

While America's puritanical roots are partly to blame, the Senate cutting funding is only going to make the problem much, much worse.

Yes sn, you and your religious friends can take great pride in the fact that your efforts to keep teens ignorant about sex and taking precautions have come to fruition by resulting in an increase in STDs. You must be proud of your horrible self and disgusting religious views.

What a shame, STD rates are on the rise and the only thing our government seems capable of doing is to cut funding in the areas that need it the most. Too many underestimate the power of prevention. Consequently, the inadequate focus on disease prevention will only lead to greater morbidity, a lower quality of life, immeasurable health costs, and excessive resource consumption.

Massachusetts study: High demand for publicly funded family planning services, despite near universal insurance

kkrisberg — Fri, 07 Feb 2014 14:54:29 +0000

Massachusetts study: High demand for publicly funded family planning services, despite near universal insurance

Higher insurance rates don’t mean people stop seeking care at publically funded health centers, found a recent study of family planning clinics in Massachusetts. The findings speak to serious concerns within public health circles that policy-makers may point to higher insurance rates as a justification to cut critical public health funding.

Published in the Jan. 24 issue of Morbidity and Mortality Weekly Report, the study examines trends among uninsured patients seeking care at Massachusetts health centers that receive Title X Family Planning Program funds. (The federal Title X program supports access to high-quality family planning and related preventive services for low-income women and men.) In Massachusetts, which passed health reform legislation in 2006 and is often cited when trying to predict future impacts of the Affordable Care Act, researchers found that higher rates of people with health insurance had little effect on patient numbers at Title X-funded clinics. The study also found that the clinics continue to serve as a critical safety net for uninsured residents.

In addition to family planning and contraceptive services, Title X-funded clinics provide breast and cervical cancer screening, pregnancy testing and counseling, education and referrals, and testing for HIV and other sexually transmitted diseases.

“As more people get insurance, some might think that there’s no longer a need for safety net programs, but we just haven’t found that to be true,” said Jill Clark, a co-author of the study and assistant director of the Family Planning Program at the Massachusetts Department of Public Health. “From the other research we’ve done, people say they feel like they receive quality care (at these clinics), that their services are kept private and their confidentiality is respected. These are organizations that people are familiar with.”

Clark and her colleagues found that between 2005 and 2012, patient volume at Title X-funded clinics remained high. In 2012, the state’s five Title X-funded health care organizations served 66,227 patients, which translates to 90 percent of their 2005 patient volume. Also from 2005–2012, the overall percentage of Massachusetts residents served by Title X-funded organizations and who did not have insurance dropped from 59 percent to 36 percent. In 2005 and among different clinic sites, the percentage of clients who did not have insurance ranged from 77 percent to 46 percent; in 2012, those without coverage ranged from 52 percent to 24 percent. All age groups experienced declines in uninsurance, with the greatest declines among teens and adults ages 20 to 29 years old.

The overall message? Despite Massachusetts’ near universal coverage rate — 97 percent of residents had insurance as of 2011 — Title X-funded clinics continue to be critical access points for both insured and uninsured residents seeking family planning care. Authors Clark, Marion Carter, Kathleen Desilets, Lorrie Gavin and Sue Moskosky write:

The results of this study indicate that in the six years following health care reform in Massachusetts, publicly funded providers continued to be used as providers of choice for many clients with health care coverage and remained as a "safety net" for uninsured persons in need of family planning services. …The continued provision of safety net family planning services is important not just for the individual clients accessing services at these organizations but for broader health equity goals as well. Adults aged 20–29 years experience the most unintended pregnancies of any age group in the United States, and these clients constitute a large proportion of clients seen by these health centers. Yet insurance coverage among these young adults lagged behind that of other age groups.

In addition to direct clinical services, Clark told me that Title X-funded clinics are also key to effective community outreach and prevention education. Because such clinics spend years cultivating relationships with the communities they serve and have reputations for providing confidential care, they’re often better equipped to reach vulnerable and at-risk populations.

“There’s always going to be people who are not comfortable going to primary care for these services,” Clark said.

William Smith, executive director of the National Coalition of STD Directors, agreed, adding that many people simply don’t want to use their primary care doctors for sensitive health problems, such as STD screening. Plus, he said, Title X providers are often sexual health specialists who can catch diseases other providers might not. For example, lots of private providers are probably familiar with common STDs such as chlamydia, but many have probably never seen a case of syphilis in their careers.

“People really do want confidential care when it comes to sexual health issues,” Smith told me. “They want competent care and publicly funded family planning clinics and STD clinics really are centers of excellence and people know it. They know they’re going to get quality care and have providers who know what they’re doing.”

Smith said Title X funding is essential to reaching at-risk populations and preventing STD infections — “this is what public health does,” he says. And while he can’t cite an exact cause-and-effect relationship, he did note that as Title X funding has declined, rates of STDs have gone up. According to the National Family Planning & Reproductive Health Association, between fiscal years 2010 and 2013, Title X family planning funds were cut by more than $39 million. As a result, Title X clients declined from 5.22 million to 4.76 million, with no indication that they found other sources of care. Ironically, the budget cut — like many public health budget cuts — won’t save money in the long run: Research shows that every $1 invested in publicly funded family planning saves $5.68 in Medicaid costs related to unplanned births.

Even if demands for clinical services do change, Clark said that public health’s role as a trusted source of information, education and support remains the same. For example, a large portion of CDC funds for breast and cervical cancer screening must go toward direct clinical services for the uninsured. But as insurance coverage rose in Massachusetts, fewer and fewer residents qualified for the screening program. However, there was still an “incredible need” for related services, Clark said, such as patient care navigation, insurance enrollment and case management. In response, public health workers applied for a waiver and were able to use the funds to support services that help women stay in care and manage their health.

As the Affordable Care Act ushers in higher insurance numbers nationwide, Clark said that the Massachusetts study offers real lessons for public health workers and policy-makers across the country.

“We really do think it’s useful for other states as they’re figuring out what health reform means to them,” she said.

To read the full Massachusetts study, click here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

kkrisberg Fri, 02/07/2014 - 09:54

But the clinics could take ACA plans to pay for the services. There is no reason since not to and it reduces the taxpayers cost. Nothing says a person could not self refer to the clinics on insurance.

I think also There is no reason since not to and it reduces the taxpayers cost. Nothing says a person could not self refer to the clinics on insurance.

It makes sense that the X-funded clinics are still in high demand even though most of Massachusetts has insurance. Even when people have insurance it doesn't always mean that their insurance will pay for all of their family planning services. As more teens are having unplanned children, family planning services are a great way to reduce this and also for the teens, or whoever else, to get these services anonymously. According to the US Department of Health and Human Services, there were 29.4 births per 1000 adolescents in 2012 I know many girls that I went to high school with that used these free clinics to get birth control without their parents knowing. Even though this may seem controversial, these girls would not otherwise get birth control because of parents' wishes. Getting free STD testing could also contribute to the continuing need of these services. People do not want to go to their family doctor to get these tests done because of embarrassment or other personal reasons. The other benefits of having these clinics are great, too. I agree with Lyle that the clinics could use the ACA to find some sort of payment for the clinics, and if not, these services still, and will most likely always be needed.

Send In The (Abstinence) Clowns

sciencepunk — Fri, 13 Mar 2009 09:43:17 +0000

Send In The (Abstinence) Clowns

For the last few weeks, community action site Amplify Your Voice have been chronicling the extraordinary vestiges of the Bush administration's disastrous policies on sexual health and education: Derek Dye, the Abstinence Clown.

Derek Dye is supported by Elizabeth's New Life Center, a Christian-orientated organisation that received a federal grant of $800,000 in 2007. Dye appears to be a little more reticent to wear these religious overtones during his talks, preferring instead to compare pre-marital sex to juggling with machetes.

For a person whose success depends upon popularity, it was strange then that Dye ordered YouTube to remove a video of him in action, spreading the message of abstinence to a group of middle school children. To their eternal credit, Amplify Your Voice have decided to host the offending video in the face of repeated legal threats from Dye and the New Life Center. What are these people so ashamed of? Aren't they proud of their covert religious piecemeal sexual education project? Is is the machetes?

During the video, the part I found most upsetting was seeing Dye compare premarital sex to juggling machetes over a prostrate child. He says:

You know what? I can't do it... ...Because if I juggle these machetes over him, there's risk. Something could happen. I could make a mistake... ...I tried to reduce the risk a little bit, by practising. But it doesn't matter how much I practice, an accident could happen. The only way I can completely eliminate risk of something happening to him, is if I put the machetes [away] and practice abstinence.

This to me is perhaps the most revealing explanation of the logic behind abstinence-only sex education, saying in essence: "be completely intolerant of risk. Do not take responsibility for yourself". This is the most depressing message I can possibly think of teaching children. Imagine that logic played to different circumstances:

Never go swimming, you might drown
The only way to eliminate the risk of crashing is to never learn to drive
Don't apply for that top college, aim low and surefire
Don't tell her how you feel, she might reject you

What a terrible world it would be if everyone lived according to these rules.

If I had one wish, it would be to see a sexual education programme that managed to instil one simple truth into kids' heads: if you're not in control of your sexual activity, you're at risk. Programmes such as Dye's are the complete opposite of this.

Abstinence-only programmes are the hallmark of a society that wants to see its children as completely innocent and chaste beings. That sadly just isn't true. It's ridiculous to believe that young men and women suddenly become responsible adults with the relevant working biology overnight on the cusp of their 16th birthday. And it's dangerous to behave as if that's the case. As we speak, Home Secretary Jacqui Smith has announced that the Government plans to investigate the sexualisation of young girls. It's a winner in terms of generating press, but what does this actually mean? Does Jacqui Smith plan to send morality squads into the bedrooms of 14 yr old girls to tear down posters of Robert Pattinson?

If you want further proof of the harm that people are willing to inflict on young women to protect them from their own burning loins, look no further than attempts by religious groups to prevent uptake of the HPV vaccine, designed to protect women against cervical cancer.

Thankfully, the Obama administration is looking like it will roll back many of the harmful sexual health policies instilled by Bush. However, it's still important that you write to your government and encourage them to ditch these failed practices. You can find out how to do this at Amplify Your Voice.

As for the abstinence clowns, perhaps you can find a new career path. After all, we still have many other laughable policies to promote.

sciencepunk Fri, 03/13/2009 - 05:43