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Lowering the Teen Birth Rate in Texas

Armed with PRC Tools and Tactics, Houston Communities Fight a Winnable Battle

December 2010

Maribel and Jorge Cruz

Sources of Advice
Maribel and Jorge Cruz of Houston, Texas, speak with teens and their families about setting goals, making choices, and planning for the future.

Maribel and Jorge Cruz of Houston, Texas, were high school sweethearts in 2006 when they learned they were expecting a baby. Now they work as partners of the University of Texas Prevention Research Center (UTPRC), telling teens about how they married, had their son, graduated, and work to support their family. Together with the PRC, the Cruzes hope that guidance, support, and education can help Texas teens think about their own futures, and at the same time, help bring schools, parents, and communities together to lower a state teen birth rate that is the third-highest in the nation.

“Sex is a difficult topic to discuss, especially in school,” said Mr. Cruz. “But this communication is necessary because so many students are sexually active today.”

Texas state data from the 2009 Youth Risk Behavior Surveillance System (YRBSS) show that 52% of high school students have had sexual intercourse, and that among sexually active teens, 42% did not use a condom during the last time having sex. On the basis of the YRBSS data and findings from other studies, the UTPRC estimates that in Texas, more than 825,000 students in grades 6 to 12 are having sex each year.

These data prompted researchers at the UTPRC to find ways to support community education about teen pregnancy prevention. One result of their efforts—and the cornerstone of the support the center offers—is an effective intervention called It’s Your Game: Keep It Real, which combines in-class instruction with lessons students can access online. In a middle school study reported in the Journal of Adolescent Health, students who did not participate in It’s Your Game were 1.29 times more likely to start having sex by the 9th grade than students who received the program. Lessons include information about puberty, reproduction, anatomy, healthy relationships, setting personal limits, use of condoms and contraception, and consequences of sex. In each of two years of middle school, students receive 12, 50-minute lessons through videos, interactive games, illustrations, and animations. In groups, students participate in role playing, discussions, and other activities; each student also keeps a journal and participates in individual activities as well.

“The lessons in the program are designed to help students select limits about their sexual behavior, detect instances when it may be hard to abide by their own rules, and learn strategies to help students protect their limits when they feel pressured to abandon them,” said UTPRC director Susan Tortolero, PhD. Developing a plan to “select, detect, and protect” becomes the student’s “game” referenced in the program title.

Picture of Cynthia Roesler

Health Class in Houston
Before her 8th graders start the human sexuality portion of health class, teacher Cynthia Roesler gives them a pretest, "to show what they don't know and what they think they know," she says.

“It’s Your Game really is a useful classroom tool,” said Cynthia Roesler, a health and physical education teacher at Lanier Middle School in Houston. “Students can find up-to-date information they need, and they really love the computer-based lessons.”

Ms. Roesler, a 33-year veteran of the classroom, added that the materials can be incorporated into her lesson plans, and she encourages her students to discuss the information with their parents at home. The PRC is developing a completely online version of the program, to widen its reach into communities wanting to make it available.

A System to Support Decision Making

The PRC offers the program to communities to use for free and is developing an online decision support system to help parents, school boards, teachers, faith-based leaders, and other community members decide if they want to use the evidence-based sexual health program to help educate their young people. The decision-support system provides teen birth statistics, introduces evidence-based programs, and gives information about their effectiveness. PRC researchers note that within a particular school district, administrators may want to provide programs about healthy sexuality and avoiding teen pregnancy and sexually transmitted infections, but they may have questions about what information is most helpful to young people or what the state of Texas requires by law. The decision-support system is being designed to answer frequently asked questions and to give information about available resources.

Melissa Peskin, PhD, associate director of evaluation at the Houston PRC

Mom, Dad, and Sex Ed Classes
Melissa Peskin, PhD, associate director of evaluation at the UTPRC, presents results of a PRC parent poll to participants of the September 2010 meeting of the Harris County School Health Leadership Group. Meeting attendees, many of whom were teachers, nurses, and other staff members working in the county's schools, said they wanted to share the information with district board members and administrators.

“We are not promoting It’s Your Game as the sole remedy for teen pregnancy in Texas,” said Dr. Tortolero. “We are trying to educate parents, teachers, school officials, and community leaders about teen pregnancy and the benefits of interventions shown to be effective.”

The decision-support system gives choices to help decision makers select the best fit for the needs and perspectives of each community. While the decision-support system is in development, the PRC offers support to the Harris County School Health Leadership Group, an organization of teachers, nurses, and other school staff working in Houston’s school districts. At the members’ request, the PRC staff attend meetings and share information, including maps that show the teen birth rate in the areas where their schools are located. Other information includes drop-out rates and lost school funding, and results from a recent survey of parents that showed a majority of respondents wanted more education about healthy sexuality provided in school. The PRC and the School Health Leadership Group discuss topics such as school policies about teaching sexuality and interpretation of Texas state laws that regulate lesson plans on sexual health.

“Getting approval to provide It’s Your Game in our school district has been a long process,” noted Rebecca Fuchs, director of Health/Health Fitness in Houston’s Spring Branch Independent School District, which has nine middle schools, four district high schools, and two charter high schools. “We have been working through the approval process for over 18 months so far. Along the way, we have been using helpful resources to educate ourselves about teen pregnancy in our neighborhoods and what we can do to help. We have a recent PRC survey, for example, that found 75% of area parents want programs like It’s Your Game provided to their children in school. And we also have the maps of teen births. When people see the map of their own zip code, their jaws drop.” (See a map of teen birth rates [PDF - 330KB] by Houston-area zip codes.)

"We believe we have the tools to lower teen pregnancy. CDC is determined to continue progress in preventing teen pregnancy so that all young people can discover their potential and take advantage of options open to them," said CDC director Thomas R. Frieden, MD, MPH.

How Teens Can Help

Dr. Tortolero added that teens also provide valuable information. A teen advisory board, for example, teaches the PRC staff how to present educational material in ways interesting to students. Through a youth program called Teen Scene Investigators (TSI), PRC researchers and partners develop community activities to lower teen pregnancy rates. The newest TSI group, for example, wants to help bring a teen-focused medical clinic to a Houston neighborhood that does not have one. The TSI team plans to survey parents, teens, and other community members to determine their interest in having a clinic nearby. TSI members will then share any positive survey results with decision makers at local health care providers to encourage them to make the facility available.

“The clinic would provide a lot of the services people my age need—like counseling, testing for pregnancy and sexually transmitted diseases, medical checkups, and even prenatal care for young women who are already pregnant,” said TSI participant Javier Lopez, 14.

Teen Scene Investigators Javier, Patricia, and Antonia Lopez

Important Perspectives
Teen Scene Investigators Javier Lopez and twin sisters Patricia and Antonia Lopez are working to bring a teen-focused medical clinic to their Houston neighborhood. The first step will be creating a survey to gauge residents' support for the facility.
 

Twin sisters Patricia and Antonia Lopez, 15, added it can be difficult for teens to know how to approach parents and adult family members for guidance. The PRC helps support healthy family discussions through training programs for parents and teens, and they hope that a new clinic would be another place in their neighborhood that could help family members speak effectively with each other about sex.

“Family communication is so important,” added Maribel Cruz. “But when family members are not talking to each other about sex, it can be really difficult to get the conversations started about staying healthy, making good choices, and thinking about the future.”

A Promising Future

When the Cruzes talk about their own future, conversations turn to education and careers. Because Mr. Cruz has always been interested in computers, he is working toward a college degree and work in a technical field. Ms. Cruz said that over the last few years, her goals have changed.

“When I was in high school, I was hoping to have a career in the fashion industry. But now that I have worked as a youth counselor, I want to continue in this field, get my master’s degree, and help teens for the rest of my life,” said Ms. Cruz, who has become a promising recruit in the fight against teen pregnancy, one of CDC’s six Winnable Battles. The term describes health priorities CDC identifies as having public health impact and prevention strategies known to be effective.

"There are so many lessons that teens need to learn. We need to know the basics about sex, but we also need to know how to develop our self-control, understand the consequences of our actions, protect ourselves, and find the right people for advice. This knowledge can help us think twice before we do something we'd regret later," said Teen Scene Investigator Javier Lopez.

"We believe we have the tools to lower teen pregnancy," said CDC director Thomas R. Frieden, MD, MPH. "CDC is determined to continue progress in preventing teen pregnancy so that all young people can discover their potential and take advantage of options open to them."

The PRC is receiving additional support through funding by the Department of Health and Human Services' Office of Adolescent Health, in a project called Teenage Pregnancy Prevention: Replication of Evidence-based Programs. Through this initiative, PRC researchers will receive $3 million a year for 5 years to make It’s Your Game available in 113 middle schools and to continue to assess its impact on students’ health.

“There are so many lessons that teens need to learn,” said TSI member Javier Lopez. “We need to know the basics about sex, but we also need to know how to develop our self-control, understand the consequences of our actions, protect ourselves, and find the right people for advice. This knowledge can help us think twice before we do something we’d regret later.”

For information about the intervention study, see Tortolero SR, Markham CM, Peskin MF, Shegog R, Addy RC, Escobar-Chaves SL, Baumler ER. It’s Your Game: Keep It Real— delaying sexual behavior with an effective middle school program. Journal of Adolescent Health 2010;46:169–79.



Teen Pregnancy Rates and Results

The United States leads the industrialized world in teen births. By state, Texas ranks third in the nation for teen births. In 2004, the most-recent year for which data are available, Texas was ranked number one in repeat teen births (24% statewide vs. 20% for the nation as a whole).

 

FactorTexasNational
Birth Rates Per 1,000 Girls Aged 15-19 in 20076443
Change in Birth Rate Among Girls Aged 15-19
1991-2005-21%-34%
2005-20074%5%
High School Students Who Have Had Sex (2009)52%46%
High School Students Who Have Had Sex with 4 or More People in Their Life17%14%


Sources

United Nations Statistics Division. Demographic Yearbook 2007. New York, NY: United Nations; 2009.

Schelar E, Franzetta K, Manlove J. Repeat teen childbearing: differences across states and by race and ethnicity. Washington, DC: Child Trends; 2007; Research Brief number: 2007-23. Available from http://www.childtrends.org/Files/Child_Trends-2007_10_25_RB_Repeat.pdf [PDF - 380KB].

Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Kirmeyer S, Osterman MJK. Births: final data for 2007. National Vital Statistics Report 2010;58(24):Table B [PDF - 1.8MB].

Centers for Disease Control and Prevention. 2009 Youth Risk Behavior Survey. Available at: www.cdc.gov/yrbss.

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A National Initiative

Through the nation’s Teen Pregnancy Prevention Initiative, the Department of Health and Human Services’ Office of Adolescent Health will allocate a minimum of $75 million to help communities implement interventions they select from a list of 28 teen pregnancy prevention programs found to be effective.

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