NEEMA Funded Projects by Topic Area – Adolescent and School Health

Estimating the size of sexual minority adolescent populations — at national, state, and local levels— is critical for recognizing and responding to disparities in health risks and outcomes. This project combines data from several different sources, including the National Survey on Family Growth, American Community Survey, and Youth Risk Behavior Survey to estimate the size of sexual minority adolescent populations. Two extensions to this project will estimate (1) the size of the sexually active high-school-age population, and (2) the proportion of high school students identifying as lesbian, gay, and bisexual.

Teen-SPARC, an Excel-based tool developed under NEEMA 1.0, was designed to assist health departments in estimating the short-term impact of behavior change on the burden of sexually transmitted infections among sexually active high-school-attending adolescents in their jurisdictions. Teen-SPARC will be expanded to integrate additional behavior changes (e.g., delays in age at first sex), biomedical and clinical enhancements (e.g., screening, treatment, or pre-exposure prophylaxis), outcomes (e.g., pregnancy) and metrics (i.e., costs) to improve the value of this tool for health department staff.

In 2018, youth aged 13 to 24 made up 21% (7,807) of the 37,832 new HIV diagnoses in the United States. The goal of EHE to reduce new HIV infections by 90% in 10 years, includes reducing incidence among youth. This project aims to estimate the impact of HIV incidence among adolescents and to address the “Treatment” and “Prevention” pillars of EHE by quantifying their relative impact in terms of reductions in incidence. This project will also estimate the level of additional PrEP coverage needed to reduce incidence among adolescents over a ten-year period and will include simulations to determine expected increases in viral suppression and reductions in incidence if the continuum of care were to be improved to the degree demonstrated in empirical intervention studies.

This effort builds off a NEEMA/CAMP 1.0 project that assessed the impact of changes in risk behaviors on STI levels among adolescents. This follow-on project focuses on pregnancies expected over ten years looking at how behavioral changes contribute to trends, including delays in age at first sex and use of a wide range of types of contraception. The analysis estimates both the pregnancies and societal costs averted by each type of behavioral change.

Over the course of the COVID-19 pandemic, the US has seen a dramatic shift in the routines of daily life as we have worked to reduce transmission. One of the most dramatic shifts has been the reduction or elimination of in-person learning in many high schools, a change that may have influenced the spread of STIs among adolescents. School closures may have resulted in a decline in sexual contacts and thereby a reduction in the spread of STI, or conversely, may have provided an opportunity for social interactions to move to less regulated spaces where earlier or more frequent sexual contact may occur, thereby increasing STI transmission. This project will use two waves of the Youth Risk Behavior Survey (YRBS) and STI surveillance data to quantify the relationship between school closures and changes in sexual behavior among high school students or STI incidence, and possible unintended consequences of school closures.

Starting from March 2020 and through the 2020-2021 school year, many schools across the nation were forced to close for extended periods as a strategy to slow down the transmission during the pandemic. Shifting from in-person learning to virtual learning may have presented psychosocial stressors to students and parents. This study will measure the impact of school closures during the COVID-19 pandemic on students’ mental health, subsequent mental health service needs, and medical costs.

Modeling studies have demonstrated that PrEP use among adolescent sexual minority males can reduce new infections and is potentially cost effective in high-incidence settings; however, initiation of PrEP use among adolescents remains low nationwide. One potential barrier that adolescents face in accessing PrEP services is parental consent requirements for HIV testing and/or treatment. Even in instances where minors are allowed to consent for HIV testing or treatment, parental consent may still be required for PrEP services because PrEP is typically considered a prevention tool. It is important that PrEP services are easily accessible among eligible adolescents, given that as part of the Ending the HIV Epidemic in the U.S. (EHE) initiative, state and local communities (in partnership with CDC and other federal agencies) employ innovative strategies to increase access to and use of PrEP. This policy analysis looks at the relationship between the interpretation of parental consent for PrEP services among adolescents (“minor consent law”) and the initiation of PrEP services among minors in the 50 states and District of Columbia.

Estimating the size of sexually active adolescent populations at a sub-national level (e.g., county) would improve the local understanding of disease burden of sexually transmitted infections (STIs). These estimates would also facilitate comparisons of disease rates, such as HIV and syphilis, between men who have sex with men (MSM) and other populations. This project combines data from several different sources, including the National Survey on Family Growth, American Community Survey and Youth Risk Behavior Survey to develop state and county-level estimates for the proportion of the high-school-age population that is sexually active.