STDs intervention program

HPPA 516 Public Health Assignment

Interventions to address STDs in adolescents and young adults in Corona, Queens

Jinjin Lin

Scope of the Problem

Many adolescents and young adults engage in sexual intercourse, often with multiple sex partners and without using condoms. There are 47.8% of high school students reported having had sexual intercourse, 7.1% of them reporting having had sexual intercourse for the first time before age 13. Although most adolescents do not have concurrent sex partners at any given point in time, the number of sex partners cumulates over time. Specifically, among high school seniors, approximately 22.4% reported having had sex with at least four different sex partners. Moreover, among sexually active adolescents, only 61.5% reported using a condom the last time they had sexual intercourse.

Young people are at greater risk of getting an STD for several reasons. For example, young people’s immature reproductive and immune systems make them more vulnerable to infection by various STD pathogens biologically; a lot young people do not get the recommended STD tests; and young people do not want to talk sex issues with their clinicians. Young people ages from 15 to 24 years account for nearly half of all new STDs cases, including HIV. If STDs are not treated, the infections may lead to serious complications including infertility, chronic pain, cervical cancer, and death. In addition, from an economic and social view, STDs also cost a lot. The lifetime medical costs of STDs acquired by youth ages from 15-24 are estimated $6.5 billion.

Internet is increasingly becoming ubiquitous among adolescents and young adults. Many young people tend to use the Internet to seek health information and meet new sex partners. However, little has been done to maximize the Internet’s potential as STDs prevention tool. Over 31% of young people are using the Internet to get health information, and 17% searching for information on health topics that are difficult to discuss with adults, such as drug use and sex. Regardless of household income, or race, young people represent the predominant demographic using the Internet.

Individual level interventions are insufficient over periods of time. Because adolescents and young adults interact more often with school, neighborhood system, and family, they can involve in to prevent sexual risk behaviors of adolescents and young adults and change behaviors. All adolescents and young adults are expected to benefit from these interventions, especially those are experiencing STDs and those are at risk.

Planning

Behavioral and environmental changes: overall to decrease sexual risk behaviors.
Delay first sexual intercourse
Reduce the number of sex partners
Decrease the number of times having unprotected sex
Increase condom use
Get hepatitis B and HPV vaccines
Improve awareness of STDs

These behaviors and environmental factors can be changed by educating adolescents and young adults. Education helps young people to take responsibility for their own health. Health programs in school and community and education from family can help youth adopt lifelong sexual attitudes and behaviors that support overall health.

Key stakeholders are health program directors and managers in school and community, funders, family members, and health care providers in Corona, Queens.
- Invite these stakeholders to a meeting, or series of meetings, depend on how much time they have available to spend with me.

At meeting, I will briefly describe my interventions and obtain a clear understanding of stakeholder interests, perceptions, and concerns relate to my interventions.

Involve stakeholders in key activities throughout the planning and implementation of evaluation, such as identifying and prioritizing interventions that need to be evaluated; and developing evaluation questions that are grounded in the perceptions, experiences and interests of stockholders.

To obtain additional information in Corona, Queens:
- Review existing STDs records of public schools and Corona community, need to get permission.
- Conducting sexual behavior surveys among adolescents and young adults in school and Corona community.

Funding:
Fund for Public Health NYC
New York Community Trust
NYC Department of Youth and Community Development
County Health Officials of New York
Astoria Corona District Health Center
Foresee my interventions program:
Based on feasibility standards, practical procedure and cost effectiveness, I think my intervention program can be feasible in the long run. The intervention program matches the goals of community health. Our goals are to seek to increase the skills of adolescents and young adults to avoid sexual risk behaviors. By teaching young people how to solve health problems, it also helps young people to develop positive connections with their parents, schools, and communities. And it mainly based on schools and family educations, which won’t cost a lot. The intervention will reduce sexual risk behaviors in the long term.

Development & Dissemination of the Intervention

Goals: Educational and behavioral intervention programs to reduce adolescent and young adults sexual risk behaviors in longer term.

Framework and inputs include:
Time: review community STDs records and conducting sexual behaviors surveys; meetings with stakeholders; design the educational information; conduct clinical services and implementation plan.
Funding: setting up community-based New Media channel; healthcare professionals online design sessions and answering questions; school-based health program education sessions and screening test cost; handouts and condoms display cost.
Physical space: school-based program need a lecture room or a class room to make modeling activities possible.
Confidential issues, especially for online consulting.

Interventions:
New Media technologies and many wireless technologies should be included in the interventions. A community-based specific channel is created for young people, which include general information about promoting safe sex and preventing STDs education. For example, show a video how to put on a condom correctly; and a media campaign to increase public awareness of STDs problems. Information should be distributed weekly and allow users (young people) to ask questions, give feedback and communicate with healthcare professionals anonymously after each session.
School-based STDs prevention program. Just as schools are important settings for preparing students academically, they are also critical for helping young people take responsibility for their own health. The educational session should be hold weekly and include modeling activities, such as how to begin a discussion about condoms with a sex partner; and role plays of communicating with sexual partners. In addition, school-based sexually transmitted disease screening. School health department has healthcare professionals available to screen STDs.
Family level intervention. Promote increasing communication between adolescents and parents about STDs prevention, and increase parental monitoring of adolescents and adolescents’ perceptions of enhanced parental monitoring. This leads to fostering a sense of increased family support as well. Family level intervention can be done at any time, does not need to restricted to a specific time.

Evaluation & Maintenance

Evaluation:
Evaluation criteria:
The number of young people in the school and community who are familiar with the program and its goals.
The number of young people who report using condoms while having sex after the intervention program.
The number of sex partners they have after program.
The reported cases of young people with STDs to see if the number of cases are decreasing.
The number of young people get Hep B and HPV vaccination.
The survey to see if young people change their sexual behavior after intervention program.
Evaluation should be done yearly.
Intervention is successful if flowing criteria are met after first year of program:
80% of young people know about the intervention program and goals.
The number of young people who report using condoms increase by 20%.
The number of sex partners should decrease.
The number of cases of STDs among young people decrease in the first year.
The number of young people who are getting Hep B and HPV vaccines increase by 20%.
Survey results show an increase awareness of STDs, and safe sex and behavioral changes.

Unsuccessful intervention:
If the intervention program is not successful, there will be no one or only few young people know about this intervention program; the number of young people report using condoms will be no change or only increase a little; the number of cases of STDs among young people will not decrease; and the survey will show no difference of young people’s awareness of STDs and behavioral change.
The intervention plan needs to be modified if it did not reach its goals. To assess the quality of implementation of the intervention and the results or any side effects of it, also collect feedback from adolescents and young adults to improve the intervention. Take a look into the program carefully from start of the interventions, include the plan, process of interventions, amount of energy, resources, and money to identify any barriers for young people to access this program, including cultural sensitivity; any ways in which an intervention process can be made more efficient and effective. Make modifications to interventions, goal redefinition or establish a new goal.

Maintenance:

I will consider sustainability throughout the duration of the STDs intervention program. Even this program funded with start-up grants, it will also benefit from constantly monitoring viability. To pursuit multiple sources of funding if the interventions are effective and being evaluated annually, I can apply for health funding from local county healthcare agencies to support the program in the long run.

Monitor whether the community has embraced this STDs prevention program among young people and get feedback.
Discuss the possibility of future financial support from the community.
Advance public health relations to highlight the need for the interventions for young people and publish its success results.
Keep the local media informed of updating program or invite a member of the press to participate in meetings and make the public more aware of what the STDs prevention program is.

References:

http://www.queenslibrary.org/services/community-information/community-resources-database

https://www.northwell.edu/sites/northwell/files/Northwell%20Health%20Queens%20County%20CHNA%202016.pdf

http://www.advocatesforyouth.org/publications/publications-a-z/550-youth-development-strengthening-prevention-strategies

https://www.cdc.gov/std/life-stages-populations/adolescents-youngadults.htm

https://www.cdc.gov/std/stats14/adol.htm

http://ctb.ku.edu/en/table-of-contents/analyze/where-to-start/identify-targets-and-agents-of-change/main

http://www.fphnyc.org/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800004/

https://www.cdc.gov/std/program/bpmm/overall_process_model.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836340/

http://www.who.int/hiv/pub/sti/en/stdcontrol_en.pdf