Prime Time Replay:
Claire Brindis, Dr. P.H.
on the work of the
National Adolescent Health Information Center
MsgId: *breakthrough(1)
Date: Wed Nov 26 11:56:19 PST 1997
From: moderator At: 152.163.205.105
Welcome to Breakthrough Medicine. I'm your host, Madeleine Lebwohl, and today I'll be speaking with Claire Brindis, Dr. P.H., executive director of the National Adolescent Health Information Center at the University of California, San Francisco. This will be an in-studio interview.
MsgId: *breakthrough(3)
Date: Wed Nov 26 12:03:31 PST 1997
From: moderator At: 152.163.205.105
CB: Hello, I'm happy to be on the show with you.
MsgId: *breakthrough(4)
Date: Wed Nov 26 12:04:57 PST 1997
From: moderator At: 152.163.205.105
What is the current issue you're working on at your Center?
MsgId: *breakthrough(5)
Date: Wed Nov 26 12:06:19 PST 1997
From: moderator At: 152.163.205.105
CB: Our NAHIC works on a variety of issues affecting young people in our society. Our role is to translate research and data findings so that larger audiences made up of young people, their families, community leaders and policy makers can make wiser decisions regarding how to improve adolescent health.
MsgId: *breakthrough(6)
Date: Wed Nov 26 12:08:28 PST 1997
From: moderator At: 152.163.205.105
Adolescent pregancy seems to be an issue that absorbs a lot of media attention, and government health dollars. Is it a health issue that can be solved?
MsgId: *breakthrough(7)
Date: Wed Nov 26 12:11:30 PST 1997
From: moderator At: 152.163.205.105
CB: Recent data indicates that we are making an important contribution to decreasing the incidence of adolescent pregancy in this country. Its important to note that the United States has one of the highest adolescent birth rates in developed countries. It is a complex issue and unfortunately, too many times people want simple solutions. We know a great deal about the consequences of adolescent pregancy. For example, the higher incidence of low birth weight babies, the poor life opportunities for the young teen mom, the fact that a large number of these babies born to teenagers are the result of a relationship with a much older man or young adult, and that many adolescents are dependent on welfare as a result of having been a teen mom.We also have gotten smarter about understanding the antecedant factors. For example, poverty is one of the great predictors. Five out of six teenage girls who have a baby grew up in poverty, so poverty is not only a consequence, its a contributing factor. Academic failure, lack of a sense of future, and the tremendous pressure that young people experience in this society to be sexually active, often prematurely, are also contributing factors.
American society is very ambivalent regarding sexuality, and being responsible about planning for sexual behavior. We use sex to sell almost every product in the American market place, yet we are prevented from having commercials on birth control and condoms on television, radio, and other media that are popular with adolescents. While most Americans assume that adolescents have ready access to sex education and information about how to prevent a pregnancy, what I still find is that many adolescents as well as adults carry misinformation or myth information. For example, we still find that its a common belief among teens that your can't get pregnant the first time you have sex.
While there has been an increase in the amount of sex education available, what we often find is that sex education focuses on the plumbing, i.e., anatomy, physiology, but often fails to equip young people with the communication and negotiation skills required in a couple to decide to either postpone sexual activity, or to be sure that any sexual activity is protected, not only against unintended pregnancy, but a sexually transmitted infection. Sex education is often not linked to other kinds of education that young people need as well. For example, drug and alcohol prevention, is an important factor. As we know from research, that young people who are intoxicated, or who have been drinking alcohol, and/or using drugs, are often incapable of thinking through their actions as it pertains to pregnancy prevention.
MsgId: *breakthrough(12)
Date: Wed Nov 26 12:25:46 PST 1997
From: moderator At: 152.163.205.105
Many of these issues seem to be introduced to teenagers by adults. Aren't these adults afraid of being arrested?
MsgId: *breakthrough(13)
Date: Wed Nov 26 12:28:41 PST 1997
From: moderator At: 152.163.205.105
CB: I'm really glad you brought this issue up. Because I feel that too often adolescents are blamed for being risk takers when they actually are mirrors to the adults in their lives. For too long the family context and the community context where the adolescents live have not been considered in developing our solutions and in funding programs. Partly because, as a society, we have ambivalence, about how much to interfere, or intervene in these areas. Yet as a society, we continue to pay the high cost associated with these risk taking behaviors.For example, for too many years we have failed to mobilize around the issue of young adult males having sex with young adolescents. Our research shows that the younger the adolescent who is sexually active, the greater the likelihood of sexual coercion. In a number of communities across the country, and as a result of the welfare reform bills that have been passed, the establishment of paternity, as well as the prosecution of older men having sex with younger women, is gaining greater focus.
Adult irresponsibility is not only in the area of sexuality. For example in the area of tobacco, we find that businesses have really targeted young people through their media campaigns, and I find that even cigar smoking has become a trendy behavior for young people who are seeking ways to be mainstreamed in our society. I don't want to just focus on the negative, however, because I believe strongly that, as a country, we have shown a number of problem areas where we have made major inroads.
Let me give you one example. The area of drinking and driving, we've made progress in changing social norms regarding the necessity of having a designated driver. We've also improved our use of seatbelts, and among many adolescents who have adopted condom use, we've made some inroads in reducing the incidence of sexually transmitted infections, including HIV.
What's important for us to take from these successful public health efforts is to consider the lessons that we've learned, and can apply to other areas. Some of the lessons include having a clear consensus about what the message should be. Another lesson is that there are a variety of strategies that reinforce that message. For example, the development of MADD, and SADD -- mothers against drunk driving, and students against drunk driving -- occurred simultaneously with media campaigns and policy changes, and an active role by the alcohol industry to reduce the incidence of irresponsible drinking.
MsgId: *breakthrough(18)
Date: Wed Nov 26 12:41:10 PST 1997
From: moderator At: 152.163.205.105
As a policy analyst, are you speaking to adolescents when you are formulating your ideas and strategies? Do you get feedback from them?
MsgId: *breakthrough(19)
Date: Wed Nov 26 12:43:49 PST 1997
From: moderator At: 152.163.205.105
CB: Yes. We actively seek the voices of young people to help shape our ideas. We conduct in-depth interviews and focus groups, however, what I'm struck by is how often young people are kept out of the decision making loop. They're often marginalized, and we have done too little to involve them in helping us create the solutions that we need. I think this is the result of some intergenerational distrust which often contributes to a we-them attitude, and I feel there's too many lost opportunitites for actively engaging young people in an affirmative and accepting manner.Let me give you two examples of where I feel that a different tone has been set. In the area of health, I find increasing committment to the concept of peer educators and outreach workers who are young people themselves. We're evaluating a network of family planning clinics in southern California where teenagers have been formally trained to provide all services from laboratory to counseling in a family planning clinic, with the exception, of course, of physical exams.
Our initial findings show that adolscent patients clearly prefer to receive their care in this manner. Another example in the judicial system, has been the establishment of youth courts, where youth are trained to serve as jury members, in reviewing juvenial justice cases. The teens provide input into the resolution of these cases. Its important to point out that sometimes they're far more rigorous than adult judges would be. I strongly believe that finding additional ways to assure that young people have a meaningful role in our society, is the most important key in reducing risk taking behaviors. As you can see I have a very broad view of how we can prevent health problems.
MsgId: *breakthrough(22)
Date: Wed Nov 26 12:52:26 PST 1997
From: moderator At: 152.163.205.105
Getting back to sex ed, how is the message of abstinence gotten across? Do you feel the current mediums transmitting it are effective? What do the teens say?
MsgId: *breakthrough(23)
Date: Wed Nov 26 12:59:40 PST 1997
From: moderator At: 152.163.205.105
CB: Across the country there is a recognition that for too long we have either directly or indirectly pushing young people to become sexually active, even when they were not ready. A number of abstinence curriculums have been developed to try to provide support and encouragement of young people to delay their sexual debut.My concern is that in the push to have the abstinence message delivered to young people, too many programs are only giving the abstinence message, and do not deal with the young people who may be either sexually already, or will become sexually active long before they're married.
Unfortunately, there are factions who believe that providing knowledge around decision making and contraceptives often encourages young people to experiment and become sexually active too early. Yet research studies clearly refute the image that knowledge is dangerous. Teenagers tell us that they need a more balanced approach to dealing with not only the pressures that they experience from their friends and the media, but how to feel comfortable about whatever decision they make.
There are young people who have no choice in whether they become sexually active or not because they've been sexually abused. There are other young people who may have had one sexual experience and decide that they want to delay any more sexual activity at this point in their lives. We need programs and education that responds to not only these two segments of the adolescent population, but other segments as well. I strongly believe in having a contiuum of options given to young people, and have faith that with counseling and nurturing support, they can make wise choices.
Poll after poll of the American public clearly supports the provision of comprehensive family life education that includes both abstinence as well as information about birth control and where services are available in a community. Education is only part of the formula for reducing the number of young people who face an unintended pregnancy. We also need to invest in having confidential and teen-friendly health services readily available. The final part of the formula is providing young people with viable alternatives to too-early child bearing, for example, educational and job opportunities. A child-free adolescence should be our motto.
Even though it sounds a bit trite I do strongly believe that it does take a village to raise an adolescent, and it does take an adolescent to raise a village. Adolescent pregnancy prevention is not merely the responbility of the education and health sectors. We need everyone to be involved. I include not only the business sector, but also religious organizations, youth-focused community organizations, family and media in this village. We need to recognize that by the year 2005 this country will experience a thirteen percent increase in the number of adolescents. In California that increase will be thirty-four percent. Much of this increase will occur among children of color. We need to be sure that we make the upfront investments in assuring that they have access to meaningful roles in society, including job and educational opportunities. We all have much to gain from this wise investment.
MsgId: *breakthrough(30)
Date: Wed Nov 26 13:24:01 PST 1997
From: moderator At: 152.163.205.105
From a technical point of view, does sex ed really give teenagers the information they need -- does it work?
MsgId: *breakthrough(31)
Date: Wed Nov 26 13:27:09 PST 1997
From: moderator At: 152.163.205.105
CB: Over the last decade we have developed an important knowledge base about what does work and does not work in sex education. The programs that are most effective have some of the following key ingredients. They are skills based, which means that not only is information imparted, but young people have an opportunity to learn how to apply these skills. For example, to role play, where they can bring up the subject of delaying having sex, thus gaining confidence and comfort in having this dialogue at a future time. Other ingredients include having approximately ten hours of classroom time, and having opportunities for young people to discuss these issues with family members.Results of these types of curriculae clearly point to the fact that young people delay having sexual intercourse when they're prepared with these types of skills, and in an 18 month followup study, among those adolescents who had started having sex in the 18 months following the program, there was a higher proportion who used contraceptives effectively to protect against an unintended pregnancy and sexually transmitted infection.
I believe that sex education should not only be limited to the classroom. Media can play a very important role in providing information as well as reinforcement for responsible behavior. For example, the availability of emergency contraception is largely unknown by young people -- the morning after pill. In a recent announcement on MTV, that discussed this option there was an 800 toll free number available, and over 3000 young people called within two weeks. Again, in the same way that I want sex education to be balanced between providing support for the young person who wants to delay having sex, as well as support for the young person who doesn't. I believe we need factual and a balanced presentation through all media channels, including public service announcements, commercials and story plots. Recently, I've had the opportunity of meeting with soap opera writers and producers to present the case for their weaving into storylines messages around communication and responsible sexual behavior. These are important influences in the lives not only of young people but adults as well. Over 22 million Americans watch soaps everyday.
I strongly believe that some of our solutions will emerge from what I call two-generation programs. For example, while approximately 85% of young people state that they did not plan to be pregnant when faced with a positive pregnancy test, between 50-60% of adult women will give the same answer under similar circumstances. Thus, I believe that we need to be sure that we are adequately providing information on these topics to both young people as well as their families. We need to increase our overall level of comfort to discuss these topics.
MsgId: *breakthrough(36)
Date: Wed Nov 26 13:39:46 PST 1997
From: moderator At: 152.163.205.105
Thank you for joining me today.
MsgId: *breakthrough(37)
Date: Wed Nov 26 13:40:21 PST 1997
From: moderator At: 152.163.205.105
CB: It was my pleasure.
MsgId: *breakthrough(38)
Date: Wed Nov 26 13:45:54 PST 1997
From: moderator At: 152.163.205.105
Please join me next week when I speak with Ellen Langer, Ph.D., professor of psychology at Harvard University and the author of "The Power of Mindful Learning."
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