Center on Adolescent Sexuality, Pregnancy and Parenting Veronica E. Stovall Project Coordinator University of Missouri Extension Making Proud Choices Steps to Prevention for Adolescences Perceived Vulnerability; Empower the Youth; Providing them with Medically Correct Sexual Health information. Provide them with Self Efficacy (skills) • Use condoms correctly and consistently, • Negotiate condom use. Making Proud Choices Center On Adolescents Sexuality, Pregnancy and Parenting. The Mission of CASPP is to : Bring together a Multi-disciplinary Team of Professionals and Laypersons to Collaborate to provide Educational Programs and Conduct Applied Research to better understand how to Prevent and Eliminate the Negative Effects of High Risk Sexual Behaviors and Early Childbearing. Making Proud Choices Programming objectives Helping adolescents and young adults develop healthy relationships and sexual decision making skills. This is achieved by providing services to community professionals as well as direct services to youth and their parents through regional HDFS extension faculty and community partnerships. Making Proud Choices Programs We Implement Missouri Volunteer Resource Mothers; Maltreatment and Adolescent Pregnancy and Parenting Program; Adolescent Mother Journaling Program; Making Proud Choices; Healthy Relationships and Marriage Education Training project. Making Proud Choices Funding MO Department of Elementary and Secondary Education (DESE); MO Department of Social Services (DSS); US Department of Health and Human Services. Making Proud Choices Other Resources Technical assistance to organizations implementing these programs; Up-to-date research and information for professionals and educators in the field; Assistance with grant writing. Making Proud Choices Please Share with the Group Hearts Condoms Ribbons Making Proud Choices Three Epidemics Among Youth • Persons aged 13-29 accounted for an estimated 34 percent of new HIV infections reported in 2006 surveillance data.1 • Approximately 19 million new STD infections occur each year with 48 percent among young people aged 15 – 24. An estimated 1 in 4 teenaged girls between the ages of 14 and 19, or 3.2 million, are infected with a STD 2. • Each year there are over 745,000 teenage pregnancies3. Source 1 Available at http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/incidence.htmf#18 2 Available at http://www.cdc.gov/std/stats/pdf/trends2006.pdf 3 Available at http://www.guttmacher.org/pubs/fb_ATSRH.html#ref27 9 What Is Risky Sexual Behavior? Early initiation of sexual intercourse Unprotected intercourse Multiple sexual partners Sex while under the influence of drugs or alcohol Risk and Protective Factors for HIV, STD, and Teen Pregnancy Risk Factors • Unprotected Vaginal and Anal Sex Protective Factors • Sexual abstinence • Consistent and correct condom* use • Abstinence from AOD** HIV STD Pregnancy * Male and female condoms ** Alcohol and other drugs 11 Making Proud Choices Making Proud Choices Training Goals Goal To Provide Educators with knowledge of Adolescence Sexual Decision Making as it relates to their Risky Sexual Behaviors; which may lead to HIV/STD and unwanted Pregnancy, Educators will obtain those Skills necessary to Empower Young Adolescents to Change their Behavior in ways that will Reduce their Risk for STDs, HIV, and Pregnancy. To Provide Educators with the Knowledge and Skills to Implement the Making Proud Choices! curriculum Effectively and with a High Degree of Reliability. Making Proud Choices Making Proud Choices A Safer Sex Approach to HIV/STD Teen Pregnancy Prevention The Modules: Module 1: Getting to Know You and Steps to Making Your Dreams Come True Module 2: The Consequences of Sex: HIV Infections Module 3: Attitudes and Beliefs about HIV/AIDS and Condom Use Module 4: Strategies for Preventing HIV/ Infections STOP THINK and ACT Making Proud Choices Making Proud Choices A Safer Sex Approach to HIV/STD Teen Pregnancy Prevention Module 5: The Consequences of Sex: STD’s and Correct Condom Use; Module 6: Module 7: Module 8: The Consequence of Sex: Pregnancy; Developing Condom Use and Negotiation Skills; Enhancing Role Plays: Refusal and Negotiation Skills. Making Proud Choices Foundation of a Healthy Relationship MPC Theory to Practice KNOWLEDGE Teens need to learn relevant and correct information. Making Proud Choices Modules2,5, & 6 MPC Theory to Practice PERCEIVED VULNERABILITY Teens need to believe they are VULNERABLE to being infected with HIV/ STDs and getting someone pregnant. Making Proud Choices Modules 2, 3, 4 & 5 MPC Theory to Practice Outcome Expectancy Beliefs Teens need to believe: -Using Condoms will not interfere with sexual pleasure; -When Partners react negatively and not approve of using a condom, they will feel confident in their ability to respond to their partner and handle the situation; Condoms can prevent HIV/STDs and that condoms and other contraceptives can prevent teen pregnancy. Making Proud Choices Module 4, 7&8 MPC Theory to Practice SKILLS Teen Needs to Learn: -Skills -Practice using the skills, -Build confidence in using skill. Making Proud Choices 4,7, & 8 MPC Theory to Practice Self Efficacy Teens need to build confidence in their ability to : •Use condoms correctly and consistently; •Negotiate condom use and get their partner to use a condom. Making Proud Choices 4, 5,7 & 8 Curriculum Teaching Strategies Setting the Environment: The Group Rules; Brainstorming; Interactive Activities and Competitive Games Processing a Video or Game; Working in Small Groups; Role Playing/Practice. Making Proud Choices Group Rules Developing guidelines as a group builds group cohesion and increases the likelihood that the rules will be followed. Module 1 Making Proud Choices Brain Storming Remember in Brainstorming you just say whatever comes to mind about a particular issue or question. Module 1 Making Proud Choices Harm and Reduction Framework Key Components People will continue to Engage in Behaviors that Society may Disapprove of like Early Sexual Activity and Drugs; Rather than Responding to these Behaviors with Punishment and Prohibition, We need to Build Trust by Helping Teens Minimize the Potential Hazards associated with their Behaviors, therefore, Making Proud Choices Harm Reduction Framework Key Continues Your Program Should Help Youth see the Risks They are Taking and Recommend Safer Behaviors including Abstinence but Start Where the Youth is Now and Attempts to Move Him/ Her in a Positive Direction. Making Proud Choices Making Proud Choices Americans Overwhelmingly Favor Broader Sex Education 93% of parents reported their child has benefited from sex education; 94% of parents say that sex education should cover contraception; Only 15% of Americans want abstinenceonly education taught in the classroom. The Guttmacher Institute 2005 Making Proud Choices What Type of Sex Education is Right for Your Teen? Abstinence-only Education; Abstinence plus or Abstinence Based Sexual Education; Comprehensive Sexual Education; Holistic Sex Education. Making Proud Choices What is Adolescence? What period do you think of when you hear the word” adolescence”? Decide when you think it begins and ends. What words or images come to your mind when you hear the word “teenager”? Make a list. Making Proud Choices Adolescence It also refers to the age period between childhood and adulthood. Phases of Adolescences TWEENS: 11-14 years (Early) TEENS: 13-16 years. (Middle) EMERGING ADULTHOOD: 16-18 (Late) Making Proud Choices Making Proud Choices Puberty Begins Puberty is a period of rapid physical growth and sexual maturation; The sequence of physical changes is universal, but the timing varies (typically lasting 3-5 years). Age of onset ranges between 8-15 years. Making Proud Choices Adolescence Awkward period between sexual maturational and the attainment of adult roles and responsibilities; Begins with the domain of physical/biological changes related to puberty, but it ends in the domain of social roles; Encompasses the transition from the status of a child (one who requires monitoring) to that of an adult. (responsible for behavior) Making Proud Choices Adolescence Adolescence is much broader and longer than the teenage years alone (has changed significantly over the past 150 years); Adolescence now stretches across more than a decade, with puberty onset often beginning by age 9-12 and adult roles delayed until mid twenties (Worth man, 1995). Making Proud Choices 33.2 28.5 26.7 30 Making Proud Choices 35 30.9 25 26.0 20 25.1 WOMEN 15 17.4 10 12.6 AGE 14.0 MEN 16.9 Young people are at high risk of unintended pregnancy and STDs for many years Adolescence Puberty Romantic Motivation Sexual Interest Emotional Intensity Sleep Cycle Changes Appetite Risk for Affective Disorders (girls) Increase in risk seeking, and novelty seeking Age/Experience Planning Logic, Reading Inhibitory Control Problem Solving Understanding Consequences Affect regulation Goal Setting and pursuit Judgment and abstract thinking Making Proud Choices Puberty T/F 1 in 7 Caucasian girls starts to develop breasts or public hair by age 8 1 in 2 African American girls starts to develop breasts or pubic hair by age 12 Average age of menarche (first menstruation) has fallen from 20-10. African American girls are about 6 months earlier Making Proud Choices Adolescent Brain Still Under Construction Teens (left) used less of the prefrontal (upper) region than adults (right) when reading emotions. Making Proud Choices FRONTAL LOBE As the “prefrontal cortex” area of the frontal lobe matures, through experience and practice, teens can reason better, develop more impulse control, and make better judgments Prefrontal cortex is one of the last areas of the brain to fully develop Increased need for structure, mentoring, guidance. Making Proud Choices Incarcerated Youth Risky Behaviors Continue 39% had used alcohol and/or other drugs before sex: 64% had not used a barrier form of protection during last intercourse. Educational Training and Research 2008 Making Proud Choices Factors that Influence Risky Sexual Behaviors Environmental Factors: Community Characteristics; Family Characteristics; Peer Characteristics; Characteristics of Romantic partners. Making Proud Choices Factors that Influence Risky Sexual Behaviors Individual Factors: Biological Factors-age, physical development and gender; Race/ethnicity; Connection to family; Connection to school and success in school; Connection to faith communities; Connection to other community organization; Child Abuse i.e Physical, Sexually, Neglect Making Proud Choices Factors that Influence Risky Sexual Behaviors Involvement in gangs; Alcohol and drug use; Aggression; Involvement in problem or sensation-seeking behavior; Paid work; Involvement in Sports; Cognitive and personality traits; Sexual beliefs, attitudes and skills. Making Proud Choices How do these changes affect teens? Adolescents are uniquely vunerable to risk taking: Novelty & sensation seeking increase dramatically at puberty Development of self-regulation lags behind Making Proud Choices What Can Adults Do? Expect inconsistency in responsibility taking and in decision making; Provide opportunities for “safe: risk taking; Avoid criticizing /comparing to others; Encourage enough sleep; Encourage/model healthy eating; Encourage /model activity Provide honest answers about sex. Making Proud Choices Making Proud Choices Making Proud Choices Making Proud Choices Making Proud Choices Making Proud Choices The Youth Risk Behavior Surveillance System (YRBSS): 2007 National, State, and Local Data http://dese.mo.gov/divimprove/c urriculum/newwebpages/docum ents/yrbs_95_07.pdf Making Proud Choices What Happening in your neck of the Woods? Making Proud Choices Where do you stand? Making Proud Choices Teaching the Adolescence Brain A young adolescent brain can hold seven items of information, plus or minus two items, in working memory; The addition of emotion can help students remember; The brain is social and requires interaction in order to develop properly; Practice/rehearsal is critical to learning for the long term. Making Proud Choices Teaching the Adolescence Brain We take in more information visually than through any other sense. Making Proud Choices Teaching At-Risk Youth Things to Remember: Have poor auditory memory. They learn best visually; They want to do well but are hampered by their inability to remember facts through lecture, discussion or reading. They learn differently from the high achievers and the gifted, but they also learn differently from one another. Making Proud Choices What Do I Say? Teach Age-Appropriate Information; Be Prepared; Know Your Group; Establish a Baseline; Teach Sexuality as Positive and Pleasurable; Teach the Right to Refuse; Making Proud Choices What Do I Say? Remember that Content is Everything Help Youth to Practice Appropriate Affection; Recognize the Importance of feeling. Making Proud Choices Different Types of Student Questions Request “Am I Normal” Generally focus on adolescent concerns about their bodies and the emotional and physical changes occurring in them. Value for Information; Questions How old should you be to have sex? Making Proud Choices Different Types of Student Questions (Continued) Slang Questions “What is a blow job?’ Personal Questions/Permission Seeking “When did you lose your virginity?” Questions You Don’t Know the Answer To Making Proud Choices Healthy Relationship A relationship that includes love, trust, mutual respect, and honesty. Making Proud Choices Foundations of a Healthy Relationship Sex Commitment/marriage Trust Similar expectations/ambitions Honoring boundaries Similarities in backgrounds Being friends Shared values Shared experiences Dating Talk Making Proud Choices Teen Dating and Domestic Violence Teen Dating Violence is a pattern of physically, sexually ,verbally, and/or emotionally abusive behavior in a dating relationship. Making Proud Choices Teen Dating Violence Statistics About one in 11 teens reports being a victim of physical dating abuse each year; About one in five teens reports being a victim of emotional abuse; The overall occurrence of dating violence is higher among black (13.9%) than Hispanic (9.3%) or white (7.0%): About 72% of students in 8th and 9th grade report “dating” by the time they are in high school, 54% report dating violence among their peers; Almost 70% of young women who have been raped knew their rapist either as a boyfiend, friend or casual acquaintance. Teen Dating Abuse most often takes place in the home of one of the partners. Chooserepect.org Making Proud Choices Making Proud Choices Teen Dating Domestic Violence Making Proud Choices What Are the Reasons? Lack of information from parents/ other important adults; Lack of communication between parents and children; Lack of quality sexuality education programs; Influence of the media; Influence of peers. Making Proud Choices How Can You Tell if a Teen is Experiencing Dating Violence? Withdrawing from school and/or other activities; Has become very secretive, ashamed, or hostile to parents, friends, family because of the relationships; Apologizes for partner’s behavior; Doesn’t do things that he/she wants to because of his /her partner. Making Proud Choices What Parents Could Do…. Tune in and Talk Question Choices Speak Up Understand Encourage Educate Be real Model Making Proud Choices What Schools Could Do Improve School Sexuality Education. Curricula should: Not only focus on content (e.g., statistics on STDs and Reproductive Anatomy & Physiology) ; • but should focus on social skills building and sexuality valuing. Making Proud Choices Teen Dating Violence Prevention website Dating and Violence Should Never Be a Couple http://www.abanet.org/ab astore/index.cfm?section =main&fm=Product.AddT oCart&pid=3070001 Making Proud Choices Helping Teens Change Behavior Youth Empowerment: Youth Need to feel Empowered to make Responsible Safer Sex Decisions: • Adolescence feel empowered when they have the belief that they are bright, worthy and have the skills to engage in safer behaviors and the belief that their behaviors affects not only themselves, but their sexual partners, friends, family and community, and a belief in a POSTIVE FUTURE. Making Proud Choices Helping Teens Change Behavior Continues Encourage teens practicing healthy behaviors to continue to do so; Encourage teens practicing unhealthy behaviors to change their behaviors; Screening for risky behaviors, followed by your brief advice and assistance, is a powerful agent for personal behavior change. Making Proud Choices Helping Teens Change Behaviors Barriers for you: Lack of problem awareness Lack of time Lack of training Belief that teens can’t or won’t change their behavior; Personal values and attitudes’ Personal behaviors; Personal characteristics Personal history. Making Proud Choices Making A Difference! Be Proud ! Be Responsible! Brainstorm Making Proud Choices? To Be Proud? To Be Responsible? Making Proud Choices Why Some Teens Have Sex Making Proud Choices Consequences of Sex AIDS Pregnancy Making Proud Choices STDs Proud and Responsible Prevention Strategies What are some ways to Prevent the Negative consequences of SEX? Making Proud Choices Goals and Dreams What are your Dreams and Goals? Making Proud Choices Goals and Dreams What are some obstacles that may hinder you from reaching your dreams and goals? How can we avoid these obstacles? What can you do to make sure you don’t get pregnant, get someone pregnant, or get an STD, like HIV? Making Proud Choices Setting Goals HOW TO SET GOALS 1. 2. 3. 4. Define the goal.* Outline the steps needed to achieve it. Consider possible obstacles and ways of dealing with them. Set deadlines. Not every wish can be a goal. For instance, you may wish you could live and stay young forever, but since there's nothing you can do to make that happen, it could never be considered a goal. In order for something to be a goal: • It has to be important to you, personally. • It has to be within your power to make it happen through your own actions. • It has to be something you have a reasonable chance of achieving. • It must be clearly defined and have a specific plan of action. Making Proud Choices HIV/AIDS Frame How do people get HIV/AIDS? (3 ways) Through what 4 body fluids has HIV been transmitted? What are the 3 sexual practices that are HIV-risk related? How can you prevent HIV? Making Proud Choices AIDS Key Words 1. What is HIV? 2. What is AIDS? 3. How is AIDS different from HIV? 4. What is the immune system? Making Proud Choices AIDS Key Words 5. What happens when someone gets the virus that cause AIDS? 6. What is the HIV antibody test? 7. What is a condom? 8. What is Spermicide? Making Proud Choices Myths and Facts about AIDS Game After the 1st Team gets 4 points (2 points answering myth or fact correctly and 2 points for explaining why correctly and 0 points if they answer it incorrectly . Making Proud Choices ATTITUDES AND BELIEFS ABOUT HIV/AIDS AND CONDOM USE AIDS CONDOM USE Making Proud Choices Strategies for Preventing HIV Infection: STOP, Think, And Act STOP-Stay Calm, take a deep breath, be in control of myself. THINK-What is the problem or conflict about? ACT-Evaluate. Make the best choice. Making Proud Choices The Consequences of Sex: STDs and Correct Condom Use What is STD? What are some of the STDs ? How do you Think People get STDs? How would you Feel if you had an STD? Making Proud Choices National STD Teen Crisis! 1 out of 4 14 to 19 year old women have at least one sexually transmitted disease. Almost HALF of the African American teens surveyed had an STD. Making Proud Choices Four most common STDs: HPV Human Papilloma Virus [HPV]: Most common, no treatment or test available Most infected people do not know they have it, more than 50% sexually active Americans have it (20 million people) Some strains cause genital warts and cervical cancer (most dangerous because no symptoms until cancer is present). New vaccine available. http://www.cdc.gov/STD/HPV/STDFact-HPV.htm Making Proud Choices Vaginal Genital Warts Penile Genital Warts Four Most Common STDs: Chlamydia Bacteria that can damage women’s reproductive organs with little or no symptoms (pelvic inflammatory disease) Can be tested and treated, also reinfection possible Young women especially vulnerable to Chlamydia and other STDs due maturing cervixes. CDC recommends yearly testing for women over 25 years old, women with multiple partners, and pregnant women. Making Proud Choices http://www.cdc.gov/std/chlamydia/STDFact-Chlamydia.htm Four Most Common STDs: Trichomaniasis Caused by a parasite Most common curable STD among young women Men usually show no symptoms Causes genital inflammation in women and increases risk of HIV infection Making Proud Choices Four Most Common STDs: Herpes Simplex Virus Caused by two viruses: HSV-1 and HSV-2 Most infected show no signs; Those who have symptoms have sores around genital region that last weeks and then disappear: can be deadly for babies; Infection can be passed during outbreak or in between outbreaks; At least 45 million adolescents and adults are infected; Can be tested, no cure, just treatment. http://www.cdc.gov/std/Herpes/STDFact-Herpes.htm Making Proud Choices Making Proud Choices Primary herpes, female Making Proud Choices Activity B Listen very Carefully; Write your Name on the side of the index card that has the letter on it; You are going to walk around the group until I say “STOP”; Then You STOP in front of the Person closer to you; I will read you an Unfinished Sentence; The two of you will complete the Sentence and discuss why you feel that way; At the end of that discussion; you will sign each others card on the side without the letter; and return it to the original owner; You will continue this process for six brief discussion. Making Proud Choices Who gets STD? Don’t answer this just think about . Making Proud Choices Condom Use Skills What is a Condom? What are some of the nick-names or slang terms for condom? Making Proud Choices Making Proud Choices Making Proud Choices How to Put on a Condom Check the expiration date on the package; Open the condom package ; The condom must be put on when the man’s penis is hard and before any contact near the partner’s sexual organs; Unroll the condom down the hard penis so that it covers the length of the penis; Leave space at the tip of the condom to collect the semen. Making Proud Choices Continuation on How to Put on a Condom After the man ejaculates, hold the base of the condom so that no semen spills out as the man pulls out of his partner; Remove the used condom and throw it in the garbage; Use each condom only once. Making Proud Choices Consequences of Sex-Pregnancy Myths and Facts about Pregnancy You can get pregnant by kissing? A a boy cannot get a girl pregnant unless he has had a wet dream? If a girl misses her period, she is definitely pregnant? A girl can get pregnant if she has sexual intercourse standing up? Vaseline makes a good lubricant for condoms during sex and prevents pregnancy? Making Proud Choices What’s happing at home? In Missouri, the pregnancy incidence rate among Hispanics from 1995 to 2005: increased 140%; Caucasian teens declined from 46.1 to 35.9 per 1000 teens and African American teens decreased from 109.8 per 1000 71.6 per 1000 teens in 2005. Teen Pregnancy rate in Missouri per 1000 girls ages 1319 was 42.5 making Missouri rank 31 in the Country for Teen Pregnancy. MissouriFamilies. Org National Teen Pregnancy Campagin.org Making Proud Choices Increase in Teen Births Decline in Teen contraceptive use has played some part in the teen birth rate increase; Recent decline in teen sexual activity; Economic hardship and the rising cost of certain birth control has made certain contractive less affordable; A decline in the % of students who report having received a formal contraceptive education. Making Proud Choices Reasons Why According to the National Institute of Health [NIH], 79% of white and 70% of African American teens stated Lack of communication that the lack of communication between a girl and her parents is often the reason teen girls have babies (NIH, 2006). It is believed that with improved communication and active listening, parents and their children can avoid teen pregnancy. Lack of education VanLenten, 2007 Making Proud Choices Genesis One of the oldest references to birth control comes from the Bible. In the book of Genesis men are called upon to practice coitus interruptus, commonly known as the "withdrawal" method. Making Proud Choices Birth Control Methods Making Proud Choices Making Proud Choices Contraceptives Over-the-Counter Methods: Prescribed Methods: Condoms Birth Control Pills Spermicide Depo-Provera Shots Making Proud Choices The Diaphragm or Cervical Cap Talk Show Type of Method; Effectiveness; Advantages; Disadvantages. Making Proud Choices Condom Line Up Making Proud Choices Developing Condom Use and Negotiation Skills S W A T “NO” to unsafe behavior. Be prepared to explain “Why” you want to be safe. Provide “Alternatives” “Talk” it out. Making Proud Choices ENHANCING ROLE-PLAYS: REFUSAL AND NEGOTIATION SKILLS. Making Proud Choices