A SPECIAL REPORT: CHLAMYDIA PREVENTION
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SEPTEMBER 2012 Recommendations for action from the Minnesota Chlamydia Partnership A SPECIAL REPORT: CHLAMYDIA PREVENTION What can Minnesotans do to support the sexual health of young people? SPECIAL SECTIONHealth Disparities: Improving the odds for young people of color
The Minnesota Chlamydia Partnership
Chlamydia is the most frequently reported sexually Disease and HIV Section of the Minnesota Department of
transmitted infection/disease (STI/STD) among young Health (MDH) and seven partners external to the MDH.
people in Minnesota — and the United States.
The result of their work is The Minnesota Chlamydia
The Minnesota Chlamydia Strategy: Action Plan
Strategy: Action Plan to Reduce and Prevent Chlamydia
for Reducing and Preventing Chlamydia is the first
in Minnesota. Available for free download, this
comprehensive, statewide action plan to address the
comprehensive document includes all of the MCP’s
local chlamydia epidemic.
recommendations, as well as an overview of data,
Funded by a one-time grant of $10,000 from the National trends and definitions.
Chlamydia Coalition, a group of over 300 concerned
partners and community members across Minnesota met Download.
The Minnesota Chlamydia Strategy: Action Plan to
at a summit in 2010 to discuss the epidemic of chlamydia
Reduce and Prevent Chlamydia in Minnesota.
among young people — and to develop a plan of action
health.state.mn.us/mcp
for addressing it. This Minnesota Chlamydia Partnership
(MCP) is the first statewide stakeholder group to focus on
chlamydia and was organized by the Sexually Transmitted
What is Chlamydia?
• Chlamydia is a sexually transmitted disease (STD)
caused by the bacterium chlamydia trachomatis
• Chlamydia can be transmitted by vaginal, oral and/
or anal sex and it can also be passed from an infected
mother to her baby during vaginal childbirth
• Any sexually active person can become infected
with chlamydia
• Over 3 million new cases are diagnosed in the US each year
• 50% of pregnant women with untreated chlamydia transmit the
infection to their infants
• In females, about 70% of cases show no symptoms1
YOUNG PEOPLE
FAMILY/CAREGIVERS
We all have a role to play. MINNESOTANS
While there is no easy answer or single reason “why” young people
contract an STD, research indicates that solutions must go beyond
the individual characteristics or behaviors of young people. For YOUTH WORKERS
example, research has shown that how connected a young person
is to their school reflects both on their educational success and their
SCHOOLS
health. It has also demonstrated that a community’s assets and
challenges can either help to “protect” a young person from
contracting chlamydia or increase their “risk” of being exposed to it.
Researchers have identified the risk and protective factors listed below to
R E L AT
be associated with STDs and sexual health:2
INDIVIDUAL
PUBLIC HEALTH
IO
RISK FACTORS PROTECTIVE FACTORS
N
Lower academic achievement People important to youth approve SH
CO
of contraception or condoms M IP S
Higher violent crime rate
ST MU
IN
Higher levels of unemployment
Attachment to a faith community
MEDICAL IT NIT Y
Opportunitiesforcommunityinvolvement UT
Greater residential mobility
IO N A
Higher level of community stress
Higher socio-economic status L
SO
Work and recreational opportunities
PUBLIC POLICY
CIETAL
This research makes it clear that we all have a role to play in preventing chlamydia. In an BUSINESS
effort to reach and activate the broader Minnesota community, the MCP has prepared this
action guide. Take a look at the Table of Contents to find the sections that make the most sense
for you. There you’ll find a short list of specific things you can do to support the sexual health of young people.
Contents
Chlamydia: Why it matters .......................................................................... 4
The Role You Play ......................................................................................... 5
Minnesotans ................................................................................................................. 5
MCP PARTNERS
Young people ................................................................................................................ 6
Dakota County Public Health
Parents, grandparents, other caregivers ................................................................... 7
Deborah E. Powell Center for
Special section — Health Disparities: Women’s Health
Improving the odds for young people of color ......................................... 8 Hennepin County Public Health
Schools & education agencies ................................................................................. 10 Medica State Public Programs
Medical community .................................................................................................. 12 Minneapolis Department of Health
Public health community .......................................................................................... 14 and Family Support
Policy makers ............................................................................................................. 15 Minnesota Department of Education
Youth workers ............................................................................................................. 16 Minnesota Department of Health
Business community ................................................................................................. 17 Planned Parenthood of Minnesota,
North Dakota and South Dakota
Contact .......................................................................................................... 18 Teenwise Minnesota
Resources ..................................................................................................... 19 University of Minnesota/Healthy
Youth Development•Prevention
References .................................................................................................... 19 Research Center
Chlamydia: Why it matters. YOUNG PEOPLE ARE
DISPROPORTIONATELY
The sexual health of young people infected females, chlamydia can
IMPACTED.
matters — to all of us. Sexual health is progress to serious and sometimes
not just about preventing disease or life-threatening consequences.7 Young people account for 14%
having babies — it is also about who Untreated chlamydia infections can of MN’s population, but 69% of
diagnosed chlamydia cases.
we are, where we fit, how our families have dramatic consequences:
thrive, what kind of relationships • infertility CHLAMYDIA
we value. As Minnesotans, we are • chronic pelvic pain CASES COMPARED
TO POPULATION
inextricably linked: whether that means • ectopic pregnancy BY AGE
eating roasted corn at the state fair
Minnesota Diagnosed
together or helping each other push cars Population Chlamydia
The costs. Cases
out of snow banks. Yet when it comes Efforts have been made to quantify the 2%
to issues like the sexual health of young costs associated with chlamydia.
people, our lack of collective response 11%
seems inconsistent with our principles. • A legislative report estimates that
the 2.8 million new US cases annually
Chlamydia rates among young people result in $598 million in related health 40%
16%
in Minnesota have reached crisis care costs4
proportions — almost doubling over • Treating a single case of pelvic
the last 12 years while at the same inflammatory disease in 2000 was
time, data shows that young people estimated $133414
are engaging in less sexual activity.
Adolescents and young adults ages • Estimated cost of treating chlamydia
in Minnesota: $1,532,0883 19%
15 – 25 accounted for 69% of the cases
that occurred in 2011. 75% of people But the impacts go well beyond health
infected in Minnesota are females and care costs. When our young people 7%
the majority of them are under age 25.3 69%
are not supported to be and stay
sexually healthy, it impacts multiple 14%
Although it is easily treatable, 75%
aspects of Minnesota’s health overall.
of females and 50% of males with Age
Researchers frequently explore the links
chlamydia are unaware of their 45+
between sexual health and educational 30-44
infections because they have no
success — links that ultimately fuel 25–29 20%
symptoms and therefore do not seek
our work force, economy and tax base. 15–24
care. 3 This results in many people not
Our investment in young people is an
MINNESOTANS
Positive healthy relationships equal
sexual health.
Experiencing sexual development in YOUR PART an immediate impact by simply talking
today’s rapidly changing and media about this report with your friends,
Know it.
driven environment can be liberating, neighbors, family and colleagues.
Most Minnesotan’s are unaware of
confusing and oppressive for young
chlamydia’s epidemic status among
people. The biggest contribution Support sexual health policies
young people. Knowing about
that adults can make to the healthy and resources.
chlamydia, its consequences and how
development of young people is by Most of the ideas presented in this plan
to prevent and treat it is the most basic
being sexually healthy and modeling require funding for implementation.
responsibility we share. By reading this
positive relationships. The quality of the Even in the best of economic times,
report and investigating the resources
relationships between adults and youth, funding for sexual health promotion
provided here, we are accomplishing
the content of dinner table discussions, is challenging so it is important to
an important first step in reducing
the media choices available to youth remember that the role our state
chlamydia rates in Minnesota.
and the reactions of adults to youth systems play in preventing and treating
sexuality create the backdrop against sexually transmitted diseases like
Talk about it.
which young people sexually develop. chlamydia is vital. Just like young
Chlamydia doesn’t usually come up
people, our personal responsibility for
This plan recommends that all in conversations at the water cooler,
being sexually healthy depends on
Minnesotan’s recognize our collective dinner table or baseball game. While
being able to access the resources that
responsibility to make that backdrop sexual health is often a more personal
keep us that way. See page 15 for ideas
a positive one — one that decreases topic, it does not need to be a shameful
on funding and policy solutions.
chlamydia rates by supporting one. Frank, informed discussions are
the healthy sexual development of vital to the health of Minnesotans. But it
adolescents and young adults. doesn’t need to be hard. You can have
CHLAMYDIA ISN’T JUST AN URBAN ISSUE.
In fact, rural and suburban counties account for over half of the
chlamydia infections among young people. Not surprisingly, the
counties with the highest rates of chlamydia infection are often those
with the least resources and the greatest challenges. Researchers have
long known about the link between poverty, health and academic
achievement.6
CHLAMYDIA RATES, 2011 (AGE 15 – 24 PER 100,000 POPULATION)
1000 + 751 — 999 501 — 750 1 — 500 DATA NOT AVAILABLE
Source: Minnesota STD Surveillance System, 2011
5
YOUNG PEOPLE
Young people lead the way.
Of all Minnesotans, chlamydia rates are who is paying for the website you are presidential election. Extend your
highest among young people.3 While reading. Government run sites are activism into sexual health by speaking
the community at large must provide generally safe and there are a number of up on the issues: good sex education at
the resources and supports that young local and national organizations that are school; more adolescent-friendly clinics
people need to be sexually healthy, they geared specifically for you. that are easily accessible to you and
are responsible, active players in any which offer testing and treatment for
effort to reduce sexually transmitted Be sexually healthy. free; decision-making power on policies
Figure out what it means to be sexually
infections. that affect you.
healthy for yourself — consider the
This plan recommends using media many roles you play: student, family
campaigns to increase awareness and community member, brother, sister,
of chlamydia and other sexually romantic partner.
transmitted infections. The MCP asks
young people in Minnesota to bring Get screened every year.
Being sexually healthy means taking
their own leadership and media skills
charge of your health. It’s everyone’s
to this challenge. First, as active and
responsibility to know how to be
informed experts, young people take
responsibility for their own health. sexually healthy and stay that way.
Yearly screening for chlamydia
Second, as new media experts,
is recommended for all sexually ONLINE
young people can use their own
blogs, public service announcements, active young women ages RESOURCES
documentaries, poems, songs, mash- 15 – 25 and their sexual
ups or graphic novel to share what they partners. Check out the
know about sexual health. local clinics that provide sexual A good place to start
health services. If you are an athlete, cdc.gov/sexualhealth
considering asking for a screening at
YOUR ROLE your sports physicals. Talk to an expert at
Stay informed; use good sexetc.org
sources. Leadership and voice. scarleteen.com
It’s easy to find information about your Your impact on our community is
sexual health online — but is it good clear — records show that the youth Be an activist
information? Be sure by checking out vote was instrumental in the last amplifyyourvoice.org
DO YOU KNOW WHERE YOUR CLINIC IS?
Young people can find a sexual health clinic near them by contacting the
Y
MN Family Planning & STD Hotline.
1-800-78FACTS | text 66746 | sexualhealthmn.org
6
PARENTS,
GRANDPARENTS
& CAREGIVERS
ONLINE RESOURCES FOR PARENTS
University of Minnesota Positive Parenting extension.umn.edu/parenteducation
Teenwise Minnesota teenwisemn.org/for_parents.html
Advocates for Youth advocatesforyouth.org/parents
Shoulder to Shoulder shouldertoshoulderminnesota.org
Parents are sexuality educators.
Research has repeatedly shown that Educate yourself to be the
parents can and should hold the role sexuality educator. It’s that Easy prepares parent educators
of primary sex educator. Whether we Discussions about sexuality are to work with parents on promoting the
believe it or not, young people want challenging, but necessary. Young healthy sexual development of their
and need their parents’ guidance people need more than the medical children. Through experiential learning,
throughout their sexual development. and biological information presented participants explore theories, research
This “tough topic” can be a challenge at school: they want and need to and best practices. Topic areas include:
to parents who are uncomfortable and understand the nature of romantic
• Attachment
unlikely to be familiar with all the latest relationships; they need to understand
• Parent–child connectedness
facts. To meet this need, sexual health your values while exploring their own;
• Child and adolescent development
organizations have created programs and they’ll need space to discuss the
• Sexual violence prevention
for parents that reexamine adolescent concept of love. When parents and
• Cultural values, morals and beliefs
development, teach communication other caregivers communicate about
• Media and popular culture
skills and bring to light the latest these issues, talk frankly about sexuality
information and resources. and all aspects of sexual health, they Participants leave the training with
are supporting the sexual health of an increased understanding of the
This plan recommends ensuring fundamentals and how they relate to
their family.
that all parents, grandparents and raising sexually healthy children. Learn
other caregivers have access to the Stay connected. more at http://itsthateasy.org/
knowledge and skills needed to Research shows that parents help
support young people’s sexual to protect their teens from STDs by
development by expanding the reach staying connected, valuing on-going
of parenting programs. communication, expressing approval
and non-judgmental disapproval
YOUR ROLE as well as appropriately monitoring
teen behavior.2 High-quality family
Be a positive parent.
Parenting experts agree that by
interactions and close connections are it’s that easy! 70
vital to raising sexually healthy youth. A GUIDE TO RAI
SING
SEXUALLY HEA
LTHY CHILDREN
balancing responsiveness, discipline
and respect, parents actively support
the development of their children.
Parental supervision and monitoring is
linked to young people’s sexual health.2
When the question
7 is tough, the answ
is … apparent!
er
S P E C I A L S E C T I O N
Health
disparities:
Improving
the odds for
young people
of color.
All young people deserve the opportunity to make healthy choices.
In Minnesota, young people in the poorest and least- experience rates that are 11 times higher than Whites;
educated households suffer the worst health outcomes. American Indians 4 times higher; Hispanics/Latinos 3 times
Using protection can help young people stay sexually higher; and rates among Asian/Pacific-Islanders are twice as
healthy — but so can living in a healthy neighborhood and high as Whites.3 So while Minnesota might be recognized as
having access to affordable medical services. a national leader in quality of life, we continue to have some of
the largest racial and economic disparities.7
Sexual health trends mirror other measures of well being:
educational attainment, poverty and income, employment Addressing community concerns like racism, poverty and
and homeownership rates. As a group, people of color fare far segregation are ambitious goals that require attention from
worse than do white people in our region. Incidence rates of social justice activists, state and local systems as well as
chlamydia also indicate racial disparities: African Americans each individual community member.
DEMOGRAPHIC CHANGES IN MINNESOTA
Looking to the future, our state will continue to become more racially and ethnically diverse. Our population growth
will be largely driven by communities of color — communities that are generally younger than white populations.
Addressing disparities in health outcomes is an investment in our future workforce and citizenry.
MINNESOTA POPULATION PROJECTIONS BY RACE/ETHNICITY, 2000-2030
2030 74% 2% 7% 6% 5% 7%
2020 76% 2% 7% 5% 4% 7%
2010 80% 2% 6% 5% 3% 5%
2000 84% 1% 4% 4% 2% 4%
TWO OR MORE RACES/
WHITE AMERICAN INDIAN AFRICAN AMERICAN ASIAN/PACIFIC ISLANDER HISPANIC/LATINO
ETHNICITIES
Source: Minnesota State Demographic Center — January, 2009.
8
OUR ROLES
SEXUAL HEALTH IS ABOUT MORE
As individuals:
• Recognize the impact that racism and
THAN HEALTH CARE
poverty have on our community According to the University of Wisconsin Population Health Institute7,
only 20% of overall health is attributable to health care — and fully
• Share your belief that all Minnesotans
half of all health is driven by factors like education, income, pollution
should have the opportunity to make the
and the built environment. As a community, we can do a better job of
choices that allow them to live a long,
making sure that everyone lives, works and plays in a neighborhood that
healthy life, regardless of their income,
supports sexual health.
education or ethnic background
• See how systems, structures and 20% CLINICAL CARE
environments contribute to — or Access to care
damage — the health and well being of Quality of care
communities of color 30% HEALTH
BEHAVIORS
Tobacco use
As health and education Diet & exercise
professionals: Alcohol use
Unsafe sex
• Educate, hire and retain a diverse
workforce
• Make sure that health education 10% PHYSICAL
materials are culturally and linguistically ENVIRONMENT
appropriate Environmental quality
Built environment 40% SOCIAL AND
• Listen to the voices, opinions and
ECONOMIC FACTORS
priorities of communities of color.
Education
Practice noticing who’s in the room Employment
during critical decision making Income
meeting — how many white people, Family & social support
how many people of color. Work to Community safety
increase the presence and voice of
people of color Source: Unequal distribution of health in the Twin Cities, Amherst H. Wilder Foundation, 2010.
• Build mutually beneficial relationships
between community-based
organizations and state systems HEALTH STARTS AT HOME
• Reorient funding by involving diverse Some Minnesotans have more opportunities to live in safe, healthy
communities in grant application and neighborhoods than others. A U of M study of mortgage practices
review processes showed that Black borrowers with incomes exceeding $157,000 faced
a 25% denial rate, compared with an 11% denial rate
among Whites making $39,250.8
As concerned adults:
• Start local or statewide advocacy groups
that advocate for the sexual health of
young women. In the urban areas, focus
especially on young women of color
• Ask your existing advocacy group to
consider how sexual health intersects
with your own interests and include
support for chlamydia prevention in
your plans
9
SCHOOLS &
EDUCATION AGENCIES
The positive intersection of education
and sexual health.
Health is a necessary part of young appropriate sexuality education paired
people’s educational experience. Not only with instruction on how and when to
do healthy students make better learners5, say no to sex can help delay a young
their relationship with school can have person’s first sexual experience and help
a positive impact on their sexual health. prevent unintended pregnancies and
Research shows that students who feel a STDs by improving condom and
greater connection to school, have higher contraceptive use.9
academic performance, aspirations and
plans for the future are more likely to stay Lacking any formalized commitment
sexually healthy.2 through education standards or funding
streams, this plan recommends that
Parents are the primary sexuality educators schools take the initiative to ensure that
for their children. Yet schools, with their effective sexuality education includes
educational mission, are also an important an emphasis on chlamydia detection
source of sexuality education, frequently as and prevention and is taught by trained
part of a larger health curriculum. educators. Further, the teen sexual health
community, public health systems and
We know what is needed — teen health clinics must continue to partner
pregnancy and STD prevention research with schools who need curriculum,
shows that accurate, developmentally training and instructors.
WHAT IS EFFECTIVE SEXUALITY EDUCATION?
W
As referenced throughout this report, a great deal of research has explored
A
h
how best to prevent teen pregnancy and STDs. Douglas Kirby, working in
c
conjunction with the National Campaign to Prevent Teen and Unintended
Pregnancy, has kept the field informed by identifying programs/curriculum
with proven results and conducting thorough reviews of the research to
provide applied strategies.
Emerging Answers, 2007. Research Findings on Programs to Reduce Teen
Pregnancy and Sexually Transmitted Diseases documents 17 characteristics
of effective curriculum based programs and identifies 15 programs with
strong evidence of positive impact on sexual behavior or pregnancy or
STD rates.9 These definitions of effectiveness are now a national standard
used by the Federal Office of Adolescent Health.
Learn more at thenationalcampaign.org/EA2007
10SCHOOLS &
EDUCATION AGENCIES
What’s the relationship between health and grades?
Percentage of US high school students who engaged in each risk behavior, by type of grades mostly earned.
According to the Centers 80
for Disease Control Currently smoke cigarettes
and Prevention, there 70 69%
Currently use alcohol
is a strong association
62%
between academic 60 Have ever had sex 59%
achievement and
involvement in health 51%
50
risk behaviors. Do low 46% 45%
grades lead to choosing 43%
risky behaviors, or 40
does engaging in risky 32% 32%
behaviors lead to low 30 27%
grades? Or do some other
factors lead to both of 20 19%
these problems? More
research is needed, but 10%
10
the relationship between
school success and health
is a significant one.5 0
% of students who receive mostly…
Source: Centers for Disease Control and Prevention, Youth Risk Behavior Survey, 2009.
YOUR ROLE
Ensure that all students with politics, engage parents and Make free, confidential
receive effective, age- negotiate with school administrators. screening available to
appropriate sex education. Teachers want and need professional all students.
A wealth of resources online and development that addresses their Work with school officials, parent
through the teen sexual health unique needs. groups, youth, public health officials
community can support this most and local medical providers to offer at
essential chlamydia prevention strategy. Teach future teachers. least one day per school year when free
In a recent survey, Minnesota chlamydia screening is available to all
Teachers are trained and have teachers reported real gaps in their students, along with follow-up care
good resources. academic preparation to teach for those who test positive. While it
Great curriculum isn’t the whole sexuality education.13 Preparing future requires extensive relationship building
answer. Teachers must be trained generations of teachers and health and support within the school system,
youth facilitators, stay up to date with educators ensures better results for there are models from other parts of the
medically accurate information, deal young people. country to emulate.
11MEDICAL COMMUNITY
Chlamydia is the leading preventable
cause of infertility in the US.
Chlamydia screening and treatment is for chlamydia and support their in some way. One good option is
a valuable, cost-effective prevention sexual health. In light of chlamydia’s Expedited Partner Therapy (EPT),
strategy. Recognizing the prevalence prevalence among young people, where diagnosed patients deliver
and seriousness of chlamydia as a screening should be a standard medications or prescriptions directly
health concern for all young people procedure in your clinic. to their partners without another
is the necessary first step for health • Routinely include of chlamydia swabs clinic visit.
care providers that don’t specialize with materials for Pap testing
in adolescent sexual health. The Create a youth-friendly
• Establish a routine procedure for
standards for screening and treatment environment.
urine-based testing Interviewing Skills. Providing
are clear, but implementation requires
an organizational commitment to • Include chlamydia screening in all chlamydia screening requires taking
serving the special needs of young sports physicals a sexual history — a conversation that
people by adapting environments, • Screen all urine pregnancy tests many practitioners and patients might
routines, coding, interviews and consider awkward. Adolescent medical
• Utilize billing codes that indicate
history taking practices. This plan specialists developed this psychosocial
screening was performed while still
recommends that health providers screening exam (HEADSSS) specifically
maintaining patient confidentiality
annually screen all young women ages to engage young people productively
15 – 25 and provide treatment to by exploring safer topics like home
infected patients and their partners. Ensure that everyone with a and education as a precursor to more
positive chlamydia test result sensitive ones. The acronym HEADSSS
YOUR ROLE is treated. reminds practitioners that young
Work with public health officials, people’s health includes their Home
Adopt the chlamydia screening insurers and pharmacies to determine life, Education, Activities, Drugs,
recommendations. ways that treatment of patients and Sexual activity, Suicide/depression and
Any adolescent visit to your clinic their partners can be provided at no Safety.
is an opportunity to screen them cost to patients or are subsidized
CHLAMYDIA SCREENING RECOMMENDATION
Screen all sexually active females 25 years of age and younger
for chlamydia infection annually. This recommendation is
supported by:
American Academy of Family Physicians
American Academy of Pediatrics
American College of Preventive Medicine
American College of Obstetricians and Gynecologists
American Medical Association
Centers for Disease Control and Prevention
US Preventive Services Task Force
12MEDICAL COMMUNITY
INNOVATIVE SCREENING TECHNIQUES
Young people have the lowest health care utilization of any age group,
making it important to explore alternatives to traditional clinic visits.
The MCP plan recommends exploring innovative
new approaches:
• Universal testing in schools RESOURCES FOR
• Street outreach CLINICS
• Home-based screening (via pharmacies or The National Chlamydia
online ordering) Coalition’s web site has an
• Use of non-medical personnel to do outreach excellent set of resources and
education and collect specimens links specifically for health care
providers. Visit prevent.org/
ChlamydiaScreening for quick
access to any of these resources:
Screening for Chlamydial
Infection: US Preventative
remains a challenge. Clinics should Services Task Force, 2007
Consent/confidentiality. All people be ready to provide referrals to or
Sexually Transmitted
seeking medical services have a right to information about family planning Disease Guidelines: Centers
confidentiality of their medical records. programs that can provide free testing for Disease Control and
Because of Minnesota’s Minor Consent through the Medicaid waiver program. Prevention, 2006
Law, adolescents under age 18 can
consent to sexual health services for Partner with schools and Adolescent Healthcare 101:
STDs and are guaranteed confidential community organizations to The Basics: Adolescent Health
Working Group
services. These assurances are critical make chlamydia screening
to many young people but can prove available to all youth. Current Procedural
problematic with commercial health • Work in conjunction with schools Terminology Codes (CPT®):
plans where explanations of benefits to start school-based clinics in The American Medical
are sent to the subscriber — usually communities that do not currently Association
the adult/parent. While necessary, this have them
Annotated HEADSSS
process may discourage young people
• Work with community-based Assessment: Adolescent
from seeking services or damage family
organizations to provide sexual health Health Working Group (see
relationships if they do. To truly create a page B-9)
education and chlamydia screening
youth-friendly environment, clinics must
in alternative settings such as Toolkit for Teen Care:
be aware of and address these concerns.
recreation centers. Consider funding American College
Free/low cost testing. Cost remains a mobile testing van that could travel of Obstetricians and
a huge challenge for young people to different locations at specific times Gynecologists.
seeking services. While clinics that to offer free screening —this could be
provide family planning services through a particularly effective way to reach
the Title X Family Planning Program or young people in rural settings prevent.org/
Medicaid make services available at ChlamydiaScreening
little or no cost, chlamydia screening
13PUBLIC HEALTH
COMMUNITY
A public health priority.
Chlamydia prevention and treatment to, state and local systems. Resource • Evidence-based sex education
are clearly established priorities in priorities should include: standards
adolescent health. STDs in general, • Mobile screening for high risk
and chlamydia specifically, have adolescent populations not typically Promote quality and
both been identified as health reached through traditional venues effective practice.
priorities by the federal Healthy Proactively provide resources, technical
• Lowering lab costs for STD testing to
People 2020 Initiative. Despite a good assistance and training for key partners:
improve affordability for community-
understanding of what works to prevent
based clinics • Medical community
and treat chlamydia, the resources
needed for quality, effective strategies • Leverage Minnesota Department • County and city public health
are scarce. of Health Partner services staff to professionals
provide field delivered medications • County health boards and
Of all the possible ways that public to individuals positive for chlamydia commissioners
health resources could be used, this who did not return for treatment
plan recommends a dual focus • Youth workers
on resource utilization and policy Inform good policy • Insurers
formation. Within these two areas, some and practice. • Policy makers
concrete actions have been suggested. Build and use your knowledge and
• Educators
expertise to recommend evidence-
YOUR ROLE based practice, policy and resource
Wrangle the resources. allocation for:
Make the most of the connections and • Clinic protocols and process
expertise resident in, and connected recommendations
FUNDING CHLAMYDIA PREVENTION, SCREENING AND TREATMENT
WHERE IS THE FUNDING? MCP FUNDING STRATEGIES
To date, there is no dedicated state funding in • Continue and increase Infertility Prevention
Minnesota that directly addresses chlamydia Project funding to provide chlamydia screening
prevention and treatment. for all individuals without insurance coverage
Minnesota does receive limited federal funding • Secure state funding to expand these services
through the Centers for Disease Control and in Minnesota
Prevention’s Infertility Prevention Project.
Unfortunately, this funding source is under • Support chlamydia screening and STD counseling
threat at the national level and anticipated state as preventive measures in the Affordable Care Act
contributions have never been realized.
• Partner with third party payers to fund EPT
(expedited partner therapy)
14POLICY MAKERS
Policy paves the way to sexual health for
all young people.
Policy makers play a central role YOUR ROLE
in determining the structure and
Secure sustained and sufficient
resources available to state and local
funding for: MINOR’S CONSENT &
agencies charged with supporting the
• Prevention education, screening CONFIDENTIALITY
health and success of young people.
and treatment for patients and their
Two vital and sometimes conflicting Since 1971, Minnesota’s Statute
partners including free or low-cost
perspectives inform funding and policy 144.341-347 guarantees a minor’s
services for at risk populations
priorities: right to access confidential
• Training and continuing education for health care. Altering this statute
1. Public health research on what works
health care providers, health teachers can jeopardize young people’s
to prevent and treat chlamydia
and parents health and well-being — as well
2. The values and interests of
as our state budget. According
Minnesota voters Promote and adopt effective to the American Journal of
Interestingly, when it comes to effective
youth sexual health policies Public Health, in Texas where
sex education in schools, Minnesota
and legislation: state law requires parent
• Implementing evidence-based consent for minors to receive
parents and the research agree: young
comprehensive sexuality education contraceptives the estimated
people should receive sex education
that includes information about • Assuring minor’s consent and annual cost as a consequence
abstinence and prevention of sexually confidentiality to this law is $43.6 million. (This
transmitted diseases like chlamydia.10 figure is based on pregnancies,
• Encouraging public and private
births, abortions and untreated
health insurers to cover the cost
Yet Minnesota still lacks the funding sexually transmitted infections
of annual chlamydia screening for
and policies required to address the among minors’ using publicly
adolescents and young adults;
current chlamydia epidemic. This plan funded reproductive health care
recommends a number of funding and in 2001.11)
policy priorities.
SEXUALITY EDUCATION: WHAT DO PARENTS REALLY
ALLY WANT?
Parent’s belief for what young people should be taught in school
10% Information about abstinence only
Sexeducationthatincludesinformationaboutabstinenceandpreventionofpregnancy
89% and sexually transmitted diseases (STDs)
In a 2007 survey of Minnesota parents, researchers at the University
y of Minnesota
found overwhelming support for sex education that included information
mation beyond
abstinence messages.
Source: Eisenberg, Journal of Adolescent Health 42 (2008) 352-359.
15POSITIVE YOUTH YOUTH WORKERS
DEVELOPMENT
Adolescent sexual health researchers
have documented the qualities
of youth development programs
that may help reduce adolescent
Positive youth development
pregnancies and prevent STDs.2 is a chlamydia prevention
strategy.
As they develop, young people become This plan recommends supporting
more and more engaged with the youth workers and youth-serving
larger community. Ideally, all young organizations to deliver quality youth
people have opportunities to positively development programming that, when
interact with adults — coaches, youth ever possible, specifically supports
ministers, homework helpers, counselor, sexual health.
farmers, musicians, computer lab
directors, librarians, spoken word artists YOUR ROLE
— who both model what it means to Use sexual health as subject
They identified a number of
elements that didn’t specifically
be a member of the community and matter.
address sexual health, but still had a support young people’s transition to Educators say it is one of the
positive impact. These included: adulthood. most engaging health topics they
• Tutoring to improve school teach12 — so why not incorporate sexual
performance These very interactions are key to the health into art, music, video, activism,
development of healthy youth. Research service learning or social marketing
• A life skills component (e.g., career
planning and goal setting) shows that connection to a caring adult programming? After school clubs have
and positive community interactions won PSA competitions with messages
• Career development activities to
actually helps to protect them against from teen mothers. School newspapers
help youth think about, believe
in and plan for future jobs and STDs and unintended pregnancy.2 This have conducted sexual health surveys
careers protective effect extends to a handful and published their results. There are
of adolescent health challenges (i.e., excellent national and local resources
• Opportunitiesforyouthtobeincharge
and to learn leadership skills alcohol and drug use, mental health, with ready-made curricula, promotional
violence). Thus programs that are ideas and online resources created by
• Structured opportunities for
designed to promote “positive (or and for young people. By focusing on
community service
healthy) youth development” are a chlamydia and STD prevention, you can
• Components to address stress
smart public health — and community engage, educate and support young
and emotional problems
— investment. people to stay sexually healthy.
• Ongoing
small group
discussions, as
well as meetings
with individual
youth to discuss
their particular PROGRAMMING RESOURCES
problems and
April is National STD Awareness Month.
needs
This promotional effort includes a website
full of great, free resources.
cdc.gov/features/stdawareness
16BUSINESS COMMUNITY
Businesses invest in young people.
Businesses can make important Pharmaceutical industry: Communications professionals:
contributions to the health of young Your industry can actively support Commercial products have marketing
people. Most directly, staff and the clinics and pharmacies who serve budgets, advertising agencies and
managers of Minnesota businesses can young people. public relations firms — resources often
serve as role models and mentors — absent from public health efforts to
• Provide ample samples to clinics
supporting young people to complete reduce chlamydia rates.
serving young people in high-risk
high school and continue learning
environments • Make available any resources or skills
after graduating.
• Encourage consistently lower pricing that can be leveraged for a public
awareness campaign
Businesses can also lend their expertise • Support the use of Expedited
and capabilities to the challenge. This Partner Therapy by implementing
plan recommends specific strategies policies and procedures that instruct Retail businesses where
for key business segments. pharmacists on how to accommodate young people are customers
written and electronic prescriptions or employees:
YOUR ROLE of antibiotics when there is no name You are in unique position to support
Insurance companies: on the prescription or an actual name both your customers and employees
Young people typically under utilize is not provided simply by providing information. After
health services, a norm that can have • Make supplies of Azithromycin all, keeping your customers and staff
dangerous (and costly) consequences and Suprax available at no cost to healthy adds to your bottom line.
when it comes to STDs. interested pharmacies so that they • Post sexual health information on
• Cover annual chlamydia screenings can supply those medications to bathroom walls, including clinics that
and treatment patients who cannot afford to pay offer STD testing
for them • Put vending machines that dispense
• Support use of expedited partner
therapy by providing universal free condoms in bathrooms
coverage Businesses with philanthropic • Give your staff time off from work for
foundations: medical services
– Encourage and enable parents
The lack of services for young people
to support the sexual health of
most affected by chlamydia is a gap
their teens by offering tips or
that can be filled through private sector
providing training to improve
philanthropy.
communication and connection
• Make funding available to clinics and
– Recommend that parents suggest
community based organizations that
annual chlamydia screenings for
provide screening, testing, treatment
youth who are sexually active
and education related to chlamydia
and other STDs
17Leadership Opportunities.
Please Apply.
In 2011, 16,898 cases of chlamydia were reported in Minnesota. 69% of those cases were in
people ages 15 – 24 years old.
Rates have nearly tripled over the past 10 years.3
There is an urgent need for action — from all Minnesotans.
By drafting “The Minnesota Chlamydia Strategy: Action Plan for Reducing and Preventing
Chlamydia in Minnesota,” the Minnesota Chlamydia Partnership has created the first
comprehensive, statewide action plan to address the epidemic of chlamydia among young
people. As shown in this booklet, everyone has a role to play because chlamydia is more than a
medical problem — it’s a community problem.
The Partnership’s work will continue — guided by the Strategy. Yet these strategies and actions
can’t be addressed solely by a small group of people — more participation and input is essential.
In fact, the strategy itself is seen as a “living document” into which many groups will provide
ideas, suggestions and recommendations. Your energy, insights and perspectives are needed.
ip.
Join the Partnersh 2 0 1 - 4015
a l l a t 6 5 1 -
Call Candy Hadscandy.hadsall@state.mn.us
or email her at ut how you or your
to learn more abo rticipate.
organization can pa
18Resources References
1
Maloney, Susan and Christine Johnson. Why Screen for
Minnesota Department of Health
Chlamydia?. Washington D.C.: Partnership for Prevention, 2009.
health.state.mn.us/mcp Print.
2
Kirby, Douglas and Gina Lepore. United States. Sexual Risk and
Advocates for Youth
Protective Factors. ETR Associates and The National Campaign
advocatesforyouth.org to Prevent Teen and Unplanned Pregnancy, 2007. Print.
3
American School Health Association 2011 Minnesota Sexually Transmitted Disease Statistics:
Minnesota Department of Health, STD and HIV Section. St. Paul:
ashaweb.org
Minnesota Department of Health, 2011. Print.
Centers For Disease Control and 4
Legislator Policy Brief: Chlamydia Screening and Treatment.
Prevention Council of State Governments’ Health State Initiative Publication,
cdc.gov/healthyyouth/adolescenthealth/index. 2007. Print.
htm
5
Centers for Disease Control and Prevention Youth Risk Behavior
Survey Fact Sheets, 2010. Accessed May, 2010 at cdc.gov/
Guttmacher Institute mmwr/pdf/ss/ss5905.pdf
guttmacher.org
6
Jensen, Eric. Teaching with Poverty in Mind, 2009. Accessed
Healthy Teen Network May, 2010 at ascd.org/publications/books/109074/chapters/how-
healthyteennetwork.org poverty-affects-behavior-and-academic-performance.aspx
7
Helmstetter, Brower and Egbart. Unequal distribution of health
Maternal and Child Health Library at in the Twin Cities. St. Paul: Amherst H. Wilder Foundation, 2010.
Georgetown University Print.
mchlibrary.info/knowledgepaths/kp_adolpreg.
8
html Institute on Race and Poverty, University of Minnesota.
Communities in Crisis: Race and Mortgage Lending in the Twin
Cities, February, 2009. Print.
National Adolescent Health Information
and Innovation Center, UCSF 9
Kirby, Douglas. United States. Emerging Answers 2007.
nahic.ucsf.edu Washington D.C.: The National Campaign To Prevent Teen and
Unplanned Pregnancies, 2007. Print.
National Campaign to Prevent Teen 10
Eisenberg, ME, Bernat, D., et al. Support for Comprehensive
Pregnancy
Sexuality Education: Perspectives from Parents of School-Age
thenationalcampaign.org
Youth. Journal of Adolescent Health, 2008. 42: 352-359.
11
Office of Adolescent Health Franzini L, Marks E, Cromwell PF, et al. Projected economic costs
hhs.gov/ash/oah/ due to health consequences of teenagers’ loss of confidentiality in
obtaining reproductive health care services in Texas. Archives of
Pediatrics and Adolescent Medicine, 2004; 158:1140-1146.
Office of the Surgeon General
surgeongeneral.gov/library/sexualhealth/call.html 12
Eisenberg, ME, Madsen, N, Oliphant, JA, Resnick M. Policies,
principals and parents: Multilevel challenges and supports in
teaching sexuality education. Sex Education, 2012. 12:3:317-329.
Sexuality Information and Education
Council of the United States (SIECUS) 13
Cases of Sexually Transmitted Diseases Reported by State Health
Community Action Toolkit Departments and Rates per 100,000 Population, United States,
communityactionkit.org 1941-2010 – Accessed May, 2012 at cdc.gov/std/stats10/tables/1.
htm
Teenwise Minnesota 14
Chesson, Harrell, John Blandford, Thomas Gift, Guoyu Tao and
teenwisemn.org
Kathleen Irwin. United States. Estimated Direct Medical Cost of
Sexually Transmitted Diseases Among American Youth, 2000.
Centers for Disease Control and Prevention, 2004. Print.
19mnchlamydiapartnership.org
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