A SPECIAL REPORT: CHLAMYDIA PREVENTION

 
A SPECIAL REPORT: CHLAMYDIA PREVENTION
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
A SPECIAL REPORT: CHLAMYDIA PREVENTION
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
A SPECIAL REPORT: CHLAMYDIA PREVENTION
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
A SPECIAL REPORT: CHLAMYDIA PREVENTION
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
A SPECIAL REPORT: CHLAMYDIA PREVENTION
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
A SPECIAL REPORT: CHLAMYDIA PREVENTION
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
A SPECIAL REPORT: CHLAMYDIA PREVENTION
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
A SPECIAL REPORT: CHLAMYDIA PREVENTION
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
A SPECIAL REPORT: CHLAMYDIA PREVENTION
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
A SPECIAL REPORT: CHLAMYDIA PREVENTION
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

                                                               10
SCHOOLS &
                                                                     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.

                                                                                           11
MEDICAL 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

                                                            12
MEDICAL 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

                                                                13
PUBLIC 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)

                                                              14
POLICY 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.

                                                                              15
POSITIVE 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

                                                             16
BUSINESS 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

                                                              17
Leadership 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

                                                     18
Resources                                            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.

                                                    19
mnchlamydiapartnership.org
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