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Adolescent at Risk 2010

Adolescent at Risk 2010 - Adolescent Sexuality STDs and.oh...

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Adolescent Sexuality, STDs and …..oh Yeah………………….. c on d o m s Peter Leone, MD Professor of Medicine
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What do you get for $200 million/yr? Pledgers had 0.1 fewer past year partners but did not differ in lifetime sex partners and age of first sex. Fewer pledgers than matched non-pledgers used birth control and condoms in the past year and birth control at last sex Rosenbaum 2009 pediatrics
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Adolescents Higher STD/HIV risk Biological susceptibility Cervical columnar epithelium Health care utilization Fewer, shorter visits (esp. males) STD knowledge, information sources Level of trust Developmental issues “Invincibility” Peer Pressure Sexuality Lifestyle choices Experimentation
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Sexual risk behaviors include: Becoming sexually active in the teen years Having more than one partner Having sex with someone who has an STD Having sex without using a condom consistently and correctly
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National Survey of Family Growth 1995 and 2002 Santelli AJPH 2007
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Decline in Adolescent Pregnancy U.S.A. Santelli JS, et. al AJPH 2007
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Alternative Constructs The low degree—high concurrency construct Persons have relatively few contacts, but their contacts overlap in time (in better accord with survey data)
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Sexual risk behaviors include: Becoming sexually active in the teen years Having more than one partner Having sex with someone who has an STD Having sex without using a condom consistently and correctly
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More Teen Sex in the 90’s 4 or more partners: males : 33.4% females : 36.5% Condom use during sex males : 62.5% (54.5% in 91) females : 50.8% (38.0% in 91)
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Adolescent Health Survey Freq. of sex (past 12.mo.) N Weighted % None 98 1.0 < 1/mo. 2786 27.2 Up to 4/mo. 2522 25.5 Up to 12/mo. 3040 31.1 > 12/mo. 1435 15.2 # lifetime partners 1 2566 20.8 2-3 3093 25.1 4-6 2875 23.8 7-10 1777 14.7 11 or more 1826 15.6
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Slide 11 DETERMINANTS OF THE RATE OF DETERMINANTS OF THE RATE OF TRANSMISSION TRANSMISSION R R 0 = = β β DC, where: DC, where: R 0 = average number of secondary cases generated by one primary case β = the average probability of transmission per partner sexual contact D = the average duration of infectiousness of an infected person C = the average number of sexual partnerships formed per unit of time Anderson RM. Transmission dynamics of sexually transmitted infections. In Sexually Transmitted Diseases. Holmes KK, Sparling PF, et al. 1999
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Slide 12 CONCURRENT SEXUAL PARTNERSHIPS CONCURRENT SEXUAL PARTNERSHIPS Sexual partnerships that overlap in time Sexual partnerships that overlap in time Permit more rapid spread of an STI throughout a population Individual infected by 1 partner already has others to infect Earlier partners are put at risk by individual’s Earlier partners are put at risk by individual’s subsequent partners subsequent partners
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Slide 13 PARTNERSHIP SEQUENCES PARTNERSHIP SEQUENCES MONTH MONTH Person Person Relation Relation 1 2 3 4 5 6 7 8 9 10 10 A Monogamy E E E E F F F B Concurrency Concurrency G G H G H G H H C Monogamy Monogamy I I I I I D Concurrency Concurrency J J J K J J J J J
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