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Project Description

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Adolescent sexual and reproductive health is of concern worldwide.  Although the rates of teen births appear to be decreasing across Manitoba and within all community areas in Winnipeg, Manitoba has one of the highest rates in the country (1), with large discrepancy by geographic area.  For births to mothers 15-19 years of age, the rate varies from 6.7-79.8/1000 in Winnipeg depending on community area, and from 2.0-101.1/1000 by non-Winnipeg RHA (2). In addition to pregnancy and birth, STIs are also a concern within this age group.  In the WRHA, adolescents 15-19 years have the second highest rate of chlamydia and gonorrhea infections (3).
 
Adolescents require sexual and reproductive health care services that are tailored to their developmental stage (4). The 1994 International Conference on Population and Development in Cairo drew attention to the specific sexual and reproductive health needs of adolescents (5). However, since this time, the services focused on prevention and education for adolescents who are not yet sexually active has outpaced the provision of services to those who have become sexually active and are facing a pregnancy or STI (6). In addition, targeted strategies are needed to meet the needs of vulnerable subgroups of the adolescent population.
 
Our focus in this project is on in-school programs as they have the potential for reducing adolescent sexual risk-taking (7).  In Manitoba, several in-school programs began in 2001 including the Healthy Child Manitoba Healthy Adolescent Development strategy, a provincial media blitz called Think Again, Teen Talk (a youth health education program using teachers and peer trainers), Teen Touch (a 24-hour province-wide telephone help line for youth) and support of regional Sexuality Education Resource Centres (SERC). In 2006, Healthy Child Manitoba (HCM) in partnership with others developed a Teen Clinic Services Manual, based on evidence, best practice and community experience to increase consistency of teen clinics (8). Currently, Healthy Child Manitoba funds 6 teen clinics in Manitoba schools. The clinics usually include programs on both reproductive health and STIs. This project will examine whether the presence/or not of in-school clinics affects teen pregnancy and STI rates of students in Grades 9 to 12, and if clinics reduce the SES inequities in teen pregnancy and STI rates.
 

Research Question

Do in-school clinics reduce the rates of teen pregnancies and STIs (Sexually Transmitted Infections) and reduce inequities in these outcomes for school-aged teens?
 

Hypotheses

1. In-School Clinics offered in Manitoba will be associated with decreases in teenage pregnancy and STIs (Chlamydia and Gonorrhea).

2. The socioeconomic gap in teen pregnancy and STIs will decrease over time for those school populations receiving the intervention.
 

References

(1) Dryburgh H. Teenage Pregnancy. Health Reports 2007;Vol. 12, No. 1.
 
(2) Brownell M, De Coster C, Penfold R et al. Manitoba child health atlas update. Winnipeg, MB: Manitoba Centre for Health Policy; 2008.
 
(3) Winnipeg Regional Health Authority. Community Health Assessment. 2010;Available at URL: http://www.wrha.mb.ca/research/cha2009/files/ReportFull.pdf (PDF). Accessed January 22, 2011.
 
(4) Bearinger LH, Sieving RE, Ferguson J, Sharma V. Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential. Lancet 2007 April 7;369(9568):1220-31.
 
(5) International Conference on Population and Development. Summary of the programme of action. 1995;Available at URL: http://www.un.org/ecosocdev/geninfo/populatin/icpd.htm. Accessed January 22, 2011.
 
(6) Dehne KL, Riedner G. Sexually transmitted infections among adolescents: the need for adequate health services. Reprod Health Matters 2001 May;9(17):170-83.
 
(7) Kirby D. The impact of schools and school programs upon adolescent sexual behavior. J Sex Res 2002 February;39(1):27-33.
 
(8) Healthy Child Manitoba. Teen Services Clinic Manual. 2006;Available at URL: http://www.gov.mb.ca/healthychild/had/had_TeenClinicServices.pdf (PDF). Accessed January 17, 2011.
 
(9) Martens PJ, Fransoo R, The Need to Know Team et al. What Works? A First Look at Evaluating Manitoba's Regional Health Programs and Policies at the Population Level. Winnipeg, MB: Manitoba Centre for Health Policy; 2008.