Disparities in Infectious Diseases Among Youth Stephanie Addison Holt MD Adolescent Medicine Specialist 1. Identify infectious disease disparities among youth  2. Describe the role of school nurse in decreasing infectious disease disparity among youth 

Disclosure Information The following presenters/planners have declared no relevant personal, financial relationships: Presenters: Stephanie Addison Holt Planners: Jennifer Bay, MS, BSN, RN-BC Gail Smith, BSN, RN The following planner/speakers have declared relevant personal, financial relationships: N/A

Objectives 1. Identify infectious disease disparities among youth 2. Describe the role of school nurse in decreasing infectious disease disparity among youth 

Part 1

Youth in Georgia (by %) According to the 2014 American Community Survey, Georgia’s population is disproportionately made up of people of color, at 60.4 percent white, 30.9 percent Black or African American, 3.5 percent Asian, 9.1 percent Hispanic or Latino, 0.3 percent American Indian, and less than 0.1 percent Native Hawaiian or Pacific Islander.1 • As of 2014, just over one quarter of Georgia’s population of 9.9 million is under the age of 18.1 There are 1,422,199 young people ages 15-24 living in Georgia, making up 14.4 percent of the state’s population.1 1. U.S. Census Bureau, 2010-2014 American Community Survey 5-Year Estimates. Georgia. Available at: http:// factfinder.census.gov/bkmk/table/1.0/en/ACS/14_5YR/ DP05/0400000US13. Accessed 7 September 2016.

STD Incidence for Youth Age 15-19 (per 1000) Data from Georgia Family Connection Parternship Among young people ages 15- 24 in 2014, Georgia ranked 8th in the nation for reported cases of chlamydia, with an infection rate of 2,502.4 cases per 100,000, ranked 8th in the nation for reported cases of gonorrhea, with an infection rate of 552.2 cases per 100,000, and ranked 2nd in the nation for reported cases of primary and secondary syphilis, with an infection rate of 24.3 per 100,000.5 5. NCHHSTP Atlas, “STD Surveillance Data” (Atlanta, GA: Centers for Disease Control and Prevention). Availble at:http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html. Accessed 7 Sept 2016.

Barriers Lack of transportation Inability to pay Clinic hours Confidentiality Embarrassment/Stigma Lack of knowledge The higher prevalence of STDs among adolescents may also reflect multiple barriers to accessing quality STD prevention and management services, including inability to pay, lack of transportation, long waiting times, conflicts between clinic hours and work and school schedules, embarrassment attached to seeking STD services, method of specimen collection, and concerns about confidentiality Traditionally, intervention efforts have targeted individual level factors associated with STD risk which do not address higher-level factors (e.g., peer norms and media influences) that may also influence behaviors.4(https://www.cdc.gov/std/stats14/adol.htm#foot4) Interventions for at-risk adolescents and young adults that address underlying aspects of the social and cultural conditions that affect sexual risk-taking behaviors are needed, as are strategies designed to improve the underlying social conditions themselves.5,6(https://www.cdc.gov/std/stats14/adol.htm#foot5) In addition, in designing STD programs, consideration should be given to the needs of adolescent and young adult populations including extended hours, optimizing privacy in waiting rooms, and urine based specimen collection.3(https://www.cdc.gov/std/stats14/adol.htm#foot3)   3 Tilson EC, Sanchez V, Ford CL, Smurzynski M, Leone PA, Fox KK et al. Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions, 2004. BMC Public Health 2004, (4):21.

Part 2

Nursing Role in Reducing Disparities “School nurses have always been useful in enhancing health protective behavior as well as providing one-on-one instruction and guidance to adolescents regarding their reproductive health.” Effectiveness of Health Education Teachers and School Nurses Teaching Sexually Transmitted Infections/Human Immunodeficiency Virus Prevention Knowledge and Skills in High School Journal of School Health 2015 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4703031/ School nurses are also likely to have more experience with facilitating the acquisition of technical skills; teaching individuals to perform technical tasks ranging from self-injection of medication to colostomy care.22,23 Nurses are recognized for their expertise in building self-efficacy and self-competence in patient encounters and interactions with individuals across healthcare and community-based settings.24 Thus, the nurses’ skill in this area may have accounted for the students reported continued confidence in their ability to use a condom (condom technical skills) at 12 months while the confidence of students who were taught by health education teachers had diminished well before that time. skill building and reducing risky sexual health behaviors

Team Based Approach School Nurse Student Healthcare Provider Community School Teacher Healthcare Provider School nurse- healthcare expert

Reducing infectious disease disparity Technical skill building Improving self-efficacy and competency Reducing risky behaviors Teaching negotiation skills Early identification and referral Understanding your community resources Eliminating barriers

Vaccine Management Vaccine Education HPV Hep A, B Study: School-based intervention for the prevention of HPV among adolescents: a cluster randomised controlled study. BMJ 2016 Hep A, B http://www.k12.wa.us/HealthServices/pubdocs/InfectiousDiseaseControlGuide.pdf http://pediatrics.aappublications.org/content/121/5/1052

Curriculum Development Study: Effectiveness of health education teachers and school nurses teaching sexually transmitted infections/human immunodeficiency virus prevention knowledge and skills in high school. Journal of School Health 2015

Questions

References U.S. Census Bureau, 2010-2014 American Community Survey 5-Year Estimates. Georgia. Available at: http:// factfinder.census.gov/bkmk/table/1.0/en/ACS/14_5YR/ DP05/0400000US13. NCHHSTP Atlas, “STD Surveillance Data” (Atlanta, GA: Centers for Disease Control and Prevention). Availble at:http://gis.cdc.gov/GRASP/NCHHSTPAtlas/main.html. Effectiveness of Health Education Teachers and School Nurses Teaching Sexually Transmitted Infections/Human Immunodeficiency Virus Prevention Knowledge and Skills in High School Role of the School Nurse in Providing School Health Services-Council on School Health