NEW YORK CITY DEPARTMENT OF HEALTH’S HIGH SCHOOL CONDOM AVAILABILITY PROGRAM: HOW MANY CONDOMS ARE ENOUGH? Philip M. Alberti, PhD Erum K. Hadi, MPH Bronx District Public Health Office NYC Department of Heath and Mental Hygiene APHA November 2007

NYC Teen Pregnancy Rates: Declining, but still unacceptably high Bronx

In 2005, the Teen Pregnancy Rate in the South Bronx was the Highest in NYC

Health Disparities and District Public Health Offices (DPHOs) It was in response to these disparities that the NYC Dept of Health created 3 District Public Health Offices - or DPHOs - 4 years ago. These offices -- in the South Bronx, East and Central Harlem and North and Central Brooklyn -- are located where the health disparities are the greatest and, not surprisingly, intersect with the poorest areas in NYC. When the SBX DPHO opened, our premiere charge was to tackle the TPR. We decided to begin our intervention around the public high schools because we knew there was a mandate within our sister agency, the Dept. of Education, that required high schools to establish a CAP…

Bronx DPHO Teen Pregnancy Prevention Strategic Plan In collaboration with the Bureau of Maternal, Infant, and Reproductive Health, the DPHO created a strategic plan to reduce the teen pregnancy rate in the South Bronx 37% by the end of 2008.

1991 Chancellor’s Mandate As a response to the AIDS epidemic, the Chancellor of Education established Health Resource Rooms (HRR) in NYC public High Schools where students can get free condoms. When the DPHO opened in 2003, approximately 50% of the South Bronx High Schools were not fully compliant with the mandate.

Condom Availability Program (CAP) Department of Health employees staff the HRR at least once a week Collect data on the number of contacts, number of condoms distributed, gender, grade, etc. Currently have a presence in 17 of 53 area High Schools

Total Condoms Distributed By Quarter And Cumulating Totals (January 2004 – June 2007)

How many condoms are enough? Or, how to evaluate the CAP?

General Estimation Procedure C = F x P C = Estimated Mean number of condoms per person F = Frequency of intercourse P = Probability of condom use C(t) = N x S x C C(t) = Total number of condoms used S = Proportion of individuals who are sexually active N = Size of population Meekers, D. & Van Rossem, R. “Explaining inconsistencies between data on condom use & condom sales”. BMC Health Services Research 2005, 5:5.

Data Used for Estimate C(t) = N x S x (F x P) Census 2000 N = Population counts for 10 DPHO zip codes Youth Risk Behavior Survey 2005 (YRBS) S = Proportion sexually active P = Proportion sexually active youth using condoms at last sex National Survey of Family Growth 2002 (NSFG) F = Frequency of Sex

This Many Condoms Are Enough 22,255 males ages 14-18 in the South Bronx¹ 40.5% are sexually active² Based on national data³ (adjusted for SBX sexual activity) we estimated frequency of sex over the past 4 weeks: 0 times = 59.5%; 1 time = 8.65%; 2-3 times = 9.87%; 4-7 times = 10.18%; 8+ times = 11.8% 584,071 condoms per year 65 condoms per sexually active SBX male teen per year 104,106 condoms per year for the students at the 17 schools in which we have DOHMH staff 1 = 2000 Census; 2 = 2005 YRBS; 3 = 2002 NSFG

How do we use this target data? Condom estimate is broken down by month by school for all schools in CAP. A monthly report is produced that lists the number of condoms distributed per month and the percent of the condom goal reached per month. 100% of target 68% of target (based on YRBS reported condom use)

All School Summary Report

Individual School Report Reports distributed to Assistant Commissioner, DOHMH staff in the HRRs and their supervisors, and the Epi staff to track program’s progress

Limitations Estimate does not adjust for lost/broken condoms (underestimate?) Condoms break or slip during 3-5% of acts of intercourse¹ Homosexual males included (overestimate?) 4.7% of male teens in SBX² Data used in calculations spans different years (2000 Census, 2002 NSFG, 2005 YRBS) and does not account for population growth and shifts in sexual behaviors. In 2007, a frequency of sex question will be included in the YRBS to allow for a totally SBX-specific estimate! 1. Hatcher, et al (2005) “Managing Contraception” 2. YRBS 2005

New Question: What’s a realistic goal? For what % of condom goal should the CAP and DPHO be responsible? Community Based Organizations distribute condoms in schools The NYC Department of Education distributes condoms Teens buy condoms Parents buy condoms for teens