“Can you get pregnant when you’re on your period?” PRL-Institute for Health Policy Studies Knowledge, Attitudes and Experiences with Contraceptives and Reproductive Health Care The Teen Voices study was aimed at enhancing our understanding of teens’ attitudes and motivations related to teen pregnancy prevention and use of family planning services. Negotiating Sex Education Questions & Misinformation Elodia Villaseñor, MPH Shelly Kaller, MPH Dr. Claire Brindis November 9, 2010

Financial Disclaimer No financial conflicts of interest. The Teen Voices Study was funded by the California Wellness Foundation.

California and U.S. Teen Birth Rates 1991- 2008 Source: California Department of Public Health

California Teen Birth Rates 2004- 2008 Birth Rate (per 1,000 females age 15-19 years) Hispanic African American Multiple Ethnicities American Indian White Asian/ PI Source: California Department of Public Health

Outcomes of Teen Births Poor educational, medical and psychosocial outcomes for mother and child. Cost to California tax payers $1.7 billion in 2006. Source: The National Campaign Fact Sheet: Recent Trends in Teen Pregnancy, Sexual Activity and Contraceptive Use. August 2001. Constantine NA, Nevarez CR, and Jerman P. No Time for Complacency: Teen Births in California. Oakland, CA: Public Health Institute. 2008.

Inclusion Criteria Self- identified Latino/a, African American, White San Francisco, Los Angeles, Fresno and Alameda Counties Self- identified Latino/a, African American, White 15- 17 years old Not teen parents The focus is on teens in counties with high teen birth rates Data (survey & focus groups) gathered from males and females separately Data (survey & focus groups) gathered from different ethnic groups separately

Participants (n=178) Race/ Ethnicity Gender Age Latino/a (83) African American (52) White (43) Gender Males (72) Females (106) Age 14- 18 years old (average 16.1)

Education 95% of participants in school 72% have had a class on preventing teen pregnancy, HIV, or STI’s 21% Middle School only 54% High School only 25% Both Middle School and High School

Birth Control or Condom Use Female vs. Male use of birth control among sexually experienced youth   Females (N=42) Males (N=27) Ever Used Last Used n % No Method Used 6 14% 11 26% 1 4% 3 11% Partner used Birth Control, but don't know what type n/a 5 19% 2 7% Oral Contraceptive Pill Depo-Provera Shot 7 17% 4 9% 0% Patch 2% NuvaRing Emergency Contraception 9 21% Condoms 33 79% 25 58% 93% 20 74% Withdrawal 16 59% Oral Sex or Anal Sex

Misinformation as a Barrier to Use of Sexual Health Services Provider Issues: Lack of confidentiality assurances “ Some teenagers don’t know if they could trust the doctor. Because… their parents pay for their insurance. And if parents are paying for it, doctors will tell everything to them.” - Latina Female

Sexual Health Misinformation Requirements to access services Age - 18 years old Parental permission Confidentiality Does it exist? What diagnoses do they tell your parents? Clinic vs. Doctor Expertise? Confidentiality?

Misinformation & Questions: Birth Control Methods So what happens with the ring? The ring sounds like a funny thing but--it sounds like funky. I'm not gonna lie. - White male “I never heard of the patch.” - White Female “It doesn’t make sense because, I mean, if you’re going to put a patch right here, how is that going to work for down there?” -Latina Female

Perception of Birth Control: Side Effects “ Birth control, um, it can mess up your intestines. Like if you don’t research the thing, it’s so many harmful things that can happen afterward. It can cut off your immune system. And instead of helping you, it can make you more, um, open to getting diseases. Like even if you have a little bit [of] bacteria from somebody’s hand, it can just spread into a disease. Like people don’t know that when they take birth control. They’re just saying, ‘Oh, I don't want to get pregnant.’ But they didn't research it. It's actually worse taking birth control than being pregnant. It would be better to get pregnant than to just have birth control because birth control, it doesn't always work and then it's messing up your body.” -African American Female

Misinformation: Emergency Contraception Actually, I had someone come up to me that was like 16 and was like, "Hey, can you get me Plan B?" I was like, "I can't because you have to be 18 to buy it." And they were like, "Yeah, I know. Can you get it for me?" I-I'm not 18, so they were screwed. Uh, but I think they got someone else to buy it for them, but that's inconvenient for them. -White Male What are they (males) going to get it for? To kill all their sperms? - Latina female

Sources of (Mis)information Friends “You talk to your friends. But you have to be careful who you talk to…”- White female Parents, Family & Guardians “My grandmother went over this. She said that a man should always count how many times it takes. For ejaculation, you know- just to be safe.” –African American Male Sex Education Programs “That only lasted like 3 minutes (talking about abstinence) and then they jumped to abortion! I was like, ‘psh! Calm down!’... It wasn’t right.” - Latina female .

Key Recommendations Work with parents, schools, and communities to provide better sex education to teens, and improve parent-teen communication. Set priorities for sexuality education instruction. Provide youth with tailored education, and “real” adults. Valuable lessons exist in successful media campaigns, components of which should be replicated in public health media messaging. Further research is needed regarding teen use of LARCs, EC policy change, contraceptive use and communication within a relationship.

. QUESTIONS? .

THANK YOU! Elodia Villaseñor, MPH Elodia.Villaseñor@ucsf.edu Shelly Kaller, MPH Shelly.Kaller@ucsf.edu