1 Missing the mark? Comparing rates of pregnancy & STIs among non- enrolled & in-school adolescents: results from a PATHS Equity for Children project Manitoba Centre for Health Policy Colleen Metge, D.Chateau, S.Shaw, C.Taylor, M.Chartier P.Martens, C.Charette, R.Santos, L.Lix & the PATHS Team CPHA May 2014

2 The effect of In-School Clinics on teen pregnancy & STI rates The original PATHS Equity for Children project evaluating the effectiveness of in-school clinics on teen pregnancy & STI rates was reported on at CPHA in Subsequently, we posited two additional research questions: 1. What is the relationship between teen pregnancy or STIs and status of school enrollment, and 2. How is socioeconomic status related to enrollment status and outcomes (teen pregnancy & STIs)?

3 Study Premise In-school clinics provide services for youth in school, including testing for STIs and advice regarding, or provision of contraception. When we looked at the effectiveness of in-school clinics, we identified in the population three groups of adolescents aged 14 to 19 years of age ( ): (1) Adolescents attending schools without clinics (2) Adolescents attending schools with clinics (3) Adolescents who were not enrolled in school

4 Subsequently… We identified a significant number of young women giving birth who were not enrolled in school, and therefore not receiving the benefits of in-school clinics. We present here an analysis of The relationship between teen pregnancy or STIs and school enrollment, and How socioeconomic status is related to school enrollment status, STIs or teen pregnancy

5 Methods Repository data held at MCHP was used to identify all teen girls with a birth outcome or males/females with STI prior to completing high school School enrollment was identified at the start of every school year; occurrence of teen births / STIs was assigned to adolescents in one of three groups: 1) enrolled in a school without an in-school clinic 2) enrolled in a school with an in-school clinic 3) NOT enrolled in school NOTE: schools which have an in-school clinic were targeted for this intervention based on teen pregnancy rates

6 STEPS: (1)Database compilation (2003/ /11) (a)Outcome variables: teen pregnancy & STIs (b)Explanatory variables: age, mother’s age at first birth, SES (income quintile), geographic place of residence (MB: N/M/S & Wpg M/L/Avg), birth control method(s) offered, hours open (by school size), academic year In-School Clinics: Effect on teen pregnancy & STI rates

7 Main Analyses: longitudinal & cross-sectional or ecologic & accounting for underlying changes in the rates (e.g., STI testing) In-School Clinics: Effect on teen pregnancy & STI rates years ……………………………….2011 In-school clinics funded by MBHealth Changes in chlamydia tests particularly relevant for males

8 In-School Clinics: Effect on teen pregnancy & STI rates Variable (Ages 14-19) WITHOUT School Clinic n=44924 WITH School Clinic n=9291 NOT Enrolled n=12324 Sex (Female)22957 (51.1%)4739 (51.1%)6796 (55.1%) Completion of 9 th grade in a timely manner (81.1%)5604 (76.5%)1393 (38.3%) Income Assistance 2793 (6.2%)1250 (13.5%)1505 (12.2%) History of protective services 9921 (22.1%)3150 (33.9%)5093 (41.0%) 12 schools WITH clinics / 276 schools WITHOUT clinics Based on the 2008/2009 academic year

9 Pregnancy 9,292 pregnancies ( ) recorded for the cohort 55% (5,140 / 9,292) occurred in the non-enrolled group Age-adjusted pregnancy rates by enrollment group were: Non school clinic: 31.8 / 1000 School clinic: 42.8 / 1000 Not enrolled: 87.9 /100 Rate for non-enrolled females was 2.1 times (p<.0001) higher than school clinic females and 2.8 times (p<.0001) higher than non school clinic females

10 Teenage Pregnancy for Manitoba Population, Crude rate of females aged years per 1,000 Teen Pregnancy Rate Academic Year

11 Age-adjusted pregnancy rates, by enrolled/not-enrolled group and income quintile,

12 Sexually Transmitted Infections (STIs) 4,297 positive STI tests were reported ( ) or 12.1 per 1000 adolescents 48% (2,047 / 4,297) occurred in the non-enrolled group Female rates (16.5/1000) were over twice as high as male rates (7.8/1000) Age-adjusted STI rates by sex and enrollment group were: Non school clinic: F 10.2 M 4.1 / 1000 School clinic: F 19.5 M 8.3 / 1000 Not enrolled: F 23.9 M 14.2 /1000 Crude STI rates for non-enrolled males was 3.5 times (p<.0001) higher than non-school clinic males and 2.3 times (p<.0001) higher than non school clinic females

13 Age-adjusted STI rates, by FEMALE enrolled/not-enrolled group and income quintile,

14 Age-adjusted STI rates, by MALE enrolled/not-enrolled group and income quintile,

15 CONCLUSION In-school clinics appear to have been systematically assigned and supported in schools with higher needs Highest rates for pregnancies and STIs were observed among non-enrolled adolescents Implications? –We may be missing the mark: Program planning & design should consider optimal strategies to engage out of school youth

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