1. Pursuing a Lifespan Women’s Health Perspective: Needs and Opportunities in the Adolescent Years AMCHP Web conference September 27, 2007

2. Epidemiology of Women and Chronic Disease Prevalence Rate Increases 1996-2002 for Women 18-44 Years – Asthma, Diabetes, Hypertension,Heart Disease In 2002 12.1% of women reported activity limitation related to depression Will add bullet point about infertility Overweight and obesity increasing over past 25 years and has risen each year. Obese women at increased risk for maternal morbidity and mortality -- Gestational diabetes,Preeclampsia

3. System Challenges “Too little, too late, too fragmented”

4. To reiterate….. Behaviors in Adolescence Can Have Life-long Consequences Adolescence as a Key Time for Shaping Health Behaviors

6. Multiple Determinants of Health (Evans & Stoddart 1990) Distal Risk Factors –Genetic –Physical environment –Social environment Proximal Risk Factors –Biomedical responses –Behavioral responses –Access to health care

7. Intervention Strategy Options Information strategies Administrative strategies Financing strategies Provider strategies Non-governmental strategies Environmental

8. H. Grason. Applying a Lifespan Approach to Safe Motherhood Interventions. Presented at “Expecting Something Better” Jacobs Institute conference. Washington, DC. May 2005.

10. Obesity-Related Strategies by Life Stage: Little Girls Environmental strategy – make neighborhoods safe and amenable for physical activity. Provider strategy – increase pediatrician practice of taking family histories. Administrative strategy – focus on food policies and education in day care and preschool settings.

11. Obesity-Related Strategies by Life Stage: Adolescent Girls Provider Strategies –Need to begin to focus on woman-centered information transfer approach. –Pediatric histories need to be relayed to family practice and internal medicine physicians and reproductive health providers. School settings –Include peer support groups. –Breastfeeding education. Different influences on behavior and different activities and places where spend time.

12. Obesity-Related Strategies by Life Stage: Young Women in their 20s Might expand provider base for health interventions to include coaches, athletic club/gym staff. Assuring information transfer across providers and over time continues to be important. –Young women change providers often. –Use multiple providers at once. –Tailoring chronic disease management to pregnancy.

13. New Territories ? Which adolescents are MCH reaching and how…schools, after school & social programs, family planning,pregnant women < 24 yrs Who is MCH not reaching….those where FP clinics have insufficient capacity or reach, or those women who don’t use family planning ?? College Students: 44% of all women (adolescents) ages 18-24 are enrolled in college; about 14.4 million !! 28% of women (adolescents) 18-24 reported no usual source of health care in 2003

14. Health, and Adolescents in College Reported unprotected sex after drinking - 15.6% males; 12.5% females* Multiple Sexual Partners* - 2+ 11%; 3+ 5.7%; 4+ 7.6% 50% report ‘always use a condom”* 32% are obese or overweight* * Source: Fall 2006 NCHA Data, 4 year Colleges

15. Healthy Campus 2010 Priorities Injuries Tobacco, alcohol, illicit drugs Sexual behavior Dietary patterns Physical activity

16. Conclusions Lifespan approach demands attention to consistency and continuity with respect to health information and health care. Patient-based approaches complemented by population- based approaches to reach women across life course are critical.