2015 Minnesota Adolescent Sexual Health Report

2015 MINNESOTA
ADOLESCENT SEXUAL
HEALTH REPORT
This report details the sexual health of Minnesota’s young people. Overall, there is much to celebrate. Teen pregnancy and
birth rates are at historic lows, with the teen pregnancy rate among 15-19 year olds having declined 63% from 1990 to 2013
and the teen birth rate having declined 54% in that same time period. In 2014, the adolescent gonorrhea rate declined and the
chlamydia rate leveled off. Young people are to be commended for making wise and healthy choices about their sexual health.
However, many challenges remain. The following Recommendations are Teenwise Minnesota’s response to the significant
disparities and challenges outlined in this report.
Recommendations
• Adolescent sexual health comprises much more than the
absence of pregnancy or disease. To fully support young people’s
health, we need to address their physical, social/emotional,
cognitive and spiritual development. Progress also depends on
addressing social factors such as education, income, housing
and livable communities.
• The systems that educate young people are not providing the
supports needed to ensure overall health, including sexual
health. Schools, out-of-school time programs, clinics and
faith communities must be better prepared to have open and
nonjudgmental conversations with youth.
• Honest, accurate and developmentally appropriate information
from parents is the first step toward raising healthy children
who make responsible decisions about sex, sexuality and
relationships. Parents/guardians need to be supported in their
role as educators.
teenwisemn.org
• Disparities in pregnancy, birth and STIs persist. We need to
assure that services and programming meet the unique needs
of youth from underserved populations, including those who are
homeless, LGBTQ, gender non-conforming, in foster care, in
juvenile justice settings, and/or from populations of color.
• Minnesota programs and policies inadequately address the
unique needs of adolescent parents and their children. Young
parents need access to confidential sexual health services, home
visiting services and parenting support.
• The normalization of sexual violence is pervasive in our culture.
It is time to work across sectors to change negative social norms
and educate young people about healthy relationships.
• Urban, suburban and rural communities are all affected by issues
of adolescent sexual health. While numbers may be higher in the
metro area, young people throughout Minnesota experience high
rates of pregnancy, birth and STIs.
PREGNANCY & BIRTH
Every day in 2013,
approximately
11 adolescents
became pregnant
and 8 gave birth in
Minnesota.1
Trends in Pregnancy and Birth
Overall, the birth rate among adolescents aged 15-19 in Minnesota decreased 9.8% from 2012 to 2013.
Pregnancy rates decreased by 10.7%. Pregnancy data indicate a decline in number of pregnancies since
2007, marking an overall decrease of 55% from 1990 to 2013. This decline in pregnancy and birth rates
is likely due to decreases in rates among Minnesota’s adolescent populations of color.
The number of pregnancies for adolescents younger than 15 decreased 26% and the number
of births for this age group decreased by 27.9% from 2012 to 2013. This change is magnified because
there are so few adolescents younger than age 15 that become pregnant and give birth each year.
FIGURE 1. MINNESOTA ADOLESCENT PREGNANCY STATISTICS, 1990-2013
NUMBER OF PREGNANCIES
1990
1995
2000
2012
2013
CHANGE SINCE 1990
CHANGE SINCE 2012
Under 15 years
159
154
150
77
57
-64.2%
-26%
15–17 years
2803
2782
2411
1220
1004
-64.2%
-17.7%
18–19 years
5833
4664
5164
3172
2874
-50.7%
-9.4%
15–19 years
8636
7446
7575
4392
3878
-55.1%
-11.7%
PREGNANCY RATES PER 1,000
1990
1995
2000
2012
2013
CHANGE SINCE 1990
CHANGE SINCE 2012
15–17 years
33.8
31.2
21.9
11.7
9.7
-71.3%
-17.1%
18–19 years
92.2
68.5
70.9
43.4
40
-56.6%
-7.8%
15–19 years
59
47.3
41.4
24.7
22.1
-62.6%
-10.7%
2013
CHANGE SINCE 1990
CHANGE SINCE 2012
FIGURE 2. MINNESOTA ADOLESCENT BIRTH STATISTICS, 1990-2013
NUMBER OF BIRTHS
1990
1995
2000
2012
94
84
87
43
31
-67%
-27.9%
15–17 years
1648
1939
1710
882
758
-54%
-14.1%
18–19 years
3688
3273
3686
2415
2192
-40.6%
-9.2%
Under 15 years
15–19 years
5336
5212
5396
3297
2950
-44.7%
-10.5%
BIRTH RATES PER 1,000
1990
1995
2000
2012
2013
CHANGE SINCE 1990
CHANGE SINCE 2012
15–17 years
19.9
21.7
15.5
8.4
7.3
-63.3%
-13.1%
18–19 years
58.3
48.1
50.6
33
30.5
-47.7%
-7.6%
15–19 years
36.5
33.1
29.5
18.6
16.8
-54%
-9.8%
National Comparison
From 2007 to 2013, the birth rate for youth aged 15–19 in the US
dropped nearly 36%, reaching a record low of 26.5 per 1,000 in
2013.2 The overall decline in the adolescent birth rate over the past
two decades has been attributed to delayed initiation of sexual
activity and increased use of the most effective contraceptive
methods (i.e. IUDs and implants).3,4
{
2
Despite reaching historic lows in 2013, the
United States continues to have the highest
adolescent pregnancy and birth rates in the
developed world. The United States’ teenage
birth rate is six times greater than Japan and
Denmark, and 10 times higher than Germany.5
{
Subsequent Births (additional births to adolescent mothers)
• Nationally, 17% of births to adolescents are subsequent births.
• In Minnesota, 14% of births to adolescents are subsequent births.6
Pregnancy prevention among adolescent mothers is a complex
issue. Subsequent births to adolescents are associated with many
factors, such as maternal age at first birth, contraceptive use,
educational attainment and living with an intimate partner rather
than living with a parent.7 When adolescents become parents,
they are less likely to achieve educational goals, which may
have longer lasting effects on their children’s development than
maternal age at first birth.8 In Minnesota, teens with the highest
percent of subsequent births are from communities of color.
Twenty-two percent of births to Asian/Pacific Islander youth are
subsequent births; 19% of births to Black and Hispanic/Latina
youth were subsequent births, compared to 10% of births to
White adolescents.9
COUNTY LEVEL
INDICATORS
10,11
Greater Minnesota disproportionately
experiences adolescent pregnancy,
births and STIs when compared with
the Twin Cities metro area.
Although the numbers of pregnancies, births and STIs are larger
in the metropolitan area, the rates are much greater in rural
Minnesota. In these areas, adolescent sexual health services
are often offered in conjunction with family planning services.
Since these services may appear geared toward those who can
get pregnant, not all adolescents may seek the care they need.
Improving adolescent sexual health in Minnesota requires a
heightened focus on rural areas and on serving young men.
SEXUALLY
TRANSMITTED
INFECTIONS:
STIs & HIV/AIDS
Even though they account for only
7% of the population in Minnesota,12
adolescents aged 15-19 accounted
for 26% of chlamydia and 20% of
gonorrhea cases in 2014.13
FI
200
Adolescents and young adults experience a high incidence of sexually
transmitted infections compared to other age groups. This increased risk
for STIs is likely related to a lack of access to STI prevention services,
socioeconomic status, discomfort with facilities designed for adults and
concerns about confidentiality.14
The gonorrhea rate among 15-19 year olds in Minnesota gradually
declined from 2007 to 2011 but increased in 2012 and 2013.15 2014
marked a 18% decline in gonorrhea rates among teens (Figure 3).
Seventy percent of reported cases of gonorrhea were in Hennepin and
Ramsey counties.16 High rates of gonorrhea tend to be reported in
communities experiencing high rates of poverty and school dropout and
in communities with low-quality and/or inaccessible health care services.
150
100
50
FI
FIGURE 3. GONORRHEA AND CHLAMYDIA RATES IN MINNESOTA,
2007-2014 (AGED 15-19 PER 100,000 POPULATION)
1458
1384
1400
1200
1164
1196
Chlamydia
1071
Gonorrhea
1000
TOP 10 COUNTIES WITH HIGHEST RATES OF:
300
BIRTH
Mahnomen
Cass
Pennington
Watonwan
Nobles
Cottonwood
Hubbard
Kandiyohi
Freeborn
Big Stone/
Beltrami
CHLAMYDIA*
Hennepin
Ramsey
Cass
Mille Lacs
Olmsted
Kandiyohi
Pine
Chippewa
Hubbard
Benton
GONORRHEA*
Hennepin
Ramsey
Lyon
Mower
Goodhue
Itasca
Clay
St. Louis
Beltrami
Anoka
*Chlamydia and gonorrhea rathes not calculated for counties with fewer than
five cases.
To view county-specific adolescent sexual health reports, please visit Teenwise
Minnesota’s website at teenwisemn.org.
3
1402
1273
1300
1100
1394
229
267
214
200
213
163
164
2009
2010
218
F
158
100
2007
2008
2011
2012
2013
2014
There were 17 new cases of HIV among adolescents aged 15-19 in
Minnesota in 2014, which is an increase of 70% from 2013 when 10
new cases were diagnosed among this age group.17 Even though HIV
indiscriminately affects individuals in the greater population, HIV cases
among Minnesota youth predominantly affect men who have sex with
men (MSM).18
The chlamydia rate for adolescents aged 15-19 increased very slightly, by
0.6%, from 2013 to 2014.19 Despite the recent leveling off of chlamydia
rates, Minnesota has experienced a 51% increase in chlamydia infection
among youth since 2003.20
1458
SEXUAL HEALTH DISPARITIES
1394
1384
1400
1402
2000
1273
1300
1200
FIGURE 3:
1196
1164
1,75
1500
Chlamydia
The birth rates for American Indian, Black and Hispanic/Latina youth in
1000
Minnesota are more than three times greater than that of White youth.
1071
1100
Gonorrhea
1000
267
229
300
214
213
218
500
200
164
163 rates
From
2012 to 2013, birth
decreased
among adolescents
158
100
in every racial group. The birth rate among American Indian and
2007
2008
2009
2010
2011
2013
2014
Asian/Pacific
Islander
youth
decreased
20%2012
and 11%
respectively.
FIGURE 5:
FIGURE 5:
Birth rates among Black youth continued to fall, decreasing 5%
2012 to 2013.21
FIGURE from
5:
2000
1500
1000
500
0
{
{
1000
Indian
Islander
Latina
6%
6%
5%
7%
553
American
Indian
5%
7%
30%
80%
80% Black
Asian/Pacific
Islander
60
48.3
Hispanic/
Latina
40
30%
20
28%
24.1
37%
FIGURE 3:
37%
11.9
8.7
adds up to 101%
American
Indian
23%
41 41.7
39
37
28%
31.1
0
adds up to 101%
Asian/Pacific
Islander
18.6 19%
adds up to 101%
FIGURE 5:
Hispanic/
Latina
545
American Indian
25
2000Asian/Pacific Islander
1500
134
Hispanic/Latino*
51
White
0
171
American
Indian
685
White
51
White
1,327
0
642
1000
54%
OTHER/
UNKNOWN
3000
51
4000
473
5000
5,607
5000
2%
545
American Indian
25
6%
685
6000
Black
Hispanic/
Latina
White
Other/
Unknown
2000
adds u
Gonorrhea
2,812
Chlamydia
5%
7%
1,705
6000
221
1,327
19%
FIGURE 9. MINNESOTA CHLAMYDIA AND GONORRHEA
RATES BY RACE
AND
FIGURE
6: HISPANIC ORIGIN, 2014
(AGED 15-19 PER 100,000 POPULATION)
Black
2000 553 3000
23%1,70
White youth (Figure 9).26
Chlamydia
4000
134
Hispanic/Latino*
Asian/Pacific Islander
2000
685
The gonorrhea rate is 33 times higher for Black youth and 11 times
642
1000
25
Black
28%
5,607
252
Asian/Pacific
Islander
Asian/Pacific
WHITE Islander
addshigher
up to
for 101%
American Indian youth when compared to the rate for
1,753
1,327
545
adds up to 101%
1,705
134
1,705
FIGURE 8:
ASIAN/
PACIFIC
ISLANDER
Note: Consistent with state and national standards, persons who identifyWhite
their origin642
37%
as Hispanic/Latino
may be of any race. These individuals are included within the racial
0
1000
categories represented in Figures 6-8. Due to rounding, totals for Figures 7 and 8 may
not equal 100.
Gonorrhea
2,812
Black
Hispanic/Latino*
Black
0
FIGURE 9:
BLACK
American Indian
19%
30% 54%
FIGURE 5. NUMBER OF BIRTHS TO YOUTH BYGonorrhea
RACE AND
FIGURE 9:
25
545
Asian/Pacific
American Indian
HISPANIC
ORIGIN,
2013Islander
(AGED 15-19)
685
2,812
Chlamydia
500
AMERICAN
INDIAN
adds up to 101%
Black
9: is used rather than “African American” in order to be
Note: TheFIGURE
term “Black”
consistent with state and national racial categories and because the data presented
FIGUREin9:this racial category includes both foreign-born and U.S.-born populations.
1000
Other/ 37%
Unknown
White
3%23%
3%
30%
28%
4% 1%
US
FIGU
221
FIGURE 8. GONORRHEA
FIGURE
4.7:ADOLESCENT BIRTH RATES BY RACE AND
FIGURE
8: AMONG YOUTH AGED
FIGURE
CASES
HISPANIC ORIGIN, MINNESOTA VS UNITED STATES, 2013
15-19 IN MINNESOTA, 2014
FIGURE
8:
FIGURE 7:(AGED 15-19 PER 1,000 POPULATION)
FIGURE
7:
4% 1%
3% 3%
MN
80
FIGURE 4:
3% 3%
134
Hispanic/Latino*
51
White
0
5,607
1,327
80%
642
1000
Whi
3% 3%
473
252
171
Unknown
473
FIGURE 7. CHLAMYDIA
CASES AMONG YOUTH
FIGURE 7:
AGED 15-19 IN MINNESOTA,
1,753
2014
2%
2%
Pregnancy, birth and STI rates among
youth
continue to vary 1000
553
473
23
across 500
racial and ethnic groups
in
Minnesota.
Strategies
252
221
171 553
to eliminate these persistent
disparities
must
address
social 500
473
0 252
determinants
of healthAsian/Pacific
(i.e. poverty,
racism
and unequal
access
221
American
Black
Hispanic/
White
Other/
171
Indianeducation),
Islander which disproportionately
Latina
Unknown
to health care and
affect 0
American
Asian/Pacific
White
Other/
the health
of youngBlack
peopleHispanic/
in communities
of color.24
171
Sexually Transmitted Infections
0
STI rates are disproportionately high for populations
of color inBlack Hispanic/
American Asian/Pacific
Indian
Islander
Minnesota. The rates for both chlamydia and
gonorrhea
were highestLatina
25
among Black youth, followed by American Indian youth.
6:
FIGUREFIGURE
6. RACIAL
COMPOSITION OF
FIGURE
6:
MINNESOTA
YOUTH
AGED 15-19, 2014
Although adolescent pregnancy and birth rates
2000
2000
are highest among Minnesota populations
1,753 of
color, the largest number of adolescent births is
1500
1,753
consistently among White females
(Figure 5).22 1500
553
252
2000
3000
4000
5000
6000
4
95%
2013 MINNESOTA STUDENT
SURVEY:92%
FIGURE 11:
(35,754)
(37,044)
FOCUS ON LGBQ YOUTH
1%
(388)
7)
4%
(267)
(1,016)
(1,066)
4%
Recognizing Sexual Orientation
95%
(1716)
The 2013 Minnesota Student
Survey was one of the
first
(37,044)
statewide attempts to include information about sexual
orientation in data collection. The sexual orientation questions
were asked of 9th and 11th graders, yielding 77,758
MALES (38,955)
respondents.
FEMALES (38,803)
1%
MALES (38,955)
(388)
Heterosexual1%
(Straight)
4%
95%
(37,044)
25.9%
18.5%
Heterosexual (Straight)
HETEROSEXUAL
(STRAIGHT)
92%
(35,754)
23.5%
18.5%
NOT SURE
(QUESTIONING)
48.7%
50.9%
FIGURE 12:
Sexual Activity
49.5%
Minnesota LGBQ adolescents reported higher54.4%
levelsMale
of sexual
25.9% youth. 50.9% of lesbian
activity when compared with straight
Female
Straight
23.5%have ever had sex compared
females and 48.7% of gay males
18.5% and 25.9% of straight males
with 23.5% of straight females
Questioning
28.1%
(Figure 11).27
48.7%
Gay/Lesbian
Pregnancy
50.9%
Pregnancy affects all young people, regardless of49.5%
their sexual
Bisexual Bisexual females were five times more likely to have
orientation.
54.4%
been pregnant than straight females. Questioning and gay males
were four times more likely than straight males to report getting
28
FIGURE
14:
someone pregnant (Figure 12).
Straight
54.4%
Female
9.9%
9.9%
18.8%
6.6%
Straight
Bisexual
2.4%
Questioning
8.9%
Female
2
9.9%
Gay/Lesbian
2.8%
14.5%
Male
8.2%
1.5%
Questioning
FIGURE 13. ALCOHOL OR DRUG USE BEFORE LAST
9.9%
SEXUAL
INTERCOURSE,
9TH AND 11TH Bisexual
GRADES
COMBINED
FIGURE
14:
Gay/Lesbian
6.6%
8.9%
Bisexual
Female
36.5%
Male
Female
36.5%
22%
29.3%
24.6%
26%
22.6%
Male
Female
Straight
Special thanks to John Salisbury from Rainbow
Health Initiative for
his assistance with these data.
14.5%
26%
22%
Male
14.5%
Questioning
22.6%
8.2%
18.8%
Straight
29.3%
Questioning
Bisexual
FIGURE 14:
2.8%
FIGURE 13:
18.8%24.6%
Bisexual
Gay/Lesbian
Gay/Lesbian
Straight
2.8%
Male
2.4%
50.9%
1.5%
49.5%
Questioning
Alcohol or Drug Use during Last Sex
LGBQ youth report higher levels of substance abuse before last 18.8% Gay/Lesbian
sex. Questioning and gay malesStraight
had the highest rates of alcohol
14.5%
or drug use at last sex, while straight males and females had the
Bisexual
lowest (Figure 13).29 This may
be a contributing factor to higher
Questioning
FIGURE 14:
22%
rates of pregnancy among LGBQ youth.
Gay/Lesbian
1.5%
28.1%
48.7%
Not sure (Questioning)
GAY OR
LESBIAN
2.4%
Straight
FIGURE 12. EVER BEEN PREGNANT OR GOTTEN
FIGURE PREGNANT,
13:
SOMEONE
9TH AND 11TH GRADES
COMBINED
Questioning
Female
Bisexual
Gay
or Lesbian
y/Lesbian
54.4%
Female
FEMALES (38,803)
Bisexual
49.5%
FIGURE 13:
Male
Male
Gay/Lesbian
BISEXUAL
28.1%
50.9%
25.9%
Questioning
MALES (38,955)
23.5%
48.7%
Bisexual
Not sure (Questioning)
(1716)
28.1%
(1,066)
FIGURE 12:
Gay or Lesbian
18.5%
Not sure (Questioning)
Gay/Lesbian
Straight
GURE 12:
GayQuestioning
or Lesbian
Female
23.5%
FEMALES (38,803)
Bisexual
Male
25.9%
Straight
1%
Bisexual
(507)
92%
3%
FEMALES
(267) (38,803)
3%
(1,016)
Not sure (Questioning)
FIGURE11.
12:PERCENT OF SEXUALLY ACTIVE ADOLESCENTS,
FIGURE
(35,754)
9TH AND 11TH GRADES COMBINED
92%
(35,754)
Heterosexual (Straight)
FIGURE 10. SEXUAL ORIENTATION, 9TH AND 11TH
FIGURE 11:
GRADES COMBINED
Bisexual
MALES (38,955)
(507) gay, bisexual and questioning
Heterosexual (Straight)youth
Bisexualrepresent
Gay or Lesbian a
Minnesotan lesbian,
population
that has1%significant
sexual health care needs.
3%
3%
95%
estioning
(1,066)
(1716)
(37,044)
Straight
3%
(267)
(1,016)
(388)
1%
E 11:
1%
3%
1%
36.5%
5
REFERENCES
1
Minnesota Department of Health (MDH), Center for Health Statistics, Minnesota Health Statistics Annual Summary, 2013.
2
Hamilton BE, Martin JA, Osterman MJK, Curtin SC, Births: Preliminary data for 2013. National Vital Statistics Reports 2014;63(2). http://www.cdc.gov/nchs/
data/nvsr/nvsr63/nvsr63_02.pdf
3
Boonstra HD, What is Behind the Declines in Teen Pregnancy Rates? Guttmacher Policy Review 2014;17(3). http://www.guttmacher.org/pubs/gpr/17/3/
gpr170315.html
4
Centers for Disease Control and Prevention (CDC). Vital Signs: Trends in Use of Long-Acting Reversible Contraception Among Teens Aged 15-19 Years
Seeking Contraceptive Services – United States, 2005-2013. MMWR 2015;64(13):363 – 369.
5
The World Bank Group, World development indicators: Reproductive health, 2014. http://wdi.worldbank.org/table/2.17
6
The National Campaign to Prevent Teen and Unplanned Pregnancy. 50-State and National Comparisons thenationalcampaign.org/data/state/minnesota .
FIGURE
CDC.
Vital 13:
Signs: Repeat Births Among Teens – United States, 2007 – 2010. MMWR 2013;62(13):249 – 255. http://www.cdc.gov/mmwr/preview/mmwrhtml/
mm6213a4.htm
Male
8
Sullivan K, Clark J, Castrucci B, Samsel R, Fonesca V, Garcia I. Continuing Education Mitigates the Negative Consequences of Adolescent Childbearing.
2.4%
Female
Maternal and Child Health Journal 2011;15:360–366.
7
Straight
1.5%
The National Campaign to Prevent Teen and Unplanned Pregnancy. 50-State and National Comparisons thenationalcampaign.org/data/state/minnesota.
9.9%
10
MDH, Center for Health Statistics, 2013 Birth Data.
9
Questioning
2.8%
MDH, STD and HIV/AIDS Surveillance Systems, Surveillance Statistics 2014.
9.9%
12
U.S. Census Bureau, American Community Survey 3 Year Estimates:
2009-2011. factfinder2.census.gov/faces/tableservices/jsf/pages/productview.
11
Gay/Lesbian
xhtml?fpt=table.
6.6%
13
MDH, STD and HIV/AIDS Surveillance Systems, Surveillance
8.9%Statistics 2014.
14
CDC. Sexually Transmitted Disease Surveillance, 2013.
http://www.cdc.gov/std/stats13/surv2013-print.pdf.
8.2%
15
Male
MDH, STD and HIV/AIDS
Surveillance Systems, Surveillance Statistics 2007-2013.
16
Female Surveillance Systems, Surveillance Statistics 2014.
MDH, STD and HIV/AIDS
17
Ibid.
Bisexual
18
9.9%
MDH, MN HIV Surveillance
Report, 2014.
19
MDH, STD and HIV/AIDS Surveillance Systems, Surveillance Statistics 2014.
9.9%
MDH, STD and HIV/AIDS
Surveillance Systems, Surveillance Statistics 2003-2014.
21 6.6%
MDH, Center for Health Statistics, 2007-2013 Birth Data.
20
MDH, Center8.9%
for Health Statistics, 2013 Birth Data.
8.2%
23
MDH, Center for Health Statistics. The Health and Well-Being of MN’s Adolescents of Color: A Data Book, May 2012. www.health.state.mn.us/divs/chs/mss/
22
8%
24
25
26
22% 27
specialreports/AdolescentsOfColor_REPORT_051412.pdf.
Male
CDC. Establishing a Holistic Framework to Reduce Inequities in HIV, Viral Hepatitis, STDs, and Tuberculosis in the United States, October 2010. www.cdc.gov/
Female
socialdeterminants/docs/SDH-White-Paper-2010.pdf.
MDH, STD and HIV/AIDS Surveillance Systems, Surveillance Statistics 2014.
36.5%
Ibid
MDH, Center for Health Statistics, 2013 MN Student Survey.
29.3%
Ibid
24.6%
29
Ibid
26%
28
22.6%
Suggested citation: Farris, J. & Regan, E. (2015). 2015 Minnesota Adolescent Sexual Health Report. Teenwise Minnesota, May 2015. St. Paul, MN
Teenwise Minnesota is the statewide leader in promoting adolescent sexual health and development. We achieve this by
strengthening the capacity to implement evidence-based practices, programs and policies. This report is a summary of the
sexual health of Minnesota’s adolescents and uses data from the most recent year available. For county-specific statistics,
visit Teenwise Minnesota’s website at teenwisemn.org/county-specific-adolescent-sexual-health-report-and-data/.
1619 Dayton Avenue, Suite 111, St. Paul, MN 55104 • 651-644-1447 • teenwisemn.org