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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 TeamCPHA May 2014

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The effect of In-School Clinics on teen pregnancy & STI

ratesThe original PATHS Equity for Children project evaluating the effectiveness of in-school clinics on teen pregnancy & STI rates was reported on at CPHA in 2013. 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)?

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Study PremiseIn-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 (2003-2010):(1) Adolescents attending schools without clinics (2) Adolescents attending schools with clinics(3) Adolescents who were not enrolled in school

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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

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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

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STEPS:(1)Database compilation (2003/04-

2010/11)(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

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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

2001 2003 2006 ……………………………….2011

In-school clinics funded by MBHealthChanges in chlamydia testsparticularly relevant for males

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In-School Clinics:Effect on teen pregnancy & STI rates

Variable(Ages 14-19)

WITHOUTSchool Clinic

n=44924

WITHSchool Clinic

n=9291

NOTEnrolledn=12324

Sex (Female) 22957 (51.1%) 4739 (51.1%) 6796 (55.1%)

Completion of 9th grade in a timely manner 30509 (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

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Pregnancy • 9,292 pregnancies (2003-2010) 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

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Teenage Pregnancy for Manitoba Population, 2003 - 2010

Crude rate of females aged 15-19 years per 1,000

Teen

Pre

gnan

cy R

ate

Academic Year

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Age-adjusted pregnancy rates, by enrolled/not-enrolled group and income quintile, 2003-2010

0

20

40

60

80

100

120

140

preg

nanc

ies/

1000

Q1(lowest)

Q2 Q3 Q4 Q5(highest)Income Quintiles

No School ClinicSchool ClinicNot enrolled

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Sexually Transmitted Infections (STIs)• 4,297 positive STI tests were reported (2003-

2010) 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

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Age-adjusted STI rates, by FEMALE enrolled/not-enrolled group and income quintile, 2003-2010

05

101520253035404550

FEM

ALE

STIs

/100

0

Q1(lowest)

Q2 Q3 Q4 Q5(highest)Income Quintiles

No School ClinicSchool ClinicNot enrolled

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Age-adjusted STI rates, by MALE enrolled/not-enrolled group and income quintile, 2003-2010

05

101520253035404550

MAL

E ST

Is/1

000

Q1(lowest)

Q2 Q3 Q4 Q5(highest)Income Quintiles

No School ClinicSchool ClinicNot enrolled

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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

Thank You / Questions• umanitoba.ca/centres/mchp • facebook.com/mchp.umanitoba• twitter.com/mchp_umanitoba (@mchp_umanitoba)• c_metge@umanitoba.ca