Health Promotion Adolescents & STDs

Running Head: ADOLESCENCE VS. SEXUALLY TRANSMITTED DISEASES Adolescents vs. Sexually Transmitted Diseases Emily Fewer SUNY Morrisville 1 ADOLESCENCE VS. SEXUALLY TRANSMITTED DISEASES 2 Abstract Sexually transmitted diseases can be controlled through prevention techniques and education. Some life stages have a higher risk of contracting a disease than others. This paper will focus on the adolescent population due to their increased risk which will be explored further in this paper. The Healthy People 2020 goal is to decrease the annual number of diagnosed sexual diseases and there are a few things that need to be done in order to achieve that goal. This paper will look at prevention on the primary, secondary, and tertiary level as well as the health behavior model in regards to sexually transmitted diseases in adolescence. This paper also addresses the national, state and local initiatives being implemented in order to achieve the Healthy People 2020 objective, and how the role of the nurse plays a crucial part in executing these. It is imperative these actions and preventative practices are implemented into society. When that’s done, it will have a positive outcome for the adolescent community. ADOLESCENCE VS. SEXUALLY TRANSMITTED DISEASES 3 Adolescence vs. Sexually Transmitted Diseases Sexually transmitted diseases (STDs) do not discriminate. It does not matter what age, race or religion someone is, everyone who is sexually active is at risk. However, certain life stages are at a higher risk to contract a STD than others. The adolescent life stage has an alarmingly high risk of contracting an STD. According to the Centers for Disease Control and Prevention (CDC) “Persons who initiate sex early in adolescence are at higher risk for STDs, along with adolescents residing in detention facilities, those who use injection drugs, adolescents attending STD clinics, and young men who have sex with men” (Special Populations, 2015). There are guidelines from the government that were created in efforts to improve these frightening numbers and help control the spread of STDs. Healthy People is a set of goals and objectives designed to guide national health promotion and disease prevention efforts to improve the health of all people in the United States with 10-year targets (Sexually Transmitted Diseases, n.d.). The goal of Healthy People 2020 is to “Promote healthy sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted diseases (STDs) and their complications (Sexually Transmitted Diseases, n.d.). It is imperative to begin education and prevention in adolescent years in order to control the numbers of STDs diagnosed in the United States every year. There are many topics that are important to be aware of in order for there to be an improvement and it begins with education on each of these topics. The topics that this paper will focus on are the national, state and local statistics in relation to adolescent sexually transmitted diseases.

It will also explore the principles of health promotion and disease prevention in the primary, secondary and tertiary regard. It will talk about the health belief model and its impact on health promotion. The national, state and local initiatives that are in place in order to achieve ADOLESCENCE VS. SEXUALLY TRANSMITTED DISEASES 4 the Healthy People 2020 objective. Lastly, this paper will talk about the crucial role registered nurses have in order to help the adolescent community and ways they target this population. National, State and Local Statistics The United States is known to have the highest rate of STD infection in the industrialized world (dosomething.org). Every year in the United States there are about 20 million new sexually transmitted infections diagnosed (11 Facts About Teens and STDs, n.d.). This is an estimated number because there are only four reportable STDs which include, chlamydia, gonorrhea, syphilis and chancroid. It is correct to assume the numbers are much higher than 20 million due to a slew of other STDs that go unreported and also accounting for the ones that go undiagnosed due to people not being tested. Results from a study done in 2016 in regards to STD testing in adolescents and young adults concluded, “confidentiality concerns may deter youth from seeking STI testing” (Cuffe, 2016). Adolescents account for 50% of all new STDs, although they represent only 25% of the sexually experienced population (11 Facts About Teens and STDs, n.d.). In New York State in 2018 there were 163,750 people diagnosed with either chlamydia, gonorrhea or syphilis (New York State Sexual Health Plan, 2018). In Oneida County in 2018, 1,048 people were diagnosed with one of the same three diseases listed above, chlamydia, gonorrhea or syphilis (New York State Sexual Health Plan, 2018). The cost of STDs to the U.S. health care system is estimated to be $16 billion dollars annually. Not only are sexually transmitted diseases an issue in regards to people’s health and affecting their livelihoods, but it is also taking a toll on our government funds and something that could be improved. Primary, Secondary and Tertiary Prevention ADOLESCENCE VS. SEXUALLY TRANSMITTED DISEASES 5 Preventative measures are the most effective way to reduce and control the spread of sexually transmitted diseases. Primary prevention is preventing an STD before it occurs. According to the WHO, primary prevention focuses on counseling and behavioral approaches. This includes STD and HIV pre and post-test counseling, comprehensive sexuality education; safer sex and risk reduction counseling along with condom promotion. This also includes, STD interventions that are targeted to key populations, such as sex workers, men who have sex with men and people who inject drugs, and STD prevention education and counseling tailored to the needs of adolescents (Sexually Transmitted Infections (STIs), 2019). Health Promotion Adolescents & STDs

Other preventative measures include barrier methods, when condoms are used correctly and consistently the offer one of the most effective methods of protection against STDs. The combination of these measures are ways that primary prevention is used to reduce the number of STDs and achieve the Healthy People 2020 objective. Secondary prevention is trying to detect a disease early and prevent it from getting worse once the disease has already been diagnosed and an individual is trying to reduce the impact on the disease. STDs can cause a domino effect of other issues such as pelvic inflammatory disease, infertility, tubal or ectopic pregnancy, cervical cancer, and perinatal or congenital infections in infants born to infected mothers (Sexually Transmitted Diseases, n.d.). It is important to the patients’ health to catch and treat the STD early, promote annual testing, and with individuals who have high risk behaviors it is important they get tested at least every six months. If diagnosed early, it is beneficial for these patients to maintain a nutritious diet, get exercise, be intentional and prompt with their medications and treating their partners prophylactically, and making their current or future sexual partners aware. ADOLESCENCE VS. SEXUALLY TRANSMITTED DISEASES 6 Tertiary prevention occurs when the illness is diagnosed, it is long term and the patient is trying to reduce the impact of the disease. In this stage it is important to treat the secondary complications of the illness, treat the pain, the psychosocial effects, maintaining adequate nutrition. Educate the patient on support groups and ways to make life with an STD bearable. Teaching patients to be aware of what changes to look out for and when to notify a health care provider, if they are on immunosuppressant medication teach them to stay away from large crowds and people who are ill. These are all efforts made in hopes of making life after diagnosis manageable. Health Belief Model “The health belief model is a framework that helps indicate whether a person will adopt or not a recommended health behavior” (In Psychology, 2018). According to the model, an individual’s perception determines whether or not they will engage in a health behavior. Therefore, if an individual’s perception is changed, they will in turn be more willing to adopt a new behavior (In Psychology, 2018). There are six factors involved in the health belief model, they include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy (Tarkang, 2015). Each factor of the Health Belief model is crucial in understanding how to treat each individual. Perceived susceptibility refers to the individuals beliefs on how susceptible they are to getting the disease (In Psychology, 2018). The adolescent population is an extremely susceptible population. They are in a stage of life where they are impressionable, vulnerable and trying to fit in. During adolescent years individuals feel invincible, like nothing can affect them. With the use of proper education on abstinence, use of condoms, staying monogamous, and keeping your sexual partners to a low number, it is more than likely they will not be affected by STDs. ADOLESCENCE VS. SEXUALLY TRANSMITTED DISEASES 7 However, without the education and implementation of these things they remain in a high risk category. Health Promotion Adolescents & STDs

Perceived severity is talking about the serious repercussions that could follow if an individual does not adopt the recommended health behavior (In Psychology, 2018). When talking about STDs these repercussions range from physical and emotional consequences, to infertility and even death (Special Populations, 2015). When an adolescence thinks about sex or having sex, they don’t see the full picture. They are naïve and only consider the pleasure, popularity or praise they may get from being sexually active. Rarely does an adolescent consider all of the life-long problems that being careless and sexually active could cause themselves or others. The belief model talks about perceived benefits as the person’s evaluation of the value of receiving medical treatment by comparing the cost and side effects of treatment with the expected consequences of being struck by an illness (In Psychology, 2018). “The person needs to see the benefits that one will get from practicing the behavior. If a person fails to see any benefit, it would be difficult for one to take the necessary action, or to maintain it. Students in the current study must perceive the benefits of the male condoms, before they can initiate and maintain their use” (Tarkang, 2015). In order for the benefits from the use of condoms to be perceived, one must be properly educated. Education is the key to this component of the health belief model in order to decrease their susceptibility of contracting an STD and the consequences that come with it. The fourth component of the health belief model are the perceived barriers. This includes “the cost of treatment, complexity of adopting a new dietary/health regimen, lack of belief that ADOLESCENCE VS. SEXUALLY TRANSMITTED DISEASES 8 one has the ability to change, side effects, and length of treatment” (In Psychology, 2018). The key to this is to identify the perceived barriers, and make efforts to reduce the barrier through reassurance, incentives and support (Tarkang, 2015). Some barriers for the adolescent life stage include physical and psychological barriers, accessibility factors, personal characteristics, hindrances to engage in preventive behaviors which include the cost, inconveniences and unpleasantness. Some other barriers also include the cost, and the complexity of the behaviors and accessibility to services that would support taking and maintaining the required actions. When a person feels they have the tools and resources to deal with these barriers, then they will be able to take the necessary actions (Tarkang, 2015). Cues to action is the next component of the health belief model, this refers to strategies that activate readiness in an individual (Tarkang, 2015). There is not always a push for STD testing. Promoting awareness, promoting reminders and providing how-to information are helpful ways to push adolescents to get tested (Tarkang, 2015). In a conducted focused group session, it was found that many people have never received testing because it was never offered or mentioned to them. Adolescents liked having reminders to get tested and also liked when their health care providers offered them a test (Schnall, 2015). By offering testing regularly instead of expecting an adolescent to ask to be tested, this can improve the numbers in the nation by early diagnoses and having awareness. The last part of the health belief model is self-efficacy which is described as one’s ability to successfully take action (Tarkang, 2015). It is crucial for individuals to feel capable of taking the necessary action because without that confidence, they would not be motivated to sustain the action. In the case of STDs, condom use would be an example of this. An intervention that would ADOLESCENCE VS. SEXUALLY TRANSMITTED DISEASES 9 be appropriate to encourage the use of condoms is providing training, guidance on how to use them and positive reinforcement (Tarkang, 2015). Health Promotion Adolescents & STDs

In adolescence it is not comfortable to talk about condoms or how to use them, and a teenage boy is not going to be willing to ask, therefore it is imperative that these conversations are initiated. These three interventions will provide an individual with confidence in their ability to successfully use condoms. National, State, and Local Initiatives Healthy people 2020 has a goal to increase access to quality services to prevent STDs, promote healthy sexual behaviors, and strengthen community capacity (Sexually Transmitted Diseases, n.d.). There are national, local and state initiatives in place in order to achieve this goal. In the United States, New York State and Oneida county there are actions being taken in efforts to prevent sexually transmitted diseases. Nationally, the CDC has clinical prevention guidelines put in place in efforts to prevent STDs. The prevention and control of STDs are based on five major strategies. The accurate risk assessment, education and counseling of people at risk on ways to avoid STDs, a pre-exposure vaccination for people at risk for vaccine preventable STDs such as human papillomavirus (HPV), and identification of asymptomatic individuals who might be infected along with individuals with symptoms associated to STDs. The last two strategies are, effective diagnoses, treatment and counseling, and follow up of the infected individual and evaluation, treatment and counseling of sex partners who are infected with an STD (Clinical Prevention Guidance, 2015). Risk factors can include but are not limited to, the use of alcohol and drugs, which leads to not using condoms and having multiple sexual partners, young women’s bodies being biologically more prone, some people not getting the recommended vaccines or testing and are less willing to ADOLESCENCE VS. SEXUALLY TRANSMITTED DISEASES 10 openly talk and be honest with a doctor or nurse about their sex lives. Some ways these are implemented are by health-care providers routinely obtaining a sexual history from their patients while showing respect, compassion, and a nonjudgmental attitude toward all patients. After obtaining a sexual history, providers should do prevention counseling in an appropriate manner according to the patient’s culture, language, gender, sexual orientation, developmental level and age. Another approach that has been found to be effective is the use of motivational interviewing, a counseling style for eliciting behavior change by helping clients resolve ambivalence, which showed to lead clients towards achievable risk-reduction goals. A few other initiatives that are encouraged nationally is the use of male condoms. In heterosexual HIV serodiscordant relationships where male condoms where used, the negative partner was 80% less likely to become infected with HIV in comparison to relationships where condoms were not used (Clinical Prevention Guidance, 2015). One of the biggest initiatives nationally is the free STD testing offered by Planned Parenthood. It is confidential, a client does not need to be 18 years of age, and it is at no cost to the individual. This is a huge incentive for people to receive their annual testing. There are many ways that STD prevention is used nationally and it begins with the healthcare system supporting and addressing this issue along with the proper education to ensure a reduction in the diagnoses and transmission of STDs. New York State has set many initiatives in place in order to reduce the number and spread of sexually transmitted diseases. “The New York State Sexual Health Plan – is a guide to ensure accurate sexual health information and quality health services are made available to all New York State Youth” (New York State Youth Sexual Health Plan, 2018). NYS has a plan to end the AIDS epidemic, their goal is to significantly reduce the number of new HIV infections by the end of 2020 and achieve the first ever decrease in HIV prevalence in NYS. There are three ADOLESCENCE VS. SEXUALLY TRANSMITTED DISEASES 11 objectives to their plan, HIV testing, access to care and support to stay in care and information and access to Pre-Exposure Prophylaxis (PrEP). Health Promotion Adolescents & STDs

The ways the state plans on accomplishing these goals is very similar to the national plan. A few additional initiatives are, having school staff provide one-on-one health education to transgender youth regarding their rights and provide understanding and awareness about their unique health needs. Another initiative is to provide educational opportunities for educators, parents and other adults for them to gain knowledge and skills for communicating with youth about sexual health. Learning and understanding communication is a crucial part to begin the journey to the prevention of STDs and NYS is making those efforts (New York State Youth Sexual Health Plan, 2018). Out of 62 counties in NYS, Oneida County is number 21 on the list for the highest number of STD cases. The counties efforts to reduce this number have been initiated by offering health clinic programs. They offer vaccines at no cost, little cost, or accept insurance, they provide immunization counseling and education for all patients, and the clinic also provides STD testing by appointment. On Oneida County’s website they also explain the importance of getting tested and the effects of HIV. Through the clinic, Oneida County is making a stride to control and prevent STD transmission in their area. Four Roles of the Registered Nurse Related to the Prevention of STDs In order to achieve the Healthy People 2020 objective, the registered nurse (RN) must uphold their duties as an educator, advocate, caregiver, and a communicator. By performing these roles, RNs will play a crucial role in helping the adolescent population along with helping to reach the nation, state, and local goals that are set in place. ADOLESCENCE VS. SEXUALLY TRANSMITTED DISEASES 12 Education is imperative to achieve the Healthy People 2020 objective. The person that a patient will be in contact with the most is the nurse. It is important for the nurse to assess the needs of the patient, some of these needs may be education on how to put on a condom, education on how to take birth control, the need for STD testing and behaviors that make individuals more at risk. All of these things are important for an adolescent to know. An example of a good opportunity for education on these topics is in the school nurse’s office. In a study done, students “who reported being in high school were provided a list of services and asked whether they had gone to a school … Health Promotion Adolescents & STDs