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HomeMy WebLinkAboutMINUTES - 05121987 - IO.1 , TO BOARD OF SUPERVISORS FROM: INTERNAL OPERATIONS COMMITTEE Contra May 11, 1987 Costa DATE: Ul� Status Report on Prevention Programs relating SUBJECT: to Teenage Pregnancy and AIDS SPECIFIC REQUEST(S) OR RECOMMENDATION(_S) & BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1. Acknowledge receipt of the attached report from Wendel Brunner, M.D. , Director of Public Health on the Health Services Department's Prevention Programs in AIDS and Teenage Pregnancy. 2. Authorize the Chair of the Board to send letters to the President of the United States, the Governor of California, and this County' s Congressional and Legislative delegations urging a more active role and greater financial participation on the part of the state and federal governments in research into the causes of and cure for AIDS and in the public education, and treatment. costs of the disease. 3 . Request the Health Services Director to prepare and forward to the Internal Operations Committee a three-year plan outlining how additional resources could best be expended in an effort to prevent unwanted pregnancies on the part of teenagers in this County. 4 . Leave this matter on referral to our Committee. BACKGROUND: On March 3, 1987, the Board approved a number of recommendations from our Committee relating to prevention programs in general and teenage pregnancy and AIDS in particular. In response to several of those recommendations, Dr. Brunner and Larry Cohen, head of the Health Service Department' s Prevention Program, met with our Committee on May 11 and submitted the attached report. In reviewing the Department' s report a number of concerns occurred to us: o We believe the emphasis must be on teenage pregnancy since the AIDS epidemic is already receiving considerable attention locally. CONTINUED ON ATTACHMENT: X YES SIGNATURE: _ RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE _ OTHER SIGNATURE s : Nancy Fanden Tom Torlakson ACTION OF BOARD ON may 12, 1987 APPROVED AS RECOMMENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT "- AND CORRECT COPY OF AN ACTION TARN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ccCounty Administrator ATTESTED M QS,y : Health Services Director _ Wendel Brunner, M.D. PHIL BA HELOR, CLERK OF THE BOARD OF Larry Cohen, Public Health SUPERVISORS AND COUNTY ADMINISTRATOR M382/7-83' BY ,DEPUTY Page 2 o We believe that the state and federal governments are not providing sufficient leadership and financial support to finding a cure for AIDS and in treating victims afflicted with AIDS. o In terms of the AIDS epidemic, we note the power of a quotation from Jack Dyer, a counselor for the County' s Teenage Program, as reported in the Contra Costa Times on April 30, 1987 : "So remember that when you have sex, you' re not just doing it with your partner. You' re also doing it with every partner they've had for the last 10 years" . o We believe more outreach is needed in the schools to engage students in an educational effort to recognize the long-term problems of teenage parenthood. o We believe that the parents of sexually active teenagers need help in learning how to talk to their children about sex and how to help them learn to prevent pregnancy. o We believe more attention should be given to the responsibility teenage boys have for their own behavior so they will recognize and accept the responsibility and consequences of their behavior. o We believe that the Health Services Department needs to prepare a three-year plan for attacking the causes of teenage pregnancy in ways that will be effective in reducing the level of teenage pregnancy, teenage abortion, and teenagers giving birth to their babies when they are unable emotionally, educationally, and financially to support their children. We are asking the Health Services Department to outline the elements of such a program and the costs both in staff, money, and other resources so the Board can consider such a program at the time they review the County' s 1987-88 budget. o We agree with Dr. Brunner that such a three-year program on teenage pregnancy must include the establishment of school-based clinics. In addition, we would like the plan to include support programs and educational services for parents of sexually active teenagers. The implementation of the GAIN program presents another opportunity for addressing a large number of women who must learn to balance their desires for a family with the realities of education, jobs and a career. We hope the plan will also incorporate this large group of women into its plans. CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT Supervisor Nancy Fanden To: Supervisor Tom Torlakson Date: May 8, 1987 I . 0. Committee ' Mark Finucane � `"�— Health Department Prevention From:Health Services Direct r ubject: Programs in AIDS and Teen- by Wendel Brunner, Age Pregnancy Director of Public Health We are preparing this report in response to a request from the Internal Operations Committee to provide information on the Health Services Department Prevention Program and in particular the efforts of the Health Services Department to prevent AIDS and teen-age pregnancy in Contra Costa County. In addition to the specific issues outlined in the Internal Operations Committee memo of February 26, 1987, we were asked by the I. 0. Committee to provide some general background on the Health Services Department's model for prevention. CONTRA COSTA COUNTY PREVENTION MODEL The problems in Contra Costa County are no different from most counties. There are current human service crises, predictable future human service crises, and inadequate resources to meet many of even the most critical needs. Human trage- dies become community problems as well . We watch unemployment, drugs, toxics, crime, hunger, homelessness, AIDS, teen pregnancy, suicide, and numerous other individual issues place major demands on our service delivery system. One of the potential solutions to be considered is a preventive approach. The Health Department has been engaged in developing a systematic, comprehensive prevention effort for nearly five years, and during that time has become recognized statewide and nationally as a model program, winning numerous state- wide and national awards. This prevention model focuses on identifying the common roots of health problems, which are interrelated but often seen in isolation. Identifying these roots indicates common preventive solutions which might not be apparent when the problems are viewed independently. For example, the majority of deaths in adults age 25 to 65 are due to preventable conditions (heart disease, cancer, trauma, cirrhosis) . A complex web of underlying causes for many of these diseases can be identified, such as smoking, alcohol and drugs, abuse and violence, environmental health and safety hazards, and unemployment.. By attacking these underlying preventable causes in a coordinated manner, we can affect many of these diseases simultaneously. A-41 3181 Supervisor Nancy Fanden -2- May 8, 1987 Supervisor Tom Torlakson The Prevention Program functions by implementing a spectrum of prevention in the community. That spectrum includes strengthening individuals' knowledge of pre- ventive health issues, promoting community education through schools, worksites, community institutions, or the media, and mobilizing existing community resour- ces for prevention by developing coalitions around key prevention issues. The overall goal of the prevention strategy is not only to influence individual behavior towards more healthy lifestyles, but also to affect societal attitudes and public policy to promote prevention. Working With Coalitions To multiply the resources of the County and the Health Department, we work with coalitions of existing community groups around major prevention issues. The Smoking Education Coalition provides a concrete example of that process. For the first time in Contra Costa County representatives of Cancer, Heart, and Lung Associations and related groups were brought together to develop and lobby for a countywide smoking ordinance,which was passed in early 1986. This month Pac Bell in San Ramon, the largest single corporation office building in the western United States, after extensive discussions and consultations with the Health Department proclaimed a complete ban on smoking at the worksites in order to implement the County's smoking ordinance. A Health Department conducted eva- luation of the effects of the smoking ordinance after the first year shows that the ordinance has induced 47 percent of County employees who are smokers to significantly decrease or quit their smoking. This is an example of how our prevention strategy has influenced both public policy, societal attitudes, and thereby individual behavior. Other examples of important prevention coalitions include the Contra Costa Family Planning Network. This organization consists of representatives from the Health Department, all the other major family planning providers in Contra Costa, and the community, professional , and religious organizations. The pur- pose of the Family Planning Network is to remove as much as possible the divi- sions engendered by the debate over abortion and focus community energies on the important task of preventing unwanted pregnancies, particularly among teen-agers. The Contra Costa AIDS Task Force is another prevention-oriented coalition and has been in existence over two years. The Task Force includes not only repre- sentatives of organizations and professional groups, but numerous individuals who volunteer their time and skills to assist in combating the AIDS epidemic in Contra Costa. The Health Department works closely with the AIDS Task Force to coordinate Health Department activities with the efforts and resources available throughout the community. Volunteers trained by the Task Force assist in com- munity education, the Health Department's AIDS alternative test clinics, and work with AIDS victims to support them in their homes. In addition to staff from the Health Department AIDS program, individuals from throughout the Department join with many others in the community to volunteer their time to work with the Task Force. The AIDS Task Force is a key part of the Health Services Department's planning for response to the AIDS crisis. Supervisor Nancy Fanden -3- May 8, 1987 Supervisor Tom Torlakson PREVENTION OF AIDS IN CONTRA COSTA The AIDS epidemic is developing into the major epidemic of at least the second half of the twentieth century. The 127 cases of AIDS which have been diagnosed in Contra Costa County represent only the tip of the iceberg; for every case of AIDS there are probably ten more persons infected with the HIV virus who are capable of spreading that infection and are at substantial risk of developing AIDS themselves and dying. Current estimates are that from 20 to 40 percent of individuals infected will develop AIDS and die within seven years, and those estimates may be revised upwards in the future. Lacking a vaccine, a cure, or even any particularly effective treatment, the only viable approach to AIDS is the prevention of infection. High-Risk Groups The Health Department's AIDS prevention program is directed both at the com- munity at large and targeted specifically at the various high-risk groups. The initial education efforts were aimed at the original highest risk group, gay and bisexual men. The Health Department worked with the AIDS Task Force and gay organizations and religious groups to hold a series of community forums to inform this group about the risks of AIDS and the methods to avoid HIV infec- tion. Unlike San Francisco, Contra Costa County has few gay organizations and gathering places, and much of the communication with Contra Costa's gay com- munity is through mass media and general community information programs. In the Bay Area and Contra Costa the vast majority of AIDS cases to date have been among gay males and bisexuals; in contrast, nearly 50 percent of the new cases in New York and New Jersey are among IV drug users. Recently there have been an increasing number of AIDS cases in Contra Costa among drug users, and we have evidence from our Disease and Infection Monitoring program that this number will increase. The Health Department AIDS program has therefore directed con- siderable efforts towards education and prevention activities among this population. Working in conjunction with the County Sheriff's Office, we have identified videotaped and other materials to use in an AIDS education program for all jail inmates. That program was begun in January, 1987 and consists of a videotape presentation followed by small group discussions with the entire jail inmate population. This program has continued through 1987 on a regular basis, and we will be evaluating its effectiveness under a grant with the State Health Services Department beginning in July. The AIDS program has also trained the staff at both methadone maintenance programs as well as five other drug treat- ment centers throughout the county. This training will allow drug program staff to do AIDS risk assessment for clients and counsel clients about avoiding HIV infection. County._and community staff have held eight AIDS awareness days in drug program centers, employing appropriate videotapes and including follow-up discussions. On four occasions these programs have included onsite HIV testing involving 100 individuals. Over the next two months we will be conducting extensive voluntary, confidential , onsite testing of clients in drug programs. This testing is accompanied by intense education about prevention of HIV infection. Supervisor Nancy Fanden -4- May 8, 1987 Supervisor Tom Torlakson AIDS Education In The Schools Although AIDS is still largely confined to gays and IV drug users, the virus can and is being transmitted heterosexually and is diffusing out into the wider population. To stop this spread, education and prevention must be directed at the wider heterosexual community. It is particularly important to focus on teen-agers who are just becoming, or will soon become, sexually active. AIDS is an issue that our teen-agers will be facing, one way or another, for the rest of their lives. We feel that an important way to reach teen-agers with accurate information on AIDS is through the school systems. The AIDS program has there- fore developed a model curriculum on AIDS for use in junior high and high schools, working in conjunction with the County Office of Education curriculum development program. The AIDS program and the Health Department's Teen-Age Program have piloted this curriculum in College Park High School in the Mt. Diablo Unified School District. That pilot program was initiated at the request of the College Park P.T.A. and implemented with the cooperation of the school administration. The parents were polled by the administration and P.T.A. as to whether they wanted their children to participate in the program, which included frank discussions of sexual issues and drug use. Of the parents of the 700 children involved, only one chose not to have their child participate. The Health Department curriculum includes a strong component which emphasizes that it is all right to say "no" when one is not ready to become sexually active. The results of this pilot program, and the second one which will be undertaken shortly, will be carefully analyzed with feedback obtained from students, parents, and teachers about the appropriateness and effectiveness of the curri- culum. On the basis of these pilot experiences the Health Department will be recommending to all the school districts in the county that they implement simi- lar programs throughout the junior high and high schools next year. We feel that an investment in education about AIDS in our teen-agers is one of the best long term AIDS prevention strategies we can implement. Costs Of The AIDS Epidemic We estimate that the Contra Costa County Health Services Department has spent between $400,000 and $500,000 this year to cope with the AIDS epidemic in this County. Those expenditures include the Public Health education and prevention programs as well as the medical care and hospice treatment. More detailed ana- lysis and future projections will be forthcoming in the Department's AIDS Response Plan. To date all of that money has been taken from other Department programs and diverted to AIDS, with the exception of a $50,000 grant from the State Health Services Department and some funding for the County's Alternative Test Site. The 87/88 budget proposal for the Health Services Department con- tains the first specific request for AIDS funding, $127,000 to be used for AIDS prevention activities. It has been estimated that""it costs between $40,000 and $120,000 to provide medical care for a single case of AIDS. New treatments, such as AZT, which are Supervisor Nancy Fanden -5- May 8, 1987 Supervisor Tom Torlakson both expensive and prolong life may well increase this cost. This estimate does not include the economic toll of loss of productive life, as most AIDS victims are struck in their peak productive years. If even one or two cases of AIDS can be prevented, the entire Public Health AIDS prevention program will be paid for. In AIDS, prevention is not only the only useful therapy, it is the most cost effective one as well . PREVENTION OF TEEN-AGE PREGNANCY The rate of teen-age pregnancy increased dramatically nationwide during the 1970' s and has maintained at a relatively high level during this period. The actual rate of teen-age pregnancy is difficult to determine because that rate includes both live births and abortions. Birth certificate information provides an accurate measure of births to teen-agers; data on abortions is not reported and must be estimated. In the 1980's national statistics indicate between 170 and 180 births per year per thousand sexually active teen-agers. The causes of teen-aged pregnancies are widely discussed and debated. Opinions on this issue vary according to social and religious perspectives. From the public health point of view we believe there are two major causes of teen pregnancy. The first cause can be described by what has become a catch phrase, "lack of self esteem". A more accurate view might be the inability of some teen-agers to make appropriate decisions about their lives. Many teen mothers come from socially deprived environments; they have felt lack of love and are dubious about their future options. Deciding to have a baby gives a social role and an object for love. A second important cause of teen-age pregnancy is lack of knowledge and understanding of basic issues of sex and reproduction. National statistics show that teen-agers are on the average sexually active for six months before seeking contraception. These statistics are borne out in Contra Costa County by our own experience in family planning and teen-age clinics with sexually active teen- agers. Nationwide, 42 percent of sexually active teen-agers never use contra- ception and another 25 percent use contraceptives only sporadically. Coupled with typical teen-age misconceptions such as "you can't get pregnant the first time" and the high rate of sexual activity in our society, the causes of teen- age pregnancy become apparent. In Contra Costa County in 1984 there were 16 babies born to mothers less than 15 years of age and another 853 babies born to women between 15 and 19. The teen- age births were disproportionately distributed in the east and west portions of the county and contributed to the elevated rates of low birth weight infants born in those regions. We know from other surveys however, that there are a considerable number of abortions performed on teen-agers in Central County, so that the rate of teen-age pregnancy may be more uniformly distributed across the county. While the choice to have an abortion is an intensely personal one, it is clearly a decision that _is better for a teen-ager not to have to face. Prevention of teen-age pregnancy is by far the preferred approach. Supervisor Nancy Fanden -6- May 8, 1987 Supervisor Tom Torlakson Social Cost of Teen Pregnancy The social cost of teen parenthood is enormous and affects the life of both the mother and the baby. Teen parents are seldom equipped to either properly finan- cially or educationally support their child. The mother and child both become dependent on the welfare system, and the pattern commonly repeats into the next generation. PREVENTION ACTIVITIES IN -THE HEALTH DEPARTMENT The prevention activities for teen-age pregnancy in the Health Department center on the Teen-Age Program (TAP), Teen Clinic, and Family Planning Clinics. The TAP program is based on health facilitators who make presentations in high school classes on issues of self-esteem and appropriate choices, sexually transmitted diseases including- AIDS, contraception, alcohol and drugs, healthy lifestyles, and by popular demand, management of acne. Last month the TAP program made major presentations in East County high schools through the P.E. departments, impacting over 2,000 students at each school. The presentations focused on sexual responsibility, sexually transmitted diseases, and the preven- tion of AIDS. Both of these presentations involved discussions of the use of condoms to prevent AIDS and other sexually transmitted diseases. The TAP program is regularly active in 17 high schools throughout the county and impacts well over 2,000 students per month. Use Of Additional Funds If additional funds became available for teen-age pregnancy prevention, the Health Services Department would recommend moving toward implementing school- based clinics in selected areas in the county. School-based clinics would not directly provide contraceptive services to students, but would form a connection between the teen-agers and the health community. The clinics would provide sports physicals, health information, birth control information and education, and make referrals to Family Planning Clinics when appropriate. To investigate the Contra Costa community attitude towards the idea of school- based clinics, the Health Services Department conducted a random sample survey of Contra Costa residents. Ninety-six percent of the adults surveyed believe that teen-age pregnancy is a serious problem, and ninety-two percent believe that family life education should be taught in schools. With regards to school- based health clinics, over two-thirds of the adults surveyed (69%) believe that schools should establish comprehensive health clinics which provide a variety of medical services. Sixty-five percent believe that these clinics should offer family planning services to teen-agers, but only forty-eight percent supported dispensing birth control devices onsite. The Health Services Department has beem working with the Pittsburg school system to plan. for possible school-based clinics in East County. Supervisor Nancy Fanden -7- May 8, 1987 Supervisor Tom Torlakson CONCLUSIONS The issues of AIDS and teen-age pregnancy both demonstrate the necessity for developing effective prevention strategies. The Contra Costa prevention model involves enhancing individual knowledge, promoting community education, deve- loping joint planning and coalitions to mobilize community resources, and pro- moting public policy which furthers prevention. This approach allows the resources of the Health Services Department to be multiplied in their effect throughout the community, and forms the basis of our response to the community crises of AIDS and teen-age pregnancy. WB:rm d_ ;