Every 10 minutes a teenager in Texas gets pregnant. Sexual activity among Texas teens is higher than the national average, and teens engage in different types of sex at early ages. This leads to high rates of sexually transmitted infections, teen births, and repeat pregnancies. While most Americans support comprehensive sex education, many Texas teens do not receive formal education about birth control and safe sex practices before becoming sexually active. Increased access to effective sex education programs could help reduce negative health and social outcomes for Texas youth.

1. We Can Do More Meeting the Challenges of Adolescent Sexual Health in Texas

2. Every 10 minutes a teenager in Texas gets pregnant Source: Texas Department of State Health Services. (2005). Teen Pregnancy Prevention. Retrieved April 28, 2008 from http://www.dshs.state.tx.us/famplan/tpp.shtm

4. Sexual Behavior Percent of High School Students Reporting to Have Ever Had Sex (2007) Source: Centers for Disease Control and Prevention. (2007). YRBSS: Youth Online Comprehensive Results. Retrieved June 4,2008 from http://apps.nccd.cdc.gov/yrbss/ Students in Texas, Houston, and Dallas are more likely to be sexually experienced compared to the national average. 47.9% NATIONAL 52.9% TEXAS 50.2% Houston 57.1% Dallas

5. Sexual Behavior Source: Shanklin, S.L., Brener, N., McManus, T., Kinchen, S., Kann, L. (2007). 2005 Middle School Youth Risk Behavior Survey. Atlanta, G.A.: Centers for Disease Control and Prevention. About 1 in 10 sixth grade students have had sex Students begin having sex at early ages

7. Sexual Behavior Students engage in different types of sex Source: Markham, C.M., Peskin, M.F., Addy, R.C., Baumler, E.R., Tortolero, S. Patterns of vaginal, oral, and anal sexual intercourse in an urban seventh grade population. Accepted to the Journal of School Health. Sexual behaviors among 7 th grade students in 2004 8.0% Oral 14.4% Any 12.2% Vaginal 6.5% Anal

8. Sexual Behavior 7 th grade sexual behavior has increased over a two year period 8.0% Oral 14.4% Any 12.2% Vaginal 6.5% Anal 8.7% Oral 15.9% Any 13.0% Vaginal 6.8% Anal 2004 2006

9. Sexual Behavior Trends in Sexual Behavior Among 7 th , 8 th , and 9 th Grade Students

10. Sexual Behavior Trends in Sexual Experience Among Students

11. Sexual Behavior Therefore… in Texas with over 2 million students in 6-12 grade, the estimated total number of students having sex in any given year Source: Shanklin, S.L., Brener, N., McManus, T., Kinchen, S., Kann, L. (2007). 2005 Middle School Youth Risk Behavior Survey. Atlanta, G.A.: Centers for Disease Control and Prevention. YRBS Results YRBSS: Youth Online Comprehensive Results. Retrieved June 4,2008 from http://apps.nccd.cdc.gov/yrbss/ Source for TX student numbers: Enrollment in TX Public Schools, 2007-2008. Available at: http://ritter.tea.state.tx.us/research/pdfs/enrollment_2007-08.pdf 826,644 Grade Percent Having Sex Number of Students Having Sex 6 th 11.2% 37,460 7 th 14.7% 48,732 8 th 18.1% 61,239 9 th 38.0% 150,582 10 th 51.0% 166,430 11 th 60.9% 176,586 12 th 70.6% 185,610 Total 826,644

12. Sexual Behavior Therefore… in a large urban school district with 200,000 students the estimated total number of students having sex in any given year Source: Shanklin, S.L., Brener, N., McManus, T., Kinchen, S., Kann, L. (2007). 2005 Middle School Youth Risk Behavior Survey. Atlanta, G.A.: Centers for Disease Control and Prevention. YRBS Results YRBSS: Youth Online Comprehensive Results. Retrieved June 4,2008 from http://apps.nccd.cdc.gov/yrbss/ Source for HISD student numbers: HISD Student Profile 2006-2007, available at http://www.houstonisd.org/ResearchAccountability/Home/Perform_Acount/DataAnalysis/District%20School%20Profiles/2007/StudentProfile_2007.pdf 28,995 Grade Percent Having Sex Number of Students Having Sex 6 th 11.2% 1,553 7 th 14.7% 2,115 8 th 18.1% 2,439 9 th 40.9% 5,556 10 th 48.2% 5,836 11 th 55.8% 5,708 12 th 61.7% 5,788 Total 28,995

14. Outcomes-Sexually Transmitted Infections Source: Weinstock, H, Berman, S, Cates, W, Jr. Sexually Transmitted Diseases among American Youth: Incidence and Prevalence Estimates, 2000. Perspect Sex Reprod Health, 2004:36(1):6-10. Detected STIs Undetected STIs In the U.S. nearly HALF of all new STI cases occur among those aged 15-24 years.

15. Outcomes-Sexually Transmitted Infections In the U.S. at least 1 in 4 teenage girls has a sexually transmitted infection

18. Source: National Office of AIDs Policy. Youth and HIV/AIDS 2000: A New American Agenda. Retrieved May 1, 2008 from http://www.thebody.com/content/art36.html . Centers for Disease Control and Prevention. AIDS Cases by Geographic Area of Residence and Metropolitain Statistical Area of Residence, 2004, . HIV/AIDS Supplement Report (2006); 12(Number 2). Available at: http://www.cdc.gov/hiv/topics/surveillance/resources/reports/. Outcomes -Sexually Transmitted Infections HIV Half of all new infections in the U.S. are among youth under age 25

19. Outcomes-Sexually Transmitted Infections Source: Texas Department of State Health Services. (2008). Texas HIV/AIDS Quarterly Report. Accessed March 4, from http://www.dshs.state.tx.us/HIVSTD/stats/pdf/HARSQ22008.pdf. In TX, over half of all HIV cases among youth occur among African Americans. Over one fourth of all HIV cases among youth occur among Hispanics in TX.

21. Outcomes-Sexually Transmitted Infections Gonorrhea rates per 100,000 adolescents ages 15 –19 years, 2006

22. Chlamydia — Prevalence among 16- to 24-year-old women entering the National Job Training Program by state of residence: United States and outlying areas, 2007 *Fewer than 100 women residing in these states/areas and entering the National Job Training Program were screened for chlamydia in 2007. SOURCE: National Job Training Program; Department of Labor (in collaboration with the Center for Disease Detection, San Antonio, Texas)

24. Outcomes-Sexually Transmitted Infections Total direct medical cost for new STI infections among 15-24 year olds. $6.5 Billion Source: Chesson, H., Blandford, J.M., Gift, T.L., Tao, G., Irwin, K.L. (2004). The estimated direct medical cost of sexually transmitted diseases among american youth. Perspectives on Sexual and Reproductive Health, 36(1): 11-19. STI Total Direct Medical Cost HIV $3.0 billion HPV $2.9 billion Genital Herpes $292.7 million Hepatitis B $5.8 million Chlamydia $248.4 million Gonorrhea $77.0 million Trichomoniasis $34.2 million Syphilis $3.6 million Total $6.5 billion

25. Outcomes - Teen Birth For the first time in 15 years the nation’s teen birth rate has increased

26. Outcomes – Teen Birth Source: United Nations Statistics Division. (2004). Demographic Yearbook 2004. New York: United Nations; Advocates for Youth Birth Rates in Developed Countries, Teens 15-19 years (per 1,000 teen girls)

27. Outcomes – Teen Birth Birth Rates across states, teens 15-19 years (per 1,000 teen girls)

28. Outcomes -Teen Birth Texas has the third highest teen birth rate in the U.S. (Rate per 1,000) Hispanic population in TX: 36.0% Hispanic population in CA: 36.2% Source: National Campaign to Prevent Teen Pregnancy. (2009). 50 State Comparison: Teen Birth Rate. Retrieved January 7, 2009 from http://www.thenationalcampaign.org/state-data/state-comparisions.asp 40 Source: U.S. Census Bureau. (2008). Table 3. Annual estimates of the population by sex, race, and Hispanic origin: April 200-Jully 2007. Retrieved January 14, 2009, from http://www.census.gov/popest/states/asrh/SC-EST2007-03.html. 63 64 62 60 62 54 68

29. In Texas, 28% of females are estimated to become teen mothers

30. In Texas, in 2006, 62% of teen births occurred among Latina girls. Source: National Campaign to Prevent Teen and Unplanned Pregnancy. (2006). 50 State Comparison. Available at: http://www.thenationalcampaign.org/state-data/state-comparisions.asp?id=4&sID=43 Outcomes – Teen Pregnancy

31. Sexual Behavior Same-sex relationships are often ignored Percent of 15-17 year olds who have had same-sex sexual contact Source: Mosher W, Chandra A, Jones J. Sexual Behavior and Selected Health Measures: Men and Women 15–44 Years of Age, United States, 2002 . Advance Data from Vital and Health Statistics; no 362. Hyattsville, MD: National Center for Health Statistics. 2005. Males Females 15-17 years 8.4% 15-17 years 3.9% 15-44 Years 11.2% 15-44 Years 6.0%

33. Outcomes – Teen Pregnancy Percent of lesbian, gay, and bisexual teens, grade 7-12, involved in a pregnancy

34. Outcomes – Teen Pregnancy If the TX teen birth rate equaled those in other countries and states, then the number of TX teen births would reduce by:

35. A local study found 42% of teen mothers had a repeat pregnancy Source: Raneria, L.G., and Weiman, C.M. (2007). Social ecological predictors of repeat adolescent pregnancy. Perspectives on Sexual Reproductive Health, 39(1): 39-47. Outcomes – Repeat Pregnancy

40. Outcomes – Teen Births Nationally, 68% of teen mothers do not graduate high school

42. Outcomes – Teen Births Cost of Teen Childbearing in Texas

43. Outcomes – Teen Pregnancy If the TX teen birth rate equaled those in other countries and states, then the average public savings in TX would be:

45. Prevention What is Prevention and What is Practical?

46. Prevention What is Practical? The age of marriage has increased.

48. Prevention Almost all Americans have sex before marrying Percent who have premarital sex by age: Source: Finer, L.B. (2007). Trends in premarital sex in the United. States, 1954-2003. Public Health Reports, 122( Jan-Feb): 73-78. 35 years 94% 25 years 89% 30 Years 93%

49. Prevention Premarital sex has been nearly universal for decades

51. Prevention In just seven years, the proportion of teens receiving information on birth control has decreased

52. Prevention Black and Hispanic teens are less likely to receive information about birth control:

55. Prevention Support for comprehensive sex education including teaching contraception Source: Kaiser, National Public Radio and JohnSource: Boonstra H, Legislators craft alternative vision of sex education to counter abstinence-only drive, The Guttmacher Report on Public Policy , 2002, 5(2):1 – 3..

56. How is Texas doing in teaching sex education?

57. Prevention Most Texas schools implement programs that are NOT evidenced-based

59. State-approved Curricula

61. Texas Legislation

63. A sexually active teen who does not use contraceptives has a 90% chance of becoming pregnant within a year Urgency Sour Sources: Harlap S, Kost K and Forrest JD, Preventing Pregnancy, Protecting Health: A New Look at Birth Control Choices in the United States , AGI, New York, 1991; and Abma JC et al., Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2002, Vital and Health Statistics, 2004, 23(24). ce: Texas Department of State Health Services. (2005). Teen Pregnancy Prevention. Retrieved April 28, 2008 from http://www.dshs.state.tx.us/famplan/tpp.shtm

64. If we don’t take care of teen pregnancy, it threatens to break the public health system in Texas Urgency Sour Sources: Harlap S, Kost K and Forrest JD, Preventing Pregnancy, Protecting Health: A New Look at Birth Control Choices in the United States , AGI, New York, 1991; and Abma JC et al., Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2002, Vital and Health Statistics, 2004, 23(24). ce: Texas Department of State Health Services. (2005). Teen Pregnancy Prevention. Retrieved April 28, 2008 from http://www.dshs.state.tx.us/famplan/tpp.shtm