RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Teen Pregnancy in Milton-Freewater, Oregon Project Date: 4/27/2009 I sought to investigate why the teen birth rate in Milton-Freewater, Oregon is so high by looking at sex education in the schools, learning about the reproductive health resources for teens in the area, and getting the perspective of the teens that live in the area. I have subsequently identified what I believe to be large factors in this problem and have made recommendations on how to improve the education and resources for teens so as to hopefully decrease the teen birth rate over time. I have also made a handout listing reproductive health resources in the area for the teens. Improving Nutritional Awareness among Pregnant Teens in Columbia County, OR: Design of a Patient Handout on “Eating Right in Pregnancy” Project Date: 3/16/2009 Teen pregnancy continues to be a controversial issue in the United States. A recent increase in the national teen birth rate in 2006 and 2007 may be reflected in the recent “epidemic” of teen pregnancies in Columbia County. Pregnant teens frequently present later for prenatal care and are more likely to suffer from nutritional deficiencies, failure to gain appropriate weight, and higher smoking rates associated with medical complications such as poor maternal weight gain, maternal anemia, low birth weight, prematurity, and developmental disabilities. Recent studies have suggested that many of these medical issues can be resolved when teens receive adequate prenatal care. This study focused on increasing nutritional awareness among pregnant teens in Columbia County as a means of improving pregnancy outcomes. The attitudes of local girls towards body weight and dieting suggest that they may be at risk for nutritional deficiencies and failure to gain appropriate weight during pregnancy. This was an observational study of resources available to teens in the OHSU Family Medicine Clinic in Scappoose, OR, including prenatal visits and one-on-one childbirth education. A review of the literature on teen pregnancy and nutrition during pregnancy was also combined with an examination of statistics on local teen pregnancy and birth rates as well as attitudes of 11th-grade girls towards body weight and dieting. A handout on nutritional issues was created written for a tenth-grade reading level and intended to be provided to pregnant teens during prenatal visits. Teen Pregnancy in Scappoose, Oregon and the Creation of an Educational Brochure Describing What to Expect and Available Resources for Pregnant Adolescents. Project Date: 12/29/2008 Although teen pregnancy rates have been declining in Columbia County since 1996, nearly 1 in 4 (23.5%) births are still to adolescent mothers aged 15-19 (1,2,3). Young woman in Columbia County face multiple challenges including higher rates of drug and alcohol use, lower economic status, earlier sexual debut, and most importantly lack of sexual education (4,5). During my clerkship in rural family medicine at OHSU’s Scappoose clinic, I saw many pregnant teenagers and was quite surprised by the questions they asked. The young woman that I saw had no idea what to expect, they did not know what resources were available to them, and some didn’t even understand their own anatomy. While researching this topic, I found that there is a great deal of effort being made in Scappoose (and Oregon as a whole) to convince parents that sexual education is important and to create curriculums that teach adolescents about safety and prevention. Prevention is always the best strategy when trying to combat health problems and I therefore understand why so much attention is being paid to prevention in the case of teen pregnancy, there is however less effort being focused on young woman who have already become pregnant. After identifying that education and resources for pregnant teenagers is an area of intense need in Scappoose, I set out to create a simple one to two page brochure that would answer common questions and concerns as well as list resources that would be helpful to young pregnant woman. Information to be included in the brochure was determined by talking with the young woman themselves and also through conversations with the physicians and nurses who take care of these woman at OHSU’s Scappoose family medicine clinic. This brochure will be handed out to pregnant teenagers who come to the Scappoose clinic for prenatal care, or those who attend the clinics prenatal classes. Targeted Sexual Education in Rural Communities Project Date: 8/4/2008 Youth growing up in our countries rural communities face a multifaceted challenge as they become sexually active. Statistically they are a high risk group - often with higher rates of alcohol use, earlier sexual debut, and frequently increased numbers of sexual partners at an earlier age. Compounding and interacting with this is the political climate in which these individuals come of age. Frequently, comprehensive sexual education is discouraged in traditionally conservative communities and school districts - often favoring abstinence-only based education that downplays the importance of contraception and discourages an open dialogue on topics of sexuality and sexual practices. These issues - along with socioeconomic forces at play in our rural counties and districts - lead to disproportionably high rates of teen pregnancy and STI transmission - even in areas where resources, providers, and adequate health care education are available and accessible. My project was designed to find the missing pieces of formal sexual education and directly target a short informational session to give students the skills and knowledge they need to make informed decisions about their health, their decision of how and when to engage sexually, and for those already sexually active - to serve as a reinforcing reminder on the importance of contraception and means of STD protection. Implementation and Continuation of Sex Education in Harney County Project Date: 10/15/2007 Teen pregnancy and teen STD transmission are both issues that are of great impact on individuals, communities and society as a whole. In Harney County Oregon, where social support networks are scarce and difficult to access, this is also true. Although rates of both teen pregnancy and STD transmission are both less than state and national averages1,2, the individuals involved are still greatly affected by these life changing events. Teen pregnancy is well correlated to individuals living in poverty and that must later be supported by a Welfare program that spends 9 billion dollars a year on family support of these individuals4. Seeing that there are 700,000 new teen pregnancies a year4, there is still a lot to do in the department of prevention. My project was aimed at that exact goal, and sought to better educate the middle school students of Hines Middle School following comprehensive national guidelines. The state of teen pregnancy in Josephine County Project Date: 4/30/2007 Nationwide Oregon ranked 16th (50th = highest) for teen pregnancy rates in 2004. The trend is an overall decrease in the number of teen pregnancies across the nation, the state, and the counties. Despite favorable statistics, further assessment of resources available in Josephine County are concerning for inadequate sexuality education, lack of contraceptive access, and few services for young parents. Teen pregnancy has considerable social, economic, and personal costs, and resources need to be re-allocated in order to continue a downward trend in teen pregnancy, rather than a stasis or increase. Risk reduction strategies for prevention of STDs and teen pregnancy in Madras, Oregon Project Date: 2/12/2007 Sexually transmitted diseases (STDs) and teen pregnancy remain major public health challenges for young people in the United States and rural Oregon is no exception. STDs in rural Oregon follow national trends: The top two STDs are HPC and Chlamydia, and about half of new infections diagnosed each year are young people 15 to 24 years of age. The service area of Madras Medical Group also has staggering teen birth rates (women age 15 to 19). 2004 estimates of teen births in the service area are 158 per 1,000 live births, almost four times the national average (CPU site information, CDC). The objective of this project was to find clinical evidence of effective risk-reduction interventions in preventing STDs and/or teen pregnancy. Literature search revealed risk-reduction counseling interventions that were effective in reducing STDs and increasing safe sex behavior, notably most effective in younger patients. Studied interventions were based on interactive counseling and the AIDS Risk Reduction Model which focuses on three stages of behavior change: labeling high risk behavior as problematic, making a commitment to change high risk behavior, and seeking and implementing solutions directed at reducing high risk activity. Similar counseling techniques were found to be effective in programs aimed at reducing teen pregnancy. From this data, a proposal for a brief, one-on-one, low cost intervention to reduce the risk of STDs and teen pregnancy was developed for Madras Medical Group. Though not yet fully implemented, the intervention has received positive feedback in informal interviews from both the target population and the clinicians. Improving Birth Outcomes Among Pregnant Adolescents in Klamath Falls, OR Project Date: 7/3/2006 U.S. adolescent pregnancy rates remain higher than any other industrialized nation. According to the Oregon Office of Rural Health, while Klamath Falls’ adolescent pregnancy rates are no higher than the Oregon average, the actual birth rate among pregnant teens is about 1.4 times higher than the Oregon average. Reasons for this have been investigated in prior community health projects, and include lack of access to or knowledge of abortion clinics, as well as the general attitude toward abortion in the community. The focus of this project was the health of those teenage mothers who do choose to give birth. Adolescent pregnancy is associated with various obstetric and birth problems such as premature labor and low-birth weight infants. Reasons for this are related to unique physical, psychological, and social factors present in adolescence. Several prior studies provide a strong argument for instituting specific programs that target this special population in order to improve pregnancy outcomes. Based on these findings, this project used two approaches to improve pregnancy outcomes – a community-based approach and a healthcare provider approach. A teenage pregnancy and parenting workshop course was developed and implemented in the community. Further, a brochure was developed for healthcare providers which provided important information to address in the care of pregnant adolescents. A talk was also given to the residents of Cascades East Family Practice regarding the issue. Teen Pregnancy In Coos County, Oregon Project Date: 5/1/2006 Although the rate of teenage pregnancy continues to decline in the United States, it continues to have a number of serious implications and to place a large burden on society. Not only does becoming pregnant as an adolescent decrease the likelihood of an adequate education and a successful future for the mother, the child often suffers from being raised by a parent who is ill-equipped for the challenge of parenting. While recent trends have shown a decreased teenage pregnancy rate in Coos County, Oregon, recent population studies suggest that this number is now on the rise. In an attempt to identify some of the factors contributing to this alarming trend, I interviewed teenage girls and some of the people who care for them. While several possible causes were identified, main factors included erratic use of contraception and a seeming lack of awareness of the risks of their sexual behavior. No concise educational material was available that discussed these concerns, so a handout was developed to address some of these issues in a matter that was appropriate for teenagers. Contraceptives: A Survey of Jefferson County Teenagers Project Date: 5/1/2006 Jefferson County has the highest rate of teen pregnancy in Oregon. Research shows that programs that combine emphasis on delayed initiation of sexual activity as well as sexual and contraceptive education helps reduce teen pregnancy rates. In order to reduce teen pregnancy in Jefferson County, sexual and contraceptive education will need to be taught in a comprehensive way. The goal of this project was to evaluate the knowledge regarding contraceptives of teenagers in Jefferson County, where they obtain their information, who they trust regarding contraceptive information, and what myths exist surrounding contraceptives among teens in this county. Surveys were administered to four health classes to a total of 79 high school students and discussions were held following the administration of the survey. Results showed teens get most of their information from school, friends, and health care professionals. They trust doctors, nurses, and parents to provide accurate information. There is good understanding that abstinence prevents pregnancy. Knowledge of comparative efficacy of specific contraceptive methods was not good. Knowledge of new contraceptive methods such as the NuvaRing and Mirena were low. Many students did not know the window of opportunity to take emergency contraception. Myths regarding side effects of contraceptives include breast cancer risk, infertility, birth defects and weight gain. Health care professionals are trusted by teens in this county generally feel safe speaking with their health care providers. Significant room for improvement exists in the education of teens in Jefferson County regarding contraceptive methods. School Based Health Center in Sweet Home, Oregon: Current self-reported health related issues and current acute-care facility usage. Project Date: 3/20/2006 There is an ongoing project by the Linn County Department of Health Services to start a school based health clinic in Sweet Home, Oregon. In an attempt to aid in the planning for this project, this report summarizes the Oregon Healthy Teens survey results for Sweet Home, and looks at emergency department and urgent care facility usage by high school aged children from this city. Findings include similar prevalence of self-reported alcohol use between Sweet Home and the state average (45.2% vs. 47.4%), as well as similar rates of use of other substances. Sweet Home students are more likely than the state average to report having had sexual intercourse, but are also more likely to report having used a condom and/or birth control. Self-reported asthma has a significantly higher prevalence in Sweet Home than across the state (16% vs. 10.8%), and is more likely to have caused students to miss school. The prevalence of self-reported depression is similar between Sweet Home and the state average (7.3% vs. 6.3%), but Sweet Home students are more likely to have considered suicide within the past year (18.1% vs. 12%). Also, at least 281 (39%) of ED/UC facility visits by this population were likely to have been issues that could have been handled appropriately in a primary care setting. Emergency Contraception availability in Grant County: Assessing the attitudes and prescribing/dispensing practices of physicians and pharmacists Project Date: 9/12/2005 The 2005 Healthy Teens survey of 11th grade students in Grant County shows that 51% have had sexual intercourse. Of these sexually active teens, 57% rely on condoms as their main birth control, 12% use oral contraceptive pills, and 26% use no birth control method or withdrawal. Based on the results of this survey, emergency contraception (EC) could be very useful in preventing unintended pregnancies for this remote community. The purpose of this project was to survey family practice physicians as well as the pharmacists in Grant County about their attitudes towards EC and their current prescribing and dispensing practices. Sex Education in Philomath, Oregon: What is the message and is it getting across? Project Date: 9/12/2005 Teen pregnancy and sexually transmitted infection (STI) rates are important indicators of issues affecting the health and future prospects of our country's youth. This project attempted to look at the sexual education provided to students at Philomath High School to help them make the decisions affecting these rates, and compare this to programs used nationally. It researches the specific components of the high school curricula, then, by means of a questionnaire, evaluates how the Philomath specific education translates into the knowledge and attitudes of the students it serves. Finally, using available data, it looks at how Philomath compares at a national and state level regarding teen pregnancy rates and rates of sexual activity. Data collected on the Philomath School District sexual education was obtained by interviews with the school nurse, high school counselor and the high school health teacher. Educating pregnant teens about their options and the resources available to them in Klamath Falls, Oregon Project Date: 8/8/2005 Though teen pregnancy rates have been on the decline in the United States for many years, they remain higher than in any industrialized country. As a medical student found in 2002, while the teen pregnancy rate in Klamath County is no higher than that of Oregon as a whole, the teen birth rate is higher because more teens choose to raise their children than elsewhere in the state. This is potentially problematic because teen parents and their children are subject to a unique set of public health problems. One of the reasons discovered for why Klamath County teens chose to become parents is lack of access to pregnancy termination, a fact that was confirmed by discussions with Klamath Falls physicians and a health educator. Resources do exist for Klamath Falls teens seeking pregnancy termination, although these resources are limited. Realizing that Klamath Falls teens may not have information available to them about pregnancy termination, and also that termination is not the choice every pregnant teen will make, an informational brochure was created to be distributed to nurses at Klamath Falls high schools. This brochure listed resources for teens that choose to become parents, those who choose to place their baby for adoption, and those who choose to terminate their pregnancy. To address the issues of teen pregnancy prevention, a second informational brochure was created for the nurses, this one describing various birth control options and informing teens of local family planning resources. Emergency Contraception: School Counselor and Pharmacist Practices and Attitudes in Coos County, OR Project Date: 4/25/2005 The rate of teenage pregnancy has been declining in Oregon, yet it still remains unacceptably high. Nearly 26 per 1000 teenage girls ages 15-17 years old in Oregon will become pregnant this year, given current trends. Rural communities are plagued with even higher rates of teenage pregnancy, in large part due to the limited access to family planning and abortion care services. Emergency contraception (EC) provides a safe, easy to use, effective and relatively inexpensive method for preventing unintended pregnancy, yet it is extremely underutilized, particularly in rural communities. The reasons for this are not well understood, and are likely multi-facetted, with responsibility resting on physicians, pharmacists, patients, and educators. Physician attitudes and prescribing practices with EC have been fairly well documented, however little is known about pharmacist and school counselor attitudes and practices with respect to EC. The aim of this community project was to examine the attitudes and practices of Coos County middle and high school nurses and counselors regarding emergency contraception. Furthermore, the project also addressed pharmacist attitudes and dispensing practices for EC. The design was a written survey distributed to local school nurses and counselors, and community pharmacists. An informational pamphlet on EC was also developed and distributed to community clinics, schools and pharmacies. The overall response to the surveys suggest that school providers in the Coos Bay/North Bend area are open to the use of EC yet do not counsel students on it unless specifically requested by a student. It was also found that pharmacists dispense EC to all customers with a valid prescription, regardless of age, yet few pharmacies reported EC requests from teenagers. Lets Talk About Sex: A look into the Attitudes and Behaviors of Jefferson County Project Date: 4/25/2005 Teenage pregnancy is a problem throughout the United States. In Oregon, Jefferson County has the second highest teenage pregnancy rate when compared to other counties. This leads to increased health risks for teens and children, and an increasing amount of financial stress on Madras, OR, the heart of the medical and educational services in the county. This study connected the researcher with Jefferson County High School teens via one-hour focus groups in a effort to generate ideas that will be helpful in decreasing the teenage pregnancy rate in Jefferson County. The focus group design and the sample population were chosen because teenagers may have insight into solutions that adults are less able to provide. The information gathered from students was compared with literature recommendations for effective community strategies for decreasing teen pregnancy. The result is a list of recommendations or suggestions for the community of Madras in addressing the important problem of teenage pregnancy. Exploring Teenage Pregnancy Prevention in John Day, OR: Development of teen education material for birth control method selection Project Date: 7/5/2004 The purpose of this project is to investigate the teenage pregnancy rate and services available to adolescent women in John Day, Oregon. For the past few years, family physicians in John Day have noticed a trend in younger teens becoming pregnant in their small town. They have also reported that adolescent women in their rural community are often more likely to choose to keep their pregnancy and raise their children when compared to their urban counterparts. Teen pregnancies and adolescent childbearing is a important issue for rural towns due to the strain it causes on their limited financial and medical resources as well as the social and health consequences to these parents and their children. Since most programs to prevent pregnancy or adolescent motherhood have targeted young women who reside in metropolitan areas, it is important to evaluate whether similar resources should be directed at rural communities. This project intends to achieve two goals: first, examine the trend in the number of teenage pregnancies in rural counties in Eastern Oregon in comparison to urban counties along the I-5 corridor as well as assess whether or not current programs for teen pregnancy prevention are adequately thwarting the number of adolescent girls becoming pregnant in John Day, OR. Second, as part of the effort of teen pregnancy prevention, a patient education handout was created in order to better assist teens in selecting a birth control method. Teenage Pregnancy in Lebanon, OR: physician attitudes and development of an educational handout for new parents Project Date: 1/5/2004 Teenage pregnancy, although on the decline, continues to be a major health issue in the United States. This study attempted to evaluate attitudes toward teenage pregnancy and produce an intercention aimed at helping these young parents once they have made a decision to parent the child. The design was a survcey administered to health practitioners in a family medicine setting, and chart review of pregnant women in the clinic practice. Observational evaluation of local services available to pregnant women was performed. Throufh interaction with teen parents in the clinic wellchild checks, firsthand information was obtained about lack of knowledge of local resources available. After a web search of pre-existing resources, meeting with a prenatal class instructor, and feedback from practitioners, a handout of essential parenting and safety information was compiled, including a list of phone numbers for important resources for parents. The handout was disseminated into the clinic practice to be given out at the two- week well-child check, and also incorporated into the prenatal class curriculum. Age Trend of First-Time Mothers and the Implications for a Central Oregon Community Clinic Project Date: 8/18/2003 Young motherhood carries with it not only risk factors for the mother and the child, but it also serves as a proxy for a number of social, economic, and behavioral risk factors contained within the community. This has implications for the mothers and their children, as well as places demands on the healthcare system and community resources. While the national trend is that women are becoming mothers at an older age1, an investigation into the trend for a Central Oregon community clinic had never been done. By examining prenatal visit records, I found that though the number of young mothers has not increased over the past decade, it has not significantly decreased. The number of very young and late teen mothers has declined, however the number of 17-18 year olds who become pregnant has increased over the past decade. Furthermore, because the entire youth population is increasing out of proportion to older age cohorts, the average age of motherhood is decreasing. In addition, I verified the presumption that women who first become pregnant at a young age do tend to have more children than women who become pregnant when older. These findings suggest that the factors that are influencing women to delay motherhood on the national level are not acting on a local level. This study does not investigate the intent of pregnancy and young motherhood among this community, nor the many potential socioeconomic and behavioral factors that have been associated with young motherhood. Hopefully, this project will serve as an entrance into an issue that deserves further attention. Assessing the needs of adolescence in a rural community with a high rate of teenage pregnancy. Project Date: 8/12/2002 This project aimed to assess the needs of adolescence in a rural community with a high rate of teenage pregnancy. Although the rate of teenage pregnancy and births has been declining across the U.S. and Oregon over the last decade, there are still many counties in Oregon that are disproportionately affected by this social burden. Linn county (as a rural community) has the highest rate of teenage pregnancy and births. This project tries to unravel the mystery of how we can best target teens with useful information that they want to hear and will further utilize. The project lead to numerous discussion groups with over 100 high school students. The results show that in the area of sex and pregnancy teens are concerned about their comfort level with the person discussing these issues and the relevance of these issues to their lives. Therefore, the most effective form of education for teens on pregnancy prevention would be one that incorporates a peer provider model into a comprehensive education program. Examination of Adolescent Pregnancy in Klamath County: Is there really a high teenage pregnancy rate? Project Date: 7/1/2002 This study sought to evaluate the validity of the widely held belief that Klamath county has continued to have a high incidence of teen pregnancy and if valid seek an explanation for this higher than normal rate. Vital statistics from the Oregon Department of Human Services were reviewed for the year of 2000 and revealed that Klamath County has teen pregnancy rate that is not significantly different from that of the state of Oregon. Klamath County does however have a significantly higher teen birth rate and a significantly lower abortion rate. These results fail to support the belief that pregnancy rates are higher but are able to explain why such a belief exists as the actual birth rate is higher than the state average. A discussion was then held with three staff members from the Klamath County Health Department who specifically work with teenagers to offer theoretical explanations for why the birth rate is significantly higher in Klamath county. Reasons cited include poor access for pregnancy termination, poor education of teenagers about pregnancy, denial, and in some cases a desire to have children at a young age. Knowledge Is Power: Rural Women's Access To Contraceptive Information. Project Date: 1/2/2002 Despite advancements in contraceptive technologies over the past two decades, unintended pregnancy, particularly teen pregnancy, rates remain high in the United States compared to other industrialized nations. Almost half of all pregnancies in the U.S. each year are unintended. Numerous factors contribute to this problem, many of which are personal, political, economic, or cultural in nature. Providing information is not the only way to increase women's contraceptive use. There are other barriers to care that have as much or more of an impact on access, particularly in the rural setting. But lack of information is not a very difficult obstacle to overcome if it is acknowledged and addressed. Contraceptive knowledge is one of the few modifiable risk factors for unwanted pregnancy. This project consists of three components: assessing patient access to contraceptive information and services, taking action to improve access, and recommending changes that may benefit some patients. Back to subject search page or search by preceptor site