HEA 609 - Community Health Interventions

Assignment #2: Product Report

16 March 2016
Alaina Carter, Nneze Eluka, Yolanda Jarrett, Jennifer McLean

Health Topic Overview

Sexually Transmitted Infections are a substantial health concern in the United

states. According to the 2014 CDC STD surveillance report, Chlamydia,
Gonorrhea, and Syphilis have shown an increase for the first time since 2006.
Its estimated that almost twenty million new cases of sexually transmitted
infections are diagnosed each year with half of the cases occurring in
individuals ages fifteen to twenty four (STD Surveillance, 2015)Teens Taking
Action (TTA) is a national peer education program that trains youth to
become advocates and leaders with the goal of having an impact in
increasing positive sexual health behaviors among their peers. In 2013,
47.3% of high school students reported having ever had sexual intercourse,
and 39. 2% reported not using condoms during their last sexual encounter.
(State Health Profile, 2013) Teens and young adults in North Carolina ages 15
to 24, have shown to have higher rates when compared nationally for
chlamydia, gonorrhea and syphilis (CDC,2103).

Organization & Program Overview

Planned Parenthood is a national and global nonprofit health care provider
with over 100 affiliates that deliver reproductive health care, sex education,
and information to both men and women. Their mission is to provide
affordable and complementary comprehensive reproductive care in a way
that protects and preserves an individuals rights and privacy. They also
advocate for public policy to help ensure access to their services as well as
support research and technology advancement around reproductive health.
Planned Parenthood offers services related to the testing and treatment of
sexually transmitted infections (STI), STI prevention, safe sex education, and
STI-related vaccines. They aim to provide these family planning services to
two target populations:, low-income individuals and teens seeking
confidential services. In the latter group, the Teens Taking Action (TTA) group
empower teens and other populations to make informed decisions regarding
their sexual health.

Critique of the program

 While the program has many strengths, there are also areas that need
improvement. One such advantage of teens educating teens is that they are
able to trust one another. This is a matching intervention where the peer
educator and the teen audience meet on a level ground. For example. the
power differential when a teen is speaking to a teen is nonexistent,
compared to a teen talking with an adult. In essence, the teens can easily
relate to each other, and ask questions without fear of judgement and
without the need to explain teen-specific cultural nuances and terminology.
Furthermore, this unspoken sense of inclusivity is closely related to the
concept of cultural sensitivity, which has been shown in public health to
increase the receptivity of a message (Meydanlioglu et al., 2014) .
Since the TTA team are responsible for their presentation curriculum, this
presents both a challenge and an opportunity. They of course seek the
guidance to the program director, but the challenge is that the TTA team
needs continue updating the information and present it in an easily
understood format. It also presents the opportunity for teens to design it
creatively and effectively. In addition to creating a curriculum for
presentation, teens in general are not always comfortable discussing sexual
health. This creates a burden for TTA to create fun and engaging program
for teens, while also educating them and correcting misconceptions about
topics such as STIs and birth control.

Program need
Our Smash or Pass game was created to help TTA improve communication
with the audience. It can be used as an icebreaker or at the end as a wrap-
up activity. If used in the beginning, it can help assess knowledge; whereas,
it would help to check for understanding and a serve as a simple evaluation
tool at the end of a presentation. Either way, it gives teens an opportunity to
express their thoughts and opinions in a comfortable space. We envision
that TTA can further make it a friendly, but competitive game where teams
play for a chance to win prizes.

Product Content

Condom Use
Teenage sexual health needs: Asking the Consumer is a review article
written about a case study of fourteen and fifteen year old students who took
part in a focus group that gauged their knowledge, attitudes and perceptions
about many things concern health (Lester & Allan, 2006). Many students
exhibited signs of low condom efficacy and one quoted, Yeah you know
when youre on the pill, you dont have to use a johnny do you (Lester &
Allan, 2006)? Other students who participated in the focus group voiced
opinions of not having to use condoms while on a birth control pill as well as
feelings of young boys believing it was better to use a condom. These among
other reasons are why we chose to address condom use in our game for the
peer educators to play with their program participants.

STIs
Another overarching theme from students in Teenage sexual health
needs: Asking the Consumer about STIs is that they believe their knowledge
about the topic is inadequate but that it does not affect them as much as it
does older people (Lester & Allan, 2006). The article also pointed out that
when using methods to deter student from risky behavior that would put
them at higher risk to contract STIs, pointing out consequences of infertility,
for example, would not have a great effect on a student because most
students do not want to get pregnant at a young age. This is why we chose
to focus the language of our information on relevant topics for teenagers.

Barriers to healthcare or education concerning STIs

Evidence has been shown that interventions focusing on safer- sex
rather than abstinence may be more effective in educating teenagers. A
study conducting abstinence and safer sex HIV risk-reduction interventions
for African American adolescents showed that while both intervention
methods proved to have significance in reducing sexual risk behaviors, safer
sex interventions may prove to have a longer lasting effect on adolescents.
The article noted that abstinence interventions appears to have more appeal
to younger adolescents but they may lack the knowledge and judgement to
make informed decisions to protect themselves. The logic behind safer-sex
interventions is that interventions that try to prevent, eliminate, or even
reduce sexual intercourse among adolescents are unrealistic; hence,
prevention programs should instead attempt to increase condom
use.(Jemmott, et al., 1998)
There is also evidence that there are both barriers and perceived
barriers to care. In Teenage sexual health needs: Asking the Consumer, one
of the barriers to care was the embarrassment of having to go to the clinic
for treatment or to receive contraception. We chose to use information about
where teens can receive local care and free contraceptive methods because
a lot of students are unaware of these resources in their community. We also
included information about STI facts and who they affect. This is to let teens
know that they are not alone and that there is nothing to be ashamed of
because many people are affected by STIs and all people who are affected
by them, need to seek care as soon as possible as well as get tested
regularly.

Using the Internet as an education source

Providing access
An important aspect of decreasing barriers to gaining sexual health
knowledge for teens is providing online access to information. The Internet
serves as an opportunity to disseminate sexual health education information
to teens. As noted by researchers, With the increase in Internet availability,
most adolescents and young adults in the United States use the Internet on a
regular basis. (Buzi, Smith, and Barrera, 127). Using online media and
Internet-based learning can help sexual health educators capitalize on these
information sources to link teens to reliable and comprehensive sexual health
information on the Web (Biddlecom and Jones, 120). For these reasons,
more internet sources of comprehensive sexual health information are
needed to educate teens on safe sexual health practices.
In the Talk With Tiff : Teens Inquiries to a Sexual Health Website
qualitative study, researchers sought to determine and address the need for
sexual health information through an online medium. Buzi, Smith, and
Barrera designed the study to have teen respondents submit questions about
sexual health concerns, with a 24 hour answer from clinic staff members
participating in the study (2015). This provided access for teens to learn new
information and correctly clarify information already processed through an
anonymous resource. Based on previous literature reviews in online health
education methods, the researchers in this study determined that Online
health sources specifically geared toward adolescent users allow teenagers
to seek advice and reassurance on sensitive topics (Buzi, Smith, and
Barrera, 127). Like the email medium used in the study, Internet-based tools
can be made available in places frequented by teens, such as teen health
clinics, Planned Parenthood, embedded in online sources, and games to
provide accurate and relevant sexual health information.

The importance of confidentiality

Confidentiality in obtaining sexual health information and resources
seems to be a major concern for teens. As evidenced in the Talk With Tiff :
Teens Inquiries to a Sexual Health Website study, using online sources to
disseminate information was observed as a positive opportunity for teens to
obtain comprehensive sexual health education information without a stigma
attached. The researchers determined that adolescents lack knowledge
about sexual health, hold misconceptions about these issues and are
concerned about confidentiality (Buzi, Smith, and Barrera, 132). Creating or
adapting an intervention that provides these comprehensive sexual health
topics in an online medium like a Jeopardy game or other data source allows
for accurate information to be updated, provided, and readily accessible to
teens or health educators who work to inform teens.

Synopsis
Based on the observed requests and inquiries of teens, there are many
areas that need to be addressed when creating or adapting a sexual health
based intervention for teens. Accurate information on condom use, STIs/HIV
information, and sexual health behaviors should be comprehensive. When
created with accurate information, providing internet-based interventions
allows for teens to have increased access that potentially feels more
comfortable to use and more confidential to obtain accurate information.
Ultimately, developing internet-based interventions helps remove potential
barriers for teens to acquire the necessary information needed to generate
discussions and learn information about comprehensive sexual health topics.

B. Product description
The product is an ice breaker jeopardy brain teaser. It will be utilized by
teen peer health educators when educating their fellow teens about STIs
and sexual health. It would take place during the first 10 minutes of the
presentation. It contains 25 questions to help facilitate the discussion and to
help each member in the audience feel more comfortable. The questions are
designed to test for knowledge on STIs and sexual health (condom use, STIs,
other contraceptives, barriers to healthcare/education concerning STIs) in a
variety of ways, including open-ended questions and knowledge-based
questions. It also includes relevant to the teen population, including popular
culture references.
The advantage of this game is two-fold, whereby benefitting the peer
educators and the teen audience. The teens would ideally find the game a
fun and informal way to express their opinions and help them to start
thinking about gaps in their knowledge; and furthermore, formulate
questions that they would like to ask during the presentation. This also
creates a more fun and open atmosphere which was found to be ideal when
educating students about health. On the other hand, the peer educators
would use the game to gauge the knowledge level of the audience, and
provide an informal guide to what what questions that they would be
addressing based on the interests of the audience.
 The title of the game is Smash or Pass and this language is
something that teenagers would be attracted to because the title lets the
teens know what they are talking about, while still keeping the topic fun. The
idea of Smash is that if a person is equipped with protective barriers,
lubrication and has been tested, they are safe to engage in healthy sexual
behavior. Pass would mean that they are not as prepared for safe sex or
may be putting themselves at risk, meaning no condoms, not educated
about STIs, have not been tested and many other factors.

Appendices
A. Smash or Pass!!! Game guide with link for Sexual Health Icebreaker game

B. Fact Sheet for Smash or Pass Jeopardy Game Leaders

C. Bonus Questions for Tiebreaker or Final Jeopardy round

D. Logic Model: Based on your interviews and research related to the program

Appendix A
Smash or Pass!!!
Teen Sexual Health Online Jeopardy Game

Source: Adapted from Teen Talks Sexual Jeopardy Game

From the Teen Talk Youth Health Education Program,
a program of Klinic Community Health in Winnipeg, Manitoba,
Canada

Goal: To have fun while educating and reinforcing information learned about
sexual health
topics; including STIs, HIV, birth control, condoms and consent.
 Materials Needed:
___ Overhead projector/SMART Board
___ Laptop or Computer with Internet access
___ Link for Smash or Pass!!! Game - https://jeopardylabs.com/play/smash-
or-pass
___ Fact sheets with questions and answers from the game (for game
leaders)
___ Scoreboard sheet (optional)
___ Final jeopardy music (optional)

Instructions:
___ Divide the group into two teams and have them choose team names.
___ Decide which team will go first. Tip: One way to decide is by getting them
to guess a
randomly chosen number between 1 and 10 that you have in mind.
___ Have the teams take turns choosing a category and points value, and
answering a
Question. Do not take away points, only add points for correct answers.
___ Keep score on a chalk/white board.
___ Encourage each team to huddle and work together to come up with the
correct answer.

Game Tips
1. If one team guesses incorrectly, you may want to give the other team a
chance to
steal if they know the correct answer.
2. Please note: There is no need to ask every question, the game can be as
brief or extended as needed.
3. You might play a final Bonus Jeopardy round where each team chooses an
amount of points to wager. See Prevention 20 for an example bonus
question.
(If playing the Bonus Jeopardy round, play the music at the end of
the Fact Sheet)

Appendix B
Fact Sheet for Smash or Pass Jeopardy Game Leaders
Lost without You - resources
100 Q: Name 2 services that Planned Parenthood in Greensboro offers
A: birth control, mens and womens health, pregnancy testing,
abortion
referral, emergency contraception
200 Q: If I go to Triad Health Project on Monday night 5pm-7pm, what
am I going
for?
A: Free HIV, Chlamydia, Gonorrhea and Hep C testing
300 Q: During heterosexual sex, if my birth control fails or I do not use a
condom
what can I purchase if I think I may be pregnant?
A: Emergency contraception, Plan B, sold over the counter at drug
stores or
can get from Planned Parenthood without parental consent
needed
400 Q: What are 2 things to look on a condom package before opening
it?
A: If there are holes, whether is lubed or non lubed, expiration date
500 Q: Do I need permission to get condoms from a clinic or store?
A: No, a parent or guardian does not need to give permission for
you to use or
buy condoms, and you dont have to be a certain age to buy
condoms. You
can always get free condoms from Planned Parenthood or Triad
Health Project, and the local health department.

What are thoooossseeee?! - STIs

http://www.std-gov.org/stds/std.htm
100 Q: What do herpes look like?
A : small bumps that turn into blisters
200 Q: Is Chlamydia curable?
A: Yes - bacteria
300 Q: How is Syphilis contracted?
A: Oral, anal, vaginal
400 Q: Name this STD: Can be transmitted orally, analy, vaginaly; is
incurable; does
not show up in men, can cause genital warts in women,
women can get a vaccine for this
A: Human Papillomavirus - HPV
500 Q: Name 5 STIs
 A: HIV/AIDS, Syphilis, Chlamydia, Gonorrhea, Trichomoniasis, HPV,
Scabies,
Herpes,

Myth busters - barriers to care and misconceptions about sex,

STIs etc.
100 Q: Confidential testing in North Carolina does not exist, true or false
A: FALSE
200 Q: I can get HIV from swapping slob
A: FALSE
300 Q: I can use a female condom for anal sex
A: TRUE
400 Q: The pull out method is a safe way to avoid pregnancy, STIs, and
HIV/AIDS
A: FALSE
500 Q: STIs and HIV only affect older people
A: FALSE

Frisky Business - Risks and Safe Sex Options

http://teentalk.ca/wp-content/uploads/2014/05/Sexual-Jeopardy_Teen-Talk-
2012.pdf
100 Q: This is the length of time it takes for HIV to show up in blood
tests
A: 1-3 months after a person is infected
200 Q: What are 2 ways to use a dental dam?
A: oral sex - female genitals and male and female anal area
300 Q: What are the steps to put on a condom the right way?
A: Open the condom (not with teeth), pinch the tip of the condom to
leave a
small amount of space at the top, gently roll down the condom
on the penis,
commence the fun!
400 Q: Three risky behaviors that may lead to getting HIV
A: Unprotected vaginal or anal sex, sharing sex toys or sharing
needles, and
breastfeeding if mom is HIV positive
500 Q: Three ways to reduce the chances of getting HIV
A: Safer: using condoms, cleaning needles properly (for HIV, not
Hep C) &
getting tested regularly
 Safest: abstinence, using new needles & not sharing needles

Relations - How to communicate effectively with your partner

100 Q: This is the definition of the word consent
A: giving permission, saying yes and only yes the entire time
200 Q: Two places where you and your sexual partner can find free
condoms and
safer sex products
A: Planned Parenthood, Guilford County Health Department, Triad
Health
Project, University Health Center, Medical Doctor
300 Q: This two-word activity involves you and your sexual partner
visiting a local
agency, center, hospital, or doctor to gain more information
about the status
of you and your partner
A: Getting Tested
400 Q: What you should do before touching someone in any way or
having sex
A: ask for consent
500 Q: Three things to talk about before having sex
A: consent, birth control; condom use; STI testing; consent; comfort
level and
boundaries; what if birth control fails; etc
Appendix C
II. Bonus Questions for Tiebreaker or Final Jeopardy round

Q: What is one advantage of the female condom over the male condom?

A: Possible answers: Can be inserted up to 8 hours before sex; doesnt

require a hard penis; alternative to latex if someone is allergic; added
protection against STIs that are transmitted by skin-to-skin contact (such as
Herpes and Genital Warts).

Q: What are 3 things you could do or say to encourage someone to get

tested?

A: Possible answers: offer to go with them (and/or get testing too); describe
the testing process to them so theyre not afraid; tell them the earlier they
get tested the easier it is to treat if they do have an STI; tell them about
good places to go that are the most convenient for them (teen clinics, health
centres, nursing stations); tell them it will be confidential; non-judgmental;
etc.
Q: What are 5 activities that are NO RISK for pregnancy and STI/HIV?

A: Possible answers: massage; hugging; masturbating; dry humping; holding

hands; abstaining from sexual activity with a partner

Possible engaging Final Jeopardy instrumental music:

https://www.youtube.com/watch?v=isjByiL4-Sk - Jeopardy theme song - trap
music

https://www.youtube.com/watch?v=1Eh_qIqwxDo - Jeopardy trap music

theme song

References

Biddlecom, A. E. and Jones, R. K. (2011). Is the Internet Filling the Sexual

Health
Information Gap for Teens? An Exploratory Study. Journal of Health
Communication, 16:112123

Lester, C., & Allan, A. (2006). Teenage sexual health needs: asking the
consumers. Health
Education, 106(4), 315328.

Buzi, R. S., Smith, P. B., & Barrera, C. (2015). Talk with Tiff: Teens Inquiries to
a Sexual
 Health Website. Journal of Sex & Marital Therapy, 41(2). Retrieved from
http://ejournals.ebsco.com.libproxy.uncg.edu/Direct.asp?
AccessToken=8UNPOPWV0UWJ3TN3K4J9K4X01JK9VPU4NO&Show=Obj
ect

Teen Talks Sexual Jeopardy Game (2012). Teen Talk Youth Health Education
Program.
Klinic Community Health. Winnipeg, Manitoba, Canada. Retrieved from
http://teentalk.ca/wp-content/uploads/2014/05/Sexual-Jeopardy_Teen-
Talk-2012
.pdf

Sexually Transmitted Diseases CDC Fact Sheets. (2016). Center for Disease
Controls.
Retrieved from http://www.cdc.gov/std/life-stages-
populations/adolescents-youngadults.htm

Sales, J., & DiClimente, R. (n.d.). Adolescent STI/HIV prevention programs:

What works for
teens? Retrieved March 09, 2016, from
http://www.actforyouth.net/resources/rf/rf_sti_0510.pdf

Meydanlioglu, A., Arikan, F., & Gozum, S. (December 01, 2015). Cultural
sensitivity levels of
university students receiving education in health disciplines. Advances
in Health Sciences Education : Theory and Practice, 20, 5, 1195-1204.

Rates of Reportable STDs among Young People 15 - 24 Years of Age North

Carolina, 2013
(Rep.). (2014, December). Retrieved
http://www.cdc.gov/std/stats/by-age/15-24-all-
STDs/state/2013/NC13.pdf

Sexually Transmitted Disease Surveillance 2014 (Rep.). (2015, November).

Retrieved from
the Centers for Disease Control website:
http://www.cdc.gov/std/stats14/surv-2014-print.pdf
North Carolina- 2013 State Health Profile (Rep.). (2013). Retrieved from the
Centers for Disease Control website:
http://www.cdc.gov/nchhstp/stateprofiles/pdf/north_carolina_profile.pdf

Jemmott, J. B., III, Jemmott, L. S., & Fong, G. T. (1998). Abstinence and Safer
Sex HIV Risk-Reduction Interventions for African American Adolescents.
Jama, 279(19), 1529-1536. Retrieved from
http://jama.jamanetwork.com/article.aspx?articleid=187546