APGO

Poster
Gail L. Stanley, MPH

Sonya S. Erickson, MD

Objective: LEADS is a longitudinal track at the University of Colorado Medical School designed to promote awareness of social influences on health and disparities, address barriers to health, and teaches advocacy skills. LEADS engages students in advocacy projects by pairing them with a community based project mentor. My objective was to explore physician leadership and advocacy in government. I therefore worked with State Senator Aguilar, a new senator but an experienced community advocate and a MD. During the previous congressional session, a review of teen pregnancy prevention programs demonstrated that overall teen birth rates had declined in Colorado, but continued to be disproportionally elevated in rural counties with large minority and/or low income populations. Our project investigated potential causes of this distribution, determining barriers for rural counties.

Methods: I completed the required LEADS electives during my first year of medical school. There, we learned about the social and cultural determinations of health, with an emphasis on local health disparities. We learned about media interviewing, building collaborative partnerships, and writing op-eds. During the following summer, we conducted our individual community projects, meeting weekly in student run classes designed to broaden our leadership and advocacy skills, and to develop our personal advocacy goals. My summer project was designed to gather background information that would inform the legislative process. I performed a systematic review of teenage pregnancy prevention programs in Colorado with a focus on health behavior models, community programs, and health education. Outcomes measured were participation, community support, teen sexual behaviors, contraception use, and pregnancy rates.

Results: We found that social cognitive theory and the theories of reasoned action and planned behavior were utilized most often. Successful programs targeted urban and minority youths. Infrastructure for reproductive services was adequate in most counties. Health education in schools was not standardized. In rural communities barriers include: community support for science-based health education and integrating youth-friendly services and clinics into existing services.

Conclusions: Community-wide initiatives focusing on teen pregnancy prevention may be responsible for the decline in Latina birth rates. These programs should be expanded into rural counties. Barriers to implementation included: limited community awareness, limited rural infrastructure for reproductive health services, and lack of standardized health education in schools. Physicians and medical students can effect change by increasing awareness of the problem, troubleshooting barriers, and referring patients to the successful programs. Government officials were responsive to our advocacy efforts, and a well crafted e-mail or factsheet can help shape the support for funding.