Stanford
Prevention Policy Modeling Lab
Research Area

Adolescent and School Health

Adolescent and School Health

Click on a project title to learn more about PPML's work in Adolescent and School Health.

Projects

Past Projects

Estimating the Population Size of Sexual Minority Adolescents 

Estimating the size of sexual minority adolescent populations — at national, state, and local levels— is critical for recognizing and responding to disparities in health risks and outcomes. This project uses state Youth Risk Behavior Survey (YRBS) data to estimate the number of adolescents who identify as lesbian, gay, or bisexual (LGB). PPML predicts estimates in states where YRBS does not measure these responses directly using machine learning methods.

Further expansion of this project using 2021 YRBS data aims to understand the proportions of high school students identifying as LGB by state, and further stratified by grade, year of age, and race/ethnicity.

Estimating the Population Size of Sexually Active Adolescents

Estimating the size of sexually active adolescent populations at a sub-national level, such as county level, can improve local understanding of the disease burden of sexually transmitted infections. These estimates would also facilitate comparisons of disease rates, such as HIV and syphilis, between men who have sex with men and other populations. This project combines data from several different sources, including the National Survey on Family Growth, American Community Survey, and Youth Risk Behavior Survey, to develop state and county-level estimates for the proportion of the high-school-age population that is sexually active.

Evaluating the Impact of Abortion Restrictions on Teen Pregnancy Outcomes

As states plan to or start enacting new abortion restrictions, it is anticipated that the rate of abortions will impact rates of live births and adverse birth outcomes among adolescent mothers. 

This project aims to understand the impact of policies that restrict access to abortions, and the subsequent impact on rates of live births among adolescents. Looking at restrictions that impact this age group, such as parental requirements, Medicaid funding, and gestational restrictions, health and economic costs will be evaluated to observe:

  • Changes in rates of live births
  • Adverse birth outcomes
  • Excess societal and medical costs

Estimating Disease Rates Among the Sexually Active Adolescent Population

Understanding disease rates among sexually active adolescents is critical to inform prevention priorities and activities. To leverage estimates of sexually active adolescents to calculate and disseminate disease rates for this population, this project seeks to:

  • Compute rates of gonorrhea and chlamydia among sexually active adolescents, particularly among lesbian, gay, and bisexual adolescents 
  • Compute rates for HIV and primary and secondary syphilis among this population

Past Projects

School-Age and Young Adult Testing for HIV: Cost-Effectiveness Analysis to Inform Guidelines

In 2006, CDC recommended routine HIV testing for adolescents and adults, ages 13 to 64, in the United States. These recommendations were based on several factors and studies, including the overall and undiagnosed prevalence of HIV in the United States, the availability, accuracy, rapidity, and low cost of the HIV test, and the availability of highly effective and life-saving therapies for HIV. Model-based analyses suggested that routine HIV testing would be very cost-effective, although these analyses did not include adolescents specifically.

The current CDC recommendations are based on a model using case surveillance among those aged 13 and over. While the recommendations imply that it is worthwhile to get tested at least once in a lifetime, this recommendation is difficult to interpret early in the life course. National data highlight that HIV prevalence varies across age groups and is much lower in teens than in young and older adults. For these reasons, there is an important need to further refine the lower end of the age range for HIV testing guidelines.

This project examined the yield, cost, and cost-effectiveness of routine HIV testing in school-aged adolescents and young adults in the United States.

Associated Publication

School-Based Screening Strategies for Chlamydia

Chlamydia diagnosis rates are highest among people under the age of 25. A significant percentage of this population is school-aged children currently enrolled in educational facilities. Schools offer a structured setting for targeted interventions intended to reduce chlamydia prevalence, such as screening. Prior studies on school-based screening programs found variation in their potential impact, with several pilots failing to demonstrate a stable reduction in chlamydia prevalence in the intervention schools. Certain factors, such as the mixing of students between intervention and non-intervention schools and variation in school participation and parental consent, are thought to limit the potential impact.

This project evaluated the impact and cost-effectiveness of school-based screening for chlamydia within a variety of community settings. The analysis explored the impact of screening programs by modeling a range of intervention strategies in urban settings, characterized by varying profiles and pre-existing levels of chlamydia screening in public high schools. Three urban school-based chlamydia screening programs provided a strong empirical basis for modeling specific programs and associated outcomes. The model incorporated the data and profile of each participating site, accommodating replication of existing programs as well as a generalization to enable exploration of potential outcomes under a wide range of different circumstances reflecting variation in epidemiology and existing health services coverage.

Associated Publication