Introduction

Introduction

As of April 2022, the COVID-19 pandemic has resulted in over 80 million cases in the United States, with almost one million of those ending in death. According to the Centers for Disease Control and Prevention (CDC), trends in COVID-19 incidence for children and adolescents age 0-17 run parallel to trends of adults. Since the summer of 2020, the number of new adolescent COVID-19 cases has risen with every consecutively increasing age group.

As the nation focused on preventing the spread of COVID-19, adolescents adjusted many aspects of their life including how and where they learn and access sexual health services (SHS). The importance of ensuring these services are available to adolescents is exemplified by the percentage of this population who report having currently or previously been sexually active, experienced STDs/STIs, or been pregnant.

• Before the COVID-19 pandemic, 38.4% of adolescents in grades 9-12 reported ever having sexual intercourse, while 27.4% reported currently being sexually active.
• Adolescents ages 15-24 years account for about half of newly reported STD cases but are only about 13% of the total population. Despite these numbers, STD screening rates among adolescents are low. Before the pandemic, only 17% of females and 7% of males, aged 15-25 years old, reported receiving STD screening in the past 12 months.
• Despite recent declines, the rate of teen pregnancy in the U.S. also remains significantly higher than that of other industrialized Western nations. In 2017, the birth rate for adolescents aged 15-19 years was 18.8 per 1000 women.

Access to adolescent SHS is essential to preventing unintended pregnancy, slowing the spread of STDs/STIs in this population, and ensuring that pregnant teens receive needed prenatal care.When considering disparities among historically marginalized groups, access to adolescent health services is critical.

• In Black females and males aged 15-19 years, the rate of reported cases of chlamydia was 4.5 and 9.1 times higher, respectively, than their white counterparts.
• In 2017, the birth rates for non-Hispanic Black female adolescents and Hispanic female adolescents aged 15-19 were 27.5 per 1,000 and 28.9 per 1000, respectively. Both are more than double the birth rate for non-Hispanic White female adolescents in the same year (13.2 per 1,000).
• LGBTQIA+ adolescents report a higher prevalence of risky sexual behaviors and are at a higher risk for adverse health outcomes such as pregnancy, STDs, and HIV than heterosexual adolescents. These risks are even higher for adolescents who report having sexual contact with both sexes than adolescents who report having sexual contact with only the same sex.

While these populations have an accentuated need for services, they often face more barriers to care, including stigma, time, transportation, and confidentiality concerns making it particularly important to ensure that their access to health care is supported.

The nation’s schools can play a critical role in addressing adolescent health by developing and implementing sustainable referral systems. Schools can help increase access to SHS by partnering with providers to enhance awareness of and connect students to adolescent-friendly school-based and community-based health services.  School-based providers can ask about sexual health during other routine appointments such as sports physicals and annual check-ups, and from there make the appropriate referral to outside SHS.

COVID and Adolescent SHS

In addition to adjusting how and where they learn, many adolescents experienced changes in the services they often relied on schools and school-community partnerships to provide, including connections to SHS creating new challenges to care. Stay-at-home orders and other efforts to mitigate the spread of COVID-19 compounded the difficulties teens experience accessing SHS. COVID-added barriers contribute to adolescents delaying care or not seeking it at all, which could have long-term impacts. Increases in pregnancy could result from an inability to access birth control. Delayed STD testing could lead to a rise in STD incidence and long-lasting health impacts if STDs are left untreated.

Increasing adolescent access to SHS is imperative during the COVID-19 pandemic. Telehealth and telemedicine are relatively new practices that have seen more frequent use as a result of the COVID-19 emergency and restrictions.  These practices have served as great solutions for increasing access to care not only during the pandemic, but also in a “post-pandemic” era, adding an extra layer of care when things begin to return to normal.

This toolkit addresses telehealth specifically and focuses on the broad scope of care, not just clinical care.  It is designed for all those involved in delivering sexual health care to adolescents, particularly community and school-based providers, nurses, social workers, and staff.  It may also be useful for policy makers, as the continued use of telehealth as a tool to increase access to sexual health services for adolescents will require a number of policy changes.