Who are those individuals that have the most influence on the choices our youth make even before their peers take over? It has been demonstrated that when parents talk to their children about sexual issues -- providing risk-avoidance and risk-reduction guidance -- their teens are more likely to abstain or use safer sex practices. Studies also have indicated that today's youth desire these conversations with their parents. We must not be so na?ve to think that it is not our child having sex. Instead, we need to discuss openly with our children the benefits of abstaining and the risks of sexual involvement at a premature time in their lives.

If we are going to seriously address this issue we have to be willing to tell youth what direction they need to go and how to get there. Let me put it this way: Do you think teens should be having sexual intercourse? Most reasonable adults would say no. Then why don't we tell them that? The skeptic, the "realist," will say, "but let's get real -- reality is our kids are going to be sexually active." For many youth, it is true that no matter what we do or say as an adult community, sexual activity will be initiated before they leave their teen years, long before they are self-sufficient, at the least. And for those who choose to be sexually active -- we must provide contraceptives and guidance, using secondary prevention models to prevent sexually transmitted disease.

Currently, as a major component of Mayor Wilder's Vision 2020, there is a Teen Pregnancy Prevention Initiative designed to raise awareness about the issue. This public awareness campaign consists of a documentary, public service announcements, and a Web site. Staff of the city's teen pregnancy initiative and the Richmond City Health Department's (RCHD) adolescent health program work collaboratively to implement teen pregnancy prevention services.

SCHOOL-BASED programming utilizing evidence-based curricula are being implemented in all middle schools and the three high schools attended by students from the identified areas where the incidence of teen births are the highest. Community-based outreach activities are being conducted in the same census tracts. Outreach activities are conducted to increase the number of sexually active youth obtaining reproductive health services.

In addition, RCHD offers pregnant teen case management services through the Resource Mothers program. This program has been very effective in reducing the number of repeat births to teens, increasing the graduation rate of pregnant and parenting teens. In addition, GEMS (Girls Empowered to Make Success) is a companion program for younger sisters of Resource Mothers participants with a goal to decrease the incidences of pregnancies among siblings of the teens participating in the Resource Mothers program.

A clinic designed to meet the needs of teens (Teen Clinic) is offered every Thursday afternoon at the RCHD's 10th Street location and reproductive health services are provided through our Family Planning Clinics on Mondays and Thursdays. Clinics focusing on the diagnosis, treatment, and counseling for sexually transmitted infections (STIs) are available all day Mondays, Wednesdays, and Fridays as well. For any of these clinics you can call 646-6850.

The RCHD is considering plans to expand our services to other locations in the city -- and we are also strategically planning to address the teen male population with a program that teaches male responsibility. Area health departments in Chesterfield, Henrico, and Hanover counties provide similar services.

I have summarized the current city services, but there is more to do. The health district cannot reduce STI rates and teen pregnancies alone. We will continue to build our coalition to draw upon the full range of potential human, social, material, and spiritual resources to improve the health status of the citizens of Richmond. And this plan will concentrate not only on these 25 percent of teenage girls who have an STI (actually probably higher than this in Richmond). Any successful plan must consider the young men of Richmond and fathers of these children. A multidimensional community-wide effort is needed employing principles of primary prevention, teen-friendly clinical services, and alternatives to becoming teen parents -- helping young people to see the potential for the future and become self-sufficient.

WE ARE LOOKING for your help. We are encouraging parents to talk with their children about sexuality and relationships; health care professionals to talk with adolescent clients about sexual decision-making and healthy choices at each visit; faith leaders to incorporate sexuality and relationship curricula into their youth programming; and caring adults to mentor youth. There is a role for anyone interested in addressing this issue.

What can you do, now? Take the time to view the Campaign to Prevent Teen Pregnancy documentary and learn more about how you can help address the issue. Visit www.richmondgov.com/tpp.
Gale E. Grant is the adolescent health coordinator with the Richmond City Health District. Contact her at (804) 646-7316.