Steps to a Healthier Cleveland Youth Risk Behavior Survey

Transcription

1 2007 Steps to a Healthier Cleveland Youth Risk Behavior Survey Center for Adolescent Health Case Western Reserve University Department of Family Medicine

2 TABLE OF CONTENTS Acknowledgements... 3 Overview... 4 Demographics... 5 Physical Activity, Nutrition, Obesity... 6 Tobacco, Alcohol, and Other Drugs... 8 Safety and Violence Other Health Issues This publication is supported by the Steps to a HealthierUS Cooperative Agreement Program of the U.S. Department of Health and Human Services (HHS). Its contents do not necessarily represent the official view of HHS. 2

3 ACKNOWLEDGEMENTS The Steps to a Healthier Cleveland Youth Risk Behavior Survey (Steps/YRBS) was successfully completed because of the expertise, cooperation and dedication of many. The Center for Adolescent Health, Department of Family Medicine at Case Western Reserve University is grateful for the technical assistance provided by the Division of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (DASH/NCCDPHP/CDC) and the WESTAT research corporation. These services were available because of the joint cooperative agreement of Steps to a Healthier Cleveland via Steps to a HealthierUS with the U.S. Department of Health and Human Services. CAH wishes to show particular appreciation to members of the Surveillance Partnership: Child and Family Health Services, City of Cleveland Department of Public Health, Cuyahoga County Board of Health, Cuyahoga County Comprehensive Partnership for Tobacco Reduction, Cuyahoga County Teen Wellness Initiative, Shaker Prevention Coalition, Social Advocates for Youth Coalition, and the Steps to a Healthier Cleveland. Through the collaboration of this partnership the adolescent surveillance reach has expanded significantly. We are especially grateful to the students, teachers, principals, superintendents, and all administrative personnel of the Cleveland Metropolitan School District who agreed to participate in the survey. A singular thank you is extended to the CMSD Department of Health and Support Services and the Department of Health and Physical Education. Also, the survey could not have been administered without the assistance of our many student volunteers. The Center for Adolescent Health appreciates the support of its home base, the Department of Family Medicine, Case Western Reserve University. Report prepared by: Center for Adolescent Health Department of Family Medicine Case Western Reserve University Euclid Avenue Cleveland, OH Michelle Del Toro, Graduate Student Research Assistant Jean Frank, Manager of Community Initiatives Edward Hill, Surveillance Coordinator Michael Rueschman, Data Coordinator Joshua Terchek, Data Manager 3

4 OVERVIEW INTRODUCTION In the spring of 2007, the Center for Adolescent Health (CAH) administered the Youth Risk Behavior Survey (YRBS) in Cleveland Metropolitan School District (CMSD) schools in partnership with Steps to a Healthier Cleveland and the Cleveland Department of Public Health. This report presents findings from the 2007 Steps to a Healthier Cleveland YRBS addressing 5 specific areas: Physical Activity, Nutrition, and Obesity Tobacco, Alcohol, and Other Drug Use Sexual Intercourse and Birth Control Safety and Violence Other Health Factors METHODS The YRBS was conducted in 15 public high schools by the Center for Adolescent Health. Each school that was contacted agreed to participate in survey administration, resulting in a 100% school response rate. Classrooms were selected randomly for participation. Within selected classrooms, a total of 1288 students were eligible to complete the survey. Student participation was both anonymous and voluntary. Permission slips were mailed to the homes of selected students, giving parents or guardians the option of excluding their child from participating in the survey. The final sample consisted of th through 12 th grade students in CMSD schools. The student participation rate was 73%, giving an overall participation rate of 73%. Once survey administration was completed, data was analyzed by Westat and the Division of Adolescent and School Health of the Centers for Disease Control and Prevention (CDC). Due to the high overall participation rate (73%), the data were weighted. Data presented in this report are reflective of all students in CMSD high schools. INSTRUMENT The Youth Risk Behavior Survey (YRBS) is a national health behavior survey developed by the Centers for Disease Control and Prevention (CDC). It is a collection of questions designed to provide a snapshot of teenage students health risk behaviors. Questions are grouped into several broad categories, which have been identified as leading causes of morbidity and mortality among adolescents. These categories include: Tobacco Use Alcohol and Other Drug Use Sexual Behaviors Dietary Behaviors Physical Activity Due to the goals of Steps to a HealthierUS, physical activity and dietary behaviors received extra attention. In addition to the standard YRBS questions, supplemental questions were added to the 2007 Steps to a Healthier Cleveland YRBS in order to meet specific goals and explore research questions. These supplemental questions enhance the YRBS by adding depth to some health topics and providing insight into some of the protective factors that may help reduce health risk behavior engagement. The instrument contained 99 items and took approximately one classroom period to complete. Students received question booklets, answer sheets, and pencils.

5 DEMOGRAPHICS This table shows the demographic makeup of the 2007 Steps to a Healthier Cleveland sample. Of the total sample, 51% or 521 students were female. The remainder of students, or 49% of the sample, was male. Over 60% or 574 students identified themselves as Black or African American of non Hispanic decent. Hispanic students made up the second largest group, with 148 students or 15.7% of the sample indicating Hispanic descent. Just fewer than 10% or 90 students identified themselves as White. 1.2% of students identified themselves as multiple races. A total of 31 students or.8% of the sample identified as any of the other races. Other races include: American Indian or Alaskan Native Asian Native Hawaiian or other Pacific Islander Due to the low representation of Whites, multiple races, and other races, comparisons in this report are limited to Black and Hispanic students. Ninth grade students made up the largest proportion of the sample, with 395 or 36.3% of students in the sample indicating they were in 9 th grade. Approximately 24% of the sample or 271 students were 10 th graders. Eleventh and twelfth graders made up the remainder of students, with about 20% of the sample falling into each of those grades. As with other research conducted in this population, increases in grade level result in lower student participation. Older students are less likely to participate for a variety of reasons including higher rates of absenteeism, increased likelihood of dropping out, and school based programs that require older students to be away from school. Half of the students in this sample were between the ages of 16 and 17. An additional 34.8% of students were 15 years or younger. Students who were 18 or older made up the smallest age group within this sample, comprising the remaining 15% Steps YRBS Demographics n % Total % Gender Female % Male % Race Black % Hispanic % White % Multiple races % All other races 31.8% Grade Level 9th % 10th % 11th % 12th % Age 15 or younger % 16 or % 18 or older % 5

6 PHYSICAL ACTIVITY, NUTRITION, OBESITY PHYSICAL ACTIVITY In 2007, a little over one in three CMSD high school students (34.6%) were physically active for at least 60 minutes per day on five or more of the past seven days. Male students (43.6%) were significantly more likely than female students (26.0%) to engage in adequate physical activity. In 2007, 25.5% of students had a physical education class on at least one of the last five school days. In terms of physical education classes, the Healthy People 2010 recommends 50% of adolescents attend PE class daily. Only 15.3% of CMSD students had a PE class every day. Adequate Exercise >3 Hours TV >3 Hours Video Games Physical Activity PE Class 35.0% 33.7% 34.6% 23.9% 26.5% 25.5% 29.3% 24.9% 27.4% 41.8% 65.4% 57.4% 0% 20% 40% 60% 80% 100% Hispanic Black Total Activities associated with lack of physical activity include excessive television watching and video game playing (>three hours on a school night). In 2007, 57.4% of CMSD high school students watched an excessive amount of television. The Healthy People 2010 is to reduce excessive television watching to less than 25%. Black students (65.4%) were at significantly greater risk for excessive television watching than were Hispanic students (41.8%). Over 25% of CMSD high school students (27.4%) played an excessive amount of video games. NUTRITION Consumed at least once in the past 7 days Drank 100% Fruit Juice 79.6% Fruit 76.4% Other Vegetables 70.1% Potatoes 61.6% Green Salad 48.4% Drank Soda or Pop 36.6% Carrots 33.0% A key focus area of Steps to a Healthier Cleveland is to improve the nutrition of CMSD high school students. The table above shows the percentage of students who ate or drank the products listed at least once in the past seven days. At first glance, soda or pop consumption seems like a relatively minor concern. However, of the students who reported drinking soda or pop at least once in the past seven days, half of these or 14.1% of the total population drank soda or pop four or more times per day. Students who are consuming soda or pop are doing so in large quantities. Eating fruits or vegetables five times per day every day is the recommended amount. While it is clear that most CMSD students ate fruits and vegetables at least once in the past seven days, only 18.7% ate fruits or vegetables at least five times in the past seven days. In other words, in a class of 30, 24 did not eat the recommended servings of fruit or vegetables. Despite the large proportion of students not consuming the recommended amount of fruits and vegetables, 64.7% of students indicated that they agreed or strongly agreed that when they want fresh fruits and vegetables, there are plenty available. 6

7 OBESITY WEIGHT LOSS AND MANAGEMENT 63.8% 16.3% BMI 19.9% Overweight At Risk For Being Overweight Normal Weight The 2007 Steps to Healthier Cleveland survey included several items related to diet and exercise. When asked What are you were trying to do about your weight?, 37% of students were trying to lose weight. Females (46.0%) were significantly more likely to be trying to lose weight than were males (27.6%). An additional 22.9% of students were trying to stay the same weight. Means of Weight Loss Exercised 50.4% Since 1980, the percentage of overweight youth has tripled, with 16% of youth ages six to 19 (over nine million) now considered overweight. The YRBS uses self reported heights and weights to calculate Body Mass Index (BMI). BMI is considered an alternative for direct measures of body fat. For children and teens, BMI is age specific and sex specific. A BMI falling above the 95 th percentile indicates an individual is overweight. BMIs between the 85 th and 95 th percentile put individuals at risk for becoming overweight. The chart above highlights the BMI break downs of CMSD students. In 2007, 16% of students had BMIs above the 95 th percentile. In other words, in a class of 30 students, five students were overweight. CMSD students did not meet the Healthy People 2010 goal of no more than 5% of students being overweight. No demographic groups were at significantly more risk for being overweight. One in five students had a BMI that fell between the 85 th and 95 th percentiles, putting them at risk for becoming overweight. Female students (25.6%) were significantly more likely to be at risk for becoming overweight than male students (14.6%). The remainder of students, or 64% of CMSD high school students, had BMIs which did not put them at risk for obesity. Dieting Fasting Diet Pills without Doctor's Advice Vomited or Took Laxatives 11.9% 5.0% 6.5% 30.6% 0% 50% 100% The chart above highlights various means of weight loss students engaged in during the last 30 days. Those highlighted in blue represent means of weight loss generally considered as healthy. Those highlighted in red represent unhealthy means. Exercise was the most common method used to lose weight or stop from gaining weight, with half of CMSD high school students (50.4%) reporting this behavior. Dieting was not as common, with 30.6% of students eating less food, fewer calories, or foods low in fat to lose weight or stop from gaining weight. Some students engage in dietary behaviors that could put their health at risk. In 2007, 11.9% of CMSD students fasted, 5% of students took diet pills or liquids without a doctor s advice, and 6.5% of students vomited or took laxatives to lose weight or keep from gaining weight. 7

8 TOBACCO, ALCOHOL, AND OTHER DRUGS CIGARETTES Tobacco use is the leading cause of preventable death in the United States. Tobacco use usually begins in early adolescence with nine in 10 smokers started smoking before the age of 21. Even though smoking rates have been declining among Americans, teenagers still smoke at a higher rate than adults. In 2007, over half (53.8%) of all CMSD high school students had ever tried smoking cigarettes. Almost 15% of students (14.1%) smoked their first cigarette before the age of 13 years. 10.8% of students had smoked at least one cigarette in the past 30 days. Significantly more Hispanic students (16.1%) were current cigarette smokers than black students (6.6%). Additionally, 5% of students had smoked a cigarette on school property during the past 30 days. CMSD students met the Healthy People 2010 goal for current cigarette use, with less than 16% reporting current cigarette use. In terms of use, of students who smoked during the last 30 days, 4.4% smoked 20 or more cigarettes per day. Smoking twenty or more cigarettes per day is considered heavy use. Approximately 7.4% of students smoked one cigarette per day every day for 30 days or were regular smokers. Hispanic students (12.4%) were significantly more likely to have smoked cigarettes daily than were Black students (4.5%). A single item was included to assess intent to smoke in the next year. In 2007, 17.1% of CMSD high school students believed they would probably or definitely smoke in the next year. OTHER TOBACCO PRODUCTS Current Cigarette Current Cigar Current Chewing Tobacco Current Tobacco Use 2.6% 1.6% 2.4% The above chart shows current tobacco use across all products. In 2007, 27.4% of students had smoked a cigar, cigarillo, or little cigar on one or more of the past 30 days. As is clear in the chart, current cigar use was more prevalent among CMSD high school students than was current cigarette use (10.4%). In total, 2.6% of students had used chewing tobacco, snuff, or dip on one or more of the past 30 days. Again, no significant differences were found between demographic groups. CMSD students had higher rates of current cigar use and current chewing tobacco use than those recommended by Healthy People 2010 (8% and 1%). RULES ABOUT SMOKING 10.8% 16.1% 6.6% 27.4% 21.6% 29.2% 0% 20% 40% 60% Total Hispanic Black Included in this year s survey were several items examining rules related to smoking. Students were asked Which statement best describes rules about smoking inside your home? In 2007, 58.0% of CMSD high school students reported that smoking was not allowed anywhere in their home. Over 60% of students agreed or strongly agreed that no one, including parents and teachers should be allowed to smoke on school grounds. 8

9 ALCOHOL The most commonly used drug in the United States is alcohol. Alcohol abuse is associated with a variety of medical conditions in later life. In adolescents it is associated with unintentional injuries, fighting, poor grades, and attendance. Alcohol Use OTHER DRUG USE Lifetime Drug Use Marijuana 45.2% Inhalant 8.3% Ecstasy 6.4% Steroids 4.1% Lifetime Alcohol Use 69.9% Methamphetamine 3.5% Heroin 3.2% Cocaine 2.6% Current Alcohol Use Binging Early Initiation Drank on School Property 4.0% 15.4% 34.2% 27.2% 0% 20% 40% 60% 80% The chart above highlights rates of alcohol use. In 2007, 69.9% of students had had at least one drink of alcohol on one or more days of their life. A total of 34.2% were considered current drinkers. Current drinking is defined as consumption of at least one drink of alcohol in the past 30 days. Additionally, 15.4% of students reported binge drinking in the last 30 days, or having had five or more drinks in a row within a couple of hours in the last 30 days. Early initiation of alcohol use is associated with alcohol abuse later in life. In 2007, 27.2% of CMSD high school students had their first drink of alcohol before 13. Male students (32.2%) were more likely to be early initiators than female students (22.3%). Nationally, rates of illegal drug use are rising. Illicit drug use is associated with higher rates of violence and delinquent behaviors among adolescents. The table above shows the prevalence of students who used those drugs at least once in their lifetime among CMSD. As is clear, marijuana was the most commonly used illegal drug, with nearly half of all CMSD high school students (45.2%) having tried it once in their life. About 12% of students had tried marijuana before the age of 13. Twenty four percent of CMSD students had used marijuana at least once in the past 30 days. Lifetime inhalant use was the second most common illegal drug used (8.3%), with cocaine use being the least common (2.6%). More than one in five students reported someone had offered, sold, or given them illegal drugs on school property in the past 12 months. Male students (28.8%) were more likely to be offered or sold illegal drugs during this time period than female students (14.0%). 9

10 SAFETY AND VIOLENCE VIOLENCE Research indicates factors associated with youth violence include low socioeconomic status (SES), poor parental supervision, harsh and erratic discipline, and delinquent peers. Nationally, a disproportionate amount of non fatal crimes occur in school facilities or on the way to or from school. Physical Fighting Violent Behaviors 48.6% SAFETY Injuries are the leading cause of death and disability in Americans under the age of 44. In 2007, 29.0% of CMSD students never or rarely wore seatbelts. Males (36.4%) were less likely to wear seatbelts than females (21.8%). In the last month, 28.7% of students rode in a car driven by someone who had been drinking alcohol. During the same time period, 5.2% of students reported driving a car or other vehicle after they had been drinking alcohol. CMSD students meet the Healthy People 2010 goal of no more than 30% reporting they had ridden in a car with someone who had been drinking. Carried a Weapon 27.1% SUICIDE Carried a Weapon on School Property Missed School Because They Felt Unsafe 7.7% 10.8% 0% 20% 40% 60% Nearly half of CMSD high school students (48.6%) had been in a physical fight at least once in the past year. Male students (56.7%) were more likely to have been in a fight than female students (40.8%). The Healthy People 2010 goal for fighting in the past year is 32%. Ninth grade students (57.9%) were more likely to report physical fighting than were 12 th grade students (33.1%). In CMSD, 21.7% of students had carried a weapon at least once in the 30 days preceding the survey. Male students were over twice as likely (30.3%) to report weapon carrying than female students (13.3%). Approximately 8% (7.7%) of students had carried a weapon on school property in the past 30 days. This was well above the Healthy People 2010 goal of 4.9%. 10.8% of students had not gone to school on one or more of the past 30 days because they felt unsafe at or on their way to or from school. Suicide is the third leading cause of death among teenagers aged In 2007, 13.4% of CMSD high school students had considered suicide in the 12 months preceding the survey. 11.4% of students had made a suicide plan during this time period. 9.4% of students had actually attempted suicide in the past year. The Healthy People 2010 goal for suicide attempts in the past year is no more than 1%. NEIGHBORHOOD Included in this survey were several items measuring students views of Cleveland and local neighborhoods. 25.2% of students agreed or strongly agreed that Cleveland is a safe place to live. 35.8% of students agreed or strongly agreed that their neighborhood is a safe place to live. Over half of students (53.6%) agreed or strongly agreed that they felt safe being physically active in their neighborhoods. Males (63.1%) were more likely to feel safe engaging in physical activities in their neighborhood than female students (44.6%). 10

11 OTHER HEALTH ISSUES CHRONIC CONDITIONS Prevalence of asthma and diabetes have seen substantial increases in the general population and young people. Lowering the burden of chronic disease such as these is a key focus of Steps to a Healthier Cleveland. In 2007, 21.7% of CMSD high school students had been told by a doctor or nurse that they had asthma during their lifetime. Additionally, 12% of the students who reported a doctor or nurse had told that them they had asthma or still have asthma (current asthma). Of those with current asthma, 37% had been to an emergency room or sought urgent care because of their asthma in the last year. Additionally, 5.1% of students had been told by a doctor or nurse that they had diabetes. 27.4% Self Reported Health 32.4% 1.5% 8.3% 30.3% Poor Fair Good Very Good Excellent Self reported health is an important predictor of actual health. The chart above shows student s self reported health. When asked to rate their health from excellent to poor, 27.4% indicated their health was excellent. About one in three reported their health to be very good. 30.3% of students indicated their health was good. 9.8% of students believed their health was either fair (8.3%) or poor (1.5%). ENVIRONMENTAL FACTORS The 2007 Steps to a Healthier Cleveland YRBS included several items measuring attitudes and behaviors associated with students environment Overall, students rated their neighborhoods more positively than they rated the entire city of Cleveland. When asked how much they agreed that Cleveland or their neighborhood was a healthy place to live, 23% agreed or strongly agreed that Cleveland is a healthy place to live. However, 25.2% agreed or strongly agreed that their neighborhood was a healthy place to live. Additionally, 66.4% of students agreed or strongly agreed that there were plenty of activities outside of school they could do if they wanted to be physically active. Examples included going for a walk, going to a park or recreation center, riding a bike, or playing basketball. In terms of family influences on health, 41.6% agreed or strongly agreed that their family does healthy things together, such as eating healthy or exercising together. Additionally, 61.4% of students agreed or strongly agreed that their family encourages each other to be healthy. 41.2% of students agreed or strongly agreed that their school thinks it is important to eat healthy and be physically active, while 61.0% agreed or strongly agreed that when they want junk food at school, there is plenty available. While Steps to a Healthier Cleveland is active in schools and addressing several of the issues highlighted in this report, it does not cover all schools within the Cleveland Metropolitan School District. Over one in four students (26.6%) heard of Steps to a Healthier Cleveland. 11