Adolescent Health Data Clay County, Missouri

Transcription

1 CLAY COUNTY PUBLIC HEALTH CENTER Adolescent Health Data Clay County, Missouri Health Planning and Policy Section H A I N E S D R I V E, L I B E R T Y M I S S O U R I

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3 Table of Contents Introduction... 1 Summary of Key Findings... 3 Discussion... 4 Future and Potential Champions... 6 Supportive Data... 7 County Overview... 7 Table 1: Clay County School Status Reports on 9-12 Grades... 8 Figure 1: Major causes of Deaths in years old... 9 Figure 2: Comparison, Clay County Vs Missouri Figure 3: Alcohol Associated Risk Measures Figure 4: Tobacco Associated Risk measure Figure 5: Marijuana Associated Risk Measures Figure 6-1: Perception of risk Insight into Clay County through the State of Missouri Figure 7-1: Measures of Risk Behaviors I Figure 7-2: Measures of Risk II Figure 7-3: Measures of Risk III Existing Programs in Clay County that Target Adolescent Health and Behavior Alcohol & Other Drugs Injury/Violence (suicide) Tobacco Nutrition Physical Activity same as Nutrition Sexual activities Future Plans at CCPHC 2011 and Beyond Conclusion Glossary References

4 Disclaimer: Information used in this report was pulled from credible sources such as the Centers for Diseases Control and Prevention (CDC), Missouri Department of Health and Senior Services (MDHSS), National Youth Behavioral Risk Surveillance System etc. Also, some data were further analyzed or compiled by the County Epidemiologist from existing surveys conducted locally in order to meet the assessment needs. The majority of the data is available on the state level. Therefore, state data could only be used as a guide for the collection of data locally. Published: October

5 Introduction The purpose of this document is to assess adolescent health in Clay County for the community health assessment project. It could also be used in the development of new programs or tools in the county to target adolescent health risk behaviors in order to mitigate and control the impacts of such behaviors during the adolescent life stages and also reduce and prevent the effects that such behaviors could likely have during adulthood. Adolescence is the transitional age from childhood to adulthood. The age range that is considered adolescence ranges from 10-years through 19-years old. The Centers for Disease Control and Prevention refers to the age group years old as early adolescence, years old as late adolescence and years old as young adults. Generally, anyone above 19 years and older is considered an adult. Healthy People 2020 consider adolescence as ages 10 to 19 years old. Adolescence and young adulthood are generally healthy times of life. However, several important public health and social problems either peak or start during these years. 8 During this transitional stage adolescents establish patterns of behavior and make lifestyle choices that affect their current and future health, their families and communities. Health problems experienced in adulthood could be the result of behaviors adopted and sustained during earlier years. Adolescents are faced with different challenges and choices as they surge into independence. Teenagers might face peer pressure to indulge in risky behaviors such as use of alcohol, tobacco, drugs and to have sex. These behaviors are known risk factors and predisposing factors to the important public health problems communities encounter with adolescents and young adults. The leading causes of illness and death among adolescents and young adults are largely preventable. Some of the public health and social problems facing adolescents include: Homicide Suicide Motor vehicle crashes, including those caused by drinking and driving Substance use and abuse Smoking Sexually transmitted infections, including human immunodeficiency virus (HIV) Teen and unplanned pregnancies Homelessness 1

6 Eating Disorders Healthy People 2010 initiatives focused on maternal and child s health and adult health and did not have initiatives for adolescent health. The Healthy People 2020 initiatives on the other hand focus on improving the healthy development, health, safety and well-being of adolescents and young adults. 2

7 Summary of Key Findings According to the State of Missouri s Child Health Profile among individuals aged years old in Clay County, unintentional injuries are the leading cause of death. Motor vehicle deaths topped the list among these deaths. Data indicate that adolescents in Clay County have a higher perception of disapproval and risk perception for alcohol, tobacco and marijuana use compared to those in the Northland (Clay, Platte and Ray together). Also, perception to access which is an individual belief that it is sort of easy or very easy to access alcohol, tobacco or marijuana was slightly lower in adolescents in Clay County compared to the Northland (Clay, Platte and Ray together). Perception of risk to tobacco is lower in middle school teens. According to The RWJ 2010 County Health Rankings, teen birth is lower in Clay County compared to the State of Missouri. School Status Report showed that in general, the dropout rates for Clay County increased from (2.7%) to school year (5.1%). However, specific data are not available for individual communities within the county. 5 The 2009, Missouri Youth Risk Behavior Survey showed that: o 80% and 86% of high school students in Clay County, respectively, reported eating less than five times per day of fruits/vegetables and ate vegetables less than 3 times a day. o Also, 56% of high school students reported that they did not attend Physical activity classes in an average week o 49 % reported that they have had sexual intercourse. o 72% of female high school students in Clay County who report having sex reported that they did not use birth control pills or Depro Provera. 3

8 Discussion Close collaboration among different organizations in the community will have huge benefits on the impact of sex education if the community speaks with one voice. Research shows that abstinence alone will not yield the needed results. More evidencebased comprehensive sex education programs are required to educate teens on the risks associated with early sexual indulgence and unprotected sexual behaviors. Possible collaboration among the healthcare system and other groups like the American Girl Scouts and Boy Scouts should be explored. Exploring more creative, non-traditional ways to reach and educate adolescents especially pre-teen girls could have a greater impact on reducing the rates of sexually transmitted diseases, infertility and early pregnancies. Modifying sexual behavior in pre-teen females by expanding the provision of certain free and no parental consented sexual related healthcare in older teenage girls should be explored. Female teens continue to be at increased risk of acquiring sexually transmitted diseases and getting pregnant because of early sexual indulgence, misinformation and not taking adequate precautions. Local community service organizations including school authorities, families and trusted community mentors should take the lead to place values on nutrition and physical activities. With the growing epidemic of overweight and obesity, pre-teens and teens are still not getting enough physical activities in school and are not consuming enough fruits and vegetables. Structured education in schools on healthy eating and increasing physical activities would help in the fight against childhood overweight and obesity. The effects of such education in schools could result in secondary benefits such as the reduction of incidence of mental illnesses and chronic diseases in the entire community at large. Public policies, laws and/or regulations for reducing those distractions, including texting while driving and answering the phone while driving, could reduce the number of accidents associated with inattention which has been noted as the leading cause of fatal injury accidents. Collaboration with private entities such as wireless carriers would help facilitate these efforts. Increasing awareness of available benefits towards reduced insurance premium for teens could motivate increased enrollment in drivers education and safety programs. Productive lives would be gained back from those years of potential lives lost to fatal accidents and disabilities. Policies and regulations towards enforcing proper and age appropriate driving lessons would ensure that teens acquire the necessary skills before getting behind the steering wheel and thus reduce fatal and injury accidents. 4

9 More policies should be considered to help keep drugs and alcohol away from adolescents. Excessive alcohol use has been associated with assaults and injuries, especially motor-vehicle crashes. Tightening state and local laws and policies related to the number of hours and days when alcohol can be sold in bars, restaurants, and liquor stores and the access of alcohol to minors could help reduce such alcohol related assault and injury. A coordinated approach by the community should be used to increase cigarette taxes and possibly applying that to healthcare and education on chronic diseases. This could affect smoking and also increase awareness and knowledge of smoking related diseases. The June 2011American Cancer Society Cancer Action Network (ACS CAN) report stated that the state average for cigarette taxes is $1.45 per pack, but the health and economic costs attributed to smoking are estimated at $10.28 per pack. According to Saving Lives, Saving Money, if every state raised its per-pack tax by $1.00, nearly 1.4 million adults would quit smoking and 1.7 million youth would never start smoking. More than 1.3 million lives would be saved, and states would raise $25.7 billion in tax revenue and save more than $600 million in health care costs over 5 years. 13 Ways should be explored to expand access to dental care in our communities. This would improve oral health and reduce related illnesses, since studies have shown that oral health also plays a role in the development of some chronic diseases such as cardiovascular diseases. 10,12 Ensure anti-bullying and anti-discrimination policies are strictly enforced in communities especially in schools and work places to ensure that bullying does not interfere with the psychological well-being of obese individuals and thus affect obesity intervention programs. The study, published in the June issue of Pediatrics, found that obese children had higher odds of being bullied regardless of their gender, race, family socioeconomic status, school demographic profile, social skills or academic achievement. 11 5

10 Future and Potential Champions Saint Luke s Hospital-Smithville Campus North Kansas City Hospital Liberty Hospital Excelsior Springs Hospital North Kansas City School District Liberty School District Smithville School District Excelsior Springs School District Kearney School District William Jewell College Metropolitan Community College-Maple Woods Family Caregiver Alliance National Association of Professional Geriatric Care Managers MetroCare-Northland Health Care Access Asthma and Allergy Foundation of America American Diabetes Association, Missouri Affiliate, Inc. Northland CARE/Metro CARE Missouri Primary Care Association (MPCA) Kansas City Quality Improvement Consortium (KCQIC) Missouri Department of Health and Services Center for Practical Bioethics Good Samaritan Center-Excelsior Springs Kearney Fitness Center YMCA-Clay-Platte Tri-County Mental Health The Family Conservancy-North Mental Health Association of the Heartland National Alliance for the Mentally Ill (NAMI) Synergy Services Inc. Industrial Rehabilitation Center Northland Community Center Northland Dependency Services Preferred Family Healthcare Planned Parenthood-North Kansas City Health Center Healthy Families Kansas City Metropolitan Organization to Counter Sexual Assault Liberty Driving School DMV Online Traffic School in Missouri American Safety Council County Providers Northland Medical Managers 6

11 Supporting Data County Overview According to the U.S Census estimate data, in 2009 approximately 13% (29,699) of the total population of Clay County (228,358) were 10 to 19 year olds. Of this 13%, 10 to14 years old made up 6.5% (14,933) and 6.5% (14,766) were 15 to 19 years old. 1 The residents of Clay County under 18-years were estimated at 25% (57,302). The State of Missouri s Child Health Profile among individuals aged 15 through 19 years old showed that total unintentional injuries (34.4/100,000), motor vehicle deaths (30.2/100,000) and suicide (9.8/100,000) were the top three leading causes of death among Clay County adolescents. Among selected health indicators in age group 15 to19-years old, rates of injury emergency room (ER) visits, injury hospitalizations and self-pay or no-charge ER visits were comparable or higher than the state rates. The self-pay or no-charge hospitalizations rate was significantly lower than the state rate. The top 10 diseases and conditions of adolescents in our county ranked in order of based upon Missouri Information for Community Assessment (Priority MICA) data are as follows: 1. Motor Vehicle Accident 2. Diabetes 3. Affective Disorder 4. Dental Health Problem 5. Falls 6. Pregnancy complications 7. Pneumonia and Influenza 8. Alcohol-and Substance-Related 9. Anxiety-Related Mental Disorder 10. Suicide and Self-Inflicted Injury According to the Missouri Department of Health and Senior Services, the health status of the county population in general is comparable to or better than that of the entire State of Missouri. Other data on children s risk behaviors also support that. For example, the 2009 County Health Rankings published by Roberts Wood Johnson show that the rate of teen birth is much lower in Clay County teens aged years old (36/1,000) compared to the state (45/1,000). Also, the percentage of children under 18 years old in poverty is half that of the state 7

12 (Clay County=9% versus Missouri = 19%). The data from the 2008 Missouri Student Survey provided comparison of some measures of risky behavior in Clay County high school students and the high school students in the Northland (Clay, Platte and Ray Counties). However, due to the limitations imposed by the available data, comparisons were only available with the Northland of which Clay County was included. The survey results for all grades show that the percentages of students who reported 30- day and lifetime use of alcohol, tobacco and marijuana in Clay County were slightly lower than those reported in the Northland. The percentages of students that reported having understanding and possession of unfavorable opinion also referred to as perception of disapproval and understanding to exposure to danger also referred to as risk perception (all positive and protective factors) to alcohol, tobacco and marijuana use were higher than those who reported on these same variables in the Northland. Understanding of the ease of obtaining alcohol, marijuana and tobacco, also referred to as perception to access (a positive and protective factor) to alcohol, tobacco and marijuana use were slightly lower than those of the Northland. In grades 9-12, the results show that the percentages of students who reported 30-day and lifetime use of alcohol, tobacco and marijuana in Clay County were much lower than those who reported on these same measures in 9-12 grades in the Northland. Student understanding and possession of unfavorable opinion was also much higher in 9th-12th grades in Clay County, while their understanding to exposure to danger was higher for alcohol and marijuana, but slightly lower for tobacco. Perception of access to alcohol, marijuana and tobacco, also referred to as perception of access was much lower in 9-12 grades Clay County students compared to the Northland students. The 2010 Status Report on Missouri s Alcohol and Drug Abuse Problems 14 showed that among Clay County 9-12 grades, that the school dropout rate and drug discipline incidents decreased from school years through school year. 6 Alcohol discipline incidents also showed a decline from to (Table 1). Table 1: Clay County School Status Reports on 9-12 Grades Dropout rate 2.7% 3.2% 5.1% Alcohol Discipline Drug Discipline Tobacco Discipline Data Source: The 2010 Status report on Missouri s Alcohol and Drug Abuse Problems. Counts do not include individuals incarcerated in state prison. 8

13 The School Health Profile is a system of surveys assessing school health policies and programs in states, territories and large urban school districts. The profile surveys are conducted by biennially among representative samples of middle and high school principals and lead health education teachers. The report presented above could be a reflection of programs and activities in place in Missouri middle and high schools. For example, the School Health Profiles showed that 65.4% (median 74.1%) of the schools posted signs marking a tobacco-free school, 55.2% (50.4%) taught 15 keys tobacco-use prevention topics in a required course and 33.1% (median=50.7%) of the schools prohibited all tobacco use at all times in all locations in school. Figure 1: Major causes of Deaths in years old Major Causes of Death Among Individuals Aged 15 to 19 years old Clay County Vs Missouri Heart Disease All Cancer (Malignant Neoplasms Causes of Death Homicide Suicide Motor Vehicle Deaths Total Unintentional Injuries All Causes Rate per 100,000 Data Source: DHSS Community Health Profile Data, Child Health 9

14 Figure 2: Comparison, Clay County Vs Missouri Comparison of the Causes of Death Among Individuals Aged 15 to 19 years old Clay County Vs Missouri Heart Disease All Cancer (Malignant Neoplasms Causes of Death Homicide Suicide Motor Vehicle Deaths Total Unintentional Injuries All Causes MO Clay Rate per 100,000 Data Source: DHSS Community Health Profile Data, Child Health. Figure 3: Alcohol Associated Risk Measures Alcohol Associated Risk Measures in High School Students Clay County Vs Northland 2008 Measures of Risk Behavior Lifetime Use Access to Perception of Risk by Kids Perception of Disapproval by Parent/Community Northland All Grades Clay All Grades Northland 9-12 grade 30 Day Use Percent Clay 9-12 Grade Perception of Disapproval = Wrong/Very Wrong Perception of Risk = Moderate/Great Risk Access = Sort of Easy/Very Easy 10

15 Figure 4: Tobacco Associated Risk measure Tobacco Associated Risk Measures in High School Students Clay County Vs Northland 2008 Measures of Risk Behavior Lifetime Use Access to Perception of Risk by Kids Perception of Disapproval by Parent/Community 30 Day Use Percent Northland All Grades Clay All Grades Northland 9-12 Grade Clay 9-12 Grade See note under Figure 3 for description of the risk behaviors for figure 4 and 5. Figure 5: Marijuana Associated Risk Measures Marijuana Associated Risk Measures in High School Students Clay County Vs Northland 2008 Measures of Risk Lifetime Use Access to Perception of Disapproval by Parent/Community 30 Day Use Northland All Grades Clay All Grades Northland 9-12 Grade Percent Clay 9-12 Grade 11

16 Figure 6-1: Perception of risk Figure 6-2: Onset of Use Percent Perception of Risk to Marijuana by High School Students Clay County Vs Northland Age of Onset of Use Comparison of the Ages at Onset of Use by High School Students Clay County Vs Northland Clay 9-12 Northland 9-12 Grades Clay All Northland All 11.4 Clay 9-12 Northland 9-12 Grade Clay All Northland All Marijuana once or twice Marijuana regularly Alcohol Tobacco Marijuana Insight into Clay County through the State of Missouri The 2009 Youth Behavior Risk Surveillance System 15 has no available data at the county level for Clay County youths; however, data on Missouri youths could serve as a guide for future collection of data on the county level. 12

17 Figure 7-1: Measures of Risk Behaviors I Measures of Risk Behvaiors to Obesity, Unhealthy Diet and Physical Inactivity Missouri, 2009 Used computers 3 or more hours/day 23 Watched television 3 or more hours/day 32 Measures of Risk Behaviors Did not attend PE classes daily Did not attend PE classes in an average week* Had physical activity at least 60 minutes/day* Did not participate in 60 mins. of physical activity /day Drank soda at least one time/day* Ate veggies less than 3 times/day Ate less than 2 times/day of fruits or 100% juice* Ate less than five times per day of fruits and veggies* Obese* Percent Data Source: The 2009 Missouri Youth Risk Behavior Survey, * Indicates that the state rate is higher than the national rate. Please refer to Appendix 1, for complete description of the surveyed risk behaviors. Figure 7-2: Measures of Risk II Measures of Risk Behaviors to Alcohol and Other Drug Use and Having Sex Among High School Students Missouri, 2009 Used a needle to inject any illegal drug 2 Measures of Risk Behaviors Drank alcohol or used drugs before last intercourse* Never taught in school about AIDS or HIV infection Did not use birth control pills or DepoProvera Did not use a condom* Had sexual intercourse with at least one person* Have had more than 4 sexual partners* Had first sexual intercourse before 13 years Ever had sexual intercourse* Percent Data Source: The 2009 Missouri Youth Risk Behavior Survey, * Indicates that the state rate is higher than the national rate. Please refer to Appendix 1, for complete description of the surveyed risk behaviors 13

18 Figure 7-3: Measures of Risk III Measures of Risk Behaviors to Cigarette and Tobacco Use Among High School Students Missouri, 2009 Measures of Risk Bebaviors Ever smoked Ever smoked cigars, cigarillos, or little cigars Used chewing tobacco, snuff, or dip on school property Ever used chewing tobacco, snuff, or dip Did not try to quit smoking cigarettes Smoked cigarettes on school property Smoked cigarettes on 20 or more days Smoked cigarettes on at least 1 day Ever tried cigarette smoking Percent Data Source: The 2009 Missouri Youth Risk Behavior Survey, Please refer to Appendix 1, for complete description of the surveyed risk behaviors 14

19 Existing Programs in Clay County that Target Adolescent Health and Behavior Alcohol & Other Drugs The Northland Coalition, Drug Free Schools and community teams run most of the alcohol, marijuana, over-the-counter (OTC) education programs. Northland alcohol social marketing programs are Those Who Host Lose the Most and Safe Prom/Graduation Partnerships. These target parents, other adults and businesses to avoid providing alcohol or hotel rooms to minors. Individual teams have also used social norms. Policies have included ordinances for 21 only bars, minors in possession by consumption, open house parties and keg registration. The perception of teens in Clay County is that access to Alcohol is not easy. Teen Outreach Program (service learning) is also an evidenced-based program used to counter teen-age pregnancy and substance abuse. See more details under Sexuality. Injury/Violence (suicide) Car crashes (drinking and driving) is usually covered under alcohol activities. Many high schools also have incorporated activities to improve the wearing of seat belts. These programs were provided in collaboration with the Highway Safety, MADD, and local police. Many of Northland schools have had programs on bullying (violence) through available resources such as Stop Violence, Synergy and Oluweiss, Rachel s Challenge and Cyber-bullying through Parent Information Nights. The Clay County Public Health Center (CCPHC) Growing With Your Teen course has a unit on internet safety. CCPHC had a Teen Suicide Prevention grant for three years. The grant ended in However, plans are been made to collaborate with Liberty Alliance for Youth Incorporated (LAFYI) on a new grant in The suicide prevention program was based on evidenced-based QPR (suicide curriculums) for adults and Signs of Suicide (SOS) curriculums for middle and high school. The health center presented health classes each semester to approximately students in Liberty, Maple Park & New Mark Middle Schools. Tobacco The Maternal and Child Health (MCH) grant available to CCPHC has tobacco as one of the focus areas. County and city ordinances have established smoking bans in Kansas City, Liberty, Gladstone and North Kansas City. Efforts to establish non-smoking ordinances need to be pursued in Excelsior Springs, Kearney and Smithville. There are four Smoke-Buster groups in Liberty HS, South Valley JHS, Smithville HS and Excelsior Springs HS. Although funding has ended, the groups still remain operational. These groups help with social marketing and advocacy. In the past, the Operation Smokescreen Summit has focused on youth advocacy and media with a tobacco through the Northland Coalition of which a CCPHC staff is a member of the steering committee. Tri County Mental Health System has received a 3-year Health Foundation grant on Tobacco. 15

20 Nutrition Childhood obesity is also one of the focus areas of the MCH grant. We continue to work with Mother & Child Coalition on Weighing In Task Force. Personal Health Inventory, Kid Power, Eat Small (Portion Distortion) and Label Reading are CCPHC programs focusing on nutrition offered to schools. The KID POWER program was delivered to 82 tweens (11 to 12 year olds) at Maple Park Middle School in The average age of participants was 12.1 years. Physical Activity same as Nutrition KID POWER covers Physical Activity as well as nutrition. Physical Activity Bingo and Dance DVD have been used with schools. Sexual activities CCPHC has offered parent child sexuality education classes since Funding sources were Children s Trust Fund, Adolescent Health Risk grants and most recently an Abstinence Only Education (AOE) grant through MO Department of Health and Senior Services. Funding ended in The AOE grant provided materials on Choosing the Best in area schools, The Teen Outreach Program for youth development and Growing With Your Child for community/parent education. In the fiscal year 2009, 744 students received 4,215 hours of abstinence education. Available data on programs offered by CCPHC were supportive of positive reinforcement and gained knowledge. 16

21 Future Plans at CCPHC 2011 and Beyond To continue to support Northland Coalition and Clay County 2000 teams in their efforts. To work with Liberty Alliance for Youth, Inc. to write a collaborative Suicide Prevention grant for Liberty Schools. To collaborate with Tri-County Maternal Health Services Health Foundation grant application and assist with their social marketing/norming campaigns at Smithville and Northgate MS in 2011 To market Kid Power to after-school programs & Maple Park Middle School CCPHC will offer three Growing With Your Child (GWYC) classes for 9 to12 yrs old and one Growing with Your Teen (GWYTeen) class in Continue to research abstinence funding with the Missouri Division of Health and Senior Services. Northgate Middle School Teen Outrage Program may be incorporated into the federal Teen Pregnancy grant that The Women s Clinic received for

22 Conclusion Adequate data are not available to conduct a good assessment of the effects of available programs on adolescent health and behaviors in Clay County. However, the results of the two years of pre-and post-test data on the Suicide Awareness Questionnaire (SAQ) suggest gained knowledge from the program. The knowledge gained on all the eleven knowledge and attitudinal items were statistically significant. The SOS Suicide Prevention Program did increase students suicide prevention knowledge. The program provided participating students the skills and knowledge needed in suicide prevention. The results from the KID POWER nutritional program were also suggestive of increased self-reported healthy nutrition and physical activity changes. Statistically significant improvements were seen in most all nutrition and physical activity behaviors surveyed except eating breakfast and self-esteem. Data may not be available to directly assess the impacts of the Teen Outreach Program which is an evidenced based program used to counter teenage pregnancy and substance abuse. Ten years ( ) data on the Growing With Your Child program indicate an average of 20% gain in knowledge by children and an increase in comfort level of both parents and child in discussing sexuality. But the 2009 County Health Ranking shows that the rate of teen birth is much lower in Clay County teens aged years (36/1,000) compared to the state (45/1,000). The positive results of the data presented earlier in this document from the 2008 Missouri Student Survey which provided comparison of some measures of risk behavior in Clay County high school students and the high school students in the Northland (Clay, Platte and Ray Counties) could also be some indirect result of the existing programs in the county. In general, Clay County adolescents perceptions to easy access to alcohol, tobacco and marijuana were lower than in the Northland. Although programs are already in existence in the county that target improvement in adolescent health and behavior, more needs to be done especially in identifying funding to continue programs that are having proven impacts and also in collaboration with other agencies to minimize cost to sustain effective programs. 18

23 Glossary Status Report Report that compares state and national rates of alcohol, tobacco, and other drug use and presents estimates of substance abuse treatment need. The report also provides statewide, regional, and county-level data on substance abuse indicators and number of individuals served in Division of Alcohol and Drug Abuse treatment programs. The 2009 Youth Behavioral Risk Surveillance System The Youth Risk Behavior Surveillance System (YRBSS) is an epidemiologic survey system established by CDC to monitor the prevalence of youth behavior that most influences health. The Missouri Student Survey (MSS) MSS is a survey conducted in even-numbered years to track risk behaviors of students in grades 6-12 attending public schools in Missouri. The survey includes questions on alcohol, tobacco, and drug use and other behaviors that endanger health and safety. The 2009 Missouri Youth Risk Behavior Survey Variables Obesity Obese = Students who were > 95th percentile for body mass index, by age and sex, based on reference data). Unhealthy Dietary Behaviors Ate less than five times per day of fruits and veggies = Ate fruits and vegetables less than five times per day during the 7 days before the survey. Ate less than 2 times/day of fruits or 100% juice = Ate fruit or drank 100% fruit juices less than two times per day during the 7 days before the survey. Ate less veggies less than 3 times/day = Ate vegetables less than three times per day during the 7 days before the survey. Drank soda at least one time /day = Drank a can, bottle, or glass of soda or pop at least one time per day during the 7 days before the survey. Physical Inactivity Did not participate in at least 60 minutes of physical activity /day= Did not participate in at least 60 minutes of physical activity on any day during the 7 days before the survey. Had physical activity at least 60 minutes/ day = physically active at least 60 minutes per day on less than 7 days during the 7 days before the survey. 19

24 Did not attend PE classes in an average week = Did not attend physical education (PE) classes in an average week when they were in school. Did not attend PE classes daily = Did not attend PE classes daily when they were in school. Watched television 3 or more hours/day = Watched television 3 or more hours per day on an average school day. Used computers 3 or more hours/day = Used computers 3 or more hours per day on an average school day. (5) Sexual Risk Behaviors Ever had sexual intercourse. Had first sexual intercourse before 13 years. Have had more than 4 sexual partners = Had sexual intercourse with four or more persons during their life. Had sexual intercourse with at least one person = Had sexual intercourse with at least one person during the 3 months before the survey. Did not use condom = Did not use a condom during last sexual intercourse. Did not use birth control pills or Depo-Provera = Did not use birth control pills or Depo-Provera before last sexual intercourse to prevent pregnancy. Never taught in school about AIDS or HIV infection = Were never taught in school about AIDS or HIV infection. Alcohol and Other Drug Use Drank alcohol or used drugs before last intercourse = Drank alcohol or used drugs before last sexual intercourse. Used a needle to inject any illegal drug = Used a needle to inject any illegal drug into their body one or more times during their life. Cigarette Use Ever tried cigarette smoking. Smoked cigarettes on at least 1 day = Smoked cigarettes on at least 1 day during the 30 days before the survey. Smoked cigarettes on 20 or more days = Smoked cigarettes on 20 or more days during the 30 days before the survey. Smoked cigarettes on school property = Smoked cigarettes on school property during the 30 days before the survey. Did not try to quit smoking cigarettes. Other Tobacco Use Ever used chewing tobacco, snuff, or dip on at least 1 day = Used chewing tobacco, snuff, or dip on at least 1 day during the 30 days before the survey. Used chewing tobacco, snuff, or dip on sch. property = Used chewing tobacco, snuff, or dip on school property on at least 1 day during the 30 days before the survey. 20

25 Ever smoked cigars, cigarillos, or little cigars = Smoked cigars, cigarillos, or little cigars on at least 1 day during the 30 days before the survey. Any Tobacco Use Ever smoked = Smoked cigarettes; smoked cigars, cigarillos or little cigars; or used chewing tobacco, snuff, or dip on at least 1 day during the 30 days before the survey. more times during their life. 21

26 References Centers for Disease Control and Prevention. Adolescents and School Health: Adolescent Health. Retrieved January 2011 from Centers for Disease Control and Prevention. Child Development. Retrieved January 2011from Centers for Disease Control and Prevention. Adolescent and School Health: Missouri. Retrieved January, 2011 from Centers for Disease Control and Prevention. Youth online: High School Youth Risk Behavior Surveillance System (YRBSS). Retrieved January, 2011from County Health Ranking (2010). Clay County, Missouri. Retrieved April, Missouri Department of Mental Health; Division of Alcohol and Drug Abuse Status Report on Clay County. Retrieved January 2011 from U.S. Census. USA Counties. Retrieved January 2011from 8. Healthy People 2020: Adolescent Health from 9. American Cancer Society: Cancer Action Network. Retrieved from Institute of Medicine of the National Academies: Oral Health Access to Services. Retrieved from Medscape Connect: Obese Youth Are Victimized at School.and at Home. From 12. Institute of Medicine of National Academies: Oral Health Imitative. Retrieved from 22

27 13. American Community Survey 2009: Clay County. Retrieved from Id=&_lang=en&_ds_name=ACS_2009_5YR_G00_&ts= 14. Missouri Department of Mental Health. Status Report on Missouri s Alcohol and Drug Abuse Problems Health and Human Services. The Youth Risk Behavior Surveillance System (YRBSS) Missouri Department of Mental Health. Missouri Student Surveys. 23