Youth Health Status Report

Transcription

1 Youth Health Status Report Youth 12 to 19 years September 2015 Huron County Health Unit 77722B London Road RR 5, Clinton, ON N0M 1L F:

2 This health status report will be updated in If there is any material you would like to see included in the 2016 update please contact the Huron County Health Unit Epidemiologist. Report prepared by Erica Clark, Epidemiologist with input from: Laura DeKroon, Public Health Promoter Samantha Docherty, Public Health Promoter Marilyn King, Public Health Nurse Amy MacDonald, Public Health Dietitian Trina O Rourke, Dental Hygienist Terri Sparling, Chief Executive Officer, Huron-Perth Centre for Children and Youth Julie Verch, Public Health Nurse Members of the Community Health, Environmental Health, and Family Health Teams assisted with reviewing and editing the document. Material in this report may be reproduced or copied without permission. The following citation should be used to indicate the source: Huron County Health Unit. (2015). Youth health status report: Youth 12 to 19 years. Clinton, Ontario. This report is available at Huron County Health Unit 1

3 Contents Summary... 3 Making Comparisons... 5 Social Determinants of Health in Huron County... 5 Income... 6 Social Support... 6 Overall Health and Well Being... 8 Nutrition Physical Activity Weight Alcohol Consumption Oral Health and Access to Dental Care Tobacco Use Injuries Resulting in Hospitalization Motor Vehicle Collision Injuries Among Huron County Youth Huron County Youth Injured by Being Struck by or Against an Object Self Harm Injuries Among Huron County Youth Injuries Due to Falls for Huron County Youth All Terrain Vehicles Injuries Among Huron County Youth Injury Summary Sexually Transmitted Infections Teen Pregnancy Rate Conclusion References Appendix: Report Limitations Population estimates and projections Birth and death data (vital statistics) Hospital discharges, outpatient clinic visits, and emergency department visits Reportable diseases Canadian Community Health Survey (CCHS) Huron County Health Unit 2

4 Summary Social determinants of health, such as income and social support, affect the health and well-being of communities. The percentage of Huron County youth living in households that cannot make ends meet is lower than Ontario but still too high (14% for Huron County versus 17% for Ontario). Social support is high in Huron County but this can have a positive and negative influence on health (Carpiano and Hystad, 2011). The challenge in Huron County is to use social support to encourage healthier behaviours among youth. Overall health and well-being of Huron County youth is high. Ninety-five per cent or more of Huron County youth rated their health and mental health as good, very good or excellent. It is important to note that self-reported mental health gauges feelings of happiness, well-being, and satisfaction, not whether a youth has a mental illness (Levinson and Kaplan, 2014). Vegetable and fruit consumption is important for youths continued growth and development. Huron County youths vegetable and fruit consumption is too low. Only a third of Huron County youth reported eating the recommended number of vegetable and fruit servings. Huron County youth reported similar levels of physical activity as the rest of the province. After taking into account how much people tend to over-estimate physical activity levels, about 60% of Huron County youth are active or moderately active (Garriguet & Colley, 2014). This percentage needs to be improved. The Canadian Physical Activity Guidelines recommend at least one hour of moderate to vigorous physical activity per day for year olds. Assessing weight at a population level does provide an estimate of how well a population is doing with behaviours that contribute to weight such as physical activity, healthy eating, and getting adequate sleep. Body mass index (BMI) is the only measure currently available to assess weight at the population level. Using the BMI, almost one quarter of Huron County youth are classified as overweight or obese. However, weight is not a good target for health programs because it is an outcome not a behaviour. Alcohol use, especially binge consumption, is a concern for youth years because it has a negative impact on youths short- and long-term health. Binge drinking, as of 2011, is defined as males drinking four or more drinks in one day and females drinking three or more drinks in one day (Butt, Beirness, Cesa, Paradis, and Stockwell, 2011). Prior to 2011, binge drinking was defined as males or females Huron County Health Unit 3

5 drinking five or more drinks on one occasion. The following data uses the old binge drinking definition. Forty per cent of underage Huron County youth (12-18 years) reported having at least one drink in the last year and 20% binge drank at least once. Among older Huron County youth (15-19 years) almost three quarters drank at least once in the last year and about half reported binge drinking. Huron County youth have good oral health but improvements are still needed. About 95% reported good to excellent oral health. Almost a third of Huron County youth reported feeling pain in their teeth or gum sometimes or often in the last month. Tobacco use among Huron County youth has been declining. In 2003, almost 60% of Huron County youth reported never smoking. In 2011/12, that percentage had risen to about 80%. Hospitalization due to injuries are significantly higher for Huron County youth that the rest of Ontario. Motor vehicle collisions, being struck by or against an object, self-harm, falls, and all terrain vehicle (ATVs, UTVs, dune buggies, dirt bikes, etc.) collisions are the top five leading causes of injuries that require hospitalizations. For motor vehicle and all terrain vehicle collision injuries, Huron County youth have a significantly higher rate of hospitalization than other rural health units and the rest of Ontario. Chlamydia, a sexually transmitted infection, is the most common reportable disease for Huron County youth and the rest of Ontario. In Huron County, the rate is lower than the rest of Ontario and varies from year to year with no apparent trend for increasing or decreasing infection rates over time. This is expected to change. The rest of Ontario, including neighbouring health units, have seen a significant increase in chlamydia infections. Gonorrhea infections (another sexually transmitted infection) have also been increasing in the rest of the province. The gonorrhea infections are becoming more difficult to treat because of increasing drug resistance. Teen mothers are at a higher risk for pre-term birth, small-for-gestational age infants, and financial stress. The teen pregnancy rate in Huron County has been about pregnancies per 1,000 girls over the last ten years. This rate has been consistently lower than the rest of the province. Huron County Health Unit 4

6 Making Comparisons Throughout this report, Huron County youth are compared to other parts of Ontario to see how similar or different they are. There are two important comparisons that are made: to other primarily rural health units and to the rest of Ontario. The primarily rural health unit group was identified by Statistics Canada when they divided up all of the health regions in Canada into groups. Statistics Canada calls the primarily rural group Peer Group D. The key characteristics that define the primarily rural group (Peer Group D) that Huron County is part of include primarily rural and low Aboriginal population. Members of Peer Group D in Ontario are the Huron County Health Unit, Grey-Bruce Health Unit, Perth District Health Unit, and Renfrew County and District Health Unit. There are other rural health units in Ontario that have high Aboriginal populations and are part of a different comparison group. Social Determinants of Health in Huron County Income, education, employment, housing, early childhood development, and social support are all examples of social determinants of health. These are factors that shape the health of Canadians (Mikkonen and Raphael, 2010). Where possible, the influence of two social determinants of health, income and gender, have been examined. Income is categorized as low, middle or high depending on household income and the number of people living in the household (see Table 1). Table 1: Definitions of income categories Number of persons in the household Household income Low Middle High 1 or 2 < $30,000 $30,000 to < $60,000 3 or 4 < $40,000 $40,000 to < $80,000 5 < $60,000 $60,000 to < $80,000 $60,000 $80,000 $80,000 To understand what it means to be in a low income household, consider how it compares to the living wage for Huron and Perth Counties. According to the Social Research and Planning Council of Perth-Huron, a family of four would need an annual income of $64,000 to make ends meet (Social Research Planning Council, 2015). In Table 1, a low income family of four has an annual income of less than $40,000; considerably less than the living wage. Huron County Health Unit 5

7 Income Income, out of all the social determinants of health, may have the biggest influence on health. This is because income has the potential to influence most of the other social determinants of health. How much income a family has determines the opportunities available to youth. For example, poor quality and crowded housing may mean youth are exposed to mould and infectious diseases that affect their short-term and long-term health. Fourteen per cent of Huron County children and youth under 18 years of age are living in low income households compared to 17 per cent for Ontario (Statistics Canada, 2013). This means 1,761 Huron County youth were living in households that did not have enough money to make ends meet in While the percentage of Huron County children and youth experiencing low income is significantly lower than the province, it is still too high for a healthy community. Social Support Social support or social capital is how closely connected people are to their communities. Do they know their neighbours? Do they have close friends that they could ask favours of? Social support is measured by asking people how strong their sense of community belonging is (Carpiano and Hystad, 2011). Seventy-eight per cent of Huron County youth rated their sense of community belonging as somewhat or very strong (see Figure 1). This is similar to youth in other rural health units and the rest of Ontario. Figure 1: Per cent of youth years who rated their sense of belonging to their community as somewhat or very strong from The difference between Ontario, Rural health units (Perth, Grey-Bruce, and Renfrew), and Huron County is not statistically significant. 100% 80% 60% 40% 20% 0% Huron County Rural health units (excl. Huron) Ontario Source: Canadian Community Health Survey Statistics Canada, Ontario Share File, Health Analytics Branch, Ontario MOHLTC. Huron County Health Unit 6

8 Social support is influenced by income. Youth living in higher income households in Huron County and the rest of Ontario were more likely to report a somewhat or very strong sense of community belonging (see Figure 2). Figure 2: Per cent of youth years who rated sense of community belonging as somewhat or very strong from according to where they lived and household income. As income increases, so does youth's self-rated sense of community belonging. This trend is statistically significant for rural health units (Perth, Grey-Bruce, and Renfrew) and the province. 100% 80% 60% 40% 20% 0% Low Middle High Low Middle High Low Middle High Huron Rural Health Units (excl. Huron) Ontario Social support influences health differently in rural areas and cities (Carpiano and Hystad, 2011). In cities, people with a lot of social support are more likely to report their health is good, very good or excellent. In rural areas, a lot of social support does not necessarily mean better health (Carpiano and Hystad, 2011). Researchers believe the lack of influence on health in rural areas reflects the positive and negative influences of close ties to the community. People are connected in more ways in rural areas. For example, a person may live on the same street as a relative who is also their co-worker and coach of their child s ball team. Close ties with a lot of people in the community can be beneficial but it can also be a source of stress and make changing behaviour hard. A number of close ties in the community can mean a lot of demands for assistance (Carpiano and Hystad, 2011). Requests to assist relatives and volunteer for events and organizations increase when people have a lot of close ties to their community. This can create stress which negatively impacts health. Close community ties can also reinforce unhealthy behaviour (Carpiano and Hystad, 2011). If most people in a group spend their weekends binge drinking at parties it can be difficult to not participate. When members of that group wear a number of different hats such as friend, neighbour, relative, and co-worker the decision not to participate becomes more difficult. Binge drinking, as of 2011, is defined as Huron County Health Unit 7

9 males drinking four or more drinks in one day and females drinking three or more drinks in one day (Butt, Beirness, Cesa, Paradis, and Stockwell, 2011). Social support can be a positive and negative determinant of health. The challenge in Huron County is to find ways to use social support to improve youth s health. Overall Health and Well Being Self-reported health and mental health provide good estimates of overall health and well being (Carpiano and Hystad, 2011; Idler and Benyamini, 1997; Levinson and Kaplan, 2014). Together, the two measures indicate the overall health of Huron County youth is high. When someone reports on their health, they are typically providing a holistic summary of their current health including mental and physical well-being (Idler and Benyamini, 1997). Self-reported health is considered a good estimate of a person s physical health (Idler and Benyamini, 1997). Self-reported mental health usually summarizes a person s feelings of happiness, well-being, and satisfaction with life (Levinson and Kaplan, 2014). Selfreported mental health does not provide good information on how common mental illness is in a community (Levinson and Kaplan, 2014). Individuals with a mental illness diagnosis may still rate their mental health as good, very good or excellent (Levinson and Kaplan, 2014). Also, these findings are limited by how the information was collected. Youth living in households that do not have a landline telephone were not included in the Canadian Community Health Survey. Many of the households in Huron County that are experiencing problems that would impact youths feelings of happiness, well-being, and satisfaction with life do not have a landline phone. Self-rated health and mental health is high for youth regardless of where they live in Ontario (see Figure 3). Ninety-five per cent or more of youth in Huron County, other rural health units, and the rest of Ontario rated their health and mental health as good, very good or excellent. Huron County Health Unit 8

10 Figure 3: Per cent of youth years who rated their health or mental health as good to excellent from The difference between Ontario, Rural health units (Perth, Grey-Bruce, and Renfrew), and Huron County is not statistically significant. 100% 80% 60% 40% 20% 0% Self-rated health Self-rated mental health Huron County Rural health units (excl. Huron) Ontario Source: Canadian Community Health Survey Statistics Canada, Ontario Share File, Health Analytics Branch, Ontario MOHLTC. Health is affected by income. Regardless of where youth live, higher income means better health. Youth living in higher income households are more likely to rate their health as good, very good or excellent (see Figure 4). Figure 4: Per cent of youth years who rated their health as good to excellent from according to where they lived and household income. As income increases, so does youth's self rated health. This trend is statistically significant for rural health units (Perth, Grey-Bruce, and Renfrew) and the province. 100% 80% 60% 40% 20% 0% Low Middle High Low Middle High Low Middle High Huron Rural Health Units (excl. Huron) Ontario Huron County Health Unit 9

11 Nutrition Good nutrition is important for the growth and development continuing to take place in youths brains and bodies. Vegetable and fruit consumption is an area that youth consistently fall short in across the province, including Huron County. The Canada Food Guide recommended number of servings for youth aged 12 to 19 is displayed in Table 2. Surveys such as the Canadian Community Health Survey ask frequency of Canada s Food Guide food group consumption (number of times per day). Although the two are not directly comparable, frequency of consumption is a commonly used proxy for actual intake and well accepted for this purpose. Table 2: Canada s Food Guide recommended servings for 12 to 19 years old Food Category years years 19 years Females Males Females Males Females Males Grain products Milk products Vegetables and fruit Meat, fish, poultry or alternatives Fast food Source: Health Canada, Limit intake Limit intake Limit intake Limit intake Limit intake Limit intake Approximately 32 per cent of Huron County youth reported eating the recommended number of servings of vegetables and/or fruit compared to 28% of other rural youth and 26% of Ontario youth (Figure 5). These differences are not statistically significant. About two thirds (68 per cent) of Huron County youth are eating less than the recommended servings of vegetables and fruit. Since vegetable and fruit consumption is important for overall health of youth now and throughout their lives, improvements are needed. Huron County Health Unit 10

12 Figure 5: Per cent of youth 12 to 19 years who reported eating the number of vegetable and fruit servings recommended by Canada's Food Guide from 2003 to Huron County youth eat about the same amount of vegetables and fruit as the rest of Ontario. Differences are not statistically significant. 100% 80% 60% 40% 20% 0% Huron County Rural health units (excl. Ontario Huron) Source: Canadian Community Health Survey Statistics Canada, Ontario Share File, Health Analytics Branch, Ontario MOHLTC. income. Self-reported vegetable and fruit consumption did not differ by gender or Physical Activity Seventy-six per cent of Huron County youth are active or moderately active which is similar to other rural youth and the rest of the province (see Figure 6). This means roughly two thirds of Huron County youth report they are getting the minimum one hour of moderate to vigorous physical activity per day recommended for years olds in the Canadian Physical Activity Guidelines. There are no differences by gender or income for Huron County youth. Figure 6: Per cent of youth 12 to 19 years who reported being active or moderately active from 2003 to Physical activity levels for Huron County youth are similar to the rest of Ontario. 100% 80% 60% 40% 20% 0% Huron County Rural health units (excl. Ontario Huron) Source: Canadian Community Health Survey Statistics Canada, Ontario Share File, Health Analytics Branch, Ontario MOHLTC. Huron County Health Unit 11

13 Self-reported physical activity over-estimates actual physical activity (Garriguet & Colley, 2014). A Statistics Canada study found about 13% of youth are misclassified as active or moderately active when self-reported physical activity is used (Garriguet & Colley, 2014). This means the true per cent of activity or moderately active youth from 2003 to 2012 is probably around 60% for youth in Huron County, other rural health units, and the rest of Ontario. More work is needed to increase physical activity levels for youth across the province. Weight It is important not to focus on weight when looking at the health of an individual. Weight is not a behaviour and therefore is not a good target for change. Instead we need to focus on the behaviours that influence health, such as healthy eating, adequate sleep, physical activity, substance misuse, and tobacco use. Improving healthy lifestyle habits will have benefits regardless of an individual s weight status. When health promotion strategies focus on weight, they fail to engage individuals whose weight is considered normal or healthy but who may also benefit from improved eating and activity habits (Bombak, 2014 and Cohen at al., 2014). Youth are also vulnerable to poor body image and increased risk for developing eating disorders (Neumark-Sztainer et.al., 2006). Shifting the focus from weight and weight loss to positive lifestyle changes will support youth to engage in healthier habits that will carry through into their adult years. Body mass index is the only measure currently available at the population level to assess weight; however, there are limitations to its use. Body type and muscle mass can result in misclassification. For example, athletes with a larger proportion of muscle mass typically score as overweight even though they are a healthy weight. Body mass index also does not measure health. An individual can be classified as overweight and active and be more healthy than another individual classified as normal weight but who is sedentary. Body mass index should only be used to assess weight, not health, at the population level. It is not intended to assess weight or health at an individual level. There are many other factors (nutrition, physical activity, smoking, alcohol and substance use, blood work results, and blood pressure) that should be considered when assessing health. Assessment of healthy growth and development for children and youth 19 years and under should track height and weight measurements over a period of time using the World Health Organization growth charts (Reference: Huron County Health Unit 12

14 Twenty-two per cent of Huron County youth 12 to 19 years are classified as overweight or obese which is similar to other rural youth and the rest of the province (see Figure 7). Significantly more males (in Huron, other rural health units, and the rest of Ontario) are overweight or obese than females. Figure 7: Per cent of youth 12 to 19 years whose BMI is categorized as overweight or obese for 2003 to Males were more likely to have a BMI categorized as overweight or obese. 100% 80% 60% 40% 20% 0% Males Females Total Huron Rural health units (excl. Huron) Ontario Source: Canadian Community Health Survey Statistics Canada, Ontario Share File, Health Analytics Branch, Ontario MOHLTC. Healthy lifestyle habits, including diet and exercise, are influenced by income and other social determinants of health and environmental determinants such as accessibility of grocery stores and walkability of communities (Raine, 2005). For example, income affects whether individuals have: Transportation to get to the grocery store. Freezer space to store leftovers and bulk food purchases. Adequate cooking tools such as pots and mixing bowls. Kitchen appliances in good working condition. Enough money to risk experimenting with recipes. Developing successful interventions to improve health of Huron County youth requires consideration of the complex interaction of factors that influence the choices youth make. Huron County Health Unit 13

15 Alcohol Consumption Alcohol use by youth is a concern. Brain development continues until youth are in their mid 20s and alcohol consumption, especially in large quantities, during this time can interfere with brain development (Tapert SF, Caldwell L, Burke, 2004). Heavy alcohol consumption can result in poor cognitive performance such as reduced memory function, attention, visuospatial skills and planning/abstract reasoning and learning impairments (Tapert SF, Caldwell L, Burke, 2004; Miller at al., 2007). In addition to brain damage, underage alcohol use, especially heavy consumption, is a risk factor in many chronic diseases that can affect youth later in life (WHO, 2004). Such chronic diseases include cancer, depression, heart disease, and liver disease (WHO, 2004). Alcohol and/or other drugs have also been reported as a factor in more than half of motor vehicle crashes involving an adolescent or young adult (aged 16-25), which is the leading cause of death among this age group (MADD). Increased alcohol consumption is associated with higher levels of risk taking behaviour as well as impaired judgement and slower reaction times, all of which can contribute to motor vehicle accidents (Miller et al., 2007; MADD). Alcohol has also been shown to be a factor in many other unintended injuries including alcohol poisoning, falls, fires, violence, unprotected sexual encounters, and death (WHO, 2004; Miller et al., 2007). The definition of heavy or binge drinking has changed. Prior to 2011, binge drinking was defined as drinking five or more drinks on one occasion. This is the definition used in the Canadian Community Health Surveys (CCHS). In 2011, the Canadian Centre on Substance Abuse revised the definition of binge drinking. A binge is now males drinking four or more drinks in one day and females drinking three or more drinks in one day (Butt, Beirness, Cesa, Paradis, and Stockwell, 2011). It is the binge or heavy alcohol consumption that can interfere with brain development and has the greatest impact on decision making (Tapert SF, Caldwell L, Burke, 2004). Underage alcohol consumption is the same in Ontario and Huron County but not other rural health units for youth 12 to 18 years of age (see Figure 8). Underage youth in Grey-Bruce, Perth, and Renfrew were significantly more likely to report binge drinking at least once in the last 12 months than youth in Huron County or Ontario. About 40 per cent of Huron County youth reported having at least one drink in the last 12 months and about 20 per cent reported binge drinking which is similar to the rest of Ontario. The CCHS uses the old definition of binge drinking: five or more drinks on one occasion for males and females. Huron County Health Unit 14

16 Figure 8: Alcohol consumption among youth 12 to 18 years in the last 12 months for 2003 to No difference between Huron County and Ontario for underage alcohol consumption but other rural health units were significantly higher than Ontario for binge consumption. Other rural health units includes Perth, Renfrew, and Grey-Bruce. 100% Huron 80% 60% 40% 20% 0% Did not drink Drank but did not binge Binge drank at least once Rural health units (excl. Huron) Ontario Source: Canadian Community Health Survey Statistics Canada, Ontario Share File, Health Analytics Branch, Ontario MOHLTC. Most teenage alcohol consumption takes place among youth between years of age. Within this age group, only the 19 year olds can legally purchase alcohol. When focusing on year olds, rather than those years, Huron County youth are similar to other rural youth but different from the rest of Ontario (see Figure 9). Older Huron County youth are more likely to report having at least one drink in the last 12 months than older Ontario youth (73 per cent for Huron County versus 63 per cent for Ontario). About half of older Huron County youth (51 per cent) reported binge drinking at least once in the last 12 months compared to 38 per cent of older Ontario youth. The CCHS uses the old definition of binge drinking: five or more drinks on one occasion for males and females. Huron County Health Unit 15

17 Figure 9: Alcohol consumption among youth 15 to 19 years in the last 12 months for 2003 to Older rural youth from Huron, Perth, Grey, Bruce, and Renfrew Counties are more likely to drink and binge drink than older Ontario youth. 100% 80% 60% 40% 20% 0% Did not drink Drank but did not binge Binge drank at least once Huron Rural health units (excl. Huron) Ontario Source: Canadian Community Health Survey Statistics Canada, Ontario Share File, Health Analytics Branch, Ontario MOHLTC. The higher alcohol consumption, especially binge alcohol consumption, is a concern. Youths brains are still developing and the part of the brain responsible for logical thought processes is not fully developed until age 24 (Tapert SF, Caldwell L, Burke, 2004). Consuming alcohol makes logical decision making difficult. Older youth are going through a lot of changes in their lives, including learning to drive, becoming sexually active, finishing high school, starting full-time work, moving away from home, and starting post-secondary school. Alcohol plus developing logic centres in the brain plus new responsibilities are a potent mixture. Youth who consume alcohol are at a higher risk for making poor decisions that can impact the rest of their lives. Huron County numbers were too small to analyze by income, however, Ontario data can provide insight into which youth are most likely to engage in drinking or binge drinking. The Ontario youth at greatest risk for alcohol consumption, including binge alcohol consumption, are those from middle to high income households. About 15% of low income Ontario youth reported binge drinking at least once in the last 12 months compared to about 20% of middle to high income youth (see Figure 10). Huron County Health Unit 16

18 Figure 10: Alcohol consumption among Ontario youth 15 to 19 years by household income for 2003 to 2012 Youth from middle to high income households are more likely to drink and binge drink 100% 80% 60% 40% 20% Low income Middle to high income 0% Did not drink Drank but did not Binge drank at least binge once Source: Canadian Community Health Survey Statistics Canada, Ontario Share File, Health Analytics Branch, Ontario MOHLTC. Work is needed to lower the percentage of youth in Huron County and other rural areas who are binge drinking. Oral Health and Access to Dental Care Good oral health is important to youth s overall health and well-being. Dental decay can affect diet, as youth who experience pain in their mouth or face will avoid nutrient rich food that require chewing (Jamieson, Mejia, Slade, and Roberts-Thomson, 2009). Dental pain increases the likelihood that youth will miss school and have poorer academic performance because dental pain makes focusing on school work difficult (Jackson, Vann, Kotch, Pahel, and Lee, 2011). The majority of youth across Ontario report good to excellent oral health and rarely or never have pain in their teeth or gums (see Figure 11). About 95% of youth in Huron County, other rural health units, and the rest of Ontario reported good to excellent oral health. Sixty-eight per cent of Huron County youth said they experienced pain in their teeth or gums rarely or never in the past month while the remainder experienced pain often or sometimes. Youth in other rural health units and the rest of Ontario appear to have less pain in their teeth or gums (78% reported pain rarely or never versus 68% in Huron County), however, the difference is not statistically significant. In other words, the percentage of youth who reported dental pain in the last month was essentially the same across the province. Apparent differences are due to sampling variability. Huron County Health Unit 17

19 Figure 11: Self-reported oral health and teeth and gum pain for youth 12 to 19 years from 2003, 2007, and No significant difference for self-reported oral health or teeth and gum pain. 100% 80% 60% 40% 20% 0% Reports excellent to good oral health Rarely or never had pain in teeth or gum in last month Huron County Rural health units (excl. Huron) Ontario Source: Canadian Community Health Survey 2003, 2007, & Statistics Canada, Ontario Share File, Health Analytics Branch, Ontario MOHLTC. The Huron County and rural health unit samples were too small to look at differences by income category but trends are apparent for all Ontario youth (see Figure 12). Youth from high income households were significantly more likely to report good to excellent oral health. They were also significantly more likely to report rarely or never having teeth or gum pain in the last month. Figure 12: Oral health and teeth and gum pain for Ontario youth 12 to 19 years by household income for 2003, 2007, and Youth from high income households are more likely to report having good to excellent oral health and less likely to report pain in their teeth or gum in the last month. 100% 80% 60% 40% Low income Middle income 20% 0% Reports excellent to good oral health Rarely or never had pain in teeth or gum in last month High income Source: Canadian Community Health Survey 2003, 2007, & Statistics Canada, Ontario Share File, Health Analytics Branch, Ontario MOHLTC. Almost all youth (96 per cent) in Huron County and the rest of Ontario reported visiting a dentist within the last three years (see Figure 13). Of the few Ontario youth that had not been to a dentist recently, the most common reasons given were thinking it wasn t necessary (52 per cent) and cost (30 per cent). The percentage of Huron Huron County Health Unit 18

20 County youth with access to dental insurance, however, is significantly lower than the rest of the province: 78% of youth in other rural health units and the rest of Ontario versus 68% of Huron County youth (see Figure 13). Figure 13: Dental visits for youth 12 to 19 years and whether they live in a houseold with dental insurance from 2003 to No difference for dental visits even though Huron County youth less likely to have dental insurance. 100% 80% 60% 40% 20% 0% Visited dentist within last 3 yrs The lower percentage of Huron County youth with access to dental insurance may be related to the labour force status in Huron County. A larger percentage of the Huron County labour force is self-employed than in Ontario (18 per cent in Huron County versus 10 per cent in Ontario) (Statistics Canada, 2013). The higher percentage of self-employed workers means fewer families have an opportunity to get dental insurance from an employer. Has dental insurance Huron County Rural health units (excl. Huron) Ontario Source: Canadian Community Health Survey Statistics Canada, Ontario Share File, Health Analytics Branch, Ontario MOHLTC. The oral health of Huron County youth is good but still needs improvement. From Figure 11, about 32% or roughly 2,000 youth experienced pain in their teeth or gum sometimes or often in the previous month. Based on the Ontario data, those youth are more likely to be from low or middle income households (see Figure 12). The Healthy Smiles dental program assists low income families with routine dental care. The Children in Need of Treatment (CINOT) provides emergency dental treatment for children whose families are experiencing financial hardship. These programs are important tools to maintain and improve youth s oral health. The provincial Healthy Smiles and CINOT programs are undergoing changes in how they are administered in It will be important to monitor oral health in the upcoming years to determine whether the program changes benefit Huron County youth. Huron County Health Unit 19

21 Tobacco Use Tobacco use is associated with a number of short- and long-term health problems. Short-term tobacco use can stain and damage teeth and irritate lungs leading to respiratory problems (Els, Kunyk, and Selby, 2013). Using tobacco over a longer period of time and in higher quantities increases the likelihood that people will experience health problems. Tobacco use, including cigarette smoking, is associated with cardiovascular disease (including heart attack and stroke), type II diabetes, nerve damage, multiple cancers, and chronic obstructive lung/pulmonary diseases which include emphysema, chronic bronchitis and other disorders such as asthma (Els, Kunyk, and Selby, 2013). There are also a number of serious reproductive effects including the potential for reduced fertility, birth defects in children and miscarriage (Els, Kunyk, and Selby, 2013). Decreasing the number of youth who start smoking and reducing the number who do smoke are important steps in reducing health problems linked to tobacco use. The percentage of youth who report never smoking has been increasing in Huron County, other rural health units, and Ontario (see Figure 14). Further, the percentage of Huron County youth who report never smoking are similar to the rest of the province. Apparent differences are likely due to sampling variability. There may be differences in smoking rates by gender or household income but the sample size was too small to detect them. Figure 14: Per cent of youth 12 to 19 years who reported never smoking. Teen smoking abstinence is rising in Huron County and the rest of Ontario. 100% 80% 60% 40% 20% 0% /8 2009/ /12 Huron County Rural health units (excl. Huron) Ontario Source: Canadian Community Health Survey Statistics Canada, Ontario Share File, Health Analytics Branch, Ontario MOHLTC. Huron County Health Unit 20

22 The increases in youth who have never smoked are promising. As the percentage of youth who smoke in Huron County and Ontario decreases, a shift in tobacco prevention efforts is occurring. Prevention efforts targeting all youth are being replaced by programs that target specific youth social identities that have high smoking rates. These social identities might be characterized by the type of music youth listen to, issues that are important to them, and activities they like to do. Injuries Resulting in Hospitalization The most common leading cause of injury resulting in hospitalization for youth 12 to 19 years in Huron County was motor vehicle collisions (see Figure 15). Being struck by or against an object, self harm, falls, and all terrain vehicles were also common leading causes of injuries resulting in hospitalization. An injury may have more than one cause but there is only one leading cause. Also, the rates only include youth that live in the region specified. For example, if a youth lives in Bruce County and is hospitalized after being involved in a snowmobile crash in Huron County, he or she will be counted in the Grey-Bruce hospitalization data but not the Huron County hospitalization data. Figure 15: Most common leading cause of injury resulting in a youth 12 to 19 years being admitted to hospital from 2007 to Injury rates for falls and self harm are not significantly different (in other words, they are essentially the same) when comparing Ontario and Huron County youth. Huron County youth have statistically significantly higher injury rates than Ontario youth for all other leading causes of hospitalization listed. Rural health units include Grey-Bruce, Perth, and Renfrew. Snowmobiles Pedal (bicycles, unicycles, etc.) Cut or pierced by an object Assault All terrain vehicles (ATVs, UTVs, dirt Falls Self harm Struck by or against an object Motor vehicle collisions Number of injuries per 100,000 youth Ontario (excl. Huron) Rural health units (excl. Huron) Huron County Source: NACRS and population estimates and projections PHU municipality (Data Year ), Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, extracted March 2015 for NACRS and April 2015 for population estimates and projections Huron County Health Unit 21

23 Although the rate of hospitalizations appears to be different between Huron County and Ontario for self harm and falls, the difference is not statistically significant. In other words, the number of hospitalizations per 100,000 youth is essentially the same in Huron County and the rest of Ontario for falls and self harm. Injury rates for Huron County versus other rural health units (Grey-Bruce, Perth, and Renfrew) are statistically significantly different for all leading causes in Figure 15 except struck by or against an object and pedal (bicycle, unicycle, etc.). The greatest rate difference can be seen for hospitalizations due to motor vehicle collisions, all terrain vehicles, and self harm. Huron County has a significantly lower rate of hospitalizations due to self harm than other rural health units. There are a number of factors that contribute to this data and it is essential to understand the lower rate does not likely reflect actual self harm rate. In contrast, Huron County has a significantly higher rate of hospitalizations due to motor vehicle collisions and all terrain vehicle injuries than other rural health units. Changes in injury rates over time (or the lack thereof) for the top five leading causes are examined in more detail in the next few sections. Those five leading causes of injury are motor vehicle collisions, being struck by or against and object, self-harm, falls, and all terrain vehicle (ATVs, UTVs, dirt bikes, etc.) injuries. Motor Vehicle Collision Injuries Among Huron County Youth Hospitalizations due to motor vehicle collisions (MVCs) have decreased significantly but emergency department visits due to MVCs have not (see Figure 16). This means that there has been no change in the rate of injuries due to MVCs but the severity of those injuries has decreased. The rate of hospitalizations due to MVC injuries for Huron County youth decreased from 33 hospitalizations per 10,000 youth in 2003/4 to 24 hospitalizations per 10,000 youth in 2013/14. Huron County Health Unit 22

24 Rate per 10,000 youth Rate per 10,000 youth Figure 16: Number of motor vehicle collision (MVC) injuries (as leading cause) per 10,000 Huron County youth 12 to 19 years requiring an emergency department (ED) visit and hospitalization from 2003 to The decrease in hospitalization rates over time is significant, however, there is no significant change in ED vists over time. In other words, there are still a lot of MVC injuries but they appear to be getting less severe / / / / / /14 Hospitalizations Huron County Youth Injured by Being Struck by or Against an Object Hospitalizations due to being struck by or against an object have decreased significantly while emergency department visits have increased significantly (see Figure 17). This indicates that Huron County youth are doing more things that may result in injury but those injuries are getting less severe. ED visits Source: NACRS and population estimates and projections PHU municipality (Data Year ), Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, extracted March 2015 for NACRS and April 2015 for population estimates and projections. Figure 17: Number of injuries (as leading cause) due to being struck by or against an object per 10,000 Huron County youth 12 to 19 years requiring an emergency department (ED) visit and hospitalization from 2003 to Hospitalization rates decreased significantly while ED visits increased significantly. In other words, youth are doing more things that may result in injury but those injuries are getting less severe / / / / / /14 Hospitalizations ED visits Source: NACRS and population estimates and projections PHU municipality (Data Year ), Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, extracted March 2015 for NACRS and April 2015 for population estimates and projections. Huron County Health Unit 23

25 Rate per 10,000 youth Being struck by or against an object may include injuries such as Being hit by a baseball or hockey puck. Being hit by a falling object. Walking into an object while texting. Someone hitting their thumb with a hammer. This type of injury is more likely to occur when youth are being active. Sedentary behaviour is worse for youth s health than going to an emergency department to get treatment for a minor injury. Therefore, minor injuries requiring an emergency department visit should not be targeted for prevention efforts but serious injuries resulting in hospitalization should. The current trend of decreasing hospitalizations and increasing emergency department visits for struck injuries is positive. Self Harm Injuries Among Huron County Youth There have been significant changes in hospitalizations and emergency department visits for Huron County youth but these are primarily due to changes in service delivery (see Figure 18). From 2003/04 to 2013/14, hospitalizations due to self-harm decreased significantly from 19 hospitalizations per 10,000 Huron County youth to 12 hospitalizations per 10,000 Huron County youth. At the same time, emergency department visits significantly decreased from 33 visits per 10,000 Huron County youth in 2003/4 to 14 visits per 10,000 Huron County youth in 2007/8 before significantly increasing to 38 visits per 10,000 Huron County youth in 2013/14. Figure 18: Number of self-harm injuries (as leading cause) per 10,000 Huron County youth 12 to 19 years requiring an emergency department (ED) visit and hospitalization from 2003 to The decrease in hospitalization rate over time is significant, however, it is due to limited psychiatric beds available for youth. There continues to be a waitlist for youth community mental health services. The changes over time for self-harm ED visits (decreases and increases) are statistically significant / / / / / /14 Hospitalizations ED visits Source: NACRS and population estimates and projections PHU municipality (Data Year ), Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, extracted March 2015 for NACRS and April 2015 for population estimates and projections. Huron County Health Unit 24

26 There are no acute care beds in Huron or Perth counties for children and youth under 16 years with acute mental health issues. Any child or youth needing hospitalization for mental health problems has to be transferred to a hospital in London, Ontario creating additional challenges for children and youth and their families. Since 1999, the Huron Perth Healthcare Alliance and the Huron-Perth Crisis Program with the Huron-Perth Centre for Children and Youth have developed a protocol to coordinate community based mental health services with the crisis response system to respond to children and youth in serious mental health crises. In 2012, LHIN funding helped expand this protocol to include emergency departments and two London hospitals in order to define an access path to acute care hospitalization. Work continues to educate police, physicians and other community partners on the protocol as practice has been to direct families directly to London-based resources. The actual rate of self harm is presumed to be higher than reflected in this report as youth cared for by communitybased services are not reflected in the emergency department or hospitalization data. The data does include children and youth who are treated in emergency departments and hospitals (including intensive care units) outside of Huron County. The protocol to divert children and youth to community care instead of hospitalization is likely the primary reason behind the significant decrease in hospitalizations over time. The significant increases and decreases in emergency department visits over time are likely influenced by changes in service delivery and exposure to suicide behaviour (Christiansen, Larsen, Agerbo, Bilenberg, & Stenager, 2014). The community care diversion protocol implemented in 1999 diverted a number of youth from emergency departments to community care but the rate of emergency department visits is also influenced by clustering of suicide attempts. When youth are exposed to a successful or unsuccessful suicide attempt it increases the risk for additional suicide attempts in the community (Christiansen, Larsen, Agerbo, Bilenberg, & Stenager, 2014). This behaviour pattern means emergency department rates for self harm will have periodic increases and decreases due to clusters of suicide attempts. Due to the limited hospital-based acute care mental health services, the hospitalization and emergency department rates for self-harm do not provide an accurate description of the need for mental health promotion and services in Huron County. Hospitalization rates for self-harm injuries suggests a decrease in need but the reality is that youth have been diverted to community mental health services. Children and youth who are in serious mental health crises do not wait for community based services. However, prioritizing this group of children and youth has a negative impact on the waiting period for less urgent mental health needs. There are waitlists for youth Huron County Health Unit 25

27 community mental health services indicating that the need for mental health services and mental health promotion exceeds what is currently available in Huron County. Huron County Health Unit 26

28 Rate per 10,000 youth Injuries Due to Falls for Huron County Youth Hospitalization rates for Huron County youth after a fall has been unchanged but emergency department visits after a fall has increased significantly from 2003/4 to 2013/14 (see Figure 19). This means Huron County youth are doing more things that may result in a fall injury but there has not been an increase in severe injuries from falls. Figure 19: Number of fall injuries (as leading cause) per 10,000 Huron County youth 12 to 19 years requiring an emergency department (ED) visit and hospitalization from 2003 to Hospitalization rates over time are unchanged but there is a significant increase in ED visits. In other words, youth are doing more things that may result in injury but there has not been an increase in severe injuries / / / / / /14 Hospitalizations ED visits Source: NACRS and population estimates and projections PHU municipality (Data Year ), Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, extracted March 2015 for NACRS and April 2015 for population estimates and projections. Youth are more likely to fall and be injured from a fall when they are being active. Sedentary behaviour carries a greater health risk than going to the emergency department for a minor injury from a fall. Therefore, although it is important to decrease serious fall injuries requiring hospitalization, minor injuries treated in the emergency department should not be the focus of prevention efforts. All Terrain Vehicles Injuries Among Huron County Youth Hospitalization rates from all terrain vehicles was unchanged from 2003/4 to 2013/14 but emergency department visits increased for Huron County youth (see Figure 20). This means Huron County youth are getting more injuries from all terrain vehicles but there has not been an increase in severe injuries requiring hospitalization. All terrain vehicles includes ATVs, UTVs, dirt bikes and other off road transportation but does not include snowmobiles and agricultural machinery (e.g. tractors). Huron County Health Unit 27