Examining the health of Erie County Youth. Erie County

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2 Examining the health of Youth

3 Foreword This Community Health Assessment provides data that directly relates to the quality of life in our community. This data is trending ; it compares our results this past year with a historical perspective from Community Health Assessments from 2005, 2008, 2011, 2013 and We can see areas of improvement, as well as areas of concern. Chooses Healthy Living! is a campaign that is built on improving these data outcomes. Please refer to our website ( for information on this campaign. We welcome all new voices to this process. This data is, at a priority, intended to be used to support grant applications and any resources support that can come to to assist in the improvement of these outcomes. So far, millions of dollars have flowed into over the years. Any person, agency or entity may use this data to complete research, to support grant proposals or to gain knowledge on areas we need help in. Our Community Health Assessment is comparable to state and national data. This is an important feature in which we all should be aware of. The Board of Health will continue to commission the Community Health Assessment process on a 2 to 3-year cyclical basis, as we see the benefits of addressing these needs through policy development and assurances back to our communities. Please contact me directly on my cell, , if I can be of any assistance with questions, comments or concerns involving this process. Sincerely, Peter T. Schade, MPH, RS Health Commissioner Health Department Community Health Center FOREWORD 1

4 Acknowledgements The 2017 Youth Community Health Assessment has been funded by: Board of Health Community Health Center Substance Abuse and Mental Health Services Administration Drug Free Communities Support Grant Total cost for the health assessment: $17,500 Community Health Assessment Workgroup: Community Health Center Health Department Partners for Prevention of School Participation: Edison Local Schools Edison High School Edison Middle School Huron City Schools Huron High School McCormick Junior High Margaretta Local Schools Margaretta High School Perkins Local Schools Perkins High School Briar Middle School Vermilion Local Schools Vermilion High School Sailorway Middle School *Please note: Sandusky City Schools declined to participate in the 2017 youth health survey. TABLE OF CONTENTS 2

5 Project Management, Secondary Data, Data Collection, and Report Development Hospital Council of Northwest Ohio Britney L. Ward, MPH Director of Community Health Improvement Selena Coley, MPH Community Health Improvement Coordinator Emily A. Golias, MPH, CHES Community Health Improvement Coordinator Margaret Wielinski, MPH Assistant Director of Community Health Improvement Tessa Elliott, MPH Community Health Improvement Coordinator Emily Stearns, MPH, CHES Community Health Improvement Coordinator Erin Rauschenberg Graduate Assistant Data Collection & Analysis Joseph A. Dake, Ph.D., MPH Professor and Chair School of Population Health The University of Toledo To see data compared to other counties, please visit the Hospital Council of Northwest Ohio s Data Link website at: The 2017 Youth Health Assessment is available on the following websites: Health Department Hospital Council of Northwest Ohio Contact Information: Peter Schade, MPH, RS Health Commissioner Health Department 420 Superior St. Sandusky, OH (419) pschade@eriecohealthohio.org TABLE OF CONTENTS 3

6 Table of Contents Executive Summary Pages 5-15 Primary Data Collection Methods Page 5 Secondary Data Collection Methods Page Ohio State Health Assessment (SHA) Page 7 Data Summary Pages 8-12 Trend Summary Pages YOUTH HEALTH Youth Weight Status Pages Youth Tobacco Use Pages Youth Alcohol Consumption Pages Youth Drug Use Pages Youth Sexual Behavior Pages Youth Mental Health Pages Youth Personal Health and Safety Pages Youth Social Determinants of Health Pages Youth Violence Pages Youth Perceptions Pages APPENDICES APPENDIX I Health Assessment Information Sources Page 52 APPENDIX II Acronyms and Terms Page 53 APPENDIX III School Participation Page 54 APPENDIX IV Sample Demographic Profile Page 55 APPENDIX V Demographics and Household Information Pages TABLE OF CONTENTS 4

7 Executive Summary This executive summary provides an overview of health-related data for youth in grades 6 through 12, who participated in a county-wide health assessment survey during November The findings are based on self-administered surveys using a structured questionnaire. The questions were modeled after the survey instrument used by the Centers for Disease Control and Prevention for their national and state Youth Risk Behavior Surveillance System (YRBSS). The Hospital Council of Northwest Ohio (HCNO) collected the data, guided the health assessment process, and integrated sources of primary and secondary data into the final report. Primary Data Collection Methods DESIGN This youth health assessment was cross-sectional in nature and included a written survey of adolescents within. From the beginning, community stakeholders were actively engaged in the planning process and helped define the content, scope, and sequence of the study. Active engagement of community members throughout the planning process is regarded as an important step in completing a valid needs assessment. INSTRUMENT DEVELOPMENT A written survey instrument was designed for this study. As a first step in the design process, members from the Partners for Prevention of (PPEC) and staff members from HCNO met to discuss potential sources of valid and reliable survey items that would be appropriate to assess the health status and health needs of adolescents. The investigators decided to derive majority of the survey items from the YRBSS. This decision was based on being able to compare local data with state and national data. Based on input from PPEC, the project coordinator composed a draft containing 82 items on the adolescent survey. The draft was reviewed and approved by health education researchers at The University of Toledo, as well as PPEC. SAMPLING Adolescent Survey Youth in grades 6 through 12 in public school districts were used as a sample for this youth survey. The following school districts agreed to participate in the 2017 Youth Risk Behavior Survey: Edison Local Schools, Huron City Schools, Margaretta Local Schools, Perkins Local Schools, and Vermilion Local Schools. The U.S Census Bureau reported that approximately 7,445 of all youth ages years old live in. A sample size of 365 adolescents was needed to ensure a 95% confidence interval with a corresponding 5% margin of error (i.e., we can be 95% sure that the true population responses are within a 5% margin of error of the survey findings). Students were randomly selected and surveyed in the schools. PROCEDURE Adolescent Survey In September 2017, staff from HCNO met with local school superintendents to receive consent to administer the assessment during the fall of The survey was approved by all participating superintendents listed above. Schools and grades were randomly selected. Each student in that grade had to have an equal chance of being in the class that was selected, such as a home room or health class. Classrooms were randomly chosen by the school principal. Passive permission slips were mailed home to parents of any student whose class was selected to participate. The response rate was 87% (n=439: CI=± 4.59). DATA ANALYSIS Individual responses were anonymous. Only group data was available. All data was analyzed by health education researchers at The University of Toledo using SPSS Crosstabs were used to calculate descriptive statistics for the data presented in this report. EXECUTIVE SUMMARY 5

8 Executive Summary, continued LIMITATIONS As with all health assessments, it is important to consider the findings in light of limitations that are present in all assessment methods. The Hospital Council of Northwest Ohio (HCNO) uses a sampling method and survey questions based on the Youth Risk Behavior Survey (YRBS) from the Centers for Disease Control and Prevention (CDC) and involves randomly selecting schools and grade levels within those schools. Probability of selection is weighted by the size of grade levels within each school. Upon selection, the school principal (or designee) selects a particular general education classroom within the selected grade band to survey. This sampling method is used to ensure the inclusion of a representative sample of youth across the county. This is in contrast to population surveying in which all students in all schools complete the survey. While population surveying provides the strongest set of data which can be broken down by district or by school to gain insight into the behaviors of that subgroup of students, it is also very time consuming and expensive. Many schools that HCNO has been working with for over a decade have indicated that the reduced testing burden is better for their teachers and students because of the significant level of required testing that already exists (standardized testing). While the methods used are a strong and efficient method for county youth assessment, it is important to also understand the limitations. First, if the random selection or the school assignment of general education classrooms resulted in a group of students that was not reflective of the county, this represents threat to the external validity of the results (the generalizability of the results to the student population of ). If there were little to no differences between respondents and non-respondents, then this would not be a limitation. Second, the sample sizes selected for this assessment were to examine student behaviors at the county level. Due to sample size limitations, it is not recommended to select a particular district, school, age, or gender and assume that the results will accurately reflect that smaller subset of the county. Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. Finally, as is the case with all self-report surveys, to the extent that students responded in a socially desirable manner which is inconsistent with reality, this would represent a threat to the internal validity of the results. Secondary Data Collection Methods HCNO collected secondary data from multiple sites, including county-level data, wherever possible. HCNO utilized sites, such as Youth Risk Behavior Surveillance System (YRBSS), numerous CDC sites, U.S. Census data, Healthy People 2020, etc. All of the data is included in the section of the report it corresponds with. All primary data collected in this report is from the 2017 Youth Health Assessment. All other data will be sourced accordingly. EXECUTIVE SUMMARY 6

9 Executive Summary, continued 2016 Ohio State Health Assessment (SHA) The 2016 Ohio State Health Assessment (SHA) provides data needed to inform health improvement priorities and strategies in the state. This assessment includes more than 140 metrics, organized into data profiles, as well as information gathered through five regional forums, a review of local health department and hospital assessments and plans and key informant interviews. Similar to the 2016 Ohio SHA, the 2017 Youth Health Assessment examined a variety of metrics from various areas of health, including, health behaviors, access to health care, and social determinants of health. Note: This symbol will be displayed in the trend summary when an indicator directly aligns with the 2016 Ohio SHA. The interconnectedness of Ohio s greatest health challenges, along with the overall consistency of health priorities identified in this assessment, indicates many opportunities for collaboration among a wide variety of partners at and between the state and local level, including physical and behavioral health organizations and sectors beyond health. It is the Health Department/ Community Health Center and it s community partner s hope that this CHA will serve as a foundation for such collaboration. To view the full 2016 Ohio State Health Assessment, please visit: /media/odh/assets/files/chss/ship/sha_fullreport_ pdf?la=en FIGURE 1.1 State Health Assessment (SHA) Sources of Information EXECUTIVE SUMMARY 7

10 Executive Summary, continued Data Summary Youth Health YOUTH WEIGHT STATUS In 2017, 13% of youth were obese, according to Body Mass Index (BMI) by age. When asked how they would describe their weight, 28% of youth reported that they were slightly or very overweight. Over two-thirds (69%) of youth were exercising for 60 minutes on 3 or more days per week. Youth BMI Classifications* 3% 3% 2% 3% 2% 4% 3% 3% 67% 67% 68% 71% 71% 55% 66% 71% 17% 13% 20% 12% 14% 28% 13% 12% 13% 17% 10% 14% 13% 13% 18% 14% Total 2017 Obese Overweight Normal Weight Underweight *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. YOUTH TOBACCO USE In 2017, 7% of youth were current smokers, having smoked at some time in the past 30 days. The average age of onset for smoking was 13.9 years old. Nineteen percent (19%) of youth used e-cigarettes/vapes in the past year. 20% Male Female 13 or younger 14 to or older Youth Who Were Current Smokers* 15% 10% 7% 9% 4% 2% 7% 8% 6% 0% Total 2017 Male Female 13 or younger 14 to or older *Current smokers indicate youth who self-reported smoking at any time during the past 30 days. **Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. EXECUTIVE SUMMARY 8

11 Executive Summary, continued YOUTH ALCOHOL USE Almost one-fifth (19%) of youth had at least one drink of alcohol in the past 30 days, increasing to 40% of those over the age of 17. Just over half (52%) of youth who reported drinking in the past 30 days had at least one episode of binge drinking. Two percent (2%) of all youth drivers had driven a car in the past month after they had been drinking alcohol. 50% Youth Who Were Current Drinkers* 40% 40% 30% 20% 19% 21% 17% 19% 13% 12% 10% 5% 0% Total 2017 Male Female 13 or younger 14 to or older * Current drinker is defined as any individual who has had at least 1 alcoholic beverage in the past 30 days **Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. YOUTH DRUG USE In 2017, 8% of youth had used marijuana at least once in the past 30 days, increasing to 19% of those ages 17 and older. Five percent (5%) of youth used medications that were not prescribed for them or took more than prescribed to get high at some time in their life. 30% Youth Marijuana Use in Past Month* 25% 20% 19% 15% 11% 10% 8% 8% 8% 8% 8% 5% 2% 0% Total 2017 Male Female 13 or younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. EXECUTIVE SUMMARY 9

12 Executive Summary, continued YOUTH SEXUAL BEHAVIOR In 2017, 23% of youth had sexual intercourse. One-fifth (20%) of youth had participated in oral sex and 6% had participated in anal sex. Twenty-four percent (24%) of youth participated in sexting. Of those who were sexually active, 60% had multiple sexual partners. 75% Youth Who Had Sexual Intercourse* 50% 53% 25% 23% 25% 20% 23% 19% 20% 2% 0% Total 2017 Male Female 13 or Younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. YOUTH MENTAL HEALTH In 2017, 15% of youth had seriously considered attempting suicide in the past year and 6% attempted suicide in the past year. More than one-quarter (29%) of youth who felt depressed or suicidal reported it would be very unlikely for them to seek help. Just over one-fifth (21%) of youth had three or more adverse childhood experiences. Youth Who Had Seriously Considered Attempting Suicide in the 30% Past 12 Months* 25% 22% 20% 15% 15% 17% 13% 15% 13% 14% 10% 10% 5% 0% Total 2017 Male Female 13 or younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. EXECUTIVE SUMMARY 10

13 Executive Summary, continued PERSONAL HEALTH AND SAFETY Eighty-percent (80%) of youth had visited a doctor or healthcare professional for a routine checkup in the past year. More than three-quarters (77%) of youth had visited a dentist within the past year. Thirty percent (30%) of youth drivers had texted while driving in the past 30 days. Four percent (4%) of youth had played the choking game, also known as the pass-out game, space monkey, or dream game. 100% Youth Visiting a Dentist in the Past Year* 80% 77% 76% 78% 74% 81% 72% 60% 40% 20% 0% Total 2017 Male Female 13 or younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. SOCIAL DETERMINANTS In 2017, approximately 1,563, or 21% of youth, had three or more adverse childhood experiences (ACEs), increasing to 28% of females in their lifetime. EXECUTIVE SUMMARY 11

14 Executive Summary, continued YOUTH VIOLENCE Nine percent (9%) of youth carried a weapon (such as a gun, knife or club) in the past month. In the past year, 23% of youth had been involved in a physical fight. Ten percent (10%) of youth had been hit, slapped, or physically hurt by an adult or caregiver in the past month. Just over two-fifths (41%) of youth had been bullied in the past year. 50% Youth Involved in a Physical Fight in the Past Year* 40% 30% 20% 23% 34% 31% 18% 21% 27% 21% 10% 11% 0% Total 2017 Male Female 13 & younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. YOUTH PERCEPTIONS In, 79% of youth reported their parents would disapprove of them using marijuana. Seventy-one percent (71%) of youth reported their peers would disapprove of them misusing prescription drugs. More than three-fifths (62%) of youth reported that people risk harming themselves if they smoke cigarettes. EXECUTIVE SUMMARY 12

15 Youth Trend Summary Youth Variables Weight Control Ohio 2013 U.S Obese 18% 14% 13% 14% 13% 14% Overweight 13% 12% 17% 19% 16% 16% Described themselves as slightly or very overweight 28% 28% 28% 30% 28% 32% Trying to lose weight 49% 47% 57% 57% 47% 46% Exercised to lose weight 51% 44% 43% 42% N/A N/A Ate less food, fewer calories, or foods lower in fat to lose weight 32% 26% 24% 26% N/A N/A Went without eating for 24 hours or more 6% 5% 2% 5% 10% 13%* Took diet pills, powders, or liquids without a doctor s advice 3% 2% 3% 3% 5% 5%* Vomited or took laxatives 1% 2% 2% 2% 5% 4%* Ate 1 to 4 servings of fruits and vegetables per day Physically active at least 60 minutes per day on every day in past week Physically active at least 60 minutes per day on 5 or more days in past week Did not participate in at least 60 minutes of physical activity on at least 1 day 79% 82% 75% 67% N/A N/A 22% 46% 26% 27% 26% 27% 47% 46% 49% 46% 48% 49% 15% 14% 13% 14% 13% 14% Watched TV 3 or more hours per day N/A 40% 26% 24% 28% 25% Unintentional Injuries and Violence Carried a weapon in the past month 5% 8% 9% 8% N/A 4% Had been in a physical fight in the past year Threatened or injured with a weapon on school property in the past year Did not go to school because felt unsafe 21% 21% 23% 17% 20% 23% 7% 7% 7% 3% N/A 6% 5% 7% 4% 2% 5% 6% Electronically/cyber bullied in past year 13% 13% 11% 9% 15% 16% Bullied in the past year 49% 42% 41% 38% N/A N/A Bullied on school property in the past year 35% 30% 27% 20% 21% 20% Hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend 3% 4% 5% 5% N/A 10% in the past year Mental Health Youth who had seriously considered attempting suicide in the past year 13% 14% 15% 18% 14% 18% Youth who had attempted suicide in past year 6% 8% 6% 6% 6% 9% Youth who felt sad or hopeless almost every day for 2 or more weeks in a row 25% 25% 25% 27% 26% 30% N/A - Not available * Comparative YRBS data for U.S. is 2013 Indicates alignment with Ohio State Health Assessment EXECUTIVE SUMMARY 13

16 Youth Trend Summary, continued Youth Variables Alcohol Consumption Ohio 2013 U.S Ever tried alcohol 37% 33% 38% 50% N/A 63% Current drinker 13% 12% 19% 27% 30% 33% Binge drinker (of all youth) 5% 7% 10% 15% 16% 18% Drank for the first time before age 13 (of all youth) 11% 11% 8% 8% 13% 17% Rode with someone who was drinking 17% 15% 12% 8% 17% 20% Drank and drove (of youth drivers) 2% 4% 8% 5% 4% 8% Obtained the alcohol they drank by someone giving it to them (of youth 38% 34% 35% 36% 38% 44% drinkers) Tobacco Use Ever tried cigarettes 18% 18% 14% 19% N/A 32% Current smokers 8% 6% 7% 9% 15% 11% Smoked a whole cigarette for the first time before the age of 13 (of all youth) 4% 3% 2% 2% N/A 7% Sexual Behavior Ever had sexual intercourse 19% 20% 23% 34% 43% 41% Used a condom at last intercourse 65% 69% 61% 62% 51% 57% Used birth control pills at last intercourse 27% 35% 35% 38% 24% 18% Did not use any method to prevent pregnancy during last sexual intercourse Had four or more sexual partners (of all youth) Had sexual intercourse before age 13 (of all youth) Youth who used marijuana in the past month 8% 14% 8% 7% 12% 14% 19% 5% 7% 18% 12% 12% 2% 4% 2% <1% 4% 4% Drug Use 11% 8% 8% 12% 21% 22% Ever used methamphetamines 2% 2% 1% 2% N/A 3% Ever used cocaine 1% 3% 3% 4% 4% 5% Ever used heroin 1% 1% 1% 2% 2% 2% Ever used steroids 2% 3% 1% 2% 3% 4% Ever used inhalants 4% 7% 5% 5% 9% 7% Ever used ecstasy/mdma/molly 2% 2% 2% 3% N/A 5% Ever misused medications 6% 6% 5% 6% N/A N/A Personal Health and Safety Visited a dentist for a check-up within the past year N/A N/A 77% 78% 75% 74% N/A Not available Indicates alignment with Ohio State Health Assessment EXECUTIVE SUMMARY 14

17 Youth Trend Summary, continued Youth Variables Weight Status Obese N/A 11% 19% 18% 14% 13% Overweight N/A 15% 11% 13% 12% 17% Tobacco Use Current smoker 16% 16% 15% 8% 6% 7% Alcohol Consumption Current drinker 30% 28% 26% 13% 12% 19% Youth who used marijuana in the past month Drug Use 13% 14% 17% 11% 8% 8% Sexual Behavior Ever had sexual intercourse N/A 30% 27% 19% 20% 23% Ever had oral sex N/A 27% 26% 19% 19% 20% Mental Health Youth who felt sad or hopeless almost every day for 2 or more weeks in a row Youth who had seriously considered attempting suicide in the past year Youth who had attempted suicide in past year N/A 22% 26% 25% 25% 25% 15% 11% 10% 13% 14% 15% 8% 6% 6% 6% 8% 6% Violence Had been in a physical fight in the past year Did not go to school because felt unsafe 31% 35% 33% 21% 21% 23% 3% 6% 3% 5% 7% 4% Electronically/cyber bullied in past year N/A 12% 12% 13% 13% 11% Bullied in the past year N/A 49% 51% 49% 42% 41% N/A Not available Indicates alignment with Ohio State Health Assessment EXECUTIVE SUMMARY 15

18 Youth Health: Weight Status Key Findings In 2017, 13% of youth were obese, according to Body Mass Index (BMI) by age. When asked how they would describe their weight, 28% of youth reported that they were slightly or very overweight. Over two-thirds (69%) of youth were exercising for 60 minutes on 3 or more days per week. Youth Weight Status BMI for children is calculated differently from adults. The CDC uses BMI-for-age, which is gender and age specific as children s body fatness changes over the years as they grow. In children and teens, BMI is used to assess underweight, normal, overweight, and obese. Dietary Recommendations The amount of fruit and vegetables children should eat are based on a child s age, gender and level of physical activity. Recommendations range from 1 to 2 ½ cups of fruit and 1 to 3 cups of vegetables. Look for whole-grain as the first ingredient in breads and cereals. Children ages 1 to 8 years, need 2 cups of milk per day and children ages 9 to 18 years, need 3 cups per day. (Source: American Heart Association, Dietary Recommendations for Healthy Children, September 2014) In 2017, 13% (approximately 968) of youth were classified as obese by Body Mass Index (BMI) calculations (2013 YRBS reported 13% for Ohio in 2013 and 14% for the U.S. in 2015). Seventeen percent (17%) of youth were classified as overweight (2013 YRBS reported 16% for Ohio and 2015 YRBS reported 16% for the U.S.). Sixty-seven percent (67%) were normal weight, and 3% were underweight. More than one-quarter (28%) of youth described themselves as being either slightly or very overweight (2013 YRBS reported 28% for Ohio and 2015 YRBS reported 32% for the U.S.). Nearly three-fifths (57%) of all youth were trying to lose weight, increasing to 65% of females (compared to 37% of males) (2013 YRBS reported 47% for Ohio and 2015 YRBS reported 46% for the U.S.). In 2017, 13% (approximately 968) of youth were classified as obese. Youth did the following to lose weight or keep from gaining weight in the past 30 days: Exercised (43%) Drank more water (39%) Ate more fruits and vegetables (25%) Ate less food, fewer calories, or foods lower in fat (24%) Skipped meals (15%) Took diet pills, powders, or liquids without a doctor s advice (3%) (2013 YRBS reported 5% for Ohio and the U.S.) Went without eating for 24 hours or more (2%) (2013 YRBS reported 10% for Ohio and 13% for the U.S.) Vomited or took laxatives (2%) (2013 YRBS reported 5% for Ohio and 4% for the U.S.) Smoked cigarettes or e-cigarettes (2%) Used illegal drugs (2%) More than two-fifths (43%) of youth did not do anything to lose or keep from gaining weight. Nutrition Twenty-five percent (25%) or 1,861 youth, ate 5 or more servings of fruits and vegetables per day. Thirty-five percent (35%) ate 3 to 4 servings of fruits and vegetables per day, and 36% ate 1 to 2 servings per day. Four percent (4%) reported not eating any fruits and vegetables per day. WEIGHT STATUS 16

19 Youth Health: Weight Status, continued Four percent (4%) of youth ate 5 or more servings of fruit per day. Twenty percent (20%) ate 3 to 4 servings of fruit per day and 68% ate 1 to 2 servings per day. Eight percent (8%) did not have any servings of fruit. Three percent (3%) of youth ate 5 or more servings of vegetables per day. Sixteen percent (16%) ate 3 to 4 servings of vegetables per day and 66% ate 1 to 2 servings per day. Fifteen percent (15%) did not have any vegetables. Five percent (5%) of youth drank 5 or more servings of sugar-sweetened beverages such as soda pop, sports drinks, or other fruit flavored drinks per day. Twenty-seven percent (27%) drank 3 to 4 servings of sugarsweetened beverages per day and 49% drank 1 to 2 servings per day. Nineteen percent (19%) did not have any sugar-sweetened beverages. Two percent (2%) of youth drank 5 or more servings of caffeinated beverages such as coffee, espresso or energy drinks per day. Eleven percent (11%) drank 3 to 4 servings of caffeinated beverages per day and 36% drank 1 to 2 servings per day. Fifty-one percent (51%) did not have any caffeinated beverages. One in twelve (8%) of youth reported they went to bed hungry on at least one day because their family did not have enough money for food. Two percent (2%) of youth went to bed hungry every night of the week. The following graph shows the percentage of youth who were classified as obese, overweight, normal weight or underweight according to Body Mass Index (BMI) by age. Examples of how to interpret the information in the graph include: 67% of all youth were classified as normal weight, 13% were obese, 17% were overweight, and 3% were underweight for their age and gender. Youth BMI Classifications* 3% 3% 2% 3% 2% 4% 3% 3% 67% 67% 68% 71% 71% 55% 66% 71% 17% 13% 20% 12% 14% 28% 13% 12% 13% 17% 10% 14% 13% 13% 18% 14% Total 2017 Male Female 13 or younger 14 to or older Obese Overweight Normal Weight Underweight *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. WEIGHT STATUS 17

20 Youth Health: Weight Status, continued Healthy People 2020 Nutrition and Weight Status (NWS) Objective 2017 Ohio 2013 U.S Healthy People 2020 Target NWS-10.4 Reduce the proportion of children and adolescents aged 2 to 19 years who are considered obese 13% ( % 14% (9-12 ( % ( %* (Youth 2-19 years) *Note: The Healthy People 2020 target is for children and youth aged 2-19 years. (Sources: Healthy People 2020 Objectives, 2013 and 2015 YRBS, 2017 Youth Health Assessment) The following pie chart shows the average daily consumption of fruits and vegetables for youth. An example of how to interpret the information in the graph include: 25% of all youth ate 5 or more servings of fruits and vegetables per day. Average Number of Servings of Fruits and Vegetables Per Day for Youth 3-4 servings, 35% 5 or more servings, 25% 1-2 servings, 36% 0 servings,, 4% *A serving size of fruits or vegetables is 1 cup. WEIGHT STATUS 18

21 Youth Health: Weight Status, continued Physical Activity Over two-thirds (69%) or approximately 5,137 youth participated in at least 60 minutes of physical activity on 3 or more days in the past week. Forty-nine percent (49%) did so on 5 or more days in the past week (2013 YRBS reports 48% for Ohio and 2015 YRBS reports 49% for the U.S.), and 26% did so every day in the past week (2013 YRBS reports 26% for Ohio and 2015 YRBS reports 27% for the U.S.). Thirteen percent (13%) of youth did not participate in at least 60 minutes of physical activity on any day in the past week (2013 YRBS reports 13% for Ohio and 2015 YRBS reports 14% for the U.S.). youth spent an average of 2.3 hours on social media, 1.9 hours watching TV/On-Demand/Netflix, 1.5 hours doing homework outside of school, and 1.3 hours playing video games on an average school. Just over one-quarter (26%) of youth spent 3 or more hours watching TV on an average day (2013 YRBS reported 28% for Ohio and 2015 YRBS reports 25% for the U.S.). youth did the following to lose weight in the past 30 days: Percent Exercised 43% Drank more water 39% Ate more fruits and vegetables 25% Ate less food, fewer calories, or foods lower in fat 24% Skipped meals 15% Took diet pills, powders, or liquids without a doctor s advice 3% Went without eating for 24 hours 2% Vomited or took laxatives 2% Smoked cigarettes 2% Used illegal drugs 2% Youth Physical Activity Guidelines The CDC recommends that children and adolescents should participate in at least 60 minutes (1 hour) of physical activity per day. Aerobic, muscle strengthening, and bone strengthening are three distinct types of physical activity that children should engage in, appropriate to their age. Most of the physical activity should be either moderate or vigorous aerobic activity. Children should participate in each of these types of activity on at least three days per week. (Source: CDC, Healthy Schools, June 2017) WEIGHT STATUS 19

22 Youth Health: Weight Status, continued Youth Comparisons Ohio 2013 U.S Obese 18% 14% 13% 14% 13% 14% Overweight 13% 12% 17% 19% 16% 16% Described themselves as slightly or very overweight 28% 28% 28% 30% 28% 32% Trying to lose weight 49% 47% 57% 57% 47% 46% Exercised to lose weight 51% 44% 43% 42% N/A N/A Ate less food, fewer calories, or foods lower in fat to lose weight Went without eating for 24 hours or more Took diet pills, powders, or liquids without a doctor s advice 32% 26% 24% 26% N/A N/A 6% 5% 2% 5% 10% 13%* 3% 2% 3% 3% 5% 5%* Vomited or took laxatives 1% 2% 2% 2% 5% 4%* Ate 1 to 4 servings of fruits and vegetables per day Physically active at least 60 minutes per day on every day in the past week Physically active at least 60 minutes per day on 5 or more days in past week Did not participate in at least 60 minutes of physical activity on at least 1 day 79% 82% 75% 67% N/A N/A 22% 27% 26% 27% 26% 27% 47% 46% 49% 46% 48% 49% 15% 14% 13% 14% 13% 14% Watched TV 3 or more hours per day 27% 25% 26% 24% 28% 25% N/A Not Available *Comparative YRBS data for the U.S. is 2013 WEIGHT STATUS 20

23 Youth Health: Tobacco Use Key Findings In 2017, 7% of youth were current smokers, having smoked at some time in the past 30 days. The average age of onset for smoking was 13.9 years old. Nineteen percent (19%) of youth used e-cigarettes/vapes in the past year. Youth Tobacco Use Behaviors In 2017, 19% (approximately 1,415) of youth had tried cigarette smoking, even one or two puffs, increasing to 27% of those ages 17 and older (YRBS reported 32% for the U.S. in 2015). Two percent (2%) of all youth had smoked a whole cigarette for the first time before the age of 13 (2015 YRBS reported 7% for the U.S. in 2015). Twelve percent (12%) of those who had smoked a whole cigarette did so at 8 years old or younger, and another 12% had done so by 12 years old. The average age of onset for smoking was 13.9 years old. Seven percent (7%) or 521 of youth, were current smokers, having smoked at some time in the past 30 days (YRBS reported 15% for Ohio in 2013 and 11% for the U.S. in 2015). In 2017, 19% (approximately 1,415) of youth used e-cigarettes/vapes in the past year. Four-fifths (80%) of youth identified as current smokers were also current drinkers, defined as having had a drink of alcohol in the past 30 days. youth used the following forms of tobacco the most in the past year: e-cigarettes/vapes (19%); Black & Mild s (8%); Swisher Sweets (8%); cigarettes (7%); cigars (4%); cigarillos (4%); chewing tobacco, snuff, dip (4%); pouch (2%); hookah (2%); bidis (1%); little cigars (1%); and dissolvable tobacco products (1%). More than one-third (36%) of youth indicated e-cigarettes/vapes were easily accessible to them. Youth Comparisons Ohio 2013 U.S Ever tried cigarettes 18% 18% 14% 19% 52%* 32% Current smokers 8% 6% 7% 9% 15% 11% Smoked a whole cigarette for the first time before the age of 13 (of all youth) *Comparative YRBS data for Ohio is % 3% 2% 2% 14%* 7% TOBACCO USE 21

24 Youth Health: Tobacco Use, continued The following graph shows the percentage of youth who were current smokers (i.e. having smoked cigarettes in the past 30 days). Examples of how to interpret the information include: 7% of all youth were current smokers: 9% of males and 4% of females. 20% Youth Who Were Current Smokers* 15% 10% 7% 9% 7% 8% 6% 4% 2% 0% Total 2017 Male Female 13 or younger 14 to or older *Current smokers indicate youth who self-reported smoking at any time during the past 30 days. **Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. The table below shows a strong correlation between smoking cigarettes and participating in other risky behaviors as well as increased mental health issues. Behaviors of Youth Current Smokers vs. Non-Current Smokers* Youth Behaviors *Current smokers are those youth surveyed who have self-reported smoking at any time during the past 30 days **See more about Adverse Childhood Experiences (ACEs) on page 43 Current Smoker Non- Current Smoker Had at least one drink of alcohol in the past 30 days 80% 14% Felt sad or hopeless almost every day for 2 or more weeks in a row in the past 12 months 60% 21% Had been bullied in any way in the past year 53% 40% Seriously considered attempting suicide in the past 12 months 47% 12% Experienced 3 or more adverse childhood experiences (ACEs) in their lifetime 46% 19% Used marijuana in the past 30 days 43% 5% Attempted suicide in the past 12 months 28% 4% Misused prescription drugs in the past 30 days 17% 2% TOBACCO USE 22

25 Youth Health: Tobacco Use, continued Objective TU-2.2 Reduce use of cigarettes by adolescents (in the past month) Healthy People 2020 Tobacco Use (TU) 2017 Ohio % ( % 9% (9-12 (9-12 U.S % (9-12 Healthy People 2020 Target 16% (9-12 (Sources: Healthy People 2020 Objectives, 2013 and 2015 YRBS, 2017 Youth Health Assessment) E-Cigarettes and Young People: A Public Health Concern E-cigarettes are devices that typically deliver nicotine flavorings and other additives to users through an inhaled aerosol. E-cigarettes are a rapidly emerging trend and are especially popular among youth and young adults. E-cigarettes can also be used to deliver other drugs, such as marijuana. In 2016, a U.S Surgeon General s Report on e-cigarette use among youth and young adults became the first report that reviewed the health issue of e-cigarettes and their impact on young people. Now, e-cigarettes are the most commonly used form of tobacco by youth in the U.S. Reasons reported by young people for use, includes: Curiosity Taste Belief that they are less harmful that other tobacco products (Source: CDC, E-Cigarettes and Young People: A Public Health Concern, January 31, 2017) TOBACCO USE 23

26 Youth Health: Alcohol Use Key Findings Almost one-fifth (19%) of youth had at least one drink of alcohol in the past 30 days, increasing to 40% of those over the age of 17. Just over half (52%) of youth who reported drinking in the past 30 days had at least one episode of binge drinking. Two percent (2%) of all youth drivers had driven a car in the past month after they had been drinking alcohol. Youth Alcohol Consumption Nearly two-fifths (38%) or 2,829 youth had at least one drink of alcohol in their life, increasing to 68% of those ages 17 and older (2015 YRBS reports 63% for the U.S.). In 2017, 19% (approximately 1,415) of youth had at least one drink in the past 30 days, increasing to 40% of those ages 17 and older (YRBS reports 30% for Ohio in 2013 and 33% for the U.S. in 2015). Based on all youth surveyed, 10% were defined as binge drinkers, increasing to 25% of those ages 17 and older (YRBS reports 16% for Ohio in 2013 and 18% for the U.S. in 2015). Of those who drank, 52% of youth had 5 or more alcoholic drinks on an occasion in the last month and would be considered binge drinkers by definition. Nearly one-quarter (24%) of youth who reported drinking at some time in their life had their first drink at 12 years old or younger; 23% took their first drink between the ages of 13 and 14, and 52% started drinking between the ages of 15 and 18. The average age of onset was 14.1 years old. Of all youth, 8% had drunk alcohol for the first time before the age of 13 (YRBS reports 13% of Ohio youth drank alcohol for the first time before the age of 13 in 2013 and 17% for the U.S. in 2015). In 2017, 19% (approximately 1,415) of youth had at least one drink in the past 30 days. Youth drinkers reported they got their alcohol from the following: someone gave it to them (35%) (2013 YRBS reports 38% for Ohio and 2015 YRBS reports 44% for the U.S.), someone older bought it (30%), their parent gave it to them (28%), an older friend or sibling bought it (23%), took it from a store or family member (15%), bought it in a liquor store/convenience store/gas station (13%), bought it with a fake ID (11%), a friend s parent gave it to them (9%), and obtained it some other way (22%). During the past month, 12% of all youth had ridden in a car driven by someone who had been drinking alcohol (YRBS reports 17% for Ohio in 2013 and 20% for the U.S. in 2015). One in twelve (8%) of youth drivers had driven a car in the past month after they had been drinking alcohol (YRBS reports 4% for Ohio in 2013 and 8% for the U.S. in 2015). Almost half (49%) of youth indicated alcohol was easily accessible to them. ALCOHOL USE 24

27 Youth Health: Alcohol Use, continued The following graphs show the percentage of youth who were current drinkers and who binge drank in the past month. Examples of how to interpret the information include: 19% of all youth had drank in the past 30 days: 21% of males and 17% of females. 50% Youth Who Were Current Drinkers* 40% 40% 30% 20% 19% 21% 17% 19% 13% 12% 10% 5% 0% Total 2017 Male Female 13 or younger 14 to or older * Current drinker is defined as any individual who has had at least 1 alcoholic beverage in the past 30 days **Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. Youth Binge Drinking in the Past Month* 40% 25% 20% 10% 12% 8% 10% 5% 7% 0% Total % Male Female 13 or younger 14 to or older *Binge drinker is defined as the consumption of five or more alcoholic beverages or more on one occasion. **Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. ALCOHOL USE 25

28 Youth Health: Alcohol Use, continued The following graph shows the percentage of youth who drank in their lifetime. Examples of how to interpret the information include: 38% of all youth had drank at some time in their life: 39% of males and 68% of those ages 17 and older. 100% Youth Who Had At Least One Drink In Their Lifetime* 80% 68% 60% 40% 38% 39% 37% 39% 37% 33% 20% 19% 0% Total 2017 Male Female 13 or younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. Youth Comparisons *Comparative YRBSS data for Ohio is Ohio 2013 U.S Ever tried alcohol 37% 33% 38% 50% 71%* 63% Current drinker 13% 12% 19% 27% 30% 33% Binge drinker (of all youth) 5% 7% 10% 15% 16% 18% Drank for the first time before age 13 (of all youth) Rode with someone who was drinking 11% 11% 8% 8% 13% 17% 17% 15% 12% 8% 17% 20% Drank and drove (of youth drivers) 2% 4% 8% 5% 4% 8% Obtained the alcohol they drank by someone giving it to them (of youth drinkers) 38% 34% 35% 36% 38% 44% ALCOHOL USE 26

29 Youth Health: Alcohol Use, continued Objective SA-14.4 Reduce the proportion of persons engaging in binge drinking during the past month (of all youth) Healthy People 2020 Substance Abuse (SA) 2017 Ohio % ( % 15% (9-12 (9-12 U.S % (9-12 Healthy People 2020 Target 9% (9-12 *Note: The Healthy People 2020 target is for youth aged years. (Sources: Healthy People 2020 Objectives, 2013 and 2015 YRBS, 2017 Youth Health Assessment) The table below shows a strong correlation between drinking alcohol and participating in other risky behaviors as well as increased mental health issues. Behaviors of Youth Current Drinkers vs. Non-Current Drinkers* Youth Behaviors Current Drinker Non-Current Drinker Had sexual intercourse in the past 12 months 51% 49% Had been bullied in any way in the past year 49% 39% Felt sad or hopeless almost every day for 2 or more weeks in a row in the past 12 months Experienced 3 or more adverse childhood experiences (ACEs) in their lifetime Misused prescription drugs in the past 30 days 10% 2% *Current drinkers are those youth surveyed who have self-reported having at least one drink of alcohol in the past 30 days. **See more about Adverse Childhood Experiences (ACEs) on page 43 46% 20% 36% 17% Had smoked cigarettes in the past 30 days 30% 2% Seriously considered attempting suicide in the past 12 months 32% 11% Used marijuana in the past 30 days 28% 3% Attempted suicide in the past 12 months 14% 4% ALCOHOL USE 27

30 Youth Health: Drug Use Key Findings In 2017, 8% of youth had used marijuana at least once in the past 30 days, increasing to 19% of those ages 17 and older. Five percent (5%) of youth used medications that were not prescribed for them or took more than prescribed to get high at some time in their life. Youth Drug Use In 2017, 8% of all youth, or 596 youth, had used marijuana at least once in the past 30 days, increasing to 19% of those over the age of 17. The 2013 YRBS found a prevalence of 21% for Ohio youth and a prevalence of 22% for U.S. youth in youth had tried the following in their life: Inhalants (5%) (YRBS reports 9% for Ohio in 2013 and 7% for the U.S. in 2015) Steroids (4%) (YRBS reports 3% for Ohio in 2013 and 4% for the U.S. in 2015) Cocaine (3%) (YRBS reports 4% for Ohio in 2013 and 5% for U.S. in 2015) Hallucinogenic drugs (3%) Misused cough syrup (3%) Liquid THC (3%) Misused over-the-counter medication (2%) Posh/salvia/synthetic marijuana (2%) Bath salts (2%) Ecstasy/MDMA/Molly (2%) (2015 YRBS reports 5% for the U.S.) Had been to a pharm party/used skittles (1%) Carfentanil/ Fentanyl (1%) K2/spice (1%) Methamphetamines (1%) (2015 YRBS reports 3% for the U.S.) Heroin (1%) (YRBS reports 2% for Ohio in 2013 and 2% for U.S. in 2015) GhB (liquid ecstasy) (1%) Misused hand sanitizer (1%) Five percent (5%), or 372 youth, used medications that were not prescribed for them or took more than prescribed to feel good or get high at some time in their lives, increasing to 10% of those over the age of 17. Three percent (3%) of youth used prescription drugs not prescribed for them in the past 30 days. Youth who misused prescription medications got them in the following ways: a parent gave it to them (28%), a friend gave it to them (25%), they took it from a friend or family member (25%), the internet (25%), bought it from a friend (12%), another family member gave it to them (12%), and bought it from someone else (8%). Youth who took prescription drugs not prescribed for them, took the following drugs most often: tranquilizers or anti-anxiety drugs (31%), narcotic pain relivers (such as OxyContin, Percocet and Vicodin) (25%), sleeping pills and other depressants (19%), and stimulants or amphetamines (such as Ritalin) (14%). Youth indicated the following reasons for not using drugs: parents would be upset (67%), their values (60%), legal consequences (53%), kicked out of extra-curricular activities (47%), health problems (40%), their friends would not approve (37%), random student drug testing (22%), and other (27%). In 2017, 33% (approximately 2,457) of youth reported that they knew someone who needed help for a drug or alcohol use/abuse problem. youth indicated the following drugs were easily accessible to them: marijuana (27%), prescription drugs not prescribed for them (22%), cocaine (5%), synthetics (such as K2/spice) (4%), heroin (3%), and methamphetamines (3%). DRUG USE 28

31 Youth Health: Drug Use, continued The following graphs indicate youth lifetime drug use and youth marijuana use in the past 30 days. Examples of how to interpret the information include: 5% of youth had misused medication at some point in their life: 6% of males and 3% of females. 15% Youth Lifetime Drug Use* 10% 5% 0% 7% 6% 6% 6% 5% 5% 5% 3% 3% 3% 3% 3% 3% 2% 2% 2% 1% 1% 1% 1% 1% 1% 0% 0% Medications Steroids Inhalants Cocaine Heroin Meth Total 2017 Male Female 2015 *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. In 2017, 33% (approximately 2,457) of youth reported that they knew someone who needed help for a drug or alcohol use/abuse problem. 30% Youth Marijuana Use in Past Month* 25% 20% 19% 15% 11% 10% 8% 8% 8% 8% 8% 5% 2% 0% Total 2017 Male Female 13 or younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. DRUG USE 29

32 Youth Health: Drug Use, continued Youth Comparisons Youth who used marijuana in the past month Ohio 2013 U.S % 8% 8% 12% 21% 22% Ever used methamphetamines 2% 2% 1% 2% N/A 3% Ever used cocaine 1% 3% 3% 4% 4% 5% Ever used heroin 1% 1% 1% 2% 2% 2% Ever used steroids 2% 3% 1% 2% 3% 4% Ever used inhalants 4% 7% 5% 5% 9% 7% Ever used ecstasy/mdma/molly 2% 2% 2% 3% N/A 5% Ever misused medications 6% 6% 5% 6% N/A N/A N/A Not available Youth Availability of Substances Substance Available Not Available Don t Know Alcohol 49% 35% 17% E-cigarettes/vapes 36% 49% 15% Tobacco 33% 54% 13% Marijuana 27% 63% 11% Prescription drugs not prescribed to you 22% 59% 19% Cocaine 5% 79% 17% Synthetic drugs (ex. K2, Spice, etc.) 4% 75% 21% Methamphetamines 2% 79% 19% Heroin 2% 80% 18% DRUG USE 30

33 Youth Health: Drug Use, continued The table below shows a strong correlation between using marijuana and participating in other risky behaviors as well as increased mental health issues. Behaviors of Youth Current Marijuana Use vs. Non-Current Marijuana Use* Youth Behavior Current Marijuana User Non-Current Marijuana User Had sexual intercourse in the past 12 months 76% 17% Had at least one drink of alcohol in the past 30 days 66% 15% Experienced 3 or more adverse childhood experiences (ACEs) in their lifetime 56% 17% Felt sad or hopeless almost every day for 2 or more weeks in a row in the past 12 months 49% 23% Had been bullied in any way in the past year 47% 40% Seriously considered attempting suicide in the past 12 months 41% 12% Smoked cigarettes in the past 30 days 38% 4% Attempted suicide in the past 12 months 24% 4% Misused prescription drugs in the past 30 days 17% 2% *Current marijuana use indicates youth who self-reported using marijuana at any time during the past 30 days. **See more about Adverse Childhood Experiences (ACEs) on page 43 DRUG USE 31

34 Youth Health: Sexual Behavior Key Findings In 2017, 23% of youth had sexual intercourse. One-fifth (20%) of youth had participated in oral sex and 6% had participated in anal sex. Twenty-four percent (24%) of youth participated in sexting. Of those who were sexually active, 60% had multiple sexual partners. Youth Sexual Behavior In 2017, 23% (approximately 1,712) of youth, had sexual intercourse, increasing to 53% of those ages 17 and over (YRBS reports 43% for Ohio in 2013 and 41% for U.S. in 2015). Twenty percent (20%), or 1,489 youth, had participated in oral sex, increasing to 46% of those ages 17 and over. Six percent (6%) of youth had participated in anal sex, increasing to 12% of those ages 17 and over. Nearly one-quarter (24%), or 1,787 youth, had participated in sexting, increasing to 50% of those ages 17 and over. Twenty-eight percent (28%) of youth had viewed pornography, increasing to 48% of males and 47% of those ages 17 and over. In 2017, 23% (approximately 1,712) of youth had sexual intercourse. Of those youth who were sexually active, 40% had one sexual partner and 60% had multiple partners. Approximately 521, or 7% of all youth had 4 or more sexual partners (YRBS reports 12% for Ohio in 2013 and 12% for the U.S. in 2015). Nearly one-third (31%) of all sexually active youth had 4 or more partners (2013 YRBS reports 28% for Ohio). Of those youth who were sexually active, 10% had done so by the age of 13. Another 53% had done so by 15 years of age. The average age of onset was 15.0 years old. Of all youth, 2% were sexually active before the age of 13 (YRBS reports 4% for Ohio in 2013 and 4% for the U.S. in 2015). Almost two-thirds (61%) of youth who were sexually active used condoms to prevent pregnancy; 35% used birth control pills; 6% used the withdrawal method; 2% used an IUD; and 1% used a shot, patch or birth control ring. Four percent (4%) reported they were gay or lesbian. However, 8% were engaging in sexual intercourse without a reliable method of protection, and 6% reported they were unsure. Percentages exceed 100% due to multiple methods being used. Youth learned about pregnancy prevention, sexually transmitted diseases, HIV, AIDS, and the use of condoms from the following: school (67%), parents (56%), the internet or other social media (32%), friends (30%), their doctor (26%), siblings (16%), church (4%), and somewhere else (6%). Fifteen percent (15%) of youth had not been taught about these subjects. SEXUAL BEHAVIOR 32

35 Youth Health: Sexual Behavior, continued The following graphs show the percentage of youth who participated in sexual intercourse and oral sex. Examples of how to interpret the information include: 23% of all youth had sexual intercourse: 25% of males, and 20% of females. 75% Youth Who Had Sexual Intercourse* 50% 53% 25% 23% 25% 20% 23% 19% 20% 0% Total % Male Female 13 or Younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. 75% Youth Who Participated in Oral Sex* 50% 46% 25% 20% 21% 19% 22% 19% 19% 0% Total % Male Female 13 or Younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. SEXUAL BEHAVIOR 33

36 Youth Health: Sexual Behavior, continued The following graphs show the percentage of youth who participated in anal sex and sexting. Examples of how to interpret the information include: 6% of all youth participated in anal sex: 10% of males, and 2% of females. 20% Youth Who Participated in Anal Sex* 12% 10% 10% 6% 7% 2% 1% 4% 3% 0% Total 2017 Male Female 13 or Younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. 75% Youth Who Participated in Sexting* 50% 50% 25% 24% 24% 24% 26% 16% 20% 4% 0% Total 2017 Male Female 13 or Younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. SEXUAL BEHAVIOR 34

37 Youth Health: Sexual Behavior, continued Youth Comparisons Ohio 2013 U.S Ever had sexual intercourse 19% 20% 23% 34% 43% 41% Used a condom at last intercourse 65% 69% 61% 62% 51% 57% Used birth control pills at last intercourse Did not use any method to prevent pregnancy during last sexual intercourse Had four or more sexual partners (of all youth) Had sexual intercourse before age 13 (of all youth) 27% 35% 35% 38% 24% 18% 8% 14% 8% 7% 12% 14% 19% 5% 7% 10% 12% 12% 2% 4% 2% 1% 4% 4% Sexual Risk Behavior Many young people engage in sexual risk behaviors that can result in unintended health outcomes. For example, among U.S. high school students surveyed in 2015: 41% had ever had sexual intercourse 30% had sexual intercourse during the previous 3 months, and of these, 43% did not use a condom the last time they had sex 14% did not use any method to prevent pregnancy 21% had drank alcohol or used drugs before last sexual intercourse Only 10% of sexually experienced students have ever been tested for HIV Sexual risk behaviors place adolescents at risk for HIV infection, other sexually transmitted diseases (STDs), and unintended pregnancy. Young people (aged 13-24) accounted for an estimated 22% of all new HIV diagnoses in the United States in Among young people (aged 13-24) diagnosed with HIV in 2015, 81% were gay and bisexual males. Half of the nearly 20 million new STDs reported each year are among young people, between the ages Nearly 230,000 babies were born to teen girls aged years in (Source: CDC, Adolescent and School Health, updated August 4, 2017) SEXUAL BEHAVIOR 35

38 Youth Health: Mental Health Key Findings In 2017, 15% of youth had seriously considered attempting suicide in the past year and 6% attempted suicide in the past year. Youth Mental Health In the past year, approximately 1,861, or 25% of youth, reported they felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities, increasing to 33% of females (YRBS reported 26% for Ohio in 2013 and 30% for the U.S. in 2015). Fifteen percent (15%), or 1,117 youth, reported they had seriously considered attempting suicide in the past 12 months. Eighteen percent (18%) of high school youth had seriously considered attempting suicide. The 2015 YRBS reported a rate of 18% for U.S. youth and the 2013 YRBS rate of 14% for Ohio youth. In the past year, approximately 447 (6%) youth had attempted suicide. Four percent (4%) of youth had made more than one attempt. The 2015 YRBS reported a suicide attempt prevalence rate of 9% for U.S. youth and a 2013 YRBS rate of 6% for Ohio youth. In 2017, 25% (approximately 1,861) of youth reported they felt so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities. Over one-fifth (28%) of youth reported they would seek help if they were dealing with anxiety, stress, depression or thoughts of suicide. youth reported the following caused them anxiety, stress and depression: academic success (45%), fighting with friends (39%), sports (33%), self-image (32%), death of close family member or friend (30%), peer pressure (29%), fighting at home (28%), other stress at home (27%), being bullied (23%), dating relationship (20%), a breakup (17%), parent divorce/separation (15%), poverty/no money (15%), caring for younger siblings (9%), parent is sick (7%), alcohol/drug us in the home (6%), not having enough to eat (4%), sexual orientation (3%), not having a place to live (2%), and other (17%). youth reported the following ways of dealing with anxiety, stress, or depression: sleeping (43%), texting someone (29%), exercising (28%), hobbies (27%), talking to a peer (25%), talking to someone in their family (21%), eating (21%), using social media (15%), pray/reading the Bible (12%), breaking something (11%), shopping (9%), writing in a journal (8%), and drink alcohol/smoke/use tobacco/use illegal drugs (7%). Nineteen percent (19%) of youth reported they did not have anxiety, stress, or depression. Of youth who felt depressed or suicidal, 27% reported they would be very likely to seek help. Over one-quarter (29%) reported it would be very unlikely for them to seek help. MENTAL HEALTH 36

39 Youth Health: Mental Health, continued The following graphs show youth who had seriously considered attempting suicide and had attempted suicide in the past year. Examples of how to interpret the information include: 15% of youth seriously considered attempting suicide in the past year: 17% of males, and 13% of females. 30% Youth Who Had Seriously Considered Attempting Suicide in the Past 12 Months* 25% 22% 20% 15% 15% 17% 13% 15% 13% 14% 10% 10% 5% 0% Total 2017 Male Female 13 or younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. 15% Youth Who Attempted Suicide in the Past 12 Months* 10% 8% 8% 5% 6% 6% 6% 5% 5% 6% 0% Total 2017 Male Female 13 or younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. MENTAL HEALTH 37

40 Youth Health: Mental Health, continued Youth Comparisons Youth who had seriously considered attempting suicide in the past year Youth who had attempted suicide in the past year Youth who felt sad or hopeless almost every day for 2 or more weeks in a row Ohio 2013 U.S % 14% 15% 18% 14% 18% 6% 8% 6% 6% 6% 9% 25% 25% 25% 27% 26% 30% The table below shows a strong correlation between contemplating suicide and participating in other risky behaviors as well as increased mental health issues. Behaviors of Youth Contemplated Suicide vs. Did Not Contemplate Suicide* Youth Behaviors *Contemplated suicide indicates youth who self-reported seriously considering attempting suicide in the past year. **See more about Adverse Childhood Experiences (ACEs) on page 43 Contemplated Suicide Did Not Contemplate Suicide Been bullied in any way in the past year 67% 36% Experienced 3 or more adverse childhood experiences (ACEs) in their lifetime 57% 14% Had at least one drink of alcohol in the past 30 days 39% 15% Smoked cigarettes in the past 30 days 22% 4% Used marijuana in the past 30 days 22% 5% Misused prescription drugs in the past 30 days 18% 1% Suicide Among Youth Suicide affects all youth, but some groups are at a higher risk than others. Boys are more likely than girls to die from suicide. Girls, however, are more likely to report attempting suicide than boys. Several factors can put a young person at risk for suicide. However, having these risk factors does not always mean that suicide will occur. Risk Factors Include: History of previous suicide attempts Family history of suicide History of depression or other mental illness Alcohol or drug abuse Stressful life event or loss Easy access to lethal methods Exposure to the suicidal behavior of others Incarceration (Source: CDC, Gateway to Health Communication & Social Marketing Practice Youth Suicide, September 15, 2017) MENTAL HEALTH 38

41 Youth Health: Personal Health and Safety Key Findings Eighty-percent (80%) of youth had visited a doctor or healthcare professional for a routine checkup in the past year. More than three-quarters (77%) of youth had visited a dentist within the past year. Thirty percent (30%) of youth drivers had texted while driving in the past 30 days. Four percent (4%) of youth had played the choking game, also known as the pass-out game, space monkey, or dream game. Personal Health youth last saw a dentist for a check-up, exam, teeth cleaning, or other dental work: less than a year ago (77%), (2013 YRBS reported 75% for Ohio), 1 to 2 years ago (11%), more than 2 years ago (5%), never (1%), and do not know (6%). Approximately 5,956, or 80% of youth, visited a doctor or healthcare professional for a routine checkup in the past year. The following graph shows youth who had visited the dentist in the past year. Examples of how to interpret the information includes: 77% of youth had visited the dentist in the past year: 76% of males, and 78% of females. 100% Youth Visiting a Dentist in the Past Year* 80% 77% 76% 78% 74% 81% 72% 60% 40% 20% 0% Total 2017 Male Female 13 or younger 14 to or older *Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey. Youth Comparisons Visited a dentist for a check-up within the past year N/A- Data not available Ohio 2013 U.S N/A N/A 77% 78% 75% 74% PERSONAL HEALTH AND SAFETY 39

42 Youth Health: Personal Health and Safety, continued Personal Safety In the past month, youth drivers did the following while driving: wore a seatbelt (91%), ate (39%), drove while tired or fatigued (36%), talked on their cell phone (31%), texted (30%), used their cell phone other than for talking or texting (26%), applied makeup (5%), used marijuana (4%), read (3%), misused prescription drugs (2%), drank alcohol (1%), and used illegal drugs (1%). Just over two-fifths (42%) of youth drivers had more than one distraction while driving. Fifty percent (50%) of youth reported that they had never heard of the choking game, also known as the pass-out game, space monkey, or dream game. Thirty-eight percent (38%) have heard of the choking game, but don t know anyone who has played it. Five percent have head of it and know others who have played, but have not played. Three percent (3%) have heard of it and was asked to play but said, No. Two percent (2%) have played choking game once and an additional two percent (2%) have played more than once. More than three-fifths (63%) of youth had taken water safety or swimming lessons, classes, or instruction. In the past 12 months, youth had gone swimming at the following places: beach, lake or bay (76%), private pool (74%), public pool (64%), a waterpark (62%), and at a pond (23%). Ninety-three percent (93%) of youth had a social media or online gaming account. Of those youth who had an account, they agreed with the following statements: I know all of the people in my friends (56%) My account is currently checked private (53%) I believe sharing personal information online is dangerous (53%) I know all of the people I play with online (32%) My parents have the password to these accounts (23%) My friends have the password to some or all of these accounts (13%) I have been asked to meet someone I met online (8%) I have been bullied as a result of these accounts (8%) I share personal information about myself, such as where I live (5%) My parents do not know I have an account (5%) I have participated in sexual activity with someone I met online (5%) Teen Drivers: Get the Facts Motor vehicle crashes are the leading cause of death for U.S. teens. In 2015, six teens ages 16-19, died every day from motor vehicle injuries. Risk Factors Include: Prevention: Males Wearing a seatbelt Teens driving with teen passengers Enforcing seatbelt laws Newly licensed teens Graduated Driver Licensing Program (GDL) Nighttime driving Not drinking and driving Drowsy driving Impaired driving (Source: CDC, Motor Vehicle Safety, Teen Drivers: Get the Facts October 16, 2017) PERSONAL HEALTH AND SAFETY 40

43 Youth Health: Social Determinants Key Findings In 2017, approximately 1,563, or 21% of youth, had three or more adverse childhood experiences (ACEs), increasing to 28% of females in their lifetime. Neighborhood and Built Environment youth reported living with: both parents (64%), mother and step-father (14%), mother only (14%), father only (6%), grandparents (5%), father and step-mother (4%), mother and her partner (2%), another relative (2%), father and his partner (1%), guardians/foster parents (1%) and on their own or with friends (1%). According to the American Community Survey 5 year estimates, 18.9% of youth under 18 years old were below the poverty level. (Source: CDC, Adolescent and School Health: Health & Almost two-thirds (64%) of children under 18 years live in Academics, October 28, 2017) owner-occupied housing units in, compared to 36% who live in renter-occupied housing units (Source: American Community Survey). Social and Community Context Youth Health and Academics Academic success of America s youth is strongly linked with their health, and is one way to predict adult health outcomes. Health-risk behaviors such as early sexual initiation, violence, and substance use are consistently linked to poor grades and test scores. Research shows that school health programs reduce the prevalence of health risk behaviors among young people and have a positive effect on academic performance. Academic success is an excellent indicator for the overall well-being of youth and a primary predictor and determinant of adult health outcomes. Ninety-one percent (91%) of youth participated in extracurricular activities. They participated in the following: sports or intramural programs (55%), school club or social organization (45%), exercising (outside of school) (38%), part-time job (26%), church or religious organization (21%), volunteering in the community (21%), church youth group (19%), babysitting for other kids (18%), caring for siblings after school (15%), caring for parents or grandparents (3%), and some other organized activity (Scouts, 4H, etc.) (10%). Youth reported the following reasons as to why they do not currently participate in extracurricular activities: no interest (28%), have a job (9%), do not fit in or feel comfortable (9%), transportation (8%), caring for younger siblings (6%), can t afford it (6%), activity doesn t exist/not offered (4%), parents won t take them (3%), and caring for parents or grandparents (2%). Youth reported the following adverse childhood experiences (ACEs) in their lifetime: parents became separated or were divorced (28%); parents or adults in home swore at them, insulted them or put them down (25%); family did not look out for each other, feel close to each other, or support each other (15%); lived with someone who was depressed, mentally ill or suicidal (13%); lived with someone who was a problem drinker or alcoholic (12%); lived with someone who served time or was sentenced to serve in prison or jail (11%); parents were not married (10%); lived with someone who used illegal drugs or misused prescription drugs (9%); parents or adults in home abused them (7%); parents or adults in the home abused each other (5%); did not have enough to eat, had to wear dirty clothes, and had no one to protect them (3%); an adult or someone 5 years older than them touched them sexually (3%); an adult or someone 5 years older than them tried to make them touch them sexually (2%); and an adult or someone 5 years older than them forced them to have sex (1%). Approximately 1,563, or 21% of youth, had three or more adverse childhood experiences, increasing to 28% of females. SOCIAL DETERMINANTS OF HEALTH 41

44 Youth Health: Social Determinants, continued Education The graph below shows the graduation rate component for the percent of students who are successfully finishing high school with a diploma in four or five years. The 4-year graduation rate applies to the Class of 2016, who entered the 9 th grade in 2013 and graduated by The 5-year graduation rate applies to the Class of 2015, who entered the 9 th grade in 2012 and graduated by Longitudinal Graduation Rate, * 98% 99% 100% 95% 95% 94% 95% 98% 80% 76% 95% 93% 86% 84% Edison Local Huron City Margaretta Local Perkins Local Sandusky City 4-years 5-years Vermilion Local (Source: Ohio Department of Education: School Report Cards, , District Graduation Rates) Ohio The table below shows a strong correlation between experiencing ACEs and participating in other risky behaviors as well as increased mental health issues. Behaviors of Youth Experienced 3 or More ACEs vs. Did Not Experience Any ACEs Youth Behaviors Experienced 3 or More ACEs Did Not Experience Any ACEs Had been bullied in any way in the past year 64% 32% Seriously considered attempting suicide in the past 12 months 57% 16% Attempted suicide in the past 12 months 56% 16% Used marijuana in the past 30 days 56% 38% Misused prescription drugs in the past 30 days 50% 21% Felt sad or hopeless almost every day for 2 or more weeks in a row in the past 12 months 47% 19% Smoked cigarettes in the past 30 days 46% 25% Had sexual intercourse in the past 12 months 38% 38% Had at least one drink of alcohol in the past 30 days 36% 33% SOCIAL DETERMINANTS OF HEALTH 42

45 Youth Health: Social Determinants, continued Adverse Childhood Experiences (ACEs) Childhood abuse, neglect, and exposure to other traumatic stressors which we term adverse childhood experiences (ACEs) are common. The most common are separated or divorced parents, verbal, physical or sexual abuse, witness of domestic violence, and having a family member with depression or mental illness. The short and long-term outcomes of these childhood exposures include a multitude of health and social problems such as: Depression Alcoholism and alcohol abuse Fetal death Chronic Obstructive Pulmonary Disease (COPD) Illicit drug use Unintended pregnancies Liver disease Suicide attempts STD s Multiple sexual partners Early initiation of smoking Risk for intimate partner violence Given the high prevalence of ACEs, additional efforts are needed at the state and local level to reduce and prevent childhood maltreatment and associated family dysfunction in the US. (Source: CDC, Adverse Childhood Experiences, June 2016) SOCIAL DETERMINANTS OF HEALTH 43