Adolescent Health Risk Behavior John Kulig, MD, MPH [email protected] Professor of Pediatrics, Tufts University School of Medicine Director, Adolescent Medicine, Floating Hospital for Children.
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Adolescent Health Risk Behavior John Kulig, MD, MPH [email protected] Professor of Pediatrics, Tufts University School of Medicine Director, Adolescent Medicine, Floating Hospital for Children at New England Medical Center, Boston, MA “The children now love luxury; they have bad manners, contempt for authority; they allow disrespect for elders and love chatter in place of exercise. Children now are tyrants, not the servants of their households. They no longer rise when elders enter the room. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and tyrannize their teachers.” Socrates Leading causes of death US population, 15-19 years, 1999 Rank Cause 1st 2nd 3rd 4th 5th unintentional injury homicide suicide malignancy heart disease # deaths 6,688 2,903 1,615 745 463 % of total 48.5 15.2 11.7 5.4 3.4 Ref: CDC - NCHS Motor vehicle crash fatalities 42,000 Americans killed in MVCs in 1999, including 5586 teenagers and 2055 children driver inexperience speeding non-use of safety belts - 14.1% rarely or never wear seat belts [YRBS 2001] driving older vehicles alcohol use Alcohol and Adolescent Mortality “Postmortem studies show that 45% - 50% of adolescent victims of violent death had been drinking alcohol before their death.” motor vehicle crashes: driver, passenger, pedestrian, motorcycle, ATV, PWC, snowmobiles unintentional injury: drowning, fire, falls homicide suicide Ref: J Stud Alcohol 1985;46:228-231 Scope of the Problem Prevalence of alcohol use: “Had 5 or more drinks in a row in the last 2 weeks.” 8th grade: 10th grade: 12th grade: 13% 25% 30% Source: Monitoring the Future Study: 2001 data Alcohol: Binge Drinking Scope of the Problem Drinking and driving: Rode Drove 9th grade: 30% 7% 10th grade: 31% 10% 11th grade: 29% 17% 12th grade: 33% 22% Source: CDC 2001 Youth Risk Behavior Survey Scope of the Problem Sexual risk behavior: “Alcohol or drug use at last sexual intercourse, among students currently sexually active.” male 25% 21% female 24% 36% 9th grade: 10th grade: 11th grade:18% 31% 12th grade: 20% 32% Source: CDC 2001 Youth Risk Behavior Survey Adolescent homicide deaths homicide is the second leading cause of death among 15-19 year-olds - first leading cause among African Americans age 15-24 years 2903 homicides in the 15-19 year high school age group in 1999 - 82% were killed with firearms two thirds of high school students report physical fighting in the past year - 4% sustained serious injury one fifth of high school students report carrying a weapon in the previous 30 days Behaviors associated with violence carried a weapon - past 30 days physical fight - past 12 months injured in fight - past 12 months forced to have sexual intercourse threatened with weapon at school felt too unsafe to attend school male female 29% 43% 5% 5% 12% 6% 6% 24% 3% 10% 7% 7% Source: CDC 2001 Youth Risk Behavior Survey Adolescent suicides youth suicide rates have tripled since the 1950s suicide is the third leading cause of death for 15-24 year-olds 1615 suicides in the 15-19 year high school age group in 1999 more youth suicides annually than cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined Behaviors associated with suicide felt sad or hopeless seriously considered suicide made a suicide plan attempted suicide attempt required medical care male female 22% 14% 12% 6% 2% 35% 24% 18% 11% 3% Source: CDC 2001 Youth Risk Behavior Survey Leading causes of death US population, total, 1999 Rank Cause # deaths % of total 1st 2nd 3rd 4th 5th 725,192 549,838 167,366 124,181 97,860 30.3 23.0 7.0 5.2 4.1 heart disease malignancy cerebrovascular lower respiratory unintentional injury Ref: CDC - NCHS Cigarettes Smokeless Tobacco Obesity Trends* Among U.S. Adults BRFSS, 1991, 1995 and 2000 (*BMI 30, or ~ 30 lbs overweight for 5’4” woman) 1991 1995 2000 No Data <10% 10%-14% 15-19% Source: Mokdad A H, et al. J Am Med Assoc 1999;282:16, 2001;286:10. 20% Behaviors associated with weight control exercised to lose weight ate less food to lose weight fasting > 24 hr to lose weight took diet pills, powders, liquids vomited or took laxatives male female 51% 28% 8% 6% 3% 68% 59% 19% 13% 8% Source: CDC 2001 Youth Risk Behavior Survey Sexual risk behavior ever had sexual intercourse male female grade 9 grade 10 grade 11 grade 12 >4 lifetime sexual partners grade 9 41% 42% 54% 61% male 14% 29% 39% 50% 60% female 6% 24% 20% grade 12 Source: CDC 2001 Youth Risk Behavior Survey Sexual risk behavior initiation of sexual intercourse before age 13 male students 9% female students 4% white students 5% black students 16% Hispanic students 8% all students 7% Source: CDC 2001 Youth Risk Behavior Survey Sexual risk behavior condom use during last sexual intercourse white students black students Hispanic students alcohol 57% 67% 54% or drug use at last sexual intercourse male students 31% female students 21% white students 28% black students 18% Hispanic students 24% Source: CDC 2001 Youth Risk Behavior Survey Adolescent Pregnancy “Have been pregnant or gotten someone pregnant.” male female white black Hispanic 4% 5% 3% 11% 6% Source: CDC 2001 Youth Risk Behavior Survey New cases of STD by age 25 yr + 33% 15-19 yr 25% 20-24 yr 42% STD Overview 3 million US adolescents acquire STDs each year 1 in 4 sexually active adolescents will acquire an STD before high school graduation 1 in 5 Americans with AIDS were infected during adolescence $10,000,000,000 total costs for STDs in US in 1994, excluding HIV infection Infection rate per 100,000 sexually active women 4500 4000 3500 3000 2500 Gonorrhea Chlamydia 2000 1500 1000 500 0 15-19 20-24 25-29 Ref: CDC Division of STD Prevention, 1995 Adolescent development and STD risk psychosexual maturation cognitive development biologic development knowledge attitudes behavior sociocultural context Pelvic inflammatory disease sequelae tubal infertility one episode two episodes three episodes ectopic 8% - 11% 20% - 30% 40% - 55% pregnancy increased risk 3 - 7 times tubo-ovarian abscess chronic PID/adhesions Ref: Lawson MA, Blythe MJ. Pediatr Clin North Am 1999; 46:767 Functional domains in adolescence individual family/home peer group school employment sociocultural What’s new in 2002? renewed interest in protective factors, such as family connectedness, school connectedness and spirituality, to offset risk factors youth development initiatives that focus on youth as assets to be developed rather than problems to be solved