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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Transcript 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.
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