Healthy Kids Colorado Survey Background, Process & Results Welcome to the Colorado Connections for Healthy Schools Coalition meeting! My name is Andrea Sherman and I am with OMNI Institute. This is my colleague Katie Page. She will be walking you through much of the data outlined in your fact sheets during the second half of the presentation. For the first part of the presentation, I will be discussing the background of the survey as well as the the recruitment and administration process. As we go through this, please feel free to ask any questions that arise keeping in mind that it is likely we will cover your questions in subsequent slides, and that we have also reserved time at the end of this presentation for questions.

Introduction Healthy Kids Colorado Survey (HKCS) State-wide effort High schools are randomly selected Conducted every two years The Healthy Kids Colorado Survey is a state-wide effort that assesses the health-related attitudes and behaviors of high school students in Colorado. The survey is conducted every two years within randomly selected high schools. As many of you may know, the state-wide Healthy Kids Colorado Survey was conducted most recently in the fall of 2009, and as a result of this effort, we now have data that can be considered representative of all high school students in Colorado.

HKCS Survey Design Module 1: Youth Risk Behavior Survey (YRBS) 2005 weighted state sample 2007 un-weighted state sample 2009 weighted state sample Module 2: Colorado Supplement Data analysis in process The Healthy Kids Colorado Survey is made up of two modules. The first module is also know as the Youth Risk Behavior Survey. For Module 1, we have only obtained weighted data twice in the past 10 years, once in 2005, and now in 2009. Having weighted data means that we can we generalize about the health-risk behaviors across all high school students in Colorado. Having weighted data also means that we can begin to look at change over time. This however, is limited by the fact that there are only 2 points in time to consider, but this is definitely a necessary and exciting beginning. The second module is the Colorado Supplement which includes questions on Risk & Protective factors. Data from this module is currently in the process of being analyzed and will be included in the comprehensive state report that will be released in August. 4

Partners State Survey Strategic Planning Team CO Department of Education CO Department of Public Health and Environment CO Department of Human Services, Division of Behavioral Health OMNI Institute Planning and recruitment for the 2009 Healthy Kids Colorado Survey was conducted through the State Survey Strategic Planning team which is made up of members from the CO Departments of Education, Public Health and Environment as well as the Division of Behavioral Health at the CO Department of Human Services, and OMNI Institute. This team met monthly to discuss recruitment strategies, create resources for schools and coordinators, identify partners and key influencers, and trouble-shoot resistant schools and districts.

Behaviors Measured Unintentional Injuries and Violence Tobacco Use Alcohol and other Drug Use Sexual Behaviors Weight Management and Diet Physical Activity The HKCS assesses the behaviors that are the leading causes of morbidity and mortality among youth. These behaviors fall into 6 categories. The first domain covers unintentional injuries and violence. This part of the survey is made up of questions regarding safety, violence-related behaviors, bullying, and suicide The second domain covers tobacco use which asks not only about cigarettes, but cigars and smokeless tobacco as well. The survey also measures alcohol and other drug use including questions about marijuana, cocaine, inhalants, heroin, ecstasy, and methamphetamines. The fourth domain asks questions that relate to students’ overall sexual health and includes questions about sexual intercourse, birth control and condom use, as well as alcohol or drug use during last sexual intercourse. The Weight Management and Diet domain asks students to self-report their height and weight in order to calculate their BMI, which allows us to determine the prevalence of overweight and obese youth. This domain also covers nutrition and unhealthy weight control behaviors. Finally, the last domain measures participation in physical activity, physical education classes and sports teams; as well as determines the level at which students are watching television, playing video games and using computers.

Purpose & Applications Determine prevalence of health-risk behaviors Monitor behaviors over time Create awareness Develop programs and policies Support health-related legislation Offer comparison data Seek funding There are several reasons why data from this survey is useful and even beneficial. First, results from the survey allow the state and their partners to determine the prevalence of health risk behaviors and monitor those behaviors over time. Second, we are able create awareness so that we can set program and policy goals around these health-risk behaviors; and then develop those programs and policies. These data can also draw support for health-related legislation to improve the health of Colorado youth Offer comparison data so that we can see how we are doing in comparison to the country as a whole and so that local communities can compare their data to state and the nation as well. Lastly, with these data, we are able to demonstrate the need for funding that can help support new and ongoing efforts in their missions to address these health-risk behaviors.

Sampling and Weighting Sampling Framework Schools selected based on probability proportional to enrollment size Equal probability classroom sampling Weighting Each response weighted to accurately represent the statewide student population Response Rates School-level response rate = 95% Student-level response rate = 66% Overall response rate = 62% Now that I’ve given you the overall background of the survey and it’s purpose, I can provide you with the details of the overall process. As I mentioned earlier, schools were randomly selected to participate. The Centers for Disease Control provides each state with the schools that are selected into their sample. Schools are selected proportional to size; that is, larger schools are more likely to be selected into the sample. Once we are working with the schools, classrooms are then randomly selected. Each classroom has an equal probability that they will be selected into the sample. CDC has a cutoff of a 60% overall response rate in order to weight state level data. This means that if that 60% is achieved, data can be considered representative of all high school students in Colorado. The overall response rate consists of the school-level response rate, meaning the percentage of schools that participated; multiplied by the percentage of selected students that participated. As you can see our school-level response rate was high. 36 out of the 38 selected schools participated. Our student-level response rate was 66%. Ideally, it would have been closer to a 70-80% response rate however, there were many factors that came into play, such as whether we were allowed access to all of the classrooms selected, whether there were absences within the classrooms selected, and whether students opted not to participate because the survey is voluntary.

2009 Sample Total Sample Size 1,511 students 36 schools 15 school districts For 2009, the total sample size was 1,511 students. These students represent 36 different high schools within 15 different school districts throughout Colorado. As you can tell by the pie charts, there is a fairly equal distribution between males and females that completed the survey; as well as between 9th through 12th grades.

To give you an idea of what the distribution looks like across Colorado, here is a break down of student participation by region. You can see that Region 2 (which consists of the Denver Metro area), had the most participation as it is the most densely populated part of our state. This is followed by Region 3 which covers the Colorado Springs area. From there, participation in the top half of the state was greater. Region 1 is made up of the northeast counties and includes Ft. Collins and Greeley; and Region 6 which is made up of the northwestern counties and includes Grand Junction and other mountain towns such as Glenwood Springs. The bottom half of the map represents southeast Colorado and the southern mountains and includes, Pueblo in Region 4 and Durango in Region 5.

Process Notify selected schools Work with school-level survey coordinator Randomly select classes Package surveys for administration Administer and return the surveys Analyze survey data Much of our focus was to ensure that schools were successful in the administration of the HKCS. In order to ensure this, we really started preparing for this effort about a year in advance. During the spring prior to administration, we notified the schools that were selected and asked the principal to identify a school-level coordinator that we could work with from that point forward. Once the fall semester started, we randomly selected classes and prepared schools for administration by offering resources such as on-line trainings, technical assistance through their OMNI point person, and through one-page handouts that could easily be shared among school staff. Once they administered the surveys, they mailed them back to OMNI for analysis.

Feedback on Process School-level coordinator feedback 93% stated that it took five hours or less to coordinate their school’s effort 86% stated that being the coordinator was easy 100% stated that if their school was selected again, they would participate In general, the feedback from the school-level coordinators was very positive and with most noting that the process was very easy and 100% stating that if their school was selected again, they would participate. I am now going to turn it over to Katie so that she can walk you through some of the key findings of the results in 2009.

2009 YRBS Results Key findings Comparison to 2005 Statistically significant differences Year* Sub-groups** Limitations

Physical Activity and Nutrition

Alcohol and Drug Use

Overall

Injury and Violence

Mental Health

Sexual Risk Behavior

Questions?

Next Steps for HKCS FFY 09-10 FY 11-12 Colorado YRBS data tables currently available on the CDE website at www.cde.state.co.us/cdeprevention/CSH_home.htm Fact sheet available in mid-May On June 3 the National YRBS data will be available from the CDC In mid-August the Colorado state report (M1 and M2) will be published FY 11-12 In Fall 2011, the next state administration!! 35