Allison Miles, MPH Kara Gehring, MPH Adapting the National Survey of Children’s Health Questions to Adolescent Health Indicators

WHY SHOULD WE BE INTERESTED IN ADOLESCENT HEALTH?

 Immediate impact and health improvements  Potential for improved health throughout the lifetime  Prevention of cumulative ‘insults’ from communicable diseases, chronic diseases, behavioral/mental health and wellness  Acquisition of health ‘assets’  Potential for improving reproductive health WHY INVEST IN ADOLESCENT HEALTH? Adolescent public health investments hold the greatest potential for improving birth outcomes within a population.

 Adolescence is a key period for:  Addressing physical, mental, emotional and reproductive health  Preventing injuries, transmission of communicable diseases, and chronic substance misuse  At least 70% of premature adult deaths reflect behaviors started or reinforced during adolescence.  Evidence-based investments in healthy adolescent development have enormous potential for impacting future global health. INVESTING IN ADOLESCENT HEALTH IS ESSENTIAL…

WHAT DATA SOURCES ARE AVAILABLE FOR THE ADOLESCENT POPULATION?

 Local health departments can obtain information about their populations’ health by  Using public data  Using state and/or local or internal data  Conducting survey or community health assessment POPULATION HEALTH SURVEILLANCE

Youth Risk Behavior Surveillance System — YRBSS National Survey of Children’s Health— NSCH National Survey of Children with Special Health Care Needs— NS-CSHCN Various Local and State-Level Surveillance

WHAT INDICATORS ARE USED TO MEASURE YOUTH HEALTH?

 Provide a glimpse of a populations health, health risks, or assets  Many sets of indicators  Chronic Disease Indicators  Core State Preconception Health Indicators  Life Course Indicators  Healthy People 2020 HEALTH INDICATORS For adolescents, there is not an agreed- upon set of indicators.

CAFI COMMUNITY ADOLESCENT FUTURES INITIATIVE

 Community Adolescent Futures Initiative (CAFI)  6 pilot communities (local health departments)  1 year  Using NSCH data and combination of state/local data  3 Pillars 1)Community Engagement 2)Analytic Methods 3)Evidence-Based Interventions CAFI PILOT PROJECT

METHODS

Chronic Disease Indicators Preconception Health Indicators Life Course Indicators Healthy People 2020 Relevant NSCH Questions Literature

DATA ANALYSIS

2007, 2011/2012 NSCH data  National level  HRSA region  7 states  15 local health departments

RESULTS

 40 Adolescent Health Indicators  Six domains  Social determinants of health  Health care access/utilization  Health status  Flourishing characteristics and adverse childhood events  Household and environmental characteristics  School engagement and extracurricular activities ADOLESCENT HEALTH INDICATORS

 Maternal education  Highest level of education in the household  Poverty (200% below FPL)  Working poor household  Unemployment  Single parent household  Residential mobility SOCIAL DETERMINANTS OF HEALTH

 Health care coverage  Medical home  Preventive care  Mental health  Unmet health care needs HEALTH CARE ACCESS AND UTILIZATION

 Physical health  Dental health  Chronic diseases  Anxiety and depression  Overweight/obesity  Physical activity  Sleep HEALTH CARE STATUS

 Flourishing  Parental stress  Adverse childhood events FLOURISHING CHARACTERISTICS AND ADVERSE CHILDHOOD EVENTS

 Tobacco exposure  Family involvement  Neighborhood characteristics and school safety HOUSEHOLD AND ENVIRONMENTAL CHARACTERISTICS

 School engagement  Extracurricular activities  Mentors  Television and electronic device use SCHOOL ENGAGEMENT, MENTORS, AND EXTRACURRICULAR ACTIVITIES

DEVELOPING ADOLESCENT HEALTH INDICATORS AT THE LOCAL LEVEL

 Is there sufficient data at the local level to justify this indicator?  Is the indicator relevant to adolescent health and/or well-being?  Does the indicator have the potential to impact population health?  Does the indicator have the potential to impact health across the lifespan?  Does the indicator have the potential to impact reproductive health?  Are there differences in equity when this indicator is examined by measures of race/ethnicity, education, etc.?  Does the indicator serve as a proxy for a social determinant of health?  Are the outcomes measured by the indicator modifiable?

DOES THIS PROCESS WORK AT THE LOCAL LEVEL?

Small numbers Missing data Selecting the best indicator Reference population

LIMITATIONS

 Parent/guardian report  Missing key questions on adolescent risk behaviors  Sexual behaviors  Alcohol and substance use  Remote access  50:50 rounding technique  Small numbers  Weighted for states, not localities  Not conducted annually (slow turn around) CHALLENGES WITH NSCH DATA AggregationSynthetic EstimatesConfidence Intervals

Questions