LEAH 2013 Lecture Series October 4, 2013 Global and National Epidemiology of Adolescent Health and Healthy People 2020 Richard F. Catalano, Ph.D. Bartley Dobb Professor for the Study and Prevention of Violence Director, Social Development Research Group School of Social Work University of Washington www.sdrg.org

Objectives What are the leading causes of mortality globally and nationally? How are behavior problems implicated in mortality? What is Healthy People and why is it important to Adolescent Health How does Healthy People 2020 incorporate adolescents and epidemiology into its goals?

Estimated Proportion of 10-24 Year Olds in the Country Population (2010) Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2008 Revision. No data < 21% ≥21 - <24% ≥24 - <27% ≥27 - <30% ≥30 - <33% ≥33%

All-cause Mortality 10-24 years (Patton et al., 2009)

All-cause Mortality 10-24 years (Patton et al., 2009)

All-cause Mortality 10-24 years (Patton et al., 2009)

All-cause Mortality 10-24 years (Patton et al., 2009)

All-cause Mortality 10-24 years 45/100,000 pa 305/100,000 pa (Patton et al., 2009)

Leading Causes Worldwide of Mortality 10-24 Year Olds Rank Cause Total deaths x1000 1 Road Traffic Accidents 259 (10.0%) 2 Self-inflicted injuries 164 (6.3%) 3 Violence 157 (6.0%) 4 Low RTI 153 (5.9%) Tuberculosis 142 (5.5%) 5 HIV/AIDS Drowning 106 (4.1%) Fire-related 67 (2.6%) Meningitis 53 (2.0%) War 46 (1.8%) 64% due to behavior problems LOW RTI=lower respiratory tract infections. Patton et al., 2009

Behavior Problems are the Leading Causes of Mortality Worldwide 70% for Males, 57% for Females worldwide Patton et al., 2009 Lancet

Leading Causes of Mortality 15-24 Year Olds (U.S.) Total deaths (per 100,000) 1 Motor Vehicle Crashes 15.9 Accidents 11.5 3 Intentional self harm (suicide) 10.7 4 Assault (homicide) 10.3 5 Malignant neoplasms 3.7 6 Diseases of heart 2.2 7 Congenital malformations, deformations and abnormalities 1.0 8 Influenza and pneumonia 0.5 9 Cerebrovascular diseases 0.4 10 Pregnancy, childbirth and the puerperium -- All other causes (Residual) 11.1 48.8/100,000 or 72% of all deaths 7.8 Hoyert & Xu, 2012 http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf

Global Shift in Mortality from Infectious to Non-communicable Diseases and Conditions Behavior problems are implicated in shift (motor vehicle fatalities, violence, mental health, and risky sex, alcohol, tobacco, and other drugs) Behavior problems cause harm in adolescence Behavior problems established in adolescence cause harm into adulthood Preventing these behavior problems during adolescence can reduce mortality and morbidity worldwide

Life Course Perspective Problem behaviors begun in adolescence have implications for morbidity and mortality across the life course eg., Preventing tobacco use among young people is critical to ending the tobacco epidemic 80% of adult smokers began smoking by 18 years of age Adolescents are uniquely susceptible to social and environmental influences Thomas Frieden quoted in USDHHS Preventing Tobacco Use Among Youth and Young Adults: A report of the Surgeon General, 2012

Selected Indicators of Behavior Problems Associated with Adolescent Health, High School Youth Risk Behavior Survey, 2011

Healthy People Background and History

What Is Healthy People? A national agenda that communicates a vision for promoting health, preventing disease and achieving health equity. A set of specific, measurable epidemiologic objectives with targets to be achieved over the decade. These objectives are organized within distinct Topic Areas. Often called a “roadmap” for nationwide health promotion and disease prevention efforts, Healthy People is about understanding where we are now, and taking informed action to get where we want to go over a ten-year period. 16

History of Healthy People 1979—ASH/SG Julius Richmond establishes first national prevention agenda: Healthy People: Surgeon General’s Report on Health Promotion and Disease Prevention HP 1990—Promoting Health/Preventing Disease: Objectives for the Nation HP 2000—Healthy People 2000: National Health Promotion and Disease Prevention Objectives HP 2010—Healthy People 2010: Objectives for Improving Health Healthy People 2020 – Launched December 2010 For 3 decades, Healthy People has provided a comprehensive set of national 10-year objectives that have served as a framework for public health activities at all levels and across the public health community. Healthy People has evolved as the Nation’s public health priorities have changed. 17

Evolution of Healthy People Target Year 1990 2000 2010 2020 Overarching Goals Decrease mortality: infants–adults Increase independence among older adults Increase span of healthy life Reduce health disparities Achieve access to preventive services for all Increase quality and years of healthy life Eliminate health disparities Attain high-quality, longer lives free of preventable disease Achieve health equity; eliminate disparities Create social and physical environments that promote good health Promote quality of life, healthy development, healthy behaviors across life stages # Topic Areas 15 22 28 39* # Objectives/ Measures 226/NA 312/NA 467/1,000 >580/1200 * With objectives The number of objectives has increased with each decade. Healthy People 1990 set forth 226 objectives, Healthy People 2000 included 312 objectives, Healthy People 2010 identified 467 objectives with 1,000 measures, and Healthy People 2020 has nearly 600 objectives with 1,200 measures.

Healthy People 2020 A Resource for Promoting Health and Preventing Disease Throughout the Nation 19

Involving Non-Health Sectors To Address Determinants of Health Healthy People 2020 for the first time emphasizes involving sectors outside health, including: Education Housing Environment Transportation Labor Agriculture WHY? This new emphasis is based on research conducted about Healthy People with various stakeholders.

Healthy People 2020 Topic Areas 1. Access to Health Services 2. Adolescent Health* 3. Arthritis, Osteoporosis, and Chronic Back Conditions 4. Blood Disorders and Blood Safety* 5. Cancer 6. Chronic Kidney Disease 7. Dementias, Including Alzheimer’s Disease* 8. Diabetes 9. Disability and Health 10. Early and Middle Childhood* 11. Educational and Community- Based Programs 12. Environmental Health 13. Family Planning 14. Food Safety * New Topic Area for 2020 There are a total of 42 topic areas for 2020. Twenty-nine were continued from Healthy People 2010, and 13 were added for 2020.

Healthy People 2020 Topic Areas (continued) 15. Genomics* 16. Global Health* 17. Healthcare-Associated Infections* 18. Health Communication and Health Information Technology 19. Health-Related Quality of Life* 20. Hearing and Other Sensory or Communication Disorders 21. Heart Disease and Stroke 22. HIV 23. Immunization and Infectious Diseases 24. Injury and Violence Prevention 25. Lesbian, Gay, Bisexual and Transgender Health Issues* 26. Maternal, Infant and Child Health 27. Medical Product Safety 28. Mental Health and Mental Disorders * New Topic Area for 2020

Healthy People 2020 Topic Areas (continued) 29. Nutrition and Weight Status 30. Occupational Safety and Health 31. Older Adults* 32. Oral Health 33. Physical Activity 34. Preparedness* 35. Public Health Infrastructure 36. Respiratory Diseases 37. Sexually Transmitted Diseases 38. Sleep Health* 39. Social Determinants of Health* 40. Substance Abuse 41. Tobacco Use 42. Vision * New Topic Area for 2020 10 of 42 topics are focused on behavior problems that affect adolescents

How Stakeholders Are Using Healthy People Epidemiologic data tool for measuring state, local, national trends Data tool for measuring program performance Framework for program planning and development Goal setting and agenda building Teaching public health courses Way to develop nontraditional partnerships

Healthy People 2020 Adolescent Health 25

Recognition of Importance of Adolescent Health Key transitional and dynamic period in life course. Tremendous physical, social, emotional, and cognitive growth and development – impact upon lifelong health outcomes. Health promotion, primary preventive and secondary interventions during adolescence can have profound and positive lasting health, educational, and economic effects.

21 Critical Health Objectives CHO Objectives fell into six health and safety domains: Mortality Unintentional Injury Violence Mental Health and Substance Abuse Reproductive Health Prevention of Adult Chronic Diseases

Outcomes Decrease in disparities, increased health equity Healthier students ready to learn and to adopt healthier behaviors Students achieving at every level in school Increased graduation rates of students with 21st century skills—including health literacy Increased percentage of healthy, productive adults Decreased adult chronic illness

Healthy People 2020 data sources Each objective is measured by an identified surveillance system that provides data points throughout the decade An objective’s ability to capture important details totally dependent on its data source Availability of data at state level – National Vital Statistics System Department of Education’s Common Core of Data A few surveillance systems use a state-based sampling frame (e.g., YRBSS, NSCH, NSCSHCN, NYTD) Most surveillance systems use a national sampling frame (e.g., MTF, NHIS, NHANES, NSDUH, NSFG, NatSCEV)

NAHIIC Data Project to Improve Adolescent and Young Adult Health: National and State Profiles Makes data more readily available to states Shows disparities across gender/race/ethnicity User-friendly format (usable by data people and non-data people) Allows users to explore the tremendous variability across states without spending hours finding, downloading, and cleaning data Enables states to easily compare their progress with other states Available at http://nahic.ucsf.edu

Future Plans On-line HP 2020 evidence-based resources for addressing adolescent health topic area objectives Structured PubMed search queries for each objective through National Library of Medicine Dissemination & diffusion of additional helpful evidence-based resources for states, communities & organizations Expand field of stakeholders Facilitate engagement with key partners Monitoring of progress through the decade

Thank You! References Allensworth D, Lewallen TC, Stevenson B, Katz S (2011, March). Addressing the needs of the whole child: what public health can do to answer the education sector’s call for a stronger partnership. Prev Chronic Dis 2011;8(2):A44. Retrieved from http://www.cdc.gov/pcd/issues/2011/mar/10_0014.htm ASCD (2011). Making the case for educating the whole child. Retrieved from http://www.wholechildeducation.org/making-the-case Basch, CE (2010, March). Healthier students are better learners: A missing link in school reforms to close the achievement gap. Equity Matters, 6. Child Trends (2011) High school dropout rates. Retrieved from http://www.childtrendsdatabank.org/alphalist?q=node/162 Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD, (2009), Global patterns of mortality in young people: a systematic analysis of population health data, Lancet, 374: 881–92.