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

2. WHY SHOULD WE BE INTERESTED IN ADOLESCENT HEALTH?

3.  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.

4.  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…

5. WHAT DATA SOURCES ARE AVAILABLE FOR THE ADOLESCENT POPULATION?

6.  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

7. 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

8. WHAT INDICATORS ARE USED TO MEASURE YOUTH HEALTH?

9.  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.

10. CAFI COMMUNITY ADOLESCENT FUTURES INITIATIVE

11.  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

12. METHODS

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

14. DATA ANALYSIS

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

16. RESULTS

17.  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

18.  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

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

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

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

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

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

24. DEVELOPING ADOLESCENT HEALTH INDICATORS AT THE LOCAL LEVEL

25.  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?

26. DOES THIS PROCESS WORK AT THE LOCAL LEVEL?

27. Small numbers Missing data Selecting the best indicator Reference population

28. LIMITATIONS

29.  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

30. Questions