Adolescent Health Services Missing Opportunities (2009) / Chapter Skim
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2 Adolescent Health Status
2 Adolescent Health Status
Pages 52-134
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From page 52... ...
Adolescence also provides many op portunities to develop habits that create a strong foundation for healthy lifestyles and behavior over the full life span. • Some specific subpopulations of adolescents defined by selected population characteristics and other circumstances -- such as those who are poor or members of a racial or ethnic minority; in the foster care system; homeless; in a family that has recently immigrated to the United States; lesbian, gay, bisexual, or trans gender; or in the juvenile justice system -- have higher rates of chronic health problems and may engage in more risky behavior relative to the overall adolescent population.
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From page 53... ...
• Certain subpopulations of adolescents, especially those who are in the juvenile justice or foster care system, are at significantly increased risk of health and mental disorders.
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From page 54... ...
These adolescents are also at increased risk of unprotected sex and pregnancy, and have higher rates of severe mental health problems and substance use. M ost adolescents are considered healthy as defined by the tradi tional medical measures of health status, such as mortality rates, incidence of disease, prevalence of chronic conditions, and use of health services.
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From page 55... ...
. With these and many other findings in mind, this chapter explores available evidence on the health status of adolescents as defined by traditional measures (mortality rates, incidence of disease, prevalence of chronic conditions, and use of health services)
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From page 56... ...
1.2 15- to 19-year-olds (per 100,000) 8.0 Reduce deaths caused by motor vehicle crashes 1999 15- to 24-year-olds (per 100,000)
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From page 57... ...
ADOLESCENT HEALTH STATUS 57 Midcourse Reviewb Targeta Progress to 1999 2000 2001 2002 2003 2004 2005 2010 Targetc 20.4 20.3 19.1 -- -- 18.7 -- 16.8 Toward 68.6 67.4 67.1 -- -- 66.4 -- 39.8 Toward 90.8 93.6 94.9 -- -- 96.4 -- 49.0 Away -- 1.5 1.3 -- -- 1.3 -- TNP TNP -- 8.0 7.9 -- -- 8.2 -- TNP TNP -- 26.3 26.3 -- -- 25.8 -- TNP TNP 11.7 12.2 12.2 12.4 -- -- -- TNP TNP -- 1.1 -- -- -- 1.0 -- TNP TNP -- NA -- -- -- 9.3 -- TNP TNP -- -- -- -- -- -- -- TNP TNP -- 5.9 5.9 6.0 -- 6.9 -- 3.0 Away -- 13.5 13.3 13.5 -- 15.3 -- 3.0 Away -- 17.0 17.0 17.0 -- 20.2 -- 3.0 Away Continued
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From page 58... ...
33.0 Increase use of safety belts 1999 9th- to 12th-grade students (percent) 84.0 Reduce injuries caused by alcohol- and drug-related motor vehicle 1998 crashes Alcohol-related injuries 15- to 24-year-olds (per 100,000)
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From page 59... ...
ADOLESCENT HEALTH STATUS 59 Midcourse Reviewb Targeta Progress to 1999 2000 2001 2002 2003 2004 2005 2010 Targetc -- -- -- -- -- -- 64.0 66.0 Toward -- -- -- -- -- -- 27.0 17.0 Toward -- -- 2.6 -- -- -- 2.3 1.0 Toward -- -- 31.0 -- 30.0 -- 28.5 30.0 Met target -- -- 86.0 -- -- -- 89.8 92.0 Toward 403.0 391.0 359.0 301.0 -- -- -- TNP TNP -- -- 33.0 -- -- -- 35.9 32.0 Toward -- -- 6.4 -- -- -- 6.5 4.9 Toward 10.1 10.4 10.6 10.7 10.6 -- 9.9 2.0 Away Continued
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From page 60... ...
11.0 Physical Activity Increase the proportion of adolescents who engage in vigorous physical 1999 activity that promotes cardiovascular fitness 3 or more days per week for 20 or more minutes per occasion 9th- to 12th-grade students (percent) 65.0 NOTES: -- = data not available; TNP = target not provided.
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From page 61... ...
ADOLESCENT HEALTH STATUS 61 Midcourse Reviewb Targeta Progress to 1999 2000 2001 2002 2003 2004 2005 2010 Targetc 8.2 8.0 8.2 7.9 -- -- 6.8 0.7 Toward -- -- 34.0 -- -- -- 28.4 21.0 Toward 56.0 54.0 -- 44.4 -- -- -- 43.0 Toward -- -- 86.0 -- 88.0 -- -- 95.0 Toward 1999– 2003– 2000 2004 -- -- 16.0 -- -- 17.0 -- 5.0 Away -- -- 65.0 -- -- -- 64.1 85.0 Away cProgress to target = toward, away from, or met target compared with baseline data. Objec tives without a projected target were not assessed.
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From page 62... ...
. Uninten tional injury was also one of the three leading causes of death among adults aged 35–54 in 2004; in contrast with adolescents, however, malignant neo 70 60 Rates per 100,000 50 Overall 40 Motor vehicle accidents 30 Homicide Suicide 20 10 0 10–14 years 15–19 years Age Group FIGURE 2-1 Adolescent mortality rates (per 100,000)
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From page 63... ...
SOURCE: National Center for Injury Prevention and Control (2007)
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From page 64... ...
. plasms and heart disease -- both physical chronic health conditions -- were the cause of almost half of all deaths in adults (National Center for Injury Prevention and Control, 2007)
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From page 65... ...
Morbidity Chronic Health Conditions Chronic conditions, or what are sometimes referred to as adolescents with special health care needs, generally encompass learning disabilities; attention-deficit hyperactivity disorder (ADHD) ; other emotional or behavioral problems; developmental delay or physical impairment; asthma or breathing problems; speech problems; diabetes; depression or anxiety; bone, joint, or muscle problems; autism; severe respiratory, food, or skin allergies; frequent or severe headaches; and hearing or vision problems not correctable with glasses.
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From page 66... ...
Not only has the prevalence of chronic health conditions in children dramatically increased since the 1960s, but it is also important to understand that more children with severe chronic conditions (e.g., leukemia, cystic fibrosis, congenital heart disease) are living longer because of medical technological advances, and that some chronic conditions (e.g., obesity, asthma, ADHD)
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From page 67... ...
Impaired fasting glucose levels have been reported in 11 percent of adolescents aged 12–19 -- with important implications for health in adulthood (Duncan, 2006)
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From page 68... ...
Anxiety Disorder Ages 12–17 15.0 11.4 18.9 Major Depression Ages 12–17 12.1 7.9 16.5 ADHD Ages 12–17 14.7 13.8 15.6 Conduct Disorder Ages 12–17 11.5 12.8 10.1 Eating Disorder Ages 12–17 6.1 3.7 8.7 Substance Disorders (%) d Alcohol Disorders Ages 12–17 5.4 5.1 5.7 Illicit Drug Disorders Ages 12–17 4.6 4.7 4.6 Sexually Transmitted Infections Chlamydia (per 100,000)
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From page 69... ...
ADOLESCENT HEALTH STATUS 69 Asian- or White-NH Black-NH AI/AN-NH A/PI-NH Hispanic 14.3 18.2 20.8h 7.7h 14.3i 3.2 3.2h 2.3h 1.4h 2.2 15.6 15.6 NA NA 13.2 12.2 10.6 NA NA 12.0 13.8 18.3 NA NA 15.1 10.9 12.4 NA NA 12.2 5.9 6.5 NA NA 6.4 6.3 2.3 7.2 2.8j 5.1 4.7 4.3 6.9 3.3 j 4.8 25.1 246.0 150.6 15.0 58.4 769.6 5,502.6 2675.3 499.9 1,674.9 5.4 93.5 20.0 3.0 9.4 120.0 2,106.3 369.0 74.3 219.6 15% of cases 69% of cases <1% of cases <1% of cases 15% of cases Continued
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From page 70... ...
adolescents aged 12–17 within the past year. Data from 2000 National Household Survey of Drug Abuse were used to estimate prevalence rates using DISC (Diagnostic Interview Schedule for Children)
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iPuerto Rican adolescents aged 10–17 have lifetime asthma prevalence rates of 29.4 percent. jIndicates Asians only; does not include Native Hawaiians or other Pacific Islanders.
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From page 72... ...
Most studies estimate that between 10 and 20 percent of adolescents are affected annually by mental disorders, while estimates for adults aged 25 and older are around 10 percent (depending on the ascertainment methods employed, sampling characteristics, and environmental conditions at the time of the study) (Costello et al., 1996; Kataoka, Zhang, and Wells, 2002; Roberts, Attkisson, and Rosenblatt, 1998; Shaffer et al., 1996; Substance Abuse and Mental Health Services Administration, 2007)
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From page 73... ...
with mental disorders are often managed in the foster care and juvenile justice systems, while nonminority adolescents with similar presentations are much more likely to be referred to mental health services (U.S. Department of Health and Human Services, 1999)
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From page 74... ...
. ADHD is one of the most frequently cited chronic conditions causing activity limitations among adolescents aged 10–17, a fact that indicates its severity (MacKay and Duran, 2007)
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Eating Disorders Eating disorders frequently co-occur with other mental disorders, such as depression, substance abuse, and anxiety disorders. The three most common eating disorders are anorexia nervosa, bulimia nervosa, and bingeeating disorder (U.S.
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and 7 million adolescents aged 18–25 (21 percent) were estimated to have abused or been dependent on alcohol or an illicit drug in the past year (Substance Abuse and Mental Health Services Administration, 2007)
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. These and other risky sexual behaviors in adolescence contribute to high rates of sexually transmitted infections (STIs)
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Between 1998 and 2005, AIDS cases among adolescents aged 13–19 increased by about 75 percent. There are more AIDS cases among male than female adolescents, although this differential has been decreasing over time (Centers for Disease Control and Prevention, 2007b)
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From page 79... ...
Risk factors for dental caries include poor eating patterns and poor food choices, coupled with a lack of fluoride use, while those for periodontal disease reflect inadequate personal oral hygiene. The risk for oral and perioral injury is increased by behavior that includes using alcohol and illicit drugs, driving without a seat belt, cycling without a helmet, engaging in contact sports without a mouth guard, and using firearms.
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From page 80... ...
80 ADOLESCENT HEALTH SERVICES TABLE 2-4 Prevalence of Behavior and Health in Adolescents by Age, Gender, and Race/Ethnicity Overall Male Female Risky Driving (%) a Rode with a driver who had been drinking alcohol 9th–12th grade 28.5 27.2 29.6 Rarely or never wore a seat belt 9th–12th grade 10.2 12.5 7.8 Violence Weapon carrying (%)
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ADOLESCENT HEALTH STATUS 81 Asian- or White-NH Black-NH AI/AN-NH A/PI-NH Hispanic 28.3 24.1 NA NA 36.1 9.4 13.4 NA NA 10.6 18.7 16.4 NA NA 19.0 39.9 59.5 NA NA NA 42.3 62.6 NA NA NA 11.1 25.4 NA NA NA 13.9 41.1 NA NA NA 15.7 8.2 26.1 3.1 10.4 22.3 9.1 18.1 7.9 17.9 7.2 7.2 14.9 1.5 6.3 NA NA NA NA NA 49.0 138.9 NA NA 135.2 25.1 88.4 NA NA 85.1 85.3 217.0 NA NA 210.9 Continued
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From page 82... ...
on at least 1 day in the past 30 days; marijuana use is expressed as percent of the population that used marijuana on at least 1 day in the past 30 days (Substance Abuse and Mental Health Services Administration, 2006)
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From page 83... ...
. hStudents who met currently recommended levels of physical activity in 2005 (percentage of students who were physically active for a total of 60 minutes or more per day on 5 or more of the past 7 days)
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From page 84... ...
Finding: Behavior that is unhealthful and/or risky, rather than infec tious or chronic diseases, is the leading cause of morbidity among adolescents. Risky Driving As discussed earlier, death rates due to motor vehicle crashes have decreased dramatically since 1970, but continue to be the leading cause of injury death for adolescents aged 10–19.
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From page 85... ...
Violence Violent behavior among adolescents is associated with other high-risk behavior, such as substance abuse and risky sexual activity. In addition to being a public health problem during adolescence, violence among adolescents is the most common precursor of violence in adults.
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Violent Crime Victimization In addition to perpetrating violence, adolescents are often its victims. In 2004, approximately 1.6 million adolescents aged 12–19 were victims of violent crime (rape, robbery, and assault)
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From page 87... ...
Fighting is a marker for other high-risk behavior in youths, including school failure, substance abuse, weapon carrying, attempted suicide, and risky sexual behavior (Sosin et al., 1995; Swahn and Donovan, 2006; Wright and Fitzpatrick, 2006)
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From page 88... ...
. In 2005, tobacco use at least once in the preceding month was reported among almost one-fourth of adolescents aged 16–17 (Substance Abuse and Mental Health Services Administration, 2006)
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From page 89... ...
. In 2005, 2 percent of high school students were reported to have used smokeless tobacco in the past month and 4 percent to have smoked cigars, a decrease since 1988 (National Institute on Drug Abuse, 1989; Substance Abuse and Mental Health Services Administration, 2006)
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From page 90... ...
In 2005, almost 17 percent of those aged 18–25 reported using marijuana on at least 1 day in the past month, a stark contrast with young adolescents aged 12–17, at almost 7 percent (Substance Abuse and Mental Health Services Administration, 2006, see Table 2-4)
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From page 91... ...
. Being the child of adolescent parents carries adverse health and social risks, including low birth weight and prematurity, poverty, school failure, and a greater likelihood of becoming involved in the juvenile justice system (for a boy)
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From page 92... ...
For example, adolescents aged 19 were nine times more likely to give birth than those aged 15. In 2004, there were more than 1 million births to mothers aged 20–24, approximately half of which were second- or higher-order births (Martin et al., 2006)
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From page 93... ...
. Adolescents aged 10–17 in urban areas are somewhat less likely than those in rural areas to be overweight -- 14.2 percent versus more than 17 percent (Maternal and Child Health Bureau, 2005b)
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From page 94... ...
. For example, in the Bogalusa Heart Study, 59 percent of males and 69 percent of females aged 15–17 who were at risk of being overweight (body mass index between the 85th and 94th percentiles)
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From page 95... ...
Finding: The percentage of overweight adolescents has more than tripled since 1980, with more than 17 percent of adolescents aged 12–19 being considered overweight. Physical Activity Currently, only one-third of adults and two-thirds of children and younger adolescents engage in regular leisure-time physical activity (Barnes and Schoenborn, 2003; Duke, Huhman, and Heitzler, 2003)
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From page 96... ...
. HEALTH OF SPECIFIC SUBPOPULATIONS The health status of adolescents can be characterized by the health conditions and behaviors discussed above.
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From page 97... ...
experienced by these specific groups of adolescents is presented throughout this chapter. It should be noted, however, that while some data exist on the health of low-income adolescents, these data are limited given that many of these adolescents are uninsured and not receiving consistent health services whereby their health status can be tracked.
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From page 98... ...
It has been reported that adolescents who have been in the foster care system have higher rates of illicit drug use than those who have never been in foster care (Substance Abuse and Mental Health Services Administration, 2005b)
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From page 99... ...
Moreover, it is difficult to locate and count individuals who have no permanent address. Collecting information on the health status of homeless adolescents is a particular challenge.
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From page 100... ...
. Sexual activity among homeless adolescents may be con 10 Survival sex can be defined as the "selling of sex to meet subsistence needs," including "shelter, food, drugs, or money" (Greene, Ennett, and Ringwalt, 1999, p.
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From page 101... ...
. Homeless adolescents may be less likely to practice safe sex because they lack access to condoms or are under the influence of alcohol or drugs, or because of the semicoercive nature of survival sex (Tyler et al., 2000)
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From page 102... ...
. More than 50 percent of homeless adolescents use alcohol, and more than a third consume in excess of 15 drinks a week (Lifson and Halcon, 2001; Van Leeuwen et al., 2004)
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From page 103... ...
In addition to the stress of living on the streets, two other factors commonly faced by homeless adolescents are highly correlated with mental health disorders: a history of physical, emotional, and sexual abuse, and current substance abuse issues. Youths with a history of abuse are far more likely to be depressed (Feldmann and Middleman, 2003; Stein, Leslie, Nyamathi, 2002)
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From page 104... ...
LGBT youths make up a sizable proportion of homeless adolescents. Numbers vary widely, but an analysis of the available literature performed by the National Gay and Lesbian Task Force suggests that between 20 and 40 percent of homeless youths are LGBT (Ray, 2006)
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From page 105... ...
LGBT homeless adolescents are far more likely than their heterosexual counterparts to engage in survival sex (Gaetz, 2004; Weber et al., 2004) ; they are more likely to engage in risky sexual behavior (Cochran et al., 2002)
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From page 106... ...
Nearly 2.5 million adolescents aged 10–19 are not U.S. citizens, compared with fewer than 1 million children aged 0–9 (U.S.
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From page 107... ...
, factors that would presumably apply to adolescents either within a migrant family or, even more so, on their own in the agricultural environment. The health status of immigrant children and adolescents has received increased emphasis in the literature recently as more attention has been paid to the overall health status of racial and ethnic minority children, particularly Latinos, in the United States.
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From page 108... ...
. As well, existing data may disproportionately reflect the experience of LGBT adolescents who are participating in more risky behavior, since those adolescents who participate less in such behavior may not have health issues that result in their appearing in health settings where the data are collected, or may be less public about their sexual orientation.
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From page 109... ...
. The rest of this section details these data in the areas of suicide, substance abuse and smoking, eating disorders, sexual activity and STIs, violence, and psychosocial stressors.
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From page 110... ...
17 and the Massachusetts YRBS, sexual orientation was an independent predictor of suicide attempts; LGB adolescents were twice as likely to attempt suicide, after controlling for such mediating factors as substance abuse, violence, victimization, and depression (Russell and Joyner, 2001; Udry and Chantala, 2002)
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From page 111... ...
In working to improve these sexual health outcomes for LGB adolescents, it is important to recognize that it is sexual activity, not sexual orientation, that puts adolescents at increased risk of these outcomes (Garofalo and Katz, 2001; Perrin, 2002)
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From page 112... ...
There are more racial and ethnic minority than white adolescents in juvenile justice residential settings (American Academy of Pediatrics Committee on Adolescence, 2001)
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From page 113... ...
. The National Center for Addiction and Substance Abuse found that a majority of the juvenile justice population was affected by addiction and substance abuse disorders.
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From page 114... ...
. Sexually Transmitted Infections Adolescents in the juvenile justice system have particularly elevated rates of STIs.
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From page 115... ...
It is important as well to provide health services that are attentive and responsive to the needs of specific subpopulations of adolescents with certain characteristics, such as being low-income, a racial/ethnic minority, in the foster care system, homeless, living in an immigrant family, LGBT, or in the juvenile justice system, since evidence shows that these young people often have higher rates of chronic health problems, may engage in more risky behavior, and may live in social environments that place them at greater risk relative to the overall adolescent population. Looking at these data, the committee is struck by the need for a focus on prevention; on behavioral health issues; on mental health issues; on oral health issues; and on disparities in health status that derive from income, race, and special circumstances.
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From page 116... ...
. Human immunodeficiency syndrome and Hepatitis B and C infections among homeless adolescents.
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From page 117... ...
. The characteristics and mental health of homeless adolescents: Age and gender differences.
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From page 118... ...
. HIV prevalence, risk behav iors, health care use, and mental health status of transgender persons: Implications for public health intervention.
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From page 119... ...
. Physical activity levels among children aged 9– 13 years: United States, 2002.
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From page 120... ...
. Homeless adolescents: Common clinical concerns.
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From page 121... ...
. Migrant farmworker children: Health status, barriers to care, and nursing innovations in health care delivery.
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From page 122... ...
. Comparing the health status of low income children in and out of foster care.
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From page 123... ...
children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159, 1548–1555.
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From page 124... ...
. Homeless adolescents' paths to separation from family: Comparison of family characteristics, psychology adjustment, and victimization.
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From page 125... ...
Los Angeles: National Child Traumatic Stress Net work, Juvenile Justice Working Group. Makadon, H
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From page 126... ...
. National Center for Mental Health and Juvenile Justice.
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From page 127... ...
. The health status of young adults in the United States.
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From page 128... ...
. Sexual abuse, alcohol and other drug use, and suicidal behaviors in homeless adolescents.
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From page 129... ...
Delmar, NY: The National Center for Mental Health and Juvenile Justice Policy Research Associates and the Office of Juvenile Justice and Delinquency Prevention. Slesinger, D., Christenson, B., and Cautley, E
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From page 130... ...
. The health status of foster children.
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From page 131... ...
. Home less youths and young adults in Los Angeles: Prevalence of mental health problems and the relationship between mental health and substance abuse disorders.
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From page 132... ...
. A snapshot of substance abuse among homeless and runaway youth in Denver, Colorado.
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From page 133... ...
. A dimensional model of psy chopathology among homeless adolescents: Suicidality, internalizing, and externalizing disorders.
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