Adolescent health what we can do to promote it
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Adolescent Health – What we can do to Promote it. Rocky Mountain Society for Adolescent Medicine Annual Dinner Meeting January 31 st , 2013 Simon J. Hambidge, MD, PhD Director, Community Health Pediatrics, Denver Health Professor of Pediatrics and of Epidemiology, University of Colorado.

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Adolescent health what we can do to promote it

Adolescent Health – What we can do to Promote it

Rocky Mountain Society for Adolescent Medicine Annual Dinner Meeting

January 31st, 2013

Simon J. Hambidge, MD, PhD

Director, Community Health Pediatrics, Denver Health

Professor of Pediatrics and of Epidemiology, University of Colorado


Disclosures

Disclosures

  • Simon Hambidge has no financial relationships to disclose, and will not be discussing any off label drug use


The health of adolescents in denver overview

The Health of Adolescents in Denver - Overview

  • Overview of adolescent population at Denver Health and in Denver

  • Immunization Status

  • Mental Health

  • Obesity Comorbidity

  • Substance abuse

  • High school completion

  • Reproductive Health


Youth in denver 2010

Youth in Denver - 2010


Adolescent population at denver health in 2012 12 18 years old

Adolescent Population at Denver Health in 2012 (12-18 years old)


Adolescent population at denver health in 2012 12 18 years old1

Adolescent Population at Denver Health in 2012 (12-18 years old)

  • Total of 17,257 patients

  • Over 1/3 of 12-18 year old population of Denver

  • 32% - 43% Spanish-speaking

  • Over 80% below 200% FPL, with most below 100% FPL


Adolescent immunization at denver health chs 2012

Adolescent Immunization at Denver Health – CHS 2012


Adolescent immunization at sbhcs 2011 2012

Adolescent Immunization at SBHCs: 2011 - 2012


Adolescent immunization at denver health 2012 summary

Adolescent Immunization at Denver Health – 2012 Summary

  • Overall rates well above national rates for almost all vaccines

  • SBHC rates similar to CHS

  • HPV rates include boys!

  • What can we do? 2 areas for future QI work:

    • 2nd and 3rd doses of HPV

    • Influenza vaccine coverage


Adolescent mental health healthy kids colorado survey

Adolescent Mental Health – Healthy Kids Colorado Survey

  • 25% Denver adolescents report feeling ‘so sad or hopeless every day for two weeks’ that they stopped usual activities

    • Higher prevalence in females compared to males

    • Higher prevalence in 8-10th grade

  • 13% of Denver adolescents report seriously considering suicide in the past month

    • Higher prevalence among females compared to males

    • Higher prevalence in 8th and 9th grade

  • 10% of Denver adolescents made a plan to attempt suicide

  • 8% of Denver adolescents attempted suicide


Sbhc mental health services

SBHC – mental health services


Sbhc mental health services1

SBHC – mental health services


Sbhc depression collaborative summary

SBHC – Depression Collaborative Summary

  • # patients in CSD registry, by SBHC (total ≈ 200)

  • % CSD patients seen in past 8 weeks (> 80%)

  • % CSD patients on therapy or meds (> 60%)

  • % CSD patients with PHQ-9 scores > 5 point improvement at follow-up (60%)

  • % CSD patients with self-management goals in past 12 months (95%)

  • % CSD patients with family involvement in past 12 months (58%)


Adolescent mental health summary denver health

Adolescent Mental Health Summary – Denver Health

  • SBHC system has good depression screening and follow-up

  • CHS has no systemic screening

    • More of a risk-based system

    • Less reliable referral sources

  • Foster care clinic at Eastside Peds – new collaborative model with MHCD

  • New collaboration with MHCD for mental health screening in CHS clinics


Mental health what can we do

Mental Health – What can we do?

  • Advocate for mental health parity with physical health

  • More robust screening and referral in CHS

  • Work to develop more integrated mental health LCSWs in medical setting

  • Work with outpatient behavioral health services at DH and MHCD to develop more robust referral sources


Adolescent substance abuse alcohol use

Adolescent Substance Abuse – Alcohol Use


Adolescent substance abuse binge drinking

Adolescent Substance Abuse – Binge Drinking


Adolescent substance abuse high school responses to hkcs

Adolescent Substance Abuse – High School Responses to HKCS

  • 7% have used cocaine in some form

  • 12% have sniffed glue or breathed the contents of aerosol spray cans

  • 3% have used heroin (4% in boys and 2% in girls)

  • 3% have used meth

  • 8% have used ecstasy or MDMA

  • 11% have taken Rx drugs without a doctor’s prescription


Substance abuse what can we do

Substance Abuse – What can we do?

  • SBIRT Training: Screening, Brief Intervention, Referral to Treatment

  • DH has good adolescent substance abuse psychiatry resource in Pavilion M (Chris Thurstone, MD)

  • Other Thoughts?


Unhealthy weight in adolescents denver

Unhealthy Weight in Adolescents: Denver

  • 22% of Denver high schoolers overweight (15%) or obese (7%) (self-reported weight and height)

  • 58% of Denver students (6-12th grade) report being ‘about the right weight’; 24% slightly or very overweight and 17% slightly or very underweight

  • 43% of Denver students reported ‘trying to loose weight’

  • 38% of Denver students met the fruit consumption recommendation (2-4 per day)

  • 17% of Denver students met with vegetable consumption recommendation (3+ per day)

  • 26% of Denver students reported drinking a soda at least once every day.


Unhealthy weight in adolescents denver health

Unhealthy Weight in Adolescents: Denver Health


Data on bmi lifestyle screening

Data on BMI & Lifestyle Screening

  • SBHC 2011 – 2012: 88% of visits had BMI measured

    • range by clinic = 76% - 95%

  • Eastside Peds clinic 2011: adolescent risk factor questionnaire

    • 27% of 250 adolescents not happy with eating habits and weight

    • How many times a week do you eat fast food?

      • 11% = Never

      • 75% = 1-2

      • 14% = > 2


  • Diabetes screening patients 12 18 years with bmi 95 who were tested for diabetes hgb a1c or glucose

    Diabetes Screening: Patients 12 – 18 years with BMI > 95% who were tested for diabetes (Hgb A1c or glucose)


    What can we do

    What can we do?

    • We do a good job of collecting BMI and counseling about exercise and nutrition (HEDIS)

    • Make sure we are screening for lifestyle factors

      (5-2-1-0 +) and counseling

    • Refer to community programs: cooking matters, rec centers, boys and girls clubs, others

    • Screen for diabetes in obese teens

    • Advocate for safe and appropriate built environment with our colleagues in public health, the schools, and the legislature

    • Mayor’s Children’s Cabinet: focus on obesity

    • There are signs the tide is turning!


    Colorado high school completion rates

    Colorado High School Completion Rates


    Colorado high school completion rates1

    Colorado High School Completion Rates


    School completion rates some thoughts

    School Completion Rates – Some Thoughts

    • In 2011, graduation rates were 77.6% for girls, but only 70.3% for boys

    • What can we do?

      • Encourage preschool! – Denver Preschool Program

      • Reach out and Read – promote early literacy

      • Keep kids healthy so they can stay in school (SBHC model)


    Reproductive health denver data from hkcs

    Reproductive Health:Denver Data from HKCS

    • 57% of Denver high schoolers have never had sex (72% in 9th grade to 38% in 12th grade)

    • Of those having sex (43%):

      • 20% report alcohol or drug use at last sexual encounter

      • 68% sex report condom use at last sexual encounter (from 72% in 9th to 60% in 12th)

      • 10% report no method of birth control

    • DH Eastside peds clinic data from 2011: If you are sexually active, do you and your partner ALWAYS use condoms when you have sex? “No” = 24% (n = 46)


    The state of adolescent sexual health in colorado 2012 colorado youth matter

    The State of Adolescent Sexual Health in Colorado 2012 – Colorado Youth Matter

    • 41% of Colorado high school students report having had sex

    • Nationally, 80% of males used a condom at first sex, a nine percent increase since 2002

    • Colorado’s birthrate has decreased by 40.4% between 1991 and 2010 for females ages 15-19

    • There were nearly 800 fewer births to teens in 2010 than the previous year in Colorado

    • Of all Colorado HIV cases reported between 2006-2010, 15% of new cases were diagnosed among youth 13-25 years old

    • 47% of adolescents nationally report they would stop using reproductive health services if parental notification was required although 99% of these adolescents would remain sexually active.


    Sti screening in sbhcs

    STI Screening in SBHCs

    Range by clinic = 56% - 100% (will be lower in CHS!)


    What can we do1

    What can we do?

    • Support comprehensive sexuality education programs that are evidence-based, medically accurate, culturally relevant, and age appropriate. These programs should include a range of pregnancy prevention options such as contraception, condoms, abstinence, healthy relationships, and decision-making skills among other topics.


    What can we do2

    What can we do?

    • Promote reproductive health education

      • In clinic

      • HEP in SBHCs

      • In community

    • Screen for STIs and HIV

    • Family Planning

      • In clinic

      • HEP for counseling

      • Title X and “Title X–like” privately funded program


    Visits by age

    Visits by Age

    • The HEP are seeing students at the following schools:

    • North

    • Montbello

    • MLK

    • Noel

    • Lake

    • South

    • West

    • JFK

    • Place Bridge Academy

    • Bruce Randolph

    • Manual

    • Lincoln

    • Kepner


    Pre post knowledge survey

    Pre-Post Knowledge Survey

    • Every student, at the beginning of the first session for the school year, is given a short knowledge quiz with True and False questions.

    • At the end of that initial session, the student was again given the survey.

    84%***

    77%

    *** Change is significant at p<.001

    Pre-test

    Post-test


    Post post attitudes and behavioral intent

    Post – Post Attitudes and Behavioral Intent

    • Every student, at the beginning of the first session for the school year, is given a short survey asking about attitudes and behavioral intent .

    • Students were then ask to complete the same survey at a follow-up session that could be from 1-3 months later.

      Of the 17 items asked, 14 items showed statistically improved responses.


    Percent who remained abstinent

    Percent Who Remained Abstinent

    Of the 2700 students seen by a HE, 495 reported being abstinent at first visit and had subsequent visits with a HE: % reporting continued abstinence at last visit.

    N=495


    Referral data

    Referral Data


    Choice of bc method

    Choice of BC Method

    Method of Contraception students report using at first visit of the school year and at their last visit of the school year.


    Effectiveness of method

    Effectiveness of Method

    Overall, 32% of students changed to a more effective method of birth control.


    Productivity

    Productivity

    On average, each student is seen by a HE, 2.5 times per year. In the follow-up sessions correct and consistent contraception and condom use are discussed as well as STIs, healthy relationships and partner and parent communication


    Dh title x patients served 2009 2012

    DH Title X Patients Served, 2009 - 2012


    Patients age 12 18 years old with a visit for prenatal care by year

    Patients age 12 – 18 years old with a visit for prenatal care, by year


    References

    References

    • Youth Risk Behavior Survey, Centers for Disease Control and Prevention, http://apps.nccd.cdc.gov/youthonline/App/Default.aspx

    • Colorado Youth Risk Behavior Survey, http://collaboration.omni.org/sites/hkc/Pages/default.aspx

    • 2011 Healthy Kids Colorado Survey Report, Colorado Coalition for Healthy Schools and Colorado Department of Education, http://collaboration.omni.org/sites/hkc/Reports%20and%20Fact%20Sheets/State%20Reports/2011%20 HKCS%20State%20Report.pdf

    • Healthy People 2020, U.S. Department of Health and Human Services, http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx

    • Table 2: Mortality and reproductive health indicators: Health Statistics and Vital Records, Colorado Department of Public Health and Environment, http://www.chd.dphe.state.co.us/HealthIndicators/Default.aspx

    • CDC WONDER, Centers for Disease Control and Prevention, http://wonder.cdc.gov/

    • Injury Prevention and Control: Data and Statistics (WISQARS), Centers for Disease Control and Prevention, http://www.cdc.gov/injury/wisqars/index.html

    • Education indicators: Colorado Department of Education, http://www.cde.state.co.us/index_stats.htm

    • Trends in High School Dropout and Completion Rates in the United States: 1972–2009, United States Department of Education, http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2012006


    Thank you

    Thank You


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