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Adolescent Health Risk Behavior

Adolescent Health Risk Behavior. John Kulig, MD, MPH jkulig@lifespan.org Professor of Pediatrics, Tufts University School of Medicine Director, Adolescent Medicine, Floating Hospital for Children at New England Medical Center, Boston, MA.

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Adolescent Health Risk Behavior

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  1. Adolescent Health Risk Behavior John Kulig, MD, MPH jkulig@lifespan.org Professor of Pediatrics, Tufts University School of Medicine Director, Adolescent Medicine, Floating Hospital for Children at New England Medical Center, Boston, MA

  2. “The children now love luxury; they have bad manners, contempt for authority; they allow disrespect for elders and love chatter in place of exercise. Children now are tyrants, not the servants of their households. They no longer rise when elders enter the room. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and tyrannize their teachers.” Socrates

  3. Leading causes of deathUS population, 15-19 years, 1999 Rank Cause# deaths% of total 1st unintentional injury 6,688 48.5 2nd homicide 2,903 15.2 3rd suicide 1,615 11.7 4th malignancy 745 5.4 5th heart disease 463 3.4 Ref: CDC - NCHS

  4. Motor vehicle crash fatalities • 42,000 Americans killed in MVCs in 1999, including 5586 teenagers and 2055 children • driver inexperience • speeding • non-use of safety belts - 14.1% rarely or never wear seat belts [YRBS 2001] • driving older vehicles • alcohol use

  5. Alcohol and Adolescent Mortality “Postmortem studies show that 45% - 50% of adolescent victims of violent death had been drinking alcohol before their death.” • motor vehicle crashes: driver, passenger, pedestrian, motorcycle, ATV, PWC, snowmobiles • unintentional injury: drowning, fire, falls • homicide • suicide Ref: J Stud Alcohol 1985;46:228-231

  6. Scope of the Problem • Prevalence of alcohol use: “Had 5 or more drinks in a row in the last 2 weeks.” 8th grade: 13% 10th grade: 25% 12th grade: 30% Source: Monitoring the Future Study: 2001 data

  7. Alcohol: Binge Drinking

  8. Scope of the Problem • Drinking and driving: Rode Drove 9th grade: 30% 7% 10th grade: 31% 10% 11th grade: 29% 17% 12th grade: 33% 22% Source: CDC 2001 Youth Risk Behavior Survey

  9. Scope of the Problem • Sexual risk behavior: “Alcohol or drug use at last sexual intercourse, among students currently sexually active.” male female 9th grade: 25% 24% 10th grade: 21% 36% 11th grade: 18% 31% 12th grade: 20% 32% Source: CDC 2001 Youth Risk Behavior Survey

  10. Adolescent homicide deaths • homicide is the second leading cause of death among 15-19 year-olds - first leading cause among African Americans age 15-24 years • 2903 homicides in the 15-19 year high school age group in 1999 - 82% were killed with firearms • two thirds of high school students report physical fighting in the past year - 4% sustained serious injury • one fifth of high school students report carrying a weapon in the previous 30 days

  11. Behaviors associated with violence male female • carried a weapon - past 30 days 29% 6% • physical fight - past 12 months 43% 24% • injured in fight - past 12 months 5% 3% • forced to have sexual intercourse 5% 10% • threatened with weapon at school 12% 7% • felt too unsafe to attend school 6% 7% Source: CDC 2001 Youth Risk Behavior Survey

  12. Adolescent suicides • youth suicide rates have tripled since the 1950s • suicide is the third leading cause of death for 15-24 year-olds • 1615 suicides in the 15-19 year high school age group in 1999 • more youth suicides annually than cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined

  13. Behaviors associated with suicide male female • felt sad or hopeless 22% 35% • seriously considered suicide 14% 24% • made a suicide plan 12% 18% • attempted suicide 6% 11% • attempt required medical care 2% 3% Source: CDC 2001 Youth Risk Behavior Survey

  14. Leading causes of deathUS population, total, 1999 Rank Cause# deaths% of total 1st heart disease 725,192 30.3 2nd malignancy 549,838 23.0 3rd cerebrovascular 167,366 7.0 4th lower respiratory 124,181 5.2 5th unintentional injury 97,860 4.1 Ref: CDC - NCHS

  15. Cigarettes

  16. Smokeless Tobacco

  17. 1991 1995 2000 No Data <10% 10%-14% 15-19% 20% Obesity Trends* Among U.S. Adults BRFSS, 1991, 1995 and 2000 (*BMI 30, or ~ 30 lbs overweight for 5’4” woman) Source: Mokdad A H, et al. J Am Med Assoc1999;282:16, 2001;286:10.

  18. Behaviors associated with weight control male female • exercised to lose weight 51% 68% • ate less food to lose weight 28% 59% • fasting > 24 hr to lose weight 8% 19% • took diet pills, powders, liquids 6% 13% • vomited or took laxatives 3% 8% Source: CDC 2001 Youth Risk Behavior Survey

  19. Sexual risk behavior • ever had sexual intercourse male female grade 9 41% 29% grade 10 42% 39% grade 11 54% 50% grade 12 61% 60% • >4 lifetime sexual partners male female grade 9 14% 6% grade 12 24% 20% Source: CDC 2001 Youth Risk Behavior Survey

  20. Sexual risk behavior • initiation of sexual intercourse before age 13 male students 9% female students 4% white students 5% black students 16% Hispanic students 8% all students 7% Source: CDC 2001 Youth Risk Behavior Survey

  21. Sexual risk behavior • condom use during last sexual intercourse white students 57% black students 67% Hispanic students 54% • alcohol or drug use at last sexual intercourse male students 31% female students 21% white students 28% black students 18% Hispanic students 24% Source: CDC 2001 Youth Risk Behavior Survey

  22. Adolescent Pregnancy “Have been pregnant or gotten someone pregnant.” male 4% female 5% white 3% black 11% Hispanic 6% Source: CDC 2001 Youth Risk Behavior Survey

  23. New cases of STD by age

  24. STD Overview • 3 million US adolescents acquire STDs each year • 1 in 4 sexually active adolescents will acquire an STD before high school graduation • 1 in 5 Americans with AIDS were infected during adolescence • $10,000,000,000 total costs for STDs in US in 1994, excluding HIV infection

  25. Infection rate per 100,000 sexually active women Ref: CDC Division of STD Prevention, 1995

  26. Adolescent development and STD risk • psychosexual maturation • cognitive development • biologic development • knowledge • attitudes • behavior • sociocultural context

  27. Pelvic inflammatory disease sequelae • tubal infertility one episode 8% - 11% two episodes 20% - 30% three episodes 40% - 55% • ectopic pregnancy increased risk 3 - 7 times • tubo-ovarian abscess • chronic PID/adhesions Ref: Lawson MA, Blythe MJ. Pediatr Clin North Am 1999; 46:767

  28. Functional domains in adolescence • individual • family/home • peer group • school • employment • sociocultural

  29. What’s new in 2002? • renewed interest in protective factors, such as family connectedness, school connectedness and spirituality, to offset risk factors • youth development initiatives that focus on youth as assets to be developed rather than problems to be solved

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