Preconception Health of Adolescents in Cuyahoga County: Data from the

Youth Risk Behavior Survey

2014 CFHS ANNUAL MEETINGAPRIL 14, 2014

ERIKA S. TRAPL, PhDCWRU Prevention Research Center for

Healthy Neighborhoods

Acknowledgements

Funding provided by: Ohio Department of Health/Federal Government,

Bureau of Child and Family Health Services through the Cuyahoga County Board of Health’s Child and Family Health Service Program

Centers for Disease Control and Prevention (1-U48-DP-001930)

St. Luke’s Foundation

The PRCHN at CWRU

Mission: To work with communities from within to prevent and reduce chronic disease

Received CDC funding to establish PRC in 2009…

BUT, we’re actually much older than that: Center for Health Promotion Research: ~2000 Center for Adolescent Health: ~1995

Today’s Presentation

Brief history and overview of YRBS

Preconception Health in Cuyahoga County

Discussion

PRCHN and the YRBS

Conducting local YRBS (in some way) since 1998 Reports publicly available since 2002

Established current approach in 2008 Countywide administration in Cuyahoga County Middle School in Spring of even years (e.g. 2012) High School in Spring of odd years (e.g. 2013) Attempt “region” representation

Cuyahoga County Regions

Outer Ring- West

Inner Ring- West Cleveland- West

Cleveland- East

Inner Ring- East

Outer Ring- East

Youth Risk Behavior Survey

Developed by the Centers for Disease Control and Prevention Started in 1991 Administered to 9th-12th grade students every other

year

Provides a “snapshot” of students’ health risk behaviors Used to follow trends over time

Measure progress against health indicators

Youth Risk Behavior Survey

Wide array of topics: Originally designed to assess 6 types of health risk

behaviors

Unintentional injuries and violence, sexual behaviors, alcohol and other drug use, tobacco use, unhealthy dietary behaviors, inadequate physical activity

Nationally expanded to include obesity and asthma

CDC provides standardized ‘optional’ items for consideration

Food Security, Preventive Health Care, Protective Factors

Why a Local YRBS?

LOCAL DATA is the richest data.National YRBS is collected at the state-level

Ohio Department of Health leads thisState level data not sufficient for counties

Rarely can sufficient sample be drawn to weight to each county

Ex: 7 high schools in Cuyahoga selected for Ohio YRBSODH is great, but has limited resources

Can offer technical assistance but cannot feasibly conduct locally

Why a Local YRBS?

Flexibility Sample selection Survey design and content Use of results

Can be used for more efficient resource planning, grant writing, and program evaluation Surveillance is a natural tool for assessment,

intervention identification, and evaluation.Responsive to community needs

Policy for Sharing

Who owns the data? CWRU is steward of the data in CC; CCBH also holds

data

Who can access it? CWRU has data sharing agreement developed with

sensitivity to funders’ needs (e.g. funding acknowledgement and publication rules)

Ensures that those using the data use it appropriately

Policy for Sharing Data

Two potential issues: Access to de-identified county-level file

Probably not a big deal Access to identifiable school-level data

Probably a BIG deal

School confidentiality has been key in Cuyahoga Use of school-level reports by media Process for school permission to release school-

specific data Schools must be a partner

YRBS & Preconception Health

Lifecourse Perspective: Preconception health considerations should begin at adolescence (i.e. puberty)

Lifestyle risk factors for poor birth outcomes often begin during adolescence

YRBS provides a natural mechanism by which to monitor preconception health of adolescent females

Granular data at local level could inform targeted program and policy approaches to improve preconception health

Presentation of the Data: Key

US-F: National data, female participantsOH-F: Ohio data, female participantsCC-All: Cuyahoga County data, all participantsCC-F: Cuyahoga County data, female participantsCity-F: Cleveland data, female participantsIR-F: Inner-ring suburbs data, female participantsOR-F: Outer-ring suburbs data, female

participants

Sexual Behavior: 2013 High School YRBS

Sex <13

4+ P

artn

ers

Curre

nt S

ex

Condo

m U

se

Preg

nant

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

7.1%

14.8%

32.0%

64.9%

3.9%3.2%

10.6%

30.9%

59.3%

3.9%

CC-AllCC-F

Sexual Behavior: 2013 High School YRBS

Sex <13

4+ P

artn

ers

Curre

nt S

ex

Condo

m U

se

Preg

nant

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

3.2%

10.6%

30.9%

59.3%

3.9%3.4%

12.6%

34.2%

54.6%

4.3%

15.8%

43.3%

35.2%

CC-FUS-FOH-F

Sexual Behavior: 2013 High School YRBS

Sex <13

4+ P

artn

ers

Curre

nt S

ex

Condo

m U

se

Preg

nant

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

3.2%

10.6%

30.9%

59.3%

3.9%5.9%

13.7%

33.6%

59.1%

8.3%3.5%

13.8%

34.3%

55.0%

5.0%

1.7%

6.7%

27.0%

64.4%

1.1%

CC-FCity-FIR-FOR-F

Substance Use: 2013 High School YRBS

Cigar

ette

s

Cigar

s

Alcoh

ol

Mar

ijuan

a

RX Dru

gs0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

8.8%

11.9%

34.9%

20.5%

8.7%6.3%

18.8%

27.0%

23.8%

8.8%10.1%

14.7%

37.3%

23.5%

10.7%9.0%

6.5%

37.0%

16.5%

7.0%

CC-FCity-FIR-FOR-F

Obesity: 2013 High School YRBS

Obese

Ovewt

Ovwt+

Obese

Trying

to L

ose

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

10.9%14.8%

25.7%

59.4%

18.4%22.7%

41.1%

55.6%

14.5%17.1%

31.6%

60.6%

4.6%9.3%

13.9%

60.1%

CC-FCity-FIR-FOR-F

Physical Activity: 2013 High School YRBS

Met PA No PA 3+hr TV 3+hr VG0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

39.4%

18.6%

30.8%

36.8%

24.1%

30.2%

49.0% 49.4%

38.3%

20.4%

35.6%38.2%

47.1%

12.1%

19.0%

30.1%

CC-FCity-FIR-FOR-F

Nutrition & Sleep: 2013 High School YRBS

5 F/V Pop daily Daily brkfst

Adeq Sleep0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

20.8%

17.3%

31.2%33.3%

17.9%

28.7%

19.7%

40.0%

17.1% 17.2%

24.2%

33.2%

25.2%

12.2%

42.3%

30.3%

CC-FCity-FIR-FOR-F

Responsible Sexual Behavior – High School

2007 2009 2011 201335%40%45%50%55%60%65%70%75%80%85%90%

68.0% 67.9%

59.8% 58.4%50.1%

47.1%42.4%

39.3%

63.2% 62.1% 62.2%65.1%

84.5%88.2% 88.1%

Ever Sexual Intercourse Current Sexual IntercourseCondom Use HIV/AIDS Education

Summary

Offers an effective means to monitor preconception health risk factors over time

Provides insight on targeting strategies or dispersing resources geographically

Surveillance is a natural evaluation of programmatic efforts

Questions?

Prevention Research Center for Healthy Neighborhoods

Erika S. Trapl, PhDAssistant Professor, Dept. of Epidemiology & Biostatistics

Associate Director, Prevention Research Center for Healthy Neighborhoods

Case Western Reserve University Phone: 216-368-0098Erika.Trapl@case.edu

Jean L. Frank, MPHManager of Community Initiatives

Phone: 216-368-5913Jean.Frank@case.edu

www.prchn.org/yrbs.aspx