Preconception Health of Adolescents in Cuyahoga County Data

Preconception Health of Adolescents in Cuyahoga County: Data from the Youth Risk Behavior Survey ERIKA S. TRAPL, Ph. D CWRU Prevention Research Center for Healthy Neighborhoods 2014 CFHS ANNUAL MEETING APRIL 14, 2014

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 -U 48 -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 Inner Ring- East Cleveland- East Inner Ring- West Outer Ring- West Cleveland- West Outer Ring- East

Youth Risk Behavior Survey �Developed by the Centers for Disease Control and Prevention Started in 1991 Administered to 9 th-12 th 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 this �State 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 YRBS �ODH 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 participants �OH-F: Ohio data, female participants �CC-All: Cuyahoga County data, all participants �CC-F: Cuyahoga County data, female participants �City-F: Cleveland data, female participants �IR-F: Inner-ring suburbs data, female participants �OR-F: Outer-ring suburbs data, female participants

Sexual Behavior: 2013 High School YRBS 70, 0% 64, 9% 59, 3% 60, 0% 50, 0% 40, 0% 32, 0% 30, 9% CC-All 30, 0% CC-F 20, 0% 14, 8% 10, 6% 7, 1% 3, 2% 3, 9% 0, 0% Sex <13 4+ Current Condom Pregnant Partners Sex Use

Sexual Behavior: 2013 High School YRBS 70, 0% 59, 3% 60, 0% 54, 6% 50, 0% 43, 3% 40, 0% 34, 2% 35, 2% CC-F 30, 9% 30, 0% US-F 20, 0% 12, 6% 10, 6% 3, 2% 3, 4% 4, 3% OH-F 15, 8% 3, 9% 0, 0% Sex <13 4+ Current Condom Pregnant Partners Sex Use

Sexual Behavior: 2013 High School YRBS 70, 0% 64, 4% 59, 3% 59, 1% 60, 0% 55, 0% 50, 0% 40, 0% 33, 6% 27, 0% 20, 0% City-F 30, 9% 30, 0% 10, 0% CC-F 34, 3% IR-F OR-F 13, 7% 13, 8% 10, 6% 5, 9% 3, 5% 3, 2% 1, 7% Sex <13 8, 3% 6, 7% 3, 9% 5, 0% 1, 1% 4+ Partners Current Sex Condom Use Pregnant

Substance Use: 2013 High School YRBS 40, 0% 37, 3% 37, 0% 34, 9% 35, 0% 30, 0% 27, 0% 25, 0% 23, 8% 23, 5% CC-F 20, 5% 20, 0% City-F 18, 8% 16, 5% 15, 0% 10, 0% IR-F 14, 7% 8, 8% 11, 9% 10, 1% 9, 0% 6, 3% 10, 7% 8, 8% 6, 5% 7, 0% 5, 0% 0, 0% Cigarettes Cigars Alcohol Marijuana RX Drugs OR-F

Obesity: 2013 High School YRBS 70, 0% 59, 4% 60, 0% 60, 6% 60, 1% 55, 6% 50, 0% 41, 1% 40, 0% CC-F 31, 6% 30, 0% 25, 7% 22, 7% 18, 4% 20, 0% 10, 9% 14, 5% 10, 0% 14, 8% City-F IR-F 17, 1% OR-F 13, 9% 9, 3% 4, 6% 0, 0% Obese Ovewt Ovwt+Obese Trying to Lose

Physical Activity: 2013 High School YRBS 60, 0% 50, 0% 40, 0% 39, 4% 49, 0% 47, 1% 38, 3% 35, 6% 30, 8% 30, 2% 30, 0% 36, 8% 38, 2% CC-F 30, 1% 24, 1% 18, 6% 20, 0% 20, 4% IR-F 19, 0% OR-F 12, 1% 10, 0% Met PA No PA City-F 3+hr TV 3+hr VG

Nutrition & Sleep: 2013 High School YRBS 45, 0% 42, 3% 40, 0% 35, 0% 33, 3% 31, 2% 25, 0% 20, 0% 30, 3% 28, 7% 30, 0% 25, 2% 20, 8% 17, 9% 17, 1% 15, 0% 33, 2% CC-F 24, 2% City-F 19, 7% 17, 3% IR-F 17, 2% OR-F 12, 2% 10, 0% 5, 0% 0, 0% 5 F/V Pop daily Daily brkfst Adeq Sleep

Responsible Sexual Behavior – High School 90% 85% 80% 75% 70% 65% 60% 55% 50% 45% 40% 35% 84, 5% 88, 2% 68, 0% 67, 9% 63, 2% 62, 1% 50, 1% 88, 1% 62, 2% 59, 8% 58, 4% 47, 1% 42, 4% 2007 65, 1% 2009 Ever Sexual Intercourse Condom Use 2011 39, 3% 2013 Current Sexual Intercourse 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, Ph. D Assistant Professor, Dept. of Epidemiology & Biostatistics Associate Director, Prevention Research Center for Healthy Neighborhoods Case Western Reserve University Phone: 216 -368 -0098 Erika. Trapl@case. edu Jean L. Frank, MPH Manager of Community Initiatives Phone: 216 -368 -5913 Jean. Frank@case. edu www. prchn. org/yrbs. aspx