Allison Miles, MPHKara Gehring, MPH

Adapting the National Survey of Children’s Health Questions to Adolescent Health

Indicators

WHY SHOULD WE BE INTERESTED IN ADOLESCENT HEALTH?

Immediate impact and health improvements Potential for improved health throughout the

lifetime Prevention of cumulative ‘insults’ from

communicable diseases, chronic diseases, behavioral/mental health and wellness

Acquisition of health ‘assets’Potential for improving reproductive health

WHY INVEST IN ADOLESCENT HEALTH?

Adolescent public health investments hold the greatest potential for improving birth

outcomes within a population.

Adolescence is a key period for: Addressing physical, mental, emotional and

reproductive health Preventing injuries, transmission of communicable

diseases, and chronic substance misuse

At least 70% of premature adult deaths reflect behaviors started or reinforced during adolescence.

Evidence-based investments in healthy adolescent development have enormous potential for impacting future global health.

INVESTING IN ADOLESCENT HEALTH IS ESSENTIAL…

WHAT DATA SOURCES ARE AVAILABLE FOR THE ADOLESCENT POPULATION?

Local health departments can obtain information about their populations’ health byUsing public dataUsing state and/or local or internal dataConducting survey or community health assessment

POPULATION HEALTH SURVEILLANCE

Youth Risk Behavior Surveillance System—YRBSS

National Survey of Children’s Health—NSCH

National Survey of Children with Special Health Care Needs—

NS-CSHCN

Various Local and State-Level Surveillance

WHAT INDICATORS ARE USED TO MEASURE YOUTH HEALTH?

Provide a glimpse of a populations health, health risks, or assets

Many sets of indicators Chronic Disease Indicators Core State Preconception Health Indicators Life Course Indicators Healthy People 2020

HEALTH INDICATORS

For adolescents, there is not an agreed-upon set of indicators.

CAFI

COMMUNITY ADOLESCENT

FUTURES INITIATIVE

Community Adolescent Futures Initiative (CAFI) 6 pilot communities (local health departments) 1 year Using NSCH data and combination of state/local data

3 Pillars1) Community Engagement2) Analytic Methods3) Evidence-Based Interventions

CAFI PILOT PROJECT

METHODS

Chronic Disease Indicators

Preconception Health IndicatorsLife Course Indicators

Healthy People 2020

Relevant NSCH Questions

Literature

DATA ANALYSIS

2007, 2011/2012 NSCH data National level HRSA region 7 states 15 local health departments

RESULTS

40 Adolescent Health IndicatorsSix domains

Social determinants of health Health care access/utilization Health status Flourishing characteristics and adverse childhood events Household and environmental characteristics School engagement and extracurricular activities

ADOLESCENT HEALTH INDICATORS

Maternal educationHighest level of education in the household Poverty (200% below FPL)Working poor householdUnemployment Single parent household Residential mobility

SOCIAL DETERMINANTS OF HEALTH

Health care coverageMedical homePreventive careMental healthUnmet health care needs

HEALTH CARE ACCESS AND UTILIZATION

Physical health Dental health Chronic diseasesAnxiety and depression Overweight/obesityPhysical activity Sleep

HEALTH CARE STATUS

Flourishing Parental stressAdverse childhood events

FLOURISHING CHARACTERISTICS AND ADVERSE CHILDHOOD EVENTS

Tobacco exposureFamily involvement Neighborhood characteristics and school safety

HOUSEHOLD AND ENVIRONMENTAL CHARACTERISTICS

School engagement Extracurricular activities Mentors Television and electronic device use

SCHOOL ENGAGEMENT, MENTORS, AND EXTRACURRICULAR ACTIVITIES

DEVELOPING ADOLESCENT

HEALTH INDICATORS AT THE LOCAL LEVEL

Is there suffi cient data at the local level to justify this indicator?

Is the indicator relevant to adolescent health and/or well-being?

Does the indicator have the potential to impact population health?

Does the indicator have the potential to impact health across the lifespan?

Does the indicator have the potential to impact reproductive health?

Are there diff erences in equity when this indicator is examined by measures of race/ethnicity, education, etc.?

Does the indicator serve as a proxy for a social determinant of health?

Are the outcomes measured by the indicator modifi able?

DOES THIS PROCESS WORK AT THE LOCAL

LEVEL?

Small numbers

Missing data

Selecting the best indicator

Reference population

LIMITATIONS

Parent/guardian reportMissing key questions on adolescent risk behaviors

Sexual behaviors Alcohol and substance use

Remote access50:50 rounding techniqueSmall numbersWeighted for states, not localities Not conducted annually (slow turn around)

CHALLENGES WITH NSCH DATA

Aggregation Synthetic Estimates

Confidence Intervals

Questions