Transcript Global Adolescent Health Trends PowerPoint

LEAH 2013 Lecture Series
October 4, 2013
Global and National Epidemiology
of Adolescent Health and Healthy
People 2020
Richard F. Catalano, Ph.D.
Bartley Dobb Professor for the Study and Prevention of Violence
Director, Social Development Research Group
School of Social Work
University of Washington
www.sdrg.org
Objectives




What are the leading causes of mortality
globally and nationally?
How are behavior problems implicated in
mortality?
What is Healthy People and why is it
important to Adolescent Health
How does Healthy People 2020
incorporate adolescents and epidemiology
into its goals?
Estimated Proportion of 10-24 Year Olds in the Country
Population (2010)
Source: Population Division of the Department of Economic and Social Affairs of the
United Nations Secretariat, World Population Prospects: The 2008 Revision.
No data
< 21%
≥21 - <24%
≥24 - <27%
≥27 - <30%
≥30 - <33%
≥33%
All-cause Mortality 10-24 years
300+
200-300
150-200
100-150
50-100
0-50
(Patton et al., 2009)
All-cause Mortality 10-24 years
300+
200-300
150-200
100-150
50-100
0-50
(Patton et al., 2009)
All-cause Mortality 10-24 years
300+
200-300
150-200
100-150
50-100
0-50
(Patton et al., 2009)
All-cause Mortality 10-24 years
300+
200-300
150-200
100-150
50-100
0-50
(Patton et al., 2009)
All-cause Mortality 10-24 years
45/100,000 pa
300+
200-300
150-200
100-150
50-100
0-50
305/100,000 pa
(Patton et al., 2009)
Leading Causes Worldwide
of Mortality 10-24 Year Olds
Rank
Cause
Total deaths x1000
1 Road Traffic Accidents
259 (10.0%)
2 Self-inflicted injuries
164 (6.3%)
3 Violence
157 (6.0%)
4 Low RTI
153 (5.9%)
5 Tuberculosis
142 (5.5%)
5 HIV/AIDS
142 (5.5%)
7 Drowning
106 (4.1%)
8 Fire-related
67 (2.6%)
9 Meningitis
53 (2.0%)
10 War
46 (1.8%)
LOW RTI=lower respiratory tract infections. Patton et al., 2009
64% due
to
behavior
problems
Behavior Problems are the Leading
Causes of Mortality Worldwide
70%Causes
for ofMales,
for
10 Leading
Death in 1057%
to 24 year
oldsFemales
worldwide
Males
Rank
1
2
3
4
5
6
7
8
9
10
Females
% total
Road traffic accidents
13.9
Violence
9.2
Self-inflicted injuries
6.4
Drownings
5.3
Tuberculosis
5.2
Lower respiratory infections 5.2
HIV/AIDS
4.9
War
2.8
Leukaemia
1.9
Meningitis
1.8
% total
Lower respiratory infections 6.7
Self-inflicted injuries
6.2
HIV/AIDS
6.1
Tuberculosis
5.8
Road traffic accidents
5.0
Fires
4.3
Maternal haemorrhage
3.2
Abortion
2.6
Drownings
2.5
Meningitis
2.3
Patton et al., 2009 Lancet
Leading Causes of Mortality 15-24 Year Olds
(U.S.)
Total deaths
(per 100,000)
48.8/100,000
Accidents
or 72% of all
Intentional self harm (suicide)
deaths
Assault (homicide)
1 Motor Vehicle Crashes
15.9
2
11.5
3
4
5 Malignant neoplasms
10.7
10.3
3.7
7.8
6 Diseases of heart
2.2
7 Congenital malformations, deformations and
abnormalities
1.0
8 Influenza and pneumonia
0.5
9 Cerebrovascular diseases
0.4
10 Pregnancy, childbirth and the puerperium
0.4
-- All other causes (Residual)
Hoyert & Xu, 2012
11.1
http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf
Global Shift in Mortality from
Infectious to Non-communicable
Diseases and Conditions
• Behavior problems are implicated in shift
(motor vehicle fatalities, violence, mental health, and
risky sex, alcohol, tobacco, and other drugs)
• Behavior problems cause harm in
adolescence
• Behavior problems established in
adolescence cause harm into adulthood
• Preventing these behavior problems
during adolescence can reduce mortality
and morbidity worldwide
Life Course Perspective
Problem behaviors begun in adolescence
have implications for morbidity and mortality
across the life course eg.,
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Preventing tobacco use among young people is
critical to ending the tobacco epidemic
80% of adult smokers began smoking by 18
years of age
Adolescents are uniquely susceptible to social
and environmental influences
Thomas Frieden quoted in USDHHS Preventing Tobacco Use Among
Youth and Young Adults: A report of the Surgeon General, 2012
Selected Indicators of Behavior Problems Associated with
Adolescent Health,
High School Youth Risk Behavior Survey, 2011
Ever drank alcohol
70.8
Ever had sex
47.4
44.7
Ever smoked
24.1
20.1
15.8
13.8
13.0
11.3
Rode with drinking driver
Bullied on school property
Considered suicide
Physically active 0 days
Obese
Drank soda 3+ times/day
0
10
20
30
40
50
60
70
80
Healthy People Background
and History
What Is Healthy People?
■ A national agenda that communicates a vision for
promoting health, preventing disease and achieving
health equity.
■ A set of specific, measurable epidemiologic objectives
with targets to be achieved over the decade.
■ These objectives are organized within distinct
Topic Areas.
History of Healthy People
■ 1979—ASH/SG Julius Richmond establishes first national
prevention agenda: Healthy People: Surgeon General’s Report on
Health Promotion and Disease Prevention
■ HP 1990—Promoting Health/Preventing Disease: Objectives for
the Nation
■ HP 2000—Healthy People 2000: National Health Promotion and
Disease Prevention Objectives
■ HP 2010—Healthy People 2010: Objectives for Improving Health
■ Healthy People 2020 – Launched December 2010
Evolution of Healthy People
Target Year
1990
Overarching • Decrease
Goals
mortality:
infants–adults
• Increase
independence
among older
adults
2000
2010
• Increase span • Increase
of healthy life
quality and
• Reduce health
years of
disparities
healthy life
• Achieve access • Eliminate
to preventive
health
services for all
disparities
2020
• Attain high-quality, longer lives
free of preventable disease
• Achieve health equity; eliminate
disparities
• Create social and physical
environments that promote good
health
• Promote quality of life, healthy
development, healthy behaviors
across life stages
# Topic Areas
15
22
28
39*
# Objectives/
Measures
226/NA
312/NA
467/1,000
>580/1200
* With objectives
Healthy People 2020
A Resource for Promoting Health and
Preventing Disease Throughout the Nation
Involving Non-Health Sectors To
Address Determinants of Health
■ Healthy People 2020 for the first time emphasizes
involving sectors outside health, including:
– Education
– Housing
– Environment
– Transportation
– Labor
– Agriculture
WHY?
Healthy People 2020
Topic Areas
1. Access to Health Services
8. Diabetes
2. Adolescent Health*
9. Disability and Health
3. Arthritis, Osteoporosis, and
Chronic Back Conditions
10. Early and Middle Childhood*
4. Blood Disorders and Blood Safety*
11. Educational and CommunityBased Programs
5. Cancer
12. Environmental Health
6. Chronic Kidney Disease
13. Family Planning
7. Dementias, Including Alzheimer’s
Disease*
14. Food Safety
* New Topic Area for 2020
Healthy People 2020
Topic Areas (continued)
15. Genomics*
22. HIV
16. Global Health*
23. Immunization and Infectious
Diseases
17. Healthcare-Associated Infections* 24. Injury and Violence Prevention
18. Health Communication and
Health Information Technology
25. Lesbian, Gay, Bisexual and
Transgender Health Issues*
19. Health-Related Quality of Life*
26. Maternal, Infant and Child Health
20. Hearing and Other Sensory or
Communication Disorders
27. Medical Product Safety
21. Heart Disease and Stroke
28. Mental Health and Mental
Disorders
* New Topic Area for 2020
Healthy People 2020
Topic Areas (continued)
29. Nutrition and Weight Status
36. Respiratory Diseases
30. Occupational Safety and Health
37. Sexually Transmitted Diseases
31. Older Adults*
38. Sleep Health*
32. Oral Health
39. Social Determinants of Health*
33. Physical Activity
40. Substance Abuse
34. Preparedness*
41. Tobacco Use
35. Public Health Infrastructure
42. Vision
* New Topic Area for 2020
10 of 42 topics are focused on behavior problems that affect adolescents
How Stakeholders Are Using
Healthy People
■ Epidemiologic data tool for measuring state, local,
national trends
■ Data tool for measuring program performance
■ Framework for program planning and development
■ Goal setting and agenda building
■ Teaching public health courses
■ Way to develop nontraditional partnerships
Healthy People 2020
Adolescent Health
Recognition of Importance of
Adolescent Health
■ Key transitional and dynamic period in life course.
■ Tremendous physical, social, emotional, and
cognitive growth and development – impact upon
lifelong health outcomes.
■ Health promotion, primary preventive and
secondary interventions during adolescence can
have profound and positive lasting health,
educational, and economic effects.
21 Critical Health Objectives
■ CHO Objectives fell into six health and safety
domains:
■ Mortality
■ Unintentional Injury
■ Violence
■ Mental Health and Substance Abuse
■ Reproductive Health
■ Prevention of Adult Chronic Diseases
Outcomes
■ Decrease in disparities, increased health equity
■ Healthier students ready to learn and to adopt
healthier behaviors
■ Students achieving at every level in school
■ Increased graduation rates of students with 21st
century skills—including health literacy
■ Increased percentage of healthy, productive adults
■ Decreased adult chronic illness
Healthy People 2020 data
sources
■ Each objective is measured by an identified
surveillance system that provides data points
throughout the decade
■ An objective’s ability to capture important details
totally dependent on its data source
■ Availability of data at state level –
 National Vital Statistics System
 Department of Education’s Common Core of Data
 A few surveillance systems use a state-based sampling frame (e.g.,
YRBSS, NSCH, NSCSHCN, NYTD)
 Most surveillance systems use a national sampling frame (e.g., MTF,
NHIS, NHANES, NSDUH, NSFG, NatSCEV)
NAHIIC Data Project to Improve
Adolescent and Young Adult Health:
National and State Profiles
■ Makes data more readily available to states
■ Shows disparities across gender/race/ethnicity
■ User-friendly format (usable by data people and
non-data people)
■ Allows users to explore the tremendous variability
across states without spending hours finding,
downloading, and cleaning data
■ Enables states to easily compare their progress with
other states
Available at
http://nahic.ucsf.edu
Future Plans
■ On-line HP 2020 evidence-based resources for
addressing adolescent health topic area objectives
■ Structured PubMed search queries for each
objective through National Library of Medicine
■ Dissemination & diffusion of additional helpful
evidence-based resources for states, communities &
organizations
■ Expand field of stakeholders
■ Facilitate engagement with key partners
■ Monitoring of progress through the decade
Thank You!
References
 Allensworth D, Lewallen TC, Stevenson B, Katz S (2011, March).
Addressing the needs of the whole child: what public health can do to
answer the education sector’s call for a stronger partnership. Prev Chronic
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Dis 2011;8(2):A44. Retrieved from
http://www.cdc.gov/pcd/issues/2011/mar/10_0014.htm
ASCD (2011). Making the case for educating the whole child. Retrieved
from http://www.wholechildeducation.org/making-the-case
Basch, CE (2010, March). Healthier students are better learners: A missing
link in school reforms to close the achievement gap. Equity Matters, 6.
Child Trends (2011) High school dropout rates. Retrieved from
http://www.childtrendsdatabank.org/alphalist?q=node/162
Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T,
Ferguson J, Mathers CD, (2009), Global patterns of mortality in young
people: a systematic analysis of population health data, Lancet, 374: 881–
92.