allison miles, mph kara gehring, mph adapting the national survey of children’s health questions...
TRANSCRIPT
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