LEAH 2013 Lecture SeriesOctober 4, 2013

Global and National Global and National Epidemiology of Adolescent Epidemiology of Adolescent

Health and Healthy People 2020Health and Healthy People 2020

Richard F. Catalano, Ph.D.Richard F. Catalano, Ph.D.

Bartley Dobb Professor for the Study and Prevention of Bartley Dobb Professor for the Study and Prevention of ViolenceViolence

Director, Social Development Research GroupDirector, Social Development Research Group

School of Social WorkSchool of Social Work

University of WashingtonUniversity of Washingtonwww.sdrg.org

ObjectivesObjectives

What are the leading causes of mortality What are the leading causes of mortality globally and nationally?globally and nationally?

How are behavior problems implicated in How are behavior problems implicated in mortality?mortality?

What is Healthy People and why is it What is Healthy People and why is it important to Adolescent Healthimportant to Adolescent Health

How does Healthy People 2020 incorporate How does Healthy People 2020 incorporate adolescents and epidemiology into its adolescents and epidemiology into its goals?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 yearsAll-cause Mortality 10-24 years

300+200-300150-200100-15050-1000-50

(Patton et al., 2009)

All-cause Mortality 10-24 yearsAll-cause Mortality 10-24 years

300+200-300150-200100-15050-1000-50

(Patton et al., 2009)

All-cause Mortality 10-24 yearsAll-cause Mortality 10-24 years

300+200-300150-200100-15050-1000-50

(Patton et al., 2009)

All-cause Mortality 10-24 yearsAll-cause Mortality 10-24 years

300+200-300150-200100-15050-1000-50

(Patton et al., 2009)

All-cause Mortality 10-24 yearsAll-cause Mortality 10-24 years

305/100,000 305/100,000 papa

45/100,000 pa45/100,000 pa

300+200-300150-200100-15050-1000-50

(Patton et al., 2009)

Leading Causes Leading Causes Worldwide of Mortality Worldwide of Mortality 10-24 Year Olds 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%)

10War 46 (1.8%)LOW RTI=lower respiratory tract infections. Patton et al.,

2009

64% due to

behavior

problems

10 Leading Causes of Death in 10 to 24 year oldsMales Females

Rank % total % total1 Road traffic accidents 13.9 Lower respiratory infections 6.72 Violence 9.2 Self-inflicted injuries 6.23 Self-inflicted injuries 6.4 HIV/AIDS 6.14 Drownings 5.3 Tuberculosis 5.85 Tuberculosis 5.2 Road traffic accidents 5.06 Lower respiratory infections 5.2 Fires 4.37 HIV/AIDS 4.9 Maternal haemorrhage 3.28 War 2.8 Abortion 2.69 Leukaemia 1.9 Drownings 2.5

10 Meningitis 1.8 Meningitis 2.3

Patton et al., 2009 Lancet

Behavior Problems are the Leading Causes of Mortality Worldwide

70% for Males, 57% for Femalesworldwide

Leading Causes of Mortality 15-24 Year Leading Causes of Mortality 15-24 Year Olds Olds (U.S.)(U.S.)

Total deaths (per

100,000)

1 Motor Vehicle Crashes 15.9

2 Accidents 11.5

3 Intentional self harm (suicide) 10.7

4 Assault (homicide) 10.3

5 Malignant neoplasms 3.7

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) 11.1

Hoyert & Xu, 2012 http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf

7.8

48.8/100,000 or 72% of

all deaths

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 Life Course PerspectivePerspective

Problem behaviors begun in adolescence Problem behaviors begun in adolescence have implications for morbidity and have implications for morbidity and mortality across the life course eg., mortality across the life course eg., Preventing tobacco use among young people Preventing tobacco use among young people is critical to ending the tobacco epidemicis critical to ending the tobacco epidemic80% of adult smokers began smoking by 18 80% of adult smokers began smoking by 18 years of ageyears of ageAdolescents are uniquely susceptible to social Adolescents are uniquely susceptible to social and environmental influencesand environmental influencesThomas Frieden quoted in USDHHS Preventing Tobacco Use Thomas Frieden quoted in USDHHS Preventing Tobacco Use Among Youth and Young Adults: A report of the Surgeon General, Among Youth and Young Adults: A report of the Surgeon General, 20122012

Selected Indicators of Behavior Problems Associated with Adolescent Health,

High School Youth Risk Behavior Survey, 2011

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 2000 2010 2020

Overarching Goals

• Decrease mortality: infants–adults

• Increase independence among older adults

• Increase span of healthy life

• Reduce health disparities

• Achieve access to preventive services for all

• Increase quality and years of healthy life

• Eliminate health disparities

• 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?

1. Access to Health Services

2. Adolescent Health*

3. Arthritis, Osteoporosis, and Chronic Back Conditions

4. Blood Disorders and Blood Safety*

5. Cancer

6. Chronic Kidney Disease

7. Dementias, Including Alzheimer’s Disease*

8. Diabetes

9. Disability and Health

10. Early and Middle Childhood*

11. Educational and Community-Based Programs

12. Environmental Health

13. Family Planning

14. Food Safety

* New Topic Area for 2020

Healthy People 2020 Topic Areas

15. Genomics*

16. Global Health*

17. Healthcare-Associated Infections*

18. Health Communication and Health Information Technology

19. Health-Related Quality of Life*

20. Hearing and Other Sensory or Communication Disorders

21. Heart Disease and Stroke

22. HIV

23. Immunization and Infectious Diseases

24. Injury and Violence Prevention

25. Lesbian, Gay, Bisexual and Transgender Health Issues*

26. Maternal, Infant and Child Health

27. Medical Product Safety

28. Mental Health and Mental Disorders

* New Topic Area for 2020

Healthy People 2020 Topic Areas (continued)

29. Nutrition and Weight Status

30. Occupational Safety and Health

31. Older Adults*

32. Oral Health

33. Physical Activity

34. Preparedness*

35. Public Health Infrastructure

36. Respiratory Diseases

37. Sexually Transmitted Diseases

38. Sleep Health*

39. Social Determinants of Health*

40. Substance Abuse

41. Tobacco Use

42. Vision

* New Topic Area for 2020

Healthy People 2020 Topic Areas (continued)

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!Thank You!

ReferencesReferencesAllensworth D, Lewallen TC, Stevenson B, Katz S (2011, March). Allensworth D, Lewallen TC, Stevenson B, Katz S (2011, March). Addressing the needs of the whole child: what public health can do to Addressing the needs of the whole child: what public health can do to answer the education sector’s call for a stronger partnershipanswer the education sector’s call for a stronger partnership. Prev Chronic . Prev Chronic Dis 2011;8(2):A44. Retrieved from Dis 2011;8(2):A44. Retrieved from http://www.cdc.gov/pcd/issues/2011/mar/10_0014.htm http://www.cdc.gov/pcd/issues/2011/mar/10_0014.htm ASCD (2011). ASCD (2011). Making the case for educating the whole childMaking the case for educating the whole child. Retrieved . Retrieved from http://www.wholechildeducation.org/making-the-case from http://www.wholechildeducation.org/making-the-case Basch, CE (2010, March). HBasch, CE (2010, March). Healthier students are better learners: A ealthier students are better learners: A missing link in school reforms to close the achievement gap. Equity missing link in school reforms to close the achievement gap. Equity MattersMatters, 6. , 6. Child Trends (2011) High school dropout rates. Retrieved from Child Trends (2011) High school dropout rates. Retrieved from http://www.childtrendsdatabank.org/alphalist?q=node/162Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, Bose K, Vos T, Ferguson J, Mathers CD, (2009), CD, (2009), Global patterns of mortality in young Global patterns of mortality in young people: a systematic analysis of population health data, Lancet, 374: 881–people: a systematic analysis of population health data, Lancet, 374: 881–92.92.