Adolescence: Preparing for Lifelong Health and Wellness

Adolescence: Preparing for Lifelong Health and Wellness


GOOD AFTERNOON,
I’M DR. PHOEBE THORPE. THANK YOU FOR JOINING US. ADOLESCENCE PREPARING FOR
LIFELONG HEALTH AND WELLNESS. LET’S GET STARTED. FIRST, HOUSEKEEPING. PUBLIC HEALTH GRAND ROUNDS HAS
CREDITS AVAILABLE. SEE OUR WEBSITE FOR MORE
INFORMATION. WE ALSO ARE ON SOCIAL MEDIA. WE HAVE A SPECIAL VIDEO CALLED
“BEYOND THE DATA” THAT WILL BE POSTED SHORTLY AFTER TODAY’S
SESSION. WE ARE ALSO TWEETING TODAY. SO, PLEASE USE #CDCGRANDROUNDS
FOR YOUR TWEETING NEEDS. WE HAVE ALSO PARTNERED WITH THE
CDC PUBLIC HEALTH LIBRARY FOR ARTICLES RELATED TO ADOLESCENCE
AND THEIR HEALTH. CDC.GOV/LIBRARY/SCICLIPS. HERE IS A PREVIEW OF OUR
UPCOMING SESSIONS. PLEASE JOIN US LIVE AROUND THE
WEB AND AS AN UPDATE WHILE THERE IS WORK TO BE DONE IN POLIO. THIS PAST TUESDAY MARKS ONE YEAR
OF NO POLIO CASES IN AFRICA. [ APPLAUSE ]
>>IN ADDITION TO OUR OUTSTANDING SPEAKERS, I WOULD
LIKE TO TAKE A MOMENT TO ACKNOWLEDGE THE IMPORTANT
CONTRIBUTIONS OF THE INDIVIDUALS LISTED HERE. THANK YOU. AND NOW, A FEW WORDS FROM CDC’S
DIRECTOR, DR. FRIEDEN.>>GOOD AFTERNOON, EVERYONE. I WORKED FOR MANY YEARS WITH AN
EDUCATOR WHO SAID THAT ONE OF THE UNFORTUNATE THINGS OF BEING
AN EDUCATOR IS THAT EVERYONE, SINCE THEY HAVE BEEN TO SCHOOL
THINKS THEY KNOW HOW TO RUN SCHOOLS. I THINK THE OPPOSITE CAN BE TRUE
OF ADOLESCENCE. SINCE WE HAVE ALL BEEN THROUGH
IT, WE HAVE NO IDEA HOW TO GET THROUGH IT IN A HEALTHY WAY. IT’S A WONDERFUL AND TERRIBLE
TIME OF LIFE AND A TIME OF RAPID CHANGE. FOR EXAMPLE, BETWEEN THE AGES OF
12 AND 17, A PARENT CAN AGE 20 YEARS. [ LAUGHTER ]
>>FROM A PUBLIC HEALTH PERSPECTIVE, ADOLESCENCE ARE
ESTABLISHING PATTERNS OF BEHAVIOR, MAKING LIFESTYLE
CHANGES THAT MAY STAY WITH THEM FOR MUCH OR ALL OF THEIR ADULT
LIVES. THEY ARE CHOOSING WHETHER OR NOT
TO SMOKE, WHETHER TO USE DRUGS AND ALCOHOL, WHETHER TO BE
SEXUALLY ACTIVE, WHAT TO EAT, HOW MUCH PHYSICAL ACTIVITY YOU
GET. ALL THE ESSENTIAL BEHAVIOR THAT
IS WILL DETERMINE, TO A GREAT EXTENT, HOW LONG AND HEALTHY
THEIR LIVES WILL BE. THEY ARE INCREASINGLY
INDEPENDENT AND WITH THAT BECOMES EXPLORATION, TRYING OUT
NEW BEHAVIORS AND OPENNESS INFLUENCES FROM A VARIETY OF
SOURCES, MANY OF THEM NOT SO HEALTHY. THAT IS WHY WE SEE NEARLY A
THIRD OF STUDENTS REPORTING HAVING TRIED TWO OR MORE TOBACCO
PRODUCTS. BARELY A QUARTER BEING ACTIVE,
BUT PROGRESS, AS YOU WILL HEAR IN AREAS. THINGS ARE GETTING BETTER IN
TERMS OF SEVERAL RISK FACTORS, WHETHER IT’S SAFE DRIVING OR
REDUCED ALCOHOL USE, TEEN PREGNANCY. BUT, STILL, MUCH UNFINISHED
BUSINESS AND MUCH MORE THAT COULD BE HEALTHIER AND MUCH
SAFER. IF WE THINK ABOUT THE INFLUENCES
ON ADOLESCENCE, THEY RANGE FROM SCHOOL TO PARENTS TO COMMUNITY
TO PEERS AND THAT WAS NOT NECESSARILY IN ORDER OF
IMPORTANCE. SOCIETIAL NORMS AND GOVERNMENTAL
CAN MAKE A DIFFERENCE. IT’S IMPORTANT TO RECOGNIZE WITH
THIS TIME OF OPENNESS, CHANGE IS ALSO A TIME OF OPPORTUNITY FOR
DEVELOPING HEALTHY LIFESTYLE THAT WILL CONTINUE FOR A
LIFETIME. INTERVENTIONS THAT ADDRESS
MULTIPLE DIFFERENT RISK FACTORS, MAYBE MORE LIKELY TO SUCCEED. IT’S TRUE FOR TOBACCO AND OTHER
PROGRAMS. INTERVENTIONS THAT CUT ACROSS
MANY VENUES THAT CAN POSSIBLY INFLUENCE BEHAVIOR ALSO MORE
LIKELY TO BE AFFECTIVE. THANKS VERY MUCH FOR OUR SPEAKS. THESE ARE A SET OF INFORMATIVE
AND STIMULATING TALKS AND LOOKING FORWARD TO A VERY
ENGAGED DISCUSSION. THANK YOU VERY MUCH. [ APPLAUSE ]
>>NOW, FOR OUR FIRST SPEAKER, DR. STEPHANIE ZAZA.>>THANK YOU, PHOEBE, VERY MUCH
AND THANK YOU DR. FRIEDEN FOR YOUR OPENING REMARKS. GOOD AFTERNOON, EVERYBODY. ADOLESCENCE IS A DEVELOPMENTAL
STAGE DURING WHICH PROFOUND PHYSICAL, INTELLECTUAL,
EMOTIONAL AND PSYCHOLOGICAL CHANGES OCCUR. SEXUAL PUBERTY ALSO OCCURS. IT GENERALLY CORRESPONDS TO
TEENAGE AND MIDDLE SCHOOL AND HIGH SCHOOL YEARS. BUT DIFFERENT ORGANIZATIONS
SELECT DIFFERENT AGE RANGES FOR THEIR OWN PURPOSES STARTING FROM
10-13 YEARS AND ENDING BETWEEN 19 AND 29. WE WILL CONCENTRATE ON PEOPLE
10-19 TO FOCUS ON THE UNIQUE ISSUES OF THIS AGE GROUP. THERE ARE ABOUT 42 MILLION
ADOLESCENCE AGE 10-19 IN THE UNITED STATES, WHICH IS ABOUT
13% OF THE TOTAL U.S. POPULATION. THE ADOLESCENT POPULATION IS
RACIALLY AND ETHNICALLY DIVERSE. THE PIE CHART SHOWS BLACK
ADOLESCENCE MAKE UP MORE THAN ONE-THIRD OF THE U.S. ADOLESCENT
POPULATION. OF THESE 42 MILLION ADOLESCENCE,
91% OR 31.8 MILLION ARE ENROLLED IN PUBLIC OR PRIVATE SCHOOL. THE DEPARTMENT OF EDUCATION
ESTIMATES THE DROPOUT RATE IN 2012 WAS 7% WITH A SIGNIFICANT
VARIATION BY RACE. 40% OF U.S. ADOLESCENCE AGE
12-17 LIVE IN LOW INCOME FAMILIES. 21% IN NEAR POOR FAMILIES AND
19% IN POOR FAMILIES. BLACK, AMERICAN INDIAN ARE
DISPROPORTIONALLY LOW INCOME AS ARE CHILDREN OF IMMIGRANT
PARENTS. THE SOUTH AND WEST HAVE THE
GREATEST PROPORTION LIVING IN LOW INCOME FAMILIES. ESTIMATES OF HOMELESSNESS AMONG
ADOLESCENCE VARY FROM 500,000 TO 2.8 MILLION A AR. MOST HOMELESSNESS IS DUE TO
RUNNING AWAY. IN 2002, 1.6 MILLION ADOLESCENCE
12-17 RAN AWAY FROM HOME AND SLEPT AT LEAST ONE NIGHT ON THE
STREET IN THE LAST 12 MONTHS. THE REV LENS OF RUNNING AWAY
INCREASES WITH AGE. ADOLESCENCE IS A RELATIVELY
HEALTHY PERIOD OF LIFE. THE STATUS IS ASSESSED IN THE
NATIONAL HEALTH INTERVIEW SURVEY. IN 2012, 97% OF TEENS HAD GOOD
HEALTH OR BETTER. LIKEWISE, 11% WERE REPORTED TO
HAVE SOME LIMITATION TO ACTIVITY DUE TO HEALTH ISSUES. THERE ARE IMPORTANT, PREVENTABLE
CAUSES TO DEATH, ILLNESS. THESE ARE THE CAUSES OF DEATH,
INJURIES, WHETHER UNINTENTIONAL OR CAUSED BY INTENT BY SUICIDE
OR HOMICIDE. OTHER MAJOR CAUSES OF DEATH
ARE CANCER, HEART DISEASE AND CONGENITAL ANOMALIES. INJURIES ARE ALSO THE LEADING
CAUSE OF NONFATAL MORBIDITY. MECHANISMS LIKE STRUCK BY
SOMETHING FALLING, OVEREXERTION AND CAR CRASHES. THERE ARE INJURIES CAUSED BY
NONSEXUAL ASSAULT AND 8% OF HIGH SCHOOL STUDENTS ATTEMPTED
SUICIDE. SEXUAL AND REPRODUCTIVE HEALTH
IS ALSO IMPORTANT DURING ADOLESCENCE. BIRTHRATES CONTINUE TO DECREASE
AMONG TEENS. IN 2013, 273,000 BIRTHS TO
MOTHERS AGE 15-19 OCCURRED. CHLAMYDIA AND GONORRHEA ARE
POPULAR AND CONSTITUTE 47% AMONG ALL AGE GROUPS. ASTHMA PREVALENCE IS 10%. 14% OF TEENS ARE OVERWEIGHT AND
OBESITY OCCURS AMONG 21%. THE ONE WAY TO ADDRESS THESE
HEALTH ISSUES, OF COURSE, THROUGH HEALTH CARE AND HEALTH
CARE ACCESS AND USE AMONG ADOLESCENCE IS HIGH IN TERMS OF
INSURANCE COVERAGE AND HAVING A DOCTOR VISIT. PREVENTIVE HEALTH SERVICES
REPRESENTED BY WELL CARE VISITS ARE UNDERUTILIZED. DOCTOR BRINDIS WILL COVER THIS
IN MORE DETAIL. RISK BEHAVIORS ARE THE OTHER
WAYS TO ADDRESS HEALTH ISSUES IN ADOLESCENCE. THEY ARE A CONTRIBUTOR TO CAUSES
OF MORBIDITY AND MORTALITY. THE HEALTH OUTCOMES I SHOWED
EARLIER. BASED ON THE 2013 RISK SURVEY
CONDUCTED AMONG NINTH AND 12th GRADERS, 88% OF HIGH SCHOOL
STUDENTS RARELY OR NEVER USE BICYCLE HELMETS. 41% TEXTED OR E-MAILED DRIVING A
CAR AND A QUARTER INVOLVED IN PHYSICAL FIGHTS. TV WATCHING TRANSFORMED INTO
OTHER TYPES OF SCREEN TIME WITH EXCESSIVE NON SCHOOL USE OF
COMPUTERS BY 41% OF CHILDREN. RISK BEHAVIORS CONTRIBUTE TO
REPRODUCTIVE HEALTH OUTCOMES. NEARLY HALF OF HIGH SCHOOL
STUDENTS ARE SEXUALLY ACTIVE, BUT FEW USE CONTRACEPTIVES AND
41% DID NOT USE CONDOMS,LEAVING A LARGE NUMBER OF TEENS WITH
PREGNANCIES AND SEXUAL DISEASES. ONE-THIRD OF HIGH SCHOOL
STUDENTS CURRENTLY USE ALCOHOL AND MARIJUANA USE EXCEED ALL
FORMS OF TOBACCO USE COMBINED, WHICH IS PREVALENT AMONG
ADOLESCENCE. LIFELONG PATTERNS OF RISKY AND
HEALTHY BEHAVIORS AMONG ADOLESCENCE. SMOKING AND BINGE DRINKING AND
ENCOURAGING HEALTHY NUTRITION AND PHYSICAL BEHAVIORS HAVE
LIFELONG BENEFITS FOR HEALTH. IN FACT, REDUCING RISKY BEHAVIOR
AND ENCOURAGING HEALTHY BEHAVIORS ARE COMMENDABLE. THIS SHOWS NATIONAL WIRELESS
DATA FROM 1991 TO 2013, WHICH DEMONSTRATE ENCOURAGING TRENDS
FROM THE BOTTOM OF THE CHART TO THE TOP. WE HAVE SEEN DECLINES IN NOT
USING SEATBELTS, CURRENT USE OF CIGARETTES, BINGE DRINKING,
RIDING IN A CAR WITH A DRIVER WHO HAD BEEN DRINKING AND
PHYSICAL FIGHTING. THESE TRENDS CAN BE ATTRIBUTED
TO COMPREHENSIVE PUBLIC HEALTH APPROACHES IN COMMUNITY, SCHOOL
AND PUBLIC LEVELS. THIS WILL BE DESCRIBED MORE BY
DOCTOR DITTUS AND MICHAEL TODAY. IMPORTANT VULNERABILITIES. THEY ARE IN GOOD HEALTH, BUT
EXPERIENCE PREVENTABLE INJURIES AND ILLNESSES AND CARE IF UNDER
USED. IT’S A PERIOD WHEN CHANGES ARE
OCCURRING AND RISK BEHAVIORS INCREASE. THEY CONTRIBUTE TO CURRENT AND
FUTURE HEALTH RISKS. I’D LIKE TO INTRODUCE DR. PATRICIA DITTUS WHO WILL
CONTINUE THE EXPLORATION OF ADOLESCENT HEALTH. THANK YOU. [ APPLAUSE ]
>>THANK YOU, STEPHANIE. GOOD AFTERNOON. ADOLESCENCE ARE NOT MINI ADULTS. THEY TRANSITION FROM EARLY TO
MIDDLE TO LATE ADOLESCENCE AND ADULTHOOD. ADOLESCENCE CHANGES IN PHYSICAL,
COGNITIVE AND SOCIAL DEVELOPMENTS PROGRESS OVER TIME. COGNITIVE DEVELOPMENT LAGS
BEHIND. MANY ADOLESCENCE APPEAR TO BE
GROWN UP, THEIR BRAINS ARE STILL DEVELOPING. FOR EXAMPLE, THE AREA OF BRAIN
THAT CONTROLS EXECUTIVE FUNCTIONS INCLUDING WEIGHING
CONSEQUENCES AND IMPULSES ARE THE LAST TO MATURE. ADOLESCENCE BEHAVIOR IS
INFLUENCED BY A NUMBER OF FACTORS WITHIN THE ENVIRONMENT
OR SOCIAL CONTEXT. AT THE INTRAPERSONAL OR
INDIVIDUAL LEVEL ARE DEVELOPMENTAL INFLUENCES IN
ADDITION TO ATTITUDES, BELIEFS AND KNOWLEDGE. AT THE INTERPERSONAL OR
RELATIONSHIP LEVEL ARE THE INFLUENCES FAMILY, PEER AND
ROMANTIC RELATIONSHIPS. AT THE INSTITUTIONAL LEVEL, WE
SEE THE INFLUENCE OF SCHOOLS AND HEALTH CARE INSTITUTIONS. SCHOOLS, FOR EXAMPLE INFLUENCE
AND PRESENT OPPORTUNITIES FOR RISK AS THEY FORM RELATIONSHIPS
WITH RISK-TAKING PEERS. NEXT, COMMUNITY LEVEL INFLUENCES
INCLUDE NEIGHBORHOOD CHARACTERISTICS AND COMMUNITY
RESOURCES AND NORMS. THE SOCIETY AND POLICY LEVEL
INCLUDE CULTURAL, POLICY AND MEDIA INFLUENCES. MOST FREQUENTLY, INTERACTIONS
FOCUS ON THE INTELLECTUAL LEVEL, HOWEVER WE CAN ON ANY LEVEL FOR
RISK. EVIDENCE BASED MULTILEVEL
INTERVENTIONS HAVE AN EFFECT AND MAXIMIZE IT. I’LL GIVE EXAMPLES NEXT OF
SPECIFIC INTERVENTIONS. FAMILIES TALKING TOGETHER AS A
PARENT BASED INTERVENTION DESIGNED TO SUPPORT AND IMPROVE
COMMUNICATION BETWEEN PARENTS AND ADOLESCENCE ABOUT AVOIDING
RISKY SEX. BRIEF FACE-TO-FACE SESSIONS. NINE WRITTEN MODULES ARE GIVEN
TO PARENTS AND BOOSTER CALLS FOLLOW UP WITH PARENTS AFTER
SESSIONS ARE OVER. HEALTH CARE PROVIDERS OR
PRINCIPALS ENCOURAGE PARTICIPATION BY ENCOURAGING
PROGRAMS. KEY PARENTS BEHAVIORS ARE
TARGETED. MONITORING OF SUPERVISION. FTT WAS EVALUATED IN TWO RANDOM
CLINICAL TRIALS OF THE MOTHERS OF LATINO AND AFRICAN-AMERICAN
MOTHERS. ONE IN PUBLIC MIDDLE SCHOOLS AND
THE OTHER IN A COMMUNITY HEALTH CLINIC. IN THE MIDDLE SCHOOL STUDY, AT
THE 12-MONTH FOE FOLLOW UP, INCREASED COMMUNICATION WITH
MOTHERS ABOUT SEX. THAT IS RELATIVE TO STUDENTS IN
CONTROLLED SCHOOLS. THIS SLIDE SHOWS PERCENTAGES AND
MEANS FOR THE OUTCOMES IN THE CLINIC STUDY. ADOLESCENCE IN THE INTERVENTION
GROUP SHOWED LOWER RATES OF SEXUAL ACTIVITY IN NINE MONTHS
THAN THE CONTROL GROUP AS WELL AS LESS FREQUENT SEX. THE AVERAGE AGE OF ADOLESCENCE
IN THIS STUDY WAS 13 YEARS. FTT IS THE ONLY PARENT
INTERVENTION IDENTIFIED BY THE HHS OFFICE OF ADOLESCENCE
HEALTH. THE COMMUNITY PREVENTIVE
SERVICES TASK FORCE RECOMMENDS INTERVENTIONS TARGETED TO
PARENTS PROJECT CONNECT IS A CDC FUNDED
SCHOOL INTERVENTION. IT IS DESIGNED FOR REPRODUCTIVE
HEALTH CARE. YOUTH ARE ALREADY PROVIDING
SERVICES TO ADOLESCENCE. A HEALTH CARE PROVIDER REFERRAL
IS DISTRIBUTED TO YOU, KEEP YOU IN SCHOOL. A LARGE RESEARCH TRIAL WAS
CONDUCTED IN 12 PUBLIC HIGH SCHOOLS IN LOS ANGELES FOR
PROJECT CONNECT. SURVEY WAS COLLECTED ON 30,000
STUDENTS FOR SCHOOL POPULATION EFFECTS. THEY ARE LATINO, AVERAGE AGE 16
AND 47% HAD ALREADY HAD SEX AT THE START OF THE STUDY. THE INTERVENTION HAD SIGNIFICANT
IMPACT ON SEXUAL AND REPRODUCTIVE HEALTH CARE ON
FEMALES, BUT NOT EFFECTIVE FOR MALES. HISTORICALLY, MALES ARE
DIFFICULT TO CONNECT TO HEALTH CARE. WE ARE ADAPTING PROJECT CONNECT
TO CONNECT MALES TO CARE. THIS SLIDE SHOWS THE PERCENT OF
EXPERIENCED FEMALES RECEIVING TESTING OR TREATMENT FOR STD
ACROSS THE FIVE STUDY WAVES. THEY REPORTED A DECREASE OF 10%
WHERE THE CONTROL GROUP IS STABLE. ALTHOUGH, NOT SHOWN, THEY ARE
FOUND FOR THE RECEIPT OF BIRTH CONTROL FROM A DOCTOR OR NURSE
OR HAVING BEEN TESTED FOR HIV. PROJECT CONNECT IS RECOMMENDED
BY CDC AND DIVISION OF STD PREVENTION AND SCHOOL HEALTH. COMMUNITIES THAT CARE IS A
COMMUNITY LEVEL INTERVENTION FOR REDUCING ADOLESCENCE ALCOHOL AND
TOBACCO USE AND VIOLENCE. THEY DEVELOP A STRATEGIC
PREVENTION PLAN. A COMMUNITY WIDE SURVEY TO
IDENTIFY RISK AND PROTECTIVE FACTORS, FORMING COALITION OF
STAKE HOLDERS AND SELECTING FROM A MENU OF INTERVENTIONS FOR
FAMILY, SCHOOLS AND COMMUNITIES. ONGOING COMMUNITY ASSESSMENTS
ARE AN IMPORTANT PART OF THE PROCESS. THE COMMUNITY YOUTH DEVELOPMENT
STUDY WAS THE FIRST TRIAL. 24 COMMUNITIES AND MATCHED PAIRS
IN SEVEN STATES WERE ASSIGNED TO RECEIVE THE CTC INTERESSENTIAL
OR SERVICE CONTROLS. BECAUSE THE CTC INTERVENTION WAS
DESIGNED FOR ADOLESCENCE BEHAVIORS, THE STUDENTS WERE
SURVEYED TO DETERMINE EFFECTIVENESS. THEY WERE SURVEYED THROUGH THE
EIGHTH GRADE. THEY WERE IMPLEMENTED TWO YEARS
BY THE EIGHTH GRADE ASSESSMENT. THIS SLIDE SHOWS PERCENTAGES AND
MEANS REPORTED BY EIGHTH GRADE STUDENTS. STUDENTS IN THE INTERVENTION
WERE LESS LIKELY TO USE ALCOHOL OR USE SMOKELESS TOBACCO, LESS
LIKELY TO BINGE DRINK OR ENGAGE IN DELINQUENT BEHAVIORS. CTC WAS LISTED ON THE NATIONAL
REGISTRY OF PROGRAMS AND PRACTICES. FINALLY, A SOCIETY LEVEL
INTERVENTION OR GDL SYSTEM SEEK TO REDUCE FATALITIES AMONG
ADOLESCENCE AMONG A THREE-TIERED LICENSING SYSTEM. LEARNERS PERMIT, EVALUATION AND
THEN DRIVERS LICENSE. ALL STATES HAVE LAWS WITH
RESTRICTIONS SUCH AS WATCHING AN ADOLESCENT, IMPOSING A RISK. GDL LAWS IN THE U.S. WERE
EVALUATED COMPARING FATAL CRASHES AMONG 16-YEAR-OLD AND
17-YEAR-OLD DRIVERS AMONG 19-25-YEAR-OLD DRIVERS. THE QUALITY OF THE LAWS WERE
INCLUDED IN THE ANALYSIS WITH GOOD GDL LAWS WITH FIVE OR MORE RESTRICTIONS. LAWS MAKE IT ILLEGAL FOR ANYONE
UNDER THE AGE OF 21 TO DRIVE WITH ANY AMOUNT OF ALCOHOL IN
THEIR SYSTEM. GDL PROGRAMS REDUCE FATAL
PROGRAMS AMONG 16-YEAR-OLDS AND 17-YEAR-OLDS. STATES WITH GOOD GDL LAWS HAD
FEWER FATALITIES. STATES WITH GDL LAWS AND A ZERO
ALCOHOL LAW HAD THE FEWEST FATALITIES AMONG ADOLESCENCE. RESTRICTIONS TO GDL LAWS FOR
FATALITIES AMONG YOUNG DRIVERS. AS ADOLESCENCE DEVELOP AND
EXPERIENCE WITH IDENTITIES, THEY TRY NEW BEHAVIORS, NOT ALL OF
WHICH ARE HEALTHY. WE SHOULD CONTINUE STRIVING TO
CREATE WAYS TO MAKE HEALTHY CHOICES THE EASY CHOICES. NOW, I TURN THINGS OVER TO DR. SHANNON MICHAEL WHO WILL DISCUSS
THE IMPORTANCE OF SCHOOLS. [ APPLAUSE ]
>>THANK YOU, PATRICIA. GOOD AFTERNOON. SCHOOLS ARE A GREAT PLACE TO
PROMOTE ADOLESCENT HEALTH AND WELLNESS. THERE ARE OVER 37,000 MIDDLE AND
HIGH SCHOOLS IN THE U.S. THAT REACH OVER 38 MILLION
ADOLESCENCE. SCHOOLS ARE DESIGNED TO BE
PLACES FOR LEARNING, INCLUDING PLACES FOR LEARNING ABOUT
HEALTH. SCHOOL CAN ALSO PROVIDE
OPPORTUNITIES FOR ADOLESCENCE TO PRACTICE HEALTHY BEHAVIOR THAT
IS IMPROVE HEALTH NOW AND WILL LEAD TO FUTURES. ACADEMIC ACHIEVEMENT, ESPECIALLY
HIGH SCHOOL GRADUATION CONVEYS LIFELONG BENEFITS FOR HEALTH. THIS GIVES EDUCATION AND HEALTH
LEADERS A SHARED INTEREST IN PROMOTING ADOLESCENT HEALTH. TODAY, I WILL FOCUS ON THREE
IMPORTANT WAYS SCHOOLS CAN IMPACT THE HEALTH OF
ADOLESCENCE. SCHOOLS CREATE ENVIRONMENT THAT
IS ARE SAFE, POSITIVE AND SUPPORTIVE HEALTHY BEHAVIOR. SECOND, SCHOOLS CAN TEACH THEM
ABOUT HEALTHY BEHAVIORS THROUGH HEALTH EDUCATION AND PHYSICAL
EDUCATION. THIRD, THEY CAN PROVIDE HEALTH
SERVICES, INCLUDING MENTAL HEALTH SERVICES FOR ADOLESCENCE. WITHIN THE SCHOOL ENVIRONMENT,
SCHOOL CLIMATE REFERS TO THE QUALITY AND CHARACTER OF SCHOOL
THAT IS DIRECTLY IMPACT THE STUDENT’S EXPERIENCES, INCLUDING
MOTIVATION TO LEARN. A POSITIVE SCHOOL ENVIRONMENT,
PRESENTING AND REDUCING RISK BEHAVIORS INCLUDING REDUCING
BULLYING AND HARASSMENT. SCHOOL CONNECTEDNESS REFERS TO
THE RELATIONSHIP THEY HAVE WITH PEERS, TEACHERS AND PARTS
ENGAGEMENT IN THE SCHOOLS. ADOLESCENCE WHO FEEL CONNECTED
TO THEIR SCHOOL DO BETTER IN SCHOOL AND ARE LESS LIKELY TO
ENGAGE IN RISKY BEHAVIORS. FINALLY, POLICIES AND PRACTICES
PROVIDE OPPORTUNITIES FOR STUDENTS TO BECOME HEALTH
LITERATE AND CHOOSE HEALTHY BEHAVIORS. LET’S LOOK AT HOW THE POLICIES
AND PRACTICES IMPACT THE SCHOOL’S ENVIRONMENT. ALMOST ALL SCHOOL DISTRICTS HAVE
LOCAL SCHOOL WELLNESS POLICIES THAT SET GOALS FOR NUTRITION AND
PHYSICAL ACTIVITY, THE QUALITY AND LEVEL OF IMPLEMENTATION
VARIES. NEW, FEDERAL REQUIREMENTS AIM TO
HOLD THEM ACCOUNTABLE FOR IMPLEMENTATION OF THE POLICIES. CDC SCHOOL HEALTH GUIDELINES TO
PROMOTE HEALTHY EATING CAN ASSIST DISTRICTS IN IDENTIFYING
EVIDENCE BASED POLICIES AND PRACTICES. THIS RESOURCE IDENTIFIES NINE
EVIDENCE BASED GUIDELINES AND 33 STRATEGIES AMONG STUDENTS. CDC USES SCHOOL HEALTH POLICIES
AND PRACTICES STUDY TO TRACK HOW WELL WE ARE DOING NATIONWIDE AND
IMPLEMENTING HEALTH POLICIES AND PRACTICES IN SCHOOLS. DATA FROM 2014 SHOW THAT LESS
THAN 20% OF SCHOOLS HAVE VENDING MACHINES, SCHOOL STORES OR SNACK
BARS THAT SELL THINGS HIGH IN FAT AND SUGAR. THEY NEED TO WORK ON HEALTHY
THINGS. 75% OF SCHOOLS LET STUDENTS
CARRY WATER BOTTLES THROUGHOUT THE DAY. HOWEVER, 25% ALLOW ADVERTISING
AND SOFT DRINKS IN VENDING MACHINES. THERE ARE MANY WAYS SCHOOLS CAN
INCREASE PHYSICAL ACTIVITY DURING THE STOOL DAY.>>THE 2014 DATA SHOW 90% OF
SCHOOLS ARE FOLLOWING NATIONAL, STATE STANDARDS. BUT, VERY FEW SCHOOLS ARE
OFFERING DAILY PHYSICAL EDUCATION. YOU SEE THAT SCHOOLS ARE DOING A
GOOD JOB OF OFFERING RECESS DURING SCHOOL. MORE SCHOOLS COULD OFFER
PHYSICAL ACTIVITY BREAKS DURING THE SCHOOL DAY. CDC HAS PROVIDED ALL 50 STATES
AND D.C. TO BUILD CAPACITY FOR SCHOOL POLICIES AND PRACTICES. BECAUSE OF THIS WORK, WE HOPE TO
SEE MORE SCHOOLS IMPACTING THE HEALTH OF ADOLESCENCE AND
IMPROVE THEIR WELL BEING. LET’S TURN TO HEALTH EDUCATION
AND PHYSICAL EDUCATION. IT’S A SECOND IMPORTANT AREA TO
IMPROVE HEALTH AND WELLNESS. HEALTH EDUCATION IS AN INTEGRAL
PART OF HEALTH. EXPERIENCES ON A VARIETY OF
TOPICS SUCH AS NUTRITION, PHYSICAL ACTIVITY, ALCOHOL AND
OTHER DRUGS, TOBACCO USE, MENTAL AND EMOTIONAL HEALTH. HEALTH EDUCATION PROVIDES
ADOLESCENCE THE OPPORTUNITY TO ACQUIRE HEALTH KNOWLEDGE AND
SKILLS THAT HELP THEM MAKE INFORMED DECISIONS THROUGHOUT
THEIR LIFE. IT HAS CONDOM USE, DECREASE
SMOKING. DAILY PHYSICAL EDUCATION IN
SCHOOL EQUIP ADOLESCENCE WITH THE APPROPRIATE KNOWLEDGE,
SKILLS AND CONFIDENCE TO BE ACTIVE FOR A LIFETIME AND HELP
THEM MEET THE RECOMMENDED 60 MINUTES OF DAILY ACTIVITY. SCHOOL SHOULD NOT ONLY BE
OFFERING PHYSICAL EDUCATION, BUT KEEPING THEM ACTIVE DURING
CLASS. THE INSTITUTE OF MEDICINE, CDC
AND SHAPE AMERICA RECOMMEND ALL MIDDLE AND HIGH SCHOOL STUDENTS
SHOULD SPEND 225 MINUTES OF PHYSICAL EDUCATION A WEEK. IN ADDITION THEY RECOMMEND
STUDENTS SHOULD HAVE HALF THE PRICE IN PHYSICAL ACTIVITY. IN SUPPORT OF STUDENTS ENGAGING
IN PHYSICAL ACTIVITY, THE PREVENTIVE SERVICES TASK FORCE
RECOMMEND PHYSICAL EDUCATION. IT INCREASES THE AMOUNT OF TIME
STUDENTS SPEND IN MODERATE PHYSICAL ACTIVITY DURING CLASSES
BY IMPROVING TEACHER STRATEGIES AND SUPPLEMENTING PARTICIPATION
IN SPORTS SUCH AS BASEBALL WITH ACTIVITIES LIKE RUNNING OR
JUMPING. SCHOOLS CAN RECEIVE SUPPORT FOR
PHYSICAL EDUCATION FROM TWO NATIONAL INITIATIVES. THE FIRST LADY’S LET’S MOVE
INITIATIVE HELP SCHOOLS DEVELOP AND IMPLEMENT PLANS AND PROGRAMS
WITH A STRONG FOCUS ON PHYSICAL EDUCATION. THE PRESIDENTIAL FIT PROGRAM
IMPROVES FITNESS TRAINING THROUGH TEACHER TRAINING AND
FITNESS ASSESSMENT. FINALLY, SCHOOLS CAN IMPACT THE
HEALTH AND WELLNESS BY PROVIDING HEALTH CARE SERVICES, INCLUDING
MENTAL HEALTH.>>>A CASE STUDY OF THE
MASSACHUSETTS ESSENTIAL SCHOOL SERVICES PROGRAM EXAMINE THE
COST BENEFITS OF SCHOOL NURSING SERVICES DELIVERED BY NURSES. THE PROGRAM COST IS $79 MILLION. THE NET BENEFIT, $98 MILLION. THIS MEANS FOR EVERY DOLLAR
INVESTED IN THE PROGRAM, $2.20 WAS SAVED. BEYOND HAVING A SCHOOL NURSE,
COMPREHENSIVE HEALTH SERVICES CAN BE PROVIDED THROUGH A SCHOOL
BASED HEALTH CENTER. THESE SERVICES HELP KEEP
ADOLESCENCE HEALTHY AND IN THE CLASSROOM. THE COMMUNITY PREVENTIVE TASK
FORCE CONDUCTED A LITERATURE REVIEW OF THE CENTER. IT FOUND THAT HEALTH CENTERS
WERE ASSOCIATED WITH IMPROVING THE HEALTH RELATED OUTCOME,
ESPECIALLY FOR URBAN, LOW INCOME AND RACIAL, ETHNIC STUDENTS. THE FINDINGS SHOWED SCHOOL BASED
HEALTH CENTERS WERE ASSOCIATED WITH OUTCOMES, INCLUDING GRADE
POINT AVERAGE AND RATES. BASED ON THE FINDINGS, THEY
RECOMMEND THE MAINTENANCE OF THE CENTERS IN LOW INCOME
COMMUNITIES. AS AN EXAMPLE, DENVER HAS 16
HEALTH CENTERS OFFERING PRIMARY CARE, MENTAL HEALTH AND
REPRODUCTIVE
HEALTH SERVICES THAT INCLUDE STD TESTING AND TREATMENT AND
PREGNANCY TESTING. 13 OF THE 16 CENTERS OFFER
CONTRACEPTION. THEY HAVE OTHER SERVICES OUTSIDE
THE SCHOOL BY MAKING AN APPOINTMENT WITH A HEALTH CARE
PROVIDER IN ONE OF 18 CLINICS. DATA INDICATES THAT ADOLESCENT
BIRTH RAYS DECLINED FROM 2009 TO 2013. THERE ARE MANY FACTORS THAT MAY
HAVE CONTRIBUTED TO THE DECLINE, AN IMPORTANT FACTOR WAS
PROVIDING THEM WITH COMPREHENSIVE SEX EDUCATION. INTERESTINGLY, SCHOOL DROPOUT
RATES DECLINED IN THE SAME PERIOD. SCHOOLS IMPACT ADOLESCENCE
HEALTH AND WELLNESS, TEACHING HEALTH AND WELLNESS AND
PROVIDING HEALTH SERVICES. TOGETHER, WE CAN INCREASE THESE
OPPORTUNITIES AND MORE IMPORTANTLY, THEIR QUALITIES. NOW, WE WILL LEARN MORE FROM DR. CLAIRE BRINDIS. [ APPLAUSE ]
>>THANK YOU, SHANNON. ADOLESCENCE IS A KEY TIME WHEN
YOUNG PEOPLE BECOME INCREASINGLY RESPONSIBLE FOR THEIR OWN HEALTH
CARE AS PART OF THEIR GROWING INDEPENDENCE AND TRANSITION TO
YOUNG ADULTHOOD. HEALTH CARE SYSTEMS CAN BE
DESIGNED TO ADDRESS THE RISK TAKING PROCEDURE THAT CAN LEAD
TO MAJOR HEALTH PROBLEMS. TODAY, I WILL SHARE WITH YOU
WAYS TO IMPROVE PREVENTIVE AND TREATMENT SERVICES FOR
ADOLESCENCE. IMPROVING HEALTH CARE FOR
ADOLESCENCE INCLUDES ACCESS TO AND USE OF CLINICAL, PREVENTIVE
SERVICES, OPPORTUNITIES FOR THE AFFORDABLE CARE ACT. DESIGNING SYSTEMS TO IMPROVE
POPULATION HEALTH AND ENSURING HEALTH CARE SERVICES ARE YOUTH
FRIENDLY. ONE CHALLENGE IS ASSURING THAT
ADOLESCENCE RECEIVE CLINICAL SERVICES. DATA SHOWS POOR DELIVERY OF
THREE MAJOR RECOMMENDED HEALTH SERVICES. LESS THAN HALF HAVE AN ANNUAL
HEALTH CARE VISIT. DELIVERY BY TYPE OF INSURANCE
COVERAGE. 55% OF ADOLESCENCE IN THE
MEDICAID PROGRAM RECEIVE CHLAMYDIA SCREENING. LOOKING FURTHER INTO WHO
ACCESSES HEALTH CARE, WE FOUND INCOME, RACIAL AND GENDER
DISPARITIES. 43% OF ADOLESCENCE HAD A
PREVENTIVE HEALTH VISIT. 38% OF THOSE LIVING IN POVERTY
WERE LIKELY TO RECEIVE SUCH SERVICES. A QUARTER OF THOSE RECEIVED A
PREVENTIVE VISIT. THERE WERE IMPORTANT RACIAL
DISPARITIES WITH 37% OF HISPANICS RECEIVING HEALTH
VISITS, 43% OF NON-HISPANICS HAS BEEN PICK BLACKS AND 45% OF
WHITES HAD ACCESS TO THE SERVICES. SCREENING AND COUNSELING FOR A
VARIETY OF RISK BEHAVIORS. HOWEVER, IF YOU WERE ONE THAT WE
SAW AND THE RISK OF SECONDHAND SMOKE. GIVEN CURRENT OBESITY RATES,
SLIGHTLY LESS THAN HALF RECEIVED GUIDANCE REGARDING HEALTHY
EATING. ONLY ONE OUT OF TEN RECEIVED
GUIDANCE ON ALL SIX RECOMMENDED PREVENTION TOPICS. WE HAVE A UNIQUE OPPORTUNITY TO
CLOSE THE INSURANCE AND HEALTH CARE GAP THROUGH THE ACA. FIRST, THE ACA HAS INCREASED THE
NUMBER OF ADOLESCENCE WITH INSURANCE COVERAGE. EVEN IF THEY HAD A PREVIOUS
DIAGNOSES. CARE, REFERRED TO AS MEDICAL
HOME. THIRD, THE ACA INCREASED ACCESS
TO PREVENTIVE SERVICES BY INCORPORATING GUIDELINES AND
CARE. FINALLY, THE ACA CAN PROVIDE A
BRIDGE TO THE TRANSITION FROM PEEVED I CAN’T SAY RICK TO ADULT
MEDICAL CARE. THE ACA HAS INCREASED INSURANCE
COVERAGE THROUGH MANY ADOLESCENCE FOR LOW INCOME
POPULATIONS. FOR OTHER ADOLESCENCE, HEALTH
CARE CHANGES HAVE BEEN — FAMILIES CAN ACCESS COVERAGE. AND AN IMPORTANT ELEMENT IN THE
ACA IS EXPANSION FOR YOUNG ADULTS. THE MEDICAL HOME IS A KEY
ELEMENT OF THE ACA, AIMED AT REDUCING FRAGMENTATION TO
IMPROVE COORDINATION OF CARE. DATA FROM 2007 SUGGESTS THIS IS
AN IMPORTANT GAP TO FILL. ONLY 54% OF ALL ADOLESCENCE WERE
AFFILIATED WITH A MEDICAL HOME PROVIDER. ABOUT A THIRD BOTH PHYSICAL
HEALTH CONDITIONS. A REQUIREMENT OF THE ACA IS A
PROVISION OF HEALTH CARE SERVICES WITHOUT COST SHARING,
UTILIZING CLINICAL GUIDELINES. THEY NEED TO TASK FORCE A AND B
RECOMMENDATIONS, ACIP AND THE INSTITUTE OF MEDICINE’S
RECOMMENDATION FOR WOMEN’S HEALTH. WITH THE INCORPORATION OF
MEDICAL HOMES, ADOLESCENCE WILL MORE EASILY FIND ADULT PRIMARY
CARE PROVIDERS AS THEY AGE OUT OF PEDIATRIC PRACTICES. THIS OFFERS OPPORTUNITIES TO
LEARN HOW TO USE THE HEALTH CARE SYSTEM MORE EFFECTIVELY AND GAIN
SKILLS AS ACTIVE HEALTH CONSUMERS WHILE INCREASING YOUR
HEALTH LITERACY. THIS IS AN AREA OF HEALTH
IMPROVEMENT AS ONLY 40% OF 12-17-YEAR-OLDS REPORT THEY HAD
BEEN ALONE WITH THEIR PROVIDER. THE ACA CAN ONLY ACHIEVE THIS
PROMISE IF CERTAIN CHALLENGES ARE ADDRESSED. ADOLESCENCE OR THEIR PARENTS
MIGHT NOT ENROLL IN HEALTH INSURANCE. IF THEY DO ENROLL, THEY MAY NOT
SEEK PREVENTIVE SERVICES, THEY MIGHT LIVE IN STATES THAT HAVE
NOT EXPANDED COVERAGE AND THUS MAY NOT HAVE ACCESS AND THEY
MIGHT NEED BUT NOT SEEK SERVICES FOR SEXUAL OR REPRODUCTIVE
HEALTH. GIVEN THE NEED FOR IMPROVED
ADOLESCENT HEALTH AND OPPORTUNITIES AFFORDED, WHAT
OPTIONS EXIST TO IMPROVE ADOLESCENT HEALTH CARE. AS AN EXAMPLE, KAISER PERMANENTE
HAS AN INTERVENTION TO INCREASE THE PROVISION OF SERVICES FOR
ADOLESCENCE AGES 14-17 IN SIX AREAS, INCLUDING SAFETY RELATED
ISSUES. THE INTERVENTION ENTAILED
SEVERAL COMPONENTS. THE NUMBERS AND TYPES OF HEALTH
CARE VISITS THEY ALREADY MAKE WERE SHARED, DEMONSTRATING
CLINICAL CARE. THEY WERE TRAINED TO INCREASE
CAPACITY TO SCREEN FOR AND COUNSEL ADOLESCENCE ABOUT A
VARIETY OF BEHAVIORS. PROVIDERS WERE GIVEN SPECIFIC
SCREENINGS AND QUESTIONS INCLUDING AFFIRMATION OF
POSITIVE HEALTH BEHAVIORS AND GUIDANCE. FINALLY, SOME SERVICES WERE
SHIFTED TO HEALTH EDUCATORS WHO PROVIDED COUNSELING ABOUT HOW TO
CHANGE POTENTIALLY RISKY BEHAVIORS. THESE DATA DEMONSTRATE THE
CHANGES IN SCREENING AND COUNSELING INTERVENTION,
COMPARING THE SITES. IN THIS LINE, I HIGHLIGHT THE
SAFETY, GIVEN THE IMPACT OF MORTALITY. FOLLOWING THE TRAINING,
SCREENING AND COUNSELING RATES INCREASE ACROSS ALL TARGETED
RISK AREAS. FOR SEATBELT USE, RATES INCREASE
FROM 43% TO 82% AND 45% TO 85%. SEATBELT SCREENING DECREASED IN
COMPARISON THROUGH THE SAME TIME PERIOD WHILE COUNSELING
INCREASED, BUT LESS THAN THE INTERVENTION SITE. THIS STUDY DEMONSTRATES THE
OF PROVIDER TRAINING AND HOW TO IMPROVE SERVICES WITH
ADOLESCENCE. A VARIETY OF FACTORS CONTRIBUTED
TO THE IMPROVEMENTS, THE INTERVENTION WAS SUPPORTED BY
HEALTH SYSTEM LEADERS SUCH AS OUTPATIENT AND OTHER SYSTEM
CHAMPIONS, INCLUDING NURSES, ANCILLARY STAFF. AN IMPORTANT PARTNERSHIP BETWEEN
ACADEMIC LEADERS AND HEALTH PLAN EXPERTS. THEY CONDUCTED TRAINING AND
CAPACITY TO INCORPORATE SUPPORT MATERIALS AS PART OF THE PATIENT
VISIT. THERE WAS A RIGOROUS EVALUATION
TO ENSURE IMPLEMENTATIONS WITH FIDELITY. ALL FACTORS LED TO SUBSTANTIAL
CHANGE IN THE CULTURE OF INCORPORATING CLINICAL
PREVENTIVE SERVICES. SO, WHAT DIFFERENCE DID THESE
CHANGES IN SCREENING MAKE FOR THE ADOLESCENT PATIENT? AS SHOWN ON THE SLIDE, IT HAD
THE MOST DRAMATIC EFFECT. THERE WAS A 140% INCREASE FROM
AGE 14 TO AGE 15 IN THE INTERVENTION SAMPLE. AS WE PURSUE NEW INTERVENTIONS,
WE ALSO HAVE TO CONSIDER PRINCIPALS WHICH GUIDE YOUTH
FRIENDLY HEALTH CARE. THESE PRINCIPALS ARE ASSURING
AVAILABILITY OF HEALTH CARE, MINIMIZING THE LENGTH OF TIME TO
WAIT FOR AN APPOINTMENT, PROVIDING HEALTH THEIR IS THE
TAILORED TO THE NEEDS OF EARLY, MIDDLE AND LATE ADOLESCENCE. .ASSURING ACCESSIBILITY SUCH AS
TRANSPORTATION AND EASE OF USE. APPROACHABILITY, WHICH PERTAINS
TO WHETHER THE ENVIRONMENT IS COMING TO ADOLESCENCE AND
ACCESSIBILITY FOR ADOLESCENCE. ARE THEY TREATED IN A
NONJUDGMENTAL MANNER? THERE ARE TWO ADDITIONAL ISSUES
THAT SHAPE HEALTH CARE DELIVERY. FIRST, CONFIDENTIALITY
MAINTAINING INFORMATION PRIVATE. PROVIDERS HAVE LIMITED ON HOW
AND WHEN THIS PATIENT INFORMATION CAN BE SHARED WITH
OTHERS. TRADITIONALLY, THEY ARE ABLE TO
SHARE HEALTH INFORMATION ON UNDER LIMITED CIRCUMSTANCES,
PARTICULARLY IF THEY ARE AT RISK FOR THEMSELVES AND OTHERS. SECOND, MINOR CONSENT LAWS
ENABLE MINORS TO CONSENT TO SOME TYPE OF HEALTH CARE. THE LAWS VARY TREMENDOUSLY
BETWEEN STATES WHETHER THEY ARE ABLE TO GIVE CONSENT FOR A
VARIETY OF HEALTH CARE SERVICES. EXAMPLE, SCREENING AND TREATMENT
FOR SEXUAL TRANSMISSIONS, SUBSTANCE ABUSE SERVICES AND
REPRODUCTIVE SERVICES. CONSENT LAWS ARE IMPORTANT TO
ADOLESCENCE PRIMARY CONCERNS AND PRIVACY CONCERNS. BEFORE THE VISIT, PRIVACY
CONCERNS MIGHT AFFECT WHETHER THE ADOLESCENT SETS UP AN
APPOINTMENT. IT IS IMPORTANT IF YOUR ROLE TO
UNDERSTAND THE CONFIDENTIALITY AND CONSENT LAWS IN YOUR STATE
SO YOU CAN PROVIDE GUIDANCE INFORMATION TO ADOLESCENCE AS
THEY SEEK INFORMATION ABOUT ACCESSING SERVICES. DURING THE VISIT, THE CONTENT OF
CARE IS PARTICULARLY IMPORTANT. RESEARCH HAS SHOWN
CONFIDENTIALITY IS BIBLE IN TERMS OF WHAT WE ARE WILLING TO
DISCLOSE TO PROVIDERS AND ALSO IMPACT CONTINUITY APPEAR FOR
SERVICES. AFTER THE VISIT, ADOLESCENCE ARE
CONCERNED ABOUT WHO WILL HAVE ACCESS TO THEIR HEALTH CARE
RECORD. THEY ARE ALSO WORRIED ABOUT
WHETHER AN EXPLANATION OF BENEFITS WILL BE SENT TO THE
PRIMARY POLICYHOLDER, REVEALING THE SENSITIVE NATURE OF A
MEDICAL CARE VISIT. A NUMBER OF STATES, INCLUDING
CALIFORNIA AND SOME INSURANCE SYSTEMS DEVELOP NEW POLICIES
ENABLING CLIENTS OF ALL AGES TO REQUEST THE DOCUMENTATION
RELATED TO SENSITIVE SERVICES BE SENT TO AN ALTERNATIVE ADDRESS
OR E-MAIL. THERE ARE SIX IMPORTANT
STRATEGIES TO PER SUE AS WE SEEK TO INCLUDE HEALTH CARE SERVICES. FIRST, ENHANCE THE CAPACITY OF
PROVIDERS TO DELIVER QUALITY SCREENING, ASSESSMENT,
MANAGEMENT, REFERABLE AND SPECIALTY SERVICES. SECOND, HEALTH CARE PROVIDERS
WORK WITH SYSTEMS CARE. THEY NEED TO RECOGNIZE THE
IMPORTANCE OF INVESTING IN THEIR LIVES AS THEY TRANSITION INTO
ADULT HEALTH CARE. WE NEED TO SYSTEMATICALLY
PROMOTE THROUGHOUT THE HEALTH CARE SYSTEM. THIRD, COORDINATE PHYSICAL AND
BEHAVIORAL SERVICES. AS ADOLESCENCE ENGAGE IN
COMMUNITY SETTINGS, INCLUDING SCHOOLS, HEALTH CARE PROVIDERS
HAVE A ROLE AND RESPONSIBILITY TO PLAY IN ENSURING COORDINATION
OF CARE. FOURTH, PROVIDERS CAN PLAY AN
IMPORTANT ROLE ENSURING ADOLESCENCE ACTIVE PARTICIPATION
IN HEALTH CARE, INCLUDING CONSENT AND ENSURING
CONFIDENTIALITY OF CARE FOR SENSITIVE CARE. FIFTH, THE HEALTH AND SERVICE
NEEDS OF ADOLESCENCE REPRESENT VULNERABLE GROUPS SUCH AS FOSTER
CARE AND LOW INCOME GROUPS WITH SPECIAL ATTENTION TO HEALTH CARE
PROVIDERS AND SYSTEMS CARE. SIXTH, AFTER WE ENGAGE THEM IN
THE SHAPING AND TYPES OF HEALTH CARE SERVICES AND THE MANNER
THEY ARE PROVIDED.>>AS WE DISCUSSED TODAY,
ADOLESCENCE MAKE UP A LARGE PART OF OUR POPULATION. PROVIDING THEM WITH HEALTH AND
WELLNESS IS CRUCIAL TO ENSURE THEY ARE HEALTHY NOW. THEY ARE DEVELOPING BRAINS MAKE
THIS PERIOD CHALLENGING, BUT RIPE WITH OPPORTUNITY TO INSTILL
HEALTHINESS. PARENTS PLAY A CRUCIAL ROLE IN
THE HEALTH AND WELLNESS OF ADOLESCENCE, TALKING WITH KIDS,
STAYING CONNECTED WITH THEIR SCHOOLS AND GIVING THEM TIME
ALONE WITH DOCTORS ARE A FEW THINGS PARENTS OF ADOLESCENCE
CAN DO. ADOLESCENCE SPEND AN ENORMOUS
AMOUNT OF TIME IN SCHOOL. THIS IS IMPORTANT TO ENSURE THE
OPPORTUNITY TO LEARN ABOUT HEALTH, PARTICIPATE AND SPEND
TIME IN HEALTHY ENVIRONMENTS. THE HEALTH CARE SYSTEM CAN
BETTER ENGAGE ADOLESCENCE TO UNDERSTAND THE RISKS, PROVIDE
TEEN FRIENDLY CARE AND ENSURE ACCESS TO USE OF PREVENTIVE,
SERVICES, CONFIDENT CARE. AND WE CAN TAKE COMMUNITY LEVEL
ACTION TO ENSURE OUR ADOLESCENCE HAVE SAFE AND SUPPORTIVE
ENVIRONMENTS WHICH TO GROW AND WHERE THE HEALTHY CHOICES ARE
THE EASY CHOICES. TOGETHER, WE CAN HELP
ADOLESCENCE PREPARE FOR LIFELONG HEALTH AND WELLNESS. THANK YOU VERY MUCH. NOW, WE ARE HAPPY TO MOVE INTO A
QUESTION AND ANSWER PERIOD, WHICH WILL BE LED BY DOCTOR
ZAZA. [ APPLAUSE ]
>>WE HAVE TIME FOR SOME QUESTIONS, SO, WHILE PEOPLE ARE
COMING TO THE MICROPHONE, I’LL START WITH THE VIRTUAL AUDIENCE.>>YES FROM OUR ONLINE
AUDIENCE, WHAT SORT OF ADAPTATIONS ARE BEING MADE TO
PROJECT CONNECT TO INCREASE EFFECTIVENESS TOWARD MALES?>>THAT’S A GREAT QUESTION. WE HAVE CONDUCTED STUDIES
[ INAUDIBLE ] ONE IS ON THE PROVIDER SIDE AND
THAT IS IDENTIFYING PROVIDER WHO IS ARE MALE FRIENDLY, INCLUDING
FOUR YOUNG MEN WITH PROVIDERS WHO ARE BEST SUITED FOR MALE
NEEDS. ON THE OTHER SIDE IS HELPING
PEOPLE WHO HAVE REGULAR CONTACT WITH YOUNG MEN TO BETTER
RECOGNIZE HEALTH CARE NEEDS OF YOUNG MEN, GETTING THEM IN A
BETTER POSITION TO MAKE REFERRALS TO CARE.>>MORE FROM THE ONLINE
AUDIENCE. WHAT ARE YOUR RECOMMENDATIONS
FOR PEOPLE PREVENTING DRUG ADDICTIONS OR DRUG ABUSE WITH
TEENS?>>I’LL START WITH THAT ONE. I AM NOT AWARE THAT WE HAVE ANY
PARTICULAR RECOMMENDATIONS BUT WE CAN FIND THAT OUT AND FOLLOW
UP WITH THE QUESTIONER. THAT’S SOME OF WHAT WE TALKED
ABOUT HERE TODAY THAT ARE TRANSLATABLE. HEALTH EDUCATION, OF COURSE, IN
SCHOOLS IS AN IMPORTANT TOPIC THAT WE SHOULD INCLUDE. I THINK WE ALSO NEED TO THINK
ABOUT REFERRALS. BEING ABLE TO RECOGNIZE THE
SIGNS OF WHO MAY BE AT RISK AND MOVE THEM QUICKLY INTO
TREATMENT. WE ALSO NEED TO THINK,
CONTINUOUSLY ABOUT THE ENVIRONMENT THAT OUR YOUNG
PEOPLE ARE IN AND MAKE SURE THEY ARE SAFE ENVIRONMENTS. SORT OF SET OF APPROACHES CAN BE
TRANSLATED, BUT WILL BE HAPPY TO HEAR ABOUT SPECIFIC
RECOMMENDATIONS OF OTHER AGENCIES THAT MIGHT HAVE THEM.>>IN ADDITION TO. [ INAUDIBLE ]
TREATMENT AVAILABLE TO THE THERAPY PROVIDED AND CO-LOCATED
SCHOOL SETTING OR AFTER SCHOOL PROGRAM AND WAYS THAT WE
COMMUNICATE TO THE PUBLIC ABOUT THE IMPORTANCE OF THIS ISSUE AND
ITS VITALITY IN TERMS OF FUTURE. ANY QUESTIONS FROM IN THE ROOM? SUSAN?>>WE HAVE ONE VIEWER THAT WOULD
LIKE TO HEAR MORE ABOUT RURAL USE. CAN YOU EXPAND ON SOME OF THIS
THAT MIGHT APPLY TO RURAL COMMUNITIES?>>ONE THING I CAN SHARE IS IN
THE IS IN THE COMMUNITY LEVEL INTERVENTION, THAT DID INCLUDE
RURAL AND URBAN COMMUNITIES. IT IS APPLICABLE FOR A WIDE
RANGE OF COMMUNITY SETTINGS.>>THERE’S STUDIES LOOKING AT
PHYSICAL EDUCATION IN DIFFERENT STUDIES AND WHAT WE KNOW IS
REGARDLESS IF THEY ARE IN A RURAL URBAN SETTING THAT
HAVING THE OPPORTUNITY TO BE — TO HAVE PHYSICAL EDUCATION IS
BENEFICIAL REGARDLESS OF WHERE THEY LIVE.>>YES, RICH.>>THANKS FOR A GREAT
PRESENTATION. I WAS WONDERING IF THERE ARE ANY
EXAMPLES TO BEST PRACTICES YOU COULD SHARE FOR HEALTH
DEPARTMENTS WORKING EFFECTIVELY WITH SCHOOLS?>>THAT’S A REALLY GREAT
QUESTION. ACTUALLY, WE — WE ACTUALLY
CURRENTLY FUND ALL 50 HEALTH DEPARTMENTS TO ADDRESS PHYSICAL
ACTIVITY IN SCHOOLS, NUTRITION IN SCHOOLS AND CHRONIC
CONDITIONS IN SCHOOLS. WE ARE WORKING FROM THE WHOLE
COMMUNITY — THE WHOLE SCHOOL — THAT REALLY WAS SCHOOL HEALTH
AND WE FOCUS ON THE KIDS AND WE ALIGN THE HEALTH DEPARTMENTS ARE
HOPING SCHOOLS DEVELOP THOSE POLICIES AND PRACTICE THAT IS
WILL HELP KIDS TO CHOOSE HEALTHY BEHAVIORS.>>YOU HAVE DOCUMENTS THAT HELP. BEING ABLE TO HELP PEOPLE
CONNECT THROUGH OUR VARIOUS PROGRAMS. ON THE ONE SIDE, WE ARE FOCUSING
ON THE INDIVIDUALS OF ADOLESCENCE IN A SCHOOL SYSTEM
AND ASK THEM TO DEVELOP UNDERSTANDING WITH LOCAL
DEPARTMENTS. THE SCHOOL HEALTH BRANCH IS
WORKING WITH HEALTH DEPARTMENTS. SO, WE DO HAVE PIECES THAT HELP
ON BOTH SIDES OF THAT EQUATION TO MAKE THE RELATIONSHIPS WORK
AND FUNDING ON BOTH SIDES.>>WHAT WE HAVE BEEN ABLE TO
SEE, THAT HEALTH DEPARTMENT WORKING WITH THE STATE HEALTH
DEPARTMENT WORKING WITH THE STATE EDUCATION DEPARTMENT, THAT
IS WHERE WE ARE SEEING GREAT SUCCESS.>>I THINK IN ADDITION TO THESE
ANSWERS, HEALTH DEPARTMENTS ARE THE LEADERS IN OUR COMMUNITIES. THEY HAVE, OFTENTIMES, VERY
STRONG RELATIONSHIPS WITH NETWORKS, COMMUNITY BASED
ORGANIZATION AND LAST WEEK, IT WAS IMPORTANT TO ALSO INCLUDE
PARENTS AS WELL AS AS WELL AS THE USE IN A COMPREHENSIVE WAY. FOR EXAMPLE, HEALTH DEPARTMENTS
FOCUSED ON INCREASING HEALTH INSURANCE HAVE BEEN WORKING WITH
A NETWORK OF SAFETY PROVIDERS TO ENSURE THERE ARE ENROLLMENTS IN
THOSE SETTINGS THAT CAN MAXIMIZE THE NUMBER OF INDIVIDUALS.>>ROBERT?>>COMMUNITY GUIDE. AS YOU ARE WELL AWARE, THERE ARE
LARGE GAPS IN HEALTH AND EDUCATIONAL OUTCOMES OF POOR AND
MINORITY CHILDREN IN THE U.S. AND POOR AND MINORITY SCHOOLS
LACK RESOURCES FOR MANY PROGRAMS. AS YOU ARE AWARE, WE HAVE DONE A
STUDY SHOW THAT SCHOOL BASED HEALTH CENTERS, THERE ARE NOT
ENOUGH. ONE WAY TO ADDRESS WHAT OTHER
WAYS YOUR PROGRAM MAY HAVE OR CONSIDER TO ADDRESS THE NEEDS OF
MINORITY CHILDREN AND SCHOOLS.>>WE WOULD ALL LIKE TO HAVE A
MAGIC WAND THAT INCREASES THE SCHOOL BASED HEALTH CENTERS TO
REPRESENT THE YOUTH LIVING IN LOW INCOME COMMUNITIES. I THINK WE CAN THINK OF SCHOOLS
IN ANOTHER WAY, WHICH IS THEY PLAY A VERY IMPORTANT
PARTNERSHIP ROLE IN ASSURING REFERRERS AND IDENTIFICATION OF
RESOURCES. MANY OF OUR FAMILIES MAY NOT
RECOGNIZE THEY ARE ACTUALLY ELIGIBLE FOR SERVICES AND HAVING
INFORMED SCHOOL STAFF, THAT CAN INCLUDE TEACHERS, THE
PSYCHOLOGISTS, CONCLUDE THE BUS DRIVER WHO IS AWARE OF THE KINDS
OF SERVICES THAT THERE ARE IN THE COMMUNITY AND HELPING TO
LINK AND KNIT WHAT GOES ON IN SOME OF THESE COMMUNITIES THAT
HAVE BOTH RESILIENT FACTORS AS WELL AS
[ INAUDIBLE ]>>I WOULD ALSO ADD, I THINK, AT
LEAST FROM THE FEDERAL FUNDING PERSPECTIVE, WHICH IS WHAT I CAN
SPEAK TO WITH THE MOST CONFIDENCE IS WE ARE ASKING OUR
GRANTEES TO IDENTIFY PRIORITY SCHOOLS. IN MOST CASES, THOSE PRIORITY
SCHOOLS ARE IN COMMUNITIES THAT HAVE THESE KINDS OF
SOCIOECONOMIC CHALLENGES. WHAT WE ARE LEARNING FROM THOSE,
BECAUSE WE ARE NOT FUNDING EVERYWHERE, AND THE STATES ARE
NOT ABLE TO FUND EVERY SCHOOL DISTRICT, WE ARE GETTING TO
REALLY LEARN WHAT WORKS BEST IN THOSE KIND OF COMMUNITIES TO
BEGIN TO BUILD INFORMATION THAT WILL ALLOW US TO PROVIDE THAT
ASSISTANCE, IF NOT FUNDING IN THE FUTURE. TRYING TO BUILD A COMMUNITY OF
KNOWLEDGE AROUND THIS ISSUE OF HOW TO BEST WORK WITH POOR
SCHOOLS AND TO HELP THEM LINK TO HEALTH SERVICES IN PARTICULAR
THAT ARE IN THE COMMUNITY, KNOW THERE’S SUCH A LACK OF CENTERS. IT’S WHAT WE ARE LEARNING IN
THIS CYCLE. ARE THERE ANY OTHER QUESTIONS?>>FROM OUR GRAND ROUNDS E-MAIL
BOX, I’M SHORTENING THIS IN THE INTEREST OF TIME. COULD THE PANEL ADDRESS ISSUES
CONCERNING WELLNESS FOR HEALTHY ADOLESCENCE, BUT ADOLESCENCE
WITH THE ILL. THE ILL STRUGGLING TO GET
HEALTHY OR DOING THE BEST THEY CAN WITH THEIR CHALLENGE.>>SO, AS I MENTIONED, WE ARE
FUNDING STATE DEPARTMENTS OF HEALTH TO ADDRESS CHRONIC
CONDITIONS AND ONE PROJECT THAT WE ARE WORKING ON IS WORKING
WITH PARENTS AND IT’S CALLED PARENTS FOR HEALTHY SCHOOLS. WHAT WE ARE DOING IS PROVIDING
INFORMATION FOR PARENTS TO BE A ADVOCATE. TO GO IN THERE AND SHARE WITH
THE SCHOOLS, THESE ARE THE ISSUES MY CHILD IS STRUGGLING
WITH. I WANT TO MAKE SURE MY CHILD HAS
THE BEST OPPORTUNITY TO SUCCEED IN SCHOOL. TO DO THAT, THESE ARE THE
SERVICES WE HOPE TO RECEIVE IN THE SCHOOL SYSTEM.>>I WAS GOING TO SAY, ALSO, I
THINK APART FROM PARENTS PLAYING A ROLE AS THEIR CHILD’S ADVOCATE
IS ALSO HAVING TEACHERS AND OTHER SCHOOL PERSONNEL WHO CAN
REALLY CONTINUE TO REAFFIRM AND AFFIRM MANAGEMENT, CHRONIC
HEALTH CARE DISEASE MANAGEMENT THAT SUPPORT AS YOUNG PERSON. THAT YOUNG PERSON MAY FEEL
EXTREMELY ISOLATED. THE SCHOOL ENVIRONMENT BECOMES
AN IMPORTANT KEY TO SUPPORT, PSYCHOLOGICAL SUPPORT TO HELP
THAT INDIVIDUAL MANAGE WELL OR BETTER THEIR CONDITION. WE NEED TO RECOGNIZE MANY
CHILDREN NOW, ARE ABLE TO SURVIVE INTO THE ADOLESCENCE
YEARS. 17% OF ADOLESCENCE ARE
ADOLESCENCE WHO HAVE A CHRONIC HEALTH CONDITION. THIS IS MORE COMMON THAN
TRADITIONALLY THINK ABOUT.>>THANK YOU.>>THANK YOU VERY MUCH. THANK YOU FOR JOINING US. JOIN US NEXT MONTH.

One comment

  1. This is very instructive. I did enjoy it so much. Please is there a link to developing health promoting lifestyle program for youth, community based intervention? Thanks

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