Preconception Health of Adolescents
in Cuyahoga County: Data from the
Youth Risk Behavior Survey
ERIKA S. TRAPL, PhD
CWRU Prevention Research Center for
Healthy Neighborhoods
2014 CFHS ANNUAL MEETING
APRIL 14, 2014
Acknowledgements
 Funding provided by:
 Ohio Department of Health/Federal Government, Bureau of
Child and Family Health Services through the Cuyahoga
County Board of Health’s Child and Family Health Service
Program
 Centers for Disease Control and Prevention (1-U48-DP001930)
 St. Luke’s Foundation
The PRCHN at CWRU
 Mission: To work with communities from within to
prevent and reduce chronic disease
 Received CDC funding to establish PRC in 2009…
 BUT, we’re actually much older than that:
 Center for Health Promotion Research: ~2000
 Center for Adolescent Health: ~1995
Today’s Presentation
 Brief history and overview of YRBS
 Preconception Health in Cuyahoga County
 Discussion
PRCHN and the YRBS
 Conducting local YRBS (in some way) since 1998
 Reports publicly available since 2002
 Established current approach in 2008
 Countywide administration in Cuyahoga County
 Middle School in Spring of even years (e.g. 2012)
 High School in Spring of odd years (e.g. 2013)
 Attempt “region” representation
Cuyahoga County Regions
Youth Risk Behavior Survey
 Developed by the Centers for Disease Control and
Prevention

Started in 1991

Administered to 9th-12th grade students every other year
 Provides a “snapshot” of students’ health risk
behaviors

Used to follow trends over time

Measure progress against health indicators
Youth Risk Behavior Survey
 Wide array of topics:

Originally designed to assess 6 types of health risk behaviors

Unintentional injuries and violence, sexual behaviors, alcohol and
other drug use, tobacco use, unhealthy dietary behaviors,
inadequate physical activity

Nationally expanded to include obesity and asthma

CDC provides standardized ‘optional’ items for consideration

Food Security, Preventive Health Care, Protective Factors
Why a Local YRBS?
 LOCAL DATA is the richest data.
 National YRBS is collected at the state-level
 Ohio Department of Health leads this
 State level data not sufficient for counties
 Rarely can sufficient sample be drawn to weight to each county
 Ex: 7 high schools in Cuyahoga selected for Ohio YRBS
 ODH is great, but has limited resources
 Can offer technical assistance but cannot feasibly conduct locally
Why a Local YRBS?
 Flexibility
 Sample selection
 Survey design and content
 Use of results
 Can be used for more efficient resource planning,
grant writing, and program evaluation

Surveillance is a natural tool for assessment, intervention
identification, and evaluation.
 Responsive to community needs
Policy for Sharing
 Who owns the data?
 CWRU is steward of the data in CC; CCBH also holds data
 Who can access it?
 CWRU has data sharing agreement developed with sensitivity
to funders’ needs (e.g. funding acknowledgement and
publication rules)
 Ensures that those using the data use it appropriately
Policy for Sharing Data
 Two potential issues:
 Access to de-identified county-level file


Probably not a big deal
Access to identifiable school-level data

Probably a BIG deal
 School confidentiality has been key in Cuyahoga
 Use of school-level reports by media
 Process for school permission to release school-specific data

Schools must be a partner
YRBS & Preconception Health
 Lifecourse Perspective: Preconception health
considerations should begin at adolescence (i.e.
puberty)
 Lifestyle risk factors for poor birth outcomes often
begin during adolescence
 YRBS provides a natural mechanism by which to
monitor preconception health of adolescent females
 Granular data at local level could inform targeted
program and policy approaches to improve
preconception health
Presentation of the Data: Key
 US-F: National data, female participants
 OH-F: Ohio data, female participants
 CC-All: Cuyahoga County data, all participants
 CC-F: Cuyahoga County data, female participants
 City-F: Cleveland data, female participants
 IR-F: Inner-ring suburbs data, female participants
 OR-F: Outer-ring suburbs data, female participants
Sexual Behavior: 2013 High School YRBS
70.0%
64.9%
59.3%
60.0%
50.0%
40.0%
32.0% 30.9%
30.0%
CC-F
20.0%
10.0%
CC-All
14.8%
10.6%
7.1%
3.2%
3.9% 3.9%
0.0%
Sex <13
4+
Current Condom Pregnant
Partners
Sex
Use
Sexual Behavior: 2013 High School YRBS
70.0%
59.3%
60.0%
54.6%
50.0%
43.3%
40.0%
34.2%
CC-F
30.9%
30.0%
US-F
OH-F
20.0%
10.0%
35.2%
12.6%
10.6%
3.2% 3.4%
4.3%
15.8%
3.9%
0.0%
Sex <13
4+
Current Condom Pregnant
Partners
Sex
Use
Sexual Behavior: 2013 High School YRBS
70.0%
64.4%
59.3% 59.1%
60.0%
55.0%
50.0%
40.0%
33.6%
27.0%
20.0%
0.0%
City-F
30.9%
30.0%
10.0%
CC-F
34.3%
IR-F
OR-F
13.7% 13.8%
10.6%
5.9%
3.5%
3.2%
1.7%
Sex <13
8.3%
6.7%
3.9%
5.0%
1.1%
4+
Partners
Current
Sex
Condom
Use
Pregnant
Substance Use: 2013 High School YRBS
40.0%
37.3% 37.0%
34.9%
35.0%
30.0%
27.0%
25.0%
23.8%
23.5%
CC-F
20.5%
20.0%
City-F
18.8%
16.5%
15.0%
10.0%
IR-F
14.7%
8.8%
11.9%
10.1%
9.0%
6.3%
10.7%
8.7% 8.8%
6.5%
7.0%
5.0%
0.0%
Cigarettes
Cigars
Alcohol
Marijuana RX Drugs
OR-F
Obesity: 2013 High School YRBS
70.0%
59.4%
60.0%
60.6% 60.1%
55.6%
50.0%
41.1%
40.0%
CC-F
31.6%
30.0%
25.7%
22.7%
18.4%
20.0%
10.0%
10.9%
14.5%
14.8%
City-F
IR-F
OR-F
17.1%
13.9%
9.3%
4.6%
0.0%
Obese
Ovewt
Ovwt+Obese
Trying to
Lose
Physical Activity: 2013 High School YRBS
60.0%
50.0%
40.0%
39.4%
49.4%
49.0%
47.1%
38.3%
35.6%
30.8%
30.2%
30.0%
36.8%
38.2%
CC-F
30.1%
24.1%
20.0%
18.6%
20.4%
IR-F
19.0%
OR-F
12.1%
10.0%
0.0%
Met PA
No PA
City-F
3+hr TV
3+hr VG
Nutrition & Sleep: 2013 High School YRBS
45.0%
42.3%
40.0%
40.0%
35.0%
33.3%
31.2%
30.0%
25.0%
20.0%
30.3%
28.7%
25.2%
20.8%
17.9%
17.1%
15.0%
33.2%
CC-F
24.2%
City-F
19.7%
17.3%
IR-F
17.2%
OR-F
12.2%
10.0%
5.0%
0.0%
5 F/V
Pop daily
Daily brkfst
Adeq Sleep
Responsible Sexual Behavior – High School
90%
85%
80%
75%
70%
65%
60%
55%
50%
45%
40%
35%
84.5%
88.2%
68.0%
67.9%
63.2%
62.1%
50.1%
88.1%
62.2%
59.8%
58.4%
47.1%
42.4%
2007
65.1%
2009
Ever Sexual Intercourse
Condom Use
2011
39.3%
2013
Current Sexual Intercourse
HIV/AIDS Education
Summary
 Offers an effective means to monitor preconception
health risk factors over time
 Provides insight on targeting strategies or dispersing
resources geographically
 Surveillance is a natural evaluation of programmatic
efforts
Questions?
Prevention Research Center for Healthy Neighborhoods
Erika S. Trapl, PhD
Assistant Professor, Dept. of Epidemiology & Biostatistics
Associate Director, Prevention Research Center for Healthy Neighborhoods
Case Western Reserve University
Phone: 216-368-0098
Erika.Trapl@case.edu
Jean L. Frank, MPH
Manager of Community Initiatives
Phone: 216-368-5913
Jean.Frank@case.edu
www.prchn.org/yrbs.aspx