School Health Assessment: Measuring Adolescent Behavioural Risk Factors

1. School Health Assessment: Measuring Adolescent Behavioural Risk Factors APHEO Conference

2. Child health in the news… • “High number of kids have high blood pressure”(CNews Canada, Mar. 6, 2003) • “Childhood obesity a growing epidemic”(CHealth News, Jan. 12, 2004) • “Teens confirm alcohol use is on the rise”(CTV.ca, June 21, 2001) • “Self-esteem can be a weighty problem”(Toronto Sun, Mar. 11, 2002) • “STD rate same for teens who pledge abstinence”(CNews Canada, Mar. 10, 2004) • “Teens overdose on student’s Ritalin”(CBC Ottawa, Mar. 26, 2004)

3. Child health in the news… • “Eating disorder a constant battle” (Brampton Guardian, Feb. 6, 2004) • “Study finds violence in teen-rated video games” (CTV.ca, Feb. 18, 2004) • “Attack revives gang fears” (London Free Press, Nov. 26, 2003) • “Marijuana use higher among teens who report other risky behaviours” (CNews Canada, June 16, 2003) • “Teens say no one waits to have sex” (CTV.ca, May 20, 2003) • “Coroner links teen’s death to Ecstacy” (Toronto Star, Mar. 25, 2004)

4. Why did we need this survey?

5. Why did we need this survey? Peel Health’s Child Health Report 2002 revealed: • In 2001, one-third of Ontario students in grades seven to 13 used an illicit drug in the past year. • In 1996/97, 28 per cent of Ontario teens had two or more sexual partners. • As of 1996, 29 per cent of Canadian girls and 35 per cent of Canadian boys aged 7-13 years were overweight. But the data in the Child Health Report relied heavily on sources across Canada… not Peel.

6. Do Peel children experience the same health risks as children across Ontario and Canada? We were not sure, and we needed to know. The School Health Assessment Survey 2004 gave us a Peel-specific picture of the health of our children.

7. The sample… • Estimated we would need approximately 6,000 students in Peel – or about 1,000 students per grade (7 to 12). • 56 schools in Peel were randomly selected -33 elementary and 23 secondary schools. • Randomly selected 2 to 3 classes per grade in elementary schools and up to 4 classes per grade in high schools.

8. The survey included questions on… • eating habits and physical activity • tobacco, alcohol, marijuana and other drugs • self-esteem, mental health and relationships • dental health • injuries • sun safety • safety and bullying in the community and at school • height and weight (as measured by a Public Health Nurse) • student’s age, sex and grade • Plus… sexual health for secondary-age students. Data were collected on a scannable form.

9. What happened in each classroom? • Public Health Nurses (PHN) checked consents and gave out incentives. • Instructed students and distributed surveys. • Helped students with survey, if necessary. • Took one student at a time to private area for height/weight measurement. • Wrapped up survey and provided support to students.

10. Data Analysis • Data were weighted to population data based on a post-adjustment method which adjusted for under-sampling and over-sampling particular grades in Peel. • Data collected from the survey were analyzed using the SPSS statistical software package Version 13.0 and Epi Info 2000 version 3.2. • Blank responses and multiple responses (when only one response was required) were excluded from the analysis if both totaled less than 5%. If higher than 5% these were noted in the report. “Don’t know” was included in the analysis if this was part of the question.

11. General results in specific topic areas across Peel overall and by sex and grade. Can compare Peel to the rest of Ontario and Canada, where applicable. What’s not available: Data by individual school or family of schools. The results were released on May 19, 2005

12. Response Rate • 11,960 students were invited to participate in the survey. • 7,853 (66%) completed the survey. • 512 (about 6%) did not specify sex and/or grade on their surveys and were excluded from the final analysis. • Approximately 2% of students either refused to have their height/weight measured or were erroneously recorded by the Public Health Nurse.

13. Eating Habits • In general fruit and vegetable consumption was low. Forty-nine per cent of students did not eat raw or cooked vegetables every day and 39% did not eat canned or fresh fruit every day. • Sugar-sweetened drinks were popular among students. Fifty-two per cent of students reported they drank sugar-sweetened beverages including Coke, Sprite, Fruitopia, or Snapple at least once a day. • Approximately 25% of students reported eating certain less nutritious foods on a daily basis.

14. Consumption of Less Nutritious Foods, Once or More Per Day, Region of Peel, 2004 Per cent of all students

15. Body Mass Index and Body Image • BMI-for-age and sex charts created by the United States Centers for Disease Control and Prevention (CDC) were used to describe body weight. Underweight BMI-for-age < 5th percentile Normal (healthy weight) BMI-for-age 5th percentile to < 85th percentile At risk of overweight (overweight) BMI-for-age 85th percentile to < 95th percentile Overweight(obese) BMI-for-age > 95th percentile

16. Body Mass Index* for Students,Region of Peel, 2004 * BMI weight categories were based on U.S. CDC recommended BMI- for–age-and-sex percentiles endorsed by the Dietitians of Canada, the Canadian Paediatric Society, the College of Family Physicians of Canada and the Community Health Nurses Association of Canada.

17. Self-Perceived Body Image by Sex,Region of Peel, 2004 Per cent of all students

18. Physical Activity • Eighteen per cent students exercised vigorously outside of school hours every day of the week. A smaller proportion of females than males reported they had exercised vigorously every day outside of school (11% and 26% respectively) and every day during physical education class at school (15% and 25%).

19. Proportion of Students Who Did Not Engage in Vigorous Physical Activity at all in the Previous 7 Days Outside of School Hours by Grade, Region of Peel, 2004 Per cent of all students

20. Sedentary Activity • Sedentary activities such as watching television or spending time on a computer are a large part of students’ lives. Forty-five per cent of students reported they watched six or more hours of television, videos or DVDs per week. Forty-three per cent of all students reported using a computer outside of school or part-time work six or more hours per week.

21. Proportion of Students Who Watch Television, Use a Computer or Play Video Games Six or More Hours per Week by Sex, Region of Peel, 2004 Per cent of all students

22. Data Limitations • We could not adjust for clustering because of our agreement with the participating school boards to not identify any schools in any report or data set. • Comparison with Ontario data was not always possible as survey questions were modified, different grades were sampled, and different analysis methods were used. • Seasonal differences. The survey was conducted using students sampled from two different cohorts. One survey occurred in the spring and the other in the fall in two different school years.

23. What are the benefits? • Peel-specific data means Peel-specific solutions. 2. Less time and money spent on initiatives that don’t meet our students’ needs. • Happier, healthier children with brighter futures.

24. Conclusions • In Peel, information about health and health-related risk behaviours of the adolescent population aged 12 to 18 years is not always available at the Regional level. • The survey was the largest of its kind at the regional and provincial level. • We now have some Regional level data on several health behaviours for youth aged 12 to 18.