[Iskander] Hello, I'm Dr. John Iskandar and welcome
to CDC Beyond the Data.
I'm here today with Dr. Kathleen Ethier Director
of CDC's Division of Adolescent and School Health.
Welcome. [Ethier] Thank you.
[Iskander] We're updating some information from a Grand Rounds
from a few years ago about the general topic
of adolescent health, and I'd like to actually introduce this
with a story involving my daughter.
So she came home from a day in ninth grade a number
of years ago with some questions about a survey,
a voluntary survey she had taken,
where she said they asked a lot of very personal questions,
and her question to me was "Does anyone say yes
to any of those questions?".
So what was that survey, and what do we learn from it?
[Ethier] That's really funny.
So the survey, I'm guessing the survey that she took
in school was the Youth Risk Behavior Survey.
It is an every other year survey that is run out of the Division
of Adolescent and School Health in partnership
with a whole variety of divisions and centers
around CDC, and it asks 121 questions about behaviors
and experiences that adolescents are having to get
at really what are the whole array of those issues for youth.
We've been doing this survey for 30 years, and so,
we've been tracking all of those behaviors and experiences
over all those years and it gives us a great sense
of both what's happening nationally for youth
around the country, but then we also run the survey in 47 states
and a whole variety of local education agencies,
local centers.
And so, it's been a really wonderful way for us
to really understand what's happening
with youth in the country.
We just released the 2017 version
of that Youth Risk Behavior Survey back in June,
and I think that the results were really both encouraging
and pointed us in directions where we need
to really do more work.
So we're finding that across a wide variety
of behaviors including sexual behaviors,
including substance use behaviors like alcohol
and marijuana, and then the higher risk substances injection
drug use across all of these risk behaviors kids are making
better decisions.
Their behaviors are going in the right direction, and so,
that's really encouraging for us.
At the same time, we're seeing things
that are happening to them.
Violence victimization like bullying
and sexual violence really not going in the right direction.
And some alarming results around mental health
and suicide thoughts and behaviors
that are very troubling.
About a third of youths say
that they've had these really persistent feelings of sadness
and hopelessness to the point
where they can't do the regular activities
at some point during the past year.
That's a real concern for us and kind of helps point us
in a direction to say yeah in terms of, you know,
the education were providing, the connections that were making
for kids, what we're doing in schools can really help them
and help them make good decisions.
But it's the other things that are happening
in their environment, and the result of mental health
and suicide issues that are really still very alarming.
[Iskander] So it sounds like on some of some of the issues
that we might classically associate
with adolescents we're making progress,
and other ones are sort of their not really new or emerging.
But we're focusing more of a lens on them.
[Ethier] Right.
[Iskander] Now, schools are not only a place where we can,
you know, get that surveillance data to help us understand.
They're also an important place for us to provide care
and help to adolescents.
[Ethier] Yes.
[Iskander] What is the current landscape of school health
or school-based health, and what are some
of its advantages and promises?
[Ethier] It's a great question.
Thank you for asking it.
So, the reason we did the surveillance in schools is
because we know that schools are such an important venue
to really both provide the knowledge and skills
that kids need to make good decisions.
It's also kind of a great vantage point to connect them
to services in their community both health services,
mental health and behavioral services,
other kinds of social services that they need
in their communities, or even in their schools so connecting them
to their school nurses,
to school-based health centers if they have them.
That's an important connection to make
if those services are available, but if they're not,
they need to know, schools need to know
where in the community they can send kids.
They can refer them.
They can connect them and making sure that the places
that they refer those kids are teen friendly.
That they understand the issues that adolescents are facing
and provide environments that support them.
And then, also schools are an important place of connection.
We know that kids who feel more connected in their schools,
more connected to their peers, more connected
to important adults where their families are engaged
in their schools, kids who feel those connections do better not
just during adolescence that far into adulthood.
So, they're much less likely to engage in risky behaviors.
They're much more likely to not experience some
of those violence factors that are important.
They had better mental health.
They're less likely to have suicidal thoughts and behaviors.
So, all of those things are really,
those connections are really made in schools.
And it's not that schools are responsible for everything,
but it's also that schools are,
especially for high school students,
the last place we have them all together
in that way before they kind of go off
into the next phase of their lives.
And so, we here at CDC really focus on schools,
and the things that schools can do.
And then, the ways that others, like providers,
can help schools do what they need to do better.
[Iskander] So you gave some good examples of sort
of protective resilience factors.
Are, you know we hear a lot
about this phrase high risk youth.
According to our data, are there groups at high risk?
Particularly groups we might not normally think of right away?
[Ethier] Sure.
Yeah. So, we know that there are substantial I'll say substantial
minority of students who have collections of risk behaviors
so three or more of the risk behaviors
and experiences that I mentioned.
So, kids who are experiencing both high risk sexual behavior,
high risk substance use, and have attempted suicide,
those would be kids who would be at very high risk.
Figuring out how to help them is something
that is really important to what we do,
and I think it's important to everyone.
We know that, you know, once kids get to that point,
there are really things.
They are very high need, and we need to kind of connect them
to the things that will help them.
There are also particular groups that have disparate risk.
So that we know that kids who we call, we term,
sexual minority youth, so kids who either identify as lesbian,
gay, or bisexual who are unsure of their sexual identity
who have same-sex partners, we know that those kids,
for a variety of reason including
that they experience more stigma,
they experience discrimination,
they may be more likely experience bullying,
they tend to be at higher risk.
And so, you see in our YRBS data, you see that those groups
of kids are more likely
to experience violence and victimization.
They are more likely
to experience mental health and suicide ideation.
They are more likely to use high risk substances, so we do work
with schools to try to help those kinds of populations
that are experiencing disparities.
[Iskander] So, thinking about the perspective of a provider,
a parent, someone involved with the school,
which could be a teacher, principal, school board member,
what are some key things
that they can do again beyond just sort
of the direct provision of care [Ethier] Right.
[Iskander] to help adolescents whether they are in one of these
at risk groups are not?
[Ethier] You know, I don't mean to sound trite
when I say it's all about connection.
So for providers, having time alone with kids
where they can make those connections
where they can answer questions
that kids might not want anybody else
in the room while they're asking
that alone time is incredibly important to be able to make
that connection between youth and their providers.
We're also trying to do a better job
of connecting providers to schools.
And so for providers in a community setting to know
where those kids are in school, for schools to be able
to make connections to local providers is really important,
so that they know where to send kids.
And that for providers kind
of understanding the school environment that the youth
that they see are in is really important.
Parents. You know we talk a lot about parent engagement,
and that can mean a whole host of things.
It can mean knowing where your kids are, and who they're with,
and what they're doing, staying engaged
in their day-to-day lives, letting your kids know
that you're engaged, letting your kids know
that you're really paying attention to what's going
on with them, and then getting engaged in their schools.
All of those are incredibly important things
that parents can do to help keep their kids feel connected,
feel safe, and help guide them
into the next stage of their lives.
[Iskander] So Dr. Ethier, as far as what schools can do,
beyond again making connections
with providers making connections with parents,
what are some other strategies
that school professionals can undertake?
[Ethier] There's a lot that schools can do.
So as you mentioned, they can connect with local providers,
they can make sure parents are engaged,
but they can also do things within the school to do some
of the things that we mentioned.
Make sure that there are curriculum in place
that provide knowledge and skills,
but also create environments where kids feel safe.
So that means in terms of both in the hallways,
in the classrooms kind of general feel of schools
that there is a feeling of safety.
That there's a sense that staff and the educators
in the schools are really centered around kids succeeding.
And that the kids in the school understand that.
And I think it's also, they are making sure that for kids
where there are disparate populations
that those kids are supported.
That there are resources and schools available to them,
and that, when kids reach out they find somebody.
So just making sure that all of those constructors
and policies are in place
to really help kids feel safe and connected.
[Iskander] So, I think that's a very productive
and optimistic note on which to end.
Thank you very much Dr. Ethier.
[Ethier] Thank you so much.
[Iskander] Please join us next time for Beyond the Data.