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Rocky Mountain Society for Adolescent Medicine Annual Dinner Meeting January 31 st, 2013 Simon J. Hambidge, MD, PhD Director, Community Health Pediatrics,

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Presentation on theme: "Rocky Mountain Society for Adolescent Medicine Annual Dinner Meeting January 31 st, 2013 Simon J. Hambidge, MD, PhD Director, Community Health Pediatrics,"— Presentation transcript:

1 Rocky Mountain Society for Adolescent Medicine Annual Dinner Meeting January 31 st, 2013 Simon J. Hambidge, MD, PhD Director, Community Health Pediatrics, Denver Health Professor of Pediatrics and of Epidemiology, University of Colorado

2 Disclosures Simon Hambidge has no financial relationships to disclose, and will not be discussing any off label drug use

3 The Health of Adolescents in Denver - Overview Overview of adolescent population at Denver Health and in Denver Immunization Status Mental Health Obesity Comorbidity Substance abuse High school completion Reproductive Health

4 Youth in Denver - 2010

5 Adolescent Population at Denver Health in 2012 (12-18 years old) Clinical Site # Patients Race/Ethnicity (%)% Female HispanicBlackWhite CHS clinics 988669%15%12%56% SBHC515270%15%10%48% CHS & SBHC 221979%12%7%62%

6 Adolescent Population at Denver Health in 2012 (12-18 years old) Total of 17,257 patients Over 1/3 of 12-18 year old population of Denver 32% - 43% Spanish-speaking Over 80% below 200% FPL, with most below 100% FPL

7 Adolescent Immunization at Denver Health – CHS 2012 1 Tdap92% 1 MCV-491% 1 HPV86% 3 HPV44% 1 Influenza (2011 – 2012)46% Tdap/MCV4/HPV - 185% Tdap/MCV4/HPV - 343%

8 Adolescent Immunization at SBHCs: 2011 - 2012

9 Adolescent Immunization at Denver Health – 2012 Summary Overall rates well above national rates for almost all vaccines SBHC rates similar to CHS HPV rates include boys! What can we do? 2 areas for future QI work: 2 nd and 3 rd doses of HPV Influenza vaccine coverage

10 Adolescent Mental Health – Healthy Kids Colorado Survey 25% Denver adolescents report feeling ‘so sad or hopeless every day for two weeks’ that they stopped usual activities Higher prevalence in females compared to males Higher prevalence in 8-10 th grade 13% of Denver adolescents report seriously considering suicide in the past month Higher prevalence among females compared to males Higher prevalence in 8 th and 9 th grade 10% of Denver adolescents made a plan to attempt suicide 8% of Denver adolescents attempted suicide

11 SBHC – mental health services


13 SBHC – Depression Collaborative Summary # patients in CSD registry, by SBHC (total ≈ 200) % CSD patients seen in past 8 weeks (> 80%) % CSD patients on therapy or meds (> 60%) % CSD patients with PHQ-9 scores > 5 point improvement at follow-up (60%) % CSD patients with self-management goals in past 12 months (95%) % CSD patients with family involvement in past 12 months (58%)


15 Adolescent Mental Health Summary – Denver Health SBHC system has good depression screening and follow-up CHS has no systemic screening More of a risk-based system Less reliable referral sources Foster care clinic at Eastside Peds – new collaborative model with MHCD New collaboration with MHCD for mental health screening in CHS clinics

16 Mental Health – What can we do? Advocate for mental health parity with physical health More robust screening and referral in CHS Work to develop more integrated mental health LCSWs in medical setting Work with outpatient behavioral health services at DH and MHCD to develop more robust referral sources

17 Adolescent Substance Abuse – Alcohol Use

18 Adolescent Substance Abuse – Binge Drinking

19 Adolescent Substance Abuse – High School Responses to HKCS 7% have used cocaine in some form 12% have sniffed glue or breathed the contents of aerosol spray cans 3% have used heroin (4% in boys and 2% in girls) 3% have used meth 8% have used ecstasy or MDMA 11% have taken Rx drugs without a doctor’s prescription

20 Substance Abuse – What can we do? SBIRT Training: Screening, Brief Intervention, Referral to Treatment DH has good adolescent substance abuse psychiatry resource in Pavilion M (Chris Thurstone, MD) Other Thoughts?


22 Unhealthy Weight in Adolescents: Denver 22% of Denver high schoolers overweight (15%) or obese (7%) (self-reported weight and height) 58% of Denver students (6-12 th grade) report being ‘about the right weight’; 24% slightly or very overweight and 17% slightly or very underweight 43% of Denver students reported ‘trying to loose weight’ 38% of Denver students met the fruit consumption recommendation (2-4 per day) 17% of Denver students met with vegetable consumption recommendation (3+ per day) 26% of Denver students reported drinking a soda at least once every day.

23 Unhealthy Weight in Adolescents: Denver Health Characteristic% Overweight% Obese Age11-14 years17%15% 15-17 years20%17% Race/EthnicityBlack14%16% Hispanic17%11% White11%12% LanguageEnglish17%10% Spanish31%23%

24 Data on BMI & Lifestyle Screening SBHC 2011 – 2012: 88% of visits had BMI measured range by clinic = 76% - 95% Eastside Peds clinic 2011: adolescent risk factor questionnaire 27% of 250 adolescents not happy with eating habits and weight How many times a week do you eat fast food? 11% = Never 75% = 1-2 14% = > 2

25 Diabetes Screening: Patients 12 – 18 years with BMI > 95% who were tested for diabetes (Hgb A1c or glucose)

26 What can we do? We do a good job of collecting BMI and counseling about exercise and nutrition (HEDIS) Make sure we are screening for lifestyle factors (5-2-1-0 +) and counseling Refer to community programs: cooking matters, rec centers, boys and girls clubs, others Screen for diabetes in obese teens Advocate for safe and appropriate built environment with our colleagues in public health, the schools, and the legislature Mayor’s Children’s Cabinet: focus on obesity There are signs the tide is turning!

27 Colorado High School Completion Rates


29 School Completion Rates – Some Thoughts In 2011, graduation rates were 77.6% for girls, but only 70.3% for boys What can we do? Encourage preschool! – Denver Preschool Program Reach out and Read – promote early literacy Keep kids healthy so they can stay in school (SBHC model)

30 Reproductive Health: Denver Data from HKCS 57% of Denver high schoolers have never had sex (72% in 9 th grade to 38% in 12 th grade) Of those having sex (43%): 20% report alcohol or drug use at last sexual encounter 68% sex report condom use at last sexual encounter (from 72% in 9 th to 60% in 12 th ) 10% report no method of birth control DH Eastside peds clinic data from 2011: If you are sexually active, do you and your partner ALWAYS use condoms when you have sex? “No” = 24% (n = 46)

31 The State of Adolescent Sexual Health in Colorado 2012 – Colorado Youth Matter 41% of Colorado high school students report having had sex Nationally, 80% of males used a condom at first sex, a nine percent increase since 2002 Colorado’s birthrate has decreased by 40.4% between 1991 and 2010 for females ages 15-19 There were nearly 800 fewer births to teens in 2010 than the previous year in Colorado Of all Colorado HIV cases reported between 2006-2010, 15% of new cases were diagnosed among youth 13-25 years old 47% of adolescents nationally report they would stop using reproductive health services if parental notification was required although 99% of these adolescents would remain sexually active.

32 STI Screening in SBHCs Range by clinic = 56% - 100% (will be lower in CHS!)

33 What can we do? Support comprehensive sexuality education programs that are evidence-based, medically accurate, culturally relevant, and age appropriate. These programs should include a range of pregnancy prevention options such as contraception, condoms, abstinence, healthy relationships, and decision-making skills among other topics.

34 What can we do? Promote reproductive health education In clinic HEP in SBHCs In community Screen for STIs and HIV Family Planning In clinic HEP for counseling Title X and “Title X–like” privately funded program


36 Visits by Age The HEP are seeing students at the following schools: North Montbello MLK Noel Lake South West JFK Place Bridge Academy Bruce Randolph Manual Lincoln Kepner

37 Pre-Post Knowledge Survey Every student, at the beginning of the first session for the school year, is given a short knowledge quiz with True and False questions. At the end of that initial session, the student was again given the survey. Pre-testPost-test 77% 84%*** *** Change is significant at p<.001

38 Post – Post Attitudes and Behavioral Intent Every student, at the beginning of the first session for the school year, is given a short survey asking about attitudes and behavioral intent. Students were then ask to complete the same survey at a follow-up session that could be from 1-3 months later. Of the 17 items asked, 14 items showed statistically improved responses.

39 Percent Who Remained Abstinent Of the 2700 students seen by a HE, 495 reported being abstinent at first visit and had subsequent visits with a HE: % reporting continued abstinence at last visit. N=495

40 Referral Data

41 Choice of BC Method Method of Contraception students report using at first visit of the school year and at their last visit of the school year.

42 Effectiveness of Method Overall, 32% of students changed to a more effective method of birth control.

43 Productivity On average, each student is seen by a HE, 2.5 times per year. In the follow-up sessions correct and consistent contraception and condom use are discussed as well as STIs, healthy relationships and partner and parent communication

44 DH Title X Patients Served, 2009 - 2012 Age2009-102010-112011-12 < 18 years11629511558 18 – 19 yrs484488643

45 Patients age 12 – 18 years old with a visit for prenatal care, by year Year# Adolescents 2006731 2007765 2008784 2009749 2010641 2011601 2012499

46 References Youth Risk Behavior Survey, Centers for Disease Control and Prevention, Colorado Youth Risk Behavior Survey, 2011 Healthy Kids Colorado Survey Report, Colorado Coalition for Healthy Schools and Colorado Department of Education, Reports/2011%20 HKCS%20State%20Report.pdf Healthy People 2020, U.S. Department of Health and Human Services, Table 2: Mortality and reproductive health indicators: Health Statistics and Vital Records, Colorado Department of Public Health and Environment, CDC WONDER, Centers for Disease Control and Prevention, Injury Prevention and Control: Data and Statistics (WISQARS), Centers for Disease Control and Prevention, Education indicators: Colorado Department of Education, Trends in High School Dropout and Completion Rates in the United States: 1972– 2009, United States Department of Education,

47 Thank You

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