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Suggested citation MacKay AP, Duran C. Adolescent Health in the United States, 2007. National Center for Health Statistics. 2007.

Library of Congress Catalog Number MacKay, Andrea P. Adolescent health in the United States, 2007. p. ; cm. — (DHHS publication ; no. 2008–1034) ‘‘December 2007.’’ Prepared by Andrea P. MacKay and Catherine Duran. Includes bibliographical references. ISBN-13: 978-0-8406-0618-1 ISBN-10: 0-8406-0618-4 1. Teenagers—Health and hygiene—United States—Statistics. 2. Teenagers—Medical care—United States—Statistics. 3. Health behavior in adolescence—United States—Statistics. I. Duran, Catherine. II. National Center for Health Statistics (U.S.) III. Title. IV. Series. [DNLM: 1. Health Status—United States—Statistics. 2. Vital Statistics— United States. 3. Adolescent—United States. 4. Adolescent Behavior— United States—Statistics. WA 900 AA1 M153a 2007] RA407.3M228 2007 362.10835—dc22 2007037705

National Center for Health Statistics Edward J. Sondik, Ph.D., Director Jennifer H. Madans, Ph.D., Acting Co-Deputy Director Michael H. Sadagursky, Acting Co-Deputy Director Jennifer H. Madans, Ph.D., Associate Director for Science Jennifer H. Madans, Ph.D., Acting Associate Director for Planning, Budget, and Legislation Michael H. Sadagursky, Associate Director for Management and Operations Lawrence H. Cox, Ph.D., Associate Director for Research and Methodology Linda B. Torian, Acting Director for Information Technology Linda B. Torian, Acting Director for Information Services Linda T. Bilheimer, Ph.D., Associate Director for Analysis and Epidemiology Charles J. Rothwell, M.S., Director for Vital Statistics Jane E. Sisk, Ph.D., Director for Health Care Statistics Jane F. Gentleman, Ph.D., Director for Health Interview Statistics Clifford L. Johnson, M.S.P.H., Director for Health and Nutrition Examination Surveys

Office of Analysis and Epidemiology Linda Bilheimer, Ph.D., Associate Director for Analysis and Epidemiology Diane M. Makuc, Dr. P.H., Associate Director for Science Acknowledgment

Acknowledgments

Adolescent Health in the United States, 2007 was prepared by Andrea P. MacKay and Catherine Duran of the Office of Analysis and Epidemiology, National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), under the general direction of Linda Bilheimer and Diane Makuc. Data analysis, technical assistance, and content review for specific charts were provided by Joyce C. Abma, Robert Anderson, Gwen Bergen, Stephen J. Blumberg, Heather N. Brown, Anjani Chandra, Alan J. Cohen, La-Tonya D. Curl, Lois A. Fingerhut, Virginia M. Freid, Deborah D. Ingram, Jo Jones, Richard J. Klein, Patricia Pastor, Mitchell B. Pierre, Jr., Cynthia A. Reuben, Susan E. Schober, and Stephanie J. Ventura of NCHS; Steve Kinchen and Shari L. Shanklin of the National Center for Chronic Disease Prevention and Health Promotion, CDC; Stuart Berman of the National Center for HIV/AIDS, Viral Hepititis, STD, and TB Prevention, CDC; William A. Carroll and Doris C. Lefkowitz of the Agency for Healthcare Research and Quality; and Stephen Provasnik of the National Center for Education Statistics. Editorial review was provided by Demarius V. Miller and Megan M. Cox, CDC/CCHIS/ NCHM/Division of Creative Services, Writer-Editor Services Branch, and Laura Drescher, Office of Information Services, Information Design and Publishing Staff, NOVA contractor. This report was typeset by Zung T. Le, CDC/CCHIS/NCHM/ Division of Creative Services, and graphics were produced by Jarmila G. Ogburn, CDC/CCHIS/NCHM/Division of Creative Services, and Kyung M. Park, CDC/CCHIS/NCHM/Division of Creative Services, NOVA contractor.

Adolescent Health in the United States, 2007 iii Contents

Contents Risk Behaviors ...... 56 Sexual Contact ...... 56 Sexual Partners ...... 58 Acknowledgments ...... iii Cigarette Smoking ...... 60 List of Figures ...... vi Alcohol Use...... 62 Drinking and Driving and Seatbelt Use...... 64 Introduction ...... 1 Use of Marijuana and Other Illicit Drugs ...... 66 Population...... 8 Weapon Carrying...... 68 Race and Ethnicity ...... 8 Physical Activity ...... 70 Poverty and Family Structure...... 10 Dietary Risk Behavior ...... 72 Dropout Rates...... 12 Health Care Access and Utilization ...... 74 Health Status ...... 14 Health Care Coverage ...... 74 Limitation of Activity...... 14 Health Care Visits ...... 76 Overweight ...... 16 Health Care Expenses ...... 78 Untreated Dental Caries ...... 18 Medical Prescription Expenses ...... 80 Suicide Ideation and Attempts ...... 20 Unmet Health Care Needs for Adolescents with Emergency Department Visits, Hospital Discharges, Special Health Care Needs ...... 82 and Death Rates ...... 22 Family Planning and Reproductive Health Medical Emergency Department Visits for Injury ...... 24 Services ...... 84 Emergency Department Visits for Selected External Dental Visits ...... 86 Causes of Injury ...... 26 Data Tables for Figures 1–40 ...... 88 Emergency Department Visits for Selected Injury Diagnoses ...... 28 Technical Notes...... 126 Emergency Department Visits for Selected Diagnoses ...... 30 Appendixes Alcohol-related Emergency Department Visits ...... 32 Appendix I: Healthy People 2010 ...... 129 Hospital Discharge Rates...... 34 Appendix II: Data Sources ...... 131 Hospital Discharge Rates for Selected Diagnoses.... 36 Death Rates ...... 38 Motor Vehicle- and Firearm-Related Deaths ...... 40 Violence and Victimization ...... 42 Violent Crime Victimization ...... 42 Dating Violence and Forced Intercourse ...... 44 Reproductive Health ...... 46 Contraceptive Use ...... 46 Pregnancy Rates...... 48 Birth Rates ...... 50 Sexually Transmitted Diseases...... 52 Acquired Immunodeficiency Syndrome (AIDS) and Human Immunodeficiency Virus (HIV) ...... 54

Adolescent Health in the United States, 2007 v List of Figures vi 4. Health 2. 1. Population List 3. 5a. 5b. 6. 7. 8. 9. 10. 11. of health Limitation age, Poverty years Race 2004–2005 adults Status 2005 States, United origin: 2003–2004 United Overweight Hispanic age, Overweight 2001–2004 poverty years Untreated age status: grades Suicide rates, Emergency 2005 States, United years vrg nul2002–2004 annual average among Initial 2002–2004 and external Initial years vrg nul2002–2004 annual average injury Initial age, nul2002–2004 annual of Status age, group, gender: by by by Figures and emergency emergency emergency diagnoses of of of of and 16–24 conditions United dropout States, 9–12, adolescents by status: ideation status family gender, age causes age: age age, age, origin: of dental Hispanic death gender: race among among department ...... United and activity and years States, by United by by selected structure among rates United United of race and and among gender rates age age caries gender: among department department department young ...... injury United adolescents adolescents origin of States, ...... 10–19 caused average among attempts States, Hispanic and and and adolescents States, age, among States, visit years among and adolescents and adults adolescents among United of Hispanic gender: gender: States, years average by ...... by rates, adolescents adolescents race 1980–2050 race annual visit visit visit 1966–1970 average among origin, adolescents age 2004 20–24 adolescents selected 12–19 12–19 adolescents States, of and average rates rates rates and United United hospital 10–17 origin, and age, 2001–2004 annual 10–19 and ...... 10–17 students Hispanic years years years Hispanic annual race for for for average chronic by and 10–19 ...... States, States, poverty through years and annual 10–19 discharge injury selected selected years 12–19 age years of and of of 10–19 young in age, age: . origin: of . of . by 15 16 13 17 21 19 23 25 27 29 11 9 20. Reproductive 18a. Violence 18b. 21b. 21a. 19. 12. 13. 14. 15. 16. 17. adolescents Contraceptive 12–19 Violent age, intercourse 12–19 Violent 2004 States, United used age, age, Pregnancy 1990–2002 States, United age: Pregnancy 2002 States, United origin: intercourse Dating rgac:Uie tts 2002 States, United pregnancy: n rd ee:Uie tts 2005 States, United level: grade and diagnoses Emergency age 2002–2004 among Alcohol-related adults 10–19 and Short-stay United vrg nul2002–2004 annual average diagnoses Short-stay age 2002–2004 Death causes age 2002–2004 of firearm-related Death nul2002–2004 annual age, and pregnancy-related and and by by by and at 21–24 rates rates years years years violence States, crime crime adolescents among by gender, last age age, gender: gender: gender: among hospital hospital among age Victimization rates rates health in among department ...... for 15–19 for sexual group: of of of race years victimization victimization the use average injuries Adolescent adolescents emergency and age age age, injury, motor and age among among United United United past adolescents adolescents and among ...... students discharge discharge years intercourse United of ...... 14–20 gender: and and being group, by vehicle by age, among diagnoses Hispanic 3 annual visit age States, States, States, adolescents adolescents young young months, intent of Health never-married rates rates ...... forced years States, department by 10–19 and ...... in age United rates and rates rates traffic-related adolescents grades 10–19 age 10–19 2002–2004 and adults adults of ...... among among average average average in origin, type who gender: of to among by for the injury 1985–2005 years for for group States, race age have specified 15–19 15–19 ...... of selected have years years United 20–24 20–24 9–12, injury, selected visit and adolescents adolescents victimization: and and female annual annual annual and of adolescents United and sexual ...... 10–19 average had and outcome rates age, years years of of States, by young natural noninjury, years years Hispanic gender: method .... noninjury age, age, sexual gender States, by years of of 2007 of of by by of 43 48 42 49 47 45 31 33 35 37 41 39 List

of Figures

22. Birth rates among adolescents 10–19 years of age, Health Care Access and Utilization by birth order, age group, and race and Hispanic origin: United States, 2004...... 51 34. Current health care coverage of adolescents 23. Sexually transmitted disease rates reported for 10–19 years of age, by age and poverty status: adolescents 15–19 years of age, by gender and United States, 2005...... 75 race and Hispanic origin: United States, 2004 .... 53 35. Lack of a health care visit in the past 12 months 24. Acquired Immunodeficiency Syndrome (AIDS) and among adolescents 10–19 years of age, by age, Human Immunodeficiency virus (HIV) transmission gender, race and Hispanic origin, and insurance categories for adolescents 13–19 years of age, by status: United States, 2005 ...... 77 gender: United States and 33 states with confidential 36. Any out-of-pocket expenses for health care incurred reporting, 2001–2005 ...... 55 by adolescents 10–21 years of age, by gender, race and Hispanic origin, and insurance status: United States, 2004...... 79 Risk Behaviors 37. Any out-of-pocket expenses for prescribed medicine 25a. Adolescents 15–19 years of age who have ever had incurred by adolescents 10–21 years of age, by sexual intercourse, by age and gender: United States, gender, race and Hispanic origin, and insurance 1988–2002 ...... 56 status: United States, 2004 ...... 81 25b. Ever had any sexual contact among adolescents 38a. Unmet health service needs among adolescents 15–19 years of age, by type of contact, age, and 10–17 years of age with special health care needs, gender: United States, 2002...... 57 by number of services needed but not obtained and 26. Number of sexual partners in lifetime among insurance status: United States, 2001 ...... 83 adolescents 15–19 years of age, by gender and 38b. Selected health service needs among adolescents race and Hispanic origin: United States, 2002 .... 59 10–17 years of age with special health care needs, 27. Current cigarette smoking among students in by type of service needed: United States, 2001 . . . 83 grades 9–12 by grade level, gender, and race and 39. Receipt of at least one family planning or Hispanic origin: United States, 2005...... 61 reproductive health medical service in the past 28. Alcohol use, binge alcohol use, and heavy alcohol year among female adolescents 15–19 years of use in the past 30 days among adolescents 12–20 age and young adults 20–24 years of age, by type of years of age, by gender and race and Hispanic provider and age group: United States, 2002 ..... 85 origin: United States, 2005...... 63 40. At least one dental visit in the past year among 29a. Drinking and driving and seatbelt use among students adolescents 10–19 years of age and young adults in grades 9–12: United States, 1991–2005 ...... 65 20–24 years of age, by age group, race and Hispanic 29b. Drinking and driving and seatbelt use among origin, and poverty status: United States, 2005.... 87 students in grades 9–12, by race and Hispanic origin: United States, 2005...... 65 30. Marijuana use in the past 30 days and lifetime use among students in grades 9–12, by grade level, gender, and race and Hispanic origin: United States, 2005 ...... 67 31. Weapon carrying in the past 30 days among students in grades 9–12, by gender, grade level, and race and Hispanic origin: United States, 2005 .... 69 32. Participation in physical activity among students in grades 9–12, by gender and race and Hispanic origin: United States, 2005...... 71 33. Dietary risk behavior in the past 30 days among students in grades 9–12, by gender and race and Hispanic origin: United States, 2005...... 73

Adolescent Health in the United States, 2007 vii Introduction

Introduction meaningful roles in their communities. More teenagers now than ever before are making commitments to community Adolescent Health in the United States, 2007 describes the service through volunteer activities. Some recent studies have health of the population 10–19 years of age. Because the found that adolescents who volunteer do better in school, feel transition to adulthood often continues through ages 20–24 more positive about themselves, and avoid risky behaviors years (young adults), data for young adults are presented in such as using drugs (2). topic areas when comparable data were available and in charts where space allowed. For many figures, additional Organization of Adolescent Health in the United information on gender, race and Hispanic origin, and age is States, 2007 available in the accompanying data table to supplement the characteristics highlighted in the figure. This report from the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics Adolescence is a period of accelerated growth and change (NCHS) presents data on the current status of adolescent that bridges the complex transition from childhood to health. Many of the measures of health status are shown by adulthood. The second decade of life is often a turbulent single year of age or by 2- or 3-year age intervals to highlight period in which adolescents experience hormonal changes, the changes that occur in health status as adolescents move physical maturation, and, frequently, opportunities to engage through this important developmental period. Summary in risk behaviors. The patterns of behavior they adopt may measures combining 5- or 10-year age groups (the standard have long-term consequences for their health and quality of for analyses of childhood health events) do not adequately life. Because of the rapid physical, cognitive, and emotional capture the wide variation in health status and the vast developments that take place during this age period, developmental differences between younger and older adolescence is also a time when many health problems may adolescents. first emerge (1). Moreover, adolescents also experience special vulnerabilities, health concerns, and barriers to Racial and ethnic variation in adolescent health is discussed accessing health care. when the data sources allow for such analysis. Differences between sexes in some aspects of health status among Definitions of adolescence and the years encompassed vary. adolescents become more apparent with age. These Adolescence is generally regarded as the period of life from differences are presented when the data allow for such puberty to maturity, the meanings of which, however, are analysis and the differences are notable. often debated by health professionals. Many children begin puberty by the age of 10, although there is considerable Socioeconomic status, as measured by family income, poverty individual variation in the developmental and maturation time status, or level of parents’ education, is as strongly line. During their teenage years, adolescents are learning associated with the health of adolescents as it is with the financial, social, and personal independence, and they are health of persons of all ages in the United States (3). expected to become capable of adult behavior and response. Differences in the life circumstances of high- and low- By the age of 19, most young people have completed high socioeconomic status adolescents and their families influence school and are experiencing new living situations and health and health risk behavior in a number of ways. Low embarking on widely divergent paths—from college to military family income decreases the ability to afford comfortable service to employment. They are completing their teenage housing, healthy food, and appropriate health care, and it years and entering the young adult realm, with new legal also reduces the opportunity to live in a safe and healthy standing, responsibilities, and independence. The transition to environment. To fully assess the impact of socioeconomic adulthood can continue during the early twenties. factors on the health of adolescents, the examination of adolescent school and family environments should be Adolescents have remarkable creativity, energy, and potential, included, as well as their broader sociostructural and the teenage years are also a time of exploration, environments (4). A comprehensive presentation on idealism, and cynicism. This period offers adolescents an socioeconomic status and adolescent health is beyond the opportunity to begin planning for their futures, to adopt scope of this report. However, information on selected social healthy attitudes about risk behaviors, and to develop determinants of health (Figures 2 and 3) and the strong

Adolescent Health in the United States, 2007 1 Introduction 2 The Population health relationship One sociodemographic 34, and Characterizing measuring approximately tobacco indicators white. physical decreased that including have describe Reproductive The and Healthy disease for health and People 2010, critical with references This 2007 reproductive characteristics, and followed Data errors data detail Appendix the and ethnic contribute permanent young utilization. first decision baseline of report are tables a figures. information discusses By when has (5). adolescent year 2010 the profound People prevention 40). use, inactivity, by section the presented. family 2050, II, of Of mortality to been the composition adults, most is between technical include 2010, available, Data adolescent health, economic and alcohol to health 44 and divided the 61 Characteristics the to The related health consequences 2010 structure, become this percent. of objectives documented effect notable percent unintentional about includes 107 Sources current unhealthy objectives. characteristics 21 includes health agenda this 40 estimates and risk The is proportion , socioeconomic and notes into objectives status, a objectives Adolescent and, a figures circumstances on of report methods health. nationwide behaviors, morbidity sexually technical key characteristics Other of of other measures. poverty . sections this current a for that objectives and for adolescents adolescents dietary table element Appendix violence in in describes and population for adolescent and is some drug Risk sociodemographic sets data several have the that of used active estimated status, some Health and but notes that accompanying on intentional and health the behaviors, status figures behaviors—including use, The specific tables charts, pertain in of been related also population and future that lists I, adolescent is health can charts adolescents. selected adolescent describe adolescents. are requires and in Healthy table ( sexual health Figure promotion the victimization, and describing is these designated the to plus for have non-Hispanic additional health to health. to dropout not injuries—may changing have care ( and also each adolescent Figures adolescents United adolescent standard in behavior, 1). not in covered People objectives text long-term measures, population. Healthy behaviors objectives access health. further Today, and figure. only Family other rates are States, related as 5, racial 6, in The Health States, and physical life-threatening old. that effects adolescent (Figure untreated and structure Many opportunities to achievement who new lifetime stressful health feature suicide health status, events were inpatient Injuries information 2002–2004, 60 struck diagnoses vehicle asthma, and among visits related for counterparts the percent male Some mental limit adolescents contusions second complete levels analyzed to of physical by status. problem of data for 4), the to 2007 of attempts crashes economic are EDs and health the for Status adolescents hospital their affects or poverty dental an adolescence, which were and adolescents of of population leading on health a four teenagers. on section against normal ( abdominal is to presents increase injury Figure all independence major activity high leading ( illnesses and a problems, ( one selected ( Figures succeed ( Figure fractures, Figure adolescents’ caries are Figure initial who external emergency care rapidly on opportunity status. diagnoses school in biological of of transitions cause 13 an indicators dental and Adolescent drop or 2002–2004 is with selected was injury-related diagnoses the ). Adolescent 7). 11 experience Although are 10 8–13 object more or that require aspects overweight increasing in ). causes Although they young ). sprains To ( most gastrointestinal of out age received Figure apparent the Upper health The and ). department affect economic and further ED changes serious for or These are of of of work measures and Health special important adults most mood responsibility, of person, of adolescents’ visits among high a life, ( is 3). and respiratory Health Figure status chronic at the adolescents percentage health mental injury ( ED are and also assess Figure force in Educational greatly sources suicidal such common in school strains, to very swings among than Figure well-being education visits: substantially (ED) the also adolescents. associated 12 cuts, as their in of accounted indicators conditions care than health or as 5a ). young the United adolescent for physical, measured reduced conditions, provide will thoughts Alcohol-related care ). emotional identify 6. falls, ED open bodies the are adolescents. can and of utilization injury their do their The United conditions have the services ( visits adjustment a States, or Figure have or be motor being wounds, of with negative common peers were for higher female very risk health and dental, or by fewer health not over 2007 2), for In Introduction

Hospital discharge rates vary by gender, chiefly because of by race and Hispanic origin (Figure 22). Birth rates among the large number of hospitalizations for pregnancy-related adolescents have declined markedly between 1991 and 2004. causes among female adolescents (Figure 14). Pregnancy- Sexually transmitted diseases (STDs) are the most commonly related discharges accounted for almost one-half of all reported infectious diseases among sexually active hospital discharges among female adolescents in 2002–2004 adolescents, and chlamydia and gonorrhea are the most (Figure 14). Asthma, psychoses, fractures, and poisoning were common bacterial causes of STDs (Figure 23). Young people among the leading first-listed diagnoses for hospitalized in the United States are at persistent risk for human adolescents in 2002–2004, and accounted for almost one-fifth immunodeficiency virus (HIV) infection, and sexual activity of all hospital discharges (Figure 15). and drug use among adolescents place them at high risk for Mortality rates are a measure of the most serious adolescent HIV transmission (Figure 24) (6). health events. Leading causes of injury mortality are presented in Figures 16–17. Motor vehicle traffic-related Risk Behaviors injuries and firearm-related injuries are the two leading causes of death among adolescents 10 to 19 years of age Adolescents today are confronting societal and peer-related (Figure 17). Changes in mortality by single year of age across pressures to have sex at earlier ages and to use tobacco, the adolescent period are significant and striking. alcohol, or other drugs. Many adolescents are engaging in risk behaviors that are harmful or dangerous to themselves Violence and Victimization and others, with consequences to their health and well-being that may be immediate or long term. Many of the patterns of The third section of this report presents selected measures behavior initiated during the adolescent years are associated on violence and victimization. Adolescents are the victims of with adult morbidity and mortality. violent acts, including rape or sexual assault, aggravated and Approximately one-half of adolescents engage in some form simple assault, and robbery (Figure 18a). Over the past two of sexual contact, most commonly oral sex or vaginal decades, crime victimization rates among adolescents and intercourse (Figure 25b). The likelihood that an adolescent young adults have changed considerably, declining almost has ever had heterosexual vaginal intercourse increases with two-thirds between 1995 and 2005 (Figure 18b). Adolescents age (Figure 25a). Among those adolescents who have been of both sexes are victims of dating violence (being hit, sexually active, a majority have had intercourse with more slapped, or physically hurt on purpose by a boyfriend or than one partner in their life (Figure 26). girlfriend) (Figure 19), and both sexes report having had forced intercourse (Figure 19). Smoking has serious long-term effects on health. Most adults who are addicted to tobacco began smoking as Reproductive Health adolescents (7). Current and frequent smoking among high school students is shown in Figure 27. Alcohol is the most The onset of puberty is one of the benchmarks of commonly used psychoactive substance during adolescence. adolescence. For the first time in their lives, adolescents are Alcohol use, including heavy alcohol use and binge alcohol facing issues and decisions about their own sexuality. The use, are shown in Figure 28. majority of today’s adolescents become sexually active during Drug use by adolescents can have immediate and long-term their teenage years and are at risk for health consequences health consequences. Marijuana is the most commonly used associated with sexual activity, such as pregnancy or sexually illicit drug among high school students. In 2005, almost 4 in transmitted disease. An important measure of adolescent 10 high school students had used marijuana in their lifetime reproductive health is contraceptive use (Figure 20). Oral (Figure 30). contraceptives and condoms are the most common methods of contraception used by female adolescents. Trends in As adolescents become more independent, they are at risk pregnancy rates among female adolescents are shown in from behaviors associated with riding in and driving cars. Figure 21a, and pregnancy rates by race and Hispanic origin Among high school students in 2005, riding with a driver who and pregnancy outcome are shown in Figure 21b. Birth rates had been drinking was more common than driving after among adolescents increase with age and vary considerably drinking alcohol (Figure 29b).

Adolescent Health in the United States, 2007 3 Introduction 4 Lack Health Weapon to resulting poor example, than screening, preventive care school likely Physical (Figure The (Figure benefits is diet, expenses and in currently care participation Dietary health for shown commonly more preventive attempt associated vision choices, have servings behaviors and weight an Figures and adolescents. obesity. taking out-of-pocket plays for those needs and of one to important likely care care students in use (Figure 31 35 risk suicide, health receive for adolescents such carrying activity of Care from recommended a near Figure ). ). or for include 36 needed and interventions care, an laxatives with from to (Figure of fruits knife adolescents. (SHCN), services behaviors in Participation more health and important smoke, preventive violence. as 33 insurance poor moderate sick measure Access the than health Adolescents and provides 32 nonpoor prescription ). or and exercising is fasting cost 37. unmet . services 38b proportion associated care. club) families care to is they includes consistent among vegetables For drink can ). associated care particularly lose Carrying level and role Insurance Physical of health to is (for families and by important is health Uninsured are and adolescents have associated health alcohol, are vigorous more weight moderately than are education, in high medication, female who of 24 physical less prescribed of with the Utilization access dental services. physical serious more care hours a each adolescents those ( school common activity, go with Figure care important. likely gun prevention or status health the use high adolescents physical on needs keep likely examinations, care, with day with receiving or to or with observations, access. and most health to marijuana, extreme and activity students medicine 34 school Adolescents along more), is a other and make among (8). special ). from diminished to wide coverage specialist eating ( strongly Among Figure eyeglasses serious Routine activity with of be emotional consequences Dietary Out-of-pocket weapon with and students health overweight gaining are vomiting, healthy diets range at uninsured SHCN are male five health and 38a the the a less are injuries from health care, shown are healthy access risk care ). of high (for most or who States, The Chartbook or Behavior in present age. population school. report were adolescents enrolled credential adolescents Educational drug, For violence-related Adolescents combined reproductive 2004), (2002–2004), National Sexual including health National main (2001–2004), National and In TB Oral adolescents, Professional enough disease proportion the insurance grades national vital Prevention past data services data health Measures included areas: and may conditions National statistics. and 2007 Consequently, data to or in Hospital Health Health year from Survey private presented 9 (i.e., to status tobacco of analyze of school surveys disclose be is reproductive through Development and and contraceptive and health dental increase the for are related adolescents adolescents National and varies Data an the in AIDS lower diploma of Vital Interview and behavior adolescents physicians’ young young number ( (YRBS), the young One from Ambulatory causing important Figure risk CDC’s and following use differences that medical care existing in 12. Nutrition by Sources Surveillance to than Statistics survey. Adolescent the of the behavior nationally Hospital Adolescent had and sexually adults adults race or adults are Figures 40 on health the of (9). National Survey limitation who (GED) is reliability if enrolled measures services, equivalent, ). not component systems, are observations all services a not disease offices a In data and by Medical Examination routine 16–24 survey are System, among use had high earned Discharge 2004, in services more specifically Health grade transmitted that representative certificate). (2004–2005—for System Hispanic sources, YRBS Center Health at in routine at of of and maternal school-aged in of in are multiple increased and years likely basis Care of 10 least activity), estimates: such age, in level a of its Mortality risk a clinics high encompass percent the based high are may variety in (2000–2004). for attending adolescent Survey early Surveys family origin the to Survey gender, designed one as of may behaviors diseases. rather the United These limited health HIV, school years school engage not age ( a and Youth health Figure risk on stages. dental United (2002–2004), prevent adolescents of the General and of planning (2002– STD, be chronic than States, were the the and settings, high are of services, to three students NCHS’s to health. large Risk in surveys in 39 alcohol, visit the YRBS The by study and race not this ). oral 2007 and in Introduction

or ethnicity groups. For certain topics, data are presented for they may be included with young adults ages 15–24 years. In all races combined in the chart, and significant race such cases, trends pertaining specifically to adolescents differences (if they exist) are discussed in the accompanying cannot be separated from those pertaining to children or text. See ‘‘Technical Notes’’ and Appendix II for more detailed young adults. In data sources that do categorize adolescents descriptions of data sources. separately, inconsistencies are present in the age ranges employed, making comparisons of data sources difficult. Other Sources of Data Furthermore, data for adolescents are often not available by single year of age. A major focus of this chartbook is to In addition to the data sources used in this chartbook, we address this limitation by presenting data by single year of would like to acknowledge other sources of available data on age when possible. adolescent health. Each of the following sources makes a Another obstacle in assessing the health status of the unique contribution to the collective body of knowledge on adolescent population is the lack of information on detailed adolescent health. The National Longitudinal Study of racial and ethnic minority groups. The socioeconomic status Adolescent Health (National Institutes of Health) was and cultures of racial and ethnic groups may vary widely and designed to study the influences on adolescent health and have important health consequences. In this report, the most health behaviors, with an emphasis on the social contexts in detailed race and ethnicity categories available are presented, which adolescents live (10). Monitoring the Future (National given the constraints of numbers of observations. For many Institute on Drug Abuse) is a nationally representative, annual data sources on adolescent health, information on the survey of 8th-, 10th-, and 12th-grade students’ values, socioeconomic status of adolescents is not available. behaviors, and lifestyle orientations (11). The National Educational attainment is often used as a measure of Adolescent Health Information Center (NAHIC) at the socioeconomic status for adults, but it is not a useful University of California, San Francisco, serves as a national measure for an age group comprising people who have not resource for adolescent health information and research (12) yet completed their education. School-based surveys may and is funded by a grant from the Maternal and Child Health collect health information directly from adolescents who are Bureau, Health Resources and Services Administration. not knowledgeable about their family’s income or other NAHIC works to ensure the integration, synthesis, measures of socioeconomic status. coordination, and dissemination of adolescent health-related information. The Kaiser Family Foundation has published two Several areas exist in which the special needs or problems of recent reports on adolescents. The first report, Generation M: adolescents have been recognized. However, national data Media in the Lives of 8–18 Year-olds, examined adolescent are not available to more fully explore these areas. Some of media use using a nationally representative survey of young those issues are briefly discussed here. people (13). The second report, Generation Rx.com: How Adolescents have an increased sensitivity about their Young People Use the Internet for Health Information, found bodies and the changes in shape and weight that that a majority of teenagers and young adults (ages 15–24 accompanies maturation. Some adolescents may develop years) use the Internet to search for health information (14). eating disorders, such as anorexia or complications, yet these Web pages designed for teenagers are available from several disorders often go undetected and untreated. The prevalence sources, including Medline (15) and the U.S. Food and Drug of eating disorders is particularly difficult to measure because Administration (16). The Centers for Disease Control and of the underlying denial and secretive nature of the behavior. Prevention provides an informative website on adolescent Although adolescent sexual activity has been well- health with links to key resources (17). documented, the extent to which sex is consensual has not been fully evaluated. Because many myths concerning rape Data Gaps persist among adolescents, acquaintance rape and date rape are often unreported and untreated (18). Available data sources present several limitations for studying adolescent health. In some sources of data, adolescents may Adolescents who are runaways and ‘‘living on the streets’’ not be considered a separate group. They may be included in are not included in national survey data. These young people tabulations for children under 15 or under 18 years of age, or are especially vulnerable and may have unique health care

Adolescent Health in the United States, 2007 5 Introduction 6 The Conclusion needs. consequences national (i.e., well social future these This status, and sources. adolescent ethnicity, health the Overall, disparities assessed Many and during The infections, problems—unintended of preventable to prevention adult transition alcohol, subsequent Adolescents population older behavioral. health as most report gay, morbidity populations. of and parents, among youth, risk Similarly, consequences the survey the The and from lesbian, by adolescents costly that violence, health strategies tobacco, population and examines behavior, (1). majority health traditional differences extend socioeconomic adolescents and morbidity for childhood leaders, exist. and data. risk Health-risk Adolescent with and incarcerated issues. bisexual, their recognition threats mortality suicide, behaviors and of into alternative widespread and may a also for are pregnancy, current adolescents measures and variety or other to in National adulthood, health society. prevent documented. requires for varies behaviors mortality. health and adulthood. risk work unintended and status. youth of drugs— adolescents of and of lifestyles behaviors transgender) care adolescents adolescent promote the force current by of Today’s data sexually-transmitted or status attention long-term are are Understanding and morbidity Intervention gender, reduce economic often from are are of healthy not injuries, The are between and measures the a adolescents have national are potentially are not included healthier health health to adolescent interrelated race face well-being have sexual United and primarily available established differences and when been and and and younger unique mortality. patterns data of of racial in the identity States. linked the health are social and as for use (19). the in of 1. References 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Park Brindis services California, Center Adolescent Moore volunteer. Pamuk Socioeconomic States, Statistics. Goodman explaining U.S. Health people CDC. Government (through U.S. adolescents/index.htm. www.cdc.gov/hiv/topics/surveillance/resources/slides/ Smoking people: for Rafiroiu index.htm. http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_1994/ RF. health-promoting CDC. 2003. high MMWR The 2003. 2007 Monitoring National www.monitoringthefuture.org/. June Roberts Foundation. 8–18 www.kff.org/entmedia/7251.cfm. Disease Covariations National school Department Department MJ, 20]. June year-olds HIV/AIDS Youth CW, 89:1522–8. for 2010. CD, E, 1998. A 48(SS–7):1–44. AC, DF, for Adolescent 2005) and Macdonald Available report 1998. J E. Makuc San differences Middle 1994. the 20]. Health Allen et Control youth adolescents. Prim Generation risk Foehr Sargent Printing The Longitudinal Volumes Health. Hyattsville, al. Future Francisco, [cited status [cited Available surveillance of behavior of behaviors. of of JP. Prev D, role Investing Adolescent Childhood risk Information 1999. UG, the from: adolescent Health Health and Health Heck Office. TM, RG, The 2007 Preventing 2007 in [cited and of behavior 17(2):231–58. 1 2007. Surgeon Rideout M: 29 Prevention. U.S. and socioeconomic San MD: from: http://nahic.ucsf.edu/. Ozer effects Parra-Medina surveillance—National Study Policy K, health and and June Media June in Oct Information Am 2000. 2007 and in 2. Reuben Health adolescents’ 2007. Francisco, clinical National Center. weight-control, www.cpc.unc.edu/addhealth. adolescents EM, Human Human 1999. 2005. survey, J Washington, V, General. of 20]. tobacco Information 20]. Adolescence of chartbook. June Health in for Adolescent volunteering Burg Available the in Available 1996. Available preventive C, 2001. Kaiser Center Center the 20]. Services. United Services, D, status lives CA: Lochner Behav use Atlanta, SJ, health. Drane United and Available Health, and DC: University Family Millstein among of from: health-risk, and for [cited States, Health from: from: gradients 2007. young 27(1):3–14. health alternative on Analysis Healthy Office GA: U.S. Health WJ, K. Am States, National the United 2007 young from: [cited J SG, Centers 1998. Valois adults young of on Public in and 2007 Introduction

14. Rideout V, for Kaiser Family Foundation. Generation Rx.com: How young people use the Internet for health information [online]. [cited 2007 June 20]. Available from: www.kff.org/entmedia/20011211a-index.cfm. 2001. 15. National Institutes of Health. Medline Plus—Teen’s page [cited 2007 June 20]. Available from: www.nlm.nih.gov/medlineplus/teenspage.html. 2007. 16. U.S. Food and Drug Administration. Health information for teens [cited 2007 June 20]. Available from: www.fda.gov/oc/opacom/kids/html/7teens.htm. 2007. 17. CDC. Adolescent health [cited 2007 June 20]. Available from: www.cdc.gov/node.do/id/0900f3ec801e457a. 2007. 18. Rape, Abuse, and Incest National Network. Are victims reporting the crime of rape [cited 2007 June 20]. Available from: www.rainn.org/statistics/reporting-rape.html. 2007. 19. CDC. Youth risk behavior surveillance—United States, 2005. MMWR 55(SS-5). 9 June 2006.

Adolescent Health in the United States, 2007 7 Population 8 Changes Race Population population adolescent behavior, and were approximately of two-fifths (Figure population, considerably population American continue Islander or population population black population. adolescents, Hispanic the lived immigrant proportion to expected fertility the 22 more In The Increasing A population ethnicity. in adolescents percent large adolescents 2005, adolescent rates 1). immigrant race and adolescents, races, to is in consisted health to Indian or of have indicate by is population like Hispanic influx expected expand. the occur over among over and had reflected adolescents and (2). the 14 racial distribution. Ethnicity will that racial important status, or percent the of immigrant 42 Hispanic population year Most 10–19 the families—that as primarily that constitute Alaska of of immigrants Hispanic, minority and adolescents million to proportion the as past and because other in the 2050. future and certain increase well years changes ethnic largest of in consequences ethnic general In Native, 20 origin through residents racial parents the disease immigrant was populations as 1990, 56 growth black years, of racial many has diversity U.S. of is, percent adolescents minority considerably have composition distribution non-Hispanic age, and in and adolescents population, the 19 immigration or contributed (1). differ the and population. and in of of ethnic recently families percent African constituting Asian adolescent the the By the of adolescent in (1,3). for group projections ethnic significantly the the 2004, U.S. measures United the of who or groups of by changed American, of had white, general adolescent surpassed who the to of and Pacific groups the health Three-fifths population 2050. adolescents are the changes was adolescent States increased are higher of and of by of of an the will two risk race the in is 1. References 2. 3. Hernandez generation. families. U.S. United Detailed Council 2007. www.census.gov/population/www/socdemo/foreign/ppl-176.html. Race. well-being Government Bureau Changing States: of Washington, tables by Economic DJ, The Printing of race Current (PPL-176) Chamey the health America: Adolescent and Census. Office. Advisers DC: Population and Hispanic C, Indicators [cited National well-being editors. 1998. Foreign-born Health for 2007 origin. the Survey—March Academy From of in President’s June of social the Washington, children generation population United 8]. Press. and Available Initiative in 2004. economic States, 1998. immigrant DC: of to the from: U.S. on 2007 Population

Figure 1. Race and Hispanic origin of adolescents 10–19 years of age: United States, 1980–2050

100

80 White, not Hispanic

60 Percent Percent

40

Hispanic

20 Black

Asian or Pacific Islander Asian

American Indian or Alaska Native 0 1980 1990 2000 2010 2020 2030 2040 2050 Projected Year

NOTES: Data for 1980–1995 are for Asian or Pacific Hispanic origin may be of any race. See data table for Islander persons; data for 2000–2050 are for Asian data points and additional notes. person only. Population projections are not available for American Indian or Alaska Native persons. Persons of SOURCE: U.S. Census Bureau.

Adolescent Health in the United States, 2007 9 Population 10 Poverty Poverty negative are of less Furthermore, access generally adolescents. available of threshold whereas families (Figure are below household highest differentials 36 families adolescents were Hispanic poverty lived 60 of school age adolescents percent percent In Adolescents One-parent In more substantially and with 1.7 2005, 2005, the lived 2). to rates line during near were consequences. an be adolescents to times linked ($19,971 likely (1), a health poverty with of of and that single as and additional in unemployed in almost 25 The poverty poverty of living all non-Hispanic to two-parent families adolescence of their than households as two percent to poverty who lack adolescent. become more adolescents care structure Hispanic line likely parent the Family a in parents. 16 non-Hispanic adolescents of live year is (one in and poverty, 20 likely than economic percent with strongly of paternal female for Adolescents to more teenage in percent (mother families. in non-Hispanic to poorer of origin have black headed a are a incomes has to 2005, in two an variety Structure household compared frequently have of head-of-household adolescents female associated immediate financial a adolescent’s resources in (4). adolescents times of all health parents white or family Non-Hispanic for other by adolescents a adolescents father), below of in a family women head-of-household families the reasons, counterparts. white status family with with income support. as families (2), and and the with poverty living adults compared income one and family 7 adolescents and experience for of poverty percent support who lasting reduced lived black including below 10–17 to four), in In parent 35 families to (3). threshold) is drop a are 2005, near percent earn in and with the of years poor only out the or pay 1. References 2. 3. 4. Livingston Washington, Center Sawhill missing Policy Duncan up U.S. supplement poor. Census brief for IV. component. G, New A. Education Teen Brooks-Gunn 38:1–8. 2006. DC: Bureau. The York, pregnancy U.S. condition Adolescent Unpublished 1998. NY: Washington, Statistics. Current Department Russell J, of prevention: editors. Health Population education analysis. 2006. Sage DC: of Consequences in Education, The Press. Welfare the 2006 2006. Survey, Brookings United 1997. in reform’s National brief. March States, of Institution. growing 2007 Population

Figure 2. Poverty status among adolescents 10–17 years of age, by family structure and race and Hispanic origin: United States, 2005

All adolescents

All races and origins Poor Near poor White only, not Hispanic

Black only, not Hispanic

Hispanic

Adolescents in married couple families

All races and origins

White only, not Hispanic

Black only, not Hispanic

Hispanic

Adolescents in female householder families

All races and origins

White only, not Hispanic

Black only, not Hispanic

Hispanic

0 20 40 60 801 00 Percent

NOTES: Poverty status is derived from the families have income of 200 percent of the ratio of the family’s income to the federal poverty threshold or more. Persons of poverty threshold, given family size. Poor Hispanic origin may be of any race. See data families have income less than 100 percent of table for data points. the poverty threshold; near poor families have income from 100 to less than 200 SOURCE: U.S. Census Bureau, Current percent of the poverty threshold; nonpoor Population Survey, March Supplement 2006.

Adolescent Health in the United States, 2007 11 Population 12 Although Dropout students than work High unemployment, assistance school likely or active reported The school, civilian are school credential measure and and 16–24 declined have to 2004 adolescents times 16–17 females. years females one-half dropouts adults and 2004, years completed non-Hispanic a cocaine; In The The Non-Hispanic not can training young status low students school force a than (3). as were of 7 2004, (2). are years years. or credential—either noninstitutionalized high regardless in percent status status (data of be age of worse gradually who In likely the in the college such high Among more those high or or dropout adults the 10 be 2004, high this used dropouts 18 in school 10.3 Rates of extent majority were black drop be to who table percent to dropout dropout involved that population, school health and as years age school, age of likely assume school in in percent black have (1). to to almost adults between of a non-Hispanic not complete out rate and school population. prison credential for of are were estimate group. have GED income of have Out-of-school of than than and the in enrolled of dropped rate rate Figure and compared in dropouts, 24 is more adolescents age aged a a 2003, 12 of school not dropped a than a certificate. dropout to population they percent who diploma fully non-Hispanic lower did 1972 increases is Hispanic adolescents percent physical measure high and (3). smoke; the enrolled likely 3 ( higher 25 Figure those ). in where their account functional have out white have Although need earnings, and over school compared years school with problem out of or to adolescents as of peers complete for use fight; adolescents Status who not 3). 16–24 Hispanic 2004, of with in an receive the fewer adolescents were 12 of for were males and for males the and to white school Dropout and earned alcohol, equivalency high percent place rate completed further age. males and who experience succeed for 57 from two with dropout years proportion opportunities over, those young had ages government high school. percent adolescents remained a adolescents. than be In complete and in are to population a 9 15 constitute rates education and marijuana, of not dropouts 2004, sexually of society. ages 16–24 percent high three 16–24 school, adults more for in percent did rates high age young In more of the of not in the high who the of 1. References 2. 3. 4. Asian rate dropout on within to The among Caspi of CDC. 63(3):424–51. Livingston 29 Washington, Center Hurst high U.S. Statistics. earn and 8 unemployment Oct rate majority years school Department D, CDC Pacific A, a for 1999. all of high Kelly Wright 2004. A. (4). Education racial less surveillance dropouts DC: of The Islander 1998. school D, students BE, than of U.S. Princiotta in and condition Adolescent Education, early Moffit Statistics. 8 4 diploma Department ethnic years adolescents summaries. percent. adulthood. who TE, of D. Health later. groups education Educational Silva National drop 2006. or of alternative Washington, MMWR PA. Am in out Education, had in the Center 2006 Childhood Sociol 2004, of the attainment United 48(SS–7). high in lowest credential for Rev DC: with National brief. school States, Education predictors a of dropout go 2007 Population

Figure 3. Status dropout rates among adolescents and young adults 16–24 years of age, by age and race and Hispanic origin: United States, 2004

Age

16 years

17 years

18 years

19 years

20–24 years

Race and Hispanic origin

All races and origins

Hispanic

White, not Hispanic

Black, not Hispanic

Asian or Pacific Islander

Two or more races

0 10 20 30 40 50 Percent

NOTES: The status dropout rate is the Persons of Hispanic origin may be of any race percentage of civilian noninstitutional or racial combination. See data table for data population 16–24 years of age who are not in points, data by gender and region, standard high school and have not earned a high errors, and additional notes. school credential, irrespective of when they dropped out. Persons who reported only SOURCE: U.S. Census Bureau, Current one race are included in single-race Population Survey, October Supplement categories; persons who reported more than 2004. Tabulated by the U.S. Department of one race shown as having two or more and Education, National Center for Education are not included in single categories. Statistics.

Adolescent Health in the United States, 2007 13 Health Status 14 Limitation Limitation Health emotional functioning age-appropriate The for adolescents specific activities, of having limitation emotional with limitations them 10–17 Disorder chronic (Figure mentioned that movements, language, treatment Adolescents multiple relationships adverse limitation disability conditions limitation. emotional, adolescents limitations males special adolescents In Learning Approximately Limitation affect National an (1). 2004–2005, were years an 4) health activity limitations settings, effects (ADHD and is had and The for of conditions problem. in education do included activity due the were or chronic that caused Status more with were or with activity 2004–2005. disabilities with of Health learning mathematical speech behavioral of more also ability most condition. to direct limitation of age gauges 10–17 (3). activities. learning activity or activity ADHD including ADHD peers. limitation more than one-fifth in approximately conditions through and ADD) Estimates Activity by than common had due Interview services. is to walking, problems; attention disabilities years a twice a understand an than and the varies may problems. as limitation This a to disability one may chronic Learning broad were Schoolwork at limitation of adolescent’s a calculations, due chronic were methods Attention of three as have condition combinations home, question causing disorder adolescents memory, An differ of Survey by (2). among age. measure to and likely the physical, is 9 female adolescent gender. and through disabilities a times impaired percent The physical, special or depending of at ADHD number chronic used Deficit (NHIS) activity to is use can ADHD; concerning the causing activity self-care, school, most ability coordinate the have adolescents, as of In mental, with questions spoken to most have education. of of and health likely functioning primary Hyperactivity condition mental, 2004–2005, is of common identifies identify limitation are adolescents causal learning limitations to due on and an classified activity adolescents other frequently long-term and undertake disorders to the current or activity or and to in have activity about or written other a mental, type and if in the due as male use of 1. References 2. 3. 4. to Physiological, between for mental, the Newacheck epidemiologic National Pediatrics learning 8]. Institutes National disorders/learningdisabilities/learningdisabilities.htm Hyperactivity Gissler attention-deficit-hyperactivity-disorder-adhd/index.shtml Health. more 1987 higher U.S. boys Finnish health emotional, M, Available Department disabilities Institute Institute of maturational, prevalence and 102(1):117–23. Jarvelin PW, Health. problems Disorder. birth profile girls Strickland from: of of Adolescent or cohort. M-R, information Available Neurologic Mental of have of other in of Bethesda, http://www.nimh.nih.gov/health/topics/ Health children behavioral, Louhiala childhood activity 1998. Acta been B, Health. behavioral from: Health Shonkoff and page Disorders Paediatr with suggested MD: P, limitation Human Attention than www.ninds.nih.gov/ Hemminki [online]. special in and National the JP, problems. girls: 88:310–4. and social Services, United et health Deficit in [cited as Follow-up Stroke. al. E. Institutes boys explanations An differences . Boys States, 1999. care 2007. 2007 National . (4). NINDS 2003. have of needs. of June 2007 the Health

Status

Figure 4. Limitation of activity caused by selected chronic health conditions among adolescents 10–17 years of age, by gender: United States, average annual 2004–2005

60 Learning disability Attention Deficit/ Other mental, emotional, Hyperactivity Disorder or behavioral problem Mental retardation or Asthma or breathing Speech problem other developmental problem problem 50

40

30

20 selected chronic health conditions per 1,000 population Number of adolescents with limitation activity caused by 10

0 Male Female

NOTES: Data are for noninstitutionalized adolescents. may have more than one chronic health condition. See Adolescents with limitation of activity caused by data table for data points, data by race, origin, and chronic health conditions were either identified by poverty status, standard errors, and additional notes. current use of special education or by a limitation in their ability to perform activities because of a chronic SOURCE: Centers for Disease Control and Prevention, physical, mental, or emotional problem. These National Center for Health Statistics, National Health conditions are not mutually exclusive: an adolescent Interview Survey.

Adolescent Health in the United States, 2007 15 Health Status 16 Overweight Overweight among hypertension, genetic contribute age adolescents 1980. more 2001–2004, by overweight adolescents, Mexican increases becoming Percent selected years1966–1970through2003–2004 Figure 5a.Overweightamongadolescents12–19yearsofage:UnitedStates, race, In The 1966–1970 Overweight were 10 20 30 40 likely 2001–2004, 0 adolescents, factors, percentage American Hispanic M uofpit rmte20 D rwhCat.Se NutritionExaminationSurvey. notes. National CenterforHealthStatistics,National and data tableforpoints,standard errors,andadditional SOURCE:CentersforDiseaseControlandPrevention, BMI cutoffpointsfromthe2000CDC GrowthCharts.See at orabovethegender- andage-specific95thpercentile NOTES: Overweightisdefinedasbodymassindex(BMI) overweight to overweight to by to and non-Hispanic who 80 there overweight and be race adolescents environment, percent 1971–1974 obesity are overweight origin, diabetes 17 female were and of increasing overweight ( or percent Figure adolescents if have Hispanic in no obese and black at teenagers. adolescents. (1). significant have least than 5a and gender serious of adults. the ). Diet, female adolescents has origin. The a health non-Hispanic one who risk

1976–1980 70 physical ( more Among health Figure percentage differences This parent percent adolescents of are conditions high than probability overweight consequences 5b 12–19 male is inactivity, chance ). cholesterol, white tripled overweight In in of all were years and of since varies of or Years Years 1. References 2. obese number diabetes, Type increased

1988–1994 Dietz predictors Department 25. General’s and fact_adolescents.htm. www.surgeongeneral.gov/topics/obesity/calltoaction/ 2 (2). diabetes, of 1998. obesity high in WH. Overweight health children call of blood Health of [online]. adult previously problems to Health action pressure, and consequences Adolescent disease. or [cited 2007. and obese adolescents to including considered prevent

1999–2000 Human 2007 Pediatrics and Health adults June of

2001–2002 some Services. and heart obesity (2). in are an 101(3 8]. decrease the 2003–2004 forms Available disease, adult at United in The Supplement):518– risk youth: of disease, overweight Surgeon for cancer. States, from: type Childhood a 2 has 2007 Health

S tatus

Figure 5b. Overweight among adolescents 12–19 years of age, by gender, race and Hispanic origin, and poverty status: United States, average annual 2001–2004

Race and Hispanic origin Male

White only, not Hispanic Female Both sexes

Black only, not Hispanic

Mexican

Poverty status

Poor

Near poor

Nonpoor

01 02 03 04 0 Percent

NOTES: Overweight is defined as body the poverty threshold; nonpoor families mass index (BMI) at or above the gender- have income of 200 percent of the poverty and age-specific 95th percentile BMI cutoff threshold or more. See data table for data points from the 2000 CDC Growth Charts. points, standard errors, and additional notes. Persons of Mexican origin may be of any race. Poverty status is derived from the ratio SOURCE: Centers for Disease Control of the family’s income to the federal poverty and Prevention, National Center for threshold, given family size. Poor families Health Statistics, National Health and have income less than 100 percent of the Nutrition Examination Survey. poverty threshold; near poor families have income from 100 to less than 200 percent of

Adolescent Health in the United States, 2007 17 Health Status 18 tooth and disease, gum cavities, Preventing health: Oral CDC. 1. Reference (see year a past had the adults in young visit and dental adolescents of percent 71 2005, caries dental counterparts. untreated white have non-Hispanic to their likely than more were and adults adolescents young American caries. Mexican dental and untreated black with Non-Hispanic adults young and adolescents dental untreated adolescents. have nonpoor to as likely caries as twice were adolescents age adolescents of of years that 16–19 than and with higher 12–15 years was tooth 20–24 caries active adults dental or young untreated lesion of caries proportion untreated The one infection. least at had adults (1). appearance school, poor from and cavities absence underweight, Untreated dysfunction, loss. cause tooth also and possible may advance and can pain are untreated, severe caries left cause Dental if adolescents. which, for infections, affect life bacterial negatively of can quality decay overall tooth the or caries dental Untreated Caries Dental Untreated nrae etlcaries. dental untreated etlvst r eesr otetdcydteh In teeth. decayed treat to necessary are visits Dental of proportion the in apparent also are differences Racial family Lower young and adolescents of percent 23 2001–2004, In osA lne20 oln] ctd20 pi 2.Available 22]. April 2008 [cited [online]. from: 2008 glance a loss—At 2008. www.cdc.gov/nccdphp/publications/aag/doh.htm. noei soitdwt ihrrt of rate higher a with associated is income n20–04 oradna poor near and poor 2001–2004, In ( iue6). Figure iue40 Figure ). dlsetHat nteUie tts 2007 States, United the in Health Adolescent

Health Status 19 0 6 12–15 years 16–19 years 20–24 years 0 4 of the poverty threshold; nonpoor families have income of 200 percent of the poverty threshold or more. See data table for data standard errors, and points, data by gender, additional notes. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey. Percent Percent 0 2 2007 NOTES: Data are based on dental examinations of a sample of the civilian of noninstitutionalized population. Persons Mexican origin may be of any race. status is derived from the ratio of Poverty the family’s income to the federal poverty families threshold, given family size. Poor have income less than 100 percent of the poverty threshold; near poor families have income from 100 to less than 200 percent 0 States, Total Poor Poor United Hispanic Nonpoor Near poor the in Poverty status Poverty Health Black only, not Hispanic Black only, White only, not Hispanic White only, young adults 20–24 years of age, by age group, race and Hispanic origin, and poverty origin, and race and Hispanic age group, of age, by adults 20–24 years young States, average annual 2001–2004 status: United Figure 6. Untreated dental caries among adolescents 12–19 years of age and of age and 12–19 years adolescents caries among 6. Untreated dental Figure Adolescent Race and Hispanic origin Race and Hispanic Health Status 20 In Suicide adolescents seriously attempt suicidal hopelessness death attempting attempts, and dependence attempts reported during one-half actually 2 attempt was suicide level significantly were. suicide grade. significantly significantly adolescents non-Hispanic race female every 12 percent 2004, months In Female Among Among In a treated and subgroups There day (1). 2005, 2005, stressful the In students than attempts thoughts but that attempted of seriously suicide (3). consider ethnicity contrast, a of Factors for previous suicide that all students female students family do Ideation more higher more by 13–19 (see all resulted about was 20 male can white two or students not life a students percent they ( reported was between worthlessness, Figure escalate may no Figure doctor likely likely or students considering history was suicide that include suicide students, the one-fifth for complete event years or 12 in significant stopped were more in the include black male rate may grades months present who to to an 7). of 16 or reported and third or feeling of of male without suicidal attempt report a (8 substantially male ). consecutive injury, nurse. in of of contribute adolescents loss age. students suicide, seriously history Hispanic suicide. percent doing all depression, completed leading suicide all 9–11, ( difference among Attempts and data students and so a (2). racial In high poisoning, having attempting thoughts suicide suicide some of sad addition, female alcohol a female table of Substance Factors were. students considered or cause to previous school preoccupation male or weeks more all or than attempting an suicides adolescent’s and in usual ethnic than feelings for attempt students). hopeless students to No students the injurious or or students. of it, many likely influencing for students 37 Figure suicide during were overdose drug male difference or suicide death activities rate abuse and percent female suicide was they of than to teenagers suicide abuse, in almost of 7 students About grade the suicide with were consider among ). or 12th About of that (4). past by 1. References 2. 3. 4. Behman of CDC, Company. suicide Gould www.cdc.gov/ncipc/dvp/Suicide/youthsuicide.htm. associated and CDC. 37(9):215–23. MMWR pediatrics. adolescents. Youth National MS, [online]. 55(SS–5):1–108. RE, 1996. with King risk Kliegman 15th 1998. Center suicidal [cited R, behavior J Adolescent ed. Am Greenwald 2007 for Philadelphia, RM, Acad ideation 9 Injury surveillance—United June October Arvin Child Health S, Prevention and 2006. AM, et Adolesc PA: 2]. al. in attempts editors. the Available Psychopathology W. and United B. Psychiatry among Saunders Nelson States, Control. 2007. from: States, children textbook 2005. Youth 2007 Health

Status

Figure 7. Suicide ideation and attempts among students in grades 9–12, by gender and race and Hispanic origin: United States, 2005

Male students Seriously considered suicide All races and origins Suicide attempt Injurious suicide attempt

White only, not Hispanic

Black only, not Hispanic

Hispanic

Female students

All races and origins

White only, not Hispanic

Black only, not Hispanic

Hispanic

0 102 03 04 05 0 Percent

NOTES: Response is for the 12 months any race. See data table for data points, data preceding the survey. Some students who by grade level, standard errors, and additional seriously considered suicide may also have notes. attempted suicide. An injurious suicide attempt resulted in an injury, poisoning, or SOURCE: Centers for Disease Control and overdose that was treated by a doctor or Prevention, National Center for Chronic nurse. Persons of Hispanic origin may be of Disease Youth Risk Behavior Survey.

Adolescent Health in the United States, 2007 21 Health Status 22 Morbidity Discharges, Emergency complete mortality inpatient morbidity EDs sources. life-threatening a underlying injury, Hospitalization insurance condition, utilization 13 rates age one-third female ages years. years to 1.8 10–19 stable for rate adolescents but was age. primary Mortality the Death adolescents age. primary pregnancy million female In In In million from same for for higher provide These Hospitalization 10–13 for and 2002–2004, 2002–2004, 2002–2004, access across rates Visit years, adolescents, both those cause data hospital male among ages higher (1). and picture that patterns but care status. ED 18–19 adolescents health hospital than rates differences for 10–14 years at unscheduled male and the the also to mortality alone. results visits 10 adolescents 15–19 of is each conditions setting. male than male that other of utilization dependent more those years Department years, hospital status, age sexual and and but adolescents adolescents almost observed on stays years the annually. for ED age, Emergency for adolescents in those years, ambulatory and range. began sources female Use data than 19 were pregnancy-related health differences of health visit in males, the Death annually. activity of to and discharge 18,000 care age. years female part 18–19 data for of age, for doubled the problems not for severity rates primarily ED In to the status adolescents the care males of 10–19 10–19 for For because adolescents with ED contrast, increase discharge provide only of department (see visit discharge adolescents health care exceeded years adolescents difference ED Among reasons were Rates (see age male Visits, utilization and rate differences between of of on 10 rates Figure years years due that may access that the was Figure of relatively information hospital care, a of remained years and rapidly the diagnoses male rate to person’s could age ( that be conditions increased Figure rates current those provide population of of (ED) increased seven 12 discharge the female from Hospital died ages and and did influenced age age 14 ). of for were range adolescents increasing at utilization. be age-related were ). stable age. and not for 8). females fairly health each these age times illness had averaged 10–13 medical on a treated was about female with Visit related from follow more Among with similar, than rate 14 about at year. the by the or by in 1. Reference increases Figures eightfold the was Note: population, are The death shown threefold Weisman Baltimore, Death 16 death that in rate and only but injury rates of that JS, rate MD: for for 17). in males Epstein female are of Figure mortality comparability Johns for females Adolescent generally male 10 AM. Hopkins 8 adolescents and as among adolescents Falling 10 per 11 Health shown to University and years 10,000. morbidity male through 11 18 in as of years the 19 adolescents and Press. per age. the years United measures, 19 100,000 safety of In 1994. years age. of contrast, States, net. age (see of they was 2007 age Health

Status

Figure 8. Emergency department visit rates, hospital discharge rates, and death rates among adolescents 10–19 years of age, by age and gender: United States, average annual 2002–2004

Deaths, discharges, and visits per 10,000 adolescents 10,000 Female Emergency department visits

Male Female 1,000

Hospital discharges Male

100

Male 10

Female Deaths

1 10 11 12 13 14 15 16 17 18 19 Years of age

NOTES: Data are presented on a log scale. See SOURCE: Centers for Disease Control and Prevention, “Technical Notes” for discussion of emergency National Center for Health Statistics, National Hospital department visits, hospital discharges, and death rates. Ambulatory Medical Care Survey, National Hospital See data table for data points and standard errors. Discharge Survey, and National Vital Statistics System, Mortality File.

Adolescent Health in the United States, 2007 23 Health Status 24 Injuries Emergency associated societal it same analysis 42 age. were ED adolescents difference adolescents, between injury-related 70 among object and among wounds, is percent percent In Initial Four The visits the being Among injury-related; injury 2002–2004, or adolescents adolescents are level initial four (2). and of ages person, were injury-related decreased cut of between with the a are than male most injury-related visit contusions (1). all major ED or 12–13 injury-related. most injuries not ED pierced among An Department falls, visit rates adolescents, common initial among include are classified ages cause visits ED common with and for motor ED is among fractures, visits (see visit female by 12–13 that 18–19 age costly for visit of visits female being injury a vehicle ED is Figure adolescents as for external injury. sharp ( rates female Figure about classified adolescents, on were and years. injury visits. injuries diagnoses struck sprains adolescents, Visits an 11 remained object traffic-related Follow-up 18–19 one-half 9). higher adolescents ). causes individual visits The In by Among constituted and as 10–19 contrast, (see or years. morbidity for in for an among but strains, of against fairly of visits this one-third ED injury Figure all and male years the injury Injury injuries, increased visits ED level male for a open visit an 10 of visits the of ). if 1. References 2. Burt departments: Health Fingerhut visits NHAMCS-ED Health 2007. www.cdc.gov/nchs/products/pubs/pubd/hestats/injury/injury.htm. CW, to Statistics. E-Stat. emergency Fingerhut L. Recommended United data. [cited Vital Adolescent National LA. departments States, 2007 Health Injury June 1992–95. definition Center Stat Health visits 8]. for 13(131). Available to for use in of National hospital Health the initial with 1998. United from: the injury Statistics. emergency Center States, for 2007 Health

Status

Figure 9. Initial emergency department visit rates for injury among adolescents 10–19 years of age, by age and gender: United States, average annual 2002–2004

Visits per 10,000 adolescents 2,000

1,600

Male

1,200

Female

800

400

0 10–11 12–13 14–15 16–17 18–19 Years of age

NOTES: See “Technical Notes” for discussion of SOURCE: Centers for Disease Control and Prevention, emergency department visits. See data table for data National Center for Health Statistics, National Hospital points and standard errors. Ambulatory Medical Care Survey.

Adolescent Health in the United States, 2007 25 Health Status 26 Four Selected Emergency object traffic-related accounted among motor mortality adolescents each rate are female all traffic-related were through age, 60 death 18–19 for all percent injury-related injury-related females One Initial Initial Initial a for female external age, similar common rates vehicle or years adolescents. adolescents female 16–17 in among person ED injury ED the for higher four (Figure for resulted adolescent for of injuries, injuries visit visits External causes traffic-related over rate years. cause adolescents motor visits age initial male visits. visits adolescents (being Department than rates for from 60 17 in were Falls from (13 associated of injury-related and ). and Among vehicle of among percent 2002–2004. male those for struck), traffic-related injury—being being these percent about accounted female being being Causes falls injuries ( adolescents Figure (see for traffic-related adolescents adolescents. of cut ED falls, were twice struck. cut with male of all adolescents Figure accounted visits. Of ED are 10 Visits all initial by for motor injury motor similar ). struck as these adolescents. injury-related of visits a a In Sports-related about was 17 high significant sharp 18–19 injury 2002–2004, injuries Injury ). visit vehicle vehicle four by among for for for about age for 18 or object— rates visits male 8 causes, years percent males against percent 10–11 for However, twice source visits) and were to those injuries at of as EDs only the of an of of Adolescent Health in the United States, 2007 Health

Status

Figure 10. Initial emergency department visit rates for selected external causes of injury among adolescents 10–19 years of age, by age and gender: United States, average annual 2002–2004

Visits per 10,000 adolescents Visits per 10,000 adolescents 700 700 Struck by or against Cut or pierced 600 600

500 500 Male 400 400

300 300

200 Female 200 Male

100 100 Female 0 0 10–11 12–13 14–15 16–17 18–19 10–11 12–13 14–15 16–17 18–19

700 700 Fall Motor vehicle traffic 600 600

500 500

400 400 Female

300 300 Male Male 200 200 Female 100 100

0 0 10–11 12–13 14–15 16–17 18–19 10–11 12–13 14–15 16–17 18–19 Years of age Years of age

NOTES: See “Technical Notes” for discussion of SOURCE: Centers for Disease Control and Prevention, emergency department visits. See data table for data National Center for Health Statistics, National Hospital points and standard errors. Ambulatory Medical Care Survey.

Adolescent Health in the United States, 2007 27 Health Status 28 Selected Emergency wounds, diagnoses of of adolescents. diagnoses most gender fractures years) rates 14–15 adolescents falls adolescents wound age Among significantly Open instruments reported years, diagnoses. initial the vehicle age. all In The The Sprains, leading were and often increased first-listed visit wound 2002–2004, accounting and years injury and traffic These adolescents pattern initial and diagnoses being were about rates for for reported There older external for for age in 10–17 strains, Open of visit contusions injuries Injury crashes, ED initial male four similar the struck males cutting age diagnoses for sharply for one-half ( (aged Figure Department were rates visit for fractures, same wounds injury initial years sprains adolescents, in ED 18–19 for and causes and are 45 among were but the rate or falls, Diagnoses no 16–19 female for among visits 11 percent were decreased contusions age the ED caused diagnoses of piercing. remained ED ). for significant female years for and were the of being age Male sprains rates visit both among groups. initial for the years) open these adolescents. male primary strains of did and primarily the of female rates and four struck, adolescents younger for all Visits among injury level age, accounted were wounds and not adolescents injuries most adolescents sprains gender adolescents. Injuries males first-listed female most or for causes vary adolescents strains, rates among and the visits contusions. by often fractures female (aged common among were at differences for and knives with resulting most visit overexertion. increased 10–17 for of each by reported injury females. open 12–13 10–19 strains 10–11 fractures. age. motor 72 In rates commonly varied and age. contrast, 10–19 percent injury Among years from Open and for in years other were by of Adolescent Health in the United States, 2007 Health

Status

Figure 11. Initial emergency department visit rates for selected injury diagnoses among adolescents 10–19 years of age, by age and gender: United States, average annual 2002–2004

Visits per 10,000 adolescents Visits per 10,000 adolescents 700 700 Fractures Sprains or strains 600 600

500 500

400 400 Female Male 300 300 Male 200 200

100 Female 100

0 0 10–11 12–13 14–15 16–17 18–19 10–11 12–13 14–15 16–17 18–19

700 700 Open wounds Contusions 600 600

500 500

Male 400 400 Male 300 300

200 200 Female Female 100 100

0 0 10–11 12–13 14–15 16–17 18–19 10–11 12–13 14–15 16–17 18–19 Years of age Years of age

NOTES: See “Technical Notes” for discussion of SOURCE: Centers for Disease Control and Prevention, emergency department visits. See data table for data National Center for Health Statistics, National Hospital points and standard errors. Ambulatory Medical Care Survey.

Adolescent Health in the United States, 2007 29 Health Status 30 Asthma, Selected Emergency gastrointestinal principal of for visits adolescents visits 15 and infections, unrelated visits female tightness, repeated for acute air treatment the due female conditions 18–19 treatment markedly infections, urinary age. percent quality more urgent In Upper Asthma ED Among treatment pregnancy-related to unrelated for for exposure 2002–2004, years. stomach adolescents adolescents, tract visits upper diagnoses sexually upper than episodes with to of of and treatment or respiratory were increased and of female is 10–19 an infections existing sexually pets, for Diagnoses female of one-fourth a age. nighttime pregnancy-related respiratory (GI) respiratory to injury to the pains, disease asthma abdominal Department transmitted an specific these or adolescents, of years Sexual made ( conditions most the of Figure with asthma. adolescent transmitted injury conditions, may wheezing, among in conditions gastroenteritis, asthma or visit did that three of young of age common in conditions, be conditions precipitating intercourse early 12 or among all age. not EDs rate affects diseases, adolescents. In ). due between GI are groups first-listed symptoms the women. 2002–2004, vary breathlessness, visits. morning predominantly diseases, Among accounted conditions for symptoms for to among cause male Visits rate the adolescents abdominal chronically by was and and of is ages factors, urinary of lungs, age and conditions female diagnoses a coughing. of may similar abdominal the The colitis. urinary ED common increased ED were for ED 12–13 for or female leading be tract visits rate causing colds such gender. another or visits suboptimal adolescents, chest visit for Among 10–19 primarily related tract GI accounted The of for years infections, cause male for as or rates and ED ED poor need years to ear and and for of Adolescent Health in the United States, 2007 Health

Status

Figure 12. Emergency department visit rates for selected noninjury diagnoses among adolescents 10–19 years of age, by age and gender: United States, average annual 2002–2004

Visits per 10,000 adolescents Visits per 10,000 adolescents 700 700 Upper respiratory infections Asthma 600 600

500 500

400 400 Female 300 300

200 200 Male 100 100 Male Female 0 0 10–11 12–13 14–15 16–17 18–19 10–11 12–13 14–15 16–17 18–19

700 700 Abdominal symptoms or diagnoses Females only 600 600

500 500 Pregnancy related 400 400 Urinary Female tract 300 300 infections

200 200 Male Sexually 100 100 transmitted diseases 0 0 10–11 12–13 14–15 16–17 18–19 10–11 12–13 14–15 16–17 18–19 Years of age Years of age

NOTES: Data points are not shown in figure when rates are SOURCE: Centers for Disease Control and Prevention, unreliable. See “Technical Notes” for discussion of National Center for Health Statistics, National Hospital emergency department visits. See data table for data Ambulatory Medical Care Survey. points and standard errors.

Adolescent Health in the United States, 2007 31 Health Status 32 Alcohol Visits Alcohol-related causes adolescents drinking increase behavior, Uniform transportation minimum increased (NHAMCS) The EDs. alcohol-related patient’s injury detailed alcohol-related over adolescents among visits for were visit and 18–20 (Figure male female younger not legal of patients patients of before age. patients both During Alcohol-related Most differ remained National rates 230,000 drinking In higher adolescents for codes years being adolescents 13 underage serious is the is Drinking information being were underage female reason the this (89 significantly and legal ). the increased the associated 2002–2004, were collects In NHAMCS, and 14–20 than recorded likelihood percent) of seen, age Hospital alcohol-related age admitted funds alcohol legal most at treated 2002–2004, by visit). drinking and age adolescents. for transferred young that Age adolescents those group 14–17 reviewing and and ED years or drinking data the were widely potentially related to were with level between Act alcohol-related has Ambulatory with (see left and of visit late those an legal Emergency to there age adults. ED among (3). on years age more unsafe of mandated more inpatient against disinhibiting ED used released risk-taking through rates data adolescent rates to visit to age to alcohol-related age. the drinkers. ED Alcohol-related were, states from accounted visit the life-threatening young 21; other Research of than females. than ED and table drug to visits for activities. Alcohol-related differed age, Medical medical definition by was units, early young 21 on that from record, older reduced three health the twice ED adults among and Visit 1988, for effects among years average drinkers and considered Alcohol-related did diagnoses to visits Department for and indicates the by Figure male adulthood sensation-seeking times Care advice those rates In visits late rates facilities, including of not all who 2% ED gender (2). federal youth ED; 1984, a that problems underage an resulted states 18– each adolescents adolescence small Survey raise 13 those visit of among ED of to had for (3). 5 may that all (1) for and percent younger hospital the 20 and visits older left year, rates the reached the number had ED of and years in ED for males the age did of 1. References 2. 3. Substance Consequences June French 2007. and NCHS. Unpublished criminal 8]. MT, National Available Abuse Maclean activity. analysis. of Hospital underage and Adolescent from: Health JC. 2006. Mental ncadi.samhsa.gov/govpubs/rpo992/. Ambulatory Underage Econ alcohol Health Health 15: alcohol use in Medical Services 1261–81. the [online]. United use, Care Administration. 2006. delinquency, [cited States, Survey. 2007 2007 Health

Status

Figure 13. Alcohol-related emergency department visit rates among adolescents 14–20 years of age and young adults 21–24 years of age, by age group and gender: United States, average annual 2002–2004

14–17 years

Male

Female

18–20 years

Male

Female

21–24 years

Male

Female

0 100 200 300 Emergency department visits per 10,000 population

NOTES: An emergency department visit was SOURCE: Centers for Disease Control and considered alcohol-related if the checkbox for Prevention, National Center for Health Statistics, alcohol was indicated, the physician ’s diagnosis was National Hospital Ambulatory Medical Care Survey. alcohol-related, an alcohol-related external cause-of-injury code was present, or the patient ’s reason for visit was alcohol-related. See data table for data points, standard errors, and additional notes.

Adolescent Health in the United States, 2007 33 Health Status 34 Hospitalization Hospital condition, utilization and problems require be similar causes, which adults. injuries than about noninjury-related pregnancy) (including because adolescents accounted female 46 female causes noninjury rate In 10–11 among pregnancy-related 18–19 years years 10–13 the hospital (53–56 the 25 contrast, percent percent hospitalized Adolescents Hospital In The The expected expected appropriate among those of of 49 2002–2004, are years years years. hospitalization Adolescents adolescents percent) teenagers, female hospitalization. than increased adolescents injury expected discharges. age. age of percent (1). discharge may but deliveries followed for of of of among hospitalizations the females discharge and those and of Discharge was source source A all noninjury older Similarly, also 5 hospital contract adolescents. is (2). noninjury age person percent was care are discharges. 81 causes, dependent of 18–19 principal with more causes pregnancy-related hospitalizations on for female by persons Younger have and percent rate all and Among was among increased have private of for for rates. ambulatory those younger rates discharge age hospital more who the discharges payment than of 19 years. 34 among diagnoses chronic 2.5 excluding higher (nonpregnancy-related) increased the adolescents. all method for percent rate percent for the injury For among delays (3). insurance; vary not children for times double Rates serious hospital lowest both pregnancy-related by Hospital children discharges least younger for males noninjury hospital only conditions for rate by care and 50 for (2). the of or pregnancy, female associated among of male sexes more dramatically that gender, causes health and percent likely on rates for payment injury does injury discharges noninjury increased access rate In public but In discharge a discharge children of adolescent adolescents. adolescents contrast, and than ( 2002–2004, person’s adolescents among of males. of Figure and for have females not conditions and discharges accounted in between all hospitalization, coverage nonpregnancy and with accounted males varied one-half large receive other diagnoses, noninjury persons by discharge marginally. lower and causes among 14 Among rates female among rates medical age aged ). males part 10–11 health young among have Injuries ages The that rates 16–19 timely for was and for for to for 1. References 2. 3. pregnancy-related was coverage 1990s, to women Adolescent through (SCHIP), provide private Weisman Baltimore, NCHS. Kozak analysis. Discharge diagnosis Statistics. federal by the Title for greater expanding LJ, reproductive National insurance State two-thirds 2006. JS, and Vital XXI MD: Survey: Lees and Epstein Children’s procedure discharges, health of Health Johns state KA, Hospital Adolescent the income 2003 for of DeFrances health AM. policy Hopkins insurance Stat Social 24 discharges. annual Discharge data. Health percent Falling 13(160). eligibility the coverage expanded Health Security University National summary CJ. expected coverage through Insurance of Survey. 2006. National In in requirements. discharges the Act. the Center is Medicaid Press. with the also payment United Unpublished 1980s for Hospital Program safety detailed for available 1994. pregnant States, Health and eligibility and net. source public 2007 Health

Status

Figure 14. Short-stay hospital discharge rates for injury, noninjury, and pregnancy-related diagnoses among adolescents 10–19 years of age, by age and gender: United States, average annual 2002–2004

Discharges per 10,000 adolescents Discharges per 10,000 adolescents 1,000 1,000 Female Male

800 800

Pregnancy-related

600 600

400 400

Noninjury1 Noninjury 200 200

Injury Injury

0 0 10–11 12–13 14–15 16–17 18–19 10–11 12–13 14–15 16–17 18–19 Years of age Years of age

1Noninjury discharge rates for female adolescents do not “Technical Notes” for discussion of hospital diagnoses. include pregnancy-related discharges. See data table for data points and standard errors.

NOTES: Data points are not shown in figure when rates SOURCE: Centers for Disease Control and are unreliable. Cause-specific hospital discharge data are Prevention, National Center for Health Statistics, National defined based on the first-listed diagnosis. See Hospital Discharge Survey.

Adolescent Health in the United States, 2007 35 Health Status 36 Asthma, Diagnoses Hospital leading 18 Patterns diagnoses. tightness, repeated can triggers hospital two-thirds sharply by 18–19 declined for is psychoses include Ninth fractures injury-related among unintentional Female adolescents ‘‘major percent about 23 Asthma Psychoses In Adolescents be Revision, 2002–2004, percent years teenagers controlled those first-listed through that adolescents discharge psychoses, by among increased episodes 50 depressive and with of diagnoses is age to percent can of Discharge poisoning. hospitalizations. all for a of nighttime age, hospitalizations be Clinical age, ages are disease females. and hospital cause all all by diagnoses are hospitalized rates fractures of with and male psychoses, at fractures, were with rates disorder, gender taking wheezing, 14–15 ( classified International risk Modification an About or for age rates that discharges age The and significantly leveled attack. early for male medicine were years; differ in among Rates affects Hospital ( leading single for 31 one-half and Figure among both for 2002–2004, as ICD breathlessness, morning adolescents percent the female poisoning In off for poisoning suicide for Classification intentional (ICD–9–CM) male the among 290–299). episode,’’ 2002–2004, 15 and leading among each diagnosis more adolescents discharge for adolescents of ). lungs, adolescents coughing. of all avoiding adolescents. attempts of accounting Selected adolescents. likely all in poisonings males were cause declined these and which 2002–2004. causing female for chest rates of codes asthma than among increased the 16–17 this Asthma and Diseases, (1). of accounts declined for by male for group and the 1. Reference Litovitz report Toxic 19(5):337–96. Exposures of TL, the Klein-Schwartz American 2001. Surveillance Adolescent Association W, System. Health White of S, in Poison Am the et J al. United Emerg Control 2000 States, Annual Med Centers 2007 Health

Status

Figure 15. Short–stay hospital discharge rates for selected diagnoses among adolescents 10–19 years of age, by age and gender: United States, average annual 2002–2004

Discharges per 10,000 adolescents Discharges per 10,000 adolescents 100 100 Asthma Psychoses 80 80 Female

60 60

Male 40 40

Male 20 20

Female 0 0 10–11 12–13 14–15 16–17 18–19 10–11 12–13 14–15 16–17 18–19

100 100 Fractures Poisoning 80 80

60 60

40 40

20 Male 20 Female Female Male 0 0 10–11 12–13 14–15 16–17 18–19 10–11 12–13 14–15 16–17 18–19 Years of age Years of age

NOTES: Data points are not shown in figure when rates are SOURCE: Centers for Disease Control and unreliable. Cause-specific hospital discharge data are Prevention, National Center for Health Statistics, National defined based on the first-listed diagnosis. See “Technical Hospital Discharge Survey. Notes” for discussion of hospital diagnoses. See data table for data points and standard errors.

Adolescent Health in the United States, 2007 37 Health Status 38 Deaths Death natural used presented for the the intent the person adolescents almost compared natural adolescents The with 18 death of male exceeded years exceeded years, adolescents 15 death increased years times rates females than adolescents rates years females rate females, years times ICD–10, Injuries Death Among Among injury. injury injury proportion doubled age, natural to adolescents for for that cannot of of of rate rates and 13,000 causes (homicide) causes; are categorize 14–19 10 age. age, age, natural male the of Rates from was was those natural more The rates using with of for the male female cause categorized whereas years for age. which as 10–19 19 did cause between rate males be Beginning the the males inflicted self-inflicted adolescents. adolescents manner 42 difference ( about of years injuries, do years that natural varied slowly not for the causes determined) adolescents, cause of natural injury deaths of was percent more (1). takes adolescents natural causes death years injury 10 increase is, external those age, the 10–19 5,000 of of ages 1.3 by purposefully with or years 71 is death by death than age, exceeded death at age, into death that cause of increased rates. whereas a among intent gender. at causes. percent times 10 of the (suicide) 12 died age. Among adolescents years 10 term age 10 cause account twice as and, injury of death). the were years death rates rate years rates cause rate and 10–13 Injury death age. years of annually sharply Among were that similar male injury of In when of those For the the was as due female death or for of 19 for with or of rates at of age 2002–2004, Injury all for of the death many years not caused of rate injury injury natural inflicted the age. years. adolescents natural each natural age, six death to death: deaths with who to male intentional, age. females for age from was manner rates for (in injury period adolescents was noninjury times data Compared injuries; deaths of rates mortality injury age involves age died some natural to Among adolescents rate 2.6 by cause injuries causes causes upon age, injury were among about 80 are increased ( the the through an as or 2002–2004, Figure times for from death was percent 10–11 cases, among whether death intent injury. among did that another death causes higher injury rate or male matrix whether female 2.5 for with 19 almost that the 16 rates is 19 for 19 of ). at 1. Reference majority and the declined increased In proportion 78 Hoyert for Hyattsville, 2002–2004, percent 2003. of with with injury DL, age, National of age. MD: Heron among deaths: injury unintentional whereas National Adolescent MP, vital female deaths 63 Murphy statistics Center homicide percent adolescents. that Health injuries SL, for reports; were among Kung and Health in constituted the unintentional vol suicide H. For male Statistics. United Deaths: 54 both no adolescents deaths States, the 13. Final sexes, 2006. data 2007 Health

Status

Figure 16. Death rates for injury, by intent of injury and natural causes among adolescents 10–19 years of age, by age and gender: United States, average annual 2002–2004

Discharges per 10,000 adolescents Discharges per 10,000 adolescents 1,000 1,000

Female Male Injury 100 100 Injury Natural causes

10 10 Natural causes

1 1

0.1 0.1 10 11 12 13 14 15 16 17 18 19 10 11 12 13 14 15 16 17 18 19

1,000 1,000 Female Male

100 100 Unintentional injury Unintentional injury

10 10

Suicide Suicide Homicide Homicide 1 1

0.1 0.1 10 11 12 13 14 15 16 17 18 19 10 11 12 13 14 15 16 17 18 19 Years of age Years of age

NOTES: Death rates are graphed on a log scale to clearly SOURCE: Centers for Disease Control and Prevention, illustrate how rates change across the entire span 10–19 National Center for Health Statistics, National Vital years. Data points are not shown in figure when rates are Statistics System, Mortality File. unreliable. See “Technical Notes” for discussion of cause-of-death coding. See data table for data points and standard errors.

Adolescent Health in the United States, 2007 39 Health Status xedn h otdsedlmtwsacnrbtn atrto factor contributing a was or limit conditions, speed for posted fast the officer too exceeding an driving if racing, or that offense indicated speeding-related a with charged (3). passengers increases teenage also of risk number the the risk and with crash drivers, (2). the teenage drive increases unsupervised to passengers of eligible teenage are of teenagers presence that The year first the during by driven truck or car a in riding else. when someone belts seat worn (see never alcohol drinking after and drove 28 alcohol, Figure they a drinking that in been reported rode had percent they who 15 days, driver 30 a previous with the car school in high that of reported percent 29 students among almost behavior 2005, risk In to adolescents. attributable partially are injuries adolescents. Islander lowest Pacific and or adolescents Asian among Native among Alaska highest or were Indian rates American injury vehicle motor female females, and male for ( injuries adolescents vehicle motor from death vehicle motor for rates visit ED (see the injuries in traffic-related noted was ages these 40 males for adolescents rates female and male 17 for (Figure age with markedly increased all of percent 7 for accounted group, (1). age deaths this cause for By natural death adolescents. leading of for the deaths neoplasms, injury malignant all all comparison, of of percent percent 72 51 and for year). deaths accounted per causes 2,740 two (averaging these year), firearms Together, per from deaths injuries adolescents 6,360 by for (averaging followed death age injury of of years cause 10–19 leading the were injuries among age. death of injury years of 10–19 causes adolescents leading injuries two firearm-related the and are injuries traffic-related vehicle Motor Deaths Firearm-Related and Vehicle- Motor rs scniee peigrltdi h rvrwas driver the if speeding-related considered is crash A high particularly is crash vehicle motor a of risk The traffic-related vehicle motor from death of rates high The of rates in apparent were ethnicity and race by Disparities o oo eil rfi-eae nuydah,rates deaths, injury traffic-related vehicle motor For traffic-related vehicle motor 2002–2004, period the For reto tdnssree a aeyor rarely had surveyed students of percent Ten ). tby ewe gs1 n 6yas the years, 16 and 15 ages between Notably, ). aatbefrFgr 17 Figure for table data n eae obe.Asmlrices at increase similar A doubled. females and iue10 Figure ). ). mn ae and males Among References .Ce ,BkrS,Bae R iG arigpsegr sa as passengers Carrying G. Li ER, Braver SP, Baker L, Chen 3. 2006: facts Fatality Safety. Highway for Institute Insurance analysis. Unpublished System. 2. Statistics Vital National NCHS. 1. sadraoecnscmae ihohrrc n ethnicity and race Pacific other or groups with Asian and compared white adolescents non-Hispanic Islander death for injury lower Firearm-related were groups. rates among ethnic than and adolescents racial Rates black other adolescents. among female higher and remarkably male were for ethnicity and race females. 11-year-old was In for females age. rate 19-year-old of the for years times 11 rate nine was and death age 10 firearm of those the years for contrast, 19 rate males the for times rate 59 the age; with substantially (4). crash speeding the were of percent 39 were time 2003, who the in age at crashes of fatal years in 15–20 involved drivers male Among crash. the .Ntoa iha rfi aeyAmnsrto.Tafcsafety Traffic Administration. Safety Traffic Highway National 4. ifrne xs nframrltdijr et ae by rates death injury firearm-related in exist Differences increase also rates death injury Firearm-related engr oln] ctd20 pi 2.Aalbefrom: Available 22]. www.iihs.org/research/fatality_facts_2006/teenagers.html April . 2008 [cited [online]. Teenagers 2006. at 03 vriw ahntn C ..Dprmn of Department U.S. 2004. DC: Transportation. Washington, Overview. 2003: facts drivers. old 17-year and 16- 2000. to 283(12):1578–82. fatal JAMA crashes for factor risk aatbefrFgr 17 Figure for table (data dlsetHat nteUie tts 2007 States, United the in Health Adolescent ). Health

Status

Figure 17. Death rates for motor vehicle traffic-related and firearm-related injuries among adolescents 10–19 years of age, by age and gender: United States, average annual 2002–2004

Deaths per 100,000 adolescents Deaths per 100,000 adolescents 60 60 Motor vehicle traffic Firearm

Male

40 40

Male

20 20 Female

Female

0 0 10 11 12 13 14 15 16 17 18 19 10 11 12 13 14 15 16 17 18 19 Years of age Years of age

NOTES: The firearm death rates for females 10–12 years of SOURCE: Centers for Disease Control and Prevention, age are unreliable and are not shown. Firearm rates for National Center for Health Statistics, National Vital Statistics female adolescents begin at 13 years of age. See “Technical System. Notes” for discussion of cause-of-death coding. See data table for data points, standard errors, and data on race and ethnicity.

Adolescent Health in the United States, 2007 41 Violence and Victimization 42 victimization: UnitedStates,2004 age andyoungadults20–24yearsofage,bygender, agegroup,andtypeof Figure 18a.Violent crimevictimizationratesamongadolescents12–19yearsof Adolescents Violent Violence school, sexual years 900,000 crime. age—males the victims similar. for Overall, more women 20 40 60 80 Victimizations per1,000population 0 rape In Among Among crime sal,rbey aeadsxa sal.Sedt al Statistics,NationalCrimeVictimization Survey. SOURCE:U.S. Department ofJustice,BureauJustice for datapoints. assault, robbery, rapeandsexualassault.Seedata table NOTES: Violentcrimesincludesimple andaggravated likely of 2004, assault, of and in female and young age victimization serious all Crime younger female to in were are approximately 21 1–9 20–24 16–19 12–15 sexual were other be the aggravated adults and adolescents the the almost crimes community. adolescents reported age adolescents—those assault victims Victimization victims ages rates Victimization groups twice ( Figure 1.6 and 20–24 as were of and for of Violent violent million victims Male as and (1). sexual simple males young 18a similar likely were young ). acts crimes adolescents and of By assault assaults, adults as 12–15 also across violent age adults, in females females victims include the are than 20–24 years age and crime. home, the four 12–19 were are to groups. of robbery. rape of years, rates be times Almost violent at Age inyears or 1. Reference adolescents Rates from 2005 received robbery 21 1–9 20–24 16–19 12–15 Over In 1985 U.S. the NCJ www.ojp.gov/bjs/pub/pdf/cvus0403.pdf. to 2004, generally received levels United hospital the Department 213257. through and 5 past percent well States, increased young hospital care [online]. two 1995 below Female of Adolescent 2004 decades, and of Justice. adults and adolescent [cited Aggravated assault care Simple assault Robbery Rape orsexualassault those for 10 statistical then adolescents percent have Criminal (1). 2007 Health crime in declined 1985 June changed tables victims of victimization in victimization 2006. ( the adolescent 8]. Figure [online]. and between Available of United considerably. young violent 18b in States, rates ). victims from 1995 adults crimes for 2007 and of Violence

and Figure 18b. Violent crime victimization rates among adolescents 12–19 years of age and young adults 20–24 years of age, by age group: United States, Victimization 1985–2005

Victimizations per 1,000 population in age group 200

Age 12–15 years Age 16–19 years

Age 20–24 years

150

100

50

0 1985 1990 1995 2000 2005

NOTES: Violent crimes include simple and SOURCE: U.S. Department of Justice, Bureau of aggravated assault, robbery, rape and sexual assault. Justice Statistics, National Crime Victimization Survey. See data table for data points.

Adolescent Health in the United States, 2007 43 Violence and Victimization 44 Physical Dating within reports injury engage substance suicidal can In in defined the slap, asked the ‘‘no’’ reported dating students physically not sexual among (Figure adulthood, the In In past 12 want be might or and a 2005, 2005, Youth whether violence intercourse months 19 male being a as ideation in physically dating 12 dating dating between to. precursor ). forced death, Violence risky use, a have months, The about almost Risk students response especially a preceding they relationship. increased violence episodic violence victim sexual or included to prevalence victims Behavior 9th hurt was 9 attempts for have 8 had did percent percent and in of of behavior, you intimate higher among and your (PDV) heavy ( had each of PDV data sexual the ‘‘yes’’ students from 12th Survey, on dating Each (1). of of a survey; boyfriend of (1). of table among purpose?’’ Forced 7 drinking, boyfriend is having women male partner grade. to students intercourse Dating unhealthy percent grades year, defined violence a In who PDV for single addition and therefore, female been 1 (1,2). Figure violence or had violence physical 9 victimization to or in Students had female as girlfriend Intercourse through question: dieting are 11 11 girlfriend not when forced physical students to 19 ever percent adolescents more a been victimization the ). victimization fighting, students response they behaviors, Overall, 12 were been to ever risk ‘‘During likely during was violence dating. have than for did for hit, not and to of 1. References 2. CDC. United Smith dating Am J Public Physical PH, violence States, White Health 2003. dating among JW, Adolescent 93:1104–9. MMWR Holland violence adolescent 55:532–5. Health LJ. among 2003. A and longitudinal in high college-age the 2006. school United perspective students— States, women. 2007 on Violence

and Figure 19. Dating violence and being forced to have sexual intercourse among students in grades 9–12, by gender and grade level: United States, 2005 Victimization

Grade level Dating violence 9th Male 10th Female 11th 12th

9th 10th 11th 12th

Forced intercourse

9th 10th 11th 12th

9th 10th 11th 12th

01 02 03 04 0 Percent

NOTES: Dating violence is the percentage of students table for data points, data by race and Hispanic origin, who were hit, slapped, or physically hurt on purpose and standard errors. by their boyfriend or girlfriend during the past 12 months; forced intercourse is the percentage of SOURCE: Centers for Disease Control and Prevention, students who have ever been physically forced to National Center for Chronic Disease Prevention and have intercourse when they did not want to. See data Health Promotion, Youth Risk Behavior Survey.

Adolescent Health in the United States, 2007 45 Reproductive Health 46 Contraceptive Contraceptive Reproductive between more contraceptive injectable are 0.3 2 include (4 increasing who common least Nine intercourse include injectables), contraception non-Hispanic non-Hispanic after contraception 75 contraceptives white whereas among non-Hispanic 2002, at intercourse method male intercourse not percent. percent) their percent percent In Contraceptive Of use the had intercourse). percent one adolescents effective teenagers 26 2002, all non-Hispanic periodic injectables first most of any 1995 use methods sexual percent sexually method (Depo-Provera Methods the contraception of (2). used before was with intercourse, Norplant 83 method of reliable of white black white methods non-Hispanic (the at use failure contraceptive and were Consistency percent sexually other abstinence reported perfect than intercourse their other had use of 15–19 were use among experienced 15 (such 2002, female adolescents teenagers. with used contraception (1). black methods, rates. Use (a among last years not hormonal among of most hormonal Health of use, condoms T) contraceptive and higher at experienced years as by and high-dose used intercourse more sexually never-married adolescents teenagers and black their (1–9 in of and Depo-Provera methods 71 frequently among followed non-Hispanic non-Hispanic contracepting the age, with of failure females any percent, oral often methods differs. percent) first correctness methods. female and age, past ( active Figure method a 35 oral contraceptive those intercourse than teenagers compared among (1). by failure patch), rates oral used percent condom Ninety used 3 15–19 and contraceptives adolescents. female the was and teenagers months Among T 20 who black among contraceptives. These white with of teenagers and by ). 18 rate of male some non-Hispanic and more withdrawal percent contraception The years did use had use teenagers, percent with with adolescents (1). Lunelle perfect teenagers, and of methods had (the emergency condom not method most common may increased at their Among recent of Oral used of chose first ‘‘pill’’) use shortly T age did use vary, first the at a of at in 1. References 2. before birth use age, compared not probability twice a methods adolescent 52 very 21 method percent percent In Between use at effective increases the Chandra Fertility, women: National Abma 2005. in childbearing, Vital as 2002, age first the a probability high of Health of method with of United JC, to over women intercourse. 20 contraception family the Data contraception 1995 Center A, a 61 injectable at was Martinez with 13 first Martinez Stat the probability each percent, 2002. States: from percent of planning, and who 18 of for birth age time 23 contraception Adolescent age the a percent National Health GM, 2002, (24). Among methods had GM, Sexual and first between period and were 2002 by level at and of Mosher 2004. ever Mosher birth is Statistics. first notable age a those (2). Center National activity, young reproductive observed. associated Health (1). as female increased used intercourse by 19. ages The WD, at that WD, who age for increases first Among women contraceptive in Vital Survey the probability Dawson adolescent 17 of Health Abma the had 15 The intercourse, adolescents with health and Health pill from United was (1). those ever of 15–24 percentage JC, increased Statistics. BS. contraceptive 20 in Family 10 of Stat 1 Jones of some States, use, used years giving Teenagers U.S. percent percent who a years 23(25). the Growth. using first and J. the did was from birth 2007 of of to Reproductive

Figure 20. Contraceptive use among never-married female adolescents 15–19 years of age who have had sexual intercourse in the past 3 months, by specified Health method used at last intercourse and race and Hispanic origin: United States, 2002

Any method Condom Oral contraceptive (pill) Other hormonal Dual methods No method (hormonal and condom) Percent 100

80

60

40

20

0 All never-married females White only, not Black only, not reported who had sexual Hispanic Hispanic intercourse in past 3 months

NOTES: Categories are not mutually exclusive. Condom condom and hormonal methods. Estimates for Hispanic includes condom use alone or in combination with any adolescents did not meet standards of reliability and other method. Oral contraceptive (pill) includes pill use precision, and are not shown. See data table for data alone or in combination with any other method. Other points, standard errors, and additional notes. hormonal includes Depo-Provera® injectable, Lunelle® injectable, Norplant implants, emergency contraception, SOURCE: Centers for Disease Control and Prevention, and contraceptive patch. Data are not shown separately for National Center for Health Statistics, National Survey of “other methods,” which include all other methods besides Family Growth.

Adolescent Health in the United States, 2007 47 Reproductive Health proportion high origin. (Figure pregnancies among and unintended outcomes 48 1990–2002 Figure 21a.Pregnancyratesamongadolescents15–19yearsofage:UnitedStates, either higher live age welfare fewer include consequences of Approximately Pregnancy are become 100 150 Pregnancies per1,000femaleadolescents 50 all Teenage The 0 unplanned births, still end among unintended employment Hispanic pregnancy rate estimation. See data table for data points. SK. Recenttrends inteenagepregnancytheUnited SK. pregnancy rateestimation.Seedata tablefordatapoints. NOTES: See“Technical Notes” foradiscussionof In among 90 91 92 93 94 95 96 97 98 99 00 01 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 21a non-Hispanic unintended receipt, number births). pregnant in 2002, among of induced ). induced pregnancies non-Hispanic per pregnancy pregnancies non-Hispanic 750,000 of (82 or pregnancy and In of 1,000 Rates pregnancies unintended their annually. non-Hispanic 2002, percent), opportunities, pregnancies births, abortions, abortion poorer white infants young adolescents rates among the black that reduced rates teenagers The health black accounting (1). pregnancy pregnancy vary and women each (2). ended adolescents white is and majority were increased teenagers About fetal and estimated by educational year 15–19 Hispanic in ( 15–19 race teenagers. more Figure developmental losses for rate induced for of 40 (1). years and more likelihood teen adolescents percent than 15–19 than was years as The 21b teenagers (miscarriages attainment, Hispanic the pregnancies abortion ). than of twice 76.4 among The of years age sum of of age one-fifth as as of was of Year Health Statistics.2006. States, 1990–2002.HealthE-stat. NationalCenterfor SOURCE: Ventura SJ, AbmaJC,MosherWD, Henshaw 3. 4. 2. 1. References 15–19 116.8 15–19 the effective over contraceptive decreased By Between decrease those National trends Ventura New 2006. teenpreg1990-2002/teenpreg1990-2002.htm Available Alan Reprod pregnancy Finer Vital childbearing, in Abma pregnancies years years 2002, the contraceptive Health York, Guttmacher LB, from United JC, years, in Health SJ, 1988 of of Center the in use teenage from: Henshaw Martinez NY: in age age 55 pregnancy Stat Abma 2002. teenage the States: and among and per 38(2):90–6. Alan www.cdc.gov/nchs/products/pubs/pubd/hestats/ percent for who had 23(24). Institute. United Adolescent pregnancy JC, contracepting methods. National 1,000 Health SK. GM, 2002, Guttmacher Sexual decreased ever sexually Mosher pregnancy Disparities rates to States, 2004. Mosher Sex young Statistics. the 2006. 46 had Center activity, in Health These among percent WD, and percentage the 1994 active Institute. sexual WD, 35 women teenagers in rate America’s United for Henshaw contraception in Health percent rates factors and Dawson teenagers. Health the teenagers (4). for intercourse 1994. 2001. . States, in United of E-Stat. young of Moreover, 1990 teenagers. SK. contributed unintended from Statistics. chose BS. teenagers Perspect Recent 1990–2002. States, use, Teenagers increased women (3). a more peak and 2007 Sex to of Reproductive

Figure 21b. Pregnancy rates among adolescents 15–19 years of age, by age, race and Hispanic origin, and outcome of pregnancy: United States, 2002 Health

Per 1,000 female adolescents 250 Fetal loss Induced abortion Live birth 200

150

100

50

0 15–17 18–19 15–17 18–19 15–17 18–19 years years years White, not Hispanic Black, not Hispanic Hispanic

NOTES: See “Technical Notes” for discussion of SOURCE: Ventura SJ, Abma JC, Mosher WD, Henshaw pregnancy rate estimation. Persons of Hispanic origin may SK. Recent Trends in Teenage Pregnancy in the United be of any race. See data table for data points. States, 1990–2002. Health E-stat. National Center for Health Statistics. 2006.

Adolescent Health in the United States, 2007 49 Reproductive Health 50 Adolescent Birth consequences higher for Compared mothers mothers and steady assistance adolescents all age the age) age, teenagers give In highest Native lowest rates Hispanic Asian during adolescents adolescents rates 2004 groups women commence all In age 2004, 2004, (1). births. young In Among Birth Birth Adolescent birth financial was smoked birth regardless was among for (declining or 2004, order They 1991–2004; teenagers; birth employment (5). birth to Rates are are rate Hispanic 14 rates rates Pacific black teenagers 41.1 The 0.7 as women aged receive with and adolescents, care mothers percent rates. 10–19 15–19 10–14 responsibilities are there not less births rates, during those non-Hispanic for (5). births birth vary among compared teenagers mothers experience peers 47 of 18–19 Islander prepared in also very likely and Asian and Among timely were race percent) further the birth followed aged years years years rate considerably (133.5) pregnancy and of are per more young who adolescent their non-Hispanic adolescent third years to or are approximately for at or rates are birth 1,000 teenagers prenatal 15–17 with of of of fell complete women increase for ethnicity black and delay greater marital Pacific likely were adolescent children than much by trimester age, age age more adolescents more were the rates fell older adolescent (6). challenges American years. (103.9 and during by did childbearing, to three accounting emotional, women 33 care 18–19 mothers less likely Islander instability risk three steeply the increase high (29.6). ( smoke mothers race (2). black Figure rates percent 50 or 422,000 and to women of likely risk this births to Most percent have school times years and Indian (10–14 steadily four adverse of teenagers women, for receive between 15–19 during 22 teenagers are of period(5). (4). parenthood psychological, with (1). for than among ). Hispanic other teenage no per poor teenage times 15–19 as of births more Overall, or or 10 among Second years maternal care age, declined older years pregnancy. 1,000) likely health have public whereas Alaska percent outcomes population 1991and those had likely to had years Birth at origin. birth of (3). to of and and the the of to of of 1. References 2. 3. 4. 5. 6. 7. timing also age childbearing Characteristics 20 had Ventura the vol Klerman Statistics. teen Maynard Teen social The Alan New Martin 2004. MD: NCHS. in Center Abma in childbearing, Vital of the the compared 49 United a an Urban National mothers. Health York, Guttmacher Pregnancy. National consequences health United JC, first JA, no for Health, until adolescent SJ, LV. RA, 2001. 10. Martinez Health Hamilton NY: States, Institute birth. Stat Mathews Another 2002. of after States: Center editor. Hyattsville, Washington, with vital Alan of United Americans. 23(24). 2004. Institute. Statistics. Adolescent For adolescents’ 1940–2000. age National 8 Press. statistics GM, BE, Guttmacher Kids birth, chance: for of Sexual percent TJ, States, female teen 20 Health Sutton 2004. Mosher MD: having Hamilton Sex 1997. 23 DC: Table (7). 2006. Center activity, pregnancy. reports; Preventing Health 2006, National percent whose adolescents National and Statistics. National PD, mothers Institute. kids: WD, 12. BE. America’s for et with contraceptive in Hyattsville, vol Dawson Economic mother al. Center Health the Births had vital Washington, Campaign additional 55 chartbook 1994. 2006. influence Births: United no statistics a whose teenagers. to Statistics. for BS. birth delayed 1. MD: teenagers costs Final Health Hyattsville, States, use, births Teenagers to on before mother their DC: National reports; Prevent and data trends and to 2007 in for Reproductive

Figure 22. Birth rates among adolescents 10–19 years of age, by birth order, age group, and race and Hispanic origin: United States, 2004 Health

Years of age White, not Hispanic Second and higher births First births Less than 15 * 15–17 18–19

Black, not Hispanic Less than 15 15–17 18–19

Hispanic Less than 15 * 15–17

18–19 * * American Indian or Alaska Native Less than 15 15–17 18–19

Asian or Pacific Islander Less than 15 * 15–17 18–19

0 25 50 75 100 125 150 175 Live births per 1,000 female adolescents

*Rates based on fewer than 50 events are considered may be of any race. See data table for data points unreliable; rates based on fewer than 20 events are and data for ages 20–24 years. considered highly unreliable and are not shown. SOURCE: Centers for Disease Control and NOTES: Live births of unknown birth order are Prevention, National Center for Health Statistics, distributed proportionally. Persons of Hispanic origin National Vital Statistics System, Birth File.

Adolescent Health in the United States, 2007 51 Reproductive Health e atesmyntb igoe rrpre (1). reported or diagnosed be not their may among partners chlamydia sex young whereas in screening, infection through asymptomatic women primarily of are detection counterparts to male attributable their among than women fete edr ae mn on oe 02 er of ( years high 20–24 as women nearly young were persons among age older rates and gender; chlamydial males either of adolescent of rates of reported those higher than adolescents had infections female age 2004, of In years States. 15–19 United the in disease five to two infections (3). HIV times may to STDs susceptibility epididymitis. increase untreated and also men, urethritis young cause in In can result (3). infections also infertility may or they pregnancy pain; ectopic and pelvic tubes chronic fallopian and the ovaries, in pelvic abscesses cause disease, can inflammatory left gonorrhea When and adolescents. chlamydia antimicrobials. among untreated, with rare curable relatively are is and Syphilis STDs of causes bacterial of lack and pay, to ability or (1). insurance transportation of lack designed adults, services for and about facilities concern with as discomfort such confidentiality, services, prevention STD receiving (1). of ectopy because cervical infection a increased to have susceptibility may high increased women at physiologically Adolescent themselves (1,2). are STDs who for partners risk have unprotected to in and partners engage intercourse, sexual to multiple relationships, have short-term to and a (1). likely for reasons more STDs cultural are acquiring and Adolescents for biological, risk behavioral, higher of (20–24 at combination adults are young age) and of age) years of active years sexually (10–19 adults, adolescents older active with sexually Compared among adolescents. diseases infectious reported commonly oeb 0pretbten19 n 2004. and 1998 between males percent 50 adolescent by among rose rates young chlamydia in reported chlamydia (3); of men detection increased to contributing eotdrtsof rates reported 52 Diseases Transmitted Sexually hayi ean h otcmol eotdinfectious reported commonly most the remains Chlamydia common most the are syphilis and gonorrhea, Chlamydia, to barriers face often adolescents active Sexually most the are (STDs) diseases transmitted Sexually h viaiiyo rn et o hayi a be may chlamydia for tests urine of availability The hayi mn dlset n young and adolescents among chlamydia aatbefrFgr 23 Figure for table data .The ). higher 4. .CC rnsi eotbesxal rnmte iessi the in diseases transmitted sexually reportable in Trends CDC. in diseases transmitted Sexually 3. CE. Irwin EB, Gittes 2. 2004. Surveillance, Diseases Transmitted Sexually CDC. 1. References groups ethnic and racial 23 other (Figure gonorrhea in and adolescents chlamydia did of than rates black higher non-Hispanic had 2004, adolescents In gonorrhea. and chlamydia group, age percent. 29 same was the decline in the adolescents almost male declined among age percent; of 22 years 15–19 (3). adolescents persons female older and males adolescent for 15–19 than adolescents age of female of rates for years 2004, higher In also States. were United gonorrhea the in disease notifiable lc dlset r ipootoaeyafce by affected disproportionately are adolescents Black for rate gonorrhea the 2004, and (4) 1998 Between reported commonly most second the is Gonorrhea ainlCne o elhSaitc.2000. Statistics. MD: Health Hyattsville, for 2000. Center States, National United health Health, Adolescent In: CR. chartbook. Duran LA, Fingerhut AP, MacKay A ..Dprmn fHat n ua evcs Available Services. Human and Atlanta, Health from: 8]. of June Department 2007 U.S. [cited GA: [online]. chlamydia, syphilis for and data gonorrhea, surveillance 2004—National States, United 1993. 14(5):180–9. Rev Pediatr adolescents. Services. Human and Health 2005. of Sept Department U.S. GA: Atlanta, ). o 2005. Nov www.cdc.gov/std/stats04/04pdf/trends2004.pdf. dlsetHat nteUie tts 2007 States, United the in Health Adolescent Reproductive

Figure 23. Sexually transmitted disease rates reported for adolescents 15–19 years of age, by gender and race and Hispanic origin: United States, 2004 Health

Chlamydia Female Male White, not Hispanic

Black, not Hispanic

Hispanic

American Indian or Alaska Native

Asian or Pacific Islander 0 2,000 4,000 6,000 8,000 10,000 Reported cases per 100,000 adolescents

Gonorrhea Female White, not Hispanic Male

Black, not Hispanic

Hispanic

American Indian or Alaska Native

Asian or Pacific Islander 0 2,000 4,000 6,000 8,000 10,000

Reported cases per 100,000 adolescents

NOTES: Persons of Hispanic origin may be SOURCE: Centers for Disease Control and of any race. See data table for data points Prevention, National Center for HIV, STD, and and data for ages 10–14 and 20–24 years. TB Prevention, STD Surveillance.

Adolescent Health in the United States, 2007 53 Reproductive Health 54 Acquired Virus (AIDS) Acquired associated human use Surveillance HIV picture services However, necessarily infections) infected the transmission contact transmitted vulnerability, inequality are HIV According years) not men are they who have infected varies disproportionately of As in diagnoses infections; 2005 AIDS treatment Among Among The past let more less activities transmission. transmission (3). do are one by who other of immunodeficiency (Figure not (4). proportion recently, may cases (HIV) likely than (1). MSM less immunodeficiency likely race the in the or and to these because no morbidity female male HIV reflect have disclose relationships, data lack people more of a transmit has among likely number the epidemic longer Immunodeficiency to who and reported recent 24 to HIV for data adolescents, Human seek had whereas of is ). on picture become affected be trends female adolescents, of to ethnicity. several do some Young males recognition infection know their and accurately adolescents HIV infected adolescents sex now of the know CDC HIV not and among new provided mortality, in infections virus sexual virus people with sex they and others more by having represent women disclose testing. reasons, syndrome study HIV the it. Immunodeficiency The is HIV AIDS, with the partners, Furthermore, having men, (HIV). were to adolescents through of represent the need available, incidence orientation black were with place of sex most diagnoses women and their by HIV are results If provide their most accounting young more including sexually persons they AIDS for Sexual (AIDS), sex new with young at infected (2). population partners’ them common MSM high sexual prevention common risk trends as become from Syndrome with trends than (i.e., males diagnoses men data a aged are because does risk well activity at adults who attracted more for who biologic with older infection some one-half for new orientation high more (aged alone. risk in method heterosexual sexually in (MSM). 13–19 as is are not method become infected, its 69 new complete new and with men and risk to factors, MSM time were likely percent tested to 15–22 men. HIV did with care AIDS years AIDS of for drug who in of to 1. References 2. 3. 4. late to care, in CDC. GA: CDC. [cited CDC. http://www.cdc.gov/hiv/resources/factsheets/youth.htm. who 1994–2000. CDC. (through adolescents/index.htm. www.cdc.gov/hiv/topics/surveillance/resources/slides/ the or U.S. do 2007 HIV/AIDS HIV/AIDS HIV/STD HIV/AIDS course for not 2005) Department whom June disclose MMWR of [online]. risks Surveillance among surveillance 8]. HIV treatment Adolescent 52:81–5. Available their in of infection, 2007. young youth [cited Health sexual in has Report, Health 2003. 2007 fact from: men adolescents and orientation—Six who failed sheet who June Human in 2004. have the have [online]. (2). 20]. United Vol and Services. limited Available sex 16. young U.S. with States, Atlanta, access 2007. 2005. cities, men adults from: 2007 Reproductive

Figure 24. Acquired immunodeficiency syndrome (AIDS) and Human immunodeficiency virus (HIV) transmission categories for adolescents 13–19 years Health of age, by gender: United States and 33 states with confidential reporting, 2001–2005

Male to Injection MSM High risk Other or male sexual drug use and IDU heterosexual not identified contact (IDU) contact (MSM)

AIDS cases reported, United States1

Male

Female

HIV/AIDS cases reported, 33 states2

Male

Female

0 20 40 60 80 100 Percent

1Includes Puerto Rico and Virgin Islands. Data for HIV/AIDS cases include persons with a 2Data for HIV/AIDS cases are from 33 states with diagnosis of HIV infection regardless of AIDS status at confidential name–based HIV infection reporting since at diagnosis. See data table for data points, estimated least 2001. numbers of cases, data for ages 20–24 years, and additional notes. NOTES: High risk heterosexual contact is contact with a person known to have or at high risk for HIV infection. SOURCE: Centers for Disease Control and Prevention, Other category includes hemophilia, blood transfusion, National Center for HIV, STD, and TB Prevention, perinatal, and risk factor not reported or not identified. HIVAIDS Surveillance System.

Adolescent Health in the United States, 2007 55 Risk Behaviors 100 56 health Many Sexual Risk race parents activities, the who likely years contact By of contact age (data intercourse females adolescents Percent by ageandgender:UnitedStates,1988–2002 Figure 25a.Adolescents15–19yearsofagewhohaveeverhadsexualintercourse, 50 25 75 males 0 age In Oral In likelihood from appear and table fordatapointsandstandard errors. intercourse only, notothertypesofsexualactivity. Seedata NOTES: Percentages reflectheterosexual vaginal to table different of 2002, 2002, and with among 18–19 (1,2). be 15–17 sex Behaviors age and ethnicity 15–17 academic Contact responsible for among involved 15–19 older the approximately 46 was had of 83 Early years, Figure factors adolescents years percent being opposite years percent 15–17 slightly ever or play males years puberty performance, in more 25b of the in sexually of engaged sexual sexual a of age. adolescents’ of more ). role, proportion age of sex 15–17 never-married physically one-half females. and and age during to activity behavior. as common experienced, Male in young early 20–24 and had and do some of increased their Every attitudes, developed 18–19 ever lives than menstruation relationships adolescents adults years Gender, than female form life had their affect type years and 18–19 vaginal ( of increased Figure of to involvement intercourse peers are of and age age, sexual their 78 teenagers of sexual 15–17 with increase more percent male 25b age and sexual (2). with ). and (3). in Family Growth. National CenterforHealthStatistics, NationalSurveyof SOURCE: CentersforDiseaseControl andPrevention, 1. References 2. 3. and declined sexually same percent For was The About the 18–19 someone Manlove Williams childbearing, research Resnick Child www.childtrends.org/Files/K1Brief.pdf. adolescents study 1997. Abma in childbearing, Health age 15–17 the majority had percentage 98 95 2002 1995 1988 active significantly three-fourths Trends or on United JC, years Stat a MD, S, J, up shows adolescent with first Martinez in Terry-Humen Ryan 23(24). from of to and 2002. Research Bearman, States: of 2002 partner female whom 3 [online]. of age Female between sexually harm: S. Adolescent years never-married National 2004. GM, of had health. Preventing Sexual who they female Brief. teenagers, PS, who Findings [cited Mosher older E, a transmitted had first 1995 Papillo Blum J Center were activity, Available was Health Am 2007 than adolescents teenage ever male WD, from 18–19 RW, and Med 6 ‘‘going AR, male for their June contraceptive in or they 2002. had diseases: Dawson the partner et from: 2002 Assoc Health the Franzetta more pregnancy, al. adolescents first 8]. national were steady’’ intercourse United Protecting who ( Washington, 278(10), Figure Statistics. years sexual BS. who What (3). K, States, use, were longitudinal Teenagers (3). was Eight older. 25a the partner 823–32. 15–17 and Vital ) the 2007 DC: (3). Risk

Behaviors

Figure 25b. Ever had any sexual contact among adolescents 15–19 years of age, by type of contact, age, and gender: United States, 2002 Percent 100 Any Vaginal Oral Anal Same–sex opposite intercourse sex with sex with sexual sex contact opposite sex opposite sex contact

80

60

40

20

0 15–17 years 18–19 years 15–17 years 18–19 years

Male Female

NOTES: Same–sex contact was measured with SOURCE: Centers for Disease Control and Prevention, substantially different questions for males and females. National Center for Health Statistics, National Survey of See data table for data point, standard errors, and Family Growth. additional notes.

Adolescent Health in the United States, 2007 57 Risk Behaviors 58 Sexually Sexual HIV unintentionally. ages Those their transmitted adolescents adolescents vaginal ever intercourse, one distribution similar group of ethnicity. Hispanic compared contrast, teenagers non-Hispanic with of begin have age, sexual In Among The Age infected, partner only risk had are a having 2002, (data who for higher intercourse 29 number at active Among males among of exposed sexual 7 risk with had male percent Partners first of percent adolescents diseases, have becoming the in table 15–17 18–19 just intercourse contracting white the behaviors number their more Teenagers 12 intercourse adolescents had majority and of female intercourse never-married under had for number percent to of lifetime (were years years teenagers of lifetime more female than Figure these non-Hispanic including multiple Hispanic pregnant of one-third who adolescents, among have other at of of partners sexually three who of than of sexual is risks ( an 26 adolescents increase age age, ( Figure have lifetime Figure non-Hispanic an and had sex ). STDs, begin HIV earlier three male teenagers. and sexual adolescents. had of over important approximately partners had experienced). (1). partners non-Hispanic intercourse 26 black male infection. 25a acquiring sexual adolescents sexual their 15 having ever ). and a age heterosexual partners, ). In longer percent within and and risks becoming had 2002, are white factor varied further partners partners, sex Adolescents female 25 sexually with more heterosexual each period of two-thirds black Among of compared males. percent at the in 15–19 by becoming increase more younger the vaginal likely age pregnant was race of level In years time. of than who had to and 1. Reference Abma in childbearing, Vital the Health United JC, Martinez Stat 2002. States: 23(24). Adolescent National GM, Sexual 2004. Mosher Center activity, Health WD, for contraceptive in Dawson Health the United Statistics. BS. States, use, Teenagers and 2007 Risk

Behaviors

Figure 26. Number of sexual partners in lifetime among adolescents 15–19 years of age, by gender and race and Hispanic origin: United States, 2002

None 1 2–3 4–6 7 or more Male

All races and origins

White only, not Hispanic

Black only, not Hispanic

Hispanic

Female

All races and origins

White only, not Hispanic

Black only, not Hispanic

Hispanic

0 20 40 60 80 100 Percent

NOTES: Percentages reflect heterosexual SOURCE: Centers for Disease Control vaginal intercourse only, not other types of and Prevention, National Center for Health sexual activity. Persons of Hispanic origin may Statistics, National Survey of Family Growth. be of any race. See data table for data points, data by age group, and standard errors.

Adolescent Health in the United States, 2007 59 Risk Behaviors 60 Smoking Cigarette the premature continue adults adolescents reported previous reported smoking frequent who reaching grades. smoked racial Hispanic non-Hispanic cigarette during changed who and during 23 reported 1999 1999 other used male 14 9 percent percent). percent In The Many Rates Among The In risk 1997 reported reported students smokeless (from and forms and 2005, addition who the the of percentage trend a smokers smoking smoking increased frequent to 30 9th students use, over has adolescents of (from 2005 of whole ethnic death nicotine 12 1997 smoked the are 13 smoke of days (2). Similarly, female almost cigarette grade. black serious frequent current months in 55 the Smoking percent and tobacco to 23 addicted (from 28 to cigarette tobacco (1). cigarette percent groups. cigarettes, (current cigarette cigarettes frequently nearly past were percent throughout addiction, percent 2 2005 with students cigars one-fourth of students) In percent Most cigarette long-term 17 the preceding smoking begin smoking students to 2005, 15 use. more grade to doubled percent period in had In 17 percentage smoking smoking), before (19 of years. young use tobacco to the 2005, on (that In adolescents percent) smoking were. 16 of students smoking-related likely tried (3). 36 percent adulthood. level, use of 2005, differ increased one effects ( past who female (from percent Figure the percent) to The between 13 all is, people non-Hispanic among to increased to 9 began or as survey and high on years reported month substantially 8 and cigarettes percent) quit of 36 percentage smoke of who more on 27 percent students), did 20 of students percent male who are about Over school ). between and then smoking health, 9th adolescents smoking of students reported or the (14 The (3). days at between cigarettes age current diseases, smoke more and then (3). students 80 fell percentage of 9 percent risk before white proportion students to percent who including among of and percent students (3). in between 12th 1991 cigarettes decreased as days). from had current students the regularly cigarette and 1991 has of and than and and of of 1. References 2. 3. U.S. Smoking health Disease U.S. Smoking people: for CDC. MMWR Disease Department Department Youth consequences A 55(SS–5). Control and and report Control risk Health. Health. and of behavior of of Adolescent 9 the Health Health and June Prevention. 2004 Preventing of Surgeon smoking. Prevention. surveillance—United 2006. and and Surgeon Health Human Human General. tobacco 2004. Atlanta, General’s 1994. in the Services, Services, use Atlanta, GA: United among report—The Centers States, Office Office GA: States, young Centers 2005. for on on 2007 Risk

Behaviors

Figure 27. Current cigarette smoking among students in grades 9–12 by grade level, gender, and race and Hispanic origin: United States, 2005

Grade level Current use 9th grade Lifetime use 10th grade Male 11th grade Female 12th grade

9th grade 10th grade 11th grade 12th grade

Race and Hispanic origin

All races and origins White only, not Hispanic Black only, not Hispanic Hispanic

All races and origins White only, not Hispanic Black only, not Hispanic Hispanic

0 204 06 0 Percent

NOTES: Current smokers are students who SOURCE: Centers for Disease Control and smoked cigarettes on one or more of the Prevention, National Center for Chronic past 30 days; frequent smokers are students Disease Prevention and Health Promotion, who smoked cigarettes on 20 or more of the Youth Risk Behavior Survey. past 30 days. Persons of Hispanic origin may be of any race. See data table for data points, standard errors, and additional notes.

Adolescent Health in the United States, 2007 61 Risk Behaviors 62 Alcohol Alcohol during age crashes, workplace; serious in and more negative reported was use increased years. alcohol binge non-Hispanic to adolescents increased students drinking times drinking which engage In Alcohol Alcohol Adolescents Adolescents was is heavy reported days as drinking 2005, One-half adolescence, 21 in consequences is alcohol until drinking five injuries, outcomes in reported likely years. significantly risk the the in drinking, and in the use, use Use ( 28 Figure or at alcohol white by the past most of in to 11th percent fighting, of more least varies ( who who binge 19 Alcohol data the injury and alcohol be past by all month (2). adolescents percent commonly 28 in and even alcohol past use 6 combine begin age persons drinks deaths; table ). between month, (1). by which alcohol percent or of crime, use 12th in than race 21 and month. death. though adolescents Binge drinking for the of are dependent binge is (2). problems grades increase 18–20 drinking more use, were used adolescents and and Figure ( ages past associated data were consumed In alcohol the drinking other ethnicity. and 2005, before non-Hispanic psychoactive than month. table 12–13 years significantly minimum reported 29b and 12–20 the in as heavy use activities ) one-third 15 school for with age those (3). and likelihood driving of on occurs years Binge In percent (binge years Figure age driving one alcohol legal 15 2005, heavy motor who and more substance black and with drinking are had are reported on occasion, of drinking), drinking 28 of of after the delay vehicle alcohol 5 use at 18–20 age four used ). likely or an 1. References 2. 3. National U.S. Human Department 2000. call [online]. Centers 2007. http://www.surgeongeneral.gov/topics/underagedrinking/about.html for Risk Chronic to Congress Behavior action Services. for [cited Institute Disease Disease of to 2007 Survey. Health on prevent on Bethesda, Adolescent alcohol June Alcohol Prevention Control and Unpublished and 18]. and Human MD: Abuse. and reduce Health Available health. and Prevention, National Services. analysis. Ninth Health underage in Secretary the from: special Institutes United Promotion, Surgeon National 2006. drinking of report States, Health of General’s Center Health. Youth to 2007 and the . Risk

Behaviors

Figure 28. Alcohol use, binge alcohol use, and heavy alcohol use in the past 30 days among adolescents 12–20 years of age, by gender and race and Hispanic origin: United States, 2005

Alcohol use Black only, not Hispanic Hispanic White only, not Hispanic Male

Female

Binge alcohol use

Male

Female

Heavy alcohol use

Male

Female

0 10 20 30 40 50 Percent

NOTES: Binge alcohol use is defined as drinking five or Persons of Hispanic origin may be of any race. See data more drinks on the same occasion (i.e., at the same table for data points, data on age and detailed race, time or within a couple of hours of each other) on at standard errors, and additional notes. least 1 day in the past 30 days. Heavy alcohol use is defined as drinking five or more drinks on the same SOURCE: Substance Abuse and Mental Health Services occasion on each of 5 or more days in the past 30 days; Administration (SAMHSA), Office of Applied Studies, all heavy alcohol users are also binge alcohol users. National Survey on Drug Use and Health.

Adolescent Health in the United States, 2007 63 Risk Behaviors school school both percentage decreased been white students who high 29 Seatbelt seatbelts students who school drinking been Hispanic likely non-Hispanic 17 grade crash young if intoxicated involved In Alcohol use injury reduce Research motor 15–24 decreased injuries 64 Between Drinking they 2005, percent percent The Between Among is had had school males to drinking drinking (2). and were vehicle who drivers consistently years have students students students the for use percentage drive and in use almost were in students. 1970 been been while In has black from by between to teenagers (4). drove fatal risk high grades of not and students and been states driving 1991 of did black and 10 after traffic-related who ( was 81 students shown significantly Figure and drinking drinking Young riding wearing of age 26 rarely compared in females, one-fifth counterparts motor school percent driving not percent. after drinking moderate and grades more had higher 9 drinking percent with 1h and 11th- 2004, of Driving 1991and ( have differ Figure were through in 29b that and drivers or high vehicle drinking 2005, not been ( alcohol students, strict a seatbelts a data common between of ). never almost death among Yet, (3). seatbelts, young car vehicle 9 significantly alcohol. more with equally to wearing injuries than young 29a school to through12 drinking to table seatbelt 12 2005. the 12th-grade are 10 driven teenagers traffic-related critical alcohol decreased ). 9 used and ride rates likely 13 non-Hispanic who adults percent. riding percent the percentage The (5). less are than 1991 drivers likely students for In of percent In seatbelts when with by a highest never and 2004, for a laws, any injury percentage than Figure likely Seatbelt 2005, by not declined who seatbelt with 15–24 and deadly someone to and students a motor of Although race 16–20 were from age properly ride using driver their of teenage rode or crashes in three-fourths female to and a 2005. male 29b death of declined young driver white male 11th years rarely use group and combination. with 40 vehicle-related in killed high from non-Hispanic fatal ). years a with who of else were 2005. and percent In Hispanic seatbelt the used, restraints ethnicity. rates and high Use high a adults or were seatbelt high who of school wore almost 2005, (1). in a driver for had female of age less driver 12th a for of had age to or 4. 5. 3. 2. 1. References for National involvement www.nsc.org/public/teen0702.pdf. 2004. www.nhtsa.dot.gov/people/injury/airbags/MVOP2004/. U.S. motor National www-nrd.nhtsa.dot.gov/pubs/810644.pdf.2006. [online]. Belt paper McCartt DC: traffic National Health in NCHS. the Statistics U.S. Safety Department crash vehicle [online]. health Statistics. Health, AT, DOT Highway Highway Highway Department Campaign. Shabanova fatality among and of HS occupant The United Americans. of 2006. Analysis. 810 Traffic Traffic Traffic Adolescent and National drivers Transportation. of 644. States, [cited protection injury VI. Transportation. Safety Safety Safety Alcohol-related and [cited Hyattsville, Teenage Safety 2007 Health estimates 2006, Administration, Administration. Administration. motorcycle 2002. 2007 facts. June Available Council’s with seat in MD: June the 2001. for Washington, 8]. chartbook belt fatalities operators United Available 2000. National 8]. Air from: use: National 2004 Motor Available Bag Washington, States, and White on Center DC: & from: in vehicle trends alcohol Seat Center 2005 from: 2007 for Risk

Behaviors

Figure 29a. Drinking and driving and seatbelt use among students in grades 9–12: United States, 1991–2005 60 Rode with a driver who had been drinking Drove after drinking alcohol (grades 11 and 12 only) Rarely or never wore a seatbelt as a passenger 40

Percent Percent 20

0 1991 1993 1995 1997 1999 2001 2003 2005 Year

Figure 29b. Drinking and driving and seatbelt use among students in grades 9–12, by race and Hispanic origin: United States, 2005

Rode with a driver who had been drinking alcohol All races and origins White only, not Hispanic Black only, not Hispanic Hispanic

Drove after drinking alcohol (grades 11 and 12 only) All races and origins White only, not Hispanic Black only, not Hispanic Hispanic

Rarely or never wore a seatbelt as a passenger All races and origins White only, not Hispanic Black only, not Hispanic Hispanic

02 04 06 0 Percent

NOTES: Rode with a driver who had been never wore a seatbelt when riding in a car drinking alcohol is defined as students who driven by someone else. Persons of Hispanic during the past 30 days rode one or more origin may be of any race. See data table for times in a car or other vehicle driven by data points, data by grade level and gender, someone who had been drinking alcohol; and standard errors. drove after drinking is defined as students who during the past 30 days drove a car or other SOURCE: Centers for Disease Control and vehicle one or more times when they had been Prevention, National Center for Chronic drinking alcohol; rarely or never wore a Disease Prevention and Health Promotion, seatbelt is defined as students who rarely or Youth Risk Behavior Survey.

Adolescent Health in the United States, 2007 65 Risk Behaviors 66 Drug Use health commonly The emotional, addictive memory, perception weaken likelihood smoke, marijuana negative reported month current Male to prevalence by marijuana marijuana Adolescents both use amphetamines. of euphoria powerfully cardiovascular heart reported freebase) reported have the 24 In Among In In as use male use students attack percent 2005, 2005, 2005, sympathetic and of (data well, use can used the using of using using effect verbal (1). or of by during by one increased addictive and used and Marijuana (1). social all of marijuana increased the immune damage or cancer one-fifth almost face table almost particularly adolescents Marijuana very marijuana marijuana overall students were or or marijuana some cocaine Research female on stroke. behavioral Stimulants skills, feeling illicit their consequences. health cerebrovascular more for their young nervous (1). 4 8 stimulant slightly significantly system the form drug of since Figure percent can in lifetime and significantly students. of in times in development use students Marijuana stimulants in consequences use 10 lungs has teenagers one can the being grades changes, and produce of among judgment, are the 1999 system more students can 30 and in cocaine during shown drug and past or have of past drugs ). (1). the more also students more between Other Among possibly Marijuana in (2). likely 9 high emergencies, more by smoke, such 30 associated Increasing adverse and past immediate 30 grades through may and their that (1). as reported that impair (powder, grade awake. days times school days. than from produce than well as month it male have marijuana increase life. in increase grades Illicit can like 9 cocaine is (2). physical, level 12, short-term grades female other in as 3 through Cocaine Lifetime use having the students. with students, and a cigarette crack, be percent the has the such distort profoundly a ( 9 most Figure of Drugs illicit the sense a acute long-term past and declined use students 9–12 and user’s mental, used or as 12 use activity is drug 12 may a 30 a of of ). for 1. References 2. stimulants. Amphetamines sleep pressure, the paranoia, using reported In drug National Institute 05–3859. CDC. MMWR problems, methamphetamines 2005, using can weight and Youth Regular 55(SS–5). 6 on Institute result Bethesda, hallucinations. percent amphetamines (including Drug risk mood loss, in use behavior Abuse on Adolescent 9 nerve and of swings, MD: Drug June of students methamphetamines) during amphetamines nutritional Research National damage, surveillance—United Abuse. 2006. in irregular Health the their in Marijuana Institutes Report past grades problems. chronic lifetime in heartbeat, the 30 can Series. United 9–12 of days abuse. psychosis, and are cause Health. States, High NIH synthetic reported 4 (2). high States, National percent chronic doses Pub 2005. 2005. blood 2007 No of Risk

Behaviors

Figure 30. Marijuana use in the past 30 days and lifetime use among students in grades 9–12, by grade level, gender, and race and Hispanic origin: United States, 2005 Current use Lifetime use Grade level 9th grade Male 10th grade Female 11th grade 12th grade

9th grade 10th grade 11th grade 12th grade

Race and Hispanic origin All races and origins White only, not Hispanic Black only, not Hispanic Hispanic

All races and origins White only, not Hispanic Black only, not Hispanic Hispanic

0 10 20 30 40 50 60 70 80 Percent

NOTES: Current marijuana use is defined SOURCE: Centers for Disease Control and as students who used marijuana one or more Prevention, National Center for Chronic times in the past 30 days; lifetime marijuana Disease Prevention and Health Promotion, use is defined as students who have used Youth Risk Behavior Survey. marijuana one or more times during their life. Persons of Hispanic origin may be of any race. See data table for data points, standard errors, and additional notes.

Adolescent Health in the United States, 2007 67 Risk Behaviors 68 Weapon Weapon resulting increases disability, does exposure fear carrying the high Among students students significantly weapon proportion 7 10 property students 2005, one of students decreased 17 1999 who 2003 2005 percent having percent percent) In Male The Not The past or and were school not and from to 36 2005, more both all proportion percentage 36 on a compared 30 carrying from to who vulnerability (4). compared students percent always or to of been the 2005 in of gun 43 violence-related between of percent report school and between students days other intimidation all 19 male Carrying a times students male reported percent risk violence. physical or students in percent (17–18 then lead of is ( other serious a that carrying data were and property of in with students (4). with associated of 1991and students physical 9th reported (2,3). did students the to to who students a carrying female percent). table Carrying weapon, of fight significantly less and 28 injury, brought 33 violent and not past injury high a behavior carried percent was percent carried threats decreased than gun for fight change were 1999 12th carrying students, 12 who it with school a who argument (1). Figure smaller The a such a is or weapon 3 months was grade. weapons. involved weapon weapon (from for strongly reported percent the and a more Although other as involves carried significantly percentage weapon as students a 43 female 31 well most between the than then gun. 26 a ). percent likely (4). did will weapon significantly to knife in Five of percentage associated percent as a bringing In weapons. serious the increased weapon not result The a school; students. weapon female on perceptions than 2005, reported physical percent 1991 or of between overall differ school for ( prevalence Figure students club, in to female a injuries male almost carrying and death, with In of in of fight in 31 of ). 1. References 2. 3. 4. CDC. Risk reports Lowry (Suppl Weapon-carrying, among Forrest Weapon-carrying other CDC. MMWR Behavior violent Measuring Youth R, 1):1–96. U.S. on K, 55(SS–5). Powell Zychowski high-risk risk adolescents. behaviors. Surveillance 1993. behavior KE, the in physical Adolescent 9 school: adolescents. June health Kann AK, Am Am Stuhldreher surveillance—United 2006. fighting System L, Prevalence behavior J Health J Health Collins Prev Public and and in Med Stud of JL, WK, fight the and adolescents: recent Health Kolbe 14:122–9. 16:133–40. Ryan United association related public States, Rep LJ. WJ. States, injury 108 1998. The health 2000. 2005. with Youth 2007 Risk

Behaviors

Figure 31. Weapon carrying in the past 30 days among students in grades 9–12, by gender, grade level, and race and Hispanic origin: United States, 2005 Current use Grade level Lifetime use 9th grade Male 10th grade Female 11th grade 12th grade

9th grade 10th grade 11th grade 12th grade

Race and Hispanic origin All races and origins White only, not Hispanic Black only, not Hispanic Hispanic

All races and origins White only, not Hispanic Black only, not Hispanic Hispanic

0 10 20 30 40 50 60 Percent

NOTES: Weapon carrying includes carrying SOURCE: Centers for Disease Control and weapons such as a gun, knife, or club on Prevention, National Center for Chronic one or more of the past 30 days. Persons of Disease Prevention and Health Promotion, Hispanic origin may be of any race. See data Youth Risk Behavior Survey. table for data points and standard errors.

Adolescent Health in the United States, 2007 69 Risk Behaviors 70 Physical Physical benefits bones, muscle, of some along Additionally, prevention associated mental self-esteem participation participate regular more academic activity negative engaged activity; increased of more Figure currently were participated recommended level Overall, non-Hispanic activity activity also is or In moderate 20 high the 2005, 30 In Adolescents’ Adolescents’ Although benefit (Figure substantially minutes likely of minutes adolescents with 2005, time 32). muscles, health, among at produces and blood that and non-Hispanic for the activity 69 health recommended in to achievement the their in a of with to for adolescents. the percent and in heavy from participation 7 in is, 36 vigorous reduce 32 healthy the Activity interscholastic black overweight pressure; currently stay of days of physical among levels a adolescents physical ). heart they percent currently behaviors social provides reduces and participation participation vigorous total currently moderate the moderate more with smokers in students preceding of fat; participated diet, also rate greatest joints; school physical white of young well-being, students recommended (1). hypertension activity and of activity level prevents likely at It in recommended and anxiety important and plays activity differs (1). recommended adolescents helps activity least In have physical to helps students or sports helps to and people. differs in in obesity. than health contrast, vigorous made the activity. use at have increases an in physical physical in by 60 and been build have or three the as control survey reduce grades are five female drugs important physical health race by minutes delays activity them (1). benefits, well participated were Studies stress currently level. and associated good less in or gender. physical or low levels activity activity Physical level and weight, (1), as adolescents’ ( grades blood more 9–12 more and data breathe students more maintain the levels likely and activity (2). conduct physical per role have and ethnicity. adolescents of of recommended emotional development Male table participated times times pressure activity, at at Students sports likely day physical in physical build 9–12 to in activity, of they with hard found the to physical that be the healthy physical students for and on and a than a have lean other are is some week. which week 5 in high who can or in 1. References 2. more moderate activity 9th (data In In grade Department Department people President and U.S. activity GA: Center 1996. likely table 2005, 2005, among the Centers Department to students for than through for and non-Hispanic participation vigorous Secretary from Figure Chronic students health: of of non-Hispanic for Health Education. the physical to Disease of Adolescent 32 physical of 62 Secretary Disease A Health ). decreased Education. report and percent in white activity moderate Control Promoting Human and black Prevention of activity. of Health and the for Human and Health Fall and from students Services Surgeon 12th Hispanic to sports: 2000. better in Prevention, 74 and and vigorous the Services. grade percent health United and A Health Human General. to students report participate students the Physical physical National for States, Promotion. for Services to Atlanta, young the were 2007 in Risk

Behaviors

Figure 32. Participation in physical activity among students in grades 9–12, by gender and race and Hispanic origin: United States, 2005

Meeting currently recommended level of physical activity

Male All races and origins Female

White only, not Hispanic

Black only, not Hispanic

Hispanic

Participation in moderate to vigorous physical activity

All races and origins

White only, not Hispanic

Black only, not Hispanic

Hispanic

0 20 40 60 801 00 Percent

NOTES: The currently recommended level of the past 7 days and/or at least 30 minutes of physical activity for students is defined as any moderate physical activity on 5 or more of the kind of physical activity that increased their past 7 days. See data table for data points, heart rate and made them breathe hard some data by grade level, and standard errors. of the time for a total of at least 60 minutes per day on 5 or more of the past 7 days; SOURCE: Centers for Disease Control and moderate to vigorous physical activity is Prevention, National Center for Chronic defined as participation in at least 20 minutes Disease Prevention and Health Promotion, of vigorous physical activity on 3 or more of Youth Risk Behavior Survey.

Adolescent Health in the United States, 2007 71 Risk Behaviors 72 Eating Dietary availability, attempts than fashion Teenagers some making laxatives—are marijuana, Despite dieters exercising vegetables students past (data students purpose. these (Figure significantly than The behaviors Female Among proportion 30 what were table activities dietary is are 33 trends, themselves taking days reported reported at controlled ). was is moderately their who exercise and each less for female Risk students voluntary less needed risk to more Figure extreme similar of and sales family, non-Hispanic practice likely lose likely day behaviors male not vomiting students, Behavior throw by professions intensely, likely were for weight campaigns (2). control. 33 to eating across and to peer, many students measures ). extreme health make report In up, to Almost more eating or as 2005, or and non-Hispanic for smoke, factors, white racial Dieting taking taking and healthy to male is vomiting (1). 24 than who for cultural dieting—such five 5 often keep to attempt 12 and hours percent and special diet a drink lose students including to twice percent reported servings laxative choices, promoted from Hispanic a ethnic or pills, practices, weight, or body black alcohol, suicide as taking of foods, more gaining of were or high likely dietary appetite, groups. of for as such weight students high using counterparts. extreme fruits by (2). the a fasting, in and use as school to laxative weight current as the school risk same well leaner report in and food were as 1. References 2. Spearing and Bethesda, Rafiroiu RF. health-promoting 2003. Covariations the AC, search M. MD: Sargent Eating National for of behaviors. Adolescent solutions. adolescent disorders: RG, Institute Parra-Medina Am NIH Health Facts weight-control, J of Publication Health Mental about in the D, Behav eating Health. Drane United No health-risk, 27(1): 01–4901. disorders WJ, States, 2001 Valois 3–14. and 2007 Risk

Behaviors

Figure 33. Dietary risk behavior in the past 30 days among students in grades 9–12, by gender and race and Hispanic origin: United States, 2005

Went without eating for 24 hours or more

All races and origins Male White only, not Hispanic Female Black only, not Hispanic Hispanic

All races and origins White only, not Hispanic Black only, not Hispanic Hispanic

Vomited or took laxatives

All races and origins White only, not Hispanic Black only, not Hispanic Hispanic

All races and origins White only, not Hispanic Black only, not Hispanic Hispanic

0 10 203 04 0 Percent

NOTES: Went without eating for 24 hours or origin may be of any race. See data table for more is defined as students who went without data points, data by grade level, and standard eating for 24 hours or more to lose weight or errors. to keep from gaining weight during the past 30 days; vomited or took laxatives is defined SOURCE: Centers for Disease Control and as students who vomited or took laxatives to Prevention, National Center for Chronic lose weight or to keep from gaining weight Disease Prevention and Health Promotion, during the past 30 days. Persons of Hispanic Youth Risk Behavior Survey.

Adolescent Health in the United States, 2007 73 Health Care Access and Utilization 74 Access Health Health dependent, services. uninsured have physician adolescent near Insurance coverage of health families (data uninsured both adolescents Family Adolescents public poor unmet table insurance, to with Compared through during are Program than adolescents Care and income will for and to Care health income more a Figure use in be younger private 18–19 great the compared families Medicaid Coverage uninsured. is care of (SCHIP). likely with course at Access a 34 health degree, under years key twice coverage ). adolescents, needs, their to below or factor of with lack care Nonetheless, age the of The insured State on the and age the 8 poverty a ( 19 the in services Figure large and year percent usual go Children’s poverty the are are reflecting ability counterparts, without (1). majority likelihood more 34 eligible threshold source Utilization in for of ). to level 2005, adolescents adolescents likely Health pay lower contact of for of had that poor or for one-fifth care, the public to rates greater no an be with and in is of a 1. Reference in NCHS. Health the health Statistics. Health, of United Americans. 2006. Adolescent States, Hyattsville, Health 2006, with in MD: the chartbook United National States, on Center trends 2007 for Health

Care

Figure 34. Current health care coverage of adolescents 10–19 years of age, by age Acce and poverty status: United States, 2005 ss Uninsured Medicaid Private Other Poor and 10–12 Utilization 13–15

16–17

18–19

Near poor

10–12

13–15

16–17

18–19

Nonpoor

10–12

13–15

16–17

18–19

0 20 40 60 801 00 Percent

NOTES: Insurance status is at the time of interview. 200 percent of the poverty threshold or more. See Poverty status is derived from the ratio of the family’s data table for data points, data by age group, standard income to the federal poverty threshold, given family errors, and additional notes. size. Poor families have income less than 100 percent of the poverty threshold; near poor families have SOURCE: Centers for Disease Control and Prevention, income from 100 to less than 200 percent of the National Center for Health Statistics, National Health poverty threshold; nonpoor families have income of Interview Survey.

Adolescent Health in the United States, 2007 75 Health Care Access and Utilization 76 Adolescents Health those problems health sexually abuse, interventions adolescents well percentage age years counterparts those who in adolescents did insurance. was Hispanic adolescent past less non-Hispanic health had years more professional 10 the years Among Uninsured Having Adolescents not (Figure a as similar likely had year. contacts of of with of past recent problems, insurance. injuries, have sick transmitted younger age) age. teenagers. not of that to Care Hispanic Among coverage. health would female year without for 35 age care includes without compared have to have and visited at health white In were affect ). adolescents with white lack and least 10–19 was In 2005, (3). unintended (2). and education, have insurance lower Visits uninsured at adolescents contrast, a and a more adolescents health violence a diseases, care a the non-Hispanic, physical more In one least recent physician older physician recent 83 with years at non-Hispanic 2005, rates adolescent visit likely health percent least one are insurance than persons, 91 did older health observations, pregnancy, adolescents, (1). health of examinations, of than the emotional percent less than 10–19 health or one not three age with or health care Routine of male proportion other other children care black likely population, always care health their are adolescents despite health as black visit times care years of care adolescents health drug visit for and less health visit. non-Hispanic, to younger health children the and in care visit adolescents assure less insurance those receive as preventive of utilization the of varied the behavioral and likely proportion screening, care age, such high adolescents professional than visit care than health past had alcohol with less that to slightly care the (18–19 for as in for 10 one have year were than health than the and an with that than as or by 1. References 2. 3. Irwin Opportunities National Green 1994. supervision National 1994. CDC. Interview CE, National M, Center Center Survey. Brindis editor. of for infants, Center for for Bright improving C, Unpublished Adolescent Education Education Langlykke children, for futures: Health adolescent Health in in analysis. K, and Guidelines Maternal Maternal Statistics, editors. adolescents. in health. the 2006. and and Health for National United Arlington, health Child Child Arlington, care States, Health Health. Health. reform: VA: 2007 VA: Health

Care

Figure 35. Lack of a health care visit in the past 12 months among adolescents Access 10–19 years of age, by age, gender, race and Hispanic origin, and insurance status: United States, 2005

Male and 10–12 years 13–15 years Utilization

16–17 years

18–19 years

Female 10–12 years

13–15 years

16–17 years

18–19 years

Insured All races and origins

White only, not Hispanic

Black only, not Hispanic

Hispanic

Uninsured All races and origins

White only, not Hispanic

Black only, not Hispanic

Hispanic

0 10 20 30 40 50 60 Percent

NOTES: Health care visit is defined as being race. See data table for data points, standard seen by a physician or other health professional errors, and additional notes. in a doctor’s office, clinic, or some other place. Excluded are visits to emergency rooms, SOURCE: Centers for Disease Control and hospitalization, home visits, and telephone Prevention, National Center for Health Statistics, calls. Persons of Hispanic origin may be of any National Health Interview Survey.

Adolescent Health in the United States, 2007 77 Health Care Access and Utilization 78 Health incurred Adolescents out-of-pocket Female incurred counterparts care ethnicity. adolescents compared and insurance private have health three-fourths out-of-pocket annual adolescents adolescents out-of-pocket insurance by adolescents In The Out-of-pocket Out-of-pocket Among 65 expenses incurred 2004, insurance; health amount percent adolescents proportion out-of-pocket out-of-pocket In coverage. spent Care with those 2004, 10–21 than with with 80 (76 of expenses expenses annually, insurance out-of-pocket decreased 71 spent of who percent those $1,439 percent). any expenses for with only health health 86 percent Hispanic Expenses of years were (83 In those percent private adolescents out-of-pocket with expenses health out-of-pocket one-half and 2004, annually compared of annually, percent) were care care of uninsured with of adolescents public who adolescents adolescents. incurred, expenses age insurance care non-Hispanic of expense expenses adolescents considerably age of were non-Hispanic for ( had were or data compared the with expenses with was ( health expenses, private data ( on data out-of-pocket uninsured; uninsured than table varied more out-of-pocket 10–21 more spent also with higher average, table with table care black more those coverage. with for than likely varied only than $1,581 by white years the public for for Figure ( for had Figure adolescents on race $1,087 likely without their $1,514 public to Figure insured average expenses Figure by average, of health incurred have or and 36 male to age 36 spent ). of 36 ). 36 ). ). Adolescent Health in the United States, 2007 Health

Care

Figure 36. Any out-of-pocket expenses for health care incurred by adolescents Access 10–21 years of age, by gender, race and Hispanic origin, and insurance status: United States, 2004

and All Utilization

Gender

Male

Female

Race and Hispanic origin White only, not Hispanic

Black only, not Hispanic

Hispanic

Insurance status

Private

Public only

Uninsured

0 204 0 608 01 00 Percent

NOTES: Expenses include inpatient hospital table for data points, data by age groups, and and physician services, ambulatory physician standard errors. and nonphysician services, home health services, dental services, and other medical SOURCE: Agency for Healthcare Research equipment, supplies, and services that were and Quality, Center for Cost and Financing purchased or rented during 2004. Persons of Studies, Medical Expenditure Panel Survey. Hispanic origin may be of any race. See data

Adolescent Health in the United States, 2007 79 Health Care Access and Utilization 80 Medical incurred during adolescents across more prescription prescription more years compared insurance Hispanic had as as for Figure prescribed twice uninsured. average, only $204 high for adolescents In The Out-of-pocket In The out-of-pocket public spent likely than as of 2004, 2004, those 37). the all for proportion average out-of-pocket age high adolescents. $394 status. age with calendar Adolescents one-half medication insurance than adolescents by expenses expenses. Prescription with 45 the without had for groups. annually adolescents about percent with average males annual prescription insured In prescription out-of-pocket expenses of of year 2004, health expenses one-third adolescents spent expenses varied non-Hispanic among Female (41 with of on with amount ( out-of-pocket adolescents Figure adolescents the percent) prescriptions, insurance. who $432 in any private by drug expenses those proportion the was of adolescents Expenses prescription race for were 37 spent private annually, non-Hispanic with expenses past ). $389 prescribed to white with or The and as uninsured. have out-of-pocket out-of-pocket prescription 10–21 public year also insurance any for and of ( proportion ethnicity. adolescents data compared (49 expenses adolescents out-of-pocket those was was varied expense health adolescents years medication table percent) black similar almost spent, who expense In by of for insurance of for and with 2004, 10–21 was age were were who twice on with Adolescent Health in the United States, 2007 Health

Care

Figure 37. Any out-of-pocket expenses for prescribed medicine incurred by Access adolescents 10–21 years of age, by gender, race and Hispanic origin, and insurance status: United States, 2004

and All Utilization

Gender

Male

Female

Race and Hispanic origin White only, not Hispanic

Black only, not Hispanic

Hispanic

Insurance status

Private

Public only

Uninsured

0 204 06 08 01 00 Percent

NOTES: Expenses include all prescribed SOURCE: Agency for Healthcare Research medications that were purchased or refilled and Quality, Center for Cost and Financing during 2004. Persons of Hispanic origin may Studies, Medical Expenditure Panel Survey. be of any race. See data table for data points graphed, data by age groups, and standard errors.

Adolescent Health in the United States, 2007 81 Health Care Access and Utilization 82 Consistent Needs Adolescents Unmet particularly needs behavioral, ‘‘those and the required abilities, and emotional SHCN special (13 report commonly dental medication, services needed medications parent service Adolescents reasons, adolescents’ providers, reported services dental 2 all among adolescents percent the Sixteen Need A In percent) Services definition related support specific 2001, of (SHCN) care, care medications in reported who uninsured needs that among and by that (Figure to including the 2001. for who health competing Health needed access important or have percent did have and [adolescents] services the (87 specialist had (1). services may 19 willingness needed perceived a they parents represent service emotional (18 needed (1). particular adolescents not percent Male that parent percent) 38a eyeglasses at and an a not adolescents; percent) need financial to services Adolescents with needed. receive chronic least of ). an unmet of but Care for demands a to most adolescents development. receive need Almost care, adolescents prescription perceived need a wide a adolescent of access maintain to condition adolescents not and service one wide type generally’’ adolescents Special receive than commonly need all physical, was barriers, for preventive with or range obtained for Needs services dental 11 unmet that or range vision almost on adolescents to with female considered percent that was SHCN for their amount as were and a families’ care was medication 10–17 did of (1). broad care lack need. one being SHCN developmental, service. with of care based perceived health were one-half physical, they Health who care, not with adolescents for more needed, were (1). levels Adolescents of of or (85 beyond special years ( array needed. receive time, those Figure need also with most are unmet SHCN access more on prescription care percent). Among likely prescription did of of mental, parental defined as of SHCN require whereas of and Care for functional common needing health that uninsured health services 38b not if all were age to medical being to were various the meeting the ). have of receive are had and as The health care the care most only is 1. References U.S. Resources Health health Department Department care Bureau. and needs: of Health The Services of Adolescent Chartbook Health National and Administration, Human and survey Health 2001. Human Services. of Rockville, in children the Services, Maternal United 2004. MD: with Health and States, U.S. special Child 2007 Health

Care

Figure 38a. Unmet health service needs among adolescents 10–17 years of age Access with special health care needs, by number of services needed but not obtained and insurance status: United States, 2001

More than one service One service and

All Utilization Uninsured

Private and public Public only Private only

0 10 20 30 40 50 60 Percent

Figure 38b. Selected health service needs among adolescents 10–17 years of age with special health care needs, by type of service needed: United States, 2001

Unmet need

Dental care

Mental health care

Specialist care

PT/OT/Speech therapy

Preventive care

Eyeglasses or vision care

Prescription medication

Medical supplies

0 1020 30 40 50 60 70 80 901 00 Percent needing service

NOTES: Unmet need is defined as not SOURCE: Centers for Disease Control and receiving all of the service that was needed Prevention, National Center for Health and is based on parents’ perceived need. PT Statistics, National Survey of Children with is physical therapy and OT is occupational Special Health Care Needs. therapy. See data table for data points, standard errors, and additional notes.

Adolescent Health in the United States, 2007 83 Health Care Access and Utilization 84 20–24 of percent from 18 age, to with year-olds. year-olds decreased 15–17 clinic of X percent who Title 30 proportion a the at or contrast, services doctor In received private age. a with from increased service, services HMO health received reproductive who or proportion planning the family one least at ( years 15–17 20–24 ages ages at at percent percent 38 81 the from to in age years service with health increased reproductive year or past planning family school. one in least still are many and entry-level benefits, at health work no often offer low employed that and are jobs young who generally Those are (2). system income clinic Women the counseling. by HIV and served and diagnosis STD pregnancy preventive exams, and of pelvic screening, number as a such provide services also health clinics X uninsured Title and (1). supplies low-income women contraceptive to make available to services health designed and reproductive was and solely X planning is Title family that care. of program provision federal the the only of for the X is Title Act, under Health authorized Public Program, Planning Family AIDS. The or HIV including services STDs, and to services, related health areas: maternal main services, three contraceptive encompass services and health Sexual reproductive (HMOs). through organizations available maintenance also health are services and These clinics, offices. planning physicians’ family clinics, settings, health of and school-linked range school-based wide clinics, a community-based in including health available reproductive are and services planning care and family adolescents routine of adults, needs young care health reproductive meet To Services Health Medical Reproductive and Planning Family mn on oe 52 er faeworeceived who age of years 15–24 women young Among at received who women young of percentage the 2002, In iue39 Figure ). .Aa utahrIsiue uliln h rms:Pbi policy Public promise: the Fullfilling Institute. Guttmacher Alan 2. Planning Family of Office Affairs. Population of Office 1. References oeae ctd20 ue8.Aalbefrom: Available 2007. 8]. www.hhs.gov/opa/familyplanning/index.html. June 2007 [cited homepage. utahrIsiue ctd20 ue8.Aalbefrom: Available 8]. 2000. June Alan http://www.guttmacher.org/pubs/fulfill.pdf. NY: 2007 York, [cited New Institute. clinics. Guttmacher planning family U.S. and dlsetHat nteUie tts 2007 States, United the in Health Adolescent Health

Care

Figure 39. Receipt of at least one family planning or reproductive health medical Access service in the past year among female adolescents 15–19 years of age and young adults 20–24 years of age, by type of provider and age group: United States, 2002

100 At least one family planning Title X clinics only and or medical service Other

Private doctor or HMO Utilization

Any clinic (includes 80 Title X clinics)

60 Percent Percent

40

20

0 15–17 years 18–19 years 20–24 years Age

NOTES: Family planning services include sterilizing organization. Other is any other place not listed. operation, birth control method, checkup or medical test Percentages for provider types do not add to total who related to birth control, counseling about birth control, “received at least one family planning or medical service” counseling about getting sterilized, mergency because women may have received more than one contraception, or counseling about mergency service and reported more than one provider. See data contraception. Medical services include Pap smear, pelvic table for data points. exam, prenatal care, postpartum care, counseling, testing or treatment for sexually transmitted infections, abortion, SOURCE: Centers for Disease Control and Prevention, or pregnancy test. Percent in Title X clinics is also National Center for Health Statistics, National Survey of included in any clinic. HMO is health maintenance Family Growth.

Adolescent Health in the United States, 2007 85 Health Care Access and Utilization 86 poverty the below visit or dental near a families threshold. have in to adolescents likely were threshold more than poverty significantly the were of more percent 200 or at incomes from with Adolescents status. families socioeconomic by apparent also age and all black in non-Hispanic apparent their than ( visit counterparts dental Hispanic more a were have adults to origin. young likely Hispanic and and adolescents race white by Non-Hispanic varied visit dental recent ( percent age 54 of and 40 years Figure age, 20–24 of adults age years young of 16–19 for years those 10–15 for adolescents percent decreased 73 for visit to percent the 84 dental in from recent visit age, a dental with with one proportion least The at year. had past years 20–24 adults young preventive effective the also of are (2). surfaces fluoride measures chewing of the use to teeth—and dentist back a by sealants—plastic applied maintaining Dental coatings in teeth. role healthy important preserving an and diet, play Proper flossing are years. and home teen brushing, at the practiced during care important hygiene particularly oral and nutrition Good (1). need treatment in and involvement evaluation oral professional advanced other of have or may disease, dentist periodontal not a caries, has by health routinely early oral monitored its whose been in patient disease adolescent existing The may disclose stages. basis or routine disease a oral on prevent care dental preventive Professional Visits Dental iprte ntepooto iharcn etlvstwere visit dental recent a with proportion the in Disparities The and years 10–19 adolescents of percent 71 2005, In rprinof proportion ). groups. dlset n on dlswt a with adults young and adolescents iue40 Figure .Tedisp The ). aatbefor table data rte were arities .CC rlhat:Peetn aiis u ies,adtooth and disease, gum cavities, Preventing health: Oral CDC. 2. Affairs Clinical Dentistry, Pediatric of Academy American 1. References osA lne20 oln] ctd20 pi 2.Available 22]. April 2008 [cited [online]. from: 2008 glance a loss—At Clinical care. health 2005. oral Guidelines adolescent on Guideline Committee. 2008. www.cdc.gov/nccdphp/publications/aag/doh.htm. dlsetHat nteUie tts 2007 States, United the in Health Adolescent Health

Care

Figure 40. At least one dental visit in the past year among adolescents 10–19 years Access of age and young adults 20–24 years of age, by age group, race and Hispanic origin, and poverty status: United States, 2005

10–15 years 16–19 years 20–24 years and

Race and Hispanic origin Utilization

All races and origins

White only, not Hispanic

Black only, not Hispanic

Hispanic

Poverty status

Poor

Near poor

Nonpoor

0 25 50 75 100 Percent

NOTES: Poverty status is derived from the threshold or more. Persons of Hispanic origin ratio of the family’s income to the federal may be of any race. See data table for data poverty threshold, given family size. Poor points and standard errors. families have income less than 100 percent of the poverty threshold; near poor families have SOURCE: Centers for Disease Control and income from 100 to less than 200 percent of Prevention, National Center for Health the poverty threshold; nonpoor families have Statistics, National Health Interview Survey. income of 200 percent of the poverty

Adolescent Health in the United States, 2007 87 Data Tables for Figures 1–40 www.census.gov/population/www/usinterimproj.html Population www.census.gov/ipc/www/usinterimproj/ Population National United Current Population SOURCES: category included beyond years. conform 1980 2050 88 NOTES: Category - - - Data (percent): 1985 1990 1995 2000 2005 2010 2020 2030 2040 Individuals States ...... table are Population to Cancer in Standard included estimates data data the the shown U.S. Projected not resident 1997 single-race United for for for Year Institute. Census applicable. could only errors in Reports. 2000–2005 1990 Office for single-race Figure population Asian. report 2010–2050 and are Bureau. 2004. States, categories. of Series not 1995 Management only are [cited 1. available. categories; by Population from: are one P-25, Distribution are county, 1980–2050 2007 In . from: race from: 1980–1995, U.S. No. Hispanic White, Data and June 75.6 44.3 72.5 69.4 67.0 63.3 60.7 57.8 53.7 51.0 47.6 single-year persons not in National data 1095. population U.S. Race 1980–1995, Budget are 24]. for . interim Washington: for and who the Available 1980 Center of Hispanic Standards the of estimates Asian Black, selected 14.2 14.5 Hispanic 14.7 14.8 14.7 15.0 age, --­ projections --­ --­ --­ --­ not adolescents and resident and for from: category sex, 1985 more Health U.S. for more by population. race, origin www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm are Hispanic Federal than Government by age, Statistics. 28.9 13.4 15.5 17.5 20.0 23.1 24.7 27.0 11.7 includes than age, from: 7.9 9.7 and one sex, one Data 10–19 sex, Hispanic U.S. race Persons race, Asian Bridged-race race Printing race, on White population beginning 83.1 69.8 81.5 80.1 79.4 77.5 76.6 76 74.6 73.2 71.7 and Race in and origin, years of and 2000 Hispanic Office, Hispanic Native and Hispanic prepared Black in estimates 14.5 15.7 15.0 15.3 15.5 15.3 15.8 15.5 15.3 15.5 15.4 intercensal and Ethnicity 2000. of Feb Hawaiian origin: beyond origin age origin 1993. Persons by Alaska by and July may estimates the American are by Indian age, (internet). or are 1, U.S. --­ --­ --­ --­ --­ Adolescent 0.8 1.0 1.1 1.2 1.3 1.3 be other shown who race sex, 2005. Native not of or Census of selected any Pacific race, Race directly Available as the [cited and race. having July Health and Bureau Islander; Asian 2007 comparable only --­ --­ --­ --­ 7.0 3.7 3.8 4.2 4.9 5.4 6.2 Hispanic Race 1, from: Hispanic . 2 1990–July one or in June with data in more the race Asian Islander 2000 Pacific support 24]. origin: for United with --­ --­ --­ --­ --­ --­ --­ 1.6 2.6 3.4 3.9 races in origin Available 1, 2000 and 2000 or data 1999, 1980–1991. from and States, beyond and for and Two the are races more from: earlier beyond --­ --­ --­ --­ --­ --­ --­ --­ --­ 2.0 2.4 2007 not this or Data

Tables

Data table for Figure 2. Poverty status among adolescents 10–17 years of age, by family structure and for race and Hispanic origin: United States, 2005

Family structure, race, and Hispanic origin Poor Near poor Figures

Percent All adolescents: Allraces and origins ...... 15.5 20.3 White only, not Hispanic ...... 8.6 15.0 Black only, not Hispanic ...... 31.1 26.4 1–40 Hispanic ...... 25.9 32.8 Adolescents in married couple families: Allraces and origins ...... 7.2 16.6 White only, not Hispanic ...... 3.5 11.6 Black only, not Hispanic ...... 12.8 19.8 Hispanic ...... 17.6 34.1 Adolescents in female householder families: Allraces and origins ...... 36.1 29.1 White, not Hispanic ...... 26.5 26.4 Black, not Hispanic ...... 44.2 30.9 Hispanic ...... 45.8 32.3

NOTES: Standard errors are not available. Poverty status is derived from the ratio of the family’s income to the federal poverty threshold, given family size. Poor families have income less than 100 percent of the poverty threshold; near poor families have income from 100 to less than 200 percent of the poverty threshold; nonpoor families have income of 200 percent of the poverty threshold or more. Persons of Hispanic origin may be of any race. SOURCE: U.S. Census Bureau, Current Population Survey, March Supplement 2006.

Adolescent Health in the United States, 2007 89 Data Tables for Figures 1–40 West South Midwest Northeast SOURCE: separately. dropped Persons Not a in Hispanic 16 18 17 19 90 1 Data NOTES: Female Male...... Total...... 20–24 by SE high single-race More Asian/Pacific Black White years years years years is age, Hispanic: school standard ...... years table ...... of out. Status than or ...... U.S. Hispanic ...... gender, African Beginning categories; credential Race one ...... Census dropout for error. Islander race origin Characteristic and American Figure in Bureau, rate Gender (either and Region persons Hispanic ...... Age 2003, may ...... is race the a be 3. Current respondents diploma ...... who of percentage Status origin any and reported Population race. or equivalency Hispanic were dropout of Due more the able Survey, to civilian than small to credential identify one origin, rates October noninstitutionalized sample race themselves dropout such Status are among 2004. size, 12.2 23.8 10.6 10.3 12.6 11.4 11.8 11.2 11.6 rate and 8.0 8.8 6.1 3.6 6.8 3.8 5.2 9.0 shown as American a region: General as as adolescents population being having Indians Education more United two 16–24 or ‘‘than SE or Alaska 0.6 0.4 0.4 0.5 1.5 0.9 0.7 0.7 0.2 0.4 0.5 0.7 0.3 0.7 0.3 0.2 0.3 more Development 1 years and one States, Natives races race.’’ of young age and are Persons [GED] 2004 who Adolescent are included are adults distribution not certificate), dropouts Percent who 100.0 not of included 26.9 39.1 17.8 16.3 39.8 15.8 40.6 10.6 43.2 56.8 67.6 11.7 1.0 1.5 4.5 5.6 in all in Health reported the high 16–24 total irrespective in school in single-race only but the years one are and United of not race have categories when shown of States, SE are 1.1 1.2 0.9 0.8 0.3 0.3 1.3 0.9 1.2 0.5 0.6 0.7 1.2 1.2 1.1 0.8 n/a not they age, 1 included earned . 2007 Data

Tables

Data table for Figure 4. Limitation of activity caused by selected chronic health conditions among for adolescents 10–17 years of age, by gender, race and Hispanic origin, and poverty status: United States, average annual 2004–2005 Figures Gender

Total Male Female Type of chronic health condition Rate SE 1 Rate SE 1 Rate SE 1 1–40 Conditions per 1,000 population Any chronic condition ...... 8.6 0.2 10.7 0.3 6.4 0.3 Learning disability ...... 26.1 1.2 29.4 1.7 22.7 1.6 Attention Deficit/Hyperactivity Disorder ...... 23.0 1.2 34.8 1.9 10.7 1.1 Other mental, emotional, or behavioral problem ...... 14.4 0.9 20.0 1.4 8.6 1.0 Mental retardation or other developmental problem..... 11.0 0.8 12.9 1.1 9.0 1.0 Asthmaorbreathingproblem...... 5.8 0.6 6.0 0.8 5.5 0.8 Speech problem ...... 7.4 0.6 9.7 1.0 5.0 0.7

Race and Hispanic origin

White only, not Hispanic Black only, not Hispanic Hispanic

Rate SE 1 Rate SE 1 Rate SE 1

Any chronic condition ...... 9.0 0.3 9.9 0.6 6.8 0.4 Learning disability ...... 26.3 1.6 28.3 3.0 23.7 2.2 Attention Deficit/Hyperactivity Disorder ...... 24.0 1.5 28.6 3.3 14.7 1.8 Other mental, emotional, or behavioral problem ...... 13.3 1.1 21.2 2.8 12.1 1.5 Mental retardation or other developmental problem .... 10.9 1.0 12.9 2.1 10.2 1.4 Asthmaorbreathingproblem...... 5.0 0.7 9.6 1.8 4.8 1.1 Speech problem ...... 7.8 0.8 6.3 1.4 6.9 1.2

Poverty status

Poor Near poor Not poor

Rate SE 1 Rate SE 1 Rate SE 1

Any chronic condition ...... 12.1 0.6 10.0 0.6 7.3 0.3 Learning disability ...... 34.6 3.3 31.3 3.2 22.0 1.5 Attention Deficit/Hyperactivity Disorder ...... 30.7 3.5 26.4 2.8 19.9 1.4 Other mental, emotional, or behavioral problem ...... 23.8 2.7 17.7 2.1 10.7 1.0 Mental retardation or other developmental problem .... 15.4 2.2 13.2 2.0 9.0 0.9 Asthmaorbreathingproblem...... 11.1 2.1 5.7 1.3 4.3 0.6 Speech problem ...... 7.7 1.6 8.8 1.5 6.8 0.8

1SE is standard error. NOTES: Data are for noninstitutionalized adolescents. Adolescents with limitation of activity caused by chronic health conditions were either identified by current use of special education or by a limitation in their ability to perform activities usual for their age group because of a physical, mental, or emotional problem. Conditions refer to response categories in the National Health Interview Survey. The selected health conditions are classified as chronic in this analysis. These conditions are not mutually exclusive: adolescents who were reported to have more than one chronic health condition as the cause of their activity limitation were counted in each reported category. Persons of Hispanic origin may be of any race. The income groups are derived from the ratio of the family’s incometo the federal poverty threshold, given family size. Poor families have income less than 100 percent of the poverty threshold; near poor families have income from 100 to less than 200 percent of the poverty threshold; nonpoor families have income of 200 percent of the poverty threshold or more. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Adolescent Health in the United States, 2007 91 Data Tables for Figures 1–40 the SOURCE: N poverty N P M of of are Data SOURCE: N Hispanic Charts: Charts: A 92 1 Data 1 2003–2004 2001–2002 1999–2000 1988–1994 1976–1980 1971–1974 1966–1970 Data NOTES: NOTES: Hispanic years SE SE oor lrcsadorigins and races ll onpoor ear ot exican Blackonly...... Whiteonly...... examination examination poverty derived is is Hispanic: on poor ...... standard standard United United table table threshold; Race Overweight Overweight origins, 1966–1970 ...... Centers Centers ...... threshold from ...... origin, and States. States. at at for for error. error. the not mobile mobile Race near Ethnicity; for for ratio just is is Figure Figure or Advance Advance Disease Disease defined defined poor Poverty ...... more. and and examination examination those Year of through the estimates families Hispanic shown as as Control Control poverty data data 5b. 5a. family’s status body body from from have center. center. Overweight Overweight separately. are 2003–2004 and and mass mass origin income vital vital income for Prevention, Prevention, status: Estimates Estimates index index persons and and to The from the health health (BMI) (BMI) two federal who United National 100 National for for among among statistics; statistics; at at non-Hispanic females females reported to or or poverty less above above Center Center States, than exclude exclude adolescents adolescents no no only the the threshold, 314. 314. for for race 200 one edr and gender- and gender- Health Health Percent pregnant pregnant Hyattsville, Hyattsville, percent categories 17.0 16.3 18.2 20.0 Percent 17.7 17.9 17.9 racial average given Percent Statistics, Statistics, All 17.4 16.7 14.9 10.5 group. of 5.0 6.1 4.6 adolescents. adolescents. adolescents family age-specific age-specific 12–19 12–19 the Maryland: Maryland: shown Male Persons annual poverty National National size. in years years the National National All Poor threshold; 95th 95th of Health Health races table SE 2001–2004 Mexican 1.8 1.4 1.5 1.5 1.4 1.7 1.2 SE families percentile percentile 1 of of Center Center conform category and and nonpoor age: age, Adolescent origin have Nutrition Nutrition for for BMI BMI to includes may Health Health by United income the families cutoff cutoff Examination Examination 1997 be gender, Percent Health Statistics. Statistics. 17.1 23.8 14.6 16.0 points points of less adolescents have OMB any States, than in from from income race. Standards the Female race Survey Survey. 2000. 2000. SE 100 1.7 1.1 0.9 0.9 0.5 0.6 0.3 the the The of United 1 percent selected of all Age Age 2000 2000 and income 200 races for is is States, CDC CDC percent Federal o at at SE fthe 1.7 1.6 2.0 1.5 and groups the the Growt Growt 1 2007 time time of h h Data

Tables

Data table for Figure 6. Untreated dental caries among adolescents 12–19 years of age and young adults for 20–24 years of age, by age, race and Hispanic origin, poverty status, and gender: United States, average annual 2001–2004 Figures 12–15 years 16–19 years 20–24 years Race and Hispanic origin, poverty status, and gender Percent SE 1 Percent SE 1 Percent SE 1 Total...... 16 1.2 21.2 1.7 29.9 2.4 1–40 Not Hispanic: Whiteonly ...... 13.3 2.0 17.0 2.1 25.5 3.8 Blackonly ...... 20.5 1.7 30.4 2.3 41.0 4.3 Mexican ...... 22.0 2.6 27.9 2.3 35.4 4.3 Poor ...... 26.1 3.4 28.8 3.2 34.6 5.9 Near poor ...... 22.6 2.4 27.3 3.4 33.4 3.7 Nonpoor ...... 10.0 1.2 13.5 1.6 22.6 3.3 Male ...... 15.2 1.4 22.4 1.8 32.9 3.2 Female ...... 16.8 1.8 19.9 2.3 27.2 2.8

1SE is standard error. NOTES: Untreated dental caries refers to untreated coronal caries, that is caries on the crown or enamel surface of the tooth. Root caries are not included. Total category includes adolescents of all races and Hispanic origins, not just those shown separately. The two non-Hispanic race categories shown in the table conform to the 1997 OMB Standards for Federal Data on Race and Ethnicity; estimates are for persons who reported only one racial group. Persons of Mexican origin may be of any race. The income groups are derived from the ratio of the family’s income to the federal poverty threshold, given family size. Poor families have income less than 100 percent of the poverty threshold; near poor families have income from 100 to less than 200 percent of the poverty threshold; nonpoor families have income of 200 percent of the poverty threshold or more. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey.

Adolescent Health in the United States, 2007 93 Data Tables for Figures 1–40 Hispanic Hispanic Black All Black White White 94 1 Data Hispanic All subset NOTES: Black All White a gender, SOURCE: SE doctor 11th 10th 9th 12th 11th 10th 9th 12th 11th 10th 9th 12th students, students, students, is grade...... grade...... grade...... standard only, only, only, of only, only, only, table grade grade grade grade grade grade grade grade grade or Response those ...... Centers nurse. and not not not not not not grades grades grades ...... Grade attempting for error. Hispanic Hispanic Hispanic Hispanic Hispanic Hispanic Students race for is Hispanic Figure for Disease 9–12 9–12 9–12 level, the and suicide with 12 ...... race, origin ...... Control 7. months an Hispanic had injurious Suicide and an and preceding injurious Prevention, suicide origin; ideation the suicide attempt survey. National United attempt. are and Among Percent also Center 17.9 12.2 16.9 14.8 16.8 17.3 17.9 16.9 10.4 11.3 3.2 2.0 2.1 7.6 7.3 1.6 2.2 2.3 3.0 2.3 5.4 7.8 9.1 8.4 An attempts All States, included students injurious for students Chronic in attempting suicide 2005 the among SE 0.5 0.4 0.2 0.8 1.1 0.5 0.3 0.4 0.3 0.4 0.2 0.9 0.8 0.6 0.9 0.9 0.8 1.1 0.5 0.6 0.8 0.7 0.8 0.4 Disease category Seriously 1 attempt suicide, Prevention ‘‘suicide students Injurious resulted considered Percent 13 12.4 12.2 12.0 11.9 11.6 11.9 11.9 Suicide 2.8 1.4 1.5 7.8 5.2 5.2 1.0 1.4 2.2 2.1 1.8 4.3 4.5 7.6 6.8 7.0 6.0 percent attempt.’’ and in suicide Male an Health in did attempt injury, suicide Adolescent grades Persons not attempt Promotion, poisoning SE report 0.7 0.6 0.3 1.2 1.4 0.6 0.3 0.4 0.5 0.6 0.2 0.8 0.8 1.1 1.3 0.6 1.1 0.9 0.7 1.1 1.0 1.0 1.4 0.5 1 of 9–12, Hispanic Health seriously Youth or overdose in Percent by origin Risk considering 14.9 10.8 14.1 10.8 24.2 17.1 21.5 18.0 21.6 23.0 23.9 21.8 11.0 the 3.7 2.6 2.7 9.8 9.3 2.2 2.9 2.4 4.0 2.9 6.5 grade Behavior United may that Female be was suicide. States, level, of Surve treated any SE 0.7 0.5 0.4 1.1 1.2 0.8 0.4 0.6 0.4 0.6 0.3 0.8 1.3 0.9 0.9 0.5 1.6 1.1 0.9 1.4 1.5 1.0 1.3 0.7 y. A race. 2007 1 by Data

Tables

Data table for Figure 8. Emergency department visit, hospital discharge, and death rates among for adolescents 10–19 years of age, by age and gender: United States, average annual 2002–2004

Male Female Figures

Age Rate SE 1 Rate SE 1

Emergency department visits Visits per 10,000 adolescents 10years ...... 2,552.4 165.0 2423.5 170.0 11years ...... 2,663.6 196.9 2,482.5 171.0 1–40 12years...... 2,945.7 192.6 2,144.1 170.7 13years ...... 2,487.1 178.2 2,305.8 137.4 14years...... 2,829.4 170.1 3,005.0 213.0 15years...... 2,972.0 168.4 2,833.9 175.3 16years...... 2,768.4 164.8 3,864.2 218.4 17years...... 3,060.0 192.2 4,423.7 233.6 18years...... 3,413.9 170.2 5,346.8 263.3 19years...... 3,482.0 192.3 5,444.4 276.2

Hospital discharges Discharges per 10,000 adolescents 10years ...... 245.8 27.3 190.8 26.6 11years ...... 234.5 24.1 234.6 31.4 12years...... 255.0 29.9 214.1 24.0 13years...... 255.0 28.5 271.5 29.2 14years...... 299.6 30.5 349.8 33.3 15years...... 342.8 33.2 477.3 36.3 16years...... 322.8 29.2 632.1 39.6 17years...... 331.6 24.9 863.9 46.6 18years...... 330.6 20.6 1078.8 54.7 19years...... 309.7 20.6 1362.0 64.6

Deaths Deaths per 10,000 adolescents 10years...... 1.7 0.0 1.3 0.0 11years...... 1.7 0.1 1.3 0.1 12years...... 2.2 0.1 1.4 0.1 13years...... 2.5 0.1 1.7 0.1 14years...... 3.2 0.1 2.0 0.1 15years...... 4.4 0.1 2.5 0.1 16years...... 7.2 0.1 3.7 0.1 17years...... 9.1 0.1 4.2 0.1 18years...... 12.0 0.1 4.8 0.1 19years...... 13.6 0.2 4.7 0.1

0.0 Quantity more than zero but less than 0.05. 1SE is standard error. NOTE: See ‘‘Technical Notes’’ for discussion of emergency department visits, hospital discharges, and death rates. SOURCES: Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey, National Hospital Discharge Survey, and National Vital Statistics System, Mortality File.

Adolescent Health in the United States, 2007 95 Data Tables for Figures 1–40 81 years 18–19 years 16–17 years 14–15 years 12–13 years 10–11 81 years 18–19 years 16–17 years 14–15 years 12–13 years 10–11 ORE etr o ies oto n rvnin ainlCne o elhSaitc,Ntoa optlAbltr eia aeSurvey. Care Medical Ambulatory Hospital National Statistics, Health for Center National Prevention, and Control Disease for Centers SOURCE: See NOTE: 96 1 Data years Ei tnaderror. standard is SE table of ‘ehia Notes’’ ‘‘Technical age, ...... for by Figure age Age o icsino mrec eatetvisits. department emergency of discussion for and 9. Female and Male Initial gender: gender emergency United States, department average visit annual rates 1, 1, 1, 1, 1, 1, 1, 1, for Rate 2002–2004 403.3 329.3 179.0 839.2 949.7 608.9 539.0 606.3 502.0 295.7 injury iispr1,0 adolescents 10,000 per Visits Adolescent among Injury Health adolescents in the United 95.0 80.0 85.6 69.0 78.4 88.0 86.7 91.9 88.9 72.5 SE 10–19 1 States, 2007 Data

Tables

Data table for Figure 10. Initial emergency department visit rates for selected external causes of injury for among adolescents 10–19 years of age, by age and gender: United States, average annual 2002–2004

Male Female Figures

Age and cause of injury Rate SE 1 Rate SE 1

Struck by or against Visits per 10,000 adolescents 10–11 years ...... 363.9 38.5 163.5 25.2 12–13 years ...... 456.9 42.8 171.8 25.6 1–40 14–15 years ...... 558.2 48.1 287.0 41.8 16–17 years ...... 435.2 42.1 252.9 33.7 18–19 years ...... 435.9 40.2 221.3 31.9

Cut or pierce 10–11 years ...... 92.4 19.5 77.3 17.0 12–13 years ...... 97.1 16.9 43.5 9.9 14–15 years ...... 168.7 25.4 60.8 12.0 16–17 years ...... 126.3 18.5 109.8 20.4 18–19 years ...... 207.7 29.3 69.7 14.5

Fall 10–11 years ...... 250.1 27.3 260.4 29.0 12–13 years ...... 322.9 34.5 209.0 26.9 14–15 years ...... 280.9 30.6 216.4 27.6 16–17 years ...... 240.6 34.8 185.1 28.2 18–19 years ...... 195.2 25.3 169.3 28.6

Motor vehicle traffic 10–11 years ...... 96.4 21.2 66.1 16.4 12–13 years ...... 76.5 14.2 70.0 17.5 14–15 years ...... 80.7 18.3 141.9 23.5 16–17 years ...... 262.6 35.2 316.5 35.9 18–19 years ...... 247.3 38.6 390.6 42.4

1SE is standard error. NOTE: See ‘‘Technical Notes’’ for discussion of emergency department visits. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey.

Adolescent Health in the United States, 2007 97 Data Tables for Figures 1–40 ORE etr o ies oto n rvnin ainlCne o elhSaitc,Ntoa optlAbltr eia aeSurvey. Care Medical Ambulatory Hospital National Statistics, Health for Center National Prevention, and Control Disease for Centers SOURCE: See NOTE: 98 1 Data 81 years 18–19 years 16–17 years 14–15 years 12–13 years 10–11 years 18–19 years 16–17 41 years 14–15 years 12–13 years 10–11 81 years 18–19 years 16–17 years 14–15 years 12–13 years 10–11 years 18–19 years 16–17 years 14–15 years 12–13 years 10–11 adolescents Ei tnaderror. standard is SE table ‘ehia Notes’’ ‘‘Technical Age ...... for pan n strains and Sprains 10–19 and pnwounds Open Figure Contusions Fractures injury years o icsino mrec eatetvisits. department emergency of discussion a for diagnosis 11. Initial of age, emergency by age and department gender: 297.3 303.4 321.2 267.0 157.6 161.6 148.8 351.9 305.7 204.7 237.3 298.3 263.8 226.4 305.1 475.5 322.7 316.1 343.0 340.8 Rate United Male visit rates States, iispr1,0 adolescents 10,000 per Visits 33.8 34.9 38.8 33.8 26.1 23.5 23.2 34.8 38.1 26.0 30.5 34.8 30.8 27.4 37.5 45.9 35.0 30.6 34.0 44.3 SE 1 for average selected Adolescent annual injury 386.9 358.6 364.7 215.4 172.8 120.1 165.3 263.5 249.3 219.1 169.5 193.7 163.3 171.8 132.0 123.7 176.5 116.6 Rate 80.4 85.3 Health 2002–2004 diagnoses Female in the United among States, 20.5 45.2 51.8 49.3 26.1 29.7 21.6 18.2 21.8 26.1 40.9 34.2 26.6 27.3 32.2 21.8 26.6 24.2 22.5 25.2 SE 1 2007 Data

Tables

Data table for Figure 12. Emergency department visit rates for selected noninjury diagnoses among for adolescents 10–19 years of age, by age and gender: United States, average annual 2002–2004

Male Female Figures

Age and diagnosis Rate SE 1 Rate SE 1

Upper respiratory infections Visits per 10,000 adolescents 10–11 years ...... 268.4 45.6 311.7 37.5 12–13 years ...... 163.4 22.9 292.7 35.7 1–40 14–15 years ...... 196.9 31.9 244.2 33.8 16–17 years ...... 181.3 25.5 288.3 41.7 18–19 years ...... 223.2 33.0 345.5 37.7

Asthma 10–11 years ...... 94.0 21.1 66.6 15.2 12–13 years ...... 57.3 15.2 52.4 13.7 14–15 years ...... 61.7 15.0 61.8 13.8 16–17 years ...... 75.9 20.3 90.0 24.0 18–19 years ...... 42.7 11.7 65.0 15.3

Abdominal symptoms 10–11 years ...... 156.1 24.8 222.2 30.4 12–13 years ...... 138.4 24.3 154.0 26.1 14–15 years ...... 73.6 17.3 209.3 28.8 16–17 years ...... 91.0 22.0 301.3 34.7 18–19 years ...... 133.4 21.5 377.1 41.0

Sexually transmitted diseases 10–11 years ...... * * * * 12–13 years ...... * * * * 14–15 years ...... * * * * 16–17 years ...... * * 61.4 14.8 18–19 years ...... * * 134.0 23.8

Urinary tract infections 10–11 years ...... * * 77.0 21.2 12–13 years ...... * * * * 14–15 years ...... * * 77.1 17.8 16–17 years ...... * * 145.6 26.1 18–19 years ...... * * 386.6 49.1

Pregnancy-related diagnoses 10–11 years ...... * * 12–13 years ...... * * 14–15 years ...... 54.4 13.8 16–17 years ...... 162.7 21.8 18–19 years ...... 493.0 51.2

* Figure does not meet standards of reliability or precision; relative standard error is greater than 30 percent. . . . Category not applicable. 1SE Standard error. NOTE: See ‘‘Technical Notes’’ for discussion of emergency department visits. SOURCE: Centers for Disease Control and Prevention. National Center for Health Statistics, National Hospital Ambulatory Medical Care Survey.

Adolescent Health in the United States, 2007 99 Data Tables for Figures 1–40 21–24 18–19 16–17 14–15 12–13 10–11 SOURCE: external 14–20 18–19 16–17 14–15 12–13 10–11 indicated, 100 1 * Data 1 * Data . NOTES: NOTES: years diagnoses SOURCE: ‘‘Technical 2002–2004 annual SE SE . Figure Figure . 18–20 14–17 Category is is standard standard years years years years years years years years years years years years table table does does cause-of-injury Cause-specific Rates of the years years Centers Centers Notes’’ 2002–2004 age not not not physician’s Gender ...... are for for error. error. among ...... applicable. meet meet for for for for and Female Figure Figure discussion Male Age Disease Disease the standards standards code hospital and diagnosis young civilian adolescents was age Control Control 14. 13. discharge of noninstitutionalized of of present hospital was reliability reliability adults Alcohol-related Short-stay and and alcohol-related (ICD–9–CM data diagnoses. Prevention, Prevention, or or 21–24 10–19 are precision; precision. defined population. hospital E710 (ICD–9–CM National National Rate 80.7 70.4 60.0 39.3 32.9 42.4 40.6 33.0 18.5 17.5 149.8 127.7 years Total years 49.0 82.1 relative based or emergency E860), Injury Center Center An of of standard on discharge 291, emergency the or age, age, for for 303, SE the first-listed 6.1 5.8 5.7 4.9 5.1 4.7 3.9 3.9 2.6 3.1 Health Health 12.5 13.4 SE error Emergency 1 6.5 6.7 patient’s by by 305.0, 1 department department is Statistics, Statistics, age age rates greater diagnosis. 425.5, Discharges reason group and 239.5 256.8 260.9 215.7 207.2 303.6 338.5 314.5 220.0 195.1 Rate department than 535.30, visit for National National 184.0 148.8 Male for 64.7 99.9 Non-injury Noninjury gender: 30 was the injury, visit per and percent. 571.1–.3, visit considered Hospital Hospital 10,000 visits rates was discharges gender: 15.8 21.9 27.1 24.5 20.5 19.8 26.2 29.2 23.6 25.6 SE non-injury, United alcohol-related. 760.71, Ambulatory Discharge per Adolescent 1 18.5 20.1 10.7 SE adolescents alcohol-related 9.6 among 10,000 1 exclude 980, United States, Survey. Medical or population Health and adolescents pregnancy-related V-113), 874.1 368.5 Rate . . . . . 65.3 if Female . . . . . Pregnancy-related * * States, 106.1 the 115.8 . . . . . *32.5 Care average 63.7 in pregnancy-related an checkbox the Survey. alcohol-related United average diagnoses. for annual 14–20 States, alcohol 45.9 20.3 SE . . . . . 6.9 * * 18.5 17.4 SE . . . . . 7.3 8.4 . . . . . 1 related 1 2007 was See Data

Tables

Data table for Figure 15. Short-stay hospital discharge rates for selected diagnoses among adolescents for 10–19 years of age, by age and gender: United States, average annual 2002–2004

Male Female Figures

Gender and age Rate SE 1 Rate SE 1

Asthma Discharges per 10,000 adolescents 10–11 years ...... 17.7 3.3 13.9 2.9 12–13 years ...... 18.7 3.7 10.0 1.8 1–40 14–15 years ...... 8.7 1.5 8.6 2.1 16–17 years ...... 7.7 1.9 11.3 1.8 18–19 years ...... 5.4 1.3 6.7 1.4

Psychoses 10–11 years ...... 15.9 4.0 11.7 3.7 12–13 years ...... 26.9 6.4 42.2 10.6 14–15 years ...... 43.3 9.5 78.2 15.5 16–17 years ...... 53.7 10.5 70.8 11.9 18–19 years ...... 52.8 6.6 54.9 7.8

Fractures 10–11 years ...... 13.8 2.5 7.0 1.4 12–13 years ...... 16.0 2.2 6.3 1.3 14–15 years ...... 22.4 3.7 3.7 1.0 16–17 years ...... 18.0 2.6 7.4 1.4 18–19 years ...... 25.1 2.9 9.9 2.6

Poisoning 10–11 years ...... * * * * 12–13 years ...... * * 4.1 1.0 14–15 years ...... 4.5 1.1 17.5 2.5 16–17 years ...... 7.3 1.3 17.1 2.4 18–19 years ...... 8.4 1.5 16.1 2.4

* Figure does not meet standards of reliability or precision; relative standard error is greater than 30 percent. 1SE is standard error. NOTES: Diagnoses-specific hospital discharge data are based on the first-listed diagnosis. See ‘‘Technical Notes’’ for discussion of hospital diagnoses. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Hospital Discharge Survey.

Adolescent Health in the United States, 2007 101 Data Tables for Figures 1–40 20–24 19 18 17 16 15 14 13 12 11 10 SOURCE: 20–24 19 18 17 16 15 14 13 12 11 10 102 1 * Data NOTE: adolescents average SE Figure years years years years years years years years years years years years years years years years years years years years is standard See Gender years years table does ...... Centers ...... ‘‘Technical Female annual not Male ...... for error. and meet for 10–19 Figure age Disease Notes’’ standards 2002–2004 years for Control 16. discussion of reliability Death 100.6 112.0113.7 of Rate and 27.8 31.4 33.6 29.6 25.7 15.6 10.6 73.0 55.8 30.8 20.9 13.9 11.5 7.5 5.4 4.9 5.1 8.0 7.8 All age Prevention, of or injury cause rates precision; and SE 0.3 0.7 0.8 0.7 0.7 0.5 0.4 0.3 0.3 0.3 0.3 0.6 1.3 1.1 0.9 0.7 0.6 0.5 0.4 0.4 0.4 1.3 of 1 National young for death there injury, coding. Rate 18.9 23.4 26.3 23.6 20.6 61.6 65.6 46.5 36.7 19.0 14.1 60.9 11.3 Center are 7.7 5.6 4.4 4.1 4.4 9.6 8.9 6.6 6.5 Unintentional adults fewer by for than Health intent 20–24 SE 0.2 0.6 0.7 0.6 0.6 0.4 0.4 0.3 0.3 0.3 0.3 0.4 1.0 0.9 0.8 0.5 0.5 0.4 0.4 0.3 0.3 1.0 Deaths 20 1 Statistics, deaths of years per Rate 20.5 19.5 15.5 11.2 injury in 3.5 3.1 3.1 2.9 2.8 2.4 1.7 1.1 0.5 9.1 5.7 3.7 2.5 1.3 0.7 0.6 * * National 100,000 this Suicide Injury of category. age, and SE Vital 0.1 0.2 0.2 0.2 0.2 0.2 0.2 0.1 0.1 0.3 0.6 0.4 0.4 0.3 0.2 0.2 0.1 0.1 0.1 0.5 * * adolescents 1 Statistics natural by Adolescent age Rate 26.6 26.2 14.3 22.4 4.4 4.0 3.6 2.7 1.9 1.7 1.0 0.7 0.5 0.6 0.5 9.2 5.4 2.7 1.4 1.0 0.5 0.6 Homicide System, causes and Health SE Mortality gender: 0.1 0.3 0.2 0.2 0.2 0.2 0.1 0.1 0.1 0.1 0.1 0.3 0.6 0.5 0.4 0.3 0.2 0.1 0.1 0.1 0.1 0.6 1 among in File. the Rate 20.1 15.6 14.4 26.8 22.3 17.3 15.9 13.4 10.1 19.6 11.9 11.3 11.4 11.0 United United Natural 9.8 9.6 9.5 8.2 7.6 8.2 8.6 9.2 States, cause States, SE 0.3 0.5 0.5 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.3 0.6 0.5 0.5 0.5 0.4 0.4 0.4 0.4 0.4 0.6 2007 1 Data

Tables

Data table for Figure 17. Death rates for motor vehicle traffic-related and firearm-related injuries among for adolescents 10–19 years of age and young adults 20–24 years of age, by age, gender, and race and Hispanic origin: United States, average annual 2002–2004 Figures Motor vehicle deaths Firearm-related deaths

Female Male Female Male Age, race, and Hispanic origin Rate SE 1 Rate SE 1 Rate SE Rate SE 1 1–40 Deaths per 100,000 adolescents 10years ...... 2.9 0.2 3.3 0.2 * 0.1 0.6 0.1 11years ...... 2.6 0.2 3.3 0.2 0.4 0.1 0.6 0.1 12years ...... 2.5 0.2 4.5 0.3 * 0.1 1.5 0.2 13years ...... 3.8 0.2 5.3 0.3 0.6 0.1 2.3 0.2 14years ...... 5.8 0.3 8.4 0.4 1.0 0.1 4.4 0.3 15years ...... 9.2 0.4 12.5 0.4 1.7 0.2 8.1 0.4 16years ...... 17.9 0.5 27.3 0.7 2.1 0.2 13.8 0.5 17years ...... 20.6 0.6 35.1 0.7 3.1 0.2 19.0 0.5 18years ...... 22.6 0.6 44.9 0.8 3.1 0.2 29.0 0.7 19years ...... 19.3 0.6 45.9 0.9 3.4 0.2 35.4 0.7 20–24 years ...... 13.8 0.2 39.9 0.4 4.0 0.1 36.1 0.3

Ages 10–19 years Allraces and origins...... 10.6 0.1 18.8 0.2 1.6 0.1 11.3 0.1 White only, not Hispanic ...... 12.5 0.2 20.6 0.2 1.2 0.1 6.3 0.1 Black only, not Hispanic ...... 6.8 0.3 13.3 0.4 3.3 0.2 30.2 0.6 Hispanic ...... 7.3 0.3 18.6 0.4 1.5 0.1 14.0 0.4 AmericanIndian or Alaska Native ...... 17.6 1.4 26.4 1.7 3.3 0.6 13.1 1.2 Asian or Pacific Islander ...... 5.6 0.5 9.9 0.6 0.8 0.1 5.0 0.4

* Figure does not meet standards of reliability or precision; there are fewer than 20 deaths in this category. 1SE is standard error. NOTES: See ‘‘Technical Notes’’ for discussion of cause of death coding. Persons of Hispanic origin may be of any race. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Mortality File.

Adolescent Health in the United States, 2007 103 Data Tables for Figures 1–40 1991 1985 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1990 1989 1988 1987 1986 21 years 12–15 61 years 16–19 years 20–24 years 16–19 years 12–15 104 assault. Survey. sexual Victimization and Crime rape, National robbery, Statistics, assault, Justice aggravated of and Bureau simple Justice, include of crimes Department Violent U.S. available. SOURCE: not are errors Standard NOTES: Data assault. Survey. sexual Victimization and Crime rape, National robbery, Statistics, assault, Justice aggravated of and Bureau simple Justice, include of population. crimes Department sample Violent U.S. the available. SOURCE: in not events are 10 errors than Standard fewer NOTES: on based is Estimate * Data 2005 2004 02 years 20–24 young young ...... table table adults adults ...... Gender for for 20–24 20–24 Figure Figure Female and Male Year age years years 18b. 18a. group Violent Violent of of age, age, crime crime by by age gender, victimization victimization group: Total 34.1 36.8 44.5 54.7 64.7 41.6 age 12–15 101.1 113.1118.6 115.5 111.0 United 51.6 44.4 55.1 60.1 74.4 82.5 87.9 95.0 94.5 92.5 83.7 87.2 77.1 79.6 44.0 49.7 group, years rates rates assault Simple itmztospr100prosi g group age in persons 1,000 per Victimizations itmztospr100prosi g group age in persons 1,000 per Victimizations 25.1 22.0 26.7 32.3 49.4 29.2 States, and among among type 1985–2005 Type of Aggravated adolescents adolescents 16–19 assault Age victimization: of 12.9 16.0 4.1 6.6 8.2 6.0 102.8 106.6 123.9 103.7 122.6 114.2 victimization 99.1 53.1 58.3 55.9 64.4 77.5 91.3 96.3 98.2 95.9 92.4 80.8 89.4 44.3 46.0 groups years Adolescent 12–19 12–19 Robbery Health 4.2 6.4 0.4* 3.1* 7.2 2.0* United years years in the States, 20–24 United of of 100.4 103.6 Rape/sexual 86.1 43.5 47.6 44.9 49.5 68.7 67.5 68.0 91.6 78.8 80.2 85.5 80.1 82.0 74.5 85.8 95.2 47.1 43.2 age age years assault States, 0.6* 0.0* 4.5 5.1 0.0* 4.4 2004 and and 2007 Data

Tables

Data table for Figure 19. Dating violence and being forced to have sexual intercourse among students in for grades 9–12, by grade level, gender, and race and Hispanic origin: United States, 2005

All students Male Female Figures Grade level, race, and Hispanic origin Percent SE 1 Percent SE 1 Percent SE 1

Dating violence All students, grades 9–12 ...... 9.2 0.3 9.0 0.4 9.3 0.4 9thgrade ...... 7.4 0.5 7.0 0.9 7.7 0.7 1–40 10thgrade ...... 8.7 0.6 7.8 0.8 9.7 0.9 11thgrade ...... 9.9 0.7 10.4 0.9 9.4 1.0 12thgrade ...... 11.1 0.6 11.4 0.8 10.7 0.9 White only, not Hispanic ...... 8.2 0.4 8.0 0.5 8.5 0.5 Black only, not Hispanic ...... 11.9 0.9 11.8 1.1 12.0 1.1 Hispanic ...... 9.9 0.7 10.9 1.0 9.0 1.0

Forced intercourse All students, grades 9–12 ...... 7.5 0.4 4.2 0.4 10.8 0.6 9thgrade ...... 6.1 0.4 3.5 0.6 8.7 1.0 10thgrade ...... 7.2 0.6 3.8 0.7 10.7 0.8 11thgrade ...... 7.9 0.8 4.2 0.6 11.6 1.4 12thgrade ...... 9.0 0.7 5.3 0.5 12.7 1.3 White only, not Hispanic ...... 6.9 0.4 3.1 0.4 10.8 0.8 Black only, not Hispanic ...... 9.3 0.5 7.1 1.2 11.5 1.2 Hispanic ...... 7.8 0.7 6.4 0.9 9.4 1.1

1SE is standard error. NOTES: Dating violence is the percentage of students who were hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend during the past 12 months; forced intercourse is the percentage of students who have ever been physically forced to have intercourse when they did not want to. Persons of Hispanic origin may be of any race. SOURCE: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Youth Risk Behavior Survey.

Adolescent Health in the United States, 2007 105 Data Tables for Figures 1–40 Stat SOURCE: for WD, abstinence, includes emergency methods Anymethod...... 106 1 Data NOTES: who NomethodDual and SE Pill Condom te omnlmethod hormonal Other Hispanic is 23(24). Dawson methods race (oral standard have table pill Estimates (i.e., Contraceptive Centers contraception, and ...... use 2004. adolescents contraceptive) BS...... and withdrawal, had last for error. ‘‘other’’ (hormonal alone Teenagers for do intercourse Hispanic Figure sexual Disease not or methods). did in IUD, and add use combination not and in ...... contraceptive to sterilization, Control the during 20. meet intercourse 100%. condom) Categories origin: United Contraceptive standards and Data with States: Prevention, female .... patch. any are United are of other not not Sexual condom, precision Total in shown mutually Percent method. the All National column States, 83.2 34.2 54.3 16.8 19.5 activity, 9.1 races use diaphragm, separately and past exclusive. Other Center shows reliability, contraceptive and among 2002 3 hormonal origins months, persons for for cervical Condom SE 2.2 3.0 3.0 2.2 2.5 1.8 ‘‘other and Health never-married 1 Sexually use, are of includes cap, methods,’’ Statistics, includes sexual other not and by spermicidal shown. or active childbearing, Depo-Provera White specified Percent intercourse condom unknown 89.7 40.7 60.8 10.3 22.5 which National 8.0 never-married only, foam, include use female race Survey 2002. not T jelly, alone in method injectable, and all the Hispanic National cream, of other or origin adolescents Adolescent SE past Family 2.0 3.7 3.3 2.0 3.0 2.0 females in 1 methods combination Lunelle or groups, used 3 Center suppository, Growth. months who T Health besides for injectable, not at Abma Black had Health with Percent shown last 74.8 27.8 49.9 25.2 23.3 18.6 15–19 sponge, in any condom JC, the only, Statistics. Norplant intercourse separately. other Martinez United periodic years not and method implants, Hispanic V hormonal States, ital GM, Estimates SE of 5.8 6.2 6.1 5.8 5.3 4.7 Health . Pill Mosher 1 age 2007 Data

Tables

Data table for Figure 21a. Pregnancy rates among adolescents 15–19 years of age, by outcome of pregnancy: United States, 1990–2002 for

Live Induced Fetal Figures Year Pregnancy birth abortion loss

Per 1,000 female adolescents 1990 ...... 116.8 59.9 40.3 16.6 1991 ...... 116.4 61.8 37.4 17.2 1992 ...... 112.3 60.3 35.2 16.8 1–40 1993 ...... 109.4 59.0 33.9 16.5 1994 ...... 106.1 58.2 31.6 16.3 1995 ...... 101.1 56.0 29.4 15.7 1996 ...... 97.0 53.5 28.6 15.0 1997 ...... 92.7 51.3 27.1 14.3 1998 ...... 90.1 50.3 25.8 14.0 1999 ...... 86.9 48.8 24.7 13.5 2000 ...... 84.8 47.7 24.0 13.1 2001 ...... 80.6 45.3 22.8 12.4 2002 ...... 76.4 43.0 21.7 11.8

NOTES: Standard errors are not available. See ‘‘Technical Notes’’ for discussion of pregnancy rate estimation. SOURCE: Ventura SJ, Abma JC, Mosher WD, Henshaw SK. Recent Trends in Teenage Pregnancy in the United States, 1990–2002. Health E-stat. National Center for Health Statistics. 2006.

Data table for Figure 21b. Pregnancy rates among adolescents 15–19 years of age, by outcome of pregnancy, age, and race and Hispanic origin: United States, 2002

Live Induced Fetal Race, Hispanic origin, and age Pregnancy birth abortion loss

Per 1,000 female adolescents White, not Hispanic 15–17 years ...... 25.1 13.1 7.4 4.6 18–19 years ...... 85.3 51.9 21.0 12.4

Black, not Hispanic 15–17 years ...... 88.4 41.1 33.1 14.2 18–19 years ...... 217.0 110.3 80.2 26.4

Hispanic 15–17 years ...... 85.1 50.7 16.8 17.6 18–19 years ...... 210.9 133.0 46.2 31.8

NOTES: Standard errors are not available. Persons of Hispanic origin may be of any race. See ‘‘Technical Notes’’ for discussion of pregnancy rate estimation. SOURCE: Ventura SJ, Abma JC, Mosher WD, Henshaw SK. Recent Trends in Teenage Pregnancy in the United States, 1990–2002. Health E-stat. National Center for Health Statistics. 2006. [cited 2007 August 1]. Available from: www.cdc.gov/nchs/products/pubs/pubd/hestats/teenpreg1990-2002/ teenpreg1990-2002.htm.

Adolescent Health in the United States, 2007 107 Data Tables for Figures 1–40 SOURCE: NOTES: T T * T T T T 108 0.0 Data years otal...... otal otal...... otal...... otal...... otal...... Figure eodadhigher and Second is birth First higher and Second birth First higher and Second birth First higher and Second eodadhigher and Second birth First birth First higher and Second birth First Quantity ...... table does American Live of Centers more age, ...... births not Asian for Birth White, Black, meet than for with Hispanic Indian by Figure or Disease order, standards All Hispanic zero unknown ...... Pacific not not birth races or but Hispanic Hispanic race origin Alaskan Control 22. less Islander order, of birth and reliability than Birth and order Native 0.05. age Prevention, are or rates precision; distributed group, among National rates proportionally. and Center based adolescents race 10–14 *0.0 0.2 1.2 1.3 1.6 1.6 0.2 0.9 0.9 0.0 0.2 0.2 0.6 0.7 0.0 * * * on for fewer Persons and Health than Hispanic Statistics, of 10–19 20 Hispanic events Births National 15–17 43.7 49.7 32.6 37.1 26.2 30.0 12.0 19.7 22.1 11.1 origin years origin: are 7.9 0 0.8 8.9 5.8 4.2 3.7 2.2 per .9 considered may 1,000 Vital Age of be Statistics United in female age, of years Adolescent highly any System, and race. adolescents States, unreliable 18–19 133.5 103.9 22.9 94.8 72.9 29.6 38.1 30.2 38.7 24.6 61.8 87.0 48.7 52.3 70.0 17.3 6.5 9.7 young Health Birth and 2004 File. in are adults the not United shown. 20–24 20–24 165.3 126.9 109.7 101.7 States, 35.6 24.2 70.8 51.3 59.8 94.5 75.6 41.8 68.2 41.5 81.9 47.8 54.0 2007 Data

Tables

Data table for Figure 23. Sexually transmitted disease rates reported for adolescents 10–19 years of age for and for young adults 20–24 years of age, by age group, gender, and Hispanic origin: United States, 2004

Chlamydia Gonorrhea Figures Age group, race, and Hispanic origin Female Male Female Male

Reported cases per 100,000 adolescents 10–14 years ...... 132.0 10.8 36.9 5.8 White, not Hispanic ...... 50.7 1.9 10.0 0.7 1–40 Black, not Hispanic ...... 486.4 46.2 168.9 30.6 Hispanic ...... 113.6 12.5 17.8 2.6 American Indian or Alaska Native...... 210.1 26.6 27.2 5.7 Asian or Pacific Islander ...... 30.9 1.3 5.6 1.2 15–19 years ...... 2,761.5 458.3 610.9 252.9 White, not Hispanic ...... 1,408.8 147.4 201.7 37.9 Black, not Hispanic ...... 8,897.6 1,880.5 2,790.5 1,390.1 Hispanic ...... 2,810.1 485.6 307.6 124.7 American Indian or Alaska Native ...... 4,358.2 683.1 561.2 137.4 Asian or Pacific Islander...... 776.4 111.1 86.3 26.2 20–24 years ...... 2,630.7 744.7 579.1 430.6 White, not Hispanic ...... 1,434.6 354.3 209.3 90.7 Black, not Hispanic ...... 7,847.8 2,730.8 2,565.4 2,408.3 Hispanic ...... 2,924.4 685.3 291.4 193.7 American Indian or Alaska Native...... 4,672.4 1,144.6 612.8 304.6 Asian or Pacific Islander ...... 963.3 250.3 109.7 66.0

NOTES: Standard errors are not available. Persons of Hispanic origin may be of any race. SOURCE: Centers for Disease Control and Prevention, National Center for HIV, STD, and TB Prevention, STD Surveillance.

Adolescent Health in the United States, 2007 109 Data Tables for Figures 1–40 should infection SOURCE: been redistributed. category delays Male-to-malesexualcontact...... NOTES: neto rgue(IDU) use drug Injection 110 2 1 Data M a l e - t o - m a l es e x u a lc o n t a c ta n dI D U virus age, ihrs eeoeulcontact heterosexual risk High ihrs eeoeulcontact heterosexual risk High (IDU) use drug Injection identified not or Other te rntidentified not or Other Data Includes tested. for and be by table (HIV) only, Standard includes HIV/AIDS Puerto interpreted Centers Sex for gender: Data a redistribution and diagnosis for transmission Rico hemophilia, errors include for cases transmission Figure with and Disease Female United are Male ...... of are caution. persons Virgin ...... of HIV not blood from cases Control 24. available. Islands. infection HIV with 33 States ...... category transfusion, in Acquired categories states and surveillance persons a diagnosis and High ...... Prevention, with and a risk initially perinatal, later confidential reports of immunodeficiency heterosexual 33 AIDS HIV for National reported states and infection, may diagnosis, adolescents name-based risk 13–19 not Center (N without (N contact factor with =1,201) be regardless = 57 13 18 12 27 60 and 940) 9 3 representative years AIDS for an not is (United concurrent HIV confidential HIV, identified contact reported cases 13–19 infection of STD, syndrome AIDS

States with

risk and diagnoses reported or of status reporting a all not years 20–24 factor. TB (N (N

person 1 persons ) identified. =5,324) =2,708) Prevention, reporting, at 10 69 17 14 81 Cases 6 1 2 of years diagnosis. (AIDS) since known of HIV Percent infected age The without infection at to HIVAIDS least reported have, This and with and of 2001–2005 risk Adolescent 2001. cases and includes HIV or Human 13–19 Surveillance factor young (N (N case to AIDS. because =3,031) =2,441) be HIV/AIDS <1 <1 77 14 85 11 information counts persons 7 4 at years Data Health high adults immunodeficiency not System. (33 on are risk with all in HIV cases states adjusted were infected the for, a infection 20–24 diagnosi HIV United p 2 reported roportionally 20–24 ) (N (N for persons infection. =11,259) =5,586) sofHIV reporting (not States, <1 <1 75 14 12 85 years 8 5 years AIDS) have Other 2007 of Data

Tables

Data table for Figure 25a. Adolescents 15–19 years of age who have ever had sexual intercourse, by age for and gender: United States, 1988–2002 Figures 1988 1995 2002

Sex and age Percent SE 1 Percent SE 1 Percent SE 1 Male 15–17 years ...... 50.0 2.4 43.1 1.9 31.3 2.3 1–40 18–19 years ...... 77.3 2.6 75.4 2.7 64.3 3.1 Female 15–17 years ...... 37.2 2.4 38.0 1.8 30.3 2.1 18–19 years ...... 72.6 2.5 68.0 2.1 68.8 2.6

1SE is standard error. NOTE: Percentages reflect heterosexual vaginal intercourse only, not other types of sexual activity. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Survey of Family Growth. Abma JC, Martinez GM, Mosher WD, Dawson BS. Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2002. National Center for Health Statistics. Vital Health Stat 23(24). 2004.

Data table for Figure 25b. Ever had any sexual contact among adolescents 15–19 years of age and young adults 20–24 years of age, by type of contact, age, and gender: United States, 2002

Male Female

15–17 years 18–19 years 20–24 years 15–17 years 18–19 years 20–24 years

Type of sexual contact Percent SE 1 Percent SE 1 Percent SE 1 Percent SE 1 Percent SE 1 Percent SE 1

Opposite-sex sexual contact: Any sexual contact ...... 53.2 2.2 77.7 2.1 91.4 1.4 49.8 2.2 82.9 2 91.3 1.2 Vaginal ...... 36.3 2.4 65.5 3 87.6 1.7 38.7 2.1 73.8 2.3 87.3 1.5 Anyoral...... 44.0 2.2 69.5 2.3 82.3 1.8 42.0 2.3 72.3 2.6 83.1 1.5 Anal ...... 8.1 1.4 15.2 2.1 32.6 2.0 5.6 1.0 18.7 1.9 29.6 1.7 Same-sex sexual contact: Any sexual contact ...... 3.9 0.8 5.1 1.2 5.5 0.9 8.4 1.3 13.8 1.8 14.2 1.3

1SE is standard error. NOTES: Any oral sex includes given or received. Percent reporting specified types of sexual contact may add to more than the percent reporting ‘‘any sexual contact’’ because a respondent could report more than one type of sexual contact. Same-sex sexual contact is measured with substantially different questions for males and females. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Survey of Family Growth. Mosher WD, Chandra A, Jones J. Sexual behavior and selected health measures: Men and women 15–44 years of age, United States, 2002. Advance data from vital and health statistics: no 362. Hyattsville, MD: National Center for Health Statistics. 2005.

Adolescent Health in the United States, 2007 111 Data Tables for Figures 1–40 Stat Never-married 112 2 1 Never-married Data SOURCE: NOTES: WD, by SE Heterosexual Black 15–17 Hispanic Black 15–17 White 18–19 White 18–19 Hispanic is 23(24). age, Dawson standard Age, table Percentages only, only, only, only, years years years years Hispanic Centers gender, 2004...... BS. sex, vaginal not not not not for error...... females males Teenagers ...... for race, Hispanic Hispanic Hispanic Hispanic origin Figure may intercourse Disease and ...... and ...... not in add ...... race Control the 26. only, to United Number 100 and and not Percent due States: other 43.1 54.9 69.7 54.6 45.2 36.8 59.3 68.7 54.4 31.2 35.7 62.6 Prevention, Hispanic to types rounding. Sexual 0 of sexual of National SE 3.0 2.6 2.1 1.9 4.3 4.4 2.5 2.3 2.1 2.6 3.1 3.6 sexual activity, Persons 2 origin: Center activity. contraceptive partners Percent 17.3 13.7 17.7 17.4 18.9 15.3 13.3 15.5 23.9 18.5 17.5 20.6 of United Hispanic for 1 Health Number in use, origin SE 1.9 1.4 1.2 3.3 3.4 1.9 1.7 1.5 2.4 2.4 3.3 3.2 States, Statistics, lifetime 2 and may of childbearing, Percent sexual be 12.0 10.0 13.6 12.7 15.1 13.7 13.5 19.3 19.1 13.1 21.0 National 2002 9.2 of among any 2–3 1 partners race. Survey 2002. SE 1.4 1.4 1.0 2.6 3.1 1.6 1.5 0.9 1.9 2.0 2.3 3.1 adolescents 2 National of in Adolescent Family lifetime Percent 15.1 16.5 13.0 15.4 10.8 Center 7.8 4.5 7.9 6.8 4.8 9.4 5.4 Growth. 4–6 Health for 15–19 Abma Health SE 1.4 0.9 1.0 3.3 2.7 1.4 1.0 1.2 2.2 2.3 1.4 2.4 in 2 JC, the Statistics. years Martinez United Percent 12.8 12.6 11.3 7.9 2.2 6.3 9.6 5.0 4.0 7.2 1.5 4.5 7 or of V States, ital GM, more age, Health Mosher SE 1.3 0.8 0.9 2.3 2.6 1.0 0.7 0.8 1.9 1.7 0.9 1.8 2007 2 Data

Tables

Data table for Figure 27. Current cigarette smoking among students in grades 9–12, by gender, grade for level, and race and Hispanic origin: United States, 2005

All students Male Female Figures Grade level, race, and Hispanic origin Percent SE 1 Percent SE 1 Percent SE 1

Current smoker All students, grades 9–12 ...... 23.0 1.2 22.9 1.1 23.0 1.3 9thgrade ...... 19.7 1.2 18.9 1.6 20.5 1.5 1–40 10thgrade ...... 21.4 1.6 21.1 2.0 21.9 1.7 11thgrade ...... 24.3 1.6 24.2 1.5 24.3 2.1 12thgrade ...... 27.6 1.9 29.1 1.9 26.0 2.3 White only, not Hispanic ...... 25.9 1.5 24.9 1.4 27.0 1.9 Black only, not Hispanic ...... 12.9 0.9 14.0 1.3 11.9 0.9 Hispanic ...... 22.0 1.8 24.8 2.6 19.2 1.5

Frequent smoker All students, grades 9–12 ...... 9.4 0.8 9.3 0.8 9.3 0.8 9thgrade ...... 6.9 0.9 6.7 1.0 7.0 1.2 10thgrade ...... 7.7 0.9 7.0 1.1 8.4 1.1 11thgrade ...... 10.3 1.2 10.5 1.2 10.0 1.3 12thgrade ...... 13.2 1.3 13.9 1.4 12.5 1.7 White only, not Hispanic ...... 11.2 0.9 10.6 0.9 11.7 1.2 Black only, not Hispanic ...... 3.7 0.6 5.1 1.1 2.4 0.5 Hispanic ...... 6.5 1.0 8.1 1.5 4.7 1.1

1SE is standard error. NOTES: Current smokers are students who smoked cigarettes on one or more of the past 30 days; frequent smokers are students who smoked cigarettes on 20 or more of the past 30 days. Persons of Hispanic origin may be of any race. Data on cigarette use are also collected by the National Survey on Drug Use & Health (NSDUH) and Monitoring the Future Study (MTF). Rates of substance use measured by these surveys are not directly comparable. SOURCE: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Youth Risk Behavior Survey.

Adolescent Health in the United States, 2007 113 Data Tables for Figures 1–40 Not SOURCE: the Female days; Male...... at 12–20 114 1 * Data Hispanic NOTES: among 2005 SE Figure White Native American Black Hispanic Black White Hispanic Black White 18–20 16–17 14–15 12–13 Two Asian least Future is Hispanic all standard years table 1 or does ...... heavy Binge Gender, or only, only, Detailed only, only, day ...... years years years years Hawaiian Substance Study more adolescents African ...... not Indian in ...... alcohol not not alcohol not not for error...... the (MTF) races meet race, race Hispanic Hispanic Hispanic Hispanic past Characteristic American Figure or or Abuse use users standards and ...... Alaska Other 30 and and Age is the days. and are defined Hispanic 12–20 Hispanic ...... Pacific Youth 28. Native Mental also of ...... Heavy reliability Alcohol as binge Risk Islander ...... years Health drinking origin origin alcohol Behavior alcohol or Services precision; five use ..... of use, users. Survey or is age, defined more Administration binge relative Persons (YRBS). by drinks Percent as 32.3 28.7 23.7 21.7 19.0 17.6 31.9 27.5 27.9 20.4 32.6 28.9 51.1 30.1 15.1 28.2 25.9 12.0 24.0 15.5 4.2 age, standard Alcohol drinking alcohol of on Rates Hispanic (SAMHSA), the gender, five same error of use substance use, origin or SE 0.5 0.4 1.3 2.9 0.8 1.0 0.7 0.5 1.4 1.2 0.7 0.5 0.8 0.7 0.5 0.3 0.4 1.0 3.5 2.2 1.6 is occasion more 1 greater Office may and and drinks use of be (i.e., than race Applied heavy measured of Percent on at any 22.3 19.0 13.9 18.1 19.7 16.1 21.5 24.7 21.3 36.1 19.7 18.8 17.9 16.6 30 11.4 Binge 9.1 6.8 8.0 2.0 7.4 the * the percent. and race. Studies, same same alcohol alcohol by Data Hispanic these occasion time National Adolescent on use surveys or SE 0.5 0.4 1.0 2.6 0.6 0.7 0.6 0.4 1.3 1.0 0.7 0.5 0.8 0.6 0.4 0.2 0.4 0.9 2.1 1.1 alcohol * use within on 1 Survey each origin: in are use a Health couple the not on of are 5 Drug directly Percent or also in past United of 13.0 Heavy more 7.8 6.4 2.5 6.0 1.8 1.1 5.8 4.3 5.9 2.5 9.8 7.6 5.3 1.7 0.2 6.0 4.2 7.1 1.2 * the hours Use collected comparable. United 30 days and alcohol of States, each days Health. in by States, the Monitoring other) use SE 0.3 0.2 0.5 1.7 0.3 0.3 0.3 0.2 0.8 0.5 0.4 0.3 0.5 0.3 0.2 0.1 0.2 0.5 1.5 0.3 past * 1 2007 o 30 n Data

Tables

Data table for Figure 29a. Drinking and driving and seatbelt use among students in grades 9–12: for United States, 1991–2005

Rode with a driver who had Drove after drinking Rarely or never wore Figures been drinking alcohol alcohol (grades 11–12 only) a seatbelt as a passenger

Year Percent SE 1 Percent SE 1 Percent SE 1

1991 ...... 39.9 1.1 24.6 1.5 25.9 2.7 1993 ...... 35.3 1.3 19.6 1.4 19.1 1.3 1–40 1995 ...... 38.8 1.9 20.1 1.8 21.7 1.7 1997 ...... 36.6 1.1 22.7 2.4 19.3 1.8 1999 ...... 33.1 1.1 19.5 1.3 16.4 1.4 2001 ...... 30.7 1.0 19.3 1.2 14.1 0.8 2003 ...... 30.2 1.1 17.5 1.0 18.2 2.1 2005 ...... 28.5 1.0 14.5 0.9 10.2 0.9

1SE is standard error. NOTE: Rode with a driver who had been drinking alcohol is defined as students who during the past 30 days rode one or more times in a car or other vehicle driven by someone who had been drinking alcohol; and drove after drinking is defined as students who during the past 30 days drove a car or other vehicle one or more times when they had been drinking alcohol; rarely or never wore seatbelts is defined as students who rarely or never wore a seatbelt when riding ina car driven by someone else. SOURCE: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Youth Risk Behavior Survey.

Adolescent Health in the United States, 2007 115 Data Tables for Figures 1–40 SOURCE: car or driven All 116 1 Data All NOTES: Hispanic Hispanic not only, Black ht ny o Hispanic not only, White l tdns rds9–12 grades students, All Hispanic Hispanic not only, Black ht ny o Hispanic not only, White grade Hispanic Hispanic not only, Black ht ny o Hispanic not only, White SE 9thgrade...... 10thgrade...... 11thgrade...... 11thgrade...... 12thgrade...... 12thgrade...... 9thgrade...... 11thgrade...... 10thgrade...... 12thgrade...... more Grade students, students, driven is by standard table times Rode level, someone by ...... Centers level, someone when grades grades with for error. race gender, for who a they Figure driver Disease 9–12 11–12 else. and had had who ...... Persons been Hispanic ...... been and ...... Control 29b. had drinking drinking been race of and origin Drinking Hispanic drinking alcohol; Prevention, alcohol; and origin alcohol and Hispanic rarely and National may drove Percent 27.9 28.5 27.8 28.0 12.1 14.5 36.1 30.1 13.1 17.1 24.1 28.3 10.9 10.2 16.9 10.1 10.6 10.8 13.4 or is 8.6 7.5 9.4 driving be never defined after All of Center origin: students any drinking wore as Rode Rarely race. for and students seatbelts Chronic is with Drove United SE 1.3 1.0 1.3 1.5 0.9 0.9 1.7 1.2 1.4 1.2 1.1 1.3 0.9 1.0 0.9 1.0 1.0 1.4 1.1 1.0 1.7 1.1 defined seatbelt or 1 who a never is Disease driver after defined as during States, wore students drinking who use Prevention as the Percent a 25.8 27.2 26.2 27.7 14.7 16.9 37.4 29.5 17.5 19.2 24.3 26.2 13 12.5 10.9 18.7 13.2 12.5 14.1 17.7 11.5 students had 9.5 past seatbelt among who 2005 alcohol been 30 during Male and days who as Health drinking (grades students the rarely rode a Adolescent passenger SE past 1.7 1.0 1.5 1.9 1.2 1.1 2.3 1.5 2.2 1.4 1.3 1.3 1.2 1.3 1.1 1.7 1.3 1.8 1.2 1.4 2.4 1.4 Promotion, one or 1 alcohol 11 30 never or and days more Health in wore (grades 12 Youth (grades drove grades times only) Percent a in 30.1 29.6 29.5 28.1 12.2 34.7 30.7 15.0 24.0 30.4 15.1 seatbelt Risk 9.5 8.7 7.7 8.7 7.8 4.5 7.1 8.7 7.5 9.4 7.2 a the in 9–12) car 9–12) a Behavior United Female 9–12, car or when other or other States, riding Surve vehicle by SE 1.9 1.2 1.5 1.9 1.0 0.9 1.4 1.9 1.2 1.6 1.3 1.7 0.9 1.0 0.8 1.2 1.1 1.3 1.1 0.9 1.5 0.9 vehicle y. i na 1 2007 one Data

Tables

Data table for Figure 30. Marijuana use in the past month and lifetime marijuana use among students in for grades 9–12, by grade level, gender, and race and Hispanic origin: United States, 2005

All students Male Female Figures Grade level, race, and Hispanic origin Percent SE 1 Percent SE 1 Percent SE 1

Current marijuana use All students, grades 9–12 ...... 20.2 0.8 22.1 1.0 18.2 1.0 9thgrade ...... 17.4 1.2 18.6 1.6 16.2 1.4 1–40 10thgrade ...... 20.2 1.3 21.5 1.6 18.9 1.4 11thgrade ...... 21.0 1.2 23.5 1.6 18.5 1.5 12thgrade ...... 22.8 1.2 26.1 1.2 19.5 2.0 White only, not Hispanic ...... 20.3 1.1 21.3 1.3 19.2 1.4 Black only, not Hispanic ...... 20.4 1.1 22.1 1.5 18.8 1.5 Hispanic ...... 23.0 1.2 28.1 1.9 18.0 1.0

Lifetime marijuana use All students, grades 9–12 ...... 38.4 1.3 40.9 1.3 35.9 1.5 9thgrade ...... 29.3 1.5 30.9 1.8 27.8 1.7 10thgrade ...... 37.4 1.7 39.0 2.3 35.7 1.6 11thgrade ...... 42.3 1.9 45.1 2.0 39.4 2.4 12thgrade ...... 47.6 2.0 52.4 1.5 42.8 3.0 White only, not Hispanic ...... 38.0 1.6 40.0 1.7 36.0 1.9 Black only, not Hispanic ...... 40.7 1.6 43.8 1.9 37.8 2.3 Hispanic ...... 42.6 1.9 47.7 2.3 37.5 2.2

1SE is standard error. NOTES: Current marijuana use is defined as students who have used marijuana one or more times in the past 30 days; lifetime marijuana use is defined as students who used marijuana one or more times during their life. Persons of Hispanic origin may be of any race. Data on marijuana use are also collected by the National Survey on Drug Use & Health (NSDUH) and Monitoring the Future Study (MTF). Rates of substance use measured by these surveys are not directly comparable. SOURCE: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Youth Risk Behavior Survey.

Adolescent Health in the United States, 2007 117 Data Tables for Figures 1–40 Hispanic Hispanic not only, Black Hispanic not only, White 9–12 grades students, All Hispanic Hispanic not only, Black Hispanic not only, White 9–12 grades students, All OE:Wao arigicue arigawao uha u,kie rcu noeo oeo h at3 as esn fHsai rgnmyb of be may Surve origin Behavior Hispanic Risk Youth of Promotion, Persons Health days. and 30 Prevention past Disease the Chronic of for more Center or National one Prevention, on and club Control or Disease knife, for gun, Centers a SOURCE: as such weapon a race. carrying any includes carrying Weapon NOTES: 118 1 Data gender, Ei tnaderror. standard is SE 12thgrade...... 11thgrade...... 10thgrade...... 9thgrade...... 12thgrade...... 11thgrade...... 10thgrade...... 9thgrade...... Grade table ...... grade level, for Figure race, level, and ...... and 31. Hispanic race Weapon origin and carrying Hispanic Percent in 19.0 16.4 18.7 16.9 17.1 19.4 19.9 18.5 origin: 6.5 5.0 5.3 4.9 4.9 5.3 6.2 5.4 the All students past United 30 SE 0.8 0.5 0.7 0.6 0.6 0.6 0.6 0.4 1.1 0.8 1.1 0.9 1.1 1.2 1.2 0.8 days 1 States, among Percent 2005 are weapon a Carried 29.8 23.7 31.4 27.6 28.6 30.6 31.6 29.8 11.6 11.3 9.4 9.7 9.0 9.1 9.4 9.9 are gun a Carried students Male Adolescent SE 1.5 1.0 1.1 1.2 1.0 1.1 1.1 0.7 1.7 1.5 1.8 1.8 1.8 1.9 1.9 1.3 in 1 Health grades in Percent the 1.3 0.9 0.9 0.8 0.9 1.0 1.0 0.9 7.8 9.4 6.0 6.2 6.1 7.8 8.1 7.1 9–12, United Female by States, SE 0.8 1.0 0.5 0.9 0.7 0.9 0.9 0.4 0.2 0.3 0.2 0.3 0.3 0.4 0.2 0.4 y. 2007 1 Data

Tables

Data table for Figure 32. Participation in physical activity in the past 7 days among students in grades for 9–12, by grade level, gender, and race and Hispanic origin: United States, 2005

All students Male Female Figures

Grade level, race, and Hispanic origin Percent SE 1 Percent SE 1 Percent SE 1

Meeting currently recommended level of physical activity All students, grades 9–12 ...... 35.8 1.0 43.8 1.1 27.8 1.2 9thgrade...... 36.9 1.7 42.8 1.8 30.8 2.0 1–40 10thgrade...... 38.5 1.4 46.8 1.9 30.0 1.7 11thgrade ...... 34.4 1.3 43.8 1.6 25.1 1.5 12thgrade...... 32.9 1.6 41.9 1.8 24.0 1.7 White only, not Hispanic ...... 38.7 1.3 46.9 1.3 30.2 1.6 Black only, not Hispanic ...... 29.5 1.7 38.2 2.3 21.3 1.7 Hispanic ...... 32.9 1.6 39.0 2.0 26.5 1.8

Participation in moderate to vigorous physical activity All students, grades 9–12 ...... 68.7 0.8 75.8 0.9 61.5 1.2 9thgrade...... 73.5 1.3 78.4 1.5 68.4 2.1 10thgrade ...... 70.5 1.5 77.8 1.9 63.0 1.9 11thgrade...... 67.4 0.8 74.2 1.4 60.7 1.3 12thgrade...... 61.8 1.4 71.9 1.5 51.7 2.3 White only, not Hispanic ...... 70.2 1.1 77.0 1.2 63.3 1.5 Black only, not Hispanic ...... 62.0 1.4 71.7 1.9 53.1 1.8 Hispanic ...... 69.4 1.7 76.0 1.8 62.6 2.5

1SE is standard error. NOTES: Participation in the currently recommended level of physical activity for students is defined as any kind of physical activity that increased their heart rate and made them breathe hard some of the time for a total of at least 60 minutes per day on 5 or more of the past 7 days; moderate to vigorous physical activity is defined as participation in at least 20 minutes of vigorous physical activity on 3 or more of the past 7 days and/or at least 30 minutes of moderate physical activity on 5 or more of the past 7 days. Persons of Hispanic origin may be of any race. SOURCE: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Youth Risk Behavior Survey.

Adolescent Health in the United States, 2007 119 Data Tables for Figures 1–40 Hispanic SOURCE: Black All weight during Hispanic White All 120 1 Data Black White NOTES: grade SE 9th 11th 10th 9th 12th 11th 10th 12th students, students, is grade...... grade the standard only, only, Grade during only, only, table grade grade grade grade grade grade Went level, ...... past Centers not not not not the grades grades without level, ...... 30 for error...... Hispanic Hispanic Hispanic Hispanic past gender, days. for Figure race, eating Disease 30 9–12 9–12 Persons days; and ...... for ...... and Control vomited 33. 24 Hispanic of hours Hispanic race Dietary and or or took Prevention, origin more and origin laxatives risk is may Hispanic defined National behavior be is of defined as any Percent students Center 12.6 13.3 12.3 12.5 12.1 11.7 11.4 11.9 origin: race. 5.4 3.4 4.1 4.5 5.1 4.4 4.3 4.3 as All in students for students who the Chronic United went who past SE 0.5 0.5 0.4 0.3 0.6 0.6 0.4 0.6 0.5 0.8 0.7 0.5 0.9 0.7 0.9 0.8 without Disease vomited 1 30 States, eating Did days Prevention or Vomited not took Percent for 2005 eat 3.9 2.8 2.7 2.8 3.0 7.4 2.3 2.6 2.5 7.4 8.1 7.6 8.6 7.5 7.8 6.8 among laxatives 24 and hours for or Male Health 24 took to or Adolescent students hours lose more laxatives Promotion, SE 0.8 0.6 0.5 0.3 0.6 0.7 0.4 0.6 0.5 0.9 1.0 0.4 1.1 0.6 1.0 0.8 weight or to 1 lose more Health or in weight Youth to grades keep in Percent Risk or 17.7 16.2 18.4 17.0 14.0 17.6 16.0 17.2 the 6.8 4.0 5.5 6.2 7.2 6.7 5.9 6.1 from to Behavior United keep Female gaining 9–12, from States, Surve weight gaining by SE 0.6 0.8 0.7 0.4 0.9 1.0 0.6 0.9 0.7 1.0 1.1 1.1 1.2 1.2 1.3 1.4 y. 2007 1 Data

Tables

Data table for Figure 34. Current health care coverage among adolescents 10–19 years of age and for young adults 20–24 years of age, by age and poverty status: United States, 2005

Private health Figures Uninsured Medicaid insurance Other

Family income and age Percent SE 1 Percent SE 1 Percent SE 1 Percent SE 1 Poor 10–19 years ...... 20.1 1.2 55.5 1.7 22.7 1.9 1.7 0.4 1–40 10–12 years ...... 13.6 1.3 67.6 2.0 17.0 1.8 1.8 0.5 13–15 years ...... 19.0 1.6 61.3 2.2 18.1 2.0 1.5 0.5 16–17 years ...... 18.7 2.2 58.8 2.7 20.4 2.5 2.1 0.9 18–19 years ...... 30.6 3.3 30.5 2.9 37.5 4.8 1.4 0.6 20–24 years ...... 38.2 2.1 22.3 1.6 38.0 2.6 1.5 0.4

Near poor 10–19 years ...... 20.9 1.1 31.1 1.2 45.9 1.4 2.1 0.4 10–12 years ...... 16.8 1.5 36.5 1.9 43.6 2.1 3.1 0.8 13–15 years ...... 18.1 1.5 33.7 2.0 46.8 2.1 1.5 0.5 16–17 years ...... 19.2 1.8 30.2 2.2 49.5 2.4 1.1 0.5 18–19 years ...... 33.7 2.8 19.0 1.8 44.5 2.7 2.8 0.8 20–24 years ...... 41.8 1.6 12.3 1.2 43.4 1.9 2.5 0.5

Nonpoor 10–19 years ...... 7.7 0.4 5.6 0.4 84.5 0.6 2.2 0.2 10–12 years ...... 6.2 0.6 7.2 0.6 84.4 0.9 2.3 0.4 13–15 years ...... 6.5 0.6 5.4 0.6 85.9 0.8 2.2 0.3 16–17 years ...... 6.5 0.7 4.6 0.5 86.7 0.8 2.2 0.4 18–19 years ...... 13.6 1.0 4.5 0.6 79.8 1.2 2.2 0.4 20–24 years ...... 25.8 1.0 4.5 0.4 67.9 1.1 1.9 0.3

1SE is standard error. NOTES: Insurance status is at the time of interview. A person was defined as uninsured if he or she did not have any private health insurance, Medicare, Medicaid, State Children’s Health Insurance Program (SCHIP), state-sponsored or other government-sponsored health plan, or military plan at the time of the interview. A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service such as accidents or dental care. The health plan category ‘‘Medicaid’’ includes Medicaid, State Children’s Health Insurance Program (SCHIP), or state-sponsored health plan. A small number of persons were covered by both public and private plans and were included in the ‘‘private’’ health plan category. The health plan category ‘‘other’’ includes Medicare (disability), military plan, or other government-sponsored health plan. Poverty status is derived from the ratio of the family’s income to the federal poverty threshold, given family size. Poor families have income less than 100 percent of the poverty threshold; near poor families have income from 100 to less than 200 percent of the poverty threshold; nonpoor families have income of 200 percent of the poverty threshold or more. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Adolescent Health in the United States, 2007 121 Data Tables for Figures 1–40 Uninsured...... Publicinsuranceonly...... n rvt insurance private Any Hispanic Hispanic not only, Black ht ny o Hispanic not only, White Female Male...... visits Insurance insurance 02 years 10–21 122 1 Data 1 origins and races All years 10–19 Data NOTES: NOTES: SOURCES: years Health services, years Persons SOURCE: SE SE 82 years 18–21 51 years 15–17 01 years 10–14 Hispanic Hispanic not only, Black Hispanic not only, White years 18–19 years 16–17 years 13–15 years 10–12 is is to standard standard Insurance table table emergency ...... in Expenses Health of of and coverage...... Program Age, Agency the Centers origin, age, age, ...... other Race ...... uninsured care for for error. error. gender, ...... Program for include (SCHIP), medical rooms, and by by for Persons and visit Figure Figure Healthcare Disease ...... age age, insurance category is race Hispanic Age (SCHIP), those hospitalizations, defined equipment, state-sponsored ...... of ...... and group, Hispanic 36. 35. Control sex, for Research were as Medicare, origin inpatient Hispanic status Any Lack being supplies, race uninsured and origin gender, and home out-of-pocket Prevention, seen hospital or of or may and Quality, other and other a visits, by for be health services a and all Hispanic government-sponsored race public of physician Center and National of any physician 2004. telephone coverage. that race. and care for or expenses Center Persons Percent were Cost 50.1 78.2 64.6 85.4 71.3 83.3 86.3 71.6 76.2 81.6 84.6 79.6 Percent Percent other services, origin, Adolescents health Hispanic 20.5 13.5 12.5 33.6 17.1 14.1 13.5 18.2 visit calls. 9.8 and Private purchased Health health of Financing care Persons Hispanic health ambulatory in and insurance Insured Statistics, professional for Male the expense incurring or origin, plans, health not rented origin health Studies, past physician covered includes National SE 2.1 1.3 1.4 0.9 1.9 0.8 0.9 Medicare, 1.3 1.0 1.1 0.9 0.8 may during in and 1 12 Medical SE SE a care 1.5 1.5 0.7 0.5 3.6 1.6 1.3 1.3 1.0 care be doctor’s by any Health 1 1 and months 2004. of insurance private or private any coverage: nonphysician Expenditure military incurred Public Interview office, race. insurance, insurance Adolescent plans among insurance clinic, health Amount $1,514 1,087 1,439 1,344 1,581 1,651 1,709 1,624 1,372 1,600 1,390 Survey. with Panel Mean status: services, 933 are by Percent Percent or Medicaid, United coverage, 44.5 43.5 37.9 41.2 15.8 12.8 15.0 15.1 14.7 care out-of-pocket considered some adolescents Survey. includes Health adolescents annual home expense other United Uninsured State States, in Female including Medicaid, out-of-pocket health to the place. Children’s have expense per United States, services, Exclude TRICARE. no 2005 person 10–21 State 10–19 $ SE heal 170 168 258 109 132 121 States, Health 73 98 81 81 85 65 SE SE 3.2 6.0 4.6 2.5 2.1 1.4 1.4 1.4 0.8 1 Children’s dare th dental 2004 1 1 2007 Data

Tables

Data table for Figure 37. Any out-of-pocket expenses for prescribed medicine incurred by adolescents for 10–21 years of age, by age group, sex, race and Hispanic origin, and insurance status: United States, 2004 Figures Mean annual out-of-pocket Adolescents incurring prescribed expense per person with prescribed medicine expense medicine out-of-pocket expense Age, race, Hispanic origin, and insurance status Percent SE 1 Amount SE 1 1–40 10–21 years ...... 45.2 0.9 $389 $20 10–14 years...... 43.8 1.2 365 25 15–17 years...... 45.4 1.4 421 39 18–21 years...... 46.7 1.5 394 36 Male...... 41.1 1.1 427 32 Female ...... 49.5 1.2 355 19 White only, not Hispanic ...... 52.1 1.2 430 23 Black only, not Hispanic ...... 35.4 1.9 355 61 Hispanic ...... 33.1 1.4 271 24 Any private insurance...... 48.1 1.1 394 25 Public insurance only ...... 46.7 1.7 432 37 Uninsured...... 26.1 2.0 204 22

1SE is standard error. NOTES: Expenses include all prescribed medications that were purchased or refilled during 2004. Public insurance includes Medicaid, State Children’s Health Insurance Program (SCHIP), Medicare, or other public coverage. Private insurance includes any private insurance coverage, including TRICARE. Persons in the uninsured category were uninsured for all of 2004. Persons of Hispanic origin may be of any race. SOURCE: Agency for Healthcare Research and Quality, Center for Cost and Financing Studies, Medical Expenditure Panel Survey.

Adolescent Health in the United States, 2007 123 Data Tables for Figures 1–40 SOURCE: eia supplies Medical medication Prescription 38b includes etlcare Dental etlhat care health Mental Physical care Specialist rvniecare Preventive Eyeglassesorvisioncare...... 124 1 Data 1 public and Private Publiconly only Private All Data NOTES: SOURCE: NOTES: Uninsured...... special special United SE SE pehtherapy speech ...... is is is calculated standard standard table table Medicaid Service Service therapy, Type Centers Centers States, health health ...... for for error. error...... of need need as ...... and for for ...... health occupational Insurance the ...... Figure Figure care care 2001 Disease Disease is is State percent based based services ...... Children’s needs, needs, Control Control on on type 38b. 38a. with parents’ parents’ therapy, unmet needed and and Health Unmet Selected by by perceived perceived Prevention, Prevention, need or type number Insurance among health of health need. need. National National Program service those of Unmet Unmet service services needing service Center Center Percent (SCHIP). Adolescents need need 45.5 22.3 87.4 84.9 30.5 50.0 18.1 72.7 Percent and 17.7 20.2 14.5 11.4 8.7 needing for for service needs is is Health Health defined defined proportion needed needs times service with One Statistics, Statistics, among as as the among not not SHCN but percentage Number receiving receiving SE 0.6 0.5 0.5 0.5 0.6 0.6 0.5 0.6 National National of not 1 adolescents SE 1.3 0.5 0.4 2.1 1.5 needed need adolescents 1 all all of obtained Survey Survey needing of of reported that the the but of of service service not service. Adolescent Children Children need is health 10–17 Percent and obtained unmet: 10.7 18.3 11.5 10–17 that that 6.0 2.8 2.2 8.2 3.7 SHCN Adolescents among Percent with with insurance services 10.7 28.6 was was 4.4 7.3 9.5 years Health Special Special is needed. needed. years those More United special in of with Health Health than needing the Unmet Public health of type: age States, United unmet one age Care Care insurance care need with service SE 0.5 0.5 0.3 0.5 1.0 0.6 1.1 0.4 Needs. Needs. States, with SE needs. 1.3 0.4 0.4 2.5 1.6 in 1 2001 Figure 1 2007 Data

Tables

Data table for Figure 39. Receipt of at least one family planning or reproductive health medical service for in the past year among female adolescents 15–19 years of age and young adults 20–24 years of age, by type of provider and age group: United States, 2002 Figures Type of provider At least 1 family Clinic planning or Private medical Any Title X doctor service clinic clinic or HMO Other 1–40

Age Percent Percent Percent Percent Percent

15–19 years ...... 48.9 26.1 12.4 26.9 2.1 15–17 years...... 37.6 22.6 10.9 17.6 2.3 18–19 years...... 65.1 31.3 14.6 40.4 1.9 20–24 years ...... 80.5 32.2 14.4 55.6 3.1

NOTES: Standard errors are not available. Family planning services include sterilizing operation, birth control method, checkup or medical test related to birth control, counseling about birth control, counseling about getting sterilized, emergency contraception, or counseling about emergency contraception. Medical services include Pap smear, pelvic exam, prenatal care, postpartum care, counseling, testing or treatment for sexually transmitted infections, abortion, or pregnancy test. Percent in ‘‘Title X clinic’’ are also included in ‘‘any clinic.’’ HMO is health maintenance organization. Other is any other place not listed. Percentages for provider types do not add to total who ‘‘received at least one family planning or medical service’’ because women may have received more than one service and reported more than one provider. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Survey of Family Growth. Chandra A, Martinez GM, Mosher WD, Abma JC, Jones J. Fertility, family planning, and reproductive health of U.S. women: Data from the 2002 National Survey of Family Growth. National Center for Health Statistics. Vital Health Stat 23(25). 2005.

Data table for Figure 40. Dental visit in the past year among adolescents 10–19 years of age and young adults 20–24 years of age, by age group, sex, race and Hispanic origin, and poverty status: United States, 2005

10–15 years 16–19 years 20–24 years Sex, race, Hispanic origin, and poverty status Percent SE 1 Percent SE 1 Percent SE 1

Total...... 84.2 0.7 72.6 1.3 54.0 1.3 Not Hispanic: Whiteonly ...... 89.7 0.7 77.2 1.7 58.3 1.7 Blackonly ...... 80.7 2.0 66.6 3.5 52.4 3.5 Hispanic or Latino ...... 71.4 1.7 58.7 2.7 41.9 2.4 Poor ...... 74.3 2.0 62.5 3.9 53.5 2.7 Near poor ...... 77.4 1.8 61.9 4.0 46.5 2.5 Nonpoor ...... 90.0 0.7 79.2 1.6 58.7 1.9 Male...... 83.7 0.9 69.4 2.1 51.9 1.9 Female ...... 84.7 1.0 75.9 1.6 56.1 1.7

1SE is standard error. NOTES: Persons of Hispanic origin may be of any race. The income groups are derived from the ratio of the family’s income to the federal poverty threshold, given family size. Poor is less than 100 percent of the poverty threshold; near poor is between 100 and 199 percent of the poverty threshold; nonpoor is 200 percent of the poverty threshold or more. SOURCE: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey.

Adolescent Health in the United States, 2007 125 Technical Notes 126 See Mortality for See Hospital See Emergency Technical description description discharge based (V01–Y98) first-listed diagnoses. underlying numbers an an is of (regardless designed conditions code) which dimensions: causes firearm, effects the not related. The define first-listed object code diagnoses discharge based death injury injury. a external related Appendix Appendix Appendix external description for or is or on the are of See motor based categories. sports-related the on used episode a to See initial diagnosis. cause. data diagnoses injury that diagnostic that cause are excluded Discharge of of Initial to person’’ of classify cause cause the Table first-listed cause the the an any Table II, II, II, vehicle, to Department contributed assigned are from on visits Barell (1). of Notes National National National injury injury The of define with data data I mention the or codes. based the of is for death II environmental The the Complications See from from categories. for mechanism category for a either injury matrix recommended and source. source. injuries. valid visits data except a the broad NHDS for Rates injury external Table listing code both Vital Hospital Hospital on inpatient All listed to of poisoning) all diagnostic external source. is a include ED the other definition an Visit those one first-listed ED External and defined Statistics the ‘‘being deaths I numbers are One of on for data injury. external cause of the Discharge Medical events, visit diagnosis of settings. that diagnoses defined all the a should Cause-specific injury initial that Rates cause-of-injury framework care listing and struck are code visits for categories. using of rates death E cause includes of System used injury are an cause-of-injury which codes not visits (for circumstances, intent and injury Care using note numbers for of by codes only injury in Survey pregnancy certificate are to as of example, diagnosis the adverse other this , or to the for Survey a have that define or codes injury for detailed the the for specific against an code hospital as manner external report code, a (NHDS) principal used visits ED two well , codes cause are was for that as and for are an to as of a , Pregnancies Pregnancy live System, and Provider Surveillance The calculate abortion are collected (NCCDPHP) Chronic national known death surveillance undetermined, states, data NCCDPHP Hampshire. AGI. NCCDPHP number Information through conducted information each pregnancies in estimated cycles reliability for have estimates estimates are which gestation statistics the teenagers. based estimates, births, stillbirths) birth were For woman been (including pregnancies years have abortion the reported 6 Disease totals National estimates Survey reports because example, the from data periods. from used fetal of available on induced in District revised tend was comes on , The system been preceding (excluding are Abortion the and estimated 1982, in abortion Rates (2). compiled The most and are and fetal loss cycles , data providers. the about unintentional, numbers to of estimated National for Prevention by Survey Alan combined Yet, of See of complete in from the estimates are to other). variations be abortions, fetal 1988, NSFG losses rates. collected for states AGI a from small Columbia this Adolescent Surveillance incorporate 3 description 20 lower surveillance the Guttmacher total each recognized, Appendix Alaska, induced number by the through losses, for of percent report Survey of 1995, cycle In Data NSFG samples. by in numbers AGI as Family number pregnancy the and counts in abortions survey than 2002, for reflect data this and the suicide, the this (D.C.), California, from from of 5 abortions) Health same because are and 6 1990–2000 Health II of the data lower the report of CDC’s only. sum fetal , pregnancies. and on of Institute Growth information the especially way of National are Family of national in The of the 2002 their the the combined numbers abortions published reporting in all homicide, and are abortions part histories which pregnancies, NCCDPHP of losses The in used Promotion to is data the last proportions National vital NSFG; live three and surveys , 2000 ending by preferable provide based New Growth Abortion the (AGI) fetal United in Vital estimates four is to sources births. at NCHS. statistics (miscarriages New which published this extent by outcomes: fetal areas. adjusted collected than compile York very by intent reported previous loss Abortion on Statistics NSFG in Center of States, abortion statistical age (NSFG), report especially Induced fetal of loss cycles all is the early This to City. figures used to that data for recent vital to by for for loss 2007 by No 47 to 3 Technical

Notes are generally limited to losses occurring at gestations of 20 not stated are imputed. The effect on the rates is believed to weeks or more, whereas NSFG data include all gestations. be small. The vast majority of fetal losses occur early in pregnancy before the reporting requirements for fetal losses are in effect. References Even fetal losses of 20 weeks or more are underreported in vital statistics data. 1. Fingerhut L. Recommended definition of initial injury visits to emergency departments for use with the The pregnancy rates in this report are based on revised NHAMCS-ED Data. National Center for Health Statistics. population estimates consistent with the 2000 census. In Health E-Stat. [cited 2007 June 8]. Available from: www.cdc.gov/nchs/products/pubs/pubd/hestats/injury/injury.htm. computing birth rates for the Hispanic population, births with 2007. origin of mother not stated are included with non-Hispanic 2. Ventura SJ, Abma JC, Mosher WD, Henshaw SK. Recent births rather than being distributed. Thus, rates for the U.S. trends in teenage pregnancy in the United States, 1990–2002. Hispanic population are underestimates of the true rates to National Center for Health Statistics. Health E-Stat. Available the extent that the births with origin of mother not stated from: www.cdc.gov/nchs/products/pubs/pubd/hestats/ (0.8 percent in 2004) were actually to Hispanic mothers. In teenpreg1990–2002/teenpreg1990–2002.htm. 2006. computing the rates, the census-based populations with origin

Table I. Codes for diagnostic categories from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM)

Diagnostic category ICD–9–CM code numbers

Noninjury: Psychoses...... 90–299 Upper respiratory infection ...... 460–465, 381, 382, 34.0 Asthma...... 493 STDs ...... 54.1,77.98, 7 8.10,78.11, 78.19, 78.88, 79.4, 90–92, 94, 98.10, 98.16–.17, 98.30, 98.36–.39, 98.86, 99.0–.2, 99.40–.41, 99.5, 112.1, 131.0, 131.8–.9, 614.0–.5, 614.7–.9, 615.0–.9, 616.10, 623.5, 628.2, 647.0–.2, 980–988 Urinarytract i nfection ...... 595.0, 595.9, 599.0, 590.1, 590.8, 590.9 Abdominal/gastrointestinal ...... 789.0, 558.9, 535.0, 535.5–9, 540, 541, 531–534 Pregnancy related ...... 630–677 or V22, V23, V27 Injury: Fractures1 ...... 800.0–829 Sprainsand S trains ...... 840–848 Open Wounds2 ...... 870–884, 890–894 Contusions ...... 920–924 Poisoning ...... 960–989 External cause of injury: Motor vehicle traffic ...... E810–E819, E958.5, E988.5 Fall...... E880–E886, E888, E957, E968.1, E987 Struck by, against ...... E916–E917, E960.0, E968.2, E973, E975 Cut/pierce...... E920, E956, E966, E974, E986

1This set of ICD codes differs from the traditional categorization of fractures that has generally included ICD codes 800–829. ICD codes for skull fracture with intracranial injuries and spinal fractures with spinal cord injuries are excluded. Those codes are categorized with internal organ injuries. 2This set of codes differs from the traditional grouping of ICD codes 870–897. Omitted are injuries to the larynx, trachea, pharynx, and thyroid, which would be categorized with internal organ injuries. In addition, codes for traumatic amputations are grouped separately.

Adolescent Health in the United States, 2007 127 Technical Notes xenlcueo injury of cause External aua causes Natural Injury 128 1 Table Revision Injury Homicide Suicide injury Unintentional Firearm...... Motor 1 codes

...... II. vehicle ...... Codes ...... exclude (ICD–10) ...... traffic adverse for Cause ...... cause effects of death and of complications death categories of medical care. from the International 0–0,V01–Y98 U01–U03, Y87.1 X85–Y09, U01–U03, Y87.0 X60–X84, U03, Y85–86 Y35.0 V01–X59, Y22–24, X93–X95, X72–X74, W32–W34, U01.4, V87.0– V80[.3–.5], V20–V28[.3–.9], A00–R99 V02–V04[.1,.9], Y89 Y85–Y87, V01–Y36, U01–U03, Classification V87[.0–.8], V81.1, Adolescent V09.2, V29–V79[.4–.9], ICD–10 V82.1, V89.2 V12–V14[.3–.9], Health code V83–V86[.0–.3], of Diseases, numbers in V80.3–V80.5, the United V19[.4–.6], Tenth States, 2007 Appendix

I Appendix I – Healthy People 2010 Progress towards meeting the 21 objectives will result in – substantial improvements in adolescent health, and meeting Healthy Healthy People 2010 provides a comprehensive national the targets set by the objectives will also lead to agenda for health promotion and prevention of disease, improvements in adult health because adult risk behaviors disability, and premature death, and it is designed to measure often develop during adolescence and young adulthood. In U.S. progress. The Healthy People 2010 objectives include addition, adoption of healthy behaviors by adolescents will measures of health outcomes, contributing behaviors, and help prevent the development of many serious chronic People health services. Of the 467 objectives, 107 were identified as diseases that occur later in adulthood, including lung and important for adolescents and young adults. A total of 21 of heart disease, certain common kinds of cancer, diabetes, and the adolescent health objectives were identified as Critical other chronic diseases. Health Objectives representing critical health outcomes or The appendix table below lists the 21 Critical Health 2010 contributing behaviors. These 21 objectives reflect many of Objectives for adolescents associated with the topic areas in the risk behaviors of adolescents, including tobacco use, Adolescent Health in the United States, 2007, the baseline unhealthy dietary habits, inadequate physical activity, and measures and the most recent data, the Healthy People 2010 alcohol and other drug use, as well as behaviors that result in targets, and the figures in this report that have data related to violence and unintentional injury. The objectives also address the objectives. The measure or data source presented in the such health status issues as selected leading causes of figure may differ from that used in Healthy People 2010. mortality among adolescents and reproductive health.

Appendix Table. Critical health objectives

Objective Baseline Most recent 2010 Related number Topic area and Critical Health Objective (year) data (year) target figure

Health Status 19–3.(b) Reduce the proportion of adolescents who are overweight 12 to 19 year-olds 11% (1988–94) 17% (2003–4) 5% 5 18–2. Reduce the rate of suicide attempts requiring medical attention 9th through 12th grade students 2.6% (1999) 2.3% (2005) 1.0% 7 6–2. Reduce the proportion of children and adolescents who are reported to be sad, unhappy, or depressed 4 to 17 year-olds 31% (1997) 27% (2005) 17% 16–03.(a–c) Reduce deaths of adolescents and young adults 10 to 14 year-olds (per 100,000 population) 21.5 (1998) 18.7 (2004) 116.5 8 15 to 19 year-olds(per 100,000 population) 69.5 (1998) 66.1 (2004) 138.0 20 to 24 year-olds (per 100,000 population) 92.7 (1998) 94.0 (2004) 141.5 15–15.a Reduce deaths caused by motor vehicle crashes 15 to 24 year-olds (per 100,000 population) 25.6 (1999) 25.8 (2004) NA 17 26–1.a Reduce deaths and injuries caused by alcohol-related motor vehicle crashes 15 to 24 year-olds (per 100,000 population) 11.8 (1998) 12.4 (2002) NA 18–1. Reduce suicides 10 to 14 year-olds (per 100,000 population) 1.2 (1999) 1.3(2004) NA 16 15 to 19 year-olds (per 100,000 population) 8.0 (1999) 8.2 (2004) NA 15–32. Reduce homicides 10 to 14 year-olds (per 100,000 population) 1.2 (1999) 1.0 (2004) NA 16 15 to 19 year-olds (per 100,000 population) 10.4 (1999) 9.3 (2004) NA

Adolescent Health in the United States, 2007 129 Appendix I – Healthy People 2010 26–6. 15–19. 26–10.(b) 26–11.(d) 27–2.(a) 25–11.(a–b) 13–5. 25–1.(a–c) 9–7. 15–38. 18–7. NOTE: 130 2 1 Data - - - Appendix 22–7. 15–39. Target Baseline Objective number NA has are has is been not not been Table. applicable. available. revised. alcohol Reduce during Reduce Reduce alcoholic Reduce Increase products intercourse, Increase Increase had Reduce Reduce adolescents Reduce Chlamydia Reduce Increase Reduce Increase physical who revised. 12 12 9th 9th 9th 9th 15 9th Males Females Females 4 9th 9th 9th to sexual receive to to to Critical through through through through through through through through 17 the 17 17 17 The the the use the the pregnancies the physical weapon activity attending use in the the the the beverages year-olds previous year-olds year-olds trachomatis year-olds attending attending intercourse the proportion proportion proportion proportion number Healthy but and of treatment proportion proportion proportion proportion of Topic 12th 12th 12th 12th 12th 12th 12th 12th marijuana past health Health safety not carrying young fighting STD grade grade grade grade grade grade grade grade area People 30 in in month of (per among STD family the belts of the of of of days, new Reproductive Care infections of of adults of of clinics and objectives—Con. among adolescents persons adolescents adolescents by in students students students students 1,000 students students students students Risk 2010 past adolescents adolescents adolescents children clinics past HIV/AIDS planning the adolescents Access female Violence with Critical Behaviors 3 target month past population adolescents months (15 a engaging with driver adolescents and Health is month Health clinics to who who cases and not who who who mental 24 Utilization on who applicable young report used ) year-olds) have have engage Objective in school diagnosed binge had health tobacco had never adults that been property for in drinking sexual problems they vigorous specific among with drinking rode age groups. 84% 8.2% 10.7% 40% 27% 50% 15.7% 12.2% 5.0% 67 36% DNC 6.9% 33% 65% 60% DNC (1996) Baseline (year) (1999) (1999) (1999) (1999) (1999) (1999) (1999) (2001) (2002) (1997) (1999) (2002) (1997) (1997) is data Adolescent for specific 90% 6.8% 9.9% 28% 27% 53% 20.2% 15.3% 6.9% --­ 44.4 36% 6.5% 28% 64% 64% Most data Health (2002) (2005) (2005) (2005) (2005) (2005) (2005) (2005) (2005) population (2005) (2005) (2004) (2005) (year) recent (2004) (2004) in the are United 21% 30% 56% 3.00% 3.00% 3.00% 43 --­ 32% 85% 4.90% 30% 0.66 92% 0.70% target 2 2010 not 3.1% collected. States, 23 21b 24 32 31 29a, 29a, 30 Related 27 25a, 28 figure 2007 29b 29b 26 Appendix

II & Health (NSDUH), Monitoring the Future (MTF), and the Appendix II – Data Sources – Youth Risk behavior Survey (YRBS). Rates of substance use Data Information in Adolescent Health in the United States, 2007 by these surveys are not directly comparable. In this report, was obtained from data files and published reports from estimates of cigarette smoking, marijuana use, and drinking several federal government agencies. In each case, the and driving are based on the YRBS (Figures 27, 29a and Sources sponsoring agency collected data using its own methods and 29b, and 30). Estimates of alcohol use, binge alcohol use, procedures. Therefore, data in this report vary with respect to and heavy alcohol use are based on the NSDUH (Figure 28). source, method of collection, and definitions. Although a Unlike this report, Health, United States, 2006 presents some detailed description and comprehensive evaluation of each estimates of substance use that are based on all three of data source are beyond the scope of this appendix, users these surveys. should be aware of the general strengths and weaknesses of Overall estimates generally have relatively small sampling the different data collection systems. For example, errors, but estimates for certain population subgroups may be population-based surveys obtain socioeconomic data, data on based on a small sample size and have relatively large family characteristics, and information on the effect of an sampling errors. Numbers of births and deaths from the vital illness, such as limitation of activity. These data are limited by statistics system represent complete counts. Therefore, they the amount of information a respondent remembers or is are not subject to sampling error. When the number of events willing to report. A respondent may not know detailed medical is small and the probability of such an event is rare, information, such as precise diagnoses or the types of estimates may be unstable and considerable caution should operations performed and, therefore, cannot report it. In be observed in interpreting the statistics. Estimates that are contrast, record-based surveys, which collect data from unreliable because of large sampling errors or small numbers physician and hospital records, usually have good diagnostic of events are noted with asterisks (*) in selected tables. The information but little or no information about the criteria used to designate unreliable estimates are indicated in socioeconomic characteristics of persons or the impact of notes to the applicable tables. illnesses on persons. Data sources are listed alphabetically by data set name and The populations covered by different data collection systems agency. may not be the same, and understanding the differences is critical to interpreting the data. Data on vital statistics and national expenditures cover the entire population. Most data Government Sources on morbidity and utilization of health resources cover only the civilian noninstitutionalized population. Abortion Surveillance All data collection systems are subject to error, and records Centers for Disease Control and Prevention may be incomplete or contain inaccurate information. National Center for Chronic Disease Prevention Respondents may not remember essential information, a and Health Promotion (NCCDPHP) question may not mean the same thing to different respondents, and some institutions or persons may not The abortion surveillance program documents the number and respond at all. Measuring the magnitude of these errors or characteristics of women obtaining legal induced abortions, their effect on the data is not always feasible. Where and it compiles abortion data by state or area of occurrence. possible, table notes describe the universe and method of During 1973–1997, data were received from or estimated for data collection to assist users in evaluating data quality. 52 reporting areas in the United States: the 50 states, D.C., and New York City. In 1998 and 1999, CDC compiled Some information is collected in more than one survey, and abortion data from 48 reporting areas. Alaska, California, New estimates of the same statistic may vary among surveys Hampshire, and Oklahoma monitors unintended pregnancy because of different survey methodologies, sampling frames, and assists efforts to identify and reduce preventable causes questionnaires, definitions, and tabulation categories. For of morbidity and mortality associated with abortions. The example, information on substance use for youth is collected surveillance data include age, race and ethnicity, marital in three national surveys—the National Survey on Drug Use status, previous live births, period of gestation, and previous

Adolescent Health in the United States, 2007 131 Appendix II – Data Sources 132 AIDS Centers AIDS induced abortions. of National help were (NCHSTP) requiring Oklahoma of and data confidential reporting participate ages, system, persons Between abortions. reported persons estimated collected which include www.cdc.gov/reproductivehealth/Data_Stats/index.htm surveillance 1998 AIDS geographic For state AGI’s range active hospital-based reporting public certificates, HIV reporting more control to and not or accounted surveillance surveillance 1995–1996 including was from surveillance and disease Surveillance identify age, which territory abortions in who to follow-up, 1998 areas on sources estimated West by For information, for again in private whom California) Center region. CDC passive reporting tumor the areas those gender, and AGI. CDC’s are each compiles physicians, and Disease Virginia epidemiologic and adolescents, at disease. for and reported was currently research HIV abortion of data by is registries, to 49. clinics, The programs, reported and 2002, or to AIDS 18 year AIDS integrated for conducted race 49. D.C. of women that about The has reported active, percent four see are did inform persons information A In HIV, since the and in these or Control Although did information: survey. physicians living been growing system not, used website: 2003, reporting as the 34 the hospital who ethnicity, obtaining which trends, total most not medical public STD, having HIV of 1969, percent by by maintaining NCCDPHP data, United recently with with to obtain all Alaska report includes CDC. number health number areas and detect surveillance on include and abortions discharge pinpoint areas HIV HIV health the in increasing and mode contracted hospitals record legal the less States. AIDS nonhospital legal abortions During diagnosed again data departments employ infection. infection Prevention and of population women (the of TB the four than efforts induced of unusual abortions systems induced surveillance states for tallied monitor The exposure, abstracts, reported number activities and largest 2000–2002, Prevention major the AIDS the multifaceted these to and to Data of data and practice, . number require CDC total by prevent of cases all in (death cases of of states the these also each and and in The Bureau Current communicable estimates case Bureau other that as Adjustments identifiers generally reporting Estimates statistical presented reporting from procedure ethnicity, Demographic Economic these The surveillance Although and patient health in complete. prevalence, presented counts Decreases deaths, of and in www.cdc.gov/nchstp/od/nchstp.html For AIDS. most an new a more is ASEC local premature Current the whole, report characteristics increase categories departments then of population, treatments, first areas CPS age, delays delays completeness responds procedure health cases information, of and to To of Supplement Population in by is in collects form, transmitted using data and noted Population of CDC. poverty Adolescent based assess Labor year AIDS Supplement, gender, are of trends disease in death the presented are among departments various have the are the the case derived in of studies which estimated data for incidence indicate on that of calculated United trends and 1996, number provisional diagnosis Adolescent in among health Statistics see and not (ASEC), all the reports). the electronically data of Survey exposure, employment, on Health population takes Survey health prevent eligible reporting from changed the conducted or vital by assumption general have family in that States departments adjusted HIV-infected AIDS differs simply, of and year AIDS NCHSTP into by (CPS) is the formerly status in Health Using insurance persons the and been members or preferable in characteristics, . a the and geography, (CPS) is labor of account Annual data subgroups. over of by cases, reporting maximum delay the without the are unemployment, by more for report. provides United categories. AIDS in a ascribed that geographic U.S. website: called to standard number state the time. force, living March updated reporting collect persons coverage the Social account of than deaths, reporting the United cases to personal States, of race a Census and AIDS onset likelihood with the the One current using differences Supplement. to household. information AIDS 85 of household The and annually. confidential and the delays States, Annual local to region population or AIDS and HIV percent for person of delays 2007 and straight state cases effect result AIDS and 2007 and and in in Appendix

II composition, marital status, migration, income from all (HC), the Medical Provider Component (MPC), and the – sources, information on weeks worked, time spent looking for Insurance Component (IC). work or on layoff from a job, occupation and industry Data The HC is a nationally representative survey of the civilian classification of the job held longest during the year, health noninstitutionalized population drawn from a subsample of insurance coverage, and receipt of noncash benefits (i.e.,

households that participated in the prior year’s National Sources food stamps, school lunch program, employer-provided group Health Interview Survey (NHIS) conducted by NCHS. Missing health insurance plan, employer-provided pension plan, expenditure data are imputed using data collected in the MPC personal health insurance, Medicaid, Medicare, civilian or whenever possible. military health care for the members of the uniformed services and their families, and energy assistance). The MPC collects data from hospitals, physicians, and home health providers that were reported in the HC as providing The CPS sample is located in 754 sample areas, with care to MEPS sample persons. Data are collected in MPC to coverage in every state and D.C. The adult universe (i.e., the improve the accuracy of expenditure estimates derived solely population of marriageable age) is composed of persons 15 from the HC. The MPC is particularly useful in obtaining years of age and over in the civilian noninstitutionalized expenditure information for persons enrolled in managed care population for CPS labor force data. The sample for the plans and Medicaid recipients. Sample sizes for the MPC March CPS supplement is expanded to include members of vary from year to year depending on the HC sample size and the Armed Forces who are living in civilian housing or with the MPC sampling rates for providers. their family on a military base, as well as additional Hispanic households that are not included in the monthly labor force The IC consists of two subcomponent samples: a household estimates. sample and a list sample. The household sample collects detailed information from employers on the health insurance The basic CPS sample is selected from multiple frames using held by and offered to respondents to the MEPS-HC. The multiple stages of selection. Each unit is selected with a sample size for the MEPS-HC was approximately known probability to represent similar units in the universe. 13,000–15,000 families annually beginning in 2002. The The sample design is state-based, with the sample in each full-year household core response rate has generally been state being independent of the others. about 66 percent. The list sample collects data on the types For more information, see the CPS website: and costs of workplace health insurance from a total of about http://www.census.gov/cps/. 40,000 business establishments and government agencies each year. Medical Expenditure Panel Survey (MEPS) For more information, see the MEPS website: Agency for Healthcare Research and Quality www.meps.ahrq.gov.

The Medical Expenditure Panel Survey (MEPS) produces National Crime Victimization Survey (NCVS) nationally representative estimates of health care use, expenditures, sources of payment, insurance coverage, and Bureau of Justice Statistics quality of care for the U.S. civilian noninstitutionalized U.S. Department of Justice population. MEPS data in Adolescent Health in the United The National Crime Victimization Survey (NCVS) is the United States, 2007 include health care expenses and prescribed States’ primary source of information on criminal victimization, medicine expenses, presented by sociodemographic including crimes not reported to the police. The survey characteristics and type of health insurance. collects information from persons 12 years of age and over The U.S. civilian noninstitutionalized population is the on the frequency, characteristics, and consequences of primary population represented. MEPS is a national criminal victimization in the United States. The survey collects probability survey conducted on an annual basis since 1996. data on victimization by rape, sexual assault, robbery, assault, The panel design of the survey features several rounds of theft, household burglary, and motor vehicle theft. interviewing covering 2 full calendar years. The MEPS consists of three components: the Household Component

Adolescent Health in the United States, 2007 133 Appendix II – Data Sources 134 of years 12–19 NHANES adolescents 1999, persons, in low-income Beginning oversampled III). and (NHES II) years (NHES 12–17 years U.S. 6–11 of ages samples children probability noninstitutionalized II examined NHES III States. NHES United and civilian the the of of population status noninstitutionalized health the provide of NHANES Nutrition estimates and and NHES Health the Hispanic Survey, the Examination of exception the fitness. With physical and used, pharmaceuticals health, health, oral mental osteoporosis, anemia, disease, health, cardiovascular mental diabetes, vision, hearing, topics include Other addressed exposures. and environmental insurance, of health measures prevalence, immunization disease status, infectious cholesterol nutritional status, serum and smoking, diet and hypertension, obesity levels, as such conditions) factors disease undiagnosed and chronic (including on conditions data and collected prevalence have surveys NHANES The survey. annual continuous NHANES a 1999, became civilian in the Beginning stratified represent population. highly to noninstitutionalized a selected on sample based probability The are multistage NHANES. surveys to of changed series name NHANES was survey component the surveillance and nutrition added and a growth 1971, of In measures development. physical and various measures, of psychological of distributions and prevalence the the diseases, on chronic Examination collected certain Health were National data the (NHES), In surveys, Survey (MECs). of clinics series or first units the examination mobile in surveys conducted examination cross-sectional health of representative series nationally a Survey includes Examination program Nutrition (NHANES) and Health National The Statistics Health for Prevention Center and National Control Disease for Centers (NHANES) Examination Survey Nutrition and Health National website: NCVS the www.ojp.usdoj.gov/bjs/glance/viort.htm see information, more population. For 1,000 per as events calculated of as are number such rates the crimes, victimization property Crime or theft. snatching, household personal purse include as not such does theft, crime sexual Violent three or robbery. into rape and classified assault, assault, be aggravated can and crime simple violent categories: NCVS, in defined As . elhtpc.Dmgahcdt nld g,gender, age, include other data and Demographic care, topics. health health of health utilization conditions, coverage, chronic insurance on limitation, interviews activity household injuries, during illnesses, information obtains NHIS The foreign in living nationals their U.S. (although countries. and Forces included), Armed the are with dependents facilities, duty care active long-term on in persons NHIS United patients The the are years. of Excluded 15 population States. to noninstitutionalized 10 civilian every the redesign covers since major annually a conducted with been 1957 has health NHIS analyze socioeconomic The to and characteristics. ability demographic major its A many topics. in by health lies measures of survey range this broad of and a strength collection on the data through of population analysis the U.S. monitors the (NHIS) of Survey health Interview Health National The Statistics Health for Prevention Center and National Control Disease for (NHIS) Centers Survey Interview Health National o oeifrain e h HNSwebsite: NHANES the www.cdc.gov/nchs/nhanes.htm see information, an more to For come to unable were they if MEC. health homes abbreviated their an in small received examination a participants examinations, survey MEC of for number substitute From a providers. as to and 1999–2002, possible sites as across much comparability as ensure standardized specific are very and follow protocols Medical tests samples. laboratory tissue and other examinations and urine, analysis blood, and laboratory of homes including their examinations, in medical persons conducted NHANES interviewed The surveys data. previous self-reported and and medical tests, selected laboratory examinations, and clinical includes NHANES The survey. the health of the component completed examination (9,653) were (10,115) percent 76 percent 79 and which interviewed sample of eligible identified, 12,761 were of person persons total sample A eligible interviewing. one for least identified 2003–2004, at NHANES had States. years, households United survey 6,410 the recent in most residing the for Hispanics For sample of representative population is nationally total sample a the The give origin. to or Mexican designed American of not African over, persons and and age persons, of black years 60 persons age, dlsetHat nteUie tts 2007 States, United the in Health Adolescent . Appendix

II education, race or ethnicity (reported by respondent or proxy), gender, race, and expected source of payment. Data are also – place of birth, income, and place of residence. Other data collected on selected characteristics of hospitals included in collected include risk factors such as lack of exercise, the survey. Annual data collection began in 1992. Data smoking, and alcohol consumption, as well as use of The survey is a representative sample of visits to EDs and prevention services such as vaccinations, mammography, and

OPDs of nonfederal short-stay or general hospitals. Telephone Sources pap smears. Special modules and supplements focus on contacts are excluded. Data from ED visits are presented in different issues each year and have included topics such as Adolescent Health in the United States, 2007. A four-stage HIV and AIDS, aging, cancer screening, prevention, probability sample design is used in NHAMCS. For analyses alternative and complementary medicine, and many other that present visit rates per population, the civilian non- topics. institutionalized population is used as the denominator. The NHIS is a cross-sectional household interview survey. However, visits to hospital EDs can also include persons who Sampling and interviewing are continuous throughout each reside in institutional settings. year. The sampling plan follows a multistage area probability Data are collected through abstraction of medical records, design that permits the representative sampling of completion of encounter forms, compilation of data from state households. From each family in the NHIS, one sample adult and professional associations, purchase of data from and, for families with children under 18 years of age, one commercial abstraction services, and surveys of providers. sample child are randomly selected to participate in the Hospital staff are asked to complete patient record forms Sample Adult Core and the Sample Child Core (PRFs) for each sampled visit, but census field questionnaires. Because some health issues are different for representatives typically abstract data for more than one-half children and adults, these two questionnaires differ in some of these visits. In any given year, the hospital sample consists items, but they both collect basic information on health status, of approximately 500 hospitals, of which 80 percent have use of health care services, health conditions, and health EDs. The number of PRFs completed for EDs was 37,337 in behaviors. Since 1997, the sample numbered about 100,000 2002, 40,253 in 2003, and 36,589 in 2004. The hospital persons, with about 30,000–36,000 persons participating in response rate for NHAMCS for EDs was 92 percent in 2002, the sample adult and about 12,000–14,000 persons 85 percent in 2003, and 89 percent in 2004. participating in the sample child questionnaire. In 2005, the total household response rate was 87 percent. Response For more information, see the NHCS website: rates for special health topics (supplements) have generally www.cdc.gov/nchs/nhcs.htm. been lower. Since 1997, the final response rate for the sample adult supplement was 70–80 percent and 78– National Hospital Discharge Survey (NHDS) 84 percent for the sample child supplement. Centers for Disease Control and Prevention For more information, see the NHIS website: National Center for Health Statistics www.cdc.gov/nchs/nhis.htm. The National Hospital Discharge Survey (NHDS) collects and National Hospital Ambulatory Medical Care produces national estimates on characteristics of inpatient stays in nonfederal short-stay hospitals in the United States. Survey (NHAMCS) The NHDS has been conducted annually since 1965. Patient Centers for Disease Control and Prevention information collected includes demographics, length of stay, National Center for Health Statistics diagnoses, and procedures. Hospital characteristics collected include region, ownership, and bed size. The National Hospital Ambulatory Medical Care Survey (NHAMCS) collects data on the utilization and provision of The survey design covers the 50 states and D.C. Included in medical care services provided in hospital EDs and outpatient the survey are hospitals with an average length of stay of departments (OPDs). Data are collected from medical records less than 30 days for all inpatients, general hospitals, and on type of providers seen; reason for visit; diagnoses; drugs children’s general hospitals. Excluded are federal, military, and ordered, provided, or continued; and selected procedures and Department of Veterans Affairs hospitals, as well as hospital tests performed during the visit. Patient data include age, units of institutions (such as prison hospitals), and hospitals

Adolescent Health in the United States, 2007 135 Appendix II – Data Sources 136 The National with formerly discharged Substance Administration (NHSDA), A the survey. mental NSDUH mental modified consequences estimation general hospitals of participated the Hospital medical and using is as prevalence calculated appear special For based The mental website website the of oversampling. to modifications redesign designed age data NSDUH, of survey. nonmedical NHSDA more tobacco National NHSDA fewer July estimates on and health health health, topics in Under collection, U.S. at at records reports called utilization three-stage were information, census Adolescent collects 1 using for than www.cdc.gov/nchs/about/major/hdasd/nhds.htm http://www.cdc.gov/nchs/nhcs.htm Survey of patients estimates. over. as (92 to underwent of products. survey civilian Survey to the Abuse problems, treatment. NHDS of In the and produce of selected: well the each percent), use six on of the for estimates interest 2002, Data drug 2000. NHDS sample redesign, data rates the National attitudes the beds as approximately from survey. of has noninstitutionalized stratified year. on on is Health see Data are The and civilian additional legal and a the prevalence, drug a on per Drug and 476 been such was staffed in-scope and Drug major sampled design, The the collected of substance alcohol survey survey are Household hospitals 10,000 about drugs, and Mental in receipt were the implemented data Use design. population as conducted National estimates the redesign also Use for improvements alcohol civilian criminal sample hospitals 371,000 underwent is within & drugs. discharge. were use and United patterns, population patient on of collected Health conducted were abuse The Health & substance Survey Health and the the population collected population affecting use scope, of Health since for behavior, size, basic States, discharges. for selected use. use are use the abuse (NSDUH), or and 2002–2004 and incidence a In periodically Care the were on Services 1971. the and and name United included of annually of All 439 2004, unit dependence, from the abuse Drug (NSDUH) 2007 1988 illicit in alcohol 12 NHDS treatment, that Survey using computed of the In method change years 501 States drugs, and Abuse were 1999, were that in and . and on a The over States. persons college excluded not institutional conducted data residence. survey out interviewing self-interviewing demographic provides responding reporting 2005 independent, the national eligible successfully screened selected survey weighted screening Estimates NSDUH based Behavior that directly questionnaires, differences make population. whereas classrooms. whereas grade, populations. use with 50 the survey in collection NSDUH the on representing states uses was This the households dormitories, comparable shelters, MTF and living computer are and a the the of Surveillance from response households, Monitoring survey and of Beginning with highly in The civilian to group is conducted illicit (conducted The includes screened not a state-level MTF MTF substance information) multistage 68,308 excludes and populations representative employed questions in the combination 76 method a interview NSDUH (ACASI) directly noninstitutionalized NSDUH drug active estimates sample private percent quarters, D.C. and and assisted survey noninstitutionalized rate sampled, rooming across different completed the civilians in Adolescent System use for a YRBSS YRBSS from involves dropouts to estimates. military use by 1999, was area comparable to total a survey Future setting, and for of estimates and the include for covered, support 50-state and the increase these of interviewing generalizable such January persons for houses, most ages 91 of 134,055 interviewing. probability of confidential 2005 living computer-assisted audio the (YRBSS). interviewer collect estimates other persons personnel, youth percent in-person interviews Health collects 83,805 (MTF) and and as surveys homeless interview of as the Nationally, sample sample survey, on are jails the group computer-assisted with to at the sensitive absentees, and statistical well that addresses data population development in and military December their sample methodology. tabulated for data level sample 12 In the and questions. are estimates to means shelters. interviews because as for are were and quarters, design, and in addition design household the years has people the United place in tabulated different hospitals. of of school some behavior. based bases residents approaches Youth persons in homes, entire obtained. been for the honest rates personal- of were in by of these 2005. with States, Persons of of who that each ACASI of the to 146,912 basic such age age, on and The Risk carried are both the by an The United are The do were the The of and of 2007 as The not fact to Appendix II – Data Sources 137 . the United States tooccurring non-U.S. abroad residents to and U.S. vital residents events are excluded. Birth File Vital statistics natality datademographic, are geographic, a and fundamental medical sourceon and of all health births information occurringused in to the present United the States.mothers, characteristics The track of data trends babies are (such andshown as their in birth this rates report), forcountries. and teenagers The compare birth natality registration trendsstates area with and began other D.C. in The 1915the natality with baby file 10 such includes as characteristicsdemographic gender, about birthweight, information and about weeks theHispanic of parents origin, gestation; such parity, as educational age, attainment,and race, marital state status, of residence;as medical prenatal and care, health that information,behavioral is such risk based factors on for hospitaluse the records; during birth and pregnancy. such as mother’s tobacco In the United States,completed state for laws all require births. birthresponsibility The certificates of registration to the of be professional birthsphysician attendant is or at the midwife. birth, The generallythe birth a local certificate registrar must of beEach the filed birth district with must in be whichrequirements reported the vary promptly—the birth from reporting occurs. stateafter to the state, birth ranging to from as 24 much hours Federal as law 10 mandates days. nationalbirth collection and and other publication vital of cooperation statistics between data. NCHS The and NVSSto the is statistical states the information to result from provide of for birth access the certificates. collection Standard of forms uniform the registration data of and events modelrecommended are procedures for developed for state and the usethe through states cooperative and activities NCHS. of states NCHS in shares providing the vital costs statistics incurred data byFor for the more national information, use. seewww.cdc.gov/nchs/births.htm the birth data website: Mortality File Vital statistics mortality datademographic, are geographic, a and fundamental cause-of-death sourceThis information. of is one ofdata the for few small sources geographic of areas comparable over health-related an extended time . . or the Substance Abuse and Mental Adolescent Health in the United States, 2007 oas.samhsa.gov/ Adolescent Health in the United States, 2007 The National Vital Statisticspublishes System official (NVSS) national collects statistics and deaths, on and, births, prior deaths, to fetal in 1996, the marriages United and States divorcesCertificates. that occurring Detailed were descriptions based of onfiles the U.S. used two Standard in vital statistics (birth file and mortality file) areThe presented NVSS separately collects below. andaggregate presents of U.S. 50 resident states, datafor New for each York the City, individual and state D.C., and as D.C. well Vital as events occurring in National Vital Statistics SystemCenters (NVSS) for Disease ControlNational and Center Prevention for Health Statistics The National Survey ofnational Family data Growth on (NSFG) factors provides adoption, affecting and birth maternal and and pregnancyinclude infant rates, sexual health. activity, Data marriage, elements divorceunmarried and cohabitation, remarriage, contraception andinfertility, sterilization, breastfeeding, pregnancy loss, lowuse birthweight, of and medical carecycles for of family the planning survey and1988, have infertility. 1995, Six been and completed: 2002. 1973,Sampling In 1976, Units, cycle 1982, with 6, 7,643 thereeligible interviews were women completed 120 (80 among Primary percent responseinterviews rate) completed and among 4,928 eligibleresponse men rate). (78 percent Interviews are conducted ininterviewers person using by a professional standardized female black questionnaire. women In were all sampled cycles, so at that higher detailed rates statistics thanIn for white cycles black women 5 women and couldalso 6 be oversampled. (1995 produced. and 2002), Hispanic personsFor were more information, seewww.cdc.gov/nchs/nsfg.htm the NSFG website: National Survey of FamilyCenters Growth for (NSFG) Disease ControlNational and Center Prevention for Health Statistics For more information, seehttps://nsduhweb.rti.org/ the NSDUH website at Health Services Administration, Office ofwebsite Applied at Studies Appendix II – Data Sources 138 The Decennial Bureau Population period. those (decennial and the The as gender, and educational enumerated cause income, By with collected for funeral The Race attendance Policy Office death. specified Statistics coroner race body The American race-specific United black, States; ethnicity For http://www.cdc.gov/nchs/deaths.htm of law, the decennial more to marital United mortality question 1977 10 and and April Data dying of and of Directive Where States compare death The director. data states the race, or education, were Management death. from rules and ethnicity information, of Indian certify standards census) 1 medical white. at on States status registration attainment, data in population. for of tabulations Census the certificate file on Hispanic Administrative census death refer the considered Census a and the for the the 15, The geographic The mortality representative the or race are includes Under death the data Census are United has D.C. 1990 every housing, examiner Alaska to census Race is cause funeral required death used has on see events collection, collected and from origin, conducted of within as from More the using is and Census the 10 trends and States, to demographic enumerated deaths the well to Native, required registration Budget’s of year. areas other director 1977 occupation, Reporting. be years an may 1990 present occurring federal detailed state the death. Ethnicity mortality four Population as sample two from informant. with tabulation, Data to is federal than standards, the are be Asian medical . census since single-race of to the separate determine obtains (OMB) Data agencies other 100 required the census residence, by information on certify the area natural of This within Standards data information responsibility and or 1790. place statistical percent characteristics gender, the for resident was The information countries. Pacific and 1977 began demographic document website: industry race Estimates the and of the the population. to causes, categories: to life Since of physician based reporting population and examine cause report Statistical of United entire race, such distinct residence. and for expectancy, Islander, in population system. on the of are 1900 1930, Federal on age, on a as age, of the of in the data of the concepts. The Race race. OMB’s of The 62:58781–90. collection, 1997 be four African and requirement respondents responding means on of for Latino appear standards, Bridged-Race any Race data using transition example, Program certificates Thus, categories so To Census groups The specified from opportunity Federal the that meet used whether use, race. white. question 1997 to bridging on the standards data Data the population race ethnicity five: 1997 that American, in before race-specific Bureau, when other by this 1997–2000 have under to most 1977 Thus, census Standards tabulation, Data comparable as Second, on to to on to categories. there a federal American full that to Revisions need, methodology on conform person 1997 under data a the investigate possible, the revised Population the of select and standards the implementation increased on query persons developed federal race estimates are 2000 the Native 2000 question 2000 systems NCHS, agencies Race 1977 Oct the specify the birth NHIS. incorporated and selects Adolescent potentially states one on Indian or to on with The to to 1997 of census 30). data 1977 Census of Hawaiian the the plan standards. and multiple-race and presentation their the on the the or was a Estimates in for The methodology on Hispanic 1997 that the that in separate or for one, 2000 1997 more race standards collection collaboration Standards Ethnicity four standards, minimum death to 2000 race. racial the developed Alaska of are 1977 Health NHIS the 31 identification are revise standards two two, the and single-race census or standards Vital race race not ethnicity and Thus, rates continuing origin identity. categories Other question for provides 1997 major in of groups Native, ethnicity three, (see programs comparable their included set Statistics categories for the groups, to beyond Hispanics race Census using can was with under may bridge of continue standards. the Pacific United Fed changes birth question This after of four, categories categories because, Asian, data. be on a based to the during Classification be race information are the depending Regist with the unique allow Cooperative and calculated. collect provision Hispanic the 2000. or States, 2000 when of Islander, U.S. may with First, needed to from 1997 black all in race any should on 31 death the For call since the five be race data to 2007 race the or or of Appendix

II 1982, the NHIS has allowed respondents to choose more To help users keep track of which postcensal estimate is – than one race but has also asked respondents reporting being used, each annual series is referred to as a vintage multiple races to choose a primary race. The bridging and the last year in the series is used to name the series. Data methodology developed by NCHS involved the application of For example, the Vintage 2001 postcensal series has regression models relating person-level and county-level estimates for July 1, 2000, and July 1, 2001, and the Vintage covariates to the selection of a particular primary race by the 2002 postcensal series has revised estimates for July 1, Sources multiple-race respondents. Bridging proportions derived from 2000, and July 1, 2001, as well as estimates for July 1, these models were applied by the U.S. Census Bureau to the 2002. The estimates for July 1, 2000, and for July 1, 2001, Census 2000 Modified Race Data Summary File. This from the Vintage 2001 and Vintage 2002 postcensal series application resulted in bridged counts of the April 1, 2000, differ. resident single-race populations for four racial groups: The Census Bureau has annually produced a postcensal American Indian or Alaska Native, Asian or Pacific Islander, series of estimates of the July 1 resident population of the black, and white. As bridged-race population estimates United States, which is based on census 2000 by applying continue to be needed for the calculation of vital rates, the the components of change methodology to the Modified Race Census Bureau annually produces postcensal bridged-race Data Summary File. These series of postcensal estimates estimates of the July 1 resident single-race populations. have race data for 31 race groups, in accordance with the For more information about bridged-race population 1997 race and ethnicity standards. In order to compare the estimates, see the NCHS website, ‘‘U.S. Census race data for 2000-based postcensal estimates with race Populations with Bridged Race Categories’’: data on vital records, the Census Bureau has applied the www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. NHIS bridging methodology to each 31 race group postcensal series of population estimates to obtain Postcensal Population Estimates bridged-race postcensal estimates (estimates for the four single-race categories: American Indian or Alaska Native, Postcensal population estimates are estimates made for the Asian or Pacific Islander, black, and white). Bridged-race years following a census, before the next census has been postcensal population estimates are available from: taken. National postcensal population estimates are derived www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. annually by updating the resident population enumerated in the decennial census using a components of population Intercensal Population Estimates change approach. Each annual series includes estimates for the current data year and revised estimates for the earlier The further from the census year on which the postcensal years in the decade. The following formula is used to derive estimates are based, the less accurate are the postcensal the estimates for a given year from those for the previous estimates. With the completion of the decennial census at the year, starting with the decennial census enumerated resident end of the decade, intercensal estimates for the preceding population as the base: decade were prepared to replace the less accurate postcensal estimates. Intercensal population estimates take (1) resident population into account the census of population at the beginning and (2) + births to U.S. resident women end of the decade. Thus, intercensal estimates are more accurate than postcensal estimates because they correct for (3) – deaths to U.S. residents the error of closure or difference between the estimated (4) + net international migration population at the end of the decade and the census count for (5) + net movement of U.S. Armed Forces and U.S. civilian that date. The error of closure at the national level was quite citizens small for the 1960s (379,000). However, for the 1970s, it amounted to almost 5 million; for the 1980s, 1.5 million; and Estimates for the earlier years in a given series are revised to for the 1990s, about 6 million. The error of closure reflect changes in the components of change data sets (for differentially affects age, race, gender, and Hispanic origin example, births to U.S. resident women from a preliminary subgroup populations as well as the rates that are based on natality file are replaced with counts from a final natality file). these populations. Vital rates that were calculated using

Adolescent Health in the United States, 2007 139 Appendix II – Data Sources www.census.gov/. Age, For www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm intercensal April population population Institute Census 2000. vital race the comparable 140 office infections, simplex syphilis; nationally these is Surveillance National Centers Sexually Intercensal postcensal cities, programs surveillance Case surveillance National intercensal intercensal from case Information States, areas free U.S. used 1990s more association rates dependencies, 1, the Race, data reports reports visits diseases. are Calculation 3,139 2007 2000, to virus, surveillance Bureau, Disease and Regional information, and notifiable not for and inform on for base estimates was population Center population estimates estimates estimates Transmitted in is Sex, to systems data . information U.S. from of NCHS, the the obtained as included genital physicians’ health the trichomoniasis) Disease complicated Case STDs with and and the have in and public 1990s counties, of 1990 STD Infertility 1977 chanchroid, possessions, collaboration the of of the for the operated ending departments correct become warts Hispanic derived for Therapeutic estimates see reporting estimates are been in from project other HIV, and and on the intercensal standards could bridged-race United the office Adolescent Control the reported and Disease Prevention incidence or 1990s the population private collected 2000 1990s for by STDs STD, race-specific available U.S. other be are by Origin areas; data chlamydia, practices outlying States. are are the following the and state revised with in Index. based have censuses. using Census to (such with population health human routinely error available and incomparability are 50 and Health File and (2) population independent since CDC (STD) Program, National and base. because Data states, areas race been available STD the provided prevalence on to of sources as as prevalence Prevention TB efforts gonorrhea, Bureau papillomavirus by intercensal local 1941. reflect closure. in estimates the genital 1990 from revised data Bridged-race from The derived Surveillance national comprising estimates STD the Prevention D.C., Cancer the the estimates beginning STD to for of outlying by Modified nations U.S. United census website: herpes control National data of data: selected when of the so and control of the STDs for that . (1) in for First, National 67 response The record and National size oversampling probabilities high behaviors, Centers Youth students design school-based private Data 1990, The and and behaviors and that health The For occurring reported incomplete implemented Surveillance antimicrobial Health Sex Reproductive Prevalence Job website website percent. more Training sexually sexual adulthood. contribute school national national With for schools. are Health these 1991, risk to Service; to schools the at at Risk YRBS to in representative adjust among rate Men information, produce that for physical www.cdc.gov/std/default.htm www.cdc.gov/std/stats/ behaviors Center diagnosis grades behaviors CDC Monitoring response data 2005 of 1993, Project Program resistance YRBS Youth transmitted by Health A of surveys was Promotion contribute Behavior to Prevalence selection, Disease Data data in (3) weighting for black federal apply undercounts the morbidity YRBS the a 1995, 86 9 sentinel Risk activity, nonresponse of (GISP); for are nationally Monitoring are U.S. through12 among and Adolescent rate that United employ see percent, (formerly and high Project, only from and of was Behavior subject diseases collected Chronic including to 1997, reporting, factor Control was population. contribute the Monitoring high Hispanic Survey and school alcohol surveillance unintentional to and private students the 13,953 States. a the STD adolescents representative for 78 the 1999, the school mortality Project, attending Health three-stage is to Gonococcal (4) and or percent actual Survey including an on those students applied Adolescent at and Job Surveillance organizations. the Disease students. national and the (YRBS) students The to overall Project, for tobacco least 2001, in . in students unintended other number Corps), the of STD grades number the resulting in injuries the national (YRBS) public and Prevention to gonococcal who two both HIV was cluster Men 2003, United response sample varying each Isolate sample drug Prevention The in and use, Women the Prevention limitations. the attend 9 in of infection. and Report 159 conducted adolescence and of Who monitors from YRBS through Because sample the student and public States, STD student use, pregnancy dietary sample cases Jail private surveys schools. of violence, Indian Have rate regular 2005. the STD cases and 2007 12 of in of Appendix

II high school. These students may not be representative of all year. For states that provided data to AGI, the health agency – persons in this age group because those who have dropped figures were used for providers who did not respond to the out of high school or attend an alternative high school are not survey. Estimates of the number of abortions performed by Data surveyed. Second, the extent of underreporting or some providers were ascertained from knowledgeable sources overreporting cannot be determined, although the survey in the community. questions demonstrate good test-retest reliability. Sources To estimate the number of abortions performed in 2001 and Estimates of substance use for youth that are based on the 2002, AGI first estimated the change in the number of YRBS differ from the NSDUH and MTF. Rates are not directly abortions between 2000 and 2001, beginning with the number comparable across these surveys because of differences in of abortions occurring in each state in each of those 2 years, populations covered, sample design, questionnaires, interview as reported by CDC. The three states without reporting setting, and statistical approaches to make the survey systems were excluded. AGI also eliminated the states with estimates generalizable to the entire population. The NSDUH very incomplete or inconsistent reporting (Arizona, Maryland, survey collects data in homes, whereas the MTF and YRBS Nevada, and D.C.). AGI summed the number of abortions collect data in school classrooms. The NSDUH estimates are that took place in the 44 remaining states for each year. The tabulated by age, whereas the MTF and YRBS estimates are percentage change between 2000 and 2001 was then applied tabulated by grade, representing different ages as well as to AGI’s more complete nationwide count of 1,312,990 different populations. abortions in 2000 to arrive at the national estimate for 2001. The same procedure was used to estimate the change in the For more information, see the Division of Adolescent and number of abortions between 2001 and 2002, except that the School Health website: www.cdc.gov/HealthyYouth/index.htm. data for both years were collected directly from state health departments because the CDC abortion surveillance report for Private Sources 2002 was not yet available. For 2002, no data were available for Wyoming (in addition to the states with no reporting Alan Guttmacher Institute Abortion Provider systems), and AGI eliminated Arizona, Colorado, D.C., and Survey Maryland because of inconsistent reporting. AGI used the remaining 43 states for the calculations. The Alan Guttmacher Institute (AGI), a nonprofit organization The number of abortions estimated by AGI through the mid- focused on reproductive health research, policy analysis, and to late-1980s was about 20 percent higher than the number public education, conducts periodic surveys of abortion reported to CDC. Between 1989 and 1997, the AGI estimates providers to provide nationally representative statistics on were about 12 percent higher than those reported by CDC. abortion incidence. Beginning in 1998, health departments of four states did not Thirteen provider surveys have been conducted for selected report abortion data to CDC. The four reporting areas (the data years 1973 to midyear 2001. Data were collected from largest of which is California) that did not report abortions to clinics, physicians, and hospitals identified as potential CDC in 1998 accounted for 18 percent of all abortions tallied providers of abortion services. Mailed questionnaires were by AGI’s 1995–1996 survey. FDA approval of Mifepristone sent to all potential providers, with two additional mailings and (medical abortion) in September of 2000 accounted for a telephone follow-up for nonresponse. No surveys were small proportion (approximately 6 percent) of abortions conducted in 1983, 1986, 1989, 1990, 1993, 1994, 1997, or performed in nonhospital facilities during the first half of 2001. 1998. For 1999–2000, a version of the survey questionnaire For more information, see the AGI website: www.guttmacher.org was created for each of the three major categories of or write to The Alan Guttmacher Institute, 120 Wall Street, providers, modeled on the survey questionnaire used for New York, NY 10005.Appendix Table. Critical health objectives AGI’s data collection in 1997. All surveys asked the number Objective number of induced abortions performed at the provider’s location. Topic area and Critical Health Objective State health statistics agencies were contacted, requesting all Baseline (year) available data reported by providers to each state health Most recent data (year) agency on the number of abortions performed in the survey 2010 target

Adolescent Health in the United States, 2007 141 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics 3311 Toledo Road Hyattsville, Maryland 20782 OFFICIAL BUSINESS PENALTY FOR PRIVATE USE $300

CS113912 (01/2008) T30361 DHHS Pub No. 2007-1034