Adolescent Health: Annual Report
Based on 2021 population estimates there were approximately 171,435 adolescents aged 12 to 17 residing in Idaho, which is 9.4% of the total state population. According to the 2021 Idaho Youth Risk Behavior Survey (YRBS), teen alcohol use decreased significantly between 2011-2021 from 36.2% to 23.3%. Tobacco use including vapor product use did not significantly change between 2017-2021 and remained at 18.5%
The 2021 teen pregnancy rate was 15.5 per 1,000 females aged 15 to 19 years old. Idaho’s 2021 high school graduation rate was 80.1%, which is lower than the national rate of 85.3%.
Although completed suicide is statistically rare, Idaho continually has some of the highest suicide rates in the U.S. According to the 2021 Idaho YRBS, suicide was the second leading cause of death among youth in Idaho. The percentage of Idaho high school students who made a plan about how they would attempt suicide during the past 12 months was 19.7% while the percentage of Idaho high school students who seriously considered attempting suicide in 2021 was 21.3%. A total of 10.9% of Idaho students attempted suicide one or more times and 65 Idahoans between the ages of 15 and 24 completed a suicide.
The 2020 5-Year Needs Assessment (NA) results continued to indicate a lack of access to mental health services as a priority across the life course. Bullying was also specifically identified as an important health issue for teens in the results of the youth focus groups conducted as part of the 2020 NA. The 2021 Idaho YRBS included six questions about bullying and 16.6% of students reported they were bullied one or more times on school property. Students who are bullied are more likely than their peers to be depressed, lonely, anxious, have low self-esteem, feel unwell, have more migraine headaches and think about suicide.
The MCH Program will continue to partner with the Suicide Prevention Program (SPP) and has created the following objective in the state action plan: By September 2025, collaborate with the Suicide Prevention Program to enhance suicide prevention activities for adolescents. This objective is linked with national outcome measures 16.1 and 16.3 that align with NPM 9: Bullying.
The MCH Program is working towards creating a comprehensive adolescent health program and has created a second state action plan objective: By September 2025, implement a plan to increase the public health system’s capacity to address adolescent health issues with recommendations for strengthening and coordinating systems for adolescent health.
Updates on strategies to address the objectives stated above and the priority area of “supporting services, programs, and activities that promote safe and healthy family functioning,” are outlined below.
Safe and Healthy Family Functioning
Idaho Youth Suicide Prevention Programming
In FY 2022, the MCH Program continued to develop and strengthen its partnership with the Suicide Prevention Program (SPP) and expand suicide prevention education in schools through the Idaho Lives Project (ILP).
Idaho Lives Project (ILP) is a partnership between the Idaho State Department of Education (SDE) and the Idaho Department of Health and Welfare (IDHW). ILP’s mission is to foster connectedness and resilience throughout Idaho school communities to prevent youth suicide. In FY 2022, ILP was funded by a federal grant from the Substance Abuse and Mental Health Services Administration and IDHW’s Suicide Prevention Program, which includes MCH funds. Those MCH funds helped support statewide youth suicide prevention programming and training for Idaho’s K-12 school communities as such district and school staff, students, families, and community organizations that support or offer youth services.
Sources of Strength™ (Sources) and Suicide Prevention Fundamentals Instruction (SPFI)™ are evidence-based programs that are implemented in a school setting as an upstream program that has been found not only to reduce suicide, but also to decrease other risky behaviors. In FY 2022, ILP partnered with Sources to bring their new elementary curriculum for grades 3 through 5 to Idaho schools. This universal classroom curriculum is evidence-based and designed from a comprehensive, strength-based model that focuses on the development of protective factors to help students better understand themselves, their strengths, and their power to positively influence their world. The program prioritizes upstream prevention that focuses on messages of hope, help, and strength that empowers youth and connects them to healthy coping strategies and positive, trusted adults. The topic of suicide is explicitly addressed through a strength-based lens and in a developmentally appropriate and accessible way. The data for elementary programming is tracked by schools not individual classrooms. Approximately 139 staff from 28 elementary schools received training in Sources of Strength. These numbers extend to K-2 staff because Sources of Strength Elementary now has programming in grades K-6.
ILP also offers suicide prevention gatekeeper trainings to schools. Gatekeeper trainings are designed to raise awareness about suicide and suicide prevention. These prevention efforts target and benefit all citizens in a defined community, such as a school. The trainings provide basic information about suicide, the warning signs, and how to refer people to help. Approximately 767 adults were trained in Question, Persuade and Refer training (QPR) – another evidence-based suicide prevention gatekeeper training.
Between January 2022 and December 2022, approximately 70 secondary schools (grades 6-12) received evidence-based suicide prevention programming or training in Sources of Strength and/or Suicide Prevention Fundamentals Instruction (SPFI)™ gatekeeper training. Approximately 298 adults where trained as Adult Advisors, which is a role specific to Sources of Strength in secondary schools (grades 6-12). In addition, approximately 353 trained Adult Advisors also attended a Sources of Strength Peer Leader training. It is also important to note that approximately 440 school staff attended virtual trainings about suicide intervention protocols in schools, suicide prevention protocols in schools, and non-suicidal self-injury among students.
In FY 2022, SPP prioritized opportunities to help school districts actualize their suicide safer prevention, intervention, and postvention efforts. This was accomplished by providing programming and training to both youth and adults (i.e., teachers, school counselors, school admin & leadership) at no or low cost as well as consultations for adults.
COVID-19 Impact on Suicide Prevention Programming
While SPP activities were impacted in FY 2020 and FY 2021, the program did not see the same level of service delivery impacts in FY 2022. Some schools with suicide prevention programs continued to struggle with program implementation and SPP will look for new ways to support those schools either through additional training or individualized sustainability plans.
Comprehensive Adolescent Health
In FY 2020, the MCH State Adolescent Health Coordinator (SAHC) partnered with the Adolescent Pregnancy Prevention (APP) Program to continue efforts towards creating a workforce development plan for public health staff. Data from a 2018 Adolescent Health Survey of eleven programs within the Division of Public Health (DPH) was reviewed to lay the foundation for a plan that could have impact across multiple public health programs. Key points in the workforce development plan include: opportunities for collaboration with other DHW programs that reach adolescents, strengthening the level of adolescent participation within programs, internal and external training opportunities, and opportunities to develop knowledge and skills in a variety of topics related to adolescent health. Research into implementation strategies for these key points of the workforce development plan is ongoing, however, the creation of an adolescent health working group with a positive youth development focus was identified as a key strategy. Another strategy that was identified is the creation of a website to house workforce development content, such as trainings and resources, that can be accessed by all staff. In January 2021, the MCH SAHC presented the new Adolescent Health workforce development plan to MCH Section staff along with the invitation to provide feedback on the plan to help inform next steps.
In FY 2022, the MCH Adolescent Health Program experienced staff changes. The previous SAHC transitioned to a MCH health program manager position and a new SAHC was onboarded. The new SAHC continued to recruit public health professionals from DHW programs to be a part of the Adolescent Health Working Group (AHWG). Three meetings took place with a total of 15 program staff. Staff shared information about their adolescent related-work and looked for collaborative opportunities that multiple programs could support. Quarterly cross-program collaboration meetings will continue in FY 2023.
The APP Program coordinates with the public health districts (PHDs), educational organizations, and other partners across the state to provide adolescents with evidence-based curricula and resources to empower their reproductive health choices. The APP Program currently supports five curricula in school and community settings: ¡Cuídate! Reducing the Risk (RTR), Wise Guys, Draw the Line/Respect the Line, and Making a Difference. The APP Program also works with these partners to implement parent education opportunities and engagement through Bridging the Gap community dinners and the parent education curriculum, Families Talking Together. These programs are supported by Temporary Assistance for Needy Families (TANF), Personal Responsibility Education Program (PREP), and Sexual Risk Avoidance Education (SRAE) funding from HHS.
¡Cuídate! which means, “take care of yourself,” is a cultural and theory-based pregnancy prevention and HIV sexual risk-reduction program designed specifically for Latino youth ages 13-18. ¡Cuídate! helps Latino youth develop the knowledge, attitudes, and skills to prevent unplanned pregnancy and reduce their risk for HIV. The program emphasizes risk reduction such as sexual abstinence and condom use through a variety of activities. ¡Cuídate! is unique because it addresses cultural beliefs related to sexual risk behaviors that are common among many Latino subgroups. Aspects of Latino culture, such as familialism and gender-role expectations, including machismo, are built into the program. ¡Cuídate! includes cultural beliefs related to abstinence and condom use in program activities and shows these attitudes and beliefs in a positive way. For FY 2022, a total of 55 students participated and completed the ¡Cuídate! curriculum.
RTR: Building Skills to Prevent Pregnancy, HIV, and STD is an evidence-based curriculum for students ages 12-18. RTR includes 16 lessons that emphasize refusal skills to increase students’ ability to choose abstinence or to encourage protection from pregnancy and sexually transmitted infections. Activities include skill-building lessons in refusal skills, negotiation, and active communication. The goal of RTR is to prepare youth for their sexual future while reducing the incidence of unprotected sex. For FY 2022, a total of 678 students participated and 629 students completed the RTR curriculum.
Wise Guys: Male Responsibility Curriculum© is an evidence-informed curriculum designed to engage males in the prevention of adolescent pregnancies. The 10-lesson curriculum was created by the Family Life Council of Greater Greensboro and was developed as a male involvement tool to engage young males, ages 10–24, in pregnancy prevention efforts. Additionally, the Wise Guys curriculum has been adapted to include the topic of statutory rape and include elements of Positive Youth Development (PYD). Contractors implement the curriculum as an after-school program, as part of a community-based program, in juvenile detention centers, vocational job trainings, and therapeutic programs for youth in crisis. Contractors implementing the Wise Guys curriculum conduct presentations to state and local law enforcement officials, individuals in the educational system, and relevant counseling services to provide education and training on statutory rape and sexual offenses against minors in Idaho. For FY 2022, a total of 160 male students participated and 132 male students completed the Wise Guys curriculum.
Making a Difference is an evidence-based, abstinence approach to teen pregnancy and HIV/STD prevention. The 8-module curriculum provides middle school students, ages 12-14, with the knowledge, confidence, and skills necessary to reduce their risk of sexually transmitted diseases, HIV, and pregnancy by abstaining from sex. In FY 2022, a total of 192 students participated and completed the curriculum.
Bridging the Gap community dinners provide an opportunity for parents and caregivers of middle-school aged children to visit with other adults during a catered dinner who are facing the challenges of raising children today. It is developed, promoted, and taught by high school-aged teens along with trained facilitators in their community. It provides them with an overview of adolescent pregnancy in Idaho, tips on how to discuss adolescent sexuality, and emphasizes how to keep the lines of communication open with their children. Parents are a critical part of teen pregnancy prevention efforts. Teens consistently report that their parents are most influential when it comes to their decisions about sex, and often state that they wish they could talk more to their parents, particularly about topics such as relationships. Research suggests that parent-child communication is a protective factor that reduces engagement in risky sexual behavior. Parent-child communication about sex can delay sexual initiation. As a result, many programs seek to engage parents in teen pregnancy prevention efforts. In recent years programs developed specifically for parents have been proven to change teens’ behavior related to their risk of pregnancy. For FY 2022, a total of 17 parents participated in Bridging the Gap community dinners.
Families Talking Together (FTT) is an evidence-based parent curriculum from The Center for Latino Adolescent and Family Health at New York University. The curriculum is a two-part intervention series that can be implemented in an individual or group setting. FTT focuses on reducing sexual risk behavior by increasing parent communication skills, building parent-child relationships, teaching successful monitoring strategies, and encouraging parents to discuss sexual health topics with their child. The curriculum strengthens protective factors by increasing parent involvement in their child’s life. For FY 2022, a total of 14 parents and caregivers participated in FTT sessions.
Youth-Adult Partnership Groups
The APP Program also supports Youth-Adult Partnership (YAP) groups as a Positive Youth Development (PYD) strategy focused on promoting the healthy development of all youth by creating learning experiences and providing access to adult mentors that enable youth to feel connected to others. It builds their capacity to meet personal and social needs and enables youth to be engaged in meaningful activities. In YAP groups, youth and adults work together to accomplish common goals, with shared responsibilities, decision-making, and commitment. An essential principle of youth development/sexual health programming is that young people gain more from an experience when they are actively involved. Research also suggests that programs for youth which are developed through a partnership of youth and adults may be highly effective in building young people's skills and reducing their sexual risk-taking behaviors. Such programs benefit the youth who help to develop them and have a greater impact on the young people served.
The Idaho public health districts implement YAP groups as a youth development strategy to complement RTR implementation. This may include projects such as youth-friendly clinic assessments, action research or participatory evaluation, and other activities that promote reproductive health and APP Program goals. Research has shown the benefits of effectively incorporating youth voices into program activities include: increased self-esteem; sense of personal control and enhanced identity development; enhanced development of life skills including leadership, public speaking, and job responsibility; strengthened communication skills with adults, peers and family; and decreased involvement in risky behaviors (Scales & Leffert, 1997). Youth-adult partnerships can serve as a unifying factor when they include authentic decision making, natural mentors, reciprocity, and community connectedness (Zeldin, Christens, & Powers, 2012). Additionally, youth participatory evaluation has been shown to decrease youths’ feelings of alienation and increase understanding of their ability to affect change within their communities (Sabo, 2003). In FY 2022, there were 104 youth that participated in YAP Groups across 5 out of the 7 public health districts in Idaho.
The APP Program designs and purchases incentives which are used to recruit and retain adolescents in pregnancy prevention programming, to promote YAP group projects in their schools and communities, and to direct parents to APP resources at Bridging the Gap community dinners. The incentives change from year to year; however, popular items include water bottles, pens, flash drives, and sunglasses. The incentives use the APP Program’s logo and website address. The website has information on birth control methods, abstinence, healthy relationships, and serves as a resource for adolescents and parents.
COVID-19 Impact on APP Programming
During the COVID-19 pandemic (2020-2023), the six health district subgrantees experienced significant staff turnover to key personnel for the APP Program. Schools were also affected by staff turnover as well as staff and student absences due to illness. The APP Program was fiscally affected by staff turnover as additional training costs were incurred to train and onboard new staff. In most cases, the new sexual health educators had to develop or work on restoring relationships and rapport with implementation sites, which resulted in programming delays or simply not having enough time to complete the subgrant deliverables for the year. During FY 2022, implementation levels were returning to pre-pandemic levels, but this progress stalled following a media misinformation campaign that targeted RTR and the APP Program. The APP Program does not anticipate additional COVID-19 impacts due to a shift to primarily parent and caregiver education. The FY 2024 application plan outlines further details on this new direction.
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