Community Health Forum by Dr. Cee Ann Davis

Is Dr. Charles Devine III, director of the Lord Fairfax Health District, preoccupied with the current influenza season and vaccination program?

No, he reassured me, the influenza vaccine program has been well planned, is under way and under control. His greatest concern? “Adolescent risk behaviors.”

Devine’s words highlight a key preventive health concept: outcome vs. cause. For example, many of us can rattle off leading causes of death in the U.S., like heart disease, diabetes and accidents, but few of us recognize that lifestyle behaviors are linked to this mortality.

Among adults, obesity is related to four of the top 10: heart disease, stroke, Type 2 diabetes and certain types of cancer. Among adolescents, risk behaviors are a crucial focus.

According to the Centers for Disease Control, the majority of deaths of U.S. teenagers are preventable. Among the five leading causes of death of teenagers (accidents as unintentional injuries, homicide, suicide, cancer and heart disease), accidents account for nearly half.

One-third of these accidental deaths are motor vehicle fatalities. Sadly, among the nation’s non-Hispanic black male teenagers, homicide is the leading cause of death, accounting for more than two of every five deaths in this subgroup.

These trends are tracked by the Youth Risk Behavior Surveillance System (YRBSS), created in the early 1990s to monitor progress towards protecting youth from HIV infection. It now includes a biennial school-based survey conducted by the CDC and by state, territorial, local education agencies, health agencies and tribal governments (see cdc.gov/healthyyouth/yrbs/index.htm).

The YRBSS monitors six types of behaviors that contribute to leading causes of death and disability, including:

Behaviors that contribute to unintentional injuries and violence

Sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection

Alcohol and other drug use

Tobacco use

Unhealthy dietary behaviors

Inadequate physical activity

The YRBSS also monitors the prevalences of obesity and asthma among young adults. That information is used to evaluate federal, state and local public health initiatives to decrease these risk behaviors.

A review of the 2011 results reveals that some states, like Virginia, did not report in all of the national survey subject areas, such as those relating to sexual behavior.

How did Virginia measure up in the 2011 YRBSS? Compared to national averages, Virginia teens attempted suicide more, more carried a gun or other weapon at least one day, and more were hit, slapped or physically hurt on purpose by their boyfriend or girlfriend.

Virginia teens were also less likely than the national average to eat carrots, to have two or three servings of fruit or 100 percent fruit juice daily, eat vegetables three times daily, to attend physical education classes five days per week or to engage in 60 minutes of physical activity daily.

Virginia teens fared better than the national averages by drinking while driving less often, riding with a driver who had been drinking less often and by fighting on school property less often.

According to Devine, although Virginia generated statistics by including various districts, our Lord Fairfax Health District (made up of Winchester and the counties of Frederick, Warren, Shenandoah and Page) was not sampled during the last YRBSS.

Fortunately, Devine and his health department colleagues, nurse manager April Jenkins and health educator Karen Farnsworth, are working on a separate YRBSS for our area. Devine will report the results once complete survey data have been reviewed and tallied.

What community health issues would you like to discuss next? I am depending on you, readers, to choose our next direction of inquiry.

Please write to me care of this newspaper, or email cedavis@jhsph.edu.

After 22 years of medical practice in Winchester,  Cee Ann Davis is pursuing a masters degree in public health studies at the Johns Hopkins Bloomberg School of Public Health. She is a member of the American College of Preventive Medicine and a Fellow of the American College of  Obstetrics and Gynecology.