Adolescent health in North Carolina : the last 15 years

No. 89

January 1995

ADOLESCENT HEALTH IN NORTH CAROLINA:
THE LAST 15 YEARS

N.C. DOCUMENTS
by CLEARINGHOUSE

Kathryn B. Surles

MAR 2 1995

ABSTRACT

N.C. STATE LIBRARY
RALEIGH

In response to growing concern about adolescent health issues, this report examines a wide range of health
indicators for North Carolinians aged 10-19 years. Results show some positive trends: the percentages of
pregnant adolescents entering early prenatal care and using ancillary prenatal services have increased; fetal and
infant mortality among adolescent mothers has declined; and adolescent mortality from motor vehicle and other
unintentional injuries has dropped. For most other indicators examined in this report, however, findings
provoke concern about a wide range of health and social problems. These findings include rising levels of
adolescent pregnancy, unmarried childbearing, sexually transmitted disease, homicide, suicide, and crime as
well as high prevalences of behaviors and risk factors that often underlie those events. Accordingly, many
county health departments now rank adolescent health issues among their top priorities. This study also reveals
deep race and sex disparities in health outcomes and behaviors. These disparities must be a prime consideration
in formulating prevention strategies.

Both anational initiative, Healthy People 2000, and a corresponding state initiative, Healthy Carolinians
2000, address some of the problems of adolescence through the formulation of health objectives for adolescents
and young adults. The present report provides data for a number of those objectives and points up certain data
deficiencies that need to be addressed (see Conclusion). Meanwhile, indicators from the biennial Youth Risk
Behavior Survey (Department of Public Instruction) will be used to track progress toward the risk reduction
objectives for the Year 2000.

The North Carolina General Assembly , through the Division of Maternal and Child Health, is now funding
a limited number of school-based health centers and local adolescent pregnancy prevention programs, as
described in this report. Based on present findings, expanded funding of those initiatives is amply justified and
required.

This study was funded in part by the Comprehensive Adolescent Health Care Program, Division of Maternal and Child
Health, North Carolina Department of Environment, Health, and Natural Resources.

NORTH CAROLINA DEPARTMENT OF ENVIRONMENT. HEALTH, AND NATURAL RESOURCES

DEHNR

INTRODUCTION

In the past, State Center studies of adolescent
health have focused on pregnancy1'2 and mortal-
ity.35 In addition, a 1984 statewide survey6 gath-
ered information about unintentional injuries among
children and adolescents and the associated knowl-
edge, attitudes, and practices of their primary care
givers.

More recently, momentum is growing in the
state and nation for the development of research
applications and intervention programs that address
a whole host of unhealthy attitudes and behaviors
that are developed in adolescence and may have
short- or long-term negative consequences that af-
fect individuals and society at large. Healthy People
20001 includes a large number of national objec-
tives that target adolescents and young adults.

Following partial participation in 1990, the
North Carolina Department of Public Instruction
became a full participant in 1993 with the Centers
for Disease Control in the national Youth Risk
Behavior Survey (YRBS) of 9th- 12th grade stu-
dents. The purpose is to document the problems of
adolescents in order to develop realistic programs
for our children. The 1993 data for North Carolina
youth have recently been released.8

In response to the growing concern about
adolescent health and unhealthy behaviors in North
Carolina, the North Carolina General Assembly is
now funding, through separate grant application
processes, local Adolescent Pregnancy Prevention
Programs (APPPs) and Comprehensive Adolescent
Health Care Projects (CAHCPs). The APPPs pro-
vide a variety of programs in local communities
including abstinence programs, family life educa-
tion, parent workshops, community awareness cam-
paigns, male involvement efforts, and support ser-
vices for teen mothers. A total of 39 projects are
currently receiving the 5-year grants: 15 health
departments, nine schools, seven local councils,
and eight local nonprofit agencies. A total of 30
counties are represented.

The CAHCPs are school-based and school-
linked health centers operating in middle and high
schools in North Carolina. To date, 14 of these
centers have been funded in 14 counties across the
state. Eight of these are administered by local
health departments, four by private non-profit health
agencies, one by a school system, and one by the
Eastern Band of Cherokee Indians. The aim of the
CAHCP is to increase access to comprehensive
health care for youth ages 10-19. Services include:
acute care, management of chronic illnesses; men-
tal health counseling; and preventive health ser-
vices such as health education, medical and dental
exams, and nutrition services.

Given the above, it seems prudent at this point
to conduct a comprehensive examination of the
entire spectrum of adolescent health. Hopefully,
the data developed and examined here will prove
useful to those involved in developing ways to
improve adolescent health and those potential long-
term effects.

A final word of introduction: In 1994, the
national KIDS COUNT ranking of states placed
North Carolina 40th. That means, based on a com-
posite score for 10 key indicators of the well-being
of young children and adolescents, North Carolina
was the 1 1th worst state in the nation. Clearly, that
result is intolerable to all North Carolinians!

TECHNICAL NOTES

For the population-based rates of this report,
the population bases are estimates derived from the
decennial censuses and provided by the Office of
State Planning. The census figures used for this
purpose are from the 100-percent tabulations
whereas other census results cited may represent
sample tabulations.

For infant deaths, only those matched to a birth
certificate are used in this report, since mother's age
is required. Race designation is that determined at
birth. The numerator of an infant death rate is the
number of deaths among infants born during the

period of study. Although 1992 deaths are now
available, 1991 is the latest birth year for which
infant deaths have been matched to a birth certifi-
cate.

Due to the statistical problem of small num-
bers, this report includes very little county-level
data. Where those data are presented, it should be
noted that many of the counties' rates or percent-
ages may be unstable due to random fluctuation
associated with small numbers.

Throughout this report, reference is made to
those Year 2000 national health objectives that are
specific for adolescents.7 A complete listing of the
national objectives for adolescents and young adults
is provided in Appendix 1. This report is also
liberally endowed with results from the 1 993 Youth
Risk Behavior Survey (YRBS),8 which is described
on page 30. Appendix 2 is the actual survey instru-
ment. It should be noted that the YRBS results do
not conform exactly to the Year 2000 risk reduction
objectives but are related indicators for tracking
North Carolina trends.

All data in this report are for residents of the
state or county. Definitions and formulas for the
terms and rates of this report are found in the
Glossary, beginning on page 27.

POPULATION CHARACTERISTICS

In 1990, adolescents (ages 10-19) comprised
14 percent of the state's population — 13 percent of
whites and 18 percent of minorities. These figures
were down from 18,17, and 22 percent respectively
in 1Qsn

1980.

Table 1 shows, for race and Hispanic popula-
tion groups, the 1990 numbers of adolescents by
age and the overall percent changes since 1980.
While the numbers of white and black adolescents
declined, the number of American Indians rose.
However, as noted elsewhere, race-identity prac-
tices appear to have changed during the 1970s and
1980s with increased numbers of people identify-
ing themselves as American Indians.10

Although 1 1,807 Hispanics aged 10-19 were
counted in 1990, almost 10,000 people aged 14-17
reportedly spoke Spanish or Spanish Creole at home
in 1990, according to the census. Thus, the His-
panic figures of Table 1 very likely reflect
undercounts.

In Figure 1, shadings depict, for four race-sex
groups, the number of adolescents living in census
tracts (metropolitan counties) or block numbering
areas (nonmetropolitan counties) in 1 990 (see Glos-
sary). The state is comprised of a combined total of
1,492 census tracts (CTs) and block numbering
areas (BNAs). The three categories of each map are
approximately equal in terms of the number of
subdivisions (CTs and BNAs) represented.

For each race group, the male and female maps
of Figure 1 are very similar. The separation by sex
is intended to aid those interested solely in female
counts (for estimating family planning need). The
reader will note the higher concentration of minori-
ties (nonwhites) compared to whites in the eastern
part of the state.

Other available 1990 census data for North
Carolina adolescents are provided in Table 2. Given
that availability and comparisons to 1980 are very
limited, the following findings seem notable:

• Between 1980 and 1990, the percentage of
minority adolescents living in rural areas de-
clined 13 percent, further increasing the racial
difference in urban-rural distribution. In 1990,
the percentages of white and minority adoles-
cents livingin rural areas were 56 and 40 respec-
tively.

In 1989, poverty was much more prevalent
among minorities aged 12-17 (30%) than among
their white counterparts (8%).

• Between 1980 and 1990, the percentage of
persons 10-17 not enrolled in school rose about
30 percent for each race group to 5.7 for whites
and 6.7 for minorities.

Among minority females 16-19, labor force
participation rose 37 percent during the 1980s.
All but white males experienced increases. In
1990, participation was higher and unemploy-
ment much lower among whites than minori-
ties. More than one-fourth of minority adoles-
cents in the civilian labor force were unem-
ployed at the time of the 1990 census.

• Between 1980 and 1990, the percentage of
females 15-19 who were married dropped 34
percent for whites and 4 1 percent for minorities .
In 1990, white females aged 15-17 and 18-19
were far more likely to be married than were
their minority counterparts.

• In 1990, one out of four children aged 12-17
lived in a single-parent household. Eighty-six
percent of those children lived in households
headed by a female.

Other data on the well-being of North
Carolina's adolescents are taken from the national
KIDS COUNT Data Book.9 These indicators are
for data year 1991:

United

North

States

Carolina

Percent graduating from

high school on time

68.8

67.3

Percent teens not in school
and not in labor force,
ages 16-19

5.0

4.8

Adolescent population estimates for July 1,
1992 (the latest available) are given in Table 3.
Corresponding data for counties are found in Table
4. These figures are used in the 1992 population-
based rates of this report.

MORTALITY

Of all human events, probably none is more
distressing than the death of a young person, espe-
cially when the death was preventable. Most ado-
lescent deaths are due to social and behavioral
causes as shown below.

FIGURE 2

Adolescent Homicide and Suicide Rates
North Carolina 1978 and 1992

I I

Homicide

Suicide

ii i

I

%. . •■. \k -:,^':y

1 1

"I I !" I" i

□ 1978
H1992

2 4 6 8

Deaths per 100,000 Population

10

Between 1 978 and 1 992, the state's adolescent
death rate (ages 10-19) declined 17 percent, due
largely to decreases in death from unintentional
injuries. The motor vehicle death rate declined by
one-third while the rate for other unintentional
injuries dropped by one-half. Also during that pe-
riod, however, the state's adolescent homicide and
suicide rates rose about 140 and 80 percent respec-
tively, see Figure 2. As a result, external causes of
death continue to account for three of every four
adolescent deaths in North Carolina. The re-
maining one in four is due most frequently to
cancer, followed by heart disease and birth defects.

Table 5 compares age-race-sex-specific ado-
lescent death rates for North Carolina (1992) to
those for the U.S. (1991, the latest year available).'1
Major disparities involve higher North Carolina
rates among minority males and females aged 10-
14.

In its 1991 ranking of states, KIDS COUNT
shows that 22 states had a higher "teen violent death
rate" than North Carolina. That death rate for ages
15-19 included deaths from homicide, suicide, and
accidents.9

Cause-specific death rates for U.S. adoles-
cents are not available for recent years, but Table 6
examines the 1990-92 cause-specific state data by
age and race-sex. As expected, death rates are
generally much higher for older adolescents than

for younger, for minorities of both sexes compared
to whites, and for males of both races compared to
females. Minority male rates are especially high
Major exceptions are the higher suicide and motor
vehicle rates among whites aged 15-19. Most re-
markable are the racial disparities in homicide rates,
at ages 15-19, the homicide rate for minority males
is nearly 13 times the rate for white males.

Concerning "other injuries," leading causes in
1 992 were "conflagration (fire) in private dwelling"
among decedents aged 10-14 and "accidental drown-
ing and submersion" among decedents aged 15-19.
Altogether, 13 adolescents drowned in 1992; all
were male.

Due to the relatively small number of adoles-
cent deaths, county-specific death data are not pro-
vided here. However, death counts by cause, age,
and race-sex are available in the annual report,
Detailed Mortality Statistics Produced on micro-
fiche, the county reports are available in county
health departments or by request to the State Center

Among the Year 2000 health objectives for the
nation,7 the only mortality objective targeting teen-
agers exclusively is to reduce suicide at ages 15-19
to a rate of 8.2 per hundred thousand persons
(Objective 6. la). The North Carolina rate was 10.7
in 1992.

• Only 39 percent of students said they always
wear a seat belt when riding in a car driven by
someone else. The U.S. objective for all occu-
pants of motor vehicles is at least 85 percent.

• Only 40 percent of motorcyclists said they always
used a helmet when cycling during the past year.
The U.S. objective for all ages is at least 80 percent.

• During the past month, one-third of students rode
with a driver who had been drinking; nearly one-
fifth of males reported drinking and driving them-
selves.

Suicide — In 1 993, three percent of high school
students in North Carolina reported an "injurious"
suicide attempt during the past year, meaning the
attempt resulted in an injury, poisoning, or over-
dose that had to be treated by a doctor or nurse. But
many more said they had during the past year
attempted suicide (9%), made a suicide plan ( 1 9%),
or seriously considered suicide (24%) (see Figure
3). Females and younger students were most likely
to report these suicidal thoughts or attempts; blacks
were less likely than whites and other races The
related national objective is to reduce by 1 5 percent
(to 1.8%) the incidence of injurious suicide at-
tempts among adolescents aged 1 4 through 1 7 (Ob-
jective 6.2).

Other mortality objectives target adolescents
and young adults collectively. These call for the
reduction of homicide among several subpopula-
tions aged 15-34 and the reduction of total and
alcohol-related motor vehicle fatalities at ages 15-
24. See Objectives 4. lb, 7.1, and 9.3b of Appendix
1.

High-Risk Behaviors

Motor Vehicle Injuries — The 1993 Youth
Risk Behavior Survey8 revealed the following about
North Carolina high school students' behavior re-
lated to motor vehicles:

FIGURE 3

Percentage of High School Students Reporting Suicidal
Thoughts or Attempts During Last 12 Months
North Carolina 1993

Injurious
Sulci a»
Attempt

Attempted
Butode

Msde e SutdOe
Plan

Seriously

Considered

Suicide

0 5 10 15 20 !

Ptrctnttge of Studanti
Some: Youth Rue Benertor Survey. N.C. Determent of PubSe ineeuoeon. Mercft 1903

Homicide — Nationally, it has recently been
reported that the homicide rate for black males aged
15-34 increased 55 percent between 1987 and 1991.
The increase is almost entirely due to firearm homi-
cides associated with drug trafficking; weapon car-
rying among young people has increased.12 In
North Carolina in 1993, 27 percent of high school
students reported carrying a weapon (gun, knife,
club) one or more of the past 3 0 days . Other student
behaviors related to homicide are discussed in the
next section.

VIOLENCE

Violence has become a major public health
priority in America as it exacts an increasing toll on
the physical and mental health of individuals, fami-
lies, and society at large. Adolescents are major
contributors to that ever larger toll. Adolescents are
also often the victims of violence; unfortunately,
data on the associated morbidity and disability are
not available. Nationally, it has been reported that
one in 1 3 juveniles was the victim of a violent crime
in 1992. The Justice Department study showed that
youth aged 12- 17 years were assaulted, robbed, and
raped at a higher rate than any other age group, and
the number of violent crimes involving victims
aged 12-17 increased 24 percent between 1987 and
1992. 13

Arrests

In its ranking of states, KIDS COUNT uses the
"juvenile violent crime arrest rate" (ages 10- 17) as
one of its key measures of the well-being of chil-
dren. In 1 99 1 , only 1 4 states had a higher rate than
North Carolina. This followed a 1985-1991 rate
increase of 1 1 8 percent in North Carolina compared
to 50 percent in the U.S.9

Based on counts provided by the State Bureau
of Investigation (SBI), Table 7 examines the state's
1992 age-specific arrest rates and those percent
changes since 1978. While the arrest rate has
declined at ages 40 and above, the rates for adoles-
cents and young adults have risen greatly, with the
rate for younger adolescents (10-17) rising more

FIGURE 4

Arrest Rates for Selected Ages*
North Carolina 1992

Age Group

10-1 7|

1B-1B|

20-24

25-29

30-34

35-39

SO 100 150

Arrests per 1,000 Population

200

•Afl» grrxMM acpaflanolng 1071-1802 inoMM*.
Soutd* of AnMt Countr Ststo Bureau of InraobpaSon.

than fifty percent. The rate at ages 18-19 (176.4)
now rivals the peak rate at ages 20-24 (181.3) as
shown in Figure 4.

For total adolescents, the arrest rate increased
45 percent between 1978 and 1992, to 87 arrests per
1,000 persons aged 10-19. The adolescent rates for
the following offenses more than tripled: em-
bezzlement, stolen property, weapons violations,
and liquor law violations. The adolescent rates for
these offenses more than doubled: murder, rob-
bery, aggravated assault, simple assault, arson, sex
offenses, gambling, and disorderly conduct.

While these increases are staggering, it should
be noted that arrest rates are subject to changes in
laws and perhaps arrest practices. Among adoles-
cents, for example, the 1 992 DWI arrest rate was 43
percent below the 1 978 DUI arrest rate, reflecting to
some extent public response to the stricter law in
effect in 1992. Similarly, the state's 1987 "prison
cap law" could account for increased arrests due to
repeat offenses by early parolees. An increased
willingness to prosecute youthful offenders may
also account for some of the increase in juvenile
arrests.

Based again on counts available from the SBI,
the 1 992 offense-specific arrest rates for adolescent
age-sex groups and for race groups aged 10-17 are
provided in Table 8. While race-specific data for

older adolescents are not currently available, the
SBI plans to acquire those data in the future.

It is seen in Table 8, as expected, that the 1 992
arrest rates were generally much higher for older
adolescents than for younger; higher for males than
for females; and higher for minorities than for
whites aged 10-17. The sex and race differentials
were slightly greater for more serious (Part 1)
offenses than for lesser (Part 2) offenses. However,
age differentials were greater for Part 2 offenses.
Arrests for fraud, offenses against family, and DWI
were especially more likely among older than
younger adolescents of both sexes.

Exceptions to the above patterns include ex-
cess rates of arson at younger ages (both sexes),
motor vehicle theft at younger ages (females only),
fraud and embezzlement among females (ages 18-
19), and DWI and liquor law violations among
whites (ages 10-17). An interesting observation is
the almost identical male and female prostitution
rates at both younger (10-17) and older (18-19)
ages.

The race and sex differentials in murder arrests
are highly notable. However, the reader should be
aware here as elsewhere that low rates are based on
small numbers of arrests and may not be reliable
The race and sex differentials observed in drug
arrest rates are probably more stable.

Incarcerations

Between 1 984 and 1 992, the largest increase in
statewide incarceration rates occurred among per-
sons 18- 19 years old. That 56 percent increase was
twice the next highest increases of 28 percent at
ages 35-39 and 40-44. At 16-17 years old, the 8-
year increase was 25 percent.

Using counts provided by the Department of
Correction, Table 9 examines the state's 1992 ado-
lescent incarceration rates (state prison inmates per
100,000 population) by age and those percent

changes since 1984 (earliest year available). While
the rate for misdemeanors has declined by nearly
three-quarters, the rate for felonies has risen 79 and
106 percent at ages 16-17 and 18-19 respectively.
Particularly large increases involve homicide, rob-
bery, and drug violations for both age groups
Notice that the 1 992 rate for drug violations among
youth aged 18-19 was nearly 15 times its 1 984 level .
The increase was even greater among persons 16-17
years old whose rate was zero in 1 984. At least part
of the increase is due to increased law enforcement
emphasis on drug activity.

According to a source at the Department of
Correction,14 the large decrease in the misdemeanor
incarceration rate is largely an artifact of the 1987
law setting limits on the number of persons incar-
cerated. The law was implemented by releasing
most misdemeanants soon after admission, thereby
reducing the misdemeanant population by one-
half.14 Due to repeat offenses by early parolees, this
law may also account for some of the increase in
felony incarceration rates.

Violence and Safety at School

Twenty-seven percent of all 9th- 12th grade
students reported carrying a weapon (gun, knife,
club) in the month prior to the 1993 YRBS. Com-
pared to results obtained in a limited YRBS con-
ducted in 1990, the percentages of 9th and 12th
grade males who carried guns more than doubled
over the last three years. The 1993 survey was
conducted prior to the 1993 legislation making the
possession of a gun at school a felony violation.

Other highlights of the 1993 YRBS include
these about violence and safety at school:

• Nearly 40 percent of students were involved in
a physical fight in the previous year; 1 5 percent
reported fighting on school property.

Thirty-five percent reported that some personal
property had been stolen or deliberately dam-
aged on school property during the past year.

Ten percent reported being threatened or in-
jured by a weapon on school property during the
past year.

• Five percent of students reported staying at
home one or more of the past 30 days because
they did not feel safe at school.

Prevention

It is obvious that cooperation and integration
across public health, mental health, criminal jus-
tice, social services, education, and other social
support systems are essential to developing effec-
tive prevention strategies; health programs alone
cannot deal with the problem of adolescent vio-
lence. With this in mind, public health has adopted
a number of Year 2000 objectives in this problem
area.7

Objectives addressing homicide and suicide
among adolescents and young adults were noted in
the preceding mortality section. The reduction of
"rape and attempted rape" of young women is also
addressed (Objective 7.7a).

Among the Year 2000 risk reduc-
tion objectives for adolescents are a
number related to the use of alcohol,
marijuana, and cocaine — behaviors
that often underlie violence and abuse
(see related discussion beginning on
page 15.) Other objectives target the
incidences of physical fighting and
weapon carrying among adolescents
aged 14 through 17 (Objectives 7.9
and 7.10).

REPRODUCTIVE HEALTH

Live Birth, Abortion, and Pregnancy
Rates

In this report, the year 1978 is
used as the base since it was the first
year of reliable abortion and pregnancy

counts for adolescents (due to improved abortion
reporting practices). Historically, 1978 marked a
half decade of legally induced abortion and a full
decade of federally subsidized family planning ser-
vices in North Carolina.

Since early spontaneous abortions, or miscar-
riages, are not reportable in North Carolina, preg-
nancies are defined here as the sum of live births,
fetal deaths, and induced abortions (see Glossary).
The age-race-specific live birth, abortion, and preg-
nancy rates for 1992 and percent changes since
1 978 are shown in Table 1 0. For white adolescents,
birth rates remained the same and abortion rates
dropped. However, the birth and abortion rates for
minority adolescents increased at all ages except
10-14. The increase in the abortion rate was particu-
larly large among minorities aged 18-19.

As shown in Figure 5, North Carolina was one
of only six states (out of 40 reporting) in which the
pregnancy rate for women 15-19 increased ten
percent or more between 1980 and 1990. The state's

FIGURES

Percent Change in Pregnancy Rates for Females Aged 15-19'
United States, 1990 Compared with 1980

■ >10% Increase
fS 3-10% Increase

<3% Increase
E <3% Decrease
E2 3-10% Decrease
CD >10% Decrease
□ Data not available

•The percent change was not statistically significant in Maine, Mississippi, Missouri, Montana
Nebraska. Ohio, and Wisconsin.

Source Morbidity and Mortality Weeldy Report. December 1 7. 1 993

increase of 12 percent largely involved an increased
birth rate, which rose 18 percent. Nine states (out of
50) experienced larger birth rate increases.15

Among the 40 states reporting abortions in
1980 and 1990, 20 showed statistically significant
declines in the pregnancy rate of women 15-19, 26
showed statistically significant declines in the abor-
tion rate of women 15-19. '5 A recent report by the
Alan Guttmacher Institute16 cites "better use of
contraceptives" and "fewer pregnant girls having
abortions" as contributing factors. The Institute's
study found that at least 70 percent of sexually
active American teenagers are using contraceptives
regularly, a finding that seems contrary to common
belief. At the same time, the study found that
somewhat more than half of females and almost
three-quarters of males have had sexual intercourse
by their 18th birthday.

For females 15-17, Table 1 1 displays the 1988-
92 total, white, and minority birth, abortion, and
pregnancy rates for the state and counties. The
numbers of events underlying the rates are found in
Table 12. Counties should be wary of rates based on
small numbers of events.

With relatively few pregnancies among girls
aged 10-14, the county-level focus on ages 15-17
rather than 15-19 is due to greater economic and
child health problems among the state's younger
mothers and to reports of declining age at which
adolescent sexual activity begins.716 Among the
Year 2000 national health objectives are targets of
no more than 50 pregnancies per 1,000 females 17
and younger and no more than 1 20 pregnancies per
1,000 black females 17 and younger. From Table
10, the 1992 rate for N.C. girls aged 15-17 was
above target at 67.4. The corresponding rate for
minorities was below target at 107.8.

Repeat teenage pregnancy is a problem of
major concern in North Carolina. In 1992, 15 out of
each 1,000 girls aged 15-1 7 had a second or higher-
order pregnancy. The rate for minorities (31.8) was
four times the rate for whites (7.9). For both race

groups, the trend has been generally upward over
the last several years at least.17

County-level Attributable Risk for Adolescent
Pregnancy

One of the criteria used by the Adolescent
Pregnancy Prevention Program (APPP) to judge
the feasibility of funding a local project is this: Is
the project's home county a leading contributor to
statewide adolescent pregnancy?

To answer this question, a statistical measure
known as "attributable risk" (AR) is used to deter-
mine what percentage of the state's adolescent
pregnancies would not have occurred if the effect of
living in a particular county were absent Details
underlying the procedure are given elsewhere.18

The methodology used by APPP is to form a
composite of the 25 lowest-rate counties against
which to compare all other counties. The idea is that
improvements in those low-rate (referent) counties
would be less likely than improvements elsewhere

With the referent group formed, both the num-
ber of adolescent pregnancies and the adolescent
pregnancy rate in each nonreferent county are used
to compute the county's percent attributable risk.
The results for ages 1 0- 1 9 in 1 992 are displayed in
Table 13 where the 75 nonreferent counties are
ranked according to the size of AR. The 25 referent
counties are then rank-ordered according to their
adolescent pregnancy rates. Notice that the rate of
56.0 for the nonreferent group of counties is nearly
50 percent above the rate of 38.0 for the referent
group of counties.

The interpretation of AR may be illustrated as
follows: If Cumberland County's adolescent preg-
nancy rate (61.5) were reduced to the level of the
referent counties' rate (38.0), the state would have
1 .96 percent fewer adolescent pregnancies. AR is
additive, therefore, the top ten AR counties have a
combined AR of 1 2.37 percent and all 75 nonreferent
counties have a combined AR of 28.05 percent.

10

Naturally, in choosing counties for an intervention
program, the size of a county's AR would be of
interest, though not necessarily one of the most
important considerations.

Abortion Fractions

The abortion rate (discussed above) estimates
the probability of a woman becoming pregnant and
having an abortion. It may be compared to the birth
rate. The abortion fraction, on the other hand,
measures the probability of a pregnant woman
having an abortion.

The statewide abortion fractions for adoles-
cents and those 1978-1992 percent changes are
displayed in the rightmost columns of Table 10. For
ages 15-17 and 18-19, the fraction for whites de-
creased while that for minorities rose, especially at
ages 18-19. At younger ages, however, pregnant
minorities remain much less likely than whites to
obtain an abortion.

A historical note of interest here concerns the
State Abortion Fund, which was established in
1 978 to pay for abortion procedures for poor women.
The number of funded procedures peaked in FY 1 984
at 6,645. Due to reduced funding, the number had
dropped by FY 93 to 2,132. However, the fund
nearly tripled in FY 94 to $1.2 million, making
abortion more accessible to low-income women.
Abortion counseling and family planning informa-
tion must be provided to all individuals who request
state abortion funds.19

Public Family Planning Services

In the spirit of "every child a wanted child,"
North Carolina became in 1937 the first state to
include birth control as part of its public health
program.20 Many years later, in 1968, federally
subsidized family planning services were first of-
fered in North Carolina.

Family planning services do more than just
prevent unintentional pregnancies. A 1992 State

Center study21 shows that pregnant women who
previously participated in public family planning
services were more likely than others to receive
early and adequate prenatal care and to be involved
in prenatal WIC and maternity care coordination
(case management). They were also less likely than
nonparticipants to deliver a low-weight infant.

Most efforts to improve birth outcomes in the
United States have focused on the period of preg-
nancy, especially increasing the use of prenatal
care. Preconceptional interventions may also be
effective, however, because a healthy pregnancy
begins before pregnancy. For this reason, the
Institute of Medicine and others have proposed
increasing the use of family planning services as a
preventive strategy to combat high rates of low
birthweight and infant mortality.21

In North Carolina in 1978, "active" public
family planning patients numbered 90,337. A total
of 25,905 (28.7%) were under 20 years old. For
ages 15-19, about 23 percent of the estimated need
was met. Estimates of need for public family
planning services are from the Alan Guttmacher
Institute.22

By 1992, the number of active public family
planning patients under age 20 had risen to 44,924,
representing 33.2 percent of total patients. For ages
15-19, about 34 percent of need was met, an in-
crease of 48 percent since 1978.

In North Carolina, public family planning ser-
vices are provided through the Women's Preven-
tive Health Services Program, as described on page
20.

Selected Live Birth Statistics

For adolescent age groups and total mothers
aged 10-19, Table 1 4 shows by race the numbers of
1992 live births, selected percentages, and those
changes since 1978. The categories shown are often
associated with economic and child health prob-
lems among adolescent mothers.

11

The number of births to white adolescents and
to minorities aged 15- 17 was lower in 1992 than 15
years ago. This is due to reduced numbers of
adolescents (Table 1) rather than reduced adoles-
cent birth rates (Table 10).

The most dramatic change over the last 15
years is the rising percentage of adolescent mothers
who are unwed. That percentage for whites nearly
tripled, to 50.5, while the percentage for minorities
rose 20 percent, to 94.5. The percentage increases
were especially great at ages 18-19 compared to
younger ages.

As expected, adolescent mothers are much
more likely than older mothers to be unwed. The
race-specific percentages for 1992 are displayed in
Figure 6.

FIGURE 6

Percentage of Mothers Unwed by Race and Age
North Carolina 1992

While

Minority

□ 10-19
1:20+

In its ranking of states, KIDS COUNT uses the
"percent of all births that are to single teens" as one
of its key measures of children's well-being. In
1 99 1 , only seven states had a higher percentage than
North Carolina.9

As the percentage of births to unwed mothers
has increased, so has the percentage of adolescent
mothers having their second or higher-order preg-
nancy, as indicated approximately by birth order
two or more. For each race group aged 10-19, that
percentage rose 34 percent with even larger in-
creases occurring among the state's very young

mothers (ages 10-14). At all ages but especially
younger ages, the minority percentage is much
higher than the white.

On an encouraging note, the state's adolescent
mothers of both races are less likely now than
formerly to receive late or no prenatal care. Still,
more than one-third of mothers 18-19 and higher
percentages of younger mothers did not receive
first-trimester care in 1992. Lack of early prenatal
care is much more a problem of adolescents than
older mothers and of minorities than whites, as
shown in Figure 7.

FIGURE 7

Percentage of Mothers Having Lais/No Prenatal Care by Race and Age
North Carolina 1992

White

Minority

□ 10-19

El 20+

0 10 20 30 40

H—H ol MoDwr> Haring luHo frmra Cm

50

For the 5-year period 1988-92, Table 15 dis-
plays by race the adolescent numbers and percent-
ages of late/no care for the state and counties. More
than 60 percent of all adolescent mothers in Iredell,
Lenoir, Scotland, and Wayne counties received
late/no care. In another 1 8 counties, more than half
of all adolescent mothers had late or no prenatal
care. The Year 2000 national objective is that at
least 90 percent of all women receive care in the first
trimester.7

Finally, as among newborns in general, the
babies of adolescent mothers have experienced
little change over the last 1 5 years in the incidence
of low birthweight (under 2500 grams). That per-
centage remains virtually unchanged for whites
while decreasing only slightly (5 . 6%) for minorities

12

(Table 14). Low-birthweight rates among mothers
aged 10-14 have decreased, however.

As shown in Figure 8, low birthweight re-
mains a greater problem for adolescent than for
older mothers, especially among whites . The white-
minority differential in low birthweight is some-
what less pronounced.among adolescent than older
mothers, however.

FIGURE 8

Percentage of Births Under 2500 Grams by Race and Age
North Carolina 1992

poor pregnancy outcomes among low-income

women

23,24

□ 10-1B
13 20+

0 2 4 6 8 10 12 14
Percentage of Births Under 2500 Grams

Reporting on maternal smoking was added to
the North Carolina birth certificate in 1988. As
shown in Table 1 6, white adolescents givingbirth in
1 992 were far more likely to smoke than were their
minority counterparts. Moreover, among whites,
adolescent mothers (29%) were more likely to smoke
than were older mothers (19%). The reverse was
found among minorities, adolescent mothers (8%)
were half as likely as older mothers ( 1 7%) to smoke.

Items related to maternal medical history have
also been added to the birth certificate. However,
for adolescents especially, the quality of those data
and the small numbers involved preclude analysis
at this time.

Enhanced Prenatal Care

Nonmedical prenatal services such as health
and nutrition education and supplemental food pro-
grams have been shown to be effective in reducing

For adolescent age groups, Table 17 shows
1988-1992 trends in the percentages of white and
minority live births by type of service received:
Medicaid, WIC, and health department prenatal
care. Increased percentages are observed through-
out except that the percentages for health depart-
ment prenatal care all declined in 1992, perhaps
reflecting a shift of Medicaid mothers to care in the
private sector.

For the services depicted in Table 17, the
percentages are generally higher for younger than
for older adolescents and higher for minorities than
for whites, although the age and race gaps narrowed
between 1988 and 1992. During this period, the
income eligibility level for Medicaid rose from 1 00
to 185 percent of the federal poverty level, which
served to increase the percentages of pregnant
women receiving WIC and health department pre-
natal care.

Table 1 8 shows, for adolescent age groups, the
1988-1992 percentages of Medicaid births where
prenatal WIC or maternity care coordination (case
management) was received. Again, the percentages
for younger and minority adolescents are higher
than those for older and white adolescents An
increasing percentage of mothers in all age-race
groups received maternity care coordination after
the service was first offered in 1988. Still, in 1992,
about one-half of eligible adolescents in each age-
race group did not receive the service.

Efforts to increase the number of women on
Medicaid who receive maternity care coordination
and WIC should result in savings in the cost of
newborn medical care. The studies cited above
estimate that for every $1 spent on maternity care
coordination, the Medicaid program saves $2 in
early infant medical care costs, one dollar spent on
WIC is estimated to save Medicaid $3 in newborn
costs.23-24

13

The WIC program and the state's Maternal
Health Program are described on page 20 of this
report.

Fetal and Infant Mortality

For each type of death (fetal, neonatal, post-
neonatal, infant), Table 19 shows death rates by
race and age for adolescent mothers giving birth in
1991. Dueto small numbers, dataforages 10-14are
not shown separately. Generally, the minority rates
are higher than the white, an exception being the
higher postneonatal death rate among white moth-
ers aged 15-17. Differences between younger and
older adolescents are not as great as one might
expect. In fact, the fetal and neonatal death rates are
higher for white mothers aged 18-19 than for white
mothers aged 15-17.

For adolescent mothers, Figure 9 depicts the
fetal, neonatal, postneonatal, and infant death rates
by race. Each of these rates represents substantial
improvement over the last 1 5 years with the infant
death rate for each race group down nearly 50
percent since 1978. The white fetal death rate has
dropped least (1 2%) while the minority postneona-
tal death rate has declined most (60%).

FIGURE 9

Fetal, Neonatal, Postneonatal, and Infant Death Rates by Race
North Carolina Mothers 10-19, Birth Year 1991

1

1

|

1

I

Fatal L^

N

Naonatalfew-TT

□ Whit*
E§ Minority

. ,l

i i

1

InfantU^

— 7

%

0

2

4

S 8 10
OMth Rata

12

14 1

e

For the 215 infant deaths among adolescent
mothers (10-19) who gave birth in 1991, Table 20
shows the numbers and death rates for major causes
of death by race.

Sexually Transmitted Diseases (STDs)

Compared to 1978, adolescents aged 10-14 in
1992 experienced increased rates of syphilis and
gonorrhea while older adolescents experienced an
increased syphilis rate (up 1 73%) but reduced gon-
orrhea rate (down 17%). The gonorrhea reduction
involved all race-sex groups aged 15-19 except
minority males whose rate rose 65 percent.

Assuming consistent reporting practices over
time, the observed increases are disturbing. Also
disturbing are the state-national differentials ob-
served in gonorrhea. Compared to the U. S . in 1 99 1
(latest year available),25 the state's 1992 gonorrhea
rate was 115 percent higher at ages 10-14 and 80
percent higher at ages 15-19. Differences in racial
distribution may account for some of the state's
apparent excess.

For syphilis, gonorrhea, and chlamydia (the
last not reportable until 1986), Table 21 examines
the state's 1992 adolescent incidence rates in age
and race-sex detail. Wide disparities are observed
with older adolescents, females of both races, and
minorities of both sexes exhibiting exceedingly
high rates. The one exception is the approximately
equal rates of gonorrhea among minority males and
females aged 15-19.

While the age-race-sex differentials are strik-
ing, the reader should keep in mind that infectious
disease counts are subject to testing and report-
ing biases, which tend to underrepresent people
tested in the private sector.

In general, STD rates are higher at ages 20-24
than at younger ages. For white and minority
females, however, the 1992 rates of gonorrhea and
chlamydia both peaked at ages 15-19.

Concerning adolescent AIDS, three cases aged
15-19 were reported in 1992: two were white
males, one a minority male. Many more individu-
als actually acquire the HIV infection during
adolescence, however.

14

The only Year 2000 national health objective
directly addressing adolescent STDs is to reduce
the gonorrhea rate at ages 1 5- 1 9 to no more than 750
per 100,000 (Objective 19. lb). From Table 21, the
corresponding state rate was more than twice as
high at 1,675 in 1992.

Sexual Behaviors

The 1993 statewide survey of high school
students (YRBS) revealed the following behaviors
related to adolescent sexual activity. Other details
by gender and by age, grade, and race are available
from the Youth Risk Behavior Survey.8

Sixty-two percent of students said they had had
sexual intercourse. Percentages were higher for
males, minorities, and grades 11 and 12 (see
Figure 10).

Thirty-nine percent of students were sexually
active by age 15, 59 percent by age 17.

• Among sexually active students, 28 percent had
had only one partner, 22 percent had had six or
more; 1 5 percent said they drank or used drugs
prior to their last sexual intercourse, 8 1 percent
said they or their partner used some method of
birth control at last intercourse (includes with-
drawal); 5 1 percent said they or their partner
used a condom at last intercourse

Eight percent of males reported they had gotten
someone pregnant at least once. Nine percent of
females said they had been pregnant at least
once.

• Seven percent of both males and females said
they had ever been told by a doctor or nurse that
they had a sexually transmitted disease.

National objectives targeting reduced adoles-
cent sexual activity and protected sex among sexu-
ally active adolescents are listed in Appendix 1,
Objectives 5.4-5.6, 18.4a, and 18.4b.

FIGURE 10

Percentage of High School Students

Who Ever Had Sexual Intercourse

North Carolina 1993

20 40 60 80 100

Percentage of Students

Som* Tbum M* MMor Sltvp,, N.C. OaptfmM o> Pubic IMmcdon, Uvcx ism

ALCOHOL, TOBACCO, AND OTHER
DRUG USE

Data from the 1993 Youth Risk Behavior
Survey show that alcohol continues to be the drug
most frequently used by high school students in
North Carolina. Nearly three-quarters of students
reported ever using it, and 44 percent reported use
in the past 30 days (Figure 1 1). Other significant
findings for alcohol use include these:

• Nearly one-quarter of students participated in
binge drinking (5 of more drinks on one occa-
sion) during the last month.

During the past month, one-third rode with a
driver who had been drinking and nearly one-
fifth of male students reported drinking and
driving themselves.

One in five students reported that parental drink-
ing had caused them problems in the past year.

Concerning tobacco use, 56 percent of all
students had ever smoked cigarettes with 29 percent
smoking in the last month (Figure 11). Blacks were
less likely than others to smoke and to use smoke-
less tobacco.

15

Nearly 30 percent of students reported ever
using marijuana with 1 5 percent using it in the past
month (Figure 1 1). Ever-use of marijuana, cocaine,
and steroids was higher among students of other
races than among whites and blacks.

A particularly notable finding may be that
nearly half of high school students reported they
had never or only once during the past year received
information about alcohol or drugs in health or
other school classes. Further, nearly 60 percent
reported that never or only once in the past year had
they received information from their parents about
alcohol or drugs.

FIGURE 11

Percentage of High School Students Reporting

Specified Behavior During Last 30 Days

North Carolina 1993

Usee
Alcohol

Binge
Drinking

Smoked
Cigar etlea

Iliad

Marijuana

Used
Cocaine

10 20 30 40

Paranogt Reporting Benavloi

karx -out M mitt km). IC Darnel a hoc ratbam *mt IBB

National objectives for substance use/abuse
are numbers 3.5-4.11 of Appendix 1.

NUTRITION

Overweight

Overweight is a major cause of preventable
disease. The greatest health risk of overweight in
adolescence is its persistance into adulthood and the
resulting risk of heart disease, diabetes, and stroke.

Body Mass Index (BMJ) is calculated by di-
viding weight in kilograms by the square of height
in meters. The cutpoints used to define overweight

are the age-sex-specific 85th percentile values for
the combined samples of U.S. children examined in
the first two National Health and Nutrition Exami-
nation Surveys (NHANES I and NHANES II,
1971-1980).26

Data from NHANES II and NHANES ID
show that 15 and 21 percent of U.S. adolescents
aged 12- 19 were overweight in 1976-80 and 1988-
91 respectively.7,27 The U.S. objective for adoles-
cent overweight is to prevent an increase above the
1976-80 baseline of 15 percent (Objective 2.3 in
Appendix 1).

Using 1988-91 data from the state's Child
Health Program (see page 19), Table 22 shows, for
each age and sex, the numbers and percentages of
total, white, and black adolescents above the
NHANES 85th percentile. The numbers of cases
were insufficient to examine the data for American
Indians and Hispanics.

The percentages of Table 22 will be used as
baselines against which to compare future
prevalences of overweight among health depart-
ment adolescents. Compared to 29.3 percent in
1988-91, the overall prevalences of overweight
among Child Health Program participants aged 1 2-
18 were 30.8 and 29.6 percent in 1992 and 1993
respectively.

Risk Factors

The following data are again derived from the
1993 YRBS:

• Asked about foods they consumed the previous
day, the following percentages of high school
students said they did not eat the specified
foods: fruit or fruit drink, 32%; green salad or
raw or cooked vegetables, 46%; hamburger, hot
dogs, sausage, or barbecue, 48%; French fries
or potato chips, 36%; cookies, doughnuts, pie,
or cake, 40%. Males and blacks were more
likely than females and whites to eat the "high-
fat" foods.

16

• Asked about their body weight, 19 percent of
students said they were slightly or very under-
weight, 33 percent said slightly or very over-
weight.

Compared to the opposite sex, males (33%)
were more likely trying to gain weight, while
females (55%) were more likely trying to lose
weight.

• To lose or keep from gaining weight, the fol-
lowing percentages of students reported the
specified behavior during the past 7 days: di-
eted, 6%; exercised, 23%; exercised and dieted,
15%; made themselves vomit, 2%; took diet
pills, 2%; vomiting and diet pills, 1%.

PHYSICAL FITNESS

Conducted in 1992, the North Carolina Chil-
dren and Youth Fitness Study (NCCYFS)28 was
designed to measure the physical fitness and physi-
cal activity patterns of children in grades 1,3,6, and
9. Comparing these results to corresponding infor-
mation from national surveys reveals that North
Carolina children have lower scores on most fitness
measures, especially body composition, cardiores-
piratory, and flexibility tests. The NCCYFS also
revealed that North Carolina parents seldom exer-
cise with their children and that schools offer physi-
cal education only one day per week on average.
The study showed that a child's fitness assessments
were correlated with his television viewing time
and his parents' activity levels.

From the 1993 YRBS, the following results
relate to physical activity levels reported by high
school students:

Twenty percent of high school students re-
ported that, during the seven days preceding the
survey, they did not exercise or participate in
sports activities for at least 20 minutes that
made them sweat and breathe hard. The per-
centage was higher for females (28%) and
blacks (26%) and increased with advancing

grade level to 26% for seniors, as shown in
Figure 12.

Compared to doing aerobic activities, students
were even less likely to do exercises to strengthen
or tone their muscles.

• More than half (53%) of all high school students
and three-quarters of juniors and seniors said
they attended no physical education (PE) classes
during an average school week.

• Among those taking PE, 80 percent reported
exercising or playing sports for more than 20
minutes during an average class.

• Nearly 60 percent of students said that, outside
PE, they had played on no school sports team
during the past year. The percentage was higher
for females, minorities, and seniors.

In Appendix 1, Objectives 1.3 and 1.4 estab-
lish fitness goals for youth. The NCCYFS and
YRBS results should provide the necessary impetus
for improving the quantity and quality of physical
education in North Carolina schools. For more
information, contact Shellie Pfohl, Executive Di-
rector of the North Carolina Governor's Council on
Physical Fitness and Health, at (919) 733-9615.

FIGURE 12

Percentage of High School Students Who Reported No

Episode of Aerobic Exercises During Last 7 Days

North Carolina 1993

10 15 20

Percentage of Students

Sourca toudi mat Bahavtor Suva*, N.C. DwmH ot PuMc hwuoOon. Man* into

17

ORAL HEALTH

USE OF HEALTH SERVICES

A stratified cluster sample of North Carolina
public school classrooms in school year 1986-87
resulted in a total of 3,076 oral examinations of
adolescents aged 12-17 years.29 Results showed a
substantial decline in decayed, missing, and filled
teeth (DMFT) scores compared to a decade earlier.
For whites, DMFT scores declined from 5 . 9 in 1 976
to 3.1 in 1986. For minorities, the corresponding
decline was from 4.7 to 2.9. Scores were particu-
larly high for some population groups such as 17-
year-old minority females.

For all ages 12-17 years, minorities had seal-
ants about half as often as whites, and gum disease
was more prevalent among minorities. Minorities
had a strikingly higher prevalence of tartar above
and below the gum line, and the prevalence of
receding gums was also higher among minorities
than whites.

As specified in Appendix 1, Year 2000 health
objectives for the nation's adolescents include three
related to oral health. They call for the reduction of
dental caries, the reduction of untreated dental
caries, and an increase in protective sealants on the
occlusal (chewing) surfaces of permanent molar
teeth See Objectives 13.1, 13.2, and 13.8.

CAHCP SURVEYS

Beginning in Fall 1994, certain schools asso-
ciated with the Comprehensive Adolescent Health
Care Projects (CAHCPs) are conducting indepen-
dent surveys of students and their parents in order to
examine adolescent health and risk behaviors in
relation to the use of school-based health services.
The student survey will provide a profile of who
uses (does not use) what services, users' levels of
satisfaction with the services, and the effect of the
services on users and their families The data from
1994 will be used for planning purposes and for
baselines against which to measure changes over
time.

Many adolescents lack access to health care
Many are without health insurance of any kind, or
their insurance programs cover few if any preven-
tive health services. The Southern Institute on
Children and Families reports that an estimated
89,000 North Carolina youths aged 1 1-17 had no
health insurance in March 1991. 30 This number
represents about 15 percent of the population aged
11-17.

Meanwhile, data on the use of resources are
very limited in North Carolina Except for publicly
funded services, we have no data on the use of
hospital outpatient and nonhospital health services.
The North Carolina Medical Database Commission
(MDC) expects to acquire those data in the future,
however. Data on same-day surgeries are only
months away, and data on services provided through
home health and by physicians' offices are ex-
pected to follow. Eventually, the MDC hopes to
establish a statewide medical claims clearinghouse
to collect data on all types of health services.

In the meantime, here is what we do know
about the use of health care resources by the state's
adolescent population.

Hospital Discharges

Data on hospital inpatient services are rou-
tinely collected by the Medical Database Commis-
sion. Age-specific data are not routinely available,
however.

For selected primary diagnoses, Table 23 pro-
vides numbers and rates for adolescents discharged
from North Carolina hospitals during 1991, the
latest year for which data were accessible. Child-
birth and reproductive complications accounted for
43 percent of adolescent hospitalizations; mental
disorders and injury/poisoning each accounted for
just over 10 percent, genitourinary diseases for
under five percent. Pulmonary diseases and diabe-
tes were next most frequent among the selected
diagnoses.

18

The most frequently reported mental disorders
were "affective psychoses" followed by "adjust-
ment reaction." Among injuries and poisonings,
"poisoning by analgesics, antipyretics, and
antirheumatics" was the leading diagnosis followed
closely by several specific fractures. "Inflamma-
tory disease of female pelvic organs" and "infec-
tions of kidney" led the list of genitourinary dis-
eases, and asthma was by far the most frequently
reported chronic pulmonary disease.

Patient1 s race and the external cause of injuries
are not included in hospital discharge reporting.
These data are needed to document the racial and
cause-of-injury factors associated with adolescent
hospital morbidity.

An examination of the rates of Table 23 is left
to the interested reader.

Health Check: Healthy Children and Teens Pro-
gram

Formerly called Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT), this program
forMedicaid-eligible youth (ages 0-20) is adminis-
tered by the Division of Medical Assistance, N.C.
Department of Human Resources.

In FY 89 (earliest year of unduplicated counts),
a total of 7,259 youth aged 10-18 years were
screened. By FY 93, that number had increased
36.5 percent to 9,905. In FY 93, county health
departments performed 1 8 percent of the screenings
of adolescents compared to 3 1 percent of the screen-
ings of younger children.

Depending on financial and medical eligibil-
ity, Medicaid may pay for a variety of health ser-
vices for adolescents.

Mental Health/Substance Abuse

Based on data provided by the Division of
Mental Health, N.C. Department of Human Re-
sources, the numbers of North Carolina adolescents

in state institutions for treatment of substance abuse
and mental illness have declined (Table 24). At the
same time, the number of youth served by area
mental health centers increased markedly between
FY 1 984 (earliest year of comparable data) and CY
1 992 (Table 25). The number treated for substance
abuse tripled while the numbers treated for mental
illness and developmental disability rose 53 and 34
percent respectively. The substance abuse and
mental illness increases were especially great for
younger and minority youth. These increases oc-
curred over a period in which the adolescent popu-
lation generally declined.

Health Services Information System (HSIS)

HSIS is an automated reporting system used
by local health departments and special contract
providers (over 700 sites) to report on the delivery
of public health services. Data for HSIS programs
that serve a sizable number of adolescents are given
below. These programs are administered by the
Division of Maternal and Child Health.

Child Health Program

The primary objective of this program is to
provide health services to children from birth up to
21 years of age. Both screening and treatment
services are provided through local health depart-
ments. In 1992, a total of 4,727 screening services
and 9, 1 3 1 other services were provided to persons
aged 12-20 years.

Children's Special Health Services (CSHS)

Formerly called the Crippled Children's Pro-
gram (1 936- 1 985), CSHS provides comprehensive
health care for financially and medically eligible
youth (ages 0-20) with chronic disabling condi-
tions. It involves a network of specialty clinics
located in health departments, medical centers, de-
velopmental evaluation centers, and private physi-
cians' offices.

19

In FY 93, a total of 2,569 youth aged 12-19
years were served in the clinics : 68% in orthopedic,
1 9% in speech and hearing, 7% in neurology, and
2% in cardiology. The remaining 4% were seen in
neuromuscular, oral/facial, pulmonary,
myelodysplasia, and hematology/oncology clinics.

CSHS also provides reimbursement for office
visits, hospitalizations, therapy, drugs, equipment,
and other services for eligible youth. In FY 93,
reimbursement was made for 2,441 adolescents
aged 10-19 years.

Maternal Health Program

Through local health departments, most of the
state's 100 counties provide prenatal and postpar-
tum clinical examinations, counseling, and super-
vision to pregnant women. A network of 1 8 high-
risk maternity clinics has been established, these
serve mainly multi-county areas and provide
multidisciplinary care to high-risk patients.

Between FY 1 985 and CY 1 992, the number of
adolescents served by the program more than
doubled, nearly tripling at younger ages (under 1 8).

In 1992, clinic and other maternity services
numbered 62,816 for women under age 18 and
79,261 for women aged 18-19. More than half of
the services were clinic visits, about 40 percent
were for maternity care coordination. See Table 1 8
and the corresponding discussion on page 13 con-
cerning Medicaid mothers' use of maternity care
coordination.

Supplemental Food Program for Women, In-
fants, and Children (WIQ

Funded by the U.S. Department of Agricul-
ture, this program provides nutrition education for
low-income women and children and vouchers for
the purchase of specific foods and infant formula.
Eligible persons include pregnant/breastfeeding/
postpartum women and children up to age 5 who are
at medical or nutritional risk.

For adolescents who delivered a liveborn in-
fant in 1992, Table 26 shows the percentages of
prenatal WIC participants by race, marital status,
and education. As already described, trends in
prenatal WIC participation are given in Table 17
(all adolescent mothers) and Table 18 (Medicaid
adolescent mothers).

Women's Preventive Health Services Program

Also known as "family planning," these ser-
vices include contraceptive care, preconceptional
risk assessment, counseling and referral, health
screening, and basic infertility evaluation. These
services are targeted to low-income women.

For adolescent age groups, Table 27 shows
percentages of 1 992 patients by race, marital status,
education, poverty status, Title XIX (Medicaid)
reimbursement, and contraceptive method. For
adolescents as a whole, family planning patients are
predominantly not married, not (yet) high school
educated, and below 1 00 percent of poverty . A high
percentage use birth control pills.

ADOLESCENT HEALTH AS A LOCAL
PUBLIC HEALTH PRIORITY

Each biennium in North Carolina, statisticians
from the State Center provide data and conduct
workshops to assist local health departments in a
needs assessment process called Community Diag-
nosis. After data analysis and other local consider-
ations, health departments then report to the state
health director up to five priority health problems
for each county. Those results are reported in turn
to state and regional staff who may assist a county
in developing and implementing its proposed inter-
ventions.31

In 1994, this process resulted in 31 of the
state's 1 00 counties identifying teen pregnancy as a
priority health problem in their county, no other
problem was cited more often. These counties are:

20

Avery

Bertie

Carteret

Caswell

Cumberland

Duplin*

Durham

Granville

Hertford

Hoke*

Iredell

Lee

Lincoln*

McDowell

Mitchell

Pender

Person

Polk*

Richmond

Rowan*

Rutherford*

Sampson

Stanly*

Stokes

Swain

Transylvania

Vance

Wake

Wayne

Wilson

Yancey

•County reported teen pregnancy as their number one priority.

Nine other counties reported the general cat-
egory "adolescent health" as a problem of major
concern. These counties are: Camden, Chatham,
Chowan, Davie, Haywood, Montgomery,
Northampton, Pasquotank, and Perquimans. This
was Chatham County's top priority. Eight counties
reported adolescent drug and alcohol abuse as a
major public health problem: Caswell, Chatham,
Granville, New Hanover, Richmond, Surry, Wake,
and Warren. Richmond County reported this prob-
lem as its number one priority.

HEALTHY CAROLINIANS 2000

Keenly aware of North Carolina's unfavorable
ranking on many of the national health status indi-
cators, Governor James G. Martin established in
August 1991 the Governor's Task Force on Health
Objectives for the Year 2000. The deliberations of
this 25-member body resulted in the November
1992 publication of North Carolina objectives ad-
dressing 1 1 broad areas of concern. For adolescents
and young adults, specific improvement targets
were established for motor vehicle fatalities, preg-
nancy, dental decay, physical fitness, nutrition (obe-
sity), sexually transmitted diseases, and substance
abuse (tobacco, marijuana, and alcohol).32

The report of the Task Force emphasizes com-
munity-based intervention strategies. To date, lead-
ers in 52 of the state's 100 counties have plans to

develop responsive health improvement plans for
their communities; 21 counties already have active
task forces. By the end of 1 994, an additional seven
counties were expected to have active task forces

For more information about Healthy Carolin-
ians 2000, contact Sarah Ahmad, Project Director,
at (919) 715-4173.

SUMMARY

This study of the health status of North
Carolina's adolescent population reveals some posi-
tive changes over time but a number of disturbing
trends and patterns that need attention and action.
These findings are highlighted below.

Mortality

• Reductions in unintentional injury deaths have
been accompanied by large increases in adoles-
cent homicide and suicide. Hence, external
causes of death continue to account for three of
every four adolescent deaths in North Carolina.

Death rates are generally much higher for older
adolescents than for younger ones, for minori-
ties than for whites, and for males than for
females. Minority male rates are especially
high. Major exceptions are the higher suicide
and motor vehicle fatality rates among whites
aged 15-19.

At ages 15-19, the homicide rate for minority
males is 13 times the rate for white males

Violence

• The arrest rate for adolescents rose 45 percent
between 1978 and 1992 with rates for several
very serious offenses more than doubling. The
arrest rate at ages 18-19 now rivals the peak rate
at ages 20-24.

• Arrest rates are generally higher for older, male,
and minority adolescents.

21

Between 1984 and 1992, adolescents became
much less likely to be incarcerated in state
prisons for misdemeanor crimes but much more
likely to be incarcerated for felonious crimes,
especially homicide, robbery, drug violations,
and burglary/breaking/entering.

The large decrease in the misdemeanor incar-
ceration rate results from the state's 1 987 prison
cap law. Due to repeat offenses by early parol-
ees, that law may also explain some of the
increase in arrest and felony incarceration rates.

Reproductive Health

Between 1 978 and 1 992, the birth rate, abortion
rate, and abortion fraction of minority adoles-
cents all rose. The abortion increases were par-
ticularly large among minority women aged 1 8-
19.

• For all races combined, the state's 1980 to 1990
increases in adolescent pregnancy, birth, and
abortion rates are in contrast to downturns in
many other states.

In 1 994, 3 1 of the state's 1 00 counties reported
adolescent (teen) pregnancy as one of their top
five health problems. No other problem was
cited more often.

Following an upward trend, 15 of each 1,000
female population aged 15-17 had a second or
higher-order pregnancy in 1992. The rate for
minorities was four times the rate for whites.

Arising percentage ofbirths to adolescent moth-
ers represent a second or higher-order preg-
nancy. The 1 992 percentages were 3 1 for whites
and 41 for minorities.

• The most dramatic change in live birth statistics
is the rising percentage of adolescent mothers
who are unmarried. The increase has been
especially great at ages 18-19. Among adoles-
cents giving birth in 1992, more than half of
whites and nearly 95 percent of minorities were
unwed.

Among adolescents giving birth in 1 992, whites
were especially likely to smoke.

The percentage of adolescent mothers receiv-
ing late or no prenatal care has declined but
remains high, especially at younger ages and
among minorities. In 22 counties, more than
half of adolescent mothers received late or no
care during 1988-92.

Following recent increases in adolescent use of
health department prenatal care, prenatal WIC,
and Medicaid newborn care, the percentage of
adolescent mothers receiving health department
prenatal care declined in 1992, suggesting a
shift of Medicaid mothers to care in the private
sector.

Adolescent mothers on Medicaid experienced
large increases in maternity care coordination
(case management) after the service was first
offered in 1 988, but many still do not receive the
service.

In 1 992, minority adolescents were more likely
than whites to use the services cited above.

Following virtually no improvement in recent
years, low birthweight rates remain high among
adolescent mothers, especially minorities.

For adolescent mothers of both races, infant
mortality declined nearly 50 percent between
1978 and 1991. The minority rates of fetal and
infant mortality remained higher than the white
rates, except white mothers aged 15-17 experi-
enced higher postneonatal loss.

Younger adolescents have experienced increased
rates of both syphilis and gonorrhea. Although
gonorrhea has declined somewhat at ages 1 5-
19, the state's rate is still far above the national
rate.

Exceedingly high rates of syphilis, gonorrhea,
and chlamydia are observed among older,
female, and minority adolescents except that

22

gonorrhea rates for minority males and females
aged 15-19 are about equal.

• In 1992, three cases of adolescent AIDS were
reported, but many more individuals actually
acquire the HIV infection during adolescence.

Use of Health Senices

• Childbirth and reproductive complications ac-
counted for 43 percent of adolescent hospital-
izations during 1992. Mental disorders and
injury/poisoning each accounted for just over
ten percent.

Among public programs that serve adolescents,
the following appear to have experienced sub-
stantial growth during the recent past: Health
Check: Healthy Children and Teens, Area
Mental Health Centers, WIC, and Maternal
Health.

In addition to the above findings, this report is
replete with information about the health-related
behaviors of adolescents as measured by the 1993
Youth Risk Behavior Survey of 9th- 12th grade
students. The various indicators will be tracked
over time as the Department of Public Instruction
conducts this survey on a biennial basis. This report
also reveals a high prevalence of overweight among
adolescent clients of health departments and low
levels of physical fitness among the state's child and
adolescent populations.

CONCLUSION

Health care is more than medical care alone;
it includes the prevention and control of disease and
injury rather than simply their treatment.33 How
will adolescents fare in the proposed world of
health care reform? No one knows for sure, but
public health must do its part in the areas of preven-
tion and primary care.

In North Carolina, public health is committed
to expanding its role in the area of adolescent
health. School-based health centers (CAHCPs) and
local adolescent pregnancy prevention programs
(APPPs) are a reality. We must now measure the
outcomes of those efforts, fix what is wrong, and
extrapolate the successful experiences to reach ado-
lescents statewide. Otherwise, the negative conse-
quences of unhealthy behaviors developed in ado-
lescence will continue their upward trends.

Results of the biennial Youth Risk Behavior
Survey will be most helpful in defining adolescent
needs statewide, and the CAHCP surveys will de-
fine those needs for local school jurisdictions. But
certain data deficiencies remain, most notably (1)
lack of data on hospital outpatient and nonhospital
health services and (2) failure to collect patient's
race and the external cause of injuries in hospital
discharge reporting. These data are needed to
quantify and describe adolescent morbidity and
disability, particularly that associated with violence
and abuse. The development and use of these data
is crucial to making informed decisions that meet
the changing needs of the state's adolescent popu-
lation. The state's Medical Database Commission
is working toward the acquisition of data specified
in (1) above, but (2) above remains a data problem
of substantial concern. All services reported to the
Medical Database Commission should include
patient's race and the external cause of injuries in
the required dataset.

It is hoped that the legislature will see the need
to expand its funding of adolescent health pro-
grams For more information about those men-
tioned above (CAHCPs and APPPs), the reader
should contact the Division of Maternal and Child
Health of the Department of Environment, Health,
and Natural Resources. Also, grant-funded adoles-
cent parenting programs are operated through the
Division of Social Services, Department of Human
Resources.

23

REFERENCES

1. N.C. Department of Human Resources "Focus .... Teenage Pregnancies, North Carolina 1973-1977,"
PHSB Studies, No. 13. Raleigh, March 1979.

2. N.C. Department of Human Resources "Teen and Preteen Pregnancies in North Carolina, 1981,"
SCHS Studies, No. 26, Raleigh, May 1983.

3. N.C Department of Human Resources. "Accidental Death Among Children and Teenagers in North
Carolina," PHSB Studies, No. 17. Raleigh, December 1979.

4. Surles, Kathryn and Gordon Daughtry. "Death Among North Carolina's Children and Youth," SCHS
Studies, No. 29. N.C. Department of Human Resources, Raleigh, December 1983.

5. Nelson, M.D Jr. "North Carolina Child and Adolescent Mortality," CHES Studies, No. 53. N.C
Department of Environment, Health, and Natural Resources, Raleigh, July 1990.

6. Bowling, Michael J. "Unintended Childhood Injury in North Carolina," SCHS Studies, No. 37. N.C
Department of Human Resources, Raleigh, August 1985.

7. U.S. Department of Health and Human Services, Public Health Service. Healthy People 2000:
National Health Promotion and Disease Prevention Objectives, DHHS Publication No. (PHS) 91-
50212. U.S. Government Printing Office, Washington, September 1990.

8. N.C. Department of Public Instruction. 1993 Youth Risk Beha\-ior Survey. Raleigh, March 1993.

9. The Annie E. Casey Foundation. Kids Count Data Book: State Profiles of Child Weil-Being.
Baltimore, Maryland. 1994.

10. N.C. Department of Environment, Health, and Natural Resources. "Health Status of Native Americans
in North Carolina," CHES Studies, No. 75. Raleigh, August 1993.

1 1 . National Center for Health Statistics. "Advance Report of Final Mortality Statistics, 1 99 1 ," Monthly
Vital Statistics Report, Vol. 42, No. 2, Supplement. Hyattsville, Maryland: Public Health Service,
August 31, 1993

12. National Center for Health Statistics. Healthy People 2000 Review, 1993. Hyattsville, Maryland:
Public Health Service, 1994.

1 3 . "Crime Against U. S. Juveniles Rising Sharply," The Raleigh (N. C.J News and Observer, Section A,
p. 1 A, July 18, 1994.

14. Personal communication with Kenneth L. Parker, N.C. Department of Correction. Raleigh, July 20,
1994.

15. Spitz, Alison M. et al. "Surveillance for Pregnancy and Birth Rates Among Teenagers, by State —
United States, 1980 and 1990." In CDC Surveillance Summaries, Morbidity and Mortality Weekly
Report, Vol. 42, No. SS-6. U.S. Government Printing Office, Washington, December 17, 1993, p. 7.

16. The Alan Guttmacher Institute. Sex and America 's Teenagers. New York, 1994.

24

17. Surles, Kathryn B, Karen T. Graham, and Delton Atkinson. "Health Status of Blacks in North
Carolina," CHES Studies, No. 76. N.C. Department of Environment, Health, and Natural Resources,
Raleigh, October 1993.

18. Surles, Kathryn B. and Michael J. Symons. "The Measurement of Attributable Risk: A Useful Tool
for Health Administrators," SCHS Statistical Primer, No. 8. N.C. Department of Human Resources,
Raleigh, October 1986.

19. N.C. Department of Human Resources. "The State Abortion Fund Fact Sheet." Raleigh, (undated)

20. N.C. Department of Human Resources, Public Health Statistics Branch. "A Century of Public Health
in North Carolina," North Carolina MedicalJournal, Vol. 38, No. 1. January 1977.

21. Jamieson, Denise J. and Paul A. Buescher. "The Effect of Prior Family Planning Participation on
Prenatal Care Use and Low Birth Weight," CHES Studies, No. 62. N.C. Department of Environment,
Health, and Natural Resources, Raleigh, March 1992.

22. Personal Communication with William Brown, Women's Health Section, N.C. Department of
Environment, Health, and Natural Resources. Raleigh, June 28, 1994.

23. Buescher, Paul A., Marcia S. Roth, Dennis Williams, and Carolyn M. Goforth. "An Evaluation of the
Impact of Maternity Care Coordination on Medicaid Birth Outcomes in North Carolina," American
Journal of Public Health, Vol. 81, No. 12. December 1991.

24. Buescher, Paul A., Linnea C. Larson, M.D. Nelson, Jr., and Alice J. Lenihan. "Prenatal WIC
Participation Can Reduce Low Birth Weight and Newborn Medical Costs: A Cost-Benefit Analysis
of WIC Participation in North Carolina," Journal of the American Dietetic Association, Vol. 93, No.
2. February 1993

25 Centers for Disease Control. "Summary of Notifiable Diseases, United States, 1991," Morbidity and
Mortality Weekly Report, Vol. 40, No. 53. Atlanta, Georgia: Public Health Service, October 2, 1 992.

26. Centers for Disease Control and Prevention. Computer program containing NHANES (1971-1980)
age-sex-specific 85th and 95th percentile values. Obtained from Tim Byers, Atlanta, August 1994.

27. Public Health Service. "Health Objectives for the Nation: Prevalence of Overweight Among Adoles-
cents— United States, 1988-91, Morbidity and Mortality Weekly Report, Vol. 43, No. 44, U.S.
Government Printing Office, Washington, November 11, 1994, pp. 818-821.

28. Davis, Kathryn L. et al. "North Carolina Children and Youth Fitness Study," Journal of Physical
Education, Recreation and Dance . October 1994.

29. Rozier, R. Gary, George G Dudney, and C. Jean Spratt. The 1986-87 North Carolina School Oral
Health Survey. N.C. Department of Environment, Health, and Natural Resources, Division of Dental
Health, Raleigh, October 1991.

30. Shuptrine, Sarah C, VickiC. Grant, and GennyG. McKenzie. Uninsured Children in the South. The
Southern Institute on Children and Families, Columbia, South Carolina, November 1992.

25

31. N.C. Department of Environment, Health, and Natural Resources, State Center for Health and
Environmental Statistics. Guide for a Community Diagnosis: A Report for Local Health Departments.
Raleigh, July 1993.

32. Healthy Carolinians 2000: The Report of the Governor 's Task Force on Health Objectivesfor the Year
2000. Carrboro, North Carolina, November 18, 1992.

33. Smith, David R "Porches, Politics, and Public Health " In Public Health Policy Forum, American
Journal of Public Health, Vol. 84, No. 5. May 1994.

26

GLOSSARY

Abortion - Induced abortion, or the intentional interruption of pregnancy. Early spontaneous abortions are
not reportable in North Carolina.

Abortion Fraction - The number of induced abortions per 1,000 pregnancies (live births plus fetal deaths
plus abortions).

Abortion Rate - The number of induced abortions per 1,000 females in the population.

Adolescent - For this report, a person aged 10 through 19 years.

Age-Specific Rates - Events in the age group per 1 ,000 or 1 00,000 population in the age group. Events may
be births, abortions, pregnancies, deaths, diseases, arrests, etc.

APPP - Adolescent Pregnancy Prevention Program.

Arrest Rate - Arrests per 1,000 or per 100,000 population.

Birth Defect - Any abnormal condition present at birth, not including injuries caused by the delivery. These
are ICD-9 codes 740-759.

Birth Order - The sum of previous children now living, previous children born alive and now dead, and
previous fetal deaths (any gestational age) plus one for the present birth. Previous induced abortions
may be included, effective with the 1988 revised birth certificate.

Birth Rate - The number of live births per 1,000 females in the population.

Block Numbering Area (BNA) - Small statistical subdivisions of a county for grouping and numbering
blocks in nonmetropolitan counties where local census statistical areas committees have not
established census tracts. State agencies and the Census Bureau delineated BNAs for the 1 990
census, using guidelines similar to those for the delineation of census tracts (see definition)
BNAs do not cross county boundaries.

CAHCP - Comprehensive Adolescent Health Care Project.

Causes of Death - All diseases, morbid conditions, or injuries that either resulted in or contributed to death
and in the case of injuries, the circumstances of the injury or violence. In this report, deaths are
tabulated by underlying cause of death (see definition).

Census Tract - Small, relatively permanent statistical subdivisions of a county. They are delineated for all
metropolitan areas and other densely populated counties by local census statistical areas committees
following Census Bureau guidelines.

Census tracts usually have between 2,500 and 8,000 persons and, when first delineated, are designed to be
homogeneous with respect to population characteristics, economic status, and living conditions.
Census tracts do not cross county boundaries. The spatial size of census tracts varies widely
depending on the density of settlement. Census tract boundaries are delineated with the intention of

27

being maintained over a long time so that statistical comparisons can be made from census to census.
However, physical changes in street patterns caused by highway construction, new development,
etc., may require occasional revisions, census tracts occasionally are split due to large population
growth, or combined as a result of substantial population decline.

Note: Figure 1 of this report depicts for race-sex groups the numbers of adolescents (ages 10-19) living
in census tracts (metropolitan counties) and block numbering areas (nonmetropolitan counties).
Data are from the U.S. Census 1990.

Death - The permanent disappearance of any evidence of life at any time after live birth N.C. law (G S 90-
322) also defines criteria for certifying "brain death."

Deliveries - The total number of live births plus fetal deaths of 20 or more weeks gestation

DUI - Driving under the influence

DWI - Driving while impaired.

Fetal Death - Death prior to the complete expulsion or extraction from its mother of a product of human
conception, irrespective of the duration of pregnancy, as indicated by the fact that after such
expulsion or extraction the fetus does not breathe or show any evidence of life, such as beating of the
heart, pulsation of the umbilical cord, or definite movement of voluntary muscles (definition adopted
by World Health Organization in 1950). Consistent with North Carolina law, this report includes
only fetal deaths that do not qualify as therapeutic abortions and which result from pregnancies of
20 or more weeks gestation.

Felony - A serious crime such as murder, rape, or burglary.

Fetal Death Rate - Fetal deaths per 1,000 deliveries (live births plus fetal deaths).

Incarceration Rate - State prison inmates per 100,000 population.

ICD: International Classification of Diseases - A numerical system used worldwide for classifying aH
causes of death. The Ninth Revision was first applied to 1979 deaths.

Infant Death - Death of a liveborn child under one year of age. Infant deaths are the sum of neonatal and
postneonatal deaths (see definitions).

Infant Death Rate - The number of infant deaths per 1,000 live births.

Late or No Prenatal Care - No care during the first trimester (three months) of pregnancy.

Live Birth - The complete expulsion or extraction from its mother of a product of conception, irrespective
of the duration of pregnancy, which, after separation, breathes or shows any other evidence of life,
such as beating of the heart, pulsation of the umbilical cord, or any definite movement of voluntary
muscles, whether or not the umbilical cord has been cut or the placenta is attached (definition adopted
by World Health Organization in 1950).

28

Low Birthweight - 2500 grams (5 pounds, 8 ounces) or less at birth, regardless of the period of gestation
(World Health Organization 1950).

Maternity Care Coordination - A formal case management process with a primary focus on the
organization of services and resources to respond to the health care needs of a pregnant woman who
has been determined to be eligible for Medicaid.

Medicaid - A public assistance program that pays for the medical care of people who are eligible for cash
assistance payments or who have medical needs greater than their resources. The largest share of
Medicaid costs is paid by the federal government.

Misdemeanor - An offense of lesser gravity than a felony, punishable by imprisonment for no more than
two years.

Neonatal Death - Death of a liveborn child under 28 days of age.

Neonatal Death Rate - Neonatal deaths per 1,000 live births.

Postneonatal Death - Death of an infant 28 days and over but less than one year of age.

Postneonatal Death Rate - Postneonatal deaths per 1,000 neonatal survivors (live births minus neonatal
deaths).

Pregnancies - The total number of live births plus fetal deaths of 20 or more weeks gestation plus induced
abortions.

Pregnancy Rate - The number of pregnancies per 1,000 females in the population

Race - As used by the Census Bureau, race reflects self-identification; it does not denote any clear-cut
biological definition.

White—Includes persons who indicate their race as white (Caucasian) or report entries such as Canadian,
German, Italian, Lebanese, Near Easterner, Arab, or Polish.

Nonwhite or Minority— Race other than white. Blacks account for about 90 percent of the state's nonwhite
or minority population.

Repeat Pregnancy - A second or higher-order pregnancy resulting in live birth, fetal death, or induced
abortion.

Residence - The place (county, state, etc.) in which a person resides at the time of an event. College students
and military personnel are considered residents of the college or military community. For deaths of
inmates of long-term institutions, the institution is considered the residence if the decedent has
resided there at least one year. For births, residence is that of the mother.

29

Underlying Cause of Death - (a) The disease or injury that initiated the chain of morbid events leading to
death, or (b) the circumstances of the injury or violence that produced the fatal injury.

Unmarried (Unwed) Mother - At time of giving birth, woman has never been legally married or has been
widowed or legally divorced from her husband in excess of 280 days.

Violent Deaths - Deaths due to homicide, suicide, motor vehicle and other injuries, and legal intervention.

WIC - The Special Supplemental Food Program for Women, Infants, and Children. This nationwide
program, funded by the U. S . Department of Agriculture, provides nutrition education for low-incom e
women and children and vouchers for the purchase of specific supplemental foods and infant
formula. Eligible persons include pregnant/breast-feeding/postpartum women, infants, and children
up to age 5 who are at medical or nutritional risk.

Youth Risk Behavior Survey (YRBS) - A biennial survey of 9th- 1 2th grade students conducted by the N.C.
Department of Public Instruction in collaboration with the Centers for Disease Control. In 1 993, 71
N.C. schools were selected as survey sites from a base of 407 public schools containing approxi-
mately 300,000 students in grades 9-12. Fifty-nine schools and 2,531 students participated in the
survey. In all, 2,43 9 students completed usable surveys. The survey instrument is Appendix 2 of this
report.

30

TABLES

Table 1

Adolescent Population Counts by Age, Race, and Hispanic Origin

with Percent Changes Since 1980

North Carolina 1990

Age

10-14

1980-1990
Percent Change

Total

436,840

15-17 270,733

18-19 227,097

Total 10-19 934,670

Whites

Blacks

298,640

124,437

185,896

76,430

160,741

59,204

645,277

260,071

-10.9

■12.9

-9.2

American
Indians*

7,665

4,779
3,330

15,774

+ 10.7

Hispanic
Origin**

5,319

2,900

3,588

11,807

+2.2

♦Includes a small number of Eskimos and Aleuts
**Persons of Hispanic origin may be of any race

33

51.2

51.6

50.4

104.8

106.3

101.5

51.0

55.9

40.1

Table 2

Sociodemographic Indicators for Adolescents by Race
North Carolina 1990

Total White Minority

Demographics

Persons 10-19:
Percent males
Males per 100 females
Percent rural

Economics

Persons 12-17:

Percent below poverty 1989 15.3 8.2 30.2

Education

Persons 10-17:

Percent not enrolled in school 6.0 5.7 6.7

Persons 16-19:

Percent civilian, not in school,

not high school graduate 12.4 12.2 12.7

Employment

Males 16-19:

Percent in labor force

54.8

58.7

45.5

Females 16-19

Percent in labor force

49.0

52.4

41.4

Males 16-19 in civilian labor force:

Percent unemployed

14.9

11.6

25.3

Females 16-19 in civilian labor force:

Percent unemployed

16.0

12.2

26.8

Family Structure

Own Children 12-17 in Families:

Percent in married-couple family

75.6

NA

NA

Percent in male-householder family

(no spouse present)

3.5

NA

NA

Percent in female-householder family

(no spouse present)

20.9

NA

NA

Marital Status

Females 15-17:

Percent married and not separated

2.2

2.7

0.9

Females 18-19:

Percent married and not separated

10.9

13.3

5.2

Source of Data: Published census materials and computer printouts.

NA-Not Available.

34

Table 3

Adolescent Population Counts by Age, Race, and Sex
North Carolina 1992

Total

Whites

Minorities

Age

Males

Females

Males

Females

Males

Females

10-14

223,587

214,744

156,338

148,146

67,249

66,598

15-17

133,580

128,889

93,930

88,463

39,650

40,426

18-19

109,763

105,086

79,765

74,690

29,998

30,396

Total 10-19 466,930 448,719 330,033 311,299 136,897 137,420

35

sr. \o

& *

es fi

E ©

Ov 0 f>

jj Ov

b o>

S on

C fN

VO CM — O ■*

C Ov Ov fN —

- N C Ov m

<N fN — •-«

Ifl If, Ifl Ifl Ov

- » m * -

fN CM

f ■* 00 ifl —

Ov — fN — • —

— <N —

— C *» fN r-

r~ ov oo ov

M N W

t— fN *t m

t

VO VI

ci

p»

«f>

Ov

fN

fN

fN

Tf

t Ov

ei

S

>n

■t

o ts

p»

fS

— r-> p»

n c

p-

r-

VO

m

^—

m

VO

fN

00 (N

r-j

en

—

f

-T

ri

fi •—

«N

~

"—

~"

pm

n

«s

—

rsi

*-»

ro

«s

ri

I-

EC T

o 2

WJ vC

E
o
U.

X

a>

K

TS

C

re

•*

a» r^

WDcs

< ON

■»—

eu ^

u S

re -c

tf =

C/3 W

"<*

Cv

e "2

2
re

5 c
© w

H

rj re

S —

© o

•vB t-

re re

= U

&■ x

** o

e Z

cu

u

c/i

U

"o

•e

<

n c
« in

«s VC

<« oc

-= Ov

sa «■.

E vo

•» 5 vc

— lb

n Ov

eg fN

c so

N vC

ov E f~

C P- VC VO CI
Ov •** —

o> c »i Tf m
n >n oo

'J- fS

e> Ov vC VI
1- ifl fN

VO Ov fN 00 O

r^ fN o »fi

r, c N N

VO (S m 06 fv
■* rM c v>
m pi m <n

f> (N (N — O
Ov — <N —
>n vC w^ f

t — 00
t~ C <N

o-i —

Ifl K « - <t

— ts r^ ov n
^t r*i f*^

t vc — >* rs

C «* vO >n "^l

VO P-J Wl —

rvl r-i «-> r~ C

CI Ov fS Ov <N

Ov N * vB Ov
(N 00 f\ o —
>" - n is

m r- ov fvi •^>

m o h m in
(N CN * m

O — wi —
r- r- o

f f vO

— <s oo r- r~

CS Ov — 00

C CN Wl Ov Ov
■»»■ m l> •*

(s t- r- ov

c

00 VD — VO

oo r~

m

r~

p«

(N

r-

—

CNi

vO

p~

—

—

oc

r-

'S'

m \D

r-

-T

c

r~ c

^

in

ri

m

t

T

Ov

r-

u~t

•*t

9

pg

t

p<

m

w-i

Pv|

D

•>

«/-,

VO

W1

«/■>

^t

VO

<s

Ifl

i —

<N

CS

w-,

m

Pvl

p»

OC

C=

90

IT.

£ vfi

£ vc

« I-

E 80

r- 5 so

v- Li.

m - f W t

t u-i — •>«■ «n

tj- r^, — — tN

O 0> vO Ov

c — v> r»

TJ- — — <N

O- K r, n N
c r^ r^ — —
m m rvi »^*

<N — O 00 SO

ov oc oo r~i —

Vi w Ov 00 Ov

ov oc c oc

vO 00 u-v. Wl vO

rn m <n — >n

Ov Ov »— Ov

— r- ov <n —
v~t m vo — vo
v. — »» c, <si

U-, 00 VO — VO
</"l vO Ov VC W")
vo — ■* m <N

Ov m

ir.

=:

Ov

vC

rj

O

Ov

^N

rr

-r

v^,

P-

pg

p-

P<1

»

^i

rvi c

in

pg

c

oc

m

rvi

VO

VO

vO

OC

r-

m

=

oc

r*i

r^

m >n

—

p)

*s-

r^

v-,

—

fi

p-

P-

f)

in

OJ

00

rj

C

-c

fi

PB S

« Ov

*• Ov

n vc

« —

E oo

- t* -

VO

=

P~

r-

m

-t

P-

OC

-T

m

-T

V.

—

PJ

T

«-. C rl 00 Ov
rvi vo P~ n «i

r, 00 N n vo

— — r- — r-

k se <t c m
fN u-, — m p-

m - vo h vc
VO Ov — 1- 00
vt oc N m -

oc c rvi oo yr,

fi r, o io O
ov Tt vo m

oo ov r~ m fN

m c vo c <N

vo o. vo q —

•**" pi p-T pi

N IT, N oe vC

r-i m w"i *n p-

Cv N - Tf n

P- p- v. *t Pv|

— vo <n P» w-i

t m cs ^ P~ vo

— ' m"

N N O N Cv
C P» vC m P~
— 00 1- P-

oe ov h - t

OV 00 fN U-l 00
Ov •>» Ov

fN Ov P- VC O

■<t m w m fN

— — fN vo —

r> n t p so
-* f oc m o

— — fN vo —

fN Ov — Ov
VO — 00 oc
fN fN Ov C

— c*i
- rn

oo m m O <n

00 C — 0C Ov

t Ov n m vo

<t Ifl VC Ov Ifl

vo "* ^ — P-

f Ov N m N

Ov » N Ifl ifl
<N Ov Tf p- ifl

00 — 00 o —

— t* (N fN fN

(N m fl V) Ov
O 00 fN Ov O

vn pi Tf oc vo

O 00 Tt fN ifl
VO t P- ifl fN

(N N q « o>

ffl

U .£

y o

p

S5

§1

5 E

Q 3

U <

c 1
1 m o

< < <

« I
1 1 1 3 1

< QQ B9 CQ CD

36

co ca

"a
E

(S (S t N
SO CS — C*l
t— CS

V] —

r~

f-

vi

0«

oc oe -

cs

c-

V.

c

V] rS

CS C

m

OC

rs

e

VI t

—

v,

SO

o

^- vi

(S OC

in

—

rs

T

rs

' —

X

i-

rs

on oc r- m O
©v m rs r- oo
— rs <n

.2 9V M

so © m
— rs *t

rs

M n a N O
C OC Oi N -
N n ■« — (S

K ov is iO n
r- vi — tj- rs
m rs —

~ v£ m vs. ^
On vi so — v>

- -t N

©n rs r- — O
m — rs r- oe
cs m CS

X

r~

m ■>*•

vi

oc

rs

—

O

rs

rs

C*l

— in

SO

t

t-

so

v.

—

v,

m

m

V,

oc

r-

m

— C SO SC 1-

m oc — rs r-

\C m —

vi r*- on o
t rs m rf

SO ■* — m ■*

r, n r. t^ N
m v, oo so m

vo N m
r*> on —

so

oc

r-

C VI rS Tt V)

c> oe n n *

— r- ■*

— — m © O

m vi rs cs r^
cm"

— v> r- m cm

vi r-- m on oc
mm mi

r- r- m cm oc

- - t N K

m ^r f

X

ev

tt

TS

c

re

»■

v

fS

tx

ON

<

ON

»-

O

BR

u

O

-— V

«

'43

"S3

tf

C

3

>->

3

C

u

_S

£

'■£

M

C

C

•e

o

c

w

3

55

^■^

O

<ef

u

c

o

c

.3

_c

c
u

w

*-C

H

—

*3

u

O.

£

C

-—

C-

•-
o

c

Z

w

u

(A

w

"o

"O

<

(ft
u

99

E

2

re

E
es w

3

•*.

iA

re

E
r> 53

— u.

E^

2

JO

gg

E

2£

\C n - N \fl
c r- t t oc

<S h >£ - m
\C >0 r*"; vi C
m vi —

ir, e n i^ t
sC ■* m C> Tt
rf — rs ■* m

m vi Vi r*", sc
x ifi r, r^ vi
i^ — rs m n

— cm r-,

oc h o> vc r~
t^ n * - n
rs c*4 m r^i vi

m r~ O OC C

■* — t- r- cn

ITi ^ C t ^

C - O 1 IN
©> (N m C <N
v, vc ■* vO v,

C ^ (N C N

OC — VI (N Vi

V, v^ f \0 V,

rs* — ' es"

rs vi cm vi oc
O r^ <N m O

C — vi m

Ov 00 VI (N Ol
\Q VI (N VO 00

C — m rs

c

V

m

c

rr

C

VI

rs'

r^
m

c
rs

OS C O
V, 00 sC

O^

fS sc ■* t v,
SO X — V, OS

m o m ^ *<■

oe « rs t -
c v, c> r~ —
— cs —

r- r- r- vi vs.

C oc r» m m

iti n io ^™

oc cs cs O oo

^t c on m *

so t so —

— •«* vi r- >*

00 On VI — —
cs cs C v, l>

n « rs - C
rs — f so t
vn m oo Vi r-

ifi n rs m n
- Ci \fi *t ^
\C so vO —

00 Tt so m O
oo so r- vs. so
vi vo so «■

00 00 On Vi SO
so cs m C v,

— — C On

00 cs so so m

O v, vi c cs

rs — © On

ON ON
CS Vi

^^ 9mm

■c

rs r^

Xf\

On V,

-t

00

e

r^

rs

V,

m

V,

rs

Tt ON

T

00 ©

rs

*t m

00

r~ rs

rs

m

On

m

oc

r-

sC

-T

nC

so rs

C>

— ■*

•* so

T

rs "<t

00

~"

t

~*

00

T

o-

r~

C

"tf"

m

~- m

_

c*

o>

m

r~

SO

r— m

nC

r~j

SC

oc

m

2

-t

oc

^

m

-T

V,

"*

ON Tt

rs

r»

r-

t

oc

i

v.

V.

r~

-t

m

~t

C

^~

t

1 —

rs

~r

o

oc

^

^ m

**• oc m m 00
so r~ oc © ©
oo r- so »» r^

oc — — rs r-

ON V, © © Vi

v, — rs r- rs

vi vi — vi rs
Tt — vs. m rs
vi r- so rs oo

so «* C rM oc
•q- C r- rs oo
— rs in m

On © On SO On
t C © V, On
rs m — m vi

so On rs rs rs
r- ■* so Vi vi
i— •>* so r- oo

OC m — "■ so
On © m — ©
oo cs r- so oo

ji ■» rs * m
— oo rs — ©
oc — rs r- m

so so os oo rs

va on so rs ©

© t— SO m ©_^

r~ —* — ' rs*

rs — © rs oo

so rs m vi Tf
rs m — t so

.si
■§•1

Q D

o
X>

111

uj u. u.

o a

IS =

'5 re

§ 6

re o

u

c

O u w

Ii5

^7

M

E

r- so vt en f
1/1 1/1 so — 00
CM — ■"»

_ — TT

OS 1/1

© r- © so m

lO (N N N N

f"- en en CM en

r- oe

o f» * t>

\6 f. « ^ C<

- t iri o> -

— r-

— — ^ Tt

- t >o cm

— — SO

el

1/1 CM Os SO —

en i/i so m r-

r-i — c- 1

oc >e o> « o

(S IT; n oe N

— <*

© so — r~ os
(s oc - ->

— — *»• rr

en v. 1/1 so t>
O- oc r- en *t
— •ft cm

© oc oe r- —
N CI * * M

so cs r- vi oe

^ n ^ <t \e

— Cs 1/1 f-~ —

do m n m m

en cm en cm »»•

os oc t- so —

f*^ — os *c

©s r- ui oc

OC © — SO 0C

ov oc - m n

en CM so —

CM 00

- N \D *

CM so en CM

— CM ©

CM 00 SO — SO

r- r- so — —
en cm so — «

— cm cm oe so

f 1/1 00 CM

CM sC

cm so r- t

— r- os *

CM CM 1/1 SO

wi oo so oe —
so r-~ cm i/i r-
is m n cm

V) f 00 — c

cm r- — os f

CM CM O

C/2

V.

o

d

X

3C

©

c

CM

ri

CM

r-

CM

X

CM

r-

p^

00

cn

oc

t"

c

_

r~

X

oc

■*

^

SO

«n

r~

r-

CM

Os

t*i

r~

O

5C

oc

©

m

«1

en

CM

SO

en

^*

CM

m

•c

«

SO

-r

c

CM

T

c^,

CM

i/l

©,

©r

W1

— r

>/-.

1 —

1/1

en

■■

en

r-_

c

E

—

so'

"■

—

"-

—

«

-

^

V

CM)

=

tx

ON
ON

K

SO

r«l

CM

CM

00

e>

m

•*

so

rr

KM

SO

-r

m

so

>*

c

m

X

■*t

«i

oc

en

X

OC

<

u

CM

-r

SO

r^

oc

i^,

—

e—

CI

O

-t

T

c

CM

so

en

—

•"!■

—

«-.

-T

©

f

cd

SO

-T

T

CM

CM

«n

B

1/1

—

so

^

«1

t

—

en

so,

y.

S

-

so'

— "

—

—

wm

u

.Si

y-»v

«

v~

tf

c

V.

£.

>c

CM

Cs

c

o

W1

W1

CI

m

CM

^M

o

r-

CM

1/",

en

en

-T

e'-

OS

O

Os

c

_-

s
o

_u

CM

r-

B

e>

©

CI

CM

-T

P~

CM

SO

g<

i/i

ir.

CM

r~

—

—

B>

en

Tt

X

SO

ia,

CI

3

>>

SB

cs

T

n

so

t

CM

n

—

©

—

^

i/i

so

©„

sO_

O^

CM

CM

CM

CM

^*

'•C

c/3

cv

E
o

«"'

cm'

CM*

CM*

c
o

M—

c

•o
s

i
oc

u

s

V.

00

©

X

x

SO

KM

t

t

X

«1

f

t

3C

X

00

vm

©

f

Os

i/i

^™

«1

SC

-T

00

o
U

u

1/1

SO

e>

ur

f

oc

i~l

<.

1/1

1/1

yr,

CM

X

f

Os

■n

1/1

Os

CM

Os

t-

U",

-T

V*

2

Os

m

^

SO

T

r4

c

°°,

—

CM

W1

SC

oc

r~

CM

CM

CM

CM

©_

"m

"*

c

t*

—

•*

CM*

H

Ol

c

A

_o

c

U

V.

SO

00

SC

C*1

m

CM

so

^

SO

-T

r-

r^

en

r~

©

—

Cs

1*]

T

en

o

f,

1/1

g«

"3-

u

1/1

c

X

>c

m

V

Os

CI

m

CM

Os

f

OS

r»

CM

u-.

CM

~T

r~

1/1

CM

oc

e»

Os

C

"re

CM_

in

\r,

o

r>

CI

CM

CM

fMJ

CM

CM

r>

Os

sO^

—

V.

— J

~*

en

en

—

en

©^

~~

£

-

!>.

E

o

— '

so'

—

~"

~^

—

©

♦*

H

■■■

—

c

—

o

=

•

1/1

■*-

Z

£

■r

CM

oc

mm

r~

M

c,

-

©

T

Q

©

SO

OS

Q

|M

m

OC

CM

Os

CM

O

—

oc

OS

en

c

Jj

e>

Os

Os

T

t

W1

v,

»>

so

SO

-T

—

f"

OS

>*

c^

6

en

oc

Cs

CI

c>

—

©

1)

"re

en

m

sC

c>

r-

-r

CI

CM

CI

CM

m

OC

B;

t>

•-

iq

— j

—

m

en

1 —

en

rs

CM

u

2

— '

so'

— '

— '

—

—

—

js

"©

"O

G*

c

CM

B

«1

r~

CM

1/1

Os

s

SO

oc

—

r-

SO

SO

in

c

ir,

oc

i/i

CM

CM

so

r~

©

<

_«

t^

r~

tr,

o

SO

l>

rn

X

w

CM

c^

in

CI

OS

Os

-r

t

m

"9-

r-

CM

en

<~)

en

"5

©

6>

B>

•f

Os

sC

T

t

*

■*

t

m

SO

r-

—

S

S^

CM

SO

W1

rj

so

OS

en

E

I

©

"(5

CM — —

00 SO — t CM

CM 00 0C SO —
CM — © C W1

SO CM SO © CM

en so f en "*

— SO "1 «• 00

© en oo C f
«i r~ C Os —
f m •* SO 00

r- o m os -
— 00 r- en 00

CM — OS CM SO

© e- — r- ©
•»»■ — f r- t-

sC CM so © en

u

P Z 2

u. C -=

S u 5

o S

-J -J -J

u
•£

o

D

o

2 2

oc

u

3

£>

c

o

ison

in

klen

"3

o

•a c tj

o

eg

re re o

JB

2

2 2 2

2

38

s

E
o
op o

c o
o o

2 2

>
o

c
re
X

rthampton

slow

ange

o

I

5

re

O
=
cr

re o

o c u

M

re

z z

ZOO

o.

0.

1 i

u o

a. a.

-*5

- o-

re

E

X

re

s

oe r-

=C

cs

u~,

c

—

<^J

U1 NO

=

* VI f> *

o> cs

W

=

V,

<^i

c-

«—

l-H f*"j

•»

■* m rs no

<N

f*1

r*l

r*l

—

rs

fS

»■*

rs

\C <n n \fi ri
C so m ©n rs

- N N N Tf

on r- — no oc

- PI N -

m r~ f on r-
</i — r~ — m

e> c on oc r-

o> » ifl o s>

rS rs — —

— 00 Tt 00 —
C t- >n On On

1*1 ON —

n - in >o c
00 NO t —
«n •*

00 NO NO t- —
NO ■>* O rs
W) -<t

c/3 J

I E

_ r~ o

27fc

O £

£ £

5 «

rs O t — m
m o> ff> 9 h
— n ©n •♦ ■»*

— c — On On
NO •* 00 — —

— •<*• On ■* •*

t NO f fS 06

O * O h> Tf
— ■* ■* —

r- c c on
oe m rs vc
— •q- t —

On NO — On it
m t-~ m f> rs

<*• ON •>» — rs

<n m oo f o

SO — O <n O
r^ r~ r- no —
Tt — rs •—

no 'J- no r-

NO © m 00
•q- — O) —

m no — on m
on no C rs
00 e'-

en no — <**»
r- r- on rs

00 NC

xn

M OS

< ON

of »

•S * u

ill

^ u «

S 2 P
a C ;

£■■=

T" ©
c Z

u

en

p£

"o

3

re
E

2£

re

re
E

I

0C

1 —

r»

, —

CM

m

c

p

c

a

a

O

•»* O t o

CN

r~

o-

■=.

r^

t

3

m

c^

nC

c>

r*i

r-

5C

rs

w"j »/"i r^ in

ro

C

K

rs.

«

r*1

c

r~

rs

t-

r^

M

—

— NO

r-

r»

m

Cl

r^ r»i r~ t <n

NO 00 00 NO —

<n no rs no r~

On t On X •—
O C 00 CI On

m ■* t x c

lA

"re

u

re
E

c
=

C U", •q- Tf
■a- rs rs on
»* «-, oo —

— C rs no
r~ rs on no

0C NO NO —

00 On

ON

no r~ rs r~

u
"re

E
2^

O^ tt r, fs 't
f- 1 — rs «"■ —

^ On — ■ ON 00

— C *t — 00
C «", rs O oe
r*i r^ r-- m

no on m oe -*
rs no oo on on
no r^ m «n ,^'

on c rs </"> >n
O (*1 rn rs C
r- »»■ t»i no ui

rs oo — c —

r- on oe oo oc
On m m oc no

on <n no on on
t it, n r~ m
C no t oc r^

m p c rs r-

•n On m Tf o
m On no f —

^t on rs on r-i

— no no r~ r^

— — NO

"i- i--i r~ — c
NO oc — (N —

r~ ^* o

in — r~

**" r^ m

r- nok ^t

00 -*

c —

ON NO ** ON —

oo — m on c
rs •»»• oe

0C On

ON C

rs

X

On On On

ON NO

rs •*

nC:

vO

m oe r-

f

C

rj

rsi

^t

<n no — rs —
oc rs c in r-
— — ■>* •*

rs oe •<» a rs
^t >n oe t "*
— — T in

r*i m oo >n m
rs On no oe •*
r- — no <n

— On — On m
On m On rs C
m r* ~- »n

t \p t t n

On C — m Tf

m oc — — m

O ON O On rs

— m no r^ m

no oe — rs oo
On*

m r- no o <n
t~- rs »9- ■*

Tt — —

— " m \o C

On — Tt 1-
Tt — —

oc m r-i r- f*i
r~- 'j- r^ r~ on
oc r— >n c-i —

f , N t S> «".

•n — c. r~ c
on oe >n m rs

NO C 00 X —

c r- no c r~
rs c r- m rs

— On

t~-

rj

_

rs t*i

On

3C

~

f rs

r>

NT

m

— oc r~ oe —

m — ^- r- it

"". Is N * *♦

rs* — * — *

"re

no *n r^i vo O

*j k \e e> t

rs On — C On

r- no "* r- rs

NO — NO m On
NO P NO t —

p*

i-

w.

on in

On

O m

r-

T

NC

oc

r>

a

T

^

nC

oc

r- '*

t

fi C

e

rs

a

^~

oc

rs

t-

e>

rs

r-

m

NO

r«-i rs

rs

On

t»l

Cn

m

O

"»

rs — —

Ed
U

Z >

S H

o z

w o i .y

K U a: o:

fi E

E

re

■s

e:

oi bS

,o

c

■a

o

i

C
09

re

J
o

0

=

re

o
c

a:

CA

w

<7.

^

B
re
>

o

Transyl
Tyrrell
Union

uice
ake
arren
ashin

>£££

re
M
9

re

o to

re ~

U" re re
$ > >

39

Table 5

Adolescent Death Rates* by Race-Sex and Age
North Carolina 1992 and United States 1991

Ages

10-14

Ages

15-19

Race-Sex

N.C.

U.S.**

N.C.

U.S.**

White Male

29.4

30.6

100.8

112.2

White Female

19.6

17.5

49.6

46.9

Minority Male

56.5

42.3

173.7

1946

Minority Female

27.0

21.3

50.8

48.8

♦Deaths per 100,000 population
**Source is Reference 11. Provisional U.S. data for 1992 are available forages 5-14 and 15-24butnot
10-14 and 15-19.

40

Table 6

Adolescent Deaths and Death Rates for Leading Causes by Age and Race-Sex

North Carolina 1990-92

Minority Minority

Females

i

Age and Underlying

Total

White Males

White Females

Males

Females

Cause of Death

Number Rate"

Number Rate1

Number Rate1

Number Rate1

Number

Rate

AGES 10-14

All Causes

386

29.4

146

31.3

87

19.7

102

50.5

51

25.2

Unintentional Injury2-3

173

13.2

68

14.6

37

8.4

52

25.5

16

7.9

Motor Vehicle2

100

7.6

35

7.5

33

7.5

22

10.8

10

4.9

Other3 73

5.6

33

7.1

4

0.9

30

14.7

6

3.0

Homicide4

29

2.2

4

0.9

5

1.1

12

5.9

8

4.0

Suicide5

23

1.7

14

3.0

4

0.9

5

2.4

0

0.0

Cancer6 44

3.3

23

4.9

8

1.8

8

3.9

5

2.5

Heart Disease7

13

1.0

5

1.1

3

0.7

2

1.0

3

1.5

AGES 15-19

All Causes

1,280

87.4

589

110.6

231

46.4

350

161.4

110

50.6

Unintentional Injury23

660

45.1

342

64.2

154

30.9

132

60.9

32

14.7

Motor Vehicle2

516

35.2

274

51.5

135

27.1

82

37.8

25

11.5

Other3 144

9.8

68

12.8

19

3.8

50

23.1

7

3.2

Homicide4

220

15.0

29

5.4

17

3.4

149

68.7

25

11.5

Suicide5

150

10.2

110

20.7

12

2.4

25

11.5

3

1.4

Cancer6 50

3.4

22

4.1

9

1.8

10

4.6

9

4.1

Heart Disease7

30

2.0

15

2.8

1

0.2

11

5.1

3

1.4

'Deaths per 100.000 population

2ICD-9 Codes 810-825.

3ICD-9 Codes 800-807, 826-949.

'ICD-9 Codes 960-978.

'ICD-9 Codes 950-959.

6ICD-9 Codes 140-208.

7ICD-9 Codes 390-398, 402, 404-429.

''

41

Table 7

Arrests and Arrest Rates with Percent Changes Since 1978 by Age

North Carolina 1992

Arrests

Percent Chai

lges

Ages 10 and over

Number

Rate*

Number

Rate

TOTAL

486,644

828

43.4

19.0

10-17

41,730

59.5

32.2

52.8

18-19

37,889

176.4

21.7

34.9

20-24

103,668

181.3

29.2

26.8

25-29

90,697

163 3

62.2

39.0

30-34

79,592

138.1

103.3

52.5

35-39

56,707

103.2

102.0

30.3

40-44

34,171

67.8

56.1

-3.5

45-49

18,489

42.7

4.7

-28.2

50-54

9,993

29.3

-30.9

-39.8

55-59

6,003

200

-38.4

-41.4

60-64

3,662

12.6

-33.8

-44.0

65+

4,043

48

0.9

-31.7

♦Arrests per 1.000 population

Source of Arrest Counts: State Bureau of Investigation.

42

Table 8

Adolescent Arrest Rates* by Type of Offense, Age-Sex, and Age-Race

North Carolina 1992

Ages 10-17 Ages 18-19 Ages 10-17

Offense Category Males Females Males Females Whites Minorities

PARTI

Murder 24.4 2.0 75.6 4.8 3.5 36.0
Manslaughter by

Negligence 0.8 0.3 2.7 0.0 0.4 0.9

Forcible Rape 25 5 0.0 55.6 0.0 5.5 29.9

Robbery 137.8 3.5 429.1 14.3 12.9 206.1

Aggravated Assault 488.8 100.1 1,341.1 261.7 129.2 683.0

Burglary, B&E 992.8 76.0 1,946.0 130.4 423.5 815.7

Larceny 1,716.0 627.4 2,622.9 1,044.9 774.3 2,110.6

Motor Vehicle Theft 182.0 27.1 256.9 18.1 61.4 207 6

Arson 50.1 10.2 44.6 4.8 23.4 46.7

Subtotal - Part 1 3,618.2 846.5 6,774.6 1,478.8 1,434.2 4,136.5

PART 2

Simple Assault 940 7 270.3 2,335.0 610.9 276.0 1,376.7

Forgery/Counterfeiting 31.6 24.2 242.3 153.2 23.2 38.8

Fraud 77.8 66.9 752.5 855.5 60.2 100.5

Embezzlement 14 8 13.4 69.2 80 9 12.1 18 7

Stolen Property 264.3 25.3 630.4 71.4 62 6 339.4

Vandalism 608.7 71.6 768.0 154.2 283.6 485 7

Weapons 282.2 27.4 822.7 33.3 73.3 348.3

Prostitution 5 9 5.2 21.9 20.0 4.1 8.9

Sex Offenses 62.2 4.1 119.3 4.8 24.2 55.2

Drug Sales 164.1 11.6 683.3 78 0 20.3 246.4

Drug Possession 365.4 35.5 1,749.2 198.0 107.2 423.0

Gambling 2.5 0.3 10.0 5.7 0.0 4.7
Offenses Against

Family ' 15.4 2.3 185.9 24.7 6.2 15.4

DWI 225.4 34.3 2,138.2 295.9 157.1 73.9

LiquorLaws 358.4 80.0 2,351.4 437.7 261.1 132.8

Disorderly Conduct 373.5 126.6 907.4 176.0 119.5 554.9

Vagrancy 5.0 0.9 9.1 1.9 2.7 3.7

Curfews-Loitering 19.3 3.8 0.0 0.0 3.5 30.4

Runaways 157.9 174.3 0.0 0.0 111.9 288.9

All Other Arrests 1,838.1 472.6 7,734.8 1,604.4 766.1 2,084.4

Subtotal - Part 2 5,813.2 1,450.7 21,530.9 5,246.2 2,375.1 6,630.4

GRAND TOTAL 9,431.4 2,297.2 28,305.5 6,285.3 3,809.4 10,767.0

♦Arrests per 100,000 population.

Source of Arrest Counts: State Bureau of Investigation. Race-specific counts were not available for ages 18-19.

43

Table 9

Adolescent Incarceration Rates' and Percent Changes Since 1984

by Type of Crime and Age

North Carolina 1992

Ages

16-17

Ages

18-19

Crime Category

1992

Percent Change

1992

Percent Change

Total Crimes

198.9

25.3

581.3

55.5

Misdemeanors

15.5

-73.4

25.6

-74.8

Felonies

174.2

78.9

552.9

105.7

• Assaultive

81.4

226.9

238.3

164.5

Homicide

22.9

332.1

58.2

280.4

Rape and Simple

Assault

9.2

8.2

30.7

59.9

Robbery

33.2

249.5

108.9

142.0

• Public Order

26.4

**

98.2

1,302.9

Drugs

25.2

**

95.9

1,472.1

• Property

66.5

8.3

2164

26.0

Burglary, Breaking and Entering 46.4

-8.7

129.9

14.8

Larceny and Auto Theft

17.2

1.8

75.4

81.7

♦Prison inmates per 100,000 population. Counts are as of December 31. 1992.
**Rate was zero on December 31, 1984.

Source of Inmate Counts: North Carolina Department of Correction

44

Table 10

Adolescent Pregnancy Rates, Birth Rates, Abortion Rates, and Abortion Fractions

with Percent Changes Since 1978 by Age and Race

North Carolina 1992

Pregnancy Rate*

Birth Rate*

Abortion Rate*

Abortion

Fraction**

Percent

Percent

Percent

Percent

Age and Race

1992

Change

1992

Change

1992

Change

1992

Change

10-14

Total

3.3

-2.9

1.7

+6.3

1.6

-11.1

465.2

-10.7

White

1.5

-11.8

0.6

0.0

0.9

-10.0

626.1

+0.2

Minority

7.3

0.0

4.3

+ 13.2

2.8

-17.6

391.3

-15.7

15-17

Total

67.4

+ 18

446

+4.9

22.3

-3.9

326.7

-6.7

White

48.4

-5.8

30.2

+ 1.7

18.0

-15.9

371.2

-10.7

Minority

107.8

+8.3

76.1

+5.3

30.5

+ 16.9

282.8

+7.7

18-19

Total

136.2

+2.4

94.2

+4.2

41.0

-1.0

297.8

-4.3

White

107.7

-6.8

74.3

-0.9

32.7

-18.0

303.7

-12.0

Minority

203.9

+ 17.3

142.9

+ 10.9

59.2

+39.3

290.1

+18.6

Total 10-19

Total

52.8

+2.3

35.7

+5.0

16.7

-2.9

313.4

-5.9

White

40.3

-5.6

26.7

+ 1.1

13.4

-16.8

332.4

-11.7

Minority

80.3

+ 12.0

56.1

+8 1

23.4

+23.8

291.7

+ 10.9

♦Number of events per 1,000 females 1 5-44 Pregnancies are the sum of live births, fetal deaths, and abortions.
**Number of induced abortions per 1 .000 pregnancies.

45

Table 11

Live Birth, Abortion, and Pregnancy Rates for Females 15-17 by Race

North Carolina and Counties 1988-92

Birth Rate*

Al

)ortion Ral

e*

Pregnancy Rate

*

RESIDENCE

Total

White

Minority

Total

White

Minority

Total

White

Minority

North Carolina

44.3

30.1

75.7

26.9

22.7

34.6

71.7

53.1

111.4

COUNTY

Alamance

39.7

27.9

73.6

37.4

31.5

49.1

77.9

59.7

125.0

Alexander

27.2

27.2

26.9

9.4

8.7

17.9

36.6

35.9

448

Alleghany

16.4

17.0

0.0

19.9

20.6

0.0

36.3

37.6

0.0

Anson

58.4

29.4

77.4

24.3

22.7

24.3

83.1

52.1

102.3

Ashe

29.1

28.4

105.3

15.9

14.2

157.9

45.0

42.6

263.2

Avery

39.5

40.1

0.0

16.4

15.9

50.0

57.9

58.1

50.0

Beaufort

53.4

27.4

89.4

22.4

17.2

28.4

76.2

44.6

1188

Bertie

47.5

24.0

56.6

15.4

10.5

17.3

63.4

35.9

73.9

Bladen

44.7

26.5

63.0

17.2

17.1

17.2

63.3

43.6

83.2

Brunswick

50.7

44.4

66.3

22.2

22.7

20.7

73.6

68.2

87.0

Buncombe

38.1

30.7

91.2

32.8

29.0

57.8

71.5

60.2

150.5

Burke

43.2

41.1

64.7

186

17.0

31.7

61.9

58.3

96.4

Cabarrus

40.2

28.9

93.1

23.5

22.9

26.3

63.8

51 8

120.0

Caldwell

54.0

49.6

107.0

19.9

18.9

26.3

74.7

69.1

136.8

Camden

38.4

40.4

32.9

20.9

21.4

19.7

59.3

61.8

52.6

Carteret

37.9

36.1

49.2

23.7

24.1

20.6

61.7

60.5

698

Caswell

23.9

21.8

25.9

19.9

12.2

25.9

44.2

34.1

52.8

Catawba

42.9

34.9

95.4

24.6

21.5

43.1

68.1

56.9

140.3

Chatham

38.2

27.6

62.1

27.7

22.0

36.9

66.5

50.0

99.9

Cherokee

46.0

47.2

20.6

13.9

13.6

20.6

59.9

60.8

41.2

Chowan

40.7

22.3

63.0

17.2

19.6

14.2

57.9

41.9

77.2

Clay

26.7

26.8

0.0

7.6

7.7

0.0

35.6

35.8

0.0

Cleveland

66.2

44.4

123.0

21.8

20.8

24.0

88.8

65.2

149.8

Columbus

49.7

33.3

72.7

18.3

15.4

21.2

68.4

49.2

94.2

Craven

46.0

31.3

73.5

23.6

21.9

26.0

69.7

53.2

99.8

Cumberland

47.6

33.0

66.2

30.2

24.1

37.4

78.2

57.5

104.1

Currituck

31.3

27.4

50.5

18.3

19.2

13.8

49.6

46.7

64.2

Dare

15.4

11.6

89.9

21.5

20.3

33.7

37.4

32.4

123.6

Davidson

42.5

38 1

69.2

26.9

23 8

40.8

70.4

62.5

113.2

Davie

33.7

27.3

79.3

23.2

20.5

42.5

57.6

48.6

121.8

Duplin

48.6

39.6

60.9

28.2

20.2

38.8

77.0

60.2

99.8

Durham

46.3

14.2

79.7

47.1

28.8

64.9

93.8

43.0

145.4

Edgecombe

64.9

34.9

80.7

31.1

34.5

28.6

96.6

69.9

110.0

Forsyth

42.0

22.0

79.6

37.2

27.8

53.8

79.5

49.9

134.2

Franklin

43.8

19.5

75.0

22.6

16.7

30.1

67.7

37.7

106.4

Gaston

56.8

49.3

91.7

22.3

21.3

25.2

79.4

70.9

117.9

Gates

26.4

14.2

36.9

15.4

11.8

18.4

41.8

26.1

55.3

Graham

49.9

48.2

67.8

85

7.8

16.9

58.4

56.0

84.7

Granville

40.9

21.3

62.8

33.5

32.7

33.8

74.4

54.0

96.6

Greene

41.0

18.5

58.7

22.1

15.7

26.0

63.6

35.7

84.7

Guilford

41.7

22.4

77.0

39.3

30.9

47.8

81.5

53.4

126.1

Halifax

55.3

31.2

69.4

28.1

32.4

25.1

84 1

64.4

95.2

Harnett

51.7

33.9

89.5

26.2

22.2

34.0

78.3

56.3

124.4

Haywood

44.4

44.7

33.9

20.5

19.2

67.8

65.1

64.1

101.7

Henderson

38.2

35.1

85.6

23.0

21.5

47.0

61.7

57.1

132.6

Hertford

55.3

25.5

68.4

23.5

23.1

23.7

79.5

48.7

93.2

Hoke

70.1

41.1

83.4

18.1

25.9

14.0

88.2

67.0

97.4

Hyde

41.6

11.9

83.0

27.7

23.8

33.2

69.3

35.7

116.2

Iredell

47.5

34.8

93.2

22.2

18.5

34.6

70.3

540

128.3

•Number of events per

1 ,000 females 15-17. Pregnancies are the

sum of live births, letal aeatns, ana aoonions. rNumoers unuenying uic raics

are given in Table 12.

46

Table 11 (continued)

Live Birth, Abortion, and Pregnancy Rates for Females 15-17 by Race

North Carolina and Counties 1988-92

Birth Rate*

Abortion Rate*

t

Pregnancy Rate

*

RESIDENCE

Total

White

Minority

Total

White

Minority

Total

White

Minority

COUNTY

Jackson

36.8

30.4

69.0

23.3

21.1

34.5

60.6

52.0

103.4

Jonhston

45.0

30.3

90.4

25.4

23.3

30.9

71.1

54.2

122.3

Jones

39.9

23.0

57.4

22.4

13.4

31.7

63.3

38.3

89.1

Lee

53.8

33.5

99.9

27.0

21.3

37.7

81.0

54.8

138.4

Lenoir

52.9

27.7

76.8

26.2

28.3

23.0

80.0

56.6

101.0

Lincoln

49.5

43.6

92.8

20.6

19.7

27.2

70.8

63.8

121.6

McDowell

44.6

42.2

84.1

24.4

25.1

13.3

69.0

67.3

97.3

Macon

27.3

28.1

11.4

18.0

17.8

22.7

46.4

47.0

34.1

Madison

28.0

27.6

55.6

17.8

18.0

0.0

46.4

46.3

55.6

Martin

49.1

19.5

71.0

17.3

15.4

18.7

67.4

34.9

91.5

Mecklenburg

44.8

19.0

86.7

34.8

27.8

45.8

80.1

46.9

133.6

Mitchell

44.0

44 1

0.0

13.6

12.8

500.0

57.6

56.9

500.0

Montgomery

66.7

51.4

92.9

25.9

26.6

24.6

92.9

78.7

117.5

Moore

44.5

30.0

82.1

25.3

22.6

31.7

70.6

53.2

115.2

Nash

41.1

22.6

69.7

20.4

16.8

23.9

62.1

39.8

94.5

New Hanover

43.4

22.9

95.9

31.8

27.9

41.4

75.6

50.9

138.3

Northampton

59.3

33.9

69.7

31.5

24.2

33.8

91.7

58.2

104.8

Onslow

45.8

41.2

58.8

28.1

25.9

33.9

74.0

67.1

92.7

Orange

20.9

11.4

54.2

34.9

26.2

59.3

56.0

37.6

114.1

Pamlico

42.9

28.6

73.7

22.4

16.3

35.4

65.2

45.0

109.1

Pasquotank

41.7

32.1

54.4

19.9

20.9

17.9

63.2

54.1

74.6

Pender

40.2

24.0

67.9

25.4

21.8

31.6

66.0

46.4

99.5

Perquimans

44.1

18.2

81.9

2.0

3.3

0.0

46.0

21.5

81.9

Person

31.5

21.3

51.4

36.3

30.0

44.9

68.2

51.2

97.2

Pitt

484

19.9

78.5

19.6

18.5

19.9

68.9

38.6

100.0

Polk

34.2

34.3

33.3

23.7

21.2

40.0

58.8

56.6

73.3

Randolph

39.0

37.1

60.5

25.0

22.2

45.3

64.4

59.8

107.0

Richmond

54.8

41.2

77.3

22.3

21.8

22.6

77.5

63.0

101.0

Robeson

59.5

37.2

67.3

188

22.9

17.4

78.7

60.4

85.1

Rockingham

47.6

38.3

71.9

28.4

23.2

37.4

76.8

61.7

111.8

Rowan

46.3

34.3

88.3

23.3

19.8

35.4

70.0

54.3

124.6

Rutherford

51.0

46.5

72.1

18.5

18.2

19.0

70.2

65.4

92.0

Sampson

47.1

38.0

58.5

21.2

16.9

25.3

68.8

54.9

85.0

Scotland

70.3

46.9

89.0

14.3

18.2

11.3

86.2

65.1

103.1

Stanly

46.9

37.5

96.2

21.7

19.3

34.0

69.7

57.2

135.0

Stokes

25.1

24.7

31.0

19.8

19.5

20.7

45.7

44.7

55.2

Surry

37.7

35.7

75.0

17.0

16.7

21.9

54.9

52.7

96.9

Swain

87.0

56.7

136.1

24.6

26.0

22.3

112.6

84.2

158.4

Transylvania

41.9

38.3

86.2

19.9

18.3

40.2

62.6

57.5

126.4

Tyrrell

28.1

21.7

37.4

10.8

3.6

21.4

38.9

25.4

58.8

Union

35.2

21.0

84.6

19.0

17.9

22.2

54.9

39.2

109.1

Vance

57.2

34.0

77.4

30.5

29.3

31.1

89.0

64.3

110.1

Wake

27.4

11.7

68.7

27.7

21.1

43.5

55.5

33.1

113.3

Warren

38.4

27.5

41.9

25.6

34.3

22.1

64.0

61.8

64.0

Washington

45.4

21.3

65.1

10.2

8.5

11.6

57.6

29.9

80.2

Watauga

27.4

28.0

0.0

17.5

16.3

784

45.0

44.3

78.4

Wayne

44.6

24.2

72.1

21.6

19.0

24.5

66.7

43.4

97.4

Wilkes

40.0

39.3

49.9

16.6

15.8

23.6

57.3

55.7

76 1

Wilson

47.4

19.4

77.8

32.8

23.7

41.6

81.3

43.0

121.6

Yadkin

30.7

30.5

33.6

21.7

21.1

26.8

52.4

51.6

60.4

Yancey

33.8

34.0

27.8

12.8

12.5

27.8

46.7

46.4

55.6

•Number of events per
are given in Table 12

1 ,000 females 15-17. Pregnancies are the sum of live births, fetal deaths, and abortions. Numbers underlying the rates

47

Table 12

Live Births, Abortions, and Pregnancies for Females 15-17 by Race

North Carolina and Counties 1988-92

Live Births

Abortions

Pregnancies

Ik

RESIDENCE

Total

White

Minority

Total

White

Minority

Total

White

Minority

North Carolina

29,154

13,636

15,518

17,683

10,313

7,095

47,186

24,084

22,827

COUNTY

Alamance

389

203

186

366

229

124

763

434

316

Alexander

78

72

6

27

23

4

105

95

10

Alleghany

14

14

0

17

17

0

31

31

0

Anson

175

35

140

73

27

44

249

62

185

Ashe

64

62

2

35

31

3

99

93

5

Avery-

58

58

0

24

23

1

85

84

1

Beaufort

246

73

173

103

46

55

351

119

230

Bertie

114

16

98

37

7

30

152

24

128

Bladen

151

45

106

58

29

29

214

74

140

Brunswick

254

158

96

111

81

30

369

243

126

Buncombe

615

435

180

530

412

114

1,155

854

297

Burke

339

294

45

146

122

22

486

417

67

Cabarrus

391

232

159

229

184

45

621

416

205

Caldwell

399

338

61

147

129

15

552

471

78

Camden

22

17

5

12

9

3

34

26

8

Carteret

176

145

31

110

97

13

287

243

44

Caswell

54

25

29

45

14

29

100

39

59

Catawba

530

375

155

304

231

70

842

611

228

Chatham

128

64

64

93

51

38

223

116

103

Cherokee

96

94

2

29

27

2

125

121

4

Chowan

57

17

40

24

15

9

81

32

49

Clay

21

21

0

6

6

0

28

28

0

Cleveland

598

290

308

197

136

60

802

426

375

Columbus

299

117

182

110

54

53

412

173

236

Craven

381

169

212

195

118

75

577

287

288

Cumberland

1,309

510

799

831

373

451

2,152

888

1.257

Currituck

41

30

11

24

21

3

65

51

14

Dare

28

20

8

39

35

3

68

56

11

Davidson

558

429

129

353

268

76

924

704

211

Davie

96

68

28

66

51

15

164

121

43

Duplin

215

102

113

125

52

72

341

155

185

Durham

733

115

618

746

233

503

1,486

348

1,128

Edgecombe

436

81

355

209

80

126

649

162

484

Forsyth

1,059

363

696

940

459

471

2,006

822

1,174

Franklin

163

41

122

84

35

49

252

79

173

Gaston

1,090

781

309

428

338

85

1,524

1,122

397

Gates

24

6

18

14

5

9

38

11

27

Graham

35

31

4

6

5

1

41

36

5

Granville

164

45

119

134

69

64

298

114

183

Greene

65

13

52

35

11

23

101

25

75

Guilford

1,328

461

867

1,251

637

538

2,596

1,101

1,419

Halifax

356

74

282

181

77

102

542

153

387

Harnett

376

168

208

191

110

79

570

279

289

Haywood

193

189

4

89

81

8

283

271

12

Henderson

229

198

31

138

121

17

370

322

48

Hertford

148

21

127

63

19

44

213

40

173

Hoke

190

35

155

49

22

26

239

57

181

Hyde

24

4

20

16

8

8

40

12

28

Iredell

446

255 191 208

Ihs, fetal deaths, and abortions.

48

136

71

660

396

263

'Pregnancies are the

sum of live bi]

Table 12 (continued)

Live Births, Abortions, and Pregnancies for Females 15-17 by Race

North Carolina and Counties 1988-92

Live Births

Abortions

Pregnancies*

RESIDENCE

Total

White

Minority

Total

White

Minority

Total

White

Minority

COUNTY

Jackson

90

62

28

57

43

14

148

106

42

Johnston

381

194

187

215

149

64

602

347

253

Jones

41

12

29

23

7

16

65

20

45

Lee

229

99

130

115

63

49

345

162

180

Lenoir

358

91

267

177

93

8(1

541

186

351

Lincoln

257

199

58

107

90

17

367

291

76

McDowell

175

156

19

96

93

3

271

249

22

Macon

53

52

1

35

33

2

90

87

3

Madison

44

43

1

28

28

0

73

72

1

Martin

142

24

118

50

19

31

195

43

152

Mecklenburg

2,192

577

1,615

1,703

841

853

3,920

1,422

2,489

Mitchell

55

55

0

17

16

1

72

71

1

Montgomery

170

83

87

66

43

23

237

127

110

Moore

232

113

119

132

85

46

368

200

167

Nash

342

114

228

170

85

78

517

201

309

New Hanover

507

192

315

371

234

136

882

427

454

Northampton

126

21

105

67

15

51

195

36

158

Onslow

493

328

165

303

206

95

797

535

260

Orange

147

62

85

245

143

93

393

205

179

Pamlico

46

21

25

24

12

12

70

33

37

Pasquotank

130

57

73

62

37

24

197

96

100

Pender

114

43

71

72

39

33

187

83

104

Perquimans

45

11

34

2

2

0

47

13

34

Person

99

44

55

114

62

48

214

106

104

Pitt

520

110

410

211

102

104

740

213

522

Polk

39

34

5

27

21

6

67

56

11

Randolph

414

362

52

265

217

39

684

583

92

Richmond

290

136

154

118

72

45

410

208

201

Robeson

831

135

696

263

83

180

1,100

219

881

Rockingham

414

241

173

247

146

90

668

388

269

Rowan

488

281

207

245

162

83

737

445

292

Rutherford

308

232

76

112

91

20

424

326

97

Sampson

260

117

143

117

52

62

380

169

208

Scotland

314

93

221

64

36

28

385

129

256

Stanly

249

167

82

115

86

29

370

255

115

Stokes

99

90

9

78

71

6

180

163

16

Surry

242

218

24

109

102

7

353

322

31

Swain

92

37

55

26

17

9

119

55

64

Transylvania

99

84

15

47

40

7

148

126

22

Tyrrell

13

6

7

5

1

4

18

7

11

Union

334

155

179

180

132

47

521

289

231

Vance

259

72

187

138

62

75

403

136

266

Wake

1,033

321

712

1,044

578

451

2,095

906

1,174

Warren

69

12

57

46

15

30

115

27

87

Washington

71

15

56

16

6

10

90

21

69

Watauga

72

72

0

46

42

4

118

114

4

Wayne

479

149

330

232

117

112

716

267

446

Wilkes

245

226

19

102

91

9

351

320

29

Wilson

358

76

282

248

93

151

614

169

441

Yadkin

89

84

5

63

58

4

152

142

9

Yancey

50

49

1

19

18

1

69

67

2

•Pregnancies are the sum of live births, fetal deaths, and abortions.

49

Table 13

Adolescent Pregnancies, Pregnancy Rates, and Attributable Risks (Ages 10-19)

North Carolina and Counties 1992

Residence

Number of
Pregnancies*

Pregnancy
Rate*

Attributable Risk
(Percent)**

North Carolina

23,711

52.8

COUNTIES

Cumberland

Mecklenburg

Forsyth

Guilford

Onslow

Gaston

Robeson

Durham

Edgecombe

Buncombe

Catawba

Cleveland

New Hanover

Harnett

Halifax

Pitt

Davidson

Rockingham

Wayne

Wilson

Caldwell

Alamance

Craven

Nash

Iredell

Richmond

Johnston

Scotland

Lenoir

Brunswick

Rutherford

Columbus

Lee

Stanly

,219

61.5

1.96

,775

51.2

1.93

,002

60.0

1.55

,206

51.8

1.35

619

73.9

1.27

690

59.5

1.05

584

65.4

1.03

680

56.0

0.92

321

75.5

0.67

555

52.3

0.64

445

56.8

0.62

357

63.9

0.61

476

54.6

0.61

335

65.9

0.60

287

70.4

0.56

463

52.9

0.55

434

52.7

0.51

316

59.1

0.47

383

53.5

0.47

290

59.9

0.45

273

61.0

0.43

350

52.5

0.41

314

54.4

0.40

300

54.7

0.39

322

52.8

0.38

211

65.9

0.38

300

54.0

0.37

191

66.1

0.34

232

57.0

0.33

200

61.6

0.32

218

58.5

0.32

214

57.6

0.31

183

61.9

0.30

197

56.7

0.27

50

Table 13 (continued)

Adolescent Pregnancies, Pregnancy Rates, and Attributable Risks (Ages 10-19)

North Carolina and Counties 1992

Residence

Vance

Randolph

Montgomery

Rowan

Macon

Hoke

Burke

Duplin

Sampson

Beauford

Moore

Granville

Wilkes

Hertford

McDowell

Anson

Henderson

Northampton

Pender

Swain

Haywood

Greeene

Bladen

Chatham

Lincoln

Davie

Surry

Bertie

Franklin

Person

Transylvania

Jones

Jackson

Yancey

Alleghany

Warren

Caswell

Polk

Number of

Pregnancy

Attributable Risk

Pregnancies*

Rate*

(Percent)**

170

60.6

0.27

321

46.9

0.26

119

76.1

0.25

333

46.2

0.25

140

62.3

0.23

122

66.5

0.22

229

48.8

0.21

157

54.8

0.20

179

51.1

0.19

158

52.9

0.19

181

50.3

0.19

139

55.7

0.19

186

49.1

0.18

106

61.3

0.17

108

59.2

0.16

104

59.9

0.16

182

47.3

0.15

85

62.9

0.14

102

55.1

0.13

55

81.1

0.12

128

49.2

0.12

70

64.8

0.12

108

51.9

0.12

107

49.6

0.11

151

44.3

0.09

89

49.8

0.09

169

43.4

0.09

79

50.5

0.08

118

45.4

0.08

93

47.1

0.08

78

48.1

0.07

41

62.5

0.07

99

43.9

0.06

46

50.3

0.05

31

55.9

0.04

51

45.4

0.03

58

44.1

0.03

35

48.2

0.03

51

Table 13 (continued)

Adolescent Pregnancies, Pregnancy Rates, and Attributable Risks (Ages 10-19)

North Carolina and Counties 1992

Residence

Mitchell
Graham
Hyde

Number of
Pregnancies*

38
23
15

Pregnancy Attributable Risk
Rate* (Percent)**

46.3

0.03

50.9

0.02

44.4

0.01

NONREFERENT TOTAL 20,745

REFERENT COUNTIES

56.0

28.05

Carteret

140

43.0

Union

273

42.9

Cabarrus

278

42.8

Chowan

39

41.7

Pamlico

30

41.7

Pasquotank

97

41.2

Cherokee

54

40.3

Tyrrell

12

40.3

Wake

1,169

40.1

Yadkin

74

40.0

Washington

42

40.0

Martin

44

38.7

Ashe

51

38.3

Madison

48

38.0

Stokes

93

38.0

Perquimans

25

36.4

Alexander

67

36.4

Avery

37

34.6

Gates

20

33.2

Currituck

30

32.6

Clay

12

27.8

Orange

208

27.7

Watauga

84

25.6

Dare

32

24.9

Camden

7

20.2

REFERENT TOTAL

2,966

38.02

*Pregnancies are the sum of live births, fetal deaths, and abortions.
The rate is the number of pregnancies per 1,000 females 10-19.

**The percentage of statewide adolescent pregnancies that would not have occurred if the effect of living in a
particular county were absent.

52

■w V J

5 * P

g X! Cu

b£

e- co M

o\

On

o — r-

c"i O r~

oo cn Ta-

On -<J- no

Ooov

N ui —

+ + +

rn — o

1 + ■

© <N m

1 + '

^T On m

c-i rr rr

ts t vo

CN On T

CS TT NO
O 00 (N

© t- m

— ' od en

4-

U

re

u

o

Bi

re c_

—

00 00 00

r*i m o
— (N —

m — ci
— ci --

(N (N fS

O — On
O NO — i

OOnN

NO ON NO

= £

4^ On

U ON

- —

—
re

o0£

w Si

it ^

is .a <^

^ •" ON

■< 8C ON

b 2 «

u u 5

••c C u

cc «_

|1

"5 £

" J

tr.

9
c

Si

u

a "5
« a.

F S*
££

u
U

c

Bi

.Si U

§2

E

=

o — oo
in in t~-

lO Tj" IT)

NO NO NO

m in r-

m (N m

+ + +

T On C")

00 t' On

ci

ON

« -

5j On

U

U

C

r- • — o

m' t' On'

On 00 On

L. L.

X —

E

3

z

NO Cn) cs

— m r-

T m t

=2

■a
c

re

Bi

in oo tt

ci O TJ-'
m m m

+ + +

Tf oo —

"<t r»' ©

(N — ci

T O ci

in no tj-

in od t
m (N rt

NO |h T

in no cn

CN fN <N

+ + +

no m ci

ci r- —
tj- ci m

cn m o

m t"-» ©

<N Tt oo

00 NO On

in — oo
TT r*> —

NO tt On

<S On O
00 ©' NO

on t

© oo —

m m rj-'

m ci cS

+ + +

On On m

m' o —
m m ^3-

NO O On

On NO O

On r^ On

— — i tt

NO m On

+ y +

rn m +

oo m m

u~. t^ •—

+

+ —

+ <N +

+ — +

+

+

+

r- >n in

— •' ©' rr
r- in on

oo ^r no

rn no cn)

NO r- On

NO Cn) —

O O no
1 (N +

two

CI 00 t*\

r- (N <n

1 — 1

Ci

— rs On

^r On in

NO CI CI

— tj- r-

o

C~ 00 00

Tf NO t»

On in rr

— o o

o*

CI Cn)

t- NO O

oo in m

o ci r^

in (N ci

On in TT

no oo r-

>> ON

£ 0

— Bo — So o_«

oo o

^'i

o
c

u
u

u

E

o

H
c

u

o

B 3

° fc

E °

o !3

fe S c re
t) « fi S

O U i_ O

S

o

I fe

^S €

.t O B

m 2 3

o
o
Z

53

Table 15

Numbers and Percentages of Mothers Aged 10-19 Having

Late or No Prenatal Care* by Race

North Carolina and Counties 1988-92

Total

Whites

Minorities

RESIDENCE

Number

Percent

Number

Percent

Number

Percent

North Carolina

36,230

44.5

15,686

37.1

20,544

52.3

COUNTY

Alamance

556

48.2

285

42.7

271

55.8

Alexander

143

54.4

125

54.1

18

563

Alleghany

18

30.5

18

30.5

0

00

Anson

238

53.6

34

34.3

204

59 1

Ashe

54

25.5

53

25.4

1

33.3

Avery

87

49.2

87

49.2

0

0.0

Beaufort

263

43.8

78

35.1

185

48.9

Bertie

87

30.2

4

12.9

83

32.3

Bladen

225

53.1

58

39.5

167

60.3

Brunswick

329

46.6

208

44.8

121

50.0

Buncombe

420

23.6

269

19.9

151

35.4

Burke

334

34.5

275

32.4

59

49.2

Cabarrus

628

55.1

356

48.4

272

67.3

Caldwell

457

42.1

396

40.8

61

526

Camden

26

49.1

16

42.1

10

66.7

Carteret

205

40.2

158

36.9

47

57.3

Caswell

76

47.2

22

31.0

54

60 0

Catawba

677

43.4

438

37.9

239

58.9

Chatham

157

44.7

68

34.7

89

57.4

Cherokee

63

27.2

58

26.0

5

55.6

Chowan

55

36.7

19

35.8

36

37.1

Clay

10

15.2

10

15.2

0

0.0

Cleveland

880

59.3

394

49.4

486

70.7

Columbus

281

35.8

99

29.7

182

40.3

Craven

574

48.9

278

44.7

296

53.5

Cumberland

1,503

35.0

560

27.5

943

418

Currituck

50

46.3

35

41.2

15

65.2

Dare

37

35.2

29

34.9

8

36.4

Davidson

726

46.2

529

42.9

197

585

Davie

105

36.6

81

34.5

24

46.2

Duplin

280

46.9

105

36.1

175

57.2

Durham

817

43.3

139

36.2

678

45.2

Edgecombe

564

52.8

84

37.5

480

56.8

Forsyth

1,132

39.4

382

33.8

750

43.0

Franklin

197

47.7

59

46.5

138

48.3

Gaston

1,294

44.1

844

39.0

450

58.4

Gates

22

32.8

6

42.9

16

30.2

Graham

27

29.7

21

27.3

6

42.9

Granville

194

43.2

55

36.2

139

46.8

Greene

69

37.5

12

24.5

57

42.2

Guilford

1,782

49.5

595

42.7

1,187

53.9

Halifax

407

41.8

71

31.1

336

45.0

Harnett

538

44.8

214

33.4

324

57.9

Haywood

196

41.2

193

41.4

3

30.0

Henderson

167

25.7

141

24.5

26

35.6

Hertford

127

32.2

16

26.2

111

33.3

Hoke

166

34.2

31

25.6

135

37.0

Hyde

35

51.5

8

38.1

27

57.4

Iredell

762

61.8

403

53.4

359

74.9

•No care or care after the first trimester

54

Table 15 (continued)

Numbers and Percentages of Mothers Aged 10-19 Having

Late or No Prenatal Care* by Race

North Carolina and Counties 1988-92

Total

Whites

Minorities

RESIDENCE

Number

Percent

Number

Percent

Number

Percent

COUNTY

Jackson

78

28.9

53

27.9

25

31.3

Johnston

619

60.0

314

54.6

305

66.7

Jones

63

55.8

21

47.7

42

609

Lee

266

41.6

111

33.8

155

49.8

Lenoir

581

68.0

124

51.0

457

74.8

Lincoln

384

55.9

282

51 6

102

72.9

McDowell

188

36.5

159

34.1

29

59.2

Macon

49

28.2

47

27.6

2

50.0

Madison

29

19.5

28

18.9

1

100.0

Martin

130

33.4

20

22.7

110

36.5

Mecklenburg

2,430

42.8

605

34.0

1,825

46.8

Mitchell

39

23.8

39

24.2

0

0.0

Montgomery

183

42.6

89

37.6

94

48.7

Moore

290

45.3

139

40.2

151

51.4

Nash

547

59.3

179

52.5

368

63.3

New Hanover

663

51.1

250

42.4

413

58.3

Northampton

125

38.3

12

24.5

113

40.8

Onslow

677

29.2

468

26.7

209

36.9

Orange

162

39.9

56

27.7

106

52.0

Pamlico

52

46.4

n

25.0

39

65.0

Pasquotank

179

46.3

61

36.3

118

53.9

Pender

182

54.2

81

50.3

101

57.7

Perquimans

59

50.0

12

38.7

47

54.0

Person

134

39.5

47

30.7

87

46.8

Pitt

564

41.8

108

' 29.7

456

46.3

Polk

46

41.4

35

38.0

11

57.9

Randolph

517

44.3

428

42.0

89

59.7

Richmond

385

49.1

156

40.7

229

57.1

Robeson

1,229

53.5

178

44.4

1,051

55.4

Rockingham

502

45.6

242

35.0

260

63.3

Rowan

776

59.6

448

544

328

68.6

Rutherford

237

27.1

151

23.1

86

39.4

Sampson

376

55.8

153

47.8

223

63.0

Scotland

478

60.4

128

49.2

350

65.9

Stanly

310

45.9

211

42.5

99

55.3

Stokes

86

28.1

66

24.4

20

57.1

Sum1

179

25.6

155

24.4

24

38.1

Swain

79

34.2

28

27.7

51

39.2

Transylvania

101

41.2

80

38.3

21

58.3

Tyrrell

10

25.6

1

7.1

9

36.0

Union

441

45.2

162

32.7

279

58.2

Vance

388

53.8

85

39.0

303

60.2

Wake

1,476

50.8

464

42.8

1,012

55.6

Warren

73

33.3

10

27.8

63

34.4

Washington

78

36.3

16

29.6

62

38.5

Watauga

72

35.3

72

36.0

0

0.0

Wayne

978

71.0

315

586

663

78.9

Wilkes

162

22.6

149

22.9

13

20.3

Wilson

397

41.9

85

32.7

312

45.3

Yadkin

103

40.9

93

40.1

10

50.0

Yancey

38

21.7

38

21.8

0

0.0

•No care or care after the first trimester

Table 16

Percentage of Adolescent Mothers Who Smoked by Age and Race

North Carolina 1992

Age

10-14
15-17
18-19

Total 10-19

Total

19.0

White

29.3

Minority

7.0

19.5

3.5

16.4

28.5

5.9

21.0

29.8

9.8

8.0

Table 17

Percentages of Live Births by Type of Service, Race, and Adolescent Age

North Carolina 1988-1992

Type of Service, Race, and Age

Newborn Hospi
Paid by Medical

talization
d

Whites

10-17
18-19

Minorities

10-17
18-19

Mother Received Prenatal WIC*

Whites

10-17
18-19

Minorities

10-17
18-19

Mother Received Prenatal
Care in Health Department

Whites

10-17
18-19

Minorities

10-17
18-19

1988

42.6
34.1

62.1

648

55.0
43.9

70.6
63.7

42.9
34.5

51.1

48.0

1989

56.6
468

72.4
73.1

62.0
49.6

73.9
68.6

47.7
37.1

52.8
48.9

Year of Birth
1990

71.1

57.2

1991

1992

83.2
80.3

65.0
53.8

76.1

71.0

47.9
39.9

56.4
51.1

80.1

85.6

70.2

73.6

88.7

90.3

86.0

87.8

69.7

73.3

61.8

646

78.4

79.8

73.5

75.5

51.7
44.5

58.3
52.7

44.0
39.4

51.9
48.0

♦Women. Infants, and Children supplemental food program; see Glossary.

56

Table 18

Percentages of Medicaid Births by Type of Service, Race, and Adolescent Age

North Carolina 1988-1992

Type of Service, Race, and Age

Mother Received Prenatal WIC*

Whites

Minorities

10-17
18-19

10-17
18-19

1988

70.2
69.6

76.4
73.3

Year of Birth

1989

1990

1991

1992

75.1

74.5

76.4

77.8

74.1

73.2

73.6

75.1

79.5

79.0

80.5

81.5

76.6

76.1

77.5

78.6

Mother Received Maternity
Care Coordination**

Whites

10-17
18-19

Minorities 10-17
18-19

22.6

37.6

40.8

45.2

51.5

23.1

36.2

39.5

43.6

46.4

28.7

41.1

51.7

56.3

60.6

23.9

397

47.4

50.7

54.2

*Women. Infants, and Children supplemental food program; see Glossary'.
**Case management; see Glossary.

57

Table 19

Fetal, Neonatal, Postneonatal, and Infant Deaths and

Death Rates Among Adolescent Mothers by Age and Race

North Carolina Birth Year 1991

Maternal Age

Total

Whites

Minorities

and Type of Death

Number

Rate

Number

Rate

Number

Rate

15-17

Fetal1

58

9.6

19

6.6

39

12.2

Neonatal2

54

9.0

15

5.3

39

12.4

Postneonatal3

27

4.5

17

6.0

10

3.2

Infant4

81

13.5

32

11.3

49

156

18-19

Fetal1

102

10.0

49

8.7

53

11.5

Neonatal2

91

9.0

42

7.5

49

108

Postneonatal3

38

3.8

18

3.3

20

44

Infant4

129

12.8

60

10.8

69

152

TOTAL 10-19

Fetal1

164

9.8

69

8.1

95

11.7

Neonatal2

150

9.1

57

6.7

93

11.6

Postneonatal3

65

4.0

35

4.1

30

3.8

Infant4

215

13.0

92

10.8

123

15.3

'Stillbirths of at least 20 weeks gestation Rate is per 1,000 deliveries (live births plus fetal deaths).
2Death of a liveborn child under 28 days of age. Rate is per 1 ,000 live births.
'Death of an infant 28 days to one year of age. Rate is per 1,000 neonatal survivors.
'Death of a liveborn child under one year of age. Rate is per 1 ,000 live births.

58

Table 20

Infant Deaths and Death Rates Among Adolescent Mothers

by Underlying Cause and Race

North Carolina Birth Year 1991

Underlying

Total

Whites

Minorities

Cause of Death

Number Rate'

Number

Rate1

Number

Rate1

Total Infant Deaths

215 13.0

92

10.8

123

15.3

SIDS2

35 2.1

20

2.4

15

1.9

Low Birthweight/

Respiratory Distress3

52 3.1

21

2.5

31

3.9

Other Respiratory Problems4

13 0.8

2

0.2

11

1 4

Birth Defects5

31 1.9

15

18

16

20

Injuries6

11 0.7

2

0.2

9

] 1

'Number of infant deaths per 1 ,000 live births.

2ICD-9 Code 798.0.

3ICD-9 Codes 764, 765, 769-770.7.

'ICD-9 Code 770.8.

5lCD-9 Codes 740-759.

6ICD-9 Codes 800-999.

59

i

u
es

a

e
«

wo

—

(A
«

■a ,

a *

."S on
E-

w CS

c e
« —

U > o

If

*■* £
oo Z

u
.©

0)

M

£ E

E
s
Z

n

E

s
Z

S 08

E

_

£ E

s
Z

"2

■5*

s

3

z

vo vq rf
(N NO On

m r- on
in m

m T NO

m oo no

on cn m
m l~- in

•*r on r»

Os —

— (N 00

tj- in vo

NO t~- On

NO ON

O NO o

© o d

o — o

xfr iN —

r*i m on

no oo m

in O On^

On O 00

ON O ON
f> NO Tf

(N O On

— ' O On'

ci — m

fNl — »^

— On VO

no m r~-

t~-' no od
(NO©

m oo

NO O

no oo

oo o r-

On' On' XT
0< in

r- CS m

— r» On

B

8

"S
■a

1

es

©
E-

ci r» —

© wi t*-'

— (N oo

m — (N

«st in oo

in m

O rr o
m F» •—
— NO <N

-rr r-
cn on r-
no on r-

(•«■* in

e
o

3
O.

o
a.

o
o
o

©'

o

■a
c
as

«v
el

I CO

O "-

re
U

.2
•3

c P
o -

CO Q.

on "re .2

•B "t
IE o E

.. o. «= —

09

cu

a.

re

u

tn

"O

V

re

— ->

c

CA

BQ

c
a

< <

60

Table 22

Number and Percentage of Adolescents Classified as

Overweight by Race

North Carolina Child Health Program 1988-91

Total

Whites

Blacks

Sex and Age

Number

Percentage

Number

Percentage

Number

Percentage

Males

10-11

612

31 1

338

35.0

256

27.9

12-14

801

28.8

440

32.7

341

25.4

15-17

489

30.3

254

35.3

228

27.0

18

36

194

16

20.5

19

190

Females

10-11

667

324

310

31.2

331

33.3

12-14

874

30-3

414

29.7

448

31.5

15-17

487

29.3

263

31.9

217

276

18

48

240

21

21.6

26

27.4

Males 12-18

1,326

28.9

710

33.1

588

25.7

Females 12-18

1.409

29.7

698

30.2

691

300

Total 12-18

2,735

A Q-V'

29.3

1,408

31.6

1,279

27.9

tile values for the combined samples of U.S. children examined in the first two National Health
and Nutrition Examination Surveys (NHANES I and NHANES II, 1971-1980).26BM3 is calcu-
lated by dividing weight in kilograms by the square of height in meters. Here, BMI is based on
the age, height, and weight of an individual at last visit (during the 4-year period) for which
height and weight were recorded Counts were insufficient to examine the data for American
Indians and Hispanics

61

R

X

■rf . — m —

O

On

O CM CM —
fN —

oc

in

oo r~ o

v£> CM NO

0O VO T

r-

R

E

[1.

u

oc r~

CM

On

o

Tf V, vO O

o

~—

X

— CM

F<M

en

E

S

r»'

CM

—

irv

— no m

— O O

Q> i/l -

R

s

00 Tf O C",

m

r~

oo m (N oo
O

m

o\

©n' TJ-'

in oo

CM

■-

—
R

R

E

'C

s.

n

C
3
O
k

rj

K

« _

Ml —
< R

u

± u

o —

L.

E

BE

E

u. t

E

s
o Z

M

R

"r

^ t"" M Oi

oc

no

© oo r- o

d

T

r- cm

—

CM

O1 n - N

vO — CM &

CM

CM

in —
© M

en r-
o m

>n —

—'cm

"* "* °
tt r» cm

CM rn CM

r, 00 NO 0>

vO

d

r-~ no ^

© CM T On

CM

00

cm © r-

00 —

CM

CM

m oo t

ci O c , no
CM

r-

CM

r- r-

vO CM

■r

Si

OS

ts
c

-
u

R
v.

c

©

X

-

E

=

«* 5 •
M is

* Z

e
=
M

R

—

r» t rr
no ■* r-

CM

vO

n

oo

CM

r-

^T —

CM NO

00 ON

£%

m m r~- no

o

r-

pn r^ —

95 m

m cm cm oo

On

*—

00 On O

00

CM

O ■*}■ m

CM

NOT -
O — m O
— CM CM 00

On

CM

s'f

2 ■*

a c

re ■*

is

Q."-.

© 00* 00

\D On \0 On On

© On O

On CM r- — 00

O m N

T "9 "9 5 ^

O c c

c o o o c

— On •*

c

On OC f, ON o

•»» «1 \C CM oc

1/3 t/5 W5 W5 V)

o

O i> w u c>

(A "O "O

■a

•U "U "U "O "^

tiarge
9 Co
9 Co

o

o o o o o

u uu u u u

ON

t?^ ^^ ^^ o^ ©^

SiQDDQDQQD

guuuuuuuu

62

Table 24

Adolescents Served in State Psychiatric Hospitals,1 Mental Retardation Centers,2 and
Alcohol and Drug Abuse Treatment Centers3 by Specified Principal or Primary Diagnosis,

Age, Race, and Sex
North Carolina FY 1984 and CY 1992

Patient

Total

Characteristics

1984

1992

Total

1,839

1,407

Age

10-17

1,152

1,019

18-19

687

388

Race

White

1,254

916

Black

568

459

Other/Unknown

17

32

Sex

Male

1,177

903

Female

662

504

Dij

(gnosis

Developmental

Substance

Mental

Disabi

ity

Ab

use

111

ness

1984

1992

1984

1992

1984

1992

85

125

204

178

1,550

1,104

51

82

69

50

1,032

887

34

43

135

128

518

217

36

71

178

126

1,040

719

47

53

21

52

500

354

2

1

5

0

10

31

70

84

162

140

945

679

15

41

42

38

605

425

'Broughton, Cherry, Dix, and Umstead

2Black Mountain, Caswell, Murdock, O'Berry, and Western

'Black Mountain, Butner, and Jones.

Source:N.C. Department of Human Resources, Division of Mental Health, Developmental
Disability,and Substance Abuse Services.

6^

Table 25

Adolescents Served in Area Mental Health Centers by

Specified Principal or Primary Diagnosis, Age, Race, and Sex

North Carolina FY 1984 and CY 1992

Diagnosis

Patient
Characteristics

Total
1984 1992

Developmental

Disability'
1984 1992

Substance

Abuse
1984 1992

Mental

Illness

1984 1992

Total

20,791

33,988

1,505

2,019

1,460

4,663

17,826

27,306

Age
10-17
18-19

16,572
4,219

28,096
5,892

1,085
420

1,470
549

613
847

2,512
2,151

14,874
2,952

24,114
3,192

Race
White
Black
Other/Unknown

14,804

5,621

366

21,878

10,860

1,250

878
577

50

1,249

704

66

1,228
189

43

3,425

1,086

152

12,698

4,855

273

17,204
9,070
1,032

Sex
Male
Female

12,289
8,502

20,426
13,562

933

572

1,282
737

1,130
330

3,564
1,099

10,226
7,600

15,580
11,726

Source:N.C. Department of Human Resources, Division of Mental Health, Developmental Disabili
ties, and Substance Abuse Services.

64

Table 26

Percentages of Prenatal WIC Participants

by Race, Marital Status, and Education

North Carolina Mothers 1992

Patient
Characteristics

Race
White
Black
Other

Marital Status
Married
Not Married*

Highest Grade Completed
0-8
9-11
12 or more

Mother's Age at Delivery
Total
Under 20 Under 18 18-19

n = 11,563

n = 4,699

n = 6,864

51.0

45.5

54.8

486

54.1

44.8

0.3

0.3

0.4

22.8

14.2

28.7

77.2

85.8

71.3

11.8

20.8

5.6

56.8

72.9

45.8

31.4

6.4

48.6

♦Mother has never been legally married or was widowed or legally divorced more than 280 days prior to giving
birth.

65

Table 27

Percentages of Adolescent Public Family Planning Patients

by Patient Characteristics

North Carolina 1992

Patient
Characteristics

Race
White
Black

American Indian
Other

Marital Status
Married
Not Married'
Not Stated

Highest Grade Completed
0-8
9-11

12 or more
Not Stated

Percent of Poverty Level
At or below 100
101-149
150 or more

Patient's Age

Total

Under 20

Under 18

18-19

n = 44,924

n = 24,200

n = 20,724

52.6

50.3

55.3

44.7

47.3

41.7

1.6

1.5

1.6

1.1

0.8

1.4

85

5.6

11.9

87.9

90.2

853

3.5

4.2

2.8

18.0

25.6

9.0

46.6

50.3

42.2

22.2

10.5

35.8

13.3

13.6

12.9

87.9

90.8

84.5

6.7

4.8

9.0

5.4

4.4

6.6

Patient Claimed

Title XIX (Medicaid) Reimbursement

21.5

20.2

23.0

Contraceptive Method
Pill

Foam and Condom
Other
None
Not Stated

88.8

89.4

88 1

6.1

6 1

6.0

1.7

1.4

2.1

3.1

2.9

3.3

0.4

0.3

0.5

♦Never married, separated, widowed or divorced.

66

APPENDIX 1

Adolescents and Young Adults

Key Health Status Objectives Targeting Adolescents and
Young Adults

Duplicate objectives, which appear in two or more priority areas, are marked with an asterisk (*).

Except as otherwise noted, all rates in the following objectives are annual. Where the baseline rate is age adjusted,
it is age adjusted to the 1940 U.S. population, and the target is age adjusted also. If a rate is age adjusted, the crude
baseline rate may be found in Appendix D.

2.3* Reduce overweight to a prevalence of no more than 20 percent among people aged 20 and older
and no more than 15 percent among adolescents aged 12 through 19. (Baseline: 26 percent for
people aged 20 through 74 in 1976-80, 24 percent for men and 27 percent for women; 15
percent for adolescents aged 12 through 19 in 1976-80)

Note: For people aged 20 and older, overweight is defined as body mass index (BMIi equal to or greater than
27.8 for men and 27 J for women. For adolescents, overweight is defined as BMI equal to or greater than 23.0
formates aged 12 through 14, 243 for males aged 15 through 17, 25. 8 for males aged 18 through 19, 23.4 for
females aged 12 through 14, 24.8 for females aged 15 through 17, and 25. 7 for females aged 18 through 19.
The values for adolescents are the age- and gender-specific 85th percentile values of the 1976-80 National
Health and Nutrition Examination Survey (NHANES 11). corrected for sample variation. BMI is calculated b\
dividing weight in kilograms by the square of height in meters The cui points used to define overweight ap-
proximate the 120 percent of desirable body weight definition used in the 1990 objectives.

4. 1 b Reduce deaths among people aged 1 5 through 24 caused by alcohol-related motor vehicle crashes to
no more than 18 per 100,000. (Baseline: 21.5 per 100,000 in 1987)

5.1 Reduce pregnancies among girls aged 17 and younger to no more than 50 per 1.000 adolescents.
(Baseline: 71.1 pregnancies per 1,000 girls aged 15 through 17 in 1985)

Special Population Targets
Pregnancies (per 1 ,000) 1985 Baseline 2000 Target

5.1a Black adolescent girls aged 15-19 186+ 120

5.1b Hispanic adolescent girls aged 15-19 158 105

Nonwhite adolescents

Note: For black and Hispanic adolescent girls, baseline data are unavailable for those aged 15 through 17.
The targets for these r*o populations are based on data for women aged 15 through 19 If more complete data
become available, a 35-percent reduction from baseline figures should be used as the target.

6.1a* Reduce suicides among youth aged 15 through 19 to no more than 8.2 per 100,000. (Baseline:
10.3 per 100,000 in 1987)

6. lb* Reduce suicides among men aged 20 through 34 to no more than 2 1 .4 per 1 00,000. (Baseline:
25.2 per 100,000 in 1987)

6.2* Reduce by 15 percent the incidence of injurious suicide attempts among adolescents aged 14
through 17. (Baseline data available in 1991)

6.3 Reduce to less than 10 percent the prevalence of mental disorders among children and adolescents.
(Baseline: An estimated 1 2 percent among youth younger than age 18 in 1 989j

7.1 Reduce homicides to no more than 7.2 per 100,000 people. (Age-adjusted baseline: 8.5 per 100,000
in 1987)

Special Population Targets
Homicide Rate (per 1 00 ,000) 1 :

7.1b Spouses aged 15-34
7.1c Black men aged 15-34
7. Id Hispanic men aged 15-34
7.1e Black women aged 15-34

7. 1 f American Indians/Alaska Natives in Reservation Slates
7.7a Reduce rape and attempted rape of women aged 12 through 34 to no more than 225 per 100,000.
(Baseline: 250 per 100,000 in 1986)

9.3b Reduce deaths among youth aged 15 through 24 caused by motor vehicle crashes to no more than
33 per 100,000. (Baseline: 36.9 per 100,000 in 1987)

7 Baselin

e 2000 Target

1.7

1.4

90.5

72.4

53.1

42.5

20.0

16.0

14.1

11.3

Healthy People 2000

41%

25%

84%*

40%

38%

20%

31-47%*

25%

13.1 Reduce dental caries (cavities) so that the proportion of children with one or more caries (in
permanent or primary teeth) is no more than 35 percent among children aged 6 through 8 and no
more than 60 percent among adolescents aged 15. (Baseline: 53 percent of children aged 6
through 8 in 1986-87; 78 percent of adolescents aged 15 in 1986-87)

Special Population Target

Dental Caries Prevalence 1983-84 Baseline 2000 Target

13. Id American Indian/Alaska Native adolescents aged 15 93% 70%

13.2 Reduce untreated dental caries so that the proportion of children with untreated caries (in permanent
or primary teeth) is no more than 20 percent among children aged 6 through 8 and no more than

15 percent among adolescents aged 15. (Baseline: 27 percent of children aged 6-8 in 1986; 23
percent of adolescents aged 15 in 1986-87)

Special Population Targets
Untreated Dental Caries Among Adolescents 1986-87 Baseline 2000 Target

13.2a Adolescents aged 15 whose parents have less than

high school education
13.2b American Indian/Alaska Native adolescents aged 15
13.2c Black adolescents aged 15
13. 2d Hispanic adolescents aged 15

"1983-84 baseline % 1982-84 baseline
19.1b Reduce gonorrhea among adolescents aged 1 5 through 1 9 to an incidence of no more than 750
cases per 100.000. (Baseline: 1,123 per 100,000 in 1989)

Key Risk Reduction Objectives Targeting Adolescents and
Young Adults

1.3* Increase to at least 30 percent the proportion of people aged 6 and older w ho engage regularly,
preferably daily, in light to moderate physical activity for at least 30 minutes per day. (Baseline:
22 percent of people aged 1 8 and older were active for at least 30 minutes 5 or more times per
week and 12 percent were active 7 or more times per week in 1985)

Note: Light to moderate physical activity requires sustained, rhythmic muscular movements, is at least
equivalent to sustained walking, and is performed at less than 60 percent of maximum heart rale for age. Maxi-
mum heart rate equals roughly 220 beats per minute minus age Examples may include walking, swimming, cy-
cling, dancing, gardening and yardwork, various domestic and occupational activities, and games and other
childhood pursuits.

1.4 Increase to at least 20 percent the proportion of people aged 18 and older and to at least 75 percent
the proportion of children and adolescents aged 6 through 17 who engage in vigorous physical
activity that promotes the development and maintenance of cardiorespiratory fitness 3 or more
days per week for 20 or more minutes per occasion. (Baseline: 12 percent for people aged 18
and older in 1985; 66 percent for youth aged 10 through 17 in 1984)

Special Population Target
Vigorous Physical Activity 1985 Baseline 2000 Target

1.4a Lower-income people aged 18 and older (annual

family income <S20,000) 7% 12%

Note: Vigorous physical activities are rhythmic, repetitive physical activities that use large muscle groups at 60
percent or more of maximum heart rate for age. An exercise heart rale of 60 percent of maximum heart rate for
age is about 50 percent of maximal cardiorespiratory capacity and is sufficient for cardiorespiratory condition-
ing Maximum heart rate equals roughly 220 beats per minuie minus age.

Adolescents and Young Adults

2.8 Increase calcium intake so at least 50 percent of youth aged 1 2 through 24 and 50 percent of pregnant
and lactating women consume three or more servings daily of foods rich in calcium, and at least

50 percent of people aged 25 and older consume two or more servings daily. (Baseline: 7
percent of women and 14 percent of men aged 19 though 24 and 24 percent of pregnant and
lactating women consumed three or more servings, and 15 percent of women and 23 percent of
men aged 25 through 50 consumed two or more servings in 1985-86)

Note: The number of servings of foods rich in calcium is based on milk and milk products. A sewing is con-
sidered 10 be 1 cup of skim milk or its equivalent in calcium (302 mg). The number of servings in this objective
will generally provide approximately three-fourths of the 1989 Recommended Dietary Allowance (RDA) of cal-
cium The RDA is 1200 mgfor people aged 12 through 24, 800 mg for people aged 25 and older, and 1200 mg
for pregnant and lactating women.

3.5 Reduce the initiation of cigarette smoking by children and youth so that no more than 15 percent
have become regular cigarette smokers by age 20. (Baseline: 30 percent of youth had become
regular cigarette smokers by ages 20 through 24 in 1987)

Special Population Target
Initiation of Smoking 1987 Baseline 2000 Target

3.5a Lower socioeconomic status youth . 409c 18%

As measured by people aged 20-24 with a high school education or less

3.9 Reduce smokeless tobacco use by males aged 12 through 24 to a prevalence of no more than 4
percent. (Baseline: 6.6 percent among males aged 12 through 17 in 1988; 8.9 percent among
males aged 18 through 24 in 1987)

Special Population Target

Smokeless Tobacco Use 1986-87 Baseline 2000 Target

3.9a American Indian/Alaska Native youth 18-64% 10%

Note : For males aged 12 through 17, a smokeless tobacco user is someone who has used snuff or chewing
tobacco in the preceding month. For males aged 18 through 24, a smokeless tobacco user is someone who has
used either snuff or chewing tobacco at least 20 times and m ho currently uses snuff or chewing tobacco

4.5 Increase by at least 1 year the average age of first use of cigarettes, alcohol, and marijuana by
adolescents aged 12 through 17. (Baseline: Age 1 1.6 for cigarettes, age 13.1 for alcohol, and
age 13.4 for marijuana in 1988)

4.6 Reduce the proportion of young people who have used alcohol, marijuana, and cocaine in the past
month, as follows:

SubstancelAge

Alcohol/aged 12-17
Alcohol/aged 18-20
Marijuana/aged 12-17
Marijuana/aged 18-25
Cocaine/aged 12-17
Cocaine/aged 18-25

Note: The targets of this objective are consistent with the goals established by the Office of National Drug
Control Policy, Executive Office of the President.

4.7 Reduce the proportion of high school seniors and college students engaging in recent occasions of
heavy drinking of alcoholic beverages to no more than 28 percent of high school seniors and 32
percent of college students. (Baseline: 33 percent of high school seniors and 41.7 percent of
college students in 1989)

Note: Recent heavy drinking is defined as having 5 or more drinks on one occasion in the previous 2 -week
period as monitored by self-reports.

1988 Baseline

2000 Target

lil'Jc

12.6%

57.9%

29%

6.4%

3.2%

15.5%

7.8%

1.1%

0.6%

4.5%

2.3%

Healthy People 2000

1989 Baseline

2000 Target

56.4%

70%

71.1%

85%

88.9%

95%

4.9 Increase the proportion of high school seniors who perceive social disapproval associated with the
heavy use of alcohol, occasional use of marijuana, and experimentation with cocaine, as follows:

Behavior

Heavy use of alcohol

Occasional use of marijuana

Trying cocaine once or twice

Note: Heavy drinking is defined as having 5 or more drinks once or mice each weekend.

4.10 Increase the proportion of high school seniors who associate risk of physical or psychological harm
with the heavy use of alcohol, regular use of marijuana, and experimentation with cocaine, as
follows:

Behavior 1989 Baseline 2000 Target

Heavy use of alcohol 44% 70%

Regular use of marijuana 77.5% 90%

Trying cocaine once or twice 54.9% 80%
Note: Heavy drinking is defined as having 5 or more drinks once or mice each weekend

4. 1 1 Reduce to no'more than 3 percent the proportion of male high school seniors who use anabolic
steroids. (Baseline: 4.7 percent in 1989)

5.4* Reduce the proportion of adolescents who have engaged in sexual intercourse to no more than 1 5
percent by age 15 and no more than 40 percent by age 17. (Baseline: 27 percent of girls and 33
percent of boys by age 15; 50 percent of girls and 66 percent of bovs by age 17; reported in
1988)

5.5 Increase to at least 40 percent the proportion of ever sexually active adolescents aged 17 and younger
who have abstained from sexual activity for the previous three months. (Baseline: 26 percent

of sexually active girls aged 15 through 17 in 1988)

5.6 Increase to at least 90 percent the proportion of sexually active, unmarried people aged 1 9 and
younger who use contraception, especially combined method contraception that both effectively
prevents pregnancy and provides barrier protection against disease. (Baseline: 78 percent at
most recent intercourse and 63 percent at first intercourse; 2 percent used oral contraceptives
and the condom at most recent intercourse; among young women aged 15 through 19 reporting
in 1988)

Note: Strategies to achieve this objective must be undertaken sensitively to avoid indirectly encouraging or con-
doning sexual activity among teens who are not yet sexually acme.

7.9 Reduce by 20 percent the incidence of physical fighting among adolescents aged 14 through 17.
(Baseline data available in 1991)

7.10 Reduce by 20 percent the incidence of weapon-carrying by adolescents aged 14 through 17.
(Baseline data available in 1991)

8.2 Increase the high school graduation rate to at least 90 percent, thereby reducing risks for multiple
problem behaviors and poor mental and physical health. (Baseline: 79 percent of people aged
20 through 21 had graduated from high school with a regular diploma in 1989)

Note. This objective and its target are consistent with the National Education Coal to increase high school
graduation rates. The baseline estimate is a proxy. When a measure is chosen to monitor the National Educa-
tion Goal, the same measure and data source will be used to track this objective.

13.8 Increase to at least 50 percent the proportion of children who have received protective sealants on
the occlusal (chewing) surfaces of permanent molar teeth. (Baseline: 1 1 percent of children
aged 8 and 8 percent of adolescents aged 14 in 1986-87)

Note: Progress toward this objective will be monitored based on prevalence of sealants in children at age 8
and at age 14, when the majority of first and second molars, respectively, are erupted.

1 8.4a* Increase to at least 60 percent the proportion of sexually active, unmarried young women aged 15
through 19 whose partners used a condom at last sexual intercourse. (Baseline: 26 percent in
1988)

Note: Strategies to achieve this objective must be undertaken sensitively to avoid indirectly encouraging or con-
doning sexual activity among teens who are not yet sexually active.

Adolescents and Young Adults

18.4b* Increase to at least 75 percent the proportion of sexually active, unmarried young men aged 15
through 19 who used a condom at last sexual intercourse. (Baseline: 57 percent in 1988)

Note: Strategies to achieve this objective must be undertaken sensitively to avoid indirectly encouraging or con-
doning sexual activity among teens who are not yet sexually active.

2 1 .2c Increase to at least 50 percent the proportion of adolescents aged 1 3 through 1 8 who have received,
as a minimum within the appropriate interval, all of the screening and immunization services
and at least one of the counseling services appropriate for their age and gender as recommended
by the U.S. Preventive Services Task Force. (Baseline data available in 1991)

Key Services and Protection Objectives Targeting
Adolescents and Young Adults

1.8 Increase to at least 50 percent the proportion of children and adolescents in 1st through 12th grade
who participate in daily school physical education. (Baseline: 36 percent in 1984-86)

1 .9 Increase to at least 50 percent the proportion of school physical education class time that students
spend being physically active, preferably engaged in lifetime physical activities. (Baseline:
Students spent an estimated 27 percent of class time being physically active in 1983)

Note: Lifetime activities are activities that may be readily carried into adulthood because they generally need
only one or two people. Examples include swimming, bicycling, jogging, and racquet sports. Also counted as
lifetime activities are vigorous social activities such as dancing Competitive group sports and activities typical-
ly played only by young children such as group games are excluded.

5.8 Increase to at least 85 percent the proportion of people aged 10 through 18 who have discussed
human sexuality, including values surrounding sexuality, with their parents and/or have
received information through another parentally-endorsed source, such as youth, school, or
religious programs. (Baseline: 66 percent of people aged 13 through 18 have discussed
sexuality with their parents; reported in 1986)

Note: This objective, which supports family communication on a range of vital personal health issues, will be
tracked using the National Health Interview Suney, a continuing, voluntary, national sample survey of adults
who report on household characteristics including such items as illnesses, injuries, use of health services, and
demographic characteristics.

5.10* Increase to at least 60 percent the proportion of primary care providers who provide
age-appropriate preconception care and counseling. (Baseline data available in 1992)

8.9 Increase to at least 75 percent the proportion of people aged 10 and older who have discussed issues
related to nutrition, physical activity, sexual behavior, tobacco, alcohol, other drugs, or saferv

with family members on at least one occasion during the preceding month. (Baseline data
available in 1991)

Note: This objective, which supports family communication on a range of vital personal health issues, will be
tracked using the National Health Interview Survey, a continuing, voluntary, national sample survey of adults
who report on household characteristics including such items as illnesses, injuries, use of health services, and
demographic characteristics.

APPENDIX 2

1993 YOUTH RISK BEHAVIOR SURVEY

This survey is about health behavior. It has been developed so you can tell us
what you do that may affect your health. The information you give will be used to
develop better health education programs for young people like yourself.

DO NOT write your name on this survey or the answer sheet. The answers you
give will be kept private. No one will know what you write. Answer the questions based
on what you really do.

Completing the survey is voluntary. Whether or not you answer the questions will
not affect your grade in this class.

The questions that ask about your background will only be used to describe the
types of students completing this survey. The information will not be used to find out
your name. No names will ever be reported.

Place all your answers on the answer sheet. Fill in the circles completely. Make
sure to answer every question. When you are finished, follow the instructions of the
person giving you the survey.

THANK YOU VERY MUCH FOR YOUR HELP

INSTRUCTIONS: Read each question carefully. Fill in
the circle on your answer sheet that matches the letter
Of your answer. CHOOSE THE ONE BEST ANSWER
FOR EACH QUESTION.

1. How old are you?

a.
b.
c.
d.
e.
f.

g

12 years old or younger

13 years old

14 years old

15 years old

16 years old

17 years old

18 years old or older

2. What is your sex?

a.
b.

Female
Male

3. In what grade are you?

a. 9th grade

b. 10th grade

c. 11th grade

d. 12th grade

e. Ungraded or other

4. How do you describe yourself?

a. White - not Hispanic

b. Black - not Hispanic
c Hispanic

d. Asian or Pacific Islander

e. Native American or Alaskan Native
i. Other

5. In the past year, who did you live with most of the
time? (Select only one response.)

a. Both parents

b. Father (all or most of time)

c. Mother (all or most of time)

d. Foster parents

e. Other relatives

6. Compared to other students In your class, what
kind of student would you say you are?

a. One of the best

b. Far above the middle

c. A little above the middle

d. In the middle

e. A little below the middle

f. Far below the middle

g. Near the bottom

7. How often do you wear a seat belt when riding In a
car driven by someone else?

a. Never

b. Rarely

c. Sometimes

d. Most of the time

e. Always

When you rode a motorcycle during the past 12
months, how often did you wear a helmet?

a. I did not ride a motorcycle during the past 12
months

b. Never wore a helmet

c. Rarely wore a helmet

d. Sometimes wore a helmet

e. Most of the time wore a helmet

f. Always wore a helmet

When you rode a bicycle during the past 12
months, how often did you wear a helmet?

a. I did not ride a bicycle during the past 12
months

b. Never wore a helmet

c. Rarely wore a helmet

d. Sometimes wore a helmet

e. Most of the time wore a helmet

f. Always wore a helmet

1993 YRBS

10. During the past 12 months, when you went

15. During the past 30 days, on how many days did

swimming In places such as a pool, lake, river, at

you carry a weapon such as a gun, knife, or club

the beach, or pond, how often was an adult or a

on school property?

lifeguard watching you?

a. 0 (zero) days

a. I did not go swimming during the past 12

b. 1 day

months

c. 2 or 3 days

b. Never

d. 4 or 5 days

c. Rarely

e. 6 or more days

d. Sometimes

e. Most of the time

16. During the past 30 days, how many days did you

f. Always

not go to school because you felt you would be

unsafe at school or on your way to or from school?

1 1 . During the past 30 days, how many times did you

ride in a car or other vehicle driven by someone

a. 0 (zero) days

who had been drinking alcohol?

b. 1 day

c. 2 or 3 days

a. 0 (zero) times

d. 4 or 5 days

b. 1 time

e. 6 or more days

C. 2 or 3 times

d. 4 or 5"times

17. During the past 12 months, how many times has

e. 6 or more times

someone threatened or Injured you with a weapon

such as a gun, knife, or club on school property?

12. During the past 30 days, how many times did you

drive a car or other vehicle when you had been

a. 0 (zero) times

drinking alcohol?

b. 1 time

c. 2 or 3 times

a. 0 (zero) times

d. 4 or 5 times

b. 1 time

e. 6 or 7 times

c. 2 or 3 times

f. 8 or 9 times

d. 4 or 5 times

g. 10 or 11 times

e. 6 or more times

h. 12 or more times

13. During the past 30 days, on how many days did

18. During the past 12 months, how many times has

you carry a weapon such as a gun, knife, or club?

someone stolen or deliberately damaged your

property such as your car, clothing, or books on

a. 0 (zero) days

school property?

b. 1 day

c. 2 or 3 days

a. 0 (zero) times

d. 4 or 5 days

b. 1 time

e. 6 or more days

c. 2 or 3 times

d. 4 or 5 times

14. During the past 30 days, on how many days did

e. 6 or 7 times

you carry a gun?

f. 6 or 9 times

g. 10 or 11 times

a. 0 (zero) days

h. 12 or more times

b. 1 day

c. 2 or 3 days

d. 4 or 5 days

•

e. 6 or more days

i

3 1993 YRBS

19. During the past 12 months, how many times were
you In a physical fight?

a.

0 (zero) times

b.

1 time

c.

2 or 3 times

d.

4 or 5 times

e.

6 or 7 times

f.

8 or 9 times

0

10 or 11 times

h.

12 or more times

20. The last time you were In a physical Tight, with
whom did you fight?

a. | have never been In a physical fight

b. A total stranger

c. A friend or someone I know

d. A boyfriend, girlfriend, or date

e. A parent, brother, sister, or other family
member

f. Someone not listed above

g. More than one of the persons listed above

21. During the past 12 months, how many times were
you In a physical fight In which you were injured
and had to be treated by a doctor or nurse?

a. 0 (zero) times

b. 1 time

c. 2 or 3 times

d. 4 or 5 times

e. 6 or more times

22. During the past 12 months, how many times were
you in a physical fight on school property?

a.

0 (zero) times

b.

1 time

c

2or3times

d.

4 or 5 times

e.

6 or 7 times

f.

8 or 9 times

0

10 or 11 times

h.

12 or more times

These questions ask you how you feel about some
things.

23. Is It easy or hard for you to get along with your
tamily?

a. Very hard

b. Hard

c. Easy

d. Very easy

24. How easy or hard is It for you to say no if you do
not want to do something your friends are doing?

a. Very hard

b. Hard

c. Easy

d. Very easy

Sometimes people feel so depressed and hopeless
about the future that they may consider attempting
suicide, that is, taking some action to end their own
life.

25. During the past 12 months, did you ever seriously
consider attempting suicide?

a. Yes

b. No

26. During the past 12 months, did you make a plan
about how you would attempt suicide?

a.

b.

Yes
No

27. During the past 12 months, how many times did
you actually attempt suicide?

a

0 (zero) times

b.

1 time

c.

2 or 3 times

d.

4 or 5 times

e.

6 or more times

1993 YRM

28. If you attempted suicide during the past 12

32. During the past 30 days, on the days you smoked,

months, did any attempt result In an Injury,

how many cigarettes did you smoke per day?

poisoning, or overdose that had to be treated by a

doctor or nurse?

a. I did not smoke cigarettes during the past 30

days

a 1 did not attempt suicide during the past 12

b. Less than 1 cigarette per day

months

c. 1 cigarette per day

b. Yes

d. 2 to 5 cigarettes per day

C. No

e. 6 to 1 0 cigarettes per day

f. 1 1 to 20 cigarettes per day

g. More than 20 cigarettes per day

The next questions ask about tobacco use.

33. During the past 30 days, on how many days did

29. How old were you when you smoked a whole

you smoke cigarettes on school property?

cigarette for the first time?

a. 0 days

a. I have never smoked a whole cigarette

b. 1 or 2 days

b. Less than 9 years old

c. 3 to 5 days

c. 9 or 10 years old

d. 6 to 9 days

d. 11 or 12 years old

e. 10 to 19 days

e. 13 of 14 years old

f. 20 to 29 days

f. 15 or 16 years old

g. All 30 days

g. 1 7 or more years old

34. During the past 6 months, did you try to quit

30. How old were you when you first started smoking

smoking cigarettes?

cigarettes regularly (at least one cigarette every

day for 30 days)?

a. I did not smoke cigarettes during the past 6

months

a. I have never smoked cigarettes regularly

b. Yes

b. Less than 9 years old

c. No

c 9 or 10 years old

d. 11 or 12 years old

35. How old were you when you tried smokeless

e. 13 or 14 years old

tobacco (chewing tobacco or snuff) for the first

f. 15 or 16 years old

time?

g 17 or more years old

a. I have never tried smokeless tobacco

31. During the past 30 days, on how many days did

b. Less than 9 years old

you smoke cigarettes?

c. 9 or 10 years old

d. 11 or 12 years old

a. 0 (zero) days

e. 13 or 14 years old

b. 1 or 2 days

f. 15 or 16 years old

c. 3 to 5 days

g. 1 7 or more years old

d. 6 to 9 days

e. 10 to 19 days

f. 20 to 29 days

g. All 30 days

I

j 1993 YRBS

36. During the past 30 days, did you use chewing

40. During the past 30 days, on how many days did

tobacco, such as Redman, Levi Garrett, or

you have at least one drink of alcohol?

Beechnut, or snuff, such as Skoal, Skoal Bandits,

or Copenhagen?

a 0 (zero) days

b. 1 or 2 days

a No, 1 did not use chewing tobacco or snuff

c. 3 to 5 days

b. Yes, chawing tobacco only

d. 6 to 9 days

c. Yes, anuff only

a 10 to 19 days

d. Yes, both chewing tobacco and snuff

f. 20 to 29 days

g. All 30 days

37. During the past 30 days, did you use chewing

tobacco, such as Redman, Levi Garrett, or

41 . During the past 30 days, on how many days did

Beechnut, or snuff, such as Skoal, Skoal Bandits,

you have 5 or more drinks of alcohol In a row, that

or Copenhagen on school property?

Is, within a couple of hours?

a. No, 1 did not use chewing tobacco or snuff

a. 0 (zero) days

b. Yes, chewing tobacco only

b. 1 day

c. Yes, snuff only

c. 2 days

d. Yes, both chewing tobacco and snuff

d. 3 to 5 days

e. 6 to 9 days

38. Do you feet you could stop using tobacco if you

f. 10 to 19 days

wanted to?

g. 20 or more days

a 1 do not use tobacco

42. During the past 30 days, on how many days did

b. Yes

you have at least one drink of alcohol on school

c No

property?

a. 0 (zero) days

The next questions ask about drinking alcohol. This

b. 1 or 2 days

includes drinking beer, wine, wine coolers, and liquor

c. 3 to 5 days

such as rum, gin, vodka, whiskey, or moonshine. For

d. 6 to 9 days

these questions, drinking alcohol does not include

e. 10 to 19 days

drinking a few sips of wine for religious purposes.

f. 20 to 29 days

g. All 30 days

39. How old were you when you had your first drink of

alcohol other than a few sips?

43. About how many cans or bottles of beer can a

person drink and still drive safely?

a 1 have never had a drink of alcohol other than

a few sips

a. Any drinking wDI hurt driving skills

b. Less than 9 years old

b. 1 or 2 in an hour

c. 9 or 10 years old

c. 5 to 6 if you wait 2 hours

d. 11 or 12 years old

d. Some skilled drivers can drive safely after

e. 13 or 14 years old

drinking 6 or more beers in a night

1 15 or 16 years old

g. 1 7 or more years old

I

5 1993 YRB

44. If you have used alcohol In the past year, how
often has your drinking caused problems with your
teachers or your principal?

a. Never a problem

b. Once

c. Less than once a month

d. More than once a month, less than once a
week

e. More than once a week

45. If you have used alcohol In the past year, how
often has your drinking caused problems with
friends your age?

a. Never a problem

b. Once

c. Less than once a month

d. More than once a month, less than once a
week

e. More than once a week

46. If you have used alcohol in the past year, how
often has your drinking caused problems with the
police?

a. Never a problem

b. Once

c. Less than once a month

d. More than once a month, less than once a
week

e. More than once a week

47. If you have used alcohol in the past year, how
often has your drinking caused problems with your
parents or family?

a. Never a problem

b. Once

c. Lesslhan once a month

d. More than once a month, less than once a
week

e. More than once a week

48. If one of your parents has used alcohol in the past
year, how often has his or her alcohol use caused
you problems?

a. Never a problem

b. Once

c. Less than once a month

d. More than once a month, less than once a
week

e. More than once a week

49. How do your parents/guardians or family feel
about someone your age drinking alcohol?

a. They strongly approve

b. They approve

c. They don't care

d. They disapprove

e. They strongly disapprove

f. I don't know

50. How do your friends feel about someone your age
drinking alcohol?

a. They strongly approve

b. They approve

c. They don't care

d. They disapprove

e. They strongly disapprove

f. I don't know

51. How do most students In your grade feel about
someone your age drinking alcohol?

a. They strongly approve

b. They approve

c. They don't care

d. They disapprove

e. They strongly disapprove

f. I don't know

52. Do you feel you could stop using alcohol If you
wanted to?

a. I do not use alcohol

b. Yes

c. No

1993 YRBS

The next questions ask about the use of marijuana,
which is also called grass or pot.

53. How old were you when you tried marijuana for the
first time?

a. I have never tried marijuana

b. Less than 9 years old
C. 9 or 10 years old

d. 11 or 12 years old

e. 13 or 14 years old

f. 15 or 16 years old

q. 17 or more years old

54. During your life, how many times have you used

marijuana?

a. 0 (zero) times

b. 1 or 2 times

c. 3 to 9 times

d. 10 toT9 times

e. 20 to 39 times

f. 40 to 99 times

g. 100 or more times

55. During the past 30 days, how many times did you
use marijuana?

a. 0 (zero) times

b. 1 or 2 times

c. 3 to 9 times

d. 10 to 19 times

e. 20 to 39 times

f. 40 or more times

56. During the past 30 days, how many times did you
use marijuana on school property?

a. 0 (zero) times

b. 1 or 2 times

c. 3 to 9 times

d. 10 to 19 times

e. 20 to 39 times

f. 40 or more times

1

57. If you have used marijuana in the past 30 days,
how often did you use beer, wine, or liquor at
about the same time?

a. Never use either alcohol or marijuana

b. Never use alcohol with marijuana

c. Less than half the time

The next questions ask about cocaine and other drugs

58.

How old were you when you tried any form of
cocaine. Including powder, crack, or freebase, for
the first time?

a. I have never tried cocaine

b. Less than 9 years old

c. 9 or 10 years old

d. 11 or 12 years old

e. 13 or 14 years old

f. 15 or 16 years old

g. 17 or more years old

59.

60,

During your Irfe, how many times have you used
any form of cocaine, including powder, crack, or
freebase?

a. 0 (zero) times

b. 1 or 2 times

c. 3 to 9 times

d. 10 to 19 times

e. 20 to 39 times

f. 40 or more times

During the past 30 days, how many times did you
use any form of cocaine, Including powder, crack,
or freebase?

a. 0 (zero) times

b. 1 or 2 times

c. 3 to 9 times

d. 10 to 19 times
a. 20 to 39 times
f. 40 or more times

61 . During your life, how many times have you used

65. During your life, how many times have you taken

the crack or froebase forms of cocaine?

Steroid pills or shots without a doctor's

prescription?

a. 0 (zero) times

b. 1 or 2 times

a. 0 (zero) times

c. 3 to 9 times

b. 1 or 2 times

d. 10 to 19 times

c. 3 to 9 times

e. 20 to 39 times

d. 10 to 19 times

f. 40 or more times

e. 20 to 39 times

f. 40 or more times

62. How old were you when you tried LSD, PCP, or

other hallucinogens (Acid, Angel Dust) for the first

66. During your life, have you ever Injected (shot up)

time?

any Illegal drug?

a. I have never tried LSD, PCP, or hallucinogens

a. Yes

b. Less than 9 years old

b. No

c. 9 or 10 years old

d. 11 or 12 years old

67. During the past 12 months, has anyone offered,

e. 13 or 14 years old

sold, or given you an illegal drug on school

f. 15 or 16 years old

property?

g. 17 or-more years old

a. Yes

63. How old were you when you first tried UPPERS

b. No

(like speed or amphetamines) without a doctor

telling you?

68. If one or your parents has used drugs In the past

year, how often has his or her drug use caused

a. I have never tried UPPERS (like speed or

problems?

amphetamines)

b. Less than 9 years old

a. Never used drugs

c. 9 or 10 years old

b. Once

d. 11 or 12 years old

c. Less than once a month

e. 13 or 14 years old

d. More than once a month, less than once a

i 15 or 16 years old

week

g 1 7 or more years old

e. More than once a week

64. During your life, how many times have you used

69. In the past school year, how often did you get any

any other type of illegal drug, such as LSD, PCP,

Information on alcohol or drugs from health or

ecstasy, mushrooms, speed, Ice, heroin, or pills

other school classes?

without a doctor's prescription?

a. Never

a. 0 (zero) times

b. Once

b. 1 or 2 times

c. More than once

c. 3 to 9 times

d. 10 to 19 times

70. In the past school year, how often did you get any

e. 20 to 39 times

information on alcohol or drugs from counselors at

f. 40 or more times

school?

a. Never

b. Once

c. More than once

t *

<

) 1993 YRBS

71. In the past school year, how often did you get any
information on alcohol or drugs from discussions
with your family?

a Never

b. Once

c. More than once

72. In the past school year, how often did you get any
Information on alcohol or drugs from a friend your
age?

a. Never

b. Once

c. More than once

73. In the past school year, how often did you get any
Information on alcohol or drugs from classes with
a uniformed DARE police officer?

a. Never -

b. Once

c. More than once

74. Do you feel you could stop using marijuana or
other illegal drugs if you wanted to?

a. I do not use marijuana or other illegal drugs

b. Yes
C. No

The next questions ask about AIDS/HIV education and
Information.

75. Have you ever been taught about AIDS/HIV
infection in school?

a. Yes

b. No .

c. Not sure

76. Have you ever talked about AIDS/HIV Infection
with your parents or other adults in your family?

a. Yes

b. No

c. Not sure

The next questions ask about body weight.

77. How do you think of yourself?

a. Very underweight

b. Slightly underweight

c. About the right weight

d. Slightly overweight

e. Very overweight

78. Which of the following are you trying to do?

a. Lose weight

b. Gain weight

c. Stay the same weight

d. I am not trying to do anything about my
weight

79. During the past 7 days, which one of the following
did you do to lose weight or to keep from gaining
weight?

a. I did not try to lose weight or keep from
gaining weight

b. I dieted

c. I exercised

d. I exercised and dieted

e. I used some other method, but I did not
exercise or diet

80. During the past 7 days, which one of the following
did you do to lose weight or to keep from gaining .
weight?

a. I did not try to lose weight or keep from
gaining weight

b. I made myself vomit

c. I took diet pills

d. I made myself vomit and took diet pills

e. I used some other method, but I did not vomit
or take diet pills

10

1993 YRBS

The next questions ask about food you ate yesterday.
Think about all meals and snacks you ate yesterc/ay
from the time you got up until you went to bed. Be
sure to Include food you ate at home, at school, at
restaurants, or anywhere else.

81. Yesterday, did you eat fruit or drink fruit juice?

a.

No

b.

Yes. once only

c.

Yes, two times

d.

Yes, three times

e.

Yes, four or more times

82. Yesterday, did you eat green salad or raw or
cooked vegetables?

a

No

b.

Yes, once only

c.

Yes, two times

d.

Yes, three times

e.

Yes, four or more times

83. Yesterday, did you eat hamburger, hot dogs,
sausage, or barbecue?

a. No

b. Yes, once only

c. Yes, two times

d. Yes, three times

e. Yes, four or more times

84. Yesterday, did you eat french fries or potato chips?

a. No

b. Yes, once only

c. Yes, two times

d. Yes, three times

e. Yes, four or more times

85. Yesterday, did you eat cookies, doughnuts, pie, or
cake?

a. No

b. Yes, once only

c. Yes, two times

d. Yes, three times

e. Yes, four or more times

The next questions ask about physical activity.

86.

On how many of the past 7 days did you exercise
or participate in sports activities for at least 20
minutes that made you sweat and breathe hard,
such as basketball, jogging, fast dancing,
swimming laps, tennis, fast bicycling, or similar
aerobic activities?

a.

0 (zero) days

b.

Iday

c.

2 days

d.

3 days

e.

4 days

f.

5 days

g

6 days

h.

7 days

87. On how many of the past 7 days did you do
exercises to strengthen or tone your muscles,
such as push-ups, slt-ups, or weight lifting?

a.

0 (zero) days

b.

1 day

c.

2 days

d.

3 days

e.

4 days

f.

5 days

Q

6 days

h.

7 days

88. In an average week when you are in school, on
how many days do you go to physical education
(PE) classes?

a

0 (zero) days

b.

1 day

c.

2 days

d.

3 days

e

4 days

f.

5 days

11

69. During an average physical education (PE) class,
how many minutes do you spend actually
exercising or playing sports?

a. I do not take PE

b. Less than 10 minutes

c. 10 to 20 minutes

d. 21 to 30 minutes

e. More than 30 minutes

1993 YRBS

'STATE LIBRARY OF NORTH CAROLINA

soot 10586 4509

GO. During the past 12 months, on how many sports
teams run by your school, did you play? (Do not
include PE classes.)

a. 0 (zero) teams

b. 1 team

c. 2 teams

d. 3 or more teams

91. During the past 12 months, on how many sports
teams run by organizations outside of your
•chool, did you play?

a. 0 (zero) teams

b. 1 team

c. 2 teams

d. 3 or more teams

The next questions ask about sexual behavior.

92. How old were you when you had sexual
intercourse for the first time?

a.

I have never had sexual

b

Less than 12 years old

c.

12 years old

d

13 years old

e

14 years old

f.

15 years old

g

16 years old

h.

17 or more years old

93. During your life, with how many people have you
had sexual intercourse?

a

I have never had sexual Intercourse

b.

1 person

c.

2 people

d.

3 people

e.

4 people

f.

5 people

0

6 or more people

94. During the past 3 months, with how many people
did you have sexual intercourse?

a

I have never had sexual intercourse

b.

I have had sexual intercourse, but not during
the past 3 months

c.

d
e
«.

0
h.

1 person

2 people

3 people

4 people

5 people

6 or more people

95. Did you drink alcohol or use drugs before you had
sexual Intercourse the last time?

a. I have never had sexual intercourse

b. Yes

c. No

96. The last time you had sexual intercourse, did you
or your partner use a condom?

a. I have never had sexual intercourse

b. Yes

c. No

97. The last time you had sexual intercourse, what
one method did you or your partner use to
prevent pregnancy? (Select only one response.)

a. I have never had sexual intercourse

b. No method was used to prevent pregnancy

c. Birth control pills/implant

d. Condoms

e. Withdrawal

f. Some other method

g. Not sure

98. How many times have you been pregnant or
gotten someone pregnant?

a. 0 (zero) times

b. 1time

c. 2 or more times

d. Not sure

12

1993 YRBS

Have you ever been told by a doctor or nurse that
you have a sexually transmitted disease such as
genital herpes, genital warts, chlamydia, syphilis,
gonorrhea, AIDS, or HIV Infection?

a. Yes

b. No

13

1993 YRBS

Department of Environment, Health, and Natural Resources
State Center for Health and Environmental Statistics
P.O. Box 29538
Raleigh, N.C. 27626-0538
919/733-4728

BULK RATE

U.S. Postage

PAID

Raleigh, N.C. 27626-0538

Permit No. 1862

1,000 copies of this public document were printed at a cost of $1,066.00 or $1.07 per copy.