Teen Newsletter: Opioids

Public health problems are diverse and can include infectious diseases, chronic diseases, emergencies, injuries, environmental health problems, as well as other health threats. Regardless of the topic, we take the same systematic, science-based approach to a public health problem by following four general steps.

For ease of explaining and understanding the public health approach for this public health problem (opioids), let’s focus on opioid misuse among adolescents and how the CDC is addressing the problem.

1. Surveillance (What is the problem?). In public health, we identify the problem by using surveillance systems to monitor health events and behaviors occurring among a population.

To gather data on opioid use among adolescents, CDC uses the Youth Risk Behavior Surveillance System (YRBSS). YRBSS monitors six categories of health-related behaviors that contribute to the leading causes of health and disability among youth and adults, including alcohol and other drug use.

Did you know that nearly 1 in 7 students reported ever misusing prescription opioids, and approximately 1 in 14 students reported misusing them during the past 30 days?

 

 

2. Risk Factor Identification (What is the cause?). After we’ve identified the problem, the next question is, “What is the cause of the problem?” For example, are there factors that might make certain populations more susceptible to diseases, such as something in the environment or certain behaviors that people are practicing?

Adolescence is a critical high-risk period for the initiation of substance use (i.e., opioid misuse) and progression to addiction. Teens with substance use disorders experience higher rates of physical and mental illnesses and diminished overall health and well-being. Research shows that behaviors and experiences related to sexual behavior, high-risk substance use, violence victimization, and mental health contribute to substantial morbidity in youth, including risk for HIV, STDs, and teen pregnancy. Data indicate that these four risk behaviors co-occur, and some young people may experience more than one risk behavior. Primary prevention of high-risk substance use, like opioid misuse, among youth presents an important opportunity to prevent infectious diseases and protect the mental and physical health of adolescents.

Are there certain adolescents that are more at-risk for opioid misuse?

• Does it matter where you live?

 

• What about your sex?

Compared with females, males had a significantly higher prevalence of lifetime use of heroin (2.3% versus 1.0%). Compared with males, females had a significantly higher prevalence of current prescription opioid misuse (8.3% versus 6.1%) and lifetime prescription opioid misuse (16.1% versus 12.4%).

 

• Is your race/ethnicity a factor?

The prevalence of current prescription opioid misuse was significantly lower among White students (5.5%) compared with Black (8.7%) or Hispanic students (9.8%).

 

• Does your sexual identity play a role?

Students who identified as lesbian, gay, or bisexual had a higher prevalence of all studied substance use behaviors, except binge drinking, compared with students who identified as heterosexual. Similarly, students who identified as not sure of their sexual identity also had higher prevalence of approximately half of the substance use behaviors compared with heterosexual students, including current prescription opioid misuse, lifetime heroin use, and lifetime prescription opioid misuse.

 

Students reporting prescription opioid misuse commonly indicated use of other substances and other studies conducted among adolescents have identified an association between substance use and sexual risk behaviors (i.e., ever having sex, having multiple sex partners, not using a condom, and pregnancy before the age of 15 years of age).

Other common risk factors for substance abuse and sexual risk behaviors include extreme economic deprivation (poverty, over-crowding); family history of the problem behavior, family conflict, and family management problems; favorable parental attitudes towards the problem behavior and/or parental involvement in the problem behavior; lack of positive parent engagement; association with substance using peers; alienation and rebelliousness; and lack of school connectedness.

3. Intervention Evaluation (What works?). Once we’ve identified the risk factors related to the problem, we ask, “What intervention works to address the problem?” We look at what has worked in the past in addressing this same problem and if a proposed intervention makes sense with our affected population.

Teens Linked to Care (TLC) was a three-year pilot project to assess the feasibility of implementing integrated prevention strategies to address both substance use and sexual risk among youth in high-risk rural communities. The project was a collaboration between CDC’s Division of Adolescent and School Health under the National Center for HIV, Viral Hepatitis, STD, and TB Prevention, the CDC Foundation, the Conrad N. Hilton Foundation, and three pilot sites: Scott County School District 1 (Austin, Indiana), The Brighton Center (Campbell County, Kentucky), and Portsmouth City Health Department (Portsmouth, Ohio). The goal of the pilot was to develop a framework for schools to address HIV, STD, teen pregnancy, and high-risk substance use (i.e., use of prescription, illicit, or injection drugs like opioids) among youth through education, primary prevention, and early detection screening.

 

 

4. Implementation (How did we do it?). In the last step, we ask, “How can we implement the intervention? Given the resources we have and what we know about the affected population, will this work?”

Community engagement is the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people. It is a powerful vehicle for bringing about environmental and behavioral changes that will improve the health of the community and its members. It often involves partnerships and coalitions that help mobilize resources and influence systems, change relationships among partners, and serve as catalysts for changing policies, programs, and practices.

Through the pilot initiative, CDC provided a school-centered approach in three communities to educate teens on the dangers of substance use and collaborated with local health departments to offer health screenings to identify those teens most at risk for HIV, sexually transmitted diseases, teen pregnancy and high-risk substance misuse (i.e., opioid misuse). Youth and community advisory boards were vital in the initiative. Critical to the project’s success were partners’ abilities to work closely with local communities, training local health providers and leveraging local resources to raise awareness about substance use.

The three pilot sites successfully implemented and developed strategies in several key areas, including:

• Developing new health education curricula reaching all students in their respective high schools that address prevention of HIV, STD, teen pregnancy, risky sexual behavior and substance use;
• Developing and distributing products to promote youth-friendly health services in order to increase access to HIV, STD, and substance use screening and testing, as well as other health services;
• Collaborating with local health departments to offer health screenings to identify those most at risk for HIV, STDs, teen pregnancy, and high risk substance use;
• Collecting data about student opinions and experiences with bullying at school, resulting in a review of school bullying policies due to the association between bullying and substance use;
• Producing anti-bullying and anti-opioid campaign videos to promote positive school climates where students feel safe from bullying and the risk of substance use; and
• Partnering with their communities’ drug-free coalitions to leverage resources and increase youth and adult knowledge in substance use and prevention.

 

TLC is addressing issues of substance use and risky sexual behavior before they reach crisis level, where an ounce of prevention now is worth a pound of cure later.

 

Future activities include developing a framework that integrates school-based strategies for the prevention of high-risk substance use and HIV, STDs, and teen pregnancy. The framework will be based on lessons learned during the pilot and will allow the three sites to move from implementation to outcomes (i.e., behavior change evaluation). This framework will also help inform a second phase of TLC where it could be expanded to additional rural schools and modified for large urban areas with communities that have youth that are at high risk for substance use.

Using The Public Health Approach helps public health professionals identify a problem, find out what is causing it, and determine what solutions/interventions work.