Youth marijuana use: new data infographics and youth perspectives

Youth marijuana use in King County (2016)

Two new resources are now available on Public Health – Seattle and King County’s Youth Health and Marijuana website:

Among findings from the Healthy Youth Survey are:

  • Although marijuana use among youth has not gone up since retail sales of marijuana was legalized, 1 in 4 students in 12th grade report using marijuana.
  • Youth in Seattle were significantly more likely to report using marijuana than those in other King County regions (see map above).
  • Youth primarily get marijuana from friends.
  • Almost 90% of 10th graders with at least one best friend who uses marijuana report using marijuana.

Common themes that emerged in the listening sessions were:

  • Reasons youth may use marijuana..
  • Reasons youth may avoid using marijuana.
  • Youth perceptions of the risk of using marijuana.
  • Beliefs about use by other youth.
  • Perceptions about the ease of access to marijuana.
  • Where youth get their information about marijuana.
  • The kinds of information youth want about marijuana.

A key finding from the listening sessions was that youth want unbiased information from trusted, reliable sources about how marijuana works, including risks and benefits. They’re less likely to take messages seriously if they seem exaggerated or condescending.

Tracking the soda tax

Because voters passed Washington State Initiative 1634 in November, Seattle is the only city in the state that can legally tax sugar-sweetened beverages. But the Seattle tax remains in place, and its effects are being evaluated by researchers from Public Health – Seattle & King County, the University of Washington, and Children’s Hospital. According to the Seattle Times, the first 9 months of the tax generated almost $17 million in new revenue – considerably more than the original $15 million estimate for the entire year.

Photo by Josh McLain on Unsplash

The tax took effect one year ago, on January 1, 2018. Before the tax was implemented, the evaluation team collected baseline data, which they presented to Seattle City Council in August. Briefly, the report found:

  1. Beverage prices were similar in the City of Seattle and comparison areas in King County. When there were differences, Seattle prices tended to be higher. Across all areas and types of beverages, large stores had lower prices than small stores.
  2. Consumption of sugary beverages was lower in Seattle than in comparison areas and lower than the national average. The top 2 beverages consumed by Seattle children were water and flavored milk (neither subject to the new tax); among taxed beverages, Seattle children were most likely to consume soda and sugary fruit-flavored juice. These results differed from the popular impression – reported by consumer and business representatives who participated in focus groups – that sugary beverage consumption among children was common.
  3. Economic impact of the tax. While Seattle adults participating in surveys did not believe the tax would negatively affect small businesses or result in job loss, representatives of some businesses and elected officials expressed the opposite view. Business representatives gave mixed responses about whether they would absorb the tax or pass it on to clients and consumers. While consumers had mixed opinions about how the tax would affect their own purchasing and consumption behaviors, they felt the tax would financially impact low-income people and communities of color.
  4. Support for the tax. Most Seattle adults surveyed supported the Sweetened Beverage Tax and believed the tax would help improve the health and well-being of children and of the general public. Support for the tax was lower among survey participants with lower incomes and those who were non-Hispanic Black and non-Hispanic Asian.  While representatives of consumer and business groups expressed mixed support for the tax, they more consistently supported putting tax revenues toward programs to improve healthy food access for lower-income populations.

Besides raising money for nutrition education and assistance to low-income residents for the purchase of healthy foods, has the tax affected purchasing and dietary behaviors of people in Seattle? The first (6-month) evaluation report was submitted to the City in September and should become available to the public early in 2019. As reported in Community Health Indicators, results of the 2016 Healthy Youth Survey showed a decline in daily consumption of sugar-sweetened beverages by King County’s middle- and high-school students before the tax took effect.

King County schools reduce expulsions and suspensions but disparities persist

From 2013 to 2017, Highline School District reduced the Black-white discipline gap by 4.9% — the largest decline in King County [click to expand].

This week a commission led by Education Secretary Betsy DeVos recommended rescinding Obama-era guidance to prevent discrimination in school discipline for minor, nonviolent offenses . Immediately after the announcement, Washington state’s Office of the Superintendent of Public Instruction (OSPI) countered that Washington state would continue with its efforts to reduce disproportionality in school discipline – primarily by disability status, race, and ethnicity.  According to the latest available data (from the 2016-2017 school year), the disciplinary rate for students in Special Education was 3.6% above the state average; for African American students, the difference was +3.9%; and for Hispanic students the difference was +0.6%.

“This is an equity issue,” said Washington Superintendent Chris Reykdal. “Each day a student misses class for disciplinary purposes is a day they miss learning. The bottom line is this: Rescinding the 2014 guidelines will have no effect on Washington’s laws and rules related to student discipline.”

Earlier this year, The Atlantic described the ups and downs of the Highline School District’s new approach to discipline (see chart above for disciplinary trends). Although each district’s approach will be different, the Washington state Legislature heeded the 2014 federal guidance by passing legislation in 2016 “to help close opportunity gaps in learning.”  To help schools comply with the law, OSPI updated school discipline rules earlier this year. Statewide, progress has already been made.

Between the 2012-2013 and 2016-17 school years, Washington schools have experienced:

  • a 0.6% reduction in discipline rate for all students (from 4.1% to 3.5%)
  • a 0.7% reduction in the discipline rate for Special Education students (from 7.8% to 7.1%)
  • a 2.3% reduction in the Black/White difference in disciplinary rates (from 6.7% to 4.4%)
    • a 2.8% reduction in the discipline rate for Black students (from 10.2% to 7.4%)
    • a 0.5% reduction in the discipline rate for white students (from 3.5% to 3.0%)
  • a 0.4 point reduction in the ratio of Black to white students disciplined (from 2.9-to-1 in 2013 to 2.5-to-1 in 2017)
  • a 0.9% reduction in the discipline rate for Hispanic students (from 5.0% in 2013 to 4.1% in 2017)

How do King County schools compare? Using data from the OSPI website, the following table shows 2013-2017 changes and 2017 discipline rates for Washington state and King County. Data were available for 18 of 19 King County school districts. For easy comparison, data cells are colored blue if they show changes or rates that were as good as or better than those in Washington state; yellow indicates that changes or rates were worse than those for the Washington overall.

From 2013 to 2017, rates of suspensions and expulsions declined in 13 of 18 King County school districts (change in WA state rate = -.6%).

  • The largest declines were in Highline (-4.0%) and Kent (-2.9%) districts.
  • All but two of the declines were at least as large as the -.6% statewide decline.
  • Overall disciplinary rates did not decline in Enumclaw, Issaquah, Vashon, Snoqualmie Valley, and Riverview. In all of these districts except Enumclaw, the 2017 discipline rate was lower than the 2017 rate for the state.
  • Despite declines in discipline rates from 2013 to 2017, rates in 4 districts (Seattle, Federal Way, Renton, and Tukwila) exceeded the 2017 state discipline rate.

Rates of suspensions and expulsions for special education students declined in 13 of 18 King County districts (change in WA state rate = -0.7%).

  • The largest declines for Special Education students were in Highline (-7.3%), Kent (-6.2%), Bellevue (-6.1%), and Seattle (-4.1%).
  • All declines in King County districts were larger than the -.7% statewide decline.
  • Disciplinary rates for Special Education students did not decline in Issaquah, Vashon, Enumclaw, Riverview, and Snoqualmie Valley. In all these districts, however, the 2017 rate was lower than the 2017 rate for the state.
  • Despite declines in discipline rates among Special Education students between 2013 and 2017, the 2017 rates in Federal Way and Renton exceeded the 2017 state rate for Special Education students.

To avoid artificial inflation of percentages due to small numbers, we excluded districts with fewer than 100 Black students from comparisons of (a) 2013-to-2017 changes in the Black-white discipline gap and (b) calculations of the 2017 ratios of Black-to-white discipline rates. Districts with fewer than 100 Black students (with 2017 counts in parentheses) were: Enumclaw (35), Mercer Island (64 in 2015; no data for 2016 or 2017), Riverview (20), Snoqualmie Valley (57), and Vashon (no data for Blacks in any year).

The disciplinary gap between Black and white students declined in 11 of 13 King County districts with ≥100 Black students [change in WA state Black/white disciplinary gap = -2.3%]

  • In 6 of those districts, the decline in the Black-white disciplinary gap exceeded the statewide decline.
  • The largest declines in the Black-white gap were in Highline (-4.9%), Bellevue (-3.9%), Seattle (-3.3%), and Kent (-3.1%) districts.
  • Despite declines in the Black-white disciplinary gap, the size of the 2017 gap exceeded the state gap in Kent, Seattle, Federal Way, and Renton.
  • Districts where the Black-white disciplinary gap did not decline were Tukwila (+3.7%) and Issaquah (+1.4%). The size of the 2017 gap in Tuikwila exceeded the state gap.

Despite many improvements in disciplinary rates in King County districts, the ratio of Black to white students who were disciplined in 2017 exceeded the state’s 2.5-to-1 ratio in 5 of the 13 districts for which data were available.  Only 5 school districts had 2017 Black/white disciplinary ratios lower than 2-to-1.

  • Two of the 5 districts with Black/white disciplinary ratios below 2-to-1 in 2017 (Lake Washington and Northshore) also had ratios below 2-to-1 in 2013.
  • Tukwila’s Black/white disciplinary ratio rose from 1.3-to-1 in 2013 to 2.3-to-1 in 2017.
  • In Bellevue, Highline, and Tahoma, 2017 Black-to-white ratios below 2-to-1 reflected improvement between 2013 and 2017.

With this week’s announcement the state made it clear that, although generally promising, progress toward equity is just beginning. While districts like Highline began exploring alternatives to expulsion and out-of-school suspension as early as 2013, others have maintained zero-tolerance policies that lead to suspension even for minor infractions. Starting in the 2019-2020 school year, districts will have to eliminate zero-tolerance approaches that mandate suspension or expulsion for any behavior other than firearms violations. According to Superintendent Reykdal, OSPI will continue “enforcement of civil rights laws that prohibit discrimination in the administration of student discipline.”

 

 

Marijuana use up in adults, not teens

Communities Count recently completed updating all health indicators, and has added some new ones.  Findings include:

  • Since recreational use of marijuana in Washington became legal in 2012, marijuana use increased among adults, but not among teens. [New indicator]
  • Substance use among teens: Teens’ self-reported use of alcohol, marijuana, painkillers, or other illegal drugs declined from 34% in 2004 to 24% in 2016, with significant declines across all race/ethnicity groups and regions. [New indicator]
  • Teens also reported declines in overall tobacco use (excluding e-cigarettes) and cigarette smoking. Among adults, cigarette smoking has declined across all regions, although the decline among South Region adults has stalled. In teens and adults, smoking rates for American Indians/Alaska Natives and Blacks are above the King County average.
  • Across all substance-use indicators (those listed above, plus teen and adult binge drinking), rates were higher for people who identified as lesbian, gay, or bisexual (LGB). The just-released LGBTQ Community Spotlight offers some context for this pattern, noting that LGB youth were more likely than heterosexual youth to report feeling unsafe at school and on dates, and to report that they had been bullied and that an adult had intentionally hurt them. These findings are consistent with established links between traumatic experience and substance use.
  • Since expansion of coverage through the Affordable Care Act, the percentage of King County adults without health insurance has dropped by half. However, 1 in 3 Latinos did not have coverage in 2017 – 8 times the rate for non-Hispanic whites and 3 times the rate for African Americans and Native Hawaiians / Pacific Islanders.

Recent updates have also been posted for disability, infant mortality, and adolescent birth.

 

LGBTQ youth talk about healthcare experiences

By Communities Count in collaboration with Public Health Insider

Photographer, Ned Ahrens

In a first-of-its-kind effort, King County hospitals reached out to lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth and young adults to learn about their experiences with healthcare. King County Hospitals for a Healthier Community, which is a collaborative of 11 hospitals and health systems, joined with Public Health – Seattle & King County to identify the greatest needs and assets of the communities they serve and develop plans to address those needs. More than 1 in 10 King County youth identifies as lesbian, gay, or bisexual.

A series of listening sessions with LGBTQ youth and young adults age 13-24 living throughout King County, plus interviews with advocates who work with LGBTQ youth, revealed consistent themes that were also supported by survey data. The themes at the heart of the just-released LGBTQ Community Spotlight include:

  1. Lack of control of their own health

For many LGBTQ youth, lack of family support affected mental health, self-esteem, and their ability to effectively navigate the healthcare system. Youth who had stable and nurturing relationships with their families and trusted adults felt safe and supported. Those without these trusting relationships had extreme difficulty getting their health and healthcare needs met. One youth said, “… this is my body, this is my mental health, this is me; I feel like I’m not in control over any of it.”

Many youth would like more opportunities to speak privately with their providers, without family present, and feel strongly that providers should take the lead in suggesting this option. A listening session participant offered a positive example: “One thing my [provider] does to make me feel safe is asking me about telling my mom. He’ll always give me the option, ‘Do you want your mom to come along?’ or if she’s there [he’ll ask] if she should leave. He always leaves it up to me.”

  1. With providers, a need for safety, trust, and information

Youth said they needed to feel safe and develop trusting relationships with their providers before they could comfortably talk with them about their physical, mental, and emotional health needs – all topics that are broader than just sexual health. According to one participant, “[My pediatrician]’s really supportive of everything. Before she asks questions, she says ‘do you feel comfortable if I ask this?’ and it’s really nice.”

Participants also stressed the importance of a safe and supportive clinical environment where inclusive language on intake forms and behaviors from staff and providers acknowledge the possibility of gender diversity

Youth also said they needed more information – about diverse aspects of human sexuality and healthy interpersonal relationships, as well as patient rights, confidentiality, and the kinds of services that can be accessed without parental consent.

  1. Kudos for school-based health centers

Middle and high school students with access to one of the 23 King County School Based Health Centers  greatly valued the services and the privacy they provided. This is one of many enthusiastic endorsements: “They’re not only treating what’s wrong with you internally – they care about you all the way.”

  1. Safety concerns across multiple settings

In addition to explaining their need for “non-judgmental safe spaces” for healthcare services, youth expressed strong concerns about safety in their responses on a statewide survey of 8th, 10th, and 12th graders. Compared to students who identified as heterosexual, those who identified as lesbian, gay, or bisexual were significantly more likely to report feeling unsafe at school and on dates; they were also more likely to report that they had been bullied and that an adult had intentionally hurt them.

These safety concerns were echoed by the finding that more than half of LGBTQ+ respondents to the 2018 Count-Us-In survey of King County’s homeless population reported a history of domestic abuse or partner abuse.

Acknowledging the universal challenges of transitioning from childhood to adulthood, the report highlights the considerable variation in the ways this plays out with LGBTQ youth.  Findings from the report can raise awareness among the parents, teachers, healthcare providers, and other trusted adults whose support is important to these youth as they navigate a vulnerable stage of development. Check out the full report to learn more about the findings and to read more from the participating youth and advocates.

For interpreted data about LGBTQ youth in King County, click the “demographics” and “custom demographics” tabs on the following Communities Count indicators:  teen binge drinking, teen obesity, teen overweight, teen physical activity,  teen cigarette smoking and tobacco use, teen depression, teen substance use, and teen marijuana use.   The same information, without interpretation, is presented on King County’s Community Health Indicators website.