The Nebraska Student

Health and Risk

Prevention (SHARP)

Surveillance System

Statewide SHARP Webinars

February/March 2014

Jeff Armitage, NDHHS

Kim Meiergerd, UNL

Today’s Presentation

Background of SHARP surveys

Why SHARP was created

How SHARP is administered

A few results

How the data are used

The road ahead

Next Steps

YRBS

The SHARP Model

Nebraska SHARP

Surveillance System

YTS

NRPFSS

To lessen the burden on schools and communities, coordinate the administration of the three school-based student health surveys in Nebraska endorsed by both the Nebraska Department of Education and the Nebraska Department of Health and Human Services.

Youth Risk Behavior Survey (YRBS)

Developed and coordinated by the CDC

Funded by the Nebraska Department of Education

First conducted in Nebraska and U.S. in 1991

Targeted at public high school students in grades 9-12

Questions focus on a wide variety of health risk behaviors that contribute to the leading causes of death, disability, and social problems among youth and adults in the U.S.

Why important… Only representative statewide survey of youth covering a broad array of important health topics

Youth Tobacco Survey (YTS)

Developed and coordinated by the CDC

Funded by NDHHS, Division of Public Health

First conducted in Nebraska in 1999/2000

Targeted at public high school students

Questions focus on specific aspects of tobacco use and prevention, including attitudes, perceptions, media exposure, access, cessation, etc.

Why important… Captures detail beyond the YRBS necessary for effective tobacco prevention among youth

Nebraska Risk and Protective Factor

Student Survey (NRPFSS)

Sponsored by NDHHS, Division of Behavioral Health’s Strategic Prevention Framework Partnerships for Success Grant through funding from the Substance Abuse and Mental Health Services Administration.

Survey is specific to Nebraska, but adapted from nationally validated surveys

First conducted in 2003

Targeted at all public and non-public students in grades 8, 10, and 12 (census survey)

Questions focus on substance abuse, delinquent behavior, bullying, gambling, and risk and protective factors

Why important…Provides school and communities with local data for local prevention planning

NRPFSS, cont...

The Risk and Protective Factor Prevention Model

Developed by researchers at the University of Washington

Basic idea… to prevent problems from occurring we must identify the factors that contribute to or protect against these problems and target them

Risk factors increase the likelihood of problem behavior while protective factors buffer against the negative influence of risk

Grouped into four domains

Community

School

Family

Individual

This information helps communities identify broader risk and protective factors that need to be addressed and target them to reduce multiple problem behaviors

NRPFSS, Cont…

The Risk and Protective Factor Prevention Model

Because risk and protective factors have multiple dimensions, a single factor’s score is composed of the responses to several survey questions, then referenced against a cut-point.

Why SHARP?

Prior to SHARP

The survey process was overwhelming schools and was resulting in poor participation

2009 YRBS data were unweighted (49% response rate)

2008 YTS data were unweighted (38% response rate)

2007 NRPFSS completed by 32% of eligible students

Confusion around surveys (purpose/content)

Competition between surveys

Schools reported:

Negative: Too many assessment requirements/not enough time

Positive: Receptive / see importance

Lack of student data presented a great challenge to public health planning, evaluation, and ability to secure new funds

Prior to SHARP

Coordinated administration of three school-based student health surveys in Nebraska

The process: All three surveys are administered at one time by one contractor, and only administered once every two years

The goal: Collect important public health

and behavioral health data in a way that

minimizes school interruptions

What is SHARP

YTS only administered to high school students (no middle school YTS)

NRPFSS only administered to 8th, 10th, and 12th grade students (no 6th grade)

Strive to enhance the timeliness and usefulness of data reporting

Changes to SHARP during 2014

SHARP staffing/structure/support

Who oversees the funds and coordination of the surveys? Nebraska Department of Education

Division of Public Health, NDHHS

Division of Behavioral Health, NDHHS

Strong administrative support

Key stakeholders are critical

Who collects the data and does the reporting? Bureau of Sociological Research (BOSR) at UNL is the contractor

Kim Meiergerd

Amanda Richardson

Lindsey Witt

How is SHARP

actually administered?

SHARP Survey Process

Data Collection

Objective is to have schools participate in all of the surveys for

which they have been selected

Sample selection

YRBS sample is drawn

Then YTS sample

Some communities oversample for YRBS and have an additional sample drawn

All schools are eligible to participate in the NRPFSS

The target populations for each survey are a little different

YRBS: Public high schools students

YTS: Public high school students

NRPFSS: 8th, 10th, and 12th grade students from public and private schools

Goal is that no student will have to complete more than one of the

three surveys under SHARP

SHARP Survey Process, cont.

Questionnaires

YRBS

CDC develops core and states can add questions

83 core questions in 2012, Nebraska added 11, total of 94 questions

YTS

CDC develops core and states can add questions

Total of 82 questions in 2012

NRPFSS

Nebraska develops questionnaire based on national surveys

Total of 99 questions in 2012, though many sub-questions exist

SHARP Survey Process, cont.

Timeline

March/April

Receive YRBS and YTS samples from CDC

BOSR will send all schools a letter inviting participation in the

surveys for which they are eligible

Begin the recruiting process

BOSR contacts schools via mail, email, and follow-up calls

March/April-August

Recruiting continues

Work to schedule administrations and select classrooms to

participate

SHARP Survey Process, cont.

Timeline

September and October with November as a cushion

Schools decide whether to use active or passive

parental/guardian consent

Schools identify a point person to whom the surveys and

instructions for administration are sent

Students complete the paper questionnaires with pencil

YRBS utilizes a scannable bubble sheet and YTS and

NRPFSS utilize booklets

The school point person then sends the completed surveys

back to BOSR using the Fed Ex mailing label provided

SHARP Survey Process, cont.

Timeline

December to May 2015

YRBS and YTS surveys sent to CDC for processing

Data weighted if overall response rate is ≥ 60%

BOSR processes NRPFSS surveys

June-September 2015

NRPFSS reports

Reports developed for all participating school districts as well as

county and community/regional reports

YRBS and YTS reports

State level YRBS and YTS reports are developed

SHARP Improved Participation

YRBS 2012 data were weighted

70% overall response rate

Second time having weighted data since 2005 (and only sixth since 1991)

YTS 2012 data were weighted

65% overall response rate for high school, up from 49% in 2010 and 38% in 2008

NRPFSS Participation has remained higher with SHARP

~25,000 in 2003 < 27,000 in 2005 < 30,000 in 2012

422 schools participated in 2012, up from 318 in 2007

What have we learned and

how has it been used?

Preliminary Data

YRBS Results

Preliminary Data

YRBS Results

Preliminary Data

YRBS Results

Preliminary Data

YRBS Results

Table 2. Mental Health Measures by Bullying during the Past 12 Months, 2013

Overall Not Bullied

Bullied at School or

Electronically

Depressed* 19.5% 12.4% 39.3%

Considered suicide 12.1% 6.9% 26.8%

Attempted suicide 6.0% 4.3% 10.9%

*Indicator definitions can be found in Appendix A.

High School YTS Results

Percentage that were in the same room as someone who was smoking

cigarettes during the past 7 days

NOTE: 2008 and 2010 results were not weighted, thus not representative of students statewide

High School YTS Results

Percentage of students who think cigarette smoking makes them look cool and

fit in

NOTE: 2008 and 2010 results were not weighted, thus not representative of students statewide

High School YTS Results

Percentages who have had either or both parents (guardians) talk to them

about the dangers of tobacco use

NOTE: 2008 and 2010 results were not weighted, thus not representative of students statewide

NRPFSS Results

NRPFSS Results

NRPFSS Results

School 8th Grade 10th Grade 12th Grade

Risk Factors State State State

Academic Failure 31.6% 35.4% 36.1%

Low Commitment to School 34.9% 33.2% 34.3%

Protective Factors

Opportunities for Prosocial Involvement 76.4% 73.8% 74.9%

Rewards for Prosocial Involvement 64.1% 68.8% 56.8%

8th, 10th, 12th grade

(Form A)

SCHOOL

Risk Factors Academic Failure 6, 19

Low Commitment to School 7 - 9, 20, 21a - 21c

Protective Factors Opportunities for Prosocial Involvement 10, 11, 13, 14, 18

Rewards for Prosocial Involvement 12, 15 - 17

Data strengthen local and state grant applications, and to date, the surveys under SHARP have helped bring millions of dollars to Nebraska communities

Representative data allow for better health planning and evaluation of interventions aimed at reducing adolescent risk factors, including legislation

Fulfill state and federal reporting requirements

Survey data provide a platform to discuss important health issues and create public awareness

By focusing on high need health areas we can improve not only health outcomes for youth, but life satisfaction and educational outcomes

How data have, and can help Nebraska

NRPFSS school and

community specific data are

available at no cost

Results will strengthen school

and community grant

applications

What are the benefits to schools

Data are relevant to the No Child Left Behind program

Participating schools may request specific information regarding programs available and support services related to any health topic

The road

ahead

Strengths of SHARP

Only source of representative youth data for

state/communities

All of the surveys have shown improvements in

many of the areas measured

Joint administration has increased efficiency and

decreased the number of interruptions in school

schedules

Excellent administrative and stakeholder support

Agree to participate in SHARP

What You Can Do

Explain the importance of

the surveys to the

teachers and students in

your school

Encourage schools in

your region to participate

in SHARP

Encourage community use of student survey data

“SHARP was a seamless process. I didn’t have to

rely on organizing it myself or involving teachers.

We were able to administer the surveys without

disrupting class time and the organization on the

part of BOSR made the process very efficient.”

Ryan Ricenbaw, Waverly High School

How School Administrators Feel About SHARP

“SHARP has helped our district to focus on a common data

collection to inform us regarding students' self-reported risky

behaviors. We can use this data for planning awareness

activities and interventions in the school and in the

community. The data connects several community agencies

who are all working on the same social improvements. This

makes us stronger in our common efforts. SHARP data also

can provide a look at the severity of our students’ health

risks in comparison to other national and state results. We

also use the data for grant opportunities. It has been a great

improvement for Nebraska to combine the survey efforts of

different groups into one process.”

Dr. Carol Renner, Kearney Public Schools

How School Administrators Feel About SHARP

Next Steps

School Administrators

BOSR will reach out in the next few months about survey eligibility

Feel free to ask questions and familiarize yourself and others with

the surveys

Stakeholders

Please discuss all surveys and their importance with schools

To streamline communication, please inform BOSR of contact with

schools

BOSR will schedule all administrations

BOSR will contact stakeholders as needed for assistance in

recruiting schools

Resources for getting more information

SHARP Website: http://bosr.unl.edu/sharp

Nebraska Department of Education Website: http://www.education.ne.gov/HIV/2010_YRBS-Results/resources.htm

CDC YRBS Website:

http://www.cdc.gov/HealthyYouth/yrbs/index.htm

Kim Meiergerd

kmeiergerd2@unl.edu / 402-472-3692

Jeff Armitage

Jeff.Armitage@nebraska.gov / 402-471-7733

Renee Faber

Renee.Faber@nebraska.gov / 402-471-7772

Questions