Silver Street Consulting, LLC www.silverstreetconsulting.

net

Assessment of Adolescent Health in Eagle County 2012
Eagle County RE 50 School District

Prepared for the Eagle River Youth Coalition
November 2012

0023 Silver St. Edwards, CO 81632 Phone: (303) 908-4577 Ÿ E-mail: silverstreetconsulting@gmail.com

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Table of Contents
EXECUTIVE SUMMARY ...................................................................................................................................... 3 INTRODUCTION ................................................................................................................................................. 5 ALCOHOL CONSUMPTION ............................................................................................................................... 6 DRINKING AND DRIVING………………………………………………………………………………………….....16 MARIJUANA USE……………………………………………………………………………………………………… 19 PHYSICAL ACTIVITY AND NUTRITION ………………………………………………………………………………28 END NOTES ……………………………………………………………………………………………………………..38

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EXECUTIVE SUMMARY
The Eagle River Youth Coalition (ERYC) regularly conducts a scientific survey of student behaviors and perceptions in Eagle County, and then shares the results with adolescent service providers to inform program planning. This 2012 needs assessment is a synthesis of the latest survey results, with a focus on alcohol consumption, drinking and driving, marijuana use and physical activity and nutrition. It compares local data with the state and nation, and offers recommended strategies to address the issues.

Alcohol Consumption
The illegal consumption of alcohol by those under age 21 is prevalent among high school students. Locally, by the time students are seniors, 89 percent have tried alcohol, 60 percent have drank it within the past 30 days, and 42 percent have recently consumed five or more drinks in a row, also known as binge drinking. Similar to state and national figures, 22 percent of students reportedly had their first drink before age 13. The allure of alcohol use is strong as local teens explain that the popular students drink and thus, it can be a ticket to automatic acceptance. Also, drinking is the major weekend activity and students who don’t engage in this behavior may feel left out. Students report the most common place that alcohol is consumed is in someone else’s home, where the alcohol is already provided, most likely by a young adult. They say this occurs in every town. According to the literature, one of the most affective ways of reducing alcohol use by adolescents is to limit access through laws, public education and enforcement.

Drinking and Driving
Motor vehicle crashes are the leading cause of death among adolescents. Inexperience, coupled with a greater likelihood to speed and become distracted, makes them at significantly higher risk of a car crash than adults. With the addition of alcohol, the risk of a serious crash increases dramatically. Locally, 11 percent of high school students reported drinking and driving, and 27 percent reported riding with a driver that had been drinking within the previous 30 days. Students say the main reason for the behavior is that they have no other way to get home. Additionally, teens drink and drive because they think they won’t get caught; they believe they can tell when they have drank too much to drive; and the activity is illegal, which is attractive to certain teens. The National Highway Transportation Safety Administration recommends high visibility enforcement of both drinking and driving laws, and graduated drivers license laws as a means to address the issue.

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Marijuana Use
Marijuana use has negative effects on memory and attention, and can impact learning for adolescents. Marijuana is also addictive through repeated use. In Eagle County, 39 percent of high school students reported that they have tried marijuana, including 61 percent of seniors. Also, 29 percent of students reported they used it within the past 30 days. In fact, more students now use marijuana than smoke cigarettes. The percentage of Eagle County students that use marijuana is similar to both the state and nation. According to studies, teens that have psychosocial risk factors such as family conflict, a low level of school engagement, and an antisocial peer group are more likely to use marijuana. Local students say that in-school drug testing programs are a deterrent. The national literature recommends community-based interventions that build protective factors in youth.

Physical Activity and Nutrition
Over the past 20 years, the staggering increase in the percentage of overweight and obese children and adults in the U.S. has alarmed health officials. Nationally, 28 percent of students are either overweight or obese, compared to Eagle County students at 14 percent. While, Eagle County doesn’t have the same overweight and obesity problem as the rest of the nation, local youth can still benefit from programs that promote good nutrition and physical activity. Establishing these habits early often transfers to healthy behaviors in adulthood. The Centers for Disease Control and Prevention recommends strategies that promote nutrition and fitness such as restricting the availability of unhealthy foods and sugary drinks in schools, child care centers and recreation facilities; increasing physical education opportunities; and zoning for mixed-use development in order to increase walking and biking by residents.

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INTRODUCTION
The Eagle River Youth Coalition (ERYC) was founded in 2001, to build capacity toward enhancing the services of providers that work with adolescents. An important part of ERYC’s mission is to assess prevention needs through regularly administered surveys to students, in order to provide the community with ongoing measures of youth attitudes, behaviors and perceptions. Since the 2007-2008 school year, the ERYC has been working with Denver’s OMNI Institute, to administer and analyze the Healthy Kids Colorado Survey (HKCS) on a local level.1 The survey is provided to middle and high school students in the RE 50 School District, and has over 100 questions. The survey is based on the statewide HKCS2 and the national Youth Risk Behavior Survey, 3 developed by the Centers for Disease Control and Prevention (CDC). Therefore, local data can be compared with the state and nation. The latest Eagle County survey was administered during the 2011-2012 school year, and 1,316 students participated. For the purposes of this assessment, ERYC has chosen the focus areas of alcohol consumption, drinking and driving, marijuana usage, and physical activity and nutrition. Local data from these areas were compared with state and national survey results, then focus groups were held with local high school students to delve further into the issues. Finally, a literature review was conducted to determine reasons for the behaviors and types of prevention strategies available to improve these health areas.

The ERYC administers a standard survey with questions that are also asked at the state and national level, and can be used for comparison.

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ALCOHOL CONSUMPTION
The Centers for Disease Control and Prevention calls alcohol use by persons under age 21 “a major public health problem,” and the most commonly used and abused drug among teens in the United States. It goes on to say that on average, underage drinkers consume more drinks per drinking occasion than adults. 4 According to the National Institute on Alcohol Abuse and Alcoholism, each year approximately 5,000 adolescents die as a result of underage drinking from causes such as motor vehicle crashes, suicides, injuries and homicides.5 Local, state and national surveys illustrate this problem behavior in terms of the percentage of teens that have ever tried alcohol, the age of first use, the rate of current use and the proportion of students that regularly binge drink.

Ever-Drank Alcohol
According to the 2011-2012 Eagle County survey, by 7th grade, 21 percent of students had tried alcohol, and by senior year, 89 percent had had at least one drink (Figure 1). Overall, the percentage of local high school students in grades 9-12 that ever drank alcohol is similar over time, and to Colorado and the U.S. During the 2011-2012 school year, the percentage was reportedly 71 percent (Figure 2).

Figure 1. Lifetime Prevelance of Alcohol Use: The Percentage of Students that Ever
Drank Alcohol, Eagle County, 2011-2012 (N=1,804)

Figure 2. Lifetime Prevelance of Alcohol Use: The Percentage of Students that Ever
Drank Alcohol, Eagle County, CO and U.S. 9th-12th Grades Combined, (N=1164)

100% 80% 60% 40% 20% 0%
21% 34% 56% 78% 68%

89%

100% 80% 60% 40% 20% 0%
67% 72% 71% 72% 73% 71%

66%

7th 8th 9th 10th 11th 12th Grade Grade Grade Grade Grade Grade

EC EC EC 07-08 09-10 11-12

CO 2009

CO 2011

US 2009

US 2011

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Age at First Drink
According to the Department of Family Medicine at the University of Wisconsin, drinking alcohol before the 14th birthday is associated with a four-fold increase in the risk of alcohol dependence in adulthood. 6 The local, state and national surveys all ask students how young they were when they consumed their first drink. During the 2011-2012 school year, Eagle County students were fairly consistent with their state and national counterparts at 22 percent (Figure 3).i
Figure 3. Age at First Drink The Percentage of Students that Drank Alcohol for the First Time before Age 13: Eagle County, CO and U.S., 9th-12th Grades Combined, (N=1,158) 100% 80% 60% 40% 20% 0% EC 07-08 EC 11-12 CO 2009 CO 2011 US 2009 US 2011

29%

22%

23%

19%

21%

21%

Current Alcohol Use
Local, state and national surveys also measure the percentage of students who are currently drinking alcohol. According to the 2011-2012 Eagle County survey, the percentage of students that consumed alcohol within the past 30 days increased significantly with age. By the time students were juniors and seniors, 51 and 60 percent respectively reported drinking within the past 30 days (Figure 4). The overall percentage of local high school students that recently drank alcohol was 43 percent, which is a fivepercentage point decrease from past surveys, although more years of data are needed to determine whether this is a trend. Eagle County consistently has slightly higher rates of current use than state and national students, although these may not be significant over time (Figure 5).
On the 2009-2010 Healthy Kids Colorado Survey, the question regarding “age of first drink” provided an answer choice of

i

age 14, instead of 13, so was omitted from Figure 3.

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Figure 4. Current Alcohol Use The Percentage of Students that had at Least One Drink of Alcohol during the Past 30 Days, Eagle County, 2011-2012, (N=1,808) 100% 80% 60% 40% 20% 0%
15% 39% 28% 9% 60% 51%

Figure 5. Current Alcohol Use The Percentage of Students that had at Least One Drink of Alcohol during the Past 30 days: Eagle County, CO and U.S., 9th - 12th Grades Combined, (N=1,164) 100% 80% 60% 40% 20% 0%

47%

47%

43%

41%

36%

42%

39%

7th 8th 9th 10th 11th 12th Grade Grade Grade Grade Grade Grade

EC EC EC CO 07-08 09-10 11-12 2009

CO 2011

US 2009

US 2011

Binge Drinking
Binge drinking, defined as the consumption of five or more drinks in a row, is also a question on the local, state and national surveys. Locally, the percentage of students that reported binge drinking within the past 30 days significantly increased with age. By 10th grade, nearly one-quarter of students reported this behavior, and by the 12th grade, 42 percent of students reported this behavior (Figure 6).

Figure 6. Binge Drinking The Percentage of Students that Consumed Five or More Drinks within a Couple of Hours, during the Past 30 days: Eagle County, 2011-2012, (N=1,811) 100% 80% 60% 40% 24% 20% 0% 3% 5% 15% 34% 42%

7th 8th 9th 10th 11th 12th Grade Grade Grade Grade Grade Grade

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During administation of the last three local surveys, between 28 and 32 percent of high school students reported binge
100% 80% 60% 40% 20%

drinking within the past 30 days (one in every three-to-four students) (Figure 7). Local figures are consistently higher than state and national figures, possibly indicating that a larger proportion of Eagle County students binge drink.

Figure 7. Binge Drinking The Percentage of Students that had Five or more Drinks in a Row, within the Past 30 Days: Eagle County, CO, and U.S., 9th-12th Grades Combined, (N=1,165)

31%

32%

28%

25%

22%

24%

22%

REASONS FOR THE BEHAVIOR
The data on adolescent alcohol consumption shows that this is a behavior

0%

EC EC EC 07-08 09-10 11-12

CO 2009

CO 2011

US 2009

US 2011

that starts early and progresses in severity with age. The National Institutes of Health (NIH) describes reasons for the behavior in terms of development, physiology and biology. First, it characterizes the developmental period of adolescence as defined by self-discovery and increasing independence, thus lending itself to experimentation and thrill seeking, coupled with age-appropriate impulsivity. The NIH sums it up by stating, “In a sense, just being an adolescent may be a key risk factor.“7 Local focus groups with high school students support this. ii,8 Teens described the allure of drinking alcohol and the “rush” obtained from doing something rebellious with the potential of getting caught. One teen went so far as to say “It’s like having sex when your parents are home.”9 Next, according to the NIH, young people with certain personality characteristics are more prone to alcohol use and abuse such as those that are disruptive, hyperactive, or aggressive. This is also true for teens with psychiatric issues such as anti-social behavior, depression and anxiety. Also, children of alcoholics are between 4 and 10 times more likely to become alcoholics themselves, to begin drinking at a young age, and to progress to drinking problems more quickly, in part due to heredity.10

Three local focus groups were conducted in April 2012, with a cross section of students including those considered “at risk” and those considered “leaders.”
ii

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WEB MD illustrates the social attraction for the general adolescent population. According to the site, adolescent drinking tends to occur in groups, most likely among friends, and teens do it because it feels good to be doing what others are doing, although this can lead to everyone drinking too much. The site goes on to say that alcohol reduces inhibitions, allowing the teen to feel more at ease in social situations, which reinforces the behavior.11 The social aspect was the factor most emphasized by students during local focus groups. Over and over, students described the issue of peer pressure and how drinking is linked to identity and self-esteem. Several students stated that the popular students drink and everyone wants to be associated with them. Also, there is a level of automatic acceptance if a student drinks. This is supported by a study published in Academic Pediatrics, which found that teenagers are more likely to start drinking alcohol if they have a large network of friends. The study concluded that the teens that drink also have more popular friends, and more friends who drink, than those who don’t drink.12 Adding to the pressure, focus group students said that drinking is THE social activity of the weekend. They described how nondrinkers might feel left out and even be teased or bullied. The social value and reward of drinking alcohol may be the main reason that students drink early and often. Adding to the peer pressure is the misperception that other students are drinking more often than they actually are. This is evident from the local Eagle County survey (Figure 8). This misperception exists in general and has been documented extensively by social scientists H. Wesley Perkins and Alan Berkowitz. Their research
40% 20% 0%
20% 22%20% 24% 11% 17% 5% 0 Days 9% 4% 3% 2% 20-29 Days 5% 1%

Figure 8. The Percentage of Students that Drank Alcohol on 0-30 Days During the Past 30 Days: Reported Versus Student Perception, Eagle County 2011-2012, 9th-12th Grades Combined (N=1,155) 100% 80% 60%
57% Perceived Reported

shows that young people typically think that the norms for both the frequency and the quantity of drinking among their peers are higher than they actually are.13

1 or 2 3-5 Days 6-9 Days 10-19 Days Days

All 30 Days

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The reasons for adolescent alcohol consumption are complex and the allure of social acceptance is strong. During the focus groups, when asked what would deter students from drinking, participants had a hard time coming up with answers. The most popular answer in all three groups was the school’s random drug testing program, for those that formally participate in school activities. However, students did not know whether the test included alcohol, and seemed to think their chances of getting tested were low. According to the school handbook, each week, three students of each gender (6 total) are randomly selected to provide urine samples for analysis. The handbook also lists the consequences of a positive test including suspension from the sport, community service and counseling.14 Focus group participants did not think that the potential of getting caught by a parent was a deterrant. Some participants held the belief that parents of students who drink do not care that their child is drinking. However, this is inconsistent with the Eagle County survey, in which 86 percent of students reported that their own parents or guardian felt is was either wrong (23%) or very wrong (63%) for them to drink alcohol regularly. Focus group participants also did not believe that the threat of law enforcement intervention was a
Figure 9. The Number of Citations for Underage Possession and/or Consumption of Alcohol: Eagle County Sheriff's Office, Avon Police Department, Vail Police Department and Town of Eagle Police Department combined: 2009, 2010, 2011 225 205 200 177 175 150 125 100 75 50 25 0 2009 2010 2011 141

deterrent. This was supported by the local Eagle County survey, where a question asked “If a kid drank alcohol in your neighborhood, or the area around where you live, would he or she be caught by the police?” Sixty-eight percent (68%) answered “No.” However, local law enforcment does issue tickets for underage posession and consumption. Figure 9 illustrates the number these citations between 2009 and 2011. citations in the first six months alone.
iii.15

In 2012, there were 115

These figures do not include the 2012 Snowball Music Festival in Avon, where 105 minors were cited for possession/consumption of alcohol by state liquor enforcement officers.
iii

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According to the National Institutes of Health,

the

accessiblity of alcohol is one of the greatest factors that promotes the behavior.16 On the Eagle County survey, 63 percent of students reported that alcohol (beer, wine or hard liquor) was either “sort of easy” (29%) or “very easy” (34%) to obtain. The biggest consensus on how to obtain alcohol seemed to be “friends of friends.” Students said that someone always has friends of legal drinking age who will buy alcohol or friends that know of a house party. This is consistent with the Eagle County survey.

On the local Eagle County HKCS survey, 63% was of students reported that alcohol either “sort of easy” or “very easy” to get.

Among students who drank, the most common way they reported getting alcohol was by someone giving it to them (44%). The second most common way (a distant second) was by giving money to someone to purchase it (26 percent). There was also a perception that many students knew someone with a fake ID, although only 2 percent of students reported regularly purchasing alcohol themselves, presumably with a fake ID (Figure 10) .

Figure 10. How Teens that Drink Most Commonly Obtained Alcohol Eagle County 2011-2012, Grades 9 - 12 Combined, (N=488)
100%

80%

60% 44% 40% 26% 20% 16% 7% 0%
Someone gave it to me I gave $$ to someone to purchase it for me Other

2%

2%

2%

I took it from a I bought it at a I bought it at a I bought it at a store/family store restaurant/bar public event member

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Students commented that alcohol is most likely consumed at parties in someone’s home, where it is readily available. This is consistent with the literature on underage drinking and the local Eagle County survey, where 58 percent of students who drink, reported the most common place this occurs is at someone else’s house (Figure 11). Students remarked that these parties occur in every town, with the word easily spread through text messaging. Students also said that some parents let their teenager drink with friends in their home. According to the Eagle County Survey, 21 percent of students who drink reported that their most usual location is at home. The survey didn’t measure whether parents know about the behavior. Additionally, one focus group talked about “theme parks.” These are places in the woods where teens and people in their early 20s gather to drink around a bonfire. Popular areas include Wolcott, the hills of Eagle, and Red Hill in Gypsum.

Figure 11: The Location Where Adolescents Who Drink Alcohol are Most Likely to Consume it Eagle County 2011-2012, 9th - 12th Grades Combined (N=640) 100% 80% 60% 40% 20% 0% 21% 9%
Another's Home My Home

58%

5%

3%

2%
Restaurant, Bar, Club

2%
School

Beach, Park, Motor Vehicle Public Event, Parking Lot Concert, Sports

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RECOMMENDATIONS
Alcohol consumption by teenagers is a complex behavior, motivated by a desire to fit in, and reinforced by the accessibility of alcohol and drinking activities that seem to occur every weekend. There is no so-called “silver bullet” in dealing with this problem, which is endemic to American teen culture. Although some youth may need one-on-one alcohol treatment to deal with addiction issues, for general prevention efforts, the Centers for Disease Control and Prevention recommends the use of policy as the most effective prevention method. 17 Restricting access to alcohol is one such intervention that is recommeded by many of the nation’s alcohol prevention institutions. For example, raising the minimum drinking age in all states was initially a major victory.18 Colorado’s drinking age went from 18 to 21 in 1987. According to the Joint Committee of the National Research Council and Institute of Medicine (IOM), youth usually obtain alcohol from adults, which is why the committee recommends that adults be the focus of access restriction efforts. According to the committee, the effectiveness of these types of efforts can be increased by:

§ § §

Closing gaps in alcohol restriction laws Promoting compliance through public education campaigns Strengthening enforcement

The committee states that the degree to which the target audience is aware of the laws, coupled with the intensity of enforcement efforts are two of the greatest predictors of policy effectiveness. Another important element is garnering public support, especially from law enforcement officers and community leaders.19 Closing Gaps in the Law According to the Substance Abuse and Mental Health Services Administration (SAMHSA), when easy access to alcohol has been identified locally as a major contributor to adolescent consumption, then strengthening legislation around social host liability is likely to yield good result.20 A social host is an adult that knowingly provides alcohol to minors. Social Host Liability is the legal term for the criminal and civil responsibility of a person who furnishes the liquor, if a person is underage and/or causes harm to another person.

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According to the Joint Committee, social host liability laws may deter adults from hosting underage parties and purchasing alcohol for or providing alcohol to minors. That is assuming that they know the law exists and believe it will be enforced.21 Eagle County Government is subject to the same alcohol restriction laws as the State of Colorado, which has a social host law that defines the civil liability for an adult that provides alcohol to a minor, should the minor injure himself or another.22 Municipalities and home rule counties may enact additional alcohol control laws. For example, Steamboat Springs implemented a graduated social host ordinance where the adult receives a citation has to pay a penalty for holding a party with underage drinking.23 Gaining Compliance through Public Education The Joint Committee also recommends using media to increase awareness of laws that prohibit adults from providing alcohol to minors, and drawing attention to enforcement efforts. This can further increase the effectiveness of legal approaches and may help establish or reinforce community norms against such behavior. Therefore, public education is an important part of any enforcement activities to reduce provision of alcohol to minors.24 Targeted Enforcement A major way that underage drinkers gain access to alcohol is at parties. These parties frequently involve large groups and are commonly held in a home or outdoor area. The Joint Committee recommends that local police, working with community leaders, adopt and educate about their policies for detecting and terminating such parties. For example:

§

Law enforcement can respond to noise complaints and enter the premises when there is probable cause to suspect underage drinking is taking place. Increased police activity can act as a deterrent and reinforce community norms to adults regarding the unacceptability of providing alcohol to minors.

§ §

As a part of regular weekend patrols, law enforcement can check open areas where teenage drinking parties are known to occur. Local law enforcement can also routinely cite underage drinkers and, if possible, the person who supplied the alcohol when underage drinking is observed at parties.

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DRINKING AND DRIVING
Drinking and driving can lead to serious motor vehicle crashes, which are the leading cause of death for young people, both nationally and locally.25,26,27 On average, between 1 and 3 Eagle County adolescents (ages 15-20) die in a motor vehicle crash each year and 6 are hospitalized. 28 According to the National Highway Traffic Safety Administration (NHTSA), teen drivers are more likely than adults to be involved in a serious crash given their inexperience and immaturity, plus greater likelihood to speed, drink and drive, not wear a seatbelt, and become distracted.29 Local, state and national surveys illustrate this problem behavior in terms of the percentage of teens that recently drove after drinking alcohol or rode in a motor vehicle with a driver that had been drinking. The percentage of Eagle County students that reportedly drank alcohol then drove within 30 days of the survey has been consistent over time. Between 2007 and 2012, 11 to 12 percent of students reported this behavior, at a rate nearly twice that of the state (7 percent in 2009 and 6 percent in 2011) (Figure 12). In terms of riding with a driver that had been drinking, 27 percent of local high school students reportedly engaged in this behavior within 30 days of the survey, (Figure 13). In general, there is variability on this indicator between groups and over time, so a trend is hard to discern. At all geographic levels and on any given year, between 21 and 29 percent of students in general are getting in a car with someone who has been drinking.

The Percentage of Students that Drove a Motor Vehicle after Drinking Alcohol within the Past 30 Days: Eagle County, CO and U.S., 9th -12th Grades Combined,(N=1,166) 100% 80% 60% 40% 20% 0% EC EC EC 07-08 09-10 11-12 CO 2009 CO 2011 US 2009 US 2011

Figure 12. Drinking and Driving

The Percentage of Students that in the Past 30 Days ,Rode in a Motor Vehicle Driven by Someone who had been Drinking Alcohol : Eagle County, CO and U.S., 9th-12th Grades Combined

Figure 13. Drinking and Driving

100% 80% 60% 12% 12% 40% 11% 7% 6% 10% 8% 20% 0% 21% 29% 27% 25% 28% 24%

22%

EC EC EC CO 07-08 09-10 11-12 2009

CO 2011

US 2009

US 2011

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REASONS FOR THE BEHAVIOR
The Health Alliance on Alcohol, located in the state of New Yorkiv has a driving manual, which provides a succinct overview of the reasons teens get behind the wheel after they have been drinking. including: Many are similar to the reasons that teens drink in the first place

§ § §

A sense of invulnerability and feeling that nothing bad will ever happen to them A desire to test limits and take risks A desire to fit in, thereby agreeing to drive a group of friends

Additionally, the manual sites the issue of a teen not having an alternative way to get home. This was the most prevalent reason given in every local focus group. The groups said that calling a parent for a ride was not an option, because they would get in trouble. When asked whether teens were afraid of getting stopped by the police, participants said that it depended on the student. Some students absolutely won’t drive after drinking and some are even more likely to drive due to impaired judgment. One student remarked, “The more they drink, the more they believe they won’t get caught.” Students did say that sometimes a designated driver is used, if a friend volunteers not to drink for the night.

On 11%

the of

local HKCS

Eagle survey,

County

students

reported drinking and driving within the past 30 days, and 27% reportedly rode with a driver who had been drinking, during the same time frame.

In focus groups conducted by NHTSA, some teen participants reportedly did not believe there was anything wrong with underage drinking and very little wrong with driving after having consumed just a beer or two. Many believed they could tell when they were too drunk to drive.30

The Health Alliance consists of several hospital systems located in the state of New York, in partnership with the Heineken Corporation.
iv

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RECOMMENDATIONS
Highly Visibility Impaired-Driving Crackdowns According to NHTSA, when the public knows that law enforcement is on the lookout for drivers who have been drinking, people are much less likely to drink. This has resulted in alcohol-impaired highway deaths declining by as much as 20 percent. This strategy is achieved through public education campaigns to announce that law enforcement is going to concentrate their efforts in a certain area and over a certain time frame. NHTSA notes that “Teens are at far greater risk of death in an alcohol-related crash than the overall population, despite the fact they cannot legally purchase or publicly possess alcohol in any state.” To reduce teen highway deaths, NHTSA recommends that communities implement high-visibility enforcement, not only for teens who may be drinking and driving, but also for the enforcement of underage drinking laws and graduated driver licensing laws.31 Colorado’s graduated drivers license law limits the number of underage passengers and late night driving, depending on the teen’s age and driving experience. It also includes a “Zero Tolerance” policy for drinking and driving, meaning that a teen’s license can be suspended for drinking any amount of alcohol. Graduated driver’s license laws can provide a cause for stopping young drivers to check whether they have been drinking. According to NHTSA, young drivers place a high value on their license; therefore the threat of revocation has proven to be especially effective for both the punitive and deterrent effects. 32

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MARIJUANA USE
According to the National Institute on Drug Abuse, regular marijuana use has negative effects on memory and attention, and it can significantly impact learning for teens. Marijuana is addictive through repeated use, and research shows that the likelihood of becoming addicted increases 16 percent for those who start in their teens. In addition, marijuana can be a gateway to harder drug use. 33 Local, state and national surveys illustrate this problem behavior in terms of the percentage of teens that ever used marijuana, the age of first use, current use, and use while driving.

Ever-Used Marijuana
In the Eagle County survey, administered during the 2011-2012 school year, the percentage of students that reported ever-using marijuana began to increase dramatically after 7th grade. By the time students began high school, 22 percent had tried it. By senior year, this increased to 61 percent (Figure 14). The percentage of Eagle County students in grades 9 12 that reported they had ever used marijuana (39% in 2011-2012) is fairly consistent with the state and nation (40% each) (Figure 15).

Figure 14. Ever Used Marijuana The Percentage of Students that Ever
80% 60% 40% 22% 20% 4% 0% 7th 8th 9th 10th 11th 12th Grade Grade Grade Grade Grade Grade 13% Used Marijuana: Eagle County, Grades 7 - 12, 2011-2012, (N=2,032) 100% 61% 50% 31% 80% 60% 40% 20% 0%

Figure 15. Ever Used Marajuana The Percentage of Students that Ever Used Marijuana: Eagle County, CO, and U.S., 9th -12th Grades Combined

37%

40%

39%

43%

40%

37%

40%

EC EC EC CO CO US US 07-08 09-10 11-12 2009 2011 2009 2011

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Age at First Use
The percentage of Eagle County high school students that reportedly used marijuana before age 13 has decreased over the past three surveys, from 12 percent in 2007-2008, to 6 percent in 20112012. State and national figures have been consistent at 8 or 9 percent (Figure 16).
100% 80% 60% 40% 20% 0% EC EC EC CO 07-08 09-10 11-12 2009 CO 2011 US 2009 US 2011 12% 9% 6% 8% 9% 8% 8% Figure 16. Age at First Use of Marajuana The Percentage of Students that Used Marijuana for the First Time Before Age 13: Eagle County, CO, and U.S., 9th -12th Grades Combined

Current Use of Marijuana
The local, state and national surveys ask students whether they have used On the marijuana in the past 30 days.

2011-2012 Eagle County survey, current use of marijuana increased significantly with age, beginning between 7th and 8th grade. By 11th and 12th grade, 27 and 29 percent of students respectively, reported using marijuana within 30 days of the survey (Figure 17). The overall percentage of local high school students that recently used marijuana was 21 percent, and has remained consistent over the past three surveys. Usage in Eagle County is similar to Colorado (22 percent in 2011) and the US (23 percent in 2011) (Figure 18).

Figure 17. Current Use of Marijuana The Percentage of Students that Reported using Marijuana during the Past 30 Days, Eagle County, 2011-2012 (N=2,002) 100% 80% 60% 40% 20% 0% 2% 14% 19% 27% 29%

Figure 18. Current Marijuana Use The Percentage of Students that used Marijuana during the Past 30 Days: Eagle County, CO and US, 9th - 12th Grades Combined, (N=1,164) 100% 80% 60% 40% 20% 0%
22% 21% 21% 25% 22% 21% 23%

7%

7th 8th 9th 10th 11th 12th Grade Grade Grade Grade Grade Grade

EC EC EC 07-08 09-10 11-12

CO 2009

CO 2011

US 2009

US 2011

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In 2012, the Centers for Disease Control and Prevention reported that for the first time nationally, the use of marijuana by teens had surpassed the use of cigarettes. 34,35 This switch occurred earlier in both Eagle County and Colorado.36.37 In 2011-2012, 18 percent of Eagle County high school students reported recently smoking cigarettes, while 21 percent reported recently smoking marijuana (Figure 19).

The Percentage of Students that Reported Using Marijuana and the Percentage of Students that Reported Smoking Cigarettes during the Past 30 Days: Eagle County, CO, and U.S., 9th - 12th Grades Combine 100%

Figure 19. Current Use of Marijuana Versus Cigarettes

80% Marijuana 60% Cigarettes 40% 22% 22% 21% 19% 21% 25% 18% 18% 22% 16% 21% 20% 23% 18%

20%

0% EC 07-08 EC 09-10 EC 11-12 CO 2009 CO 2011 US 2009 US 2011

According to the CDC, for decades, the number of teens who smoke cigarettes has been on the decline. The National Institute on Drug Abuse (NIDA) says that rising marijuana use nationally and decreasing use of cigarettes may reflect changing perceptions and attitudes. According to NIDA, “As the perception of risks goes down, use goes up (and vice versa). Young people are showing less disapproval of marijuana use and a decreased perception that marijuana is dangerous.”38 This finding is consistent with local focus groups in which students said that teens don’t know the consequences of smoking marijuana. According to one teen, “Adults say it is bad for you, but they never say why.” A second student observed that marijuana is not like harder drugs and cigarettes, where “everyone knows why they shouldn’t use them.”

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Driving after Marijuana Use
According to the National Institute on Drug Abuse, marijuana affects a number of skills required for safe driving, including alertness, concentration, coordination, and reaction time. Marijuana makes it hard to judge distances and react to signals and sounds on the road. In addition, combining marijuana with drinking increases the risk of a crash, more so than either drug alone.39 The National Highway Transportation and Safety Administration describes how adolescents have more risk factors for a crash anyway, due to their inexperience and greater likelihood to speed and become distracted.40 During percent the of 2011-2012 Eagle which school year, 10
Figure 20. Driving After Marijuana Usage The Percentage of Students that Drove during the Past 30 days after Smoking Marijuana: Eagle County and CO, 9th-12th Grades Combined 100% 80% 60% 40% 20% 0% EC 07-08EC 09-10EC 11-12CO 2009CO 2011 14% 12% 10% 13% 11%

County is

high

school to the

students reported driving after smoking marijuana, similar percentage that reportedly drove after drinking, (11 percent). trend with small There may be a over time; decreases

however more data is needed to confirm this. Local figures are consistent with state figures, which were 13 percent in 2009 and 11 percent in 2011 (Figure 20). Comparable data nationally is not available.

REASONS FOR THE BEHAVIOR
The literature on substance abuse and marijuana use by teens generally describes the reasons for the behavior as multifactorial, involving a complex interplay among genetic, psychological, and social determinants that end up serving as either “risk” or “protective” factors. 41 , 42 Risk factors can include characteristics of youth, their peers, and their environment (e.g. school, family, community) that if present, make it more likely that they will engage in problem behaviors. Protective factors such positive family dynamics and peer interactions, plus school engagement have been shown to reduce the likelihood that youth will participate in risky behaviors. The more risk factors youth are exposed to, the more problem behaviors they are likely to exhibit.43

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This is consistent with the national Healthy People 2020 initiative, which states that because adolescents are in developmental transition, they are particularly sensitive to influences regarding their family, peer group, school, neighborhood, policies, and societal cues (i.e. media or community norms). These can either support or challenge their health and well being.44 The Journal of Adolescent Health provides example of risk factors that correlate with substance abuse among teens, such as a low level of engagement in school, affiliation with antisocial peers, parental substance use, family conflict, and/or poor family management. The National Institute on Drug Abuse lists additional risk factors such as prior physical and/or sexual abuse, which makes teens at greater risk of using marijuana and other drugs, and of beginning drug use at an early age. 45 According The Journal of Mental Health, adolescent substance use, including the use of marijuana, is higher among teens diagnosed with attention-deficit/hyperactivity disorder, and conduct disorder.46 These findings are consistent with studies by NIDA, where teens say they use marijuana to cope with feelings of anxiety, anger, depression, boredom and so on. Because teens sometimes use marijuana to cope psychologically, it is no surprise that marijuana use also correlates with other risk–taking behaviors such as alcohol abuse and cigarette smoking. 47 Teens that use marijuana regularly can become dependent, which then becomes their primary reason for using the drug. 48 Unlike alcohol use, peer pressure may not play as big a role for the general student population. While students may be peer pressured into trying marijuana for the first time, and within certain peer groups to keep using it, a stigma exists for students perceived to use it “too much.” According to local focus groups, while alcohol use is seen as “normal,” when it comes to marijuana use, it depends on how much someone uses. Students said that if someone smokes a lot, they are labeled a “pot head.” As stated earlier, teens may also not know about or not believe there are health risks from using marijuana. On the Eagle County survey, over 1/3 of students felt that marijuana use was either “only a little big wrong” (21%) or “not wrong at all (13%) (N=1,275). Similarly, when asked how much people that use marijuana risk harming themselves (physically or in other ways), over 1/3 of students felt there was only a “slight risk” (19%) or “no risk” at all (16%) (N=1,274).

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Drug Access
Marijuana seems to be easy to obtain. According to the Eagle County survey, 55 percent of students reported that marijuana was either “sort of easy” (21%) or “very easy” (34%) to get. Figure 21 displays how students that used marijuana with in 30 days of the survey “usually” obtained it. Forty-three percent (43%) said that someone gave it to them. This is consistent with local focus groups in which student said there is always someone around that has it, and people who smoke know who they are; some sell it and some share it. When asked if teens ever obtain marijuana from a dispensary, the students said they didn’t know.
Figure 21. How Students Obtain Marijuana Where Students that Used Marijuana within 30 Days of the Survey Usually Obtain It: Eagle County 2011-2012, 9th - 12th Grades Combined 100% 80% 60% 43% 40% 20% 0% 9% 35%

4%

4%
At School

<4%
From a Family Member Other

Someone Gave it From Someone At a Public Event: with a Medical Party, Bar, Club, To Me Marijuana Card Restaurant, Concert, or Sporting

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Focus groups were also asked about where students are most likely to use marijuana. The groups answered the skate park, the woods, other parks, and in someone’s car. A couple of students also said that sometimes parents are “cool” with it, so teens smoke at home, and some even smoke with their parents. This is somewhat inconsistent with the Eagle County survey that asked, “How wrong do your parents or guardians feel it would be for you to use marijuana?” Ninety percent (90%) of students answered that their own parent or guardian thought it was either “wrong” (13%) or “very wrong” (77%) (N=1,277). Also, there does not seem to be a perception of community complacency around the issue of marijuana use as 89 percent of students reported that most adults in the neighborhood or areas around where they live think it is either “wrong” (27%) or “very wrong” (62%) for kids their age to use marijuana. When asked what would be a deterrent to marijuana use, the focus groups all remarked about the drug testing that happens at Battle Mountain High School and the Vail Ski and Snowboard Academy for students in activities. Some students said that even teens that smoke marijuana regularly will give it up during their activity season so they don’t get caught through a drug test. A student from the Vail Ski and Snowboard Academy said that failing a drug test would get a student kicked out of school. Students in one focus group said that there needs to be more drug testing. Also, most students said they had never heard of anyone being tested. However, according to the Battle Mountain High School Handbook, three students of each gender (6 total) are randomly selected weekly to provide urine samples for analysis. The handbook also lists the consequences of a positive test including suspension from the sport, community service and counseling.49 Although students didn’t mention the fear of being caught by law enforcement as a deterrant, posession of marijuana and paraphenalia is against the law. Figure 22 provides the number of minors arrested between 2009 and 2011 by law enforcement agencies in the Eagle River Valley. In 2012, there have already been 60 arrests of this type.50
100 80 60 40 20 0 2009 2010 2011 74 77 68
Figure 22. Number of Minors Arrested for Posession of Marijuana and/or Paraphenlia: Eagle County Sheriff's Office, Vail Police Department, Avon Police Department, and Town of Eagle Police Department, 2009, 2010, 2011

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RECOMMENDATIONS
There are no easy answers when it comes to the prevention of marijuana use. Healthy People 2020 recommends “promoting activities that assist in the positive development of young people to prevent them from engaging in risky behaviors.”51 Eagle County does have programs like the Youth Foundation and Snowsports Outreach Society that focus on developing protective factors through sports and other activities. Research from the NIDA has also found that high school students who exercise regularly are less likely to smoke cigarettes or marijuana. According to NIDA, exercise improves the tolerance of stress in animal studies. Also, NIDA states that the initiation of substance abuse may be countered by the support of teammates, coaches, and family, other social aspects of participation in organized activities, and by the time management skills that active teens develop.”52 The Journal of Adolescent Health states that that generally, risk factors are more influential than protective factors, so prevention efforts may need to consider the root causes of risk factors, such as a low income, the cycle of family substance abuse, and childhood abuse and neglect. The Eagle County survey does measure student protective factors in the areas of school engagement, and family dynamics. During the 2011-2012 school year, over 90 percent of local students reported positive school engagement with goals for the future. These included finishing high school (97%), going to college (92%), and having a successful job or career (96%). A high percentage of students (87%) also reported that clear rules were set within their family, which is also a positive factor. A couple of indicators were a little less positive. Almost one-quarter of students indicated some disconnect with their parent or guardian reporting they did not feel like they could ask for help if they had a personal problem or they thought opportunities to participate in “fun” activities with their parent or guardian were lacking (Figure 23). Figure 23: Protective Factors Measured on the Eagle County HKCS

§ § § § § §

The rules in my family are clear: 87% YES, 13% No If I had a personal problem, I could ask my parents or guardians for help: 77% YES, 23% NO My parents or guardians give me lots chances to do fun things with them: 76% YES, 24% NO How important is it to you to finish high school? 97% IMPORTANT, 3% NOT IMPORTANT How important is it to you to go to college? 92 % IMPORTANT, 7% NOT IMPORTANT How important is it to you to be successful in a job or career? 96% IMPORTANT, 3% NOT IMPORTANT

* Note: Percentages may not add to 100 due to rounding.

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If youth serving organizations want to more formally promote protective factors, the Search Institute’s Developmental Assets model is a good method to do so. The model is based on extensive research over 20 years that has identified the basic building blocks of positive development for children, in a variety of age groups and settings (family, school, neighborhood, etc.). The Institute offers tools to measure assets, a list of age appropriate assets, and strategies to build them. organizations locally: § Service learning § Peer helping § Mentoring § Creative activities (art, theater, music, etc.) § Sports and athletics § Camping53 According to Search, four of the outcomes most commonly sought after by youth-serving programs are 1) promoting school success; 2) preventing violence, bullying, and aggression; 3) preventing the use of alcohol, tobacco, and other drugs; and 4) preventing adolescent pregnancy. Studies conducted by the Institute repeatedly show that the total number of assets young people have is linked to these outcomes, and that asset building works best when it improves young people’s developmental experiences across all parts of their lives. The studies also highlight which of the 40 Developmental Assets identified by Search may be most critical for influencing each specific outcome, such as substance abuse.54 Examples of activities that the Search Institute recommends include the following, many of which are already aspects of youth serving

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PHYSICAL ACTIVITY AND NUTRITION
Regular physical activity and good nutrition are the building blocks of a long and healthy life. Conversely, poor eating habits and a sedentary lifestyle are the main contributors to serious health problems over time, including diabetes, heart disease, stroke, and certain cancers. All of these health issues are among the leading causes of death.55 According to the American Psychological Association (APA), establishing healthy eating and exercise habits early in life can lead to long-term healthy behavior in adulthood.56

Prevalence of Overweight and Obesity
Overweight and obesity are terms used to describe ranges of weight that are greater than what is considered healthy for a given height. The staggering increase in overweight and obese individuals, including children, over the past 20 years has alarmed health experts. The American Heart Association says the number has reached epidemic proportions.57 In 2004, the Surgeon General told a Senate committee that the increasing rates of obesity, unhealthy eating habits, and physical inactivity, may result in today’s children being the first generation to have a shorter life expectancy than their parents.58 In the United States, 36.4 percent of adults are overweight and another 35.7 percent are obese.59 This means that only 28 percent are of a normal weight. percent have Comparatively, while 36.2 of Colorado lowest adults are of
100% 80% 60% 40% 20% 0% Eagle County Colorado U.S.
32.0% 10.5% 36.2% 20.1% 36.4%35.7% Figure 24: Overweight and Obesity The Percentage of Adults that are Overweight or Obese, Based on Body Mass Index, Eagle County and CO 2009-2010; US 2010 Overweight Obese

likewise overweight, the state does the percentage obese residents in the country, at 20.1 percent. However, this rate has doubled 1995.60,61 from 10.1 percent in

Eagle County has less of a severe weight problem than Colorado, with 32 percent of residents that are overweight and 10.5 percent that are obese. The culture of health and fitness in an area known for its recreational amenities may be the main reason for the difference. Figure 24 provides a comparison of overweight and obesity at local, state and national levels.

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Overweight Adolescents Eagle County and Colorado high school students appear to be leaner than their national counterparts, at 10 percent and 11 percent respectively, compared to the US at 15 percent (Figure 25). In Eagle County, the 2011-2012 school year was the first time that the HKCS recorded this measurement. Obese Adolescents Local and state data indicate a significantly less obese population of students than exists nationally. During 2011-2012, Eagle County’s rate of obesity among 9th – 12th graders was 4 percent, compared with Colorado at 7 percent, and the US at 13 percent (Figure 26). School year 2011-2012 was the first time that the local HKCS recorded this measurement.
Figure 25. Overweight Percentage of Overweight Students Eagle County, CO, US, 9th - 12th Grades Combined 100% 80% 60% 40% 10% 11% 11% 16% 15% 20% 0% EC 11-12 CO 2009 CO 2011 US 2009 US 2011 4% 7% 12% 13% Figure 26. Obesity The Percentage of Obese Students Eagle County, CO, and the US 9th - 12th Grades Combined

100% 80% 60% 40% 20% 0%

7%

EC 11-12 CO 2009 CO 2011 US 2009 US 2011

Even though Eagle County has comparatively less high school students that are overweight or obese, there are many good reasons to work with youth early to establish habits that will promote a healthy weight as an adult. According to the APA, good nutrition and plenty of exercise are the foundations for strong growth, healthy development, and lifelong wellbeing for children. In addition, the AMA says that children who exercise regularly and eat healthy are likely to:

§ § § §

Perform better academically Feel better about themselves, their bodies, and their abilities Cope with stress and regulate their emotions better Avoid feelings of low self-esteem, anxiety, and depression.62

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Behaviors
Developing the healthy habits of regular exercise and eating nutritiously is key to maintaining a healthy weight. The local, state and national surveys all ask questions about behaviors that either contribute to or prevent an individual from becoming overweight or obese. These include daily levels of physical activity, fruit and vegetable consumption and the consumption of soda pop. While the nutrition questions aren’t comprehensive in nature, they do serve as proxy measures for healthy or unhealthy eating habits. Physical Activity According to the CDC, regular physical activity has multiple benefits. First, it promotes healthy physical development and decreases the likelihood of developing chronic diseases later in life.63 Also, it increases self-esteem, reduces anxiety and stress, and may reduce risktaking behaviors such as cigarette smoking, illegal drug use, and sexual intercourse. 64 Guidelines from the US Department of Health and Human Services recommend that adolescents engage in 60 minutes or more of physical activity per day.65 In Eagle County, 50 to 56 percent of students in grades 7-12 reported being physically active for a total of 60 minutes or more per day, during 5 out of 7 days prior to taking the survey. There was little variation by grade (Figure 27). The percentage of local high school students overall that exercised at this level was similar to the state and nation at 52, 53,and 50 percent respectively (Figure 28). It is unclear why the 2009-2010 data is so variable on the local and national levels. v
The Percentage of Students Physically Active for at Least 60 Minutes Per Day on 5+ of the Past 7 Days: Eagle County, 2011-2012

Figure 27. Physical Activity

100% 80% 60% 40% 20% 0% 7th 8th 9th 10th 11th 12th Grade Grade Grade Grade Grade Grade 56% 53% 53% 54% 50% 52% 100% 80% 60% 40% 20% 0%

The Percentage of Students who were Physically Active for 60+ minutes Per Day on 5 or More of the Past 7 days: Eagle County, CO and US, 9th - 12th Grades Combined

Figure 28. Physical Activity

52% 35%

55%

53% 37%

50%

EC 09-10

EC 11-12

CO 2009

CO US 2009 US 2011 2011

v Local data from 2007-2008 were not used because there were not enough survey responses to make the results meaningful.

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Interscholastic sports are a good way to help students get the recommended level of physical activity they need. Additionally, this type of activity offers students of all skill levels an equal chance to participate.66 In Eagle County during the 2011-2012 school year, a majority of high school students played on at least one sports team. This was highest in 7th grade at 81 percent, and decreased with age to 59 percent and 61 percent respectively in 11th and 12th grades (Figure 29). Eagle County appears to have a significantly higher percentage of students that play on sports teams than students nationally, at 68 percent and 58 percent respectively, during the 2011-2012 school year. (Local data is not available prior to 2011). Colorado’s 2011 percentage of 63 percent is in between Eagle County and the US (Figure 30).

Figure 29. Played on a Sports Team The Percentage of Students who Played on 1+ Sports Teams during the Past 12 Months, Eagle County, 2011-2012

100% 80% 60% 40% 20% 0% 81% 76% 76%

Figure 30. Played on a Sports Team The Percentage of Students who Played on 1+ Sports Teams during the Past 12 Months: Eagle County, CO and the US, 9th - 12th Grades Combined 

100% 68% 59% 80% 60% 40% 20% 0%
EC 11-12 CO 2009 CO 2011 US 2009 US 2011

61%

68%

64%

63%

58%

58%

7th 8th 9th 10th 11th 12th Grade Grade Grade Grade Grade Grade

Sedentary Activities Watching TV and playing video and/or computer games are considered sedentary activities. Engaging in too much sedentary activity may interfere with a youth’s opportunity to be involved in physical activity and prevent them from developing the long-term habit of regular exercise. The local, state and national surveys ask questions regarding the types of sedentary behaviors that youth engage in for three or more hours per day, on a school day. At this level, the adolescent may not be getting the recommended level of daily physical activity.

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Watching TV Students in both Eagle County and Colorado appear to watch significantly less TV than their peers nationally. During the 2011-2012 school year, 21 percent of Colorado students and 24 percent of Eagle County students reported watching TV three or more hours per day, compared to the US at 32 percent (Figure 31).vi Playing Computer and Video Games During the 2011-2012 school year, students in Eagle County and Colorado were also significantly less likely to play video or computer games or use a computer for something that unrelated to school work, for more than three hours at a time on a school day. Locally, 22 percent of students, compared to 24 percent of Colorado students and 31 percent of students nationally, reported this sedentary behavior (Figure 32). Both Colorado and the US experienced a six-percentage point increase over the previous survey, and this question was not asked in Eagle County earlier than 2011/2012. More years of data are needed to determine whether there is a true difference in behaviors between the groups.
Figure 31. TV Watching Figure 32. Video Games/Computer Usage

The Percentage of Students that Watched TV 3+ Hours Per Day on an Average School Day: Eagle County, CO and US, 9th - 12th Grades Combined

100% 80% 60% 40% 20% 0% 20% 24% 25% 21% 33% 32%

The Percentage of Students that Played Video or Computer Games/Used a Computer for NonSchool Activities 3+ Hours Per Day on an Average School Day, Eagle County, CO and US, 9th-12th Grades Combined

100% 80% 60% 40% 20% 0% 22% 18%

 

24%

25%

31%

EC 09-10 EC 11-12 CO 2009 CO 2011 US 2009 US 2011

EC 11-12 CO 2009 CO 2011 US 2009 US 2011

This same question was asked in the Eagle County 2007-2008 survey, but there were not enough responses to make the results valid, so the data was not included in this chart.
vi

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Nutrition Soda Consumption A report from the Center for Science in the Public Interest calls soda pop “liquid candy,” say that carbonated soft drinks are the single biggest source of calories in the American diet, and that teenagers get 13 percent of their calories from carbonated and noncarbonated soft drinks per day. The average teenage boy is getting approximately 15 teaspoons of refined sugars and the average girl about 10 teaspoons from these beverages. These amounts are roughly equal to the government's recommended daily limits for teens' sugar consumption from all foods. Soft drinks are also a problem for what they push out of the diet, such as milk.67 According to a study by the University of Louisiana, the consumption of sugar-sweetened beverages has increased steadily over the past century, lending itself to risk factors of overweight, diabetes and cardiometabolic disease. These drinks increase the carbohydrate load and amounts of dietary fructose.68 According to the Obesity Prevention

Center at Children's Hospital in Boston, many children are consuming 300 or more calories per day in sweetened beverages. These children would have to do two hours of moderate exercise to burn the equivalent amount of calories.69 In Eagle County, the percentage of students that reported drinking at least one soda pop per day, during the 2011-2012 school year, ranged from 14 percent among 7th graders to 23 percent among 12th graders. This behavior seemed to increase with age, beginning in 9th grade, although consumption was lower among 11th graders at 17 percent (Figure 33).

Figure 33. Soda Consumption The Percentage of Students who Drank 1+ Cans/ Glasses/Bottles of Soda Per Day during the Past Seven Days, Eagle County, 2011-2012 100% 80% 60% 40% 20% 0% 14% 16% 20% 21% 17% 23%

7th Grade 8th Grade 9th Grade 10th Grade11th Grade12th Grade

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During the 2011-2012 school year, Eagle County students consumed significantly less soda pop than their national
100% 80% 60% 40% 20% 0%

counterparts. Twenty percent (20%) of local students reportedly drank one or more cans/glasses/bottles of soda per day, during the seven days before the survey, compared to Colorado at 23 percent and the US at 28 percent (Figure 34). The question regarding soda consumption was not asked in previous years on the Eagle County survey. Vegetable Consumption The Centers for Disease Control and Prevention recommends that adolescents consume at least three servings of vegetables per day. Only 17 percent of Eagle County high school students reportedly met this

Figure 34. Soda Consumption The Percentage of Students who Drank 1+ Cans/Glasses/Bottles of Soda Per Day during the Past Seven Days: Eagle County, 2011-2012  

20%

25%

23%

29%

28%

EC 11-12

CO 2009

CO 2011

US 2009

US 2011

100% 80% 60% 40% 20% 0%

Figure 35. Vegetable Consumption The Percentage of Students who Consumed Vegetables 3+ Times Per Day during the Past Seven Day, Eagle County, 2011-2012  

recommendation during the 2011-2012 school year. This was similar to the state at 16 percent in 2009, and the US at 15 percent in 2011 (Figure 35). This question was not asked on previous Eagle County surveys or the 2011 statewide survey.

17%

16%

14%

15%

EC 11-12

CO 2009

US 2009

US 2011

REASONS FOR THE BEHAVIORS
Americans are less active than they once were. Automation, computers, satellite TV and video games are more and more prevalent, and unless individuals make a specific effort to exercise, it is all too easy to live a completely sedentary life. In addition, the American diet has changed. Americans are eating more highly processed foods, and more fast foods, most of which are loaded with sugars and fats.70,71 According to the US Department of Health and Human Services, convenience has become one of the main criteria for

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American’s food choices. This means the consumption of more away-from-home quick service or restaurant meals or ready-to-eat, low cost, quickly accessible meals prepared at home. Research shows that children and adolescents are also eating more food away from home, drinking more sugar-sweetened drinks, and snacking more frequently.72 In a spring 2012 focus group at Battle Mountain High School (BMHS), students seemed to agree with this. They indicated that local adolescents might not eat as healthy as they should because unhealthy food is easy to get in school vending machines and the neighborhood gas station, plus it is cheaper to buy. They also said that teens may not have control over what their parents buy at the grocery store, and also that it is difficult to change bad habits. Students were also asked how peers not on the high school’s sport teams were able to get regular exercise. The group said that those not on sports teams exercise if they have a hobby that is a sport, such as snowboarding, but they aren’t intentional about doing it for health reasons like adults. The group said some students also participate in recreational sports like soccer, which is widely available in the county. In fact, one of the teachers at BMHS offers an informal chance to play soccer over lunch. The teacher states that normally, 50 or so students show up.73

RECOMMENDATIONS
The Centers for Disease Control and Prevention has initiated the Common Community Measures for Obesity Prevention Project to identify and recommend a set of 24 strategies that communities and local governments can implement toward addressing overweight and obesity. The following have been included in this report for their potential relevance to Eagle County. 1. Communities Should Restrict the Availability of Less Healthy Foods and Beverages in Public Service Venues: Less healthy foods and beverages include those with a high calorie, fat, sugar, and sodium content, and a low nutrient content. According to the CDC, Less healthy foods are more available than healthier foods in US schools. The availability of less healthy foods in schools is negatively associated with fruit and vegetable consumption and positively associated with fat intake among students. Therefore, restricting access to unhealthy food options is one component of a comprehensive plan for better nutrition.

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According to the CDC, schools can restrict the availability of less healthy foods by: § § § § Setting standards for the types of foods sold Restricting access to vending machines Banning snack foods and food as rewards in classrooms Prohibiting food sales at certain times of the school day, or changing the locations where unhealthy competitive foods are sold Other youth-oriented public service venues that could also restrict the availability of less healthy foods include after-school programs, regulated childcare centers, and community recreational facilities (e.g., parks, recreation centers, playgrounds, and swimming pools). 2. Communities Should Increase the Availability of Healthier Food and Beverage Choices in Public Service Venues: Limited availability of healthier food and beverage options can be a barrier to healthy eating and drinking. Healthier food and beverage choices include low energy dense foods and beverages with low sugar, fat, and sodium content. According to the CDC, schools are a key venue for increasing the availability of healthier foods and beverages for children. The Eagle County RE 50 School District recently started the Fresh Approach program, which includes a menu of scratch-cooked items and fresh produce to replace highly processed food options in school lunches. After piloting in the elementary schools, the program was implemented district-wide during the 2012-2013 school year. Other youth-oriented public service venues that could also offer healthier foods include after-school programs, childcare centers, and community recreational facilities (e.g., parks, playgrounds, and swimming pools). 3. Communities Should Discourage the Availability and Consumption of Sugar-Sweetened Beverages in Public Service Venues: According to the CDC, consumption of sugar-sweetened beverages occurs most often in the home; however, schools and childcare centers also contribute to the problem either by serving sugar-sweetened beverages or by allowing children to purchase sugar-sweetened beverages from vending machines. Policies that restrict the availability of sugar-sweetened beverages and 100% fruit juice in schools and childcare centers may serve to discourage the consumption of high-caloric beverages among children and adolescents.

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4. Communities Should Require Physical Education in Schools School-based physical education (PE) class increases students' level of physical activity, improves physical fitness, and is a key strategy in assuring youth get the recommended levels of physical activity per day. 5. Communities Should Increase the Amount of Physical Activity in PE Programs in Schools Time spent in PE classes does not necessarily mean that students are physically active the whole time. Increasing the amount of physical activity in school-based PE has been demonstrated to be effective in increasing fitness among children. For example, increasing the number of children moving as part of a game or activity (e.g., by modifying game rules so that more students are moving or by changing activities so all participants stay active), and increasing the amount of moderate to vigorous activity during class time are effective strategies for increasing physical activity. 6. Communities Should Increase Opportunities for Extracurricular Physical Activity Opportunities for extracurricular physical activity outside of school hours can complement formal PE class. This strategy focuses on noncompetitive opportunities such as games and dance classes available through community and after-school programs. According to the CDC, research has demonstrated that after-school programs that provide opportunities for extracurricular physical activity increase children's level of physical activity and improve other obesity-related outcomes. 7. Communities Should Zone for Mixed-Use Development Zoning for mixed-use development is one type of local land use policy that allows residential and commercial land uses to be located in close proximity to one another. Mixed-use development decreases the distance between destinations (e.g., home and shopping), thereby decreasing the number of trips persons make by automobile and increasing the number of trips persons make on foot or by bicycle. Zoning regulations that accommodate mixed land use could increase physical activity by encouraging walking and bicycling trips for non-recreational purposes.

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ENDNOTES
1 Healthy Kids Colorado Survey, Eagle County RE-50 School District: 2007-2008 Results, 2009-2010 Results, and 2011-2012 Results. Prepared by OMNI (Denver, CO) for the Eagle River Youth Coalition. Available online: http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf 2 Healthy Kids Colorado Survey, Colorado High School Survey, 2009, 2011. Prepared by OMNI (Denver, CO). Available online: http://collaboration.omni.org/sites/hkc/Data%20Tables%20and%20Results/Forms/Front%20Page.aspx 3 Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance, 2009. Morbidity and Mortality Weekly, June 4, 2010 / Vol. 59 / No. SS-5. Available online: http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf; Youth Risk Behavior Surveillance, 2011 Morbidity and Mortality Weekly, June 8, 2012/ Vol. 61 / No. 4. Available online: http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf 4 Centers for Disease Control and Prevention, “Alcohol and Public Health Fact Sheet: Underage Drinking.” Available online: http://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm (Last updated July 20, 2010). 5 U.S. Department of Health & Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert Number 67, January 2006. 6 M.P. Mundt, “The Impact of Peer Social Networks on Adolescent Alcohol Use Initiation,” Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, (July 2011). Available online: http://www.sciencedirect.com/science/article/pii/S1876285911001355 7 U.S. Department of Health & Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert Number 67, January 2006. 8 Local Focus Groups: Project Toward No Drug Abuse Class, Battle Mountain High School, Scott CanepaTeacher, 4/11/2012 and 4/25/2012; Eagle River Youth Coalition, Youth Leaders Council, 4/26/2012, Eagle, CO. 9 Local Focus Groups: Project Toward No Drug Abuse Class, Battle Mountain High School, Scott CanepaTeacher, 4/11/2012 and 4/25/2012; Eagle River Youth Coalition, Youth Leaders Council, 4/26/2012, Eagle, CO. 10 U.S. Department of Health & Human Services, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Alcohol Alert Number 67, January 2006. 11 WEB MD website: “Teen Health, Teens and Alcohol.” Available online: http://teens.webmd.com/teens-and-alcohol 12 The Partnership at DrugFree.Org, “Teens More Likely to Drink When They Have Large Networks of Friends,” September 22, 2011. Available online: http://www.drugfree.org/join-together/alcohol/teensmore-likely-to-drink-when-they-have-large-networks-of-friends. Citing the following study: Academic Pediatrics, Volume 11, Issue 5, September–October 2011, Pages 414–421 13 National Social Norms Institute at the University of Virginia website: “Research-Primary Topics, Theory.” Available online: http://www.socialnorms.org/Research/Theory.php 14 Battle Mountain High School Handbook, 2011-2012, “BMHS Random Drug Testing Policy,” pp.13-14 15 Jacob Best, Deputy Sheriff, Eagle County Sheriff’s Department and Gore Range DUI Task Force Director. (Database accessed July 2012). 16 R.J. Bonnie, M. E. O'Connell, National Research Council and Institute of Medicine Committee on Developing a Strategy to Reduce and Prevent Underage Drinking: Board on Children, Youth, and Families. “Reducing Underage Drinking: A Collective Responsibility,” (2004). ISBN: 0-309-51187-9, (2004). Available online: http://www.nap.edu/catalog/10729.html

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17 T. Friedan, Director, Centers for Disease Control and Prevention, “A Framework for Public Health Action: The Health Impact Pyramid,” American Journal of Public Health | April 2010, Vol. 100, No. 4 18 R.J. Bonnie, M. E. O'Connell, National Research Council and Institute of Medicine Committee on Developing a Strategy to Reduce and Prevent Underage Drinking, Board on Children, Youth, and Families. “Reducing Underage Drinking: A Collective Responsibility,” (2004). 19 Ibid. 20 Substance Abuse and Mental Health Services Administration Website: “Selecting Policy Strategies: Ensuring Fit.” Available online: http://captus.samhsa.gov/access-resources/selecting-policy-strategiesensuring-fit 21 R.J. Bonnie, M. E. O'Connell, National Research Council and Institute of Medicine Committee on Developing a Strategy to Reduce and Prevent Underage Drinking: Board on Children, Youth, and Families. “Reducing Underage Drinking: A Collective Responsibility,” (2004). 22 National Highway Traffic Safety Administration, Digest of Impaired Driving & Selected Alcohol Beverage Control Laws, Colorado. Available online: http://www.socialhostliability.org/NHTSA/Colorado.pdf 23 The Excellence Project, Model Social Host Liability Ordinance-Steamboat Springs, Colorado 24 R.J. Bonnie, M. E. O'Connell, National Research Council and Institute of Medicine Committee on Developing a Strategy to Reduce and Prevent Underage Drinking: Board on Children, Youth, and Families. “Reducing Underage Drinking: A Collective Responsibility,” (2004). ISBN: 0-309-51187-9, (2004). Available online: http://www.nap.edu/catalog/10729.html 25 National Vital Statistics Reports, “Deaths: Leading Causes for 2008,” Volume 60, Number 6, June 6, 2012. Available online: http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_06.pdf 26 National Highway Traffic Safety Administration website: A Comprehensive Approach to Teen Driver Safety. Available online: http://www.nhtsa.gov/Teen-Drivers 27 Colorado Department of Public Health and Environment, Colorado Health Information Dataset, (Data Query July 2012): Mortality Rates, Ages 15- 20, 2007-2011, Eagle County.” Performed by Jill Hunsaker Ryan, MPH 28 Ibid. 29 National Highway Traffic Safety Administration website: A Comprehensive Approach to Teen Driver Safety. Available online: http://www.nhtsa.gov/Teen-Drivers 30 National Highway Traffic Safety Administration website: A Comprehensive Approach to Teen Driver Safety. Available online: http://www.nhtsa.gov/Teen-Drivers 31 US. Department of Transportation, National Highway Traffic Safety Administration: “Technical Summary: Determine Why There Are Fewer Young Alcohol-Impaired Drivers,” September 2001, Available online: http://www.nhtsa.gov/people/injury/research/feweryoungdrivers/index.htm#toc 32 Ibid. 33 US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, “Marijuana Facts for Teens.” Available online: http://www.drugabuse.gov/publications/marijuana-facts-teens/some-things-to-think-about 34 CBS News Online, “More teens smoke pot than cigarettes, says CDC survey,” (June 8th, 2012), Available online: http://www.cbsnews.com/8301-504763_162-57449455-10391704/more-teens-smokepot-than-cigarettes-says-cdc-survey/ CBS News 35 Centers for Disease Control and Prevention, Youth Risk Behavior Surveillance, 2009. Morbidity and Mortality Weekly, June 4, 2010 / Vol. 59 / No. SS-5. Available online: http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf; Youth Risk Behavior Surveillance, 2011 Morbidity and Mortality Weekly, June 8, 2012/ Vol. 61 / No. 4. Available online: http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf

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36 Healthy Kids Colorado Survey, Eagle County RE-50 School District: 2007-2008 Results, 2009-2010 Results, 2011-2012 Results. Prepared by OMNI (Denver, CO) for the Eagle River Youth Coalition. Available online: http://www.cdc.gov/mmwr/pdf/ss/ss6104.pdf 36 Healthy Kids Colorado Survey, Colorado High School Survey, 2009, 2011. Prepared by OMNI (Denver, CO). Available online: http://collaboration.omni.org/sites/hkc/Data%20Tables%20and%20Results/Forms/Front%20Page.aspx 37 Ibid. 38 US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, “Drug Facts: High School and Youth Trends.” Available online: http://www.drugabuse.gov/publications/drugfacts/high-school-youth-trends 39 US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, “Marijuana: Facts for Teens.” Available online: http://www.drugabuse.gov/publications/marijuana-facts-teens/some-things-to-think-about 40 National Highway Traffic Safety Administration website: “A Comprehensive Approach to Teen Driver Safety.” Available online: http://www.nhtsa.gov/Teen-Drivers 41 M.J. Cleveland, M.E. Feinberg, D.E. Bontempo, M.T. Greenberg, “The Role of Risk and Protective Factors in Substance Use across Adolescence” The Journal of Adolescent Health. (August 2008), 43(2): 157–164. Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518980/ 42 OMNI Institute, Healthy Kids Colorado Survey Results, Eagle County School District RE 50, (20112012),“Risk and Protective Factors.” 43 Ibid. 44 Ibid. 45 US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, as cited on the New York Times’ website: About.Com, “Why do Teens Use Marijuana.” Available online: http://alcoholism.about.com/cs/pot/f/mjp_faq06.htm 46 SW Feldstein, WR Miller, “Substance Use and Risk Taking Among Adolescents,” Journal of Mental Health,” (December 2006), 15(6): 633 – 643. Available online: http://inspirationsyouth.com/TeenSubstance-Abuse/Journal-Article-Substance-Use-and-Risk-Taking-Adolescents.pdf 47 US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, as cited on the New York Times’ website: About.Com, “Why do Teens Use Marijuana.” Available online: http://alcoholism.about.com/cs/pot/f/mjp_faq06.htm 48 Ibid. 49 Battle Mountain High School Handbook, 2011-2012, “BMHS Random Drug Testing Policy,” pp. 13-14 50 Jacob Best, Deputy Sheriff, Eagle County Sheriff’s Department and Gore Range DUI Task Force Director. (Database accessed August 2012). 51 Healthy People 2020, “Topics and Objectives: Adolescent Health.” Available online: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=2 52 US Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse, “Physical Activity May Prevent Substance Abuse,” by NIDA Director Nora D. Volkow, M.D. (March 2011). Available online: http://www.drugabuse.gov/news-events/nida-notes/2011/03/physical-activitymay-prevent-substance-abuse 53 Search Institute, Developmental Assets List. Available online: http://www.searchinstitute.org/developmental-assets/lists 54 Search Institute, “Tips for Building the Developmental Assets Most Linked to Common Positive Youth Development Program Outcomes.” Available online: http://www.searchinstitute.org/system/files/PrevPrograms.pdf 55 Centers for Disease Control and Prevention, Adolescent and School Health website: Physical Activity Facts. Available online: http://www.cdc.gov/healthyyouth/physicalactivity/facts.htm 56 American Psychological Association, “Changing Diet and Exercise for Kids” Available online: http://www.apa.org/topics/children/healthy-eating.aspx

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Science Daily, “Population-Based Approach Needed To Reduce Obesity In United States.” (June 2, 2008). Available online: http://www.sciencedaily.com/releases/2008/06/080630162416.htm 58 Richard H. Carmona, M.D., M.P.H., F.A.C.S. Surgeon General , U.S. Public Health Service U.S. Department of Health and Human Services. Testimony Before the Subcommittee on Competition, Infrastructure, and Foreign Commerce Committee on Commerce, Science, and Transportation; United States Senate. “The Growing Epidemic of Childhood Obesity,” March 2, 2004. Available online: http://www.surgeongeneral.gov/news/testimony/childobesity03022004.html 59 Centers for Disease Control and Prevention, Overweight and Obesity website: “Data and Statistics.” Available online: http://www.cdc.gov/obesity/data/adult.html 60 Colorado Department of Public Health and Environment, press release: “Colorado’s Obesity Rate Grew Faster Than the Country’s,” (February 24, 2010). Available online: http://www.cdphe.state.co.us/release/2010/022410b.pdf 61 Centers for Disease Control and Prevention, Overweight and Obesity website: “Data and Statistics.” Available online: http://www.cdc.gov/obesity/data/adult.html 62 American Psychological Association, “Changing Diet and Exercise for Kids” Available online: http://www.apa.org/topics/children/healthy-eating.aspx 63 Centers for Disease Control and Prevention, Adolescent and School Health website: Physical Activity Facts. Available online: http://www.cdc.gov/healthyyouth/physicalactivity/facts.htm 64 Centers for Disease Control and Prevention, “Youth Physical Activity: The Role of Schools,” Youth Physical Activity Toolkit. Available online: http://www.cdc.gov/healthyyouth/physicalactivity/toolkit/factsheet_pa_guidelines_schools.pdf 65 US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington, DC: U.S.; (2008). Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf 66 Centers for Disease Control and Prevention, “Youth Physical Activity: The Role of Schools,” Youth Physical Activity Toolkit. Available online: http://www.cdc.gov/healthyyouth/physicalactivity/toolkit/factsheet_pa_guidelines_schools.pdf 67 M.F. Jacobson, “Liquid Candy: How Soft Drinks Are Harming Americans’ Health,” Center for Science in the Public Interest Washington, D.C. (2005). Available online: http://www.cspinet.org/new/pdf/liquid_candy_final_w_new_supplement.pdf 68 Bray G.A., Pennington Center, Louisiana State University, “Soft Drink Consumption and Obesity: it is all about Fructose.” Current Opinion in Lipidology, 2010 Feb 21(1):51-7. 69 C. Hellerman “Soft drinks: Public enemy No.1 in obesity fight?” CNN Online, Apr 27, 2012. Available online: http://www.cnn.com/2012/04/27/health/soda-obesity/index.html 70 Richard N. Fogoros, M.D., Heart Health Center, About.com. New York Times Website (2002). Available online: http://heartdisease.about.com/library/weekly/aa101402a.htm 71 Science Daily, “Population-Based Approach Needed To Reduce Obesity In United States.” (June 2, 2008). Available online: http://www.sciencedaily.com/releases/2008/06/080630162416.htm 72 US Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, “Childhood Obesity.” Available online: http://aspe.hhs.gov/health/reports/child_obesity/ 73 Local Focus Group: Project Toward No Drug Abuse Class, Battle Mountain High School, Scott CanepaTeacher, 4/25/2012
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