Children and Youth - Leeds, Grenville and Lanark District Health Unit

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Children and Youth
Community Profiles
Health Indicators for Children & Youth in the South East Region
2010
Acknowledgements
This report is the result of collaborative efforts and input from
the Children’s Services Planning Tables in the South East Region,
the United Way serving KFL&A and the project lead team (listed below).
Emily Cassell,
Data Analysis Coordinator, Lanark
John Cunningham,
Epidemiologist, PHRED Program, LL&G Public Health
Laurie Dixon,
Data Analysis Coordinator, Kingston and the Islands
Megan Hughes,
Data Analysis Coordinator, Hastings, Frontenac and Lennox & Addington
Phil Jones,
Data Analysis Coordinator, Prince Edward and Hastings
Suzanne Sinclair,
Epidemiologist, PHRED Program, KFL&A Public Health
Mary Slade,
Data Analysis Coordinator, United Counties of Leeds and Grenville
Bhavana Varma,
President and CEO, United Way serving KFL&A
Kim Hockey,
Director, Community Investment, United Way serving KFL&A
BmDodo Strategic Design,
Graphic Design
EDI and EQAO information includes
the following school boards:
Algonquin and Lakeshore Catholic District School Board
Catholic District School Board of Eastern Ontario
Conseil des écoles publiques de l’Est de l’Ontario
Conseil des écoles catholiques de langue française du Centre-Est
Hastings & Prince Edward District School Board
Limestone District School Board
Upper Canada District School Board
Chairs or co-chairs of our various Planning Tables:
Hastings-Prince Edward Children’s Services Group:
Joanne TenWolde: 613-476-6038
Terry Swift: 613-966-3100
KFL&A Children’s Services Steering Committee:
JoAnne Maltby: 613-546-8535
Daren Dougall: 613-548-4535
Every Kid in Our Community – United Counties of Leeds & Grenville:
Keith McPhee: 613-342-2917
Lanark County Planning Council for Children, Youth and Families:
Suzanne Geoffrion: 613-264-9991
Nicki Collins: 613-257-8260
The document is available at www.unitedwaykfla.ca.
This project is an ongoing process of community collaboration and
continues to evolve over time as our data collection capacity is further
developed. Every attempt has been made to ensure accuracy in this
publication, however errors may occur.
2
Table of Contents
2 Acknowledgements
3 Table of Contents
4 Health Indicator Definitions/Descriptions
8 Body Mass Index
9 Physical Activity
10 Sedentary Activities
11 Fruit and Vegetable Intake
12 Asthma
12 Injuries
13 Learning Disabilities
13 Smoking
14 Drinking
15 Live Births
17 Low Birth Weight
18 Pre-term Births
19 Therapeutic Abortion
20 Teen Pregnancy
21 Smoking During Pregnancy
22 Intention to Breastfeed
23 Child Welfare
23 Violence Against Women
24 Mental Health
25 Ontario Early Years
26 Glossary of Terms
26 References
3
Health Indicator Definitions/Descriptions
Live Birth:
Pregnancy and Smoking:
A live birth is a birth where there is evidence of life immediately
following extraction from the mother, regardless of the duration
of the pregnancy or whether or not the newborn is expected
to survive immediately following the birth.1
Maternal smoking during pregnancy can cause numerous
health effects for babies including lower birth weight,
on average 150 g less at term, compared with other infants.8
A relationship has also been demonstrated between the number
of cigarettes smoked by the pregnant mother and the slowing
of fetal development.9 Newborns whose mothers smoke during
pregnancy are also five times as likely to die from Sudden
Infant Death Syndrome (SIDS) than newborns whose mothers
did not smoke. 10
Low Birth Weight:
The World Health Organization defines low birth weight as the
weight of an infant being less than 2500g at the time of delivery,
based on evidence that showed babies who are born under
2500g are 20 times more likely to die compared to heavier
babies.1 Low birth weight at birth is the result of: pre-term birth
(before 37 weeks gestation), small size for gestational age, or
both. Low birth weight is associated with a number of health
risks including an increased risk of neonatal mortality and
morbidity, slow growth, impaired cognitive development,
and other chronic conditions later in life. A mother’s dietary
habits, her body composition at the time of conception, her
socio-economic status, infections and any physically demanding
work during pregnancy can all affect her infant’s health.2
Pre-term Birth:
A pre-term birth is defined as a fetus or infant delivered before
37 completed weeks (259 days) gestation (premature infant).1
Pre-term birth is one of the most important perinatal health
problems in industrialized nations and accounts for 75-85%
of all perinatal mortality in Canada.3 As well, pre-term infants
may experience a variety of health problems throughout their
lives including organ-specific (lung, heart, and brain) problems,
increased number of infections, and many intellectual, emotional
or physical disabilities.4 For about 50% of women, there are
no identifiable risk factors.4 A woman may be at higher risk
if she has a lifestyle risk factor (such as smoking or poor diet),
lives in poverty, is a teen or over age 35, has had a previous
pre-term birth or is pregnant with more than one fetus.
Breastfeeding:
Health Canada promotes breastfeeding as the best method
of feeding infants as it provides optimal nutritional, immunological
and emotional benefits for the growth and development of
infants.5 Exclusive breastfeeding is recommended for the first
six months of life for healthy term infants, as breast milk is the
best food for optimal growth. Infants should be introduced to
nutrient-rich, solid foods with particular attention to iron at six
months with continued breastfeeding for up to two years and
beyond.6 Exclusive breastfeeding is defined by the World Health
Organization as the practice of feeding only breast milk (including
expressed breast milk) and allows the baby to receive vitamins,
minerals or medicine.7 Water, breast milk substitutes,
other liquids and solid foods are excluded.
4
Teen pregnancy has been linked to numerous health
consequences for mothers including pregnancy induced
hypertension and poor weight gain.11 There are also numerous
potential health consequences for the babies including low
birth weight, pre-term birth, and increased risk of a congenital
anomaly.12, 13, 14
Dental Health:
Caries Immune indicates the percentage of children who have
no decayed (visual decay only), filled or lost teeth due to dental
caries. The def/DMFT is a measurement of the average number
of teeth affected by dental caries, past and present and it
includes filled teeth. CINOT Eligible is the percent of children
who meet the clinical criteria for the Children in Need of
Treatment Program. They require ‘essential’ treatment, which
is defined as a large open carious lesion visible to the naked eye.
Physical Activity:
Canada’s Physical Activity Guide to Healthy Active Living
recommends that inactive children (ages 6-9) and youth (ages
10-14) increase the amount of time they currently spend being
physically active by at least 30 minutes more per day and
decrease the time they spend on watching television, playing
computer games and surfing the Internet by at least 30 minutes
less per day. The increase in physical activity should include a
combination of moderate activity (such as brisk walking, skating
and bike riding) with vigorous activity (such as running and
playing soccer).15
The guidelines recommend that inactive children and youth
accumulate this increase in daily physical activity in periods
of at least 5 to 10 minutes each. Over several months, children
and youth should try to accumulate at least 90 minutes more
physical activity per day and decrease by at least 90 minutes per
day the amount of time spent on non-active activities such as
watching videos and sitting at a computer.15
Physical Activity Variable for Ages 6-11:
This physical activity variable indicates the total number of hours
per week that children aged 6-11 usually participate in physical
activities. These activities can be at school or outside of school.
Physical Activity Index for Ages 12-17:
Physical Activity Index categorizes respondents as being
Active (EE 3.0 or greater), Moderate (EE between 1.5 and 3.0),
or Inactive (EE 1.5 or less) based on their total daily Energy
Expenditure (kcal/kg/day).
Energy Expenditure is calculated from the frequency and
duration of sessions of physical activity as well as the MET
value of the each activity. The MET is a value of metabolic
energy cost expressed as a multiple of the resting metabolic
rate. For example an activity of 4 METS requires four times
as much energy as the body at rest.
MET values tend to be expressed in three intensity levels
(i.e. low, medium, high). The Canadian Community Health
Survey (CCHS) questions did not ask respondents to specify
the intensity level of their activities. Therefore the MET values
adopted correspond to the low intensity value of each activity.
This approach is adopted by the Canadian Fitness and Lifestyle
Research Institute because individuals tend to overestimate the
intensity, frequency and duration of their activities.16
Sedentary Activity:
Ages 6-11
This sedentary activity variable estimates the total number
of hours per day children ages 6-11 spent in sedentary activities.
Sedentary activities include watching television or videos, playing
video games and spending time on a computer playing games,
e-mailing, chatting and surfing the Internet.
Ages 12-19
This sedentary activity variable estimates the total number of
hours per week youth ages 12-17 spent in sedentary activities
(excluding reading). Sedentary activities include playing
computer games, using the internet, playing video games
and watching television or videos. Time spent at school
or work is excluded.
Canadian Community Health
Survey (CCHS) Description
The Canadian Community Health Survey (CCHS) is a relatively
new survey, conducted every two years by Statistics Canada.
This survey has replaced the National Population Health Survey
as a means to provide regular and timely access to health
determinants, health status and health system utilization
for health regions across the country.
The survey design is cross sectional and comprised of two
distinct surveys. Each two year cycle consists of a health
region-level survey in the first year with a total sample of
130,000 and a provincial-level survey in the second year with
a total sample of 30,000. Data may be viewed and/or analyzed
at a sub-provincial level (health region or combination
of health regions).
The target population of the first year of the CCHS includes
household residents ages 12 and over in all provinces and
territories, excluding of populations on Indian Reserves, Canadian
Forces Bases, and some remote areas. The CCHS covers about
98% of the Canadian population. The interview, given in person
with computer-assisted interviewing (CAI), is approximately
45 minutes in length and consists of two components:
• 30 minutes of core questions asked across the country to
meet basic health data needs and a smaller optional content
as determined by each health region.
• Each cycle is number 1, 2, 3 etc. Within in each two
year-cycle the numeral after the decimal (.1 or .2) indicates
the year. Thus 2.1 is the first year of the second cycle and
2.2 is the second year of the second cycle. The second year
of the survey is a provincial-level survey, approximately 60
minutes in length, and consists of some common content
and one focus content topic per cycle. Thus far, two of these
surveys have been completed, Cycle 1.2 Mental Health
and Well-Being and Cycle 2.2 Nutrition.
NIDAY Database
Canada’s Physical Activity Guide to
Healthy Active Living recommends that
inactive children and youth increase the
amount of time they currently spend being
physically active by at least 30 minutes
more per day
The Eastern and Southeastern Ontario Perinatal Database
was implemented in January, 1997 with the collaboration
of all hospitals in Eastern and Southeastern Ontario,
the Ottawa-Carleton Regional Health Department
(now called Ottawa Public Health), and the Kingston,
Frontenac and Lennox & Addington Health Department
(now called Kingston, Frontenac, and Lennox & Addington
Public Health). Beginning January 1, 2001, the database was
enhanced from a stand-alone computer program installed
in each hospital to the web- based Criticall Ontario system.
The database collects information on almost 95% of births
in Ontario and includes information on place of birth, the health
status of newborns, the use of obstetrical interventions
and maternal characteristics.
5
Dental Indices Survey
Co-efficient of Variation
The Ontario Dental Indices Survey (DIS) collects data on the
dental health of children for use at the public health unit level.
Some of the objectives include providing a means of measuring
dental health status of Ontario school entrants, identifying
“at risk” segments of the school aged child population who
would most benefit from targeted oral health education and
preventive programs, and determining the prevalence of dental
disease and needs for prevention and treatment.17
The co-efficient of variation (C.V.) is a standardized measure
of the dispersion (or amount of variability) of data points around
a mean (or average). It is used to compare the amount
of variation around different means, even if the means are
far apart from one another.
The Mandatory Health Programs and Services Guidelines require
that Boards of Health conduct the DIS in accordance with the
Dental Indices Survey (DIS) Protocol. The Protocol for January 1,
1998 specifies that the DIS be done for all school entrants (Junior
Kindergarten and Senior Kindergarten) in every school annually.
In this report, the C.V. is used as another indicator (in addition
to the confidence interval) of the reliability or precision of an
estimate. If the estimate has too much variability (a high C.V.,
which would also mean a wide confidence interval), the estimate
is thought to be too unstable to report. The following table,
adopted from Statistics Canada, provides guidelines on how
to interpret the C.V.
The DIS collects demographic data and dental indices, including
fluorosis index, periodontal indices, malocclusion (optional),
deft/DMFT, CINOT eligible (dental), non-urgent treatment
required, scaling required, prophylaxis required, sealant required,
fluoride required, and preventive instruction required for each
child in the survey.18
Table A. Sampling Variability Guidelines
Type of Estimate
C.V. (in %)
Guidelines
1. Unqualified
0.0 – 16.5
Estimates can be considered for general unrestricted release.
Requires no special notation.
2. Marginal
16.6 – 33.3
Estimates can be considered for general unrestricted release
but should be accompanied by a warning cautioning
subsequent users of the high sampling variability associated
with the estimates. Such estimates should be identified
by the letter M (or in some other similar fashion).
3. Unacceptable
Greater than 33.3
The Ministry of Health and Long-Term Care recommends
not releasing estimates of unacceptable quality. Conclusions
based on these data will be unreliable and most likely invalid.
These data and any consequent findings should not be
published. In statistical tables, such estimates should
be deleted and replaced by dashes (-).
Health Indicators by Geographic Zone
Table A. Various Health Indicators for Children by Geographic Zone, 2004
Indicators Children
SE Ontario
Ontario
Body Mass Index
% Overweight or obese, Ages 2-11
19.8*%
(10.8-28.8)
27.0%
(23.5-30.5)
Physical Activity
% of children who are NOT active at least 10.5 hours per week
(average of 90 mins per day), Ages 6-11
32.2*%
(20.2-44.2)
35.2%
(31.7-38.7)
Sedentary Activity
% of children who are sedentary at least 2 hours per day, Ages 6-11
35.5%
(26.4-44.6)
36.4%
(32.7-40.1)
Fruit and Vegetable Consumption
% eating fruits and vegetables less than 5 times per day.
(Quantity per time unknown), Ages 6 months-11
45.6%
(34.4-56.8)
58.5%
(54.6-62.5)
* Due to large sampling variability, estimate should be used with caution (C.V16.6-33.3)
SE Ontario comprises 6 public health units: Renfrew County & District Health Unit, Ottawa Public Health, Eastern Ontario Health Unit, Leeds,
Grenville, and Lanark District Health Unit, Kingston, Frontenac and Lennox & Addington Public Health, and Hastings & Prince Edward Counties Health
Unit Source: Canadian Community Health Survey, CCHS cycle 2.2 (2004), Statistics Canada, Ontario Sharing Files, MOHLTC (9)
Children of Eastern Ontario are not statistically significantly different from Ontario children with respect to any of the variables examined in this table.
6
Table B. Various Health Indicators for Youth by Geographic Zone, 2005-2007
Indicators
SE Ontario
2005
SE Ontario
2007
Ontario
2005
Ontario
2007
Body Mass Index
% Overweight or obese
Ages 12-17
18.7%
(13.9-23.5)
21.7%
(16.5-27.0)
21.3%
(19.6-22.9)
20.3%
(18.7-21.9)
Physical Activity Index
% Inactive
Ages 12-17
19.6%
(14.1-25.0)
23.7%
(18.9-28.4)
28.1%
(26.4-29.8)
30.8%
(28.8-32.7)
N/A
37.4%
(31.0-43.7)
N/A
34.6%
(32.6-36.7)
Fruit and Vegetable Consumption
% eating less than recommended number
of fruit and vegetable servings per day
(as per 2007 Canada’s Food Guide) Ages 14-18
—
72.9%
(67.0-78.8)
—
77.0%
(75.0-79.1)
Fruit and Vegetable Consumption
% eating less than 5 fruits and vegetables servings
per day as per 1992 Canada’s Food Guide.
Ages 14-18
47.0%
(38.8-55.2)
45.4%
(38.4-52.5)
53.1%
(49.6-56.5)
53.3%
(50.7-56.0)
Asthma
% with asthma
(diagnosed by a health professional)
Ages 12-19
14.2*%
(9.8-18.9)
15.4%
(10.8-20.0)
11.1%
(10.0-12.2)
11.5%
(10.2-12.8)
Injuries
% with injuries (broken bone, bad cut etc)
in the last 12 months serious enough to limit
normal previous activities
25.9%
(20.0-31.8)
N/A
24.4%
(22.9-25.9)
N/A
Learning Disabilities
% with learning disabilities
(diagnosed by a health professional)
Ages 12-19
12.5*%
(8.1-16.9)
N/A
7.9%
(6.9-8.9)
N/A
9.8%
(5.8-13.8)
10.4%
(6.8-14.0)
10.6%
(9.5-11.7)
9.0%
(7.9-10.2)
31.1%
(21.4-40.8)
19.9%
(12.3-27.6)
19.7%
(17.5-21.9)
18.0%
(15.9-21.9)
Sedentary Activity
% youth aged 12-19 having 30 or more
hours of sedentary activity per week
Smoking
% Daily or Occasional Smoker
Ages 12-19
Drinking
% of youth who have had 5 or more drinks
on one occasion 2 or more times per month
Ages 12-19
* Due to large sampling variability, estimate should be used with caution (C.V16.6-33.3)
SE Ontario comprises 6 public health units: Renfrew County & District Health Unit, Ottawa Public Health, Eastern Ontario Health Unit, Leeds, Grenville,
and Lanark District Health Unit, Kingston, Frontenac and Lennox & Addington Public Health, and Hastings & Prince Edward Counties Health Unit
Sources: Canadian Community Health Survey, CCHS cycle 3.1 (2005) and cycle 4.1 (2007), Statistics Canada, Ontario Sharing Files, MOHLTC (9)
Children of Eastern Ontario are not statistically significantly different from Ontario children with respect to any of the variables examined in this table.
7
Body
Mass Index
Figure X1: Body mass index of youth aged
12-19 in Southeastern Ontario, 2005 and 2007.
100%
78.3 81.3
80%
Key Findings:
• The percentage of youth self-reporting
being overweight has increased between
2005/06 and 2007/08 but not in a
statistically significant manner (Figure X1).
60%
40%
18.5 13.5
20%
3.2 5.2
0%
• Almost 80% of youth aged 12-19 years
from Southeastern Ontario self-reported
being of normal weight in 2007/08
(Figure X1).
• Similar patterns of body mass index for
youth aged 12-19 years were evident
between Southeastern Ontario and
Ontario as a whole (Figures X1 and X2).
Normal
100%
78.7 79.7
80%
• The percentage of youth aged 12-19
years in Southeastern Ontario who
reported being overweight or obese
increased between 2005 and 2007
overall and for both males and females.
However, the increase was not statistically
significant (Figure X4).
0%
Due to large sampling variability, estimate should
be used with caution
Obese
Figure X2: Body mass index of youth
aged 12-19 in Ontario, 2005 and 2007.
• There are no statistically significant
differences in percentages of youth aged
12-19 years in Southeastern Ontario who
are neither overweight nor obese between
jurisdictions within and between CCHS
cycles (Figure X3).
*
Overview
60%
40%
15.8 15.6
20%
5.5 4.7
Normal
Overview
Obese
Figure X3: Body mass index of youth aged 12-19 who are neither
overweight nor obese in Southeastern Ontario, 2005 and 2007.
88.4
100%
79.9
80%
83.0
76.4 77.2
78.2 83.3
HPECHU
LGLDHU
84.0
74.9
78.0
60%
40%
CCHS Cycle 4.1, 2007/08
20%
0%
KFL&A
CCHS Cycle 3.1, 2005/06
Leeds/Grenville
Figure X4: Youth aged 12-19 who are overweight
or obese in Southeastern Ontario, 2005 and 2007.
35%
30%
24.6
25%
21.7 18.7
21.0*
20%
18.5
16.0*
15%
10%
5%
0%
Total
8
Males
Females
Lanark
Physical
Activity
Key Findings:
• Youth aged 12-19 years in Southeastern
Ontario reported significantly lower levels
of physical inactivity when compared
to Ontario as a whole for both 2005
and 2007 (Figure X5).
• Males reported significantly higher levels
of physical activity in both Southeastern
Ontario and Ontario as a whole when
compared to females in both 2007
and 2005 (Figures X6 and X7).
*
Figure X5: Physical Activity Index for youth aged
12-19 in Southeastern Ontario and Ontario, 2007
70%
57.0
60%
53.0
47.3 49.9
50%
40%
30.8 28.1
30%
23.3 23.5 22.0 22.1
23.7
19.6
20%
10%
0%
Active
Moderately Active
SE Ontario, 2007
SE Ontario, 2005
Inactive
Ontario, 2007
Ontario, 2005
Due to large sampling variability,
estimate should be used with caution
Figure X6: Physical Activity Index for youth aged
12-19 by sex in Southeastern Ontario and Ontario, 2007
80%
70%
60.1
60%
56.5
50%
44.6
37.8
40%
38.0
30.7
30%
21.9 19.7
20%
24.7 24.2
23.7
17.1
10%
0%
Active
Moderately Active
SE Ontario Male
Ontario Male
Inactive
SE Ontario Female
Ontario Female
Figure X7: Physical Activity Index for youth aged
12-19 by sex in Southeastern Ontario and Ontario, 2005
80%
70%
60%
50%
66.1
56.5
47.3
42.7
40%
33.1
27.8
30%
24.1
23.7 24.9
19.4 19.7
20%
14.6
10%
0%
Active
Moderately Active
Inactive
9
Sedentary Activities
Key Findings:
• Just over 34% of youth aged 12-19 years in Southeastern
Ontario and 39.0% of youth from Ontario as a whole
reported spending 11 or more hours per week
on a computer in 2007 (Figure X8).
• Almost half of youth aged 12-19 years in both Southeastern
Ontario and Ontario as a whole reported not spending any
time each week playing video games in 2007(Figure X9).
• Just over 36% of youth aged 12-19 years in Southeastern
Ontario and 34.6% of youth from Ontario as a whole
reported spending 11 or more hours per week watching
television in 2007 (Figure X10).
• Almost equal percentages of youth aged 12-19 years in
both Southeastern Ontario and Ontario as a whole reported
reading between 1 and 5 hours per week 2007. Just under
14% in Southeastern Ontario reported not reading
at all (Figure X11).
• Almost 38% of youth aged 12-19 years reported 30 or
more hours of sedentary activity each week in Southeastern
Ontario. Similar results were observed for Ontario
as a whole (Figure X12).
Figure X10: Number of hours watching
television per week for youth aged 12-19
in Southeastern Ontario and Ontario, 2007
45%
40%
35.5
37.9
36.4
35%
34.6
28.1
30%
27.4
25%
20%
15%
10%
5%
0%
5 or less hours
6-10 hours
11 or more hours
Figure X11: Number of hours reading per week for youth
aged 12-19 in Southeastern Ontario and Ontario, 2007
70%
60%
Ontario
SE Ontario
53.0 53.2
50%
40%
Figure X8: Number of hours spent on a computer
per week (excluding school) for youth aged 12-19
in Southeastern Ontario and Ontario, 2007
30%
17.8
20%
19.4 18.0
13.8
13.8
10%
45%
39.0
40%
36.6
35%
34.0
11.1
0%
None
34.4
1-5 hour
6-10 hours
11 or more hours
30%
23.3
25%
22.8
20%
Figure X12: Total number of sedentary hours per week for
youth aged 12-19 in Southeastern Ontario and Ontario, 2007
15%
10%
5%
0%
6.2
3.8
None
45%
1-5 hour
6-10 hours
11 or more hours
40%
37.4
34.6
35%
31.3
30%
Figure X9: Number of hours playing video
games per week for youth aged 12-19 in
Southeastern Ontario and Ontario, 2007
60%
50%
24.6
20.9 21.6
20%
17.1
15%
46.4 45.7
40%
12.5
10%
5%
32.8 35.0
30%
0%
20.8 19.3
20%
10%
0%
None
10
25%
1-5 hour
6 or more hours
14 hours or less
15-19 hours
20-29 hours
30 or more hours
Fruit and
Vegetable Intake
Key Findings:
• Similar percentages of youth aged 14-18
years in Southeastern Ontario and Ontario
as a whole reported eating less than eight
servings of fruit and vegetable servings
per day.(Figure X13).
• Males reported eating significantly less fruit
and vegetable servings when compared
to females in both Southeastern Ontario
and Ontario as a whole (Figure X13).
• When reduced to five servings of fruit and
vegetables per day, about equal percentages
of males and females report not eating
the recommended daily intake in both
Southeastern Ontario and Ontario as
a whole. Although percentages in
Southeastern Ontario are lower they
are not statistically significant (Figure X14).
*
*
In the 2007 Canada’s Food Guide, it is recommended
that males ages 14-18 eat a minimum of 8, and females
eat a minimum of 7, fruit and vegetable servings per day.
In the previous edition of Canada’s Food Guide (1992),
it was recommended that males and females ages 14-18
eat a minimum of five fruit and vegetable servings per day.
Figure X13: Proportion of youth aged 14-18 eating
less fruits and vegetables than recommended*
in Southeastern Ontario and Ontario, 2007.
100%
80%
81.8 80.6
72.9 77.0
73.4
64.4
60%
40%
20%
0%
Total
Male
SE Ontario
Female
Ontario
Figure X14: Proportion of youth aged 14-18 eating
less than 5 servings of fruits and vegetables per day
in Southeastern Ontario and Ontario, 2005 and 2007*.
70%
56.5
60%
50%
53.4 53.1
47.0
55.5
51.2
51.4 49.4
45.4
49.6
42.8 41.7
40%
30%
20%
10%
0%
Total
Male
Female
SE Ontario, 2007
Ontario, 2007
SE Ontario, 2005
Ontario, 2005
11
Asthma
Figure X15: Percentage of youth aged 12-19 with asthma
in Southeastern Ontario and Ontario, 2005 and 2007.
Key Findings:
• More youth aged 12-19 years in
Southeastern Ontario in both 2005
and 2007 reported having asthma
than in Ontario as a whole. However,
the difference was not significant
(Figure X15).
• Similar percentages of males and
females report having asthma in both
Southeastern Ontario and Ontario
as a whole (Figure X15).
Injuries
30%
25%
19.0
20%
15%
15.4 14.2
15.5
11.5 11.1
12.0
12.8
11.3 11.5
10%
11.6 10.7
5%
0%
Total
Male
Female
SE Ontario, 2007
Ontario, 2007
SE Ontario, 2005
Ontario, 2005
Figure X16: Percentage of injuries in youth aged
12-19 that limited normal activity in the past
12 months in Southeastern Ontario, 2007
40%
35%
Key Findings:
• Youth aged 12-19 years in LGLDHU
reported the highest percentages
of injury that limited normal activity
in 2007 and HPECHU reported the
lowest. However, the differences were
not statistically significant (Figure X16).
• Males reported a higher percentage
of injury that limited normal activity
than females in 2007 in Southeastern
Ontario. However, the differences were
not statistically significant (Figure X17).
*
30.6
30%
27.6*
25.9
25%
19.2
20%
15%
10%
5%
0%
KFL&A
HPEHU
LGLHU
SE Ontario
Due to large sampling variability,
estimate should be used with caution
Figure X17: Percentage of injuries in youth aged
12-19 by sex that limited normal activity in the
past 12 months in Southeastern Ontario, 2007
35%
29.2
30%
25.9
25%
22.4
20%
15%
10%
5%
0%
Total
12
Male
Female
OUCH!
Learning
Disabilities
Key Findings:
• A higher percentage of youth aged
12-19 years in Southeastern Ontario
were reported to have a learning disability
in 2005 than for Ontario as a whole.
However, the difference was not
statistically significant (Figure X18).
• Similar percentages of both males and
females were reported to have a learning
disability in Southeastern Ontario.
*
Figure X18: Percentage of youth aged 12-19 with learning
disabilities in Southeastern Ontario and Ontario, 2005
16%
13.5
14%
12.5
Key Findings:
• Overall percentages of youth aged 12-19
years who report smoking in both 2005 and
2007 were similar for both Southeastern
Ontario and Ontario as a whole (Figure X19).
• A higher percentage of females in
Southeastern Ontario report smoking in
2007 than in 2005. This is counter to what
is observed for Ontario as a whole. None
of the differences observed were
statistically significant.
Ontario
9.9
10%
7.9
8%
5.8
6%
4%
2%
0%
Total
Due to large sampling variability,
estimate should be used with caution
Smoking
SE Ontario
11.5
12%
Male
Female
Figure X19: Youth aged 12-19 who currently smoke, either daily
or occasional in Southeastern Ontario and Ontario, 2005 and 2007.
14%
12.8
12%
10.4
10%
10.9
10.6
9.8
9.9
9.5
9.0
8.5
8.2
8%
10.3
9.8
6%
4%
2%
0%
Total
Male
SE Ontario, 2007
Ontario, 2007
SE Ontario, 2005
Ontario, 2005
Female
13
Drinking
Key Findings:
• Overall percentages of youth aged
12-19 years who report drinking for both
Southeastern Ontario and Ontario as a
whole have remained fairly constant over
the past 7-years (5-years for Ontario).
The same trend can be seen when
stratifying by sex (Figure X20).
• The percentage of youth aged 12-19
years who report drinking 2 or more times
per month in Southeastern Ontario have
remained constant over the past 7-years.
However, a significantly higher percentage
of males in Southeastern Ontario reported
drinking than females in both 2003 and
2005 (Figure X21).
• The percentage of youth aged 12-19 years
who report binge drinking 2 or more times
per month in Southeastern Ontario have
remained constant over the past 7-years
(Figure X22).
*
Due to large sampling variability,
estimate should be used with caution
Figure X20: Percentage of youth aged 12-19 who have had a drink in
the past 12 months in Southeastern Ontario and Ontario, 2005 and 2007
60%
46.4 50.1 49.3
50%
53.3 52.4
46.7
44.7
46.3 47.8
47.6 46.7 46.1
45.3
45.6
43.1
40%
30%
20%
10%
0%
Total
Male
Female
Figure X21: Youth aged 12-19 (who have had a drink in the past 12
months) who drink 2 or more times per month in Southeastern Ontario
and Ontario, 2005 and 2007
70%
63.7 62.9
60%
50.1 47.7
50%
46.6
49.8
45.6
42.1 42.9
41.1
38.1 38.9
40%
32.6
35.8*
30%
23.1*
SE Ontario, 2007
20%
10%
SE Ontario, 2005
0%
Total
Male
Female
SE Ontario, 2003
Ontario, 2007
Figure X22: Youth aged 12-19 (who have had a drink in the
past 12 months) who binge drink 2 or more times per month
in Southeastern Ontario and Ontario, 2005 and 2007
Ontario, 2005
35%
31.1
30%
25%
20%
19.9*
19.7*
15%
10%
5%
0%
Total
14
18.0
19.7
Live Births
Figure X23: Number of live births in Southeastern Ontario, 1986 - 2006
2,500
2,000
1,500
1,000
500
0
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
KFL&A 2082 2014 2030 2081 2250 2289 2373 2172 2179 2077 1926 1669 1758 1765 1653 1695 1678 1621 1646 1682 1708
HPECHU 1808 1860 1878 1931 2003 1875 2043 1956 1796 1864 1683 1568 1566 1477 1510 1401 1450 1411 1525 1481 1453
LGLHU 1900 1839 1826 1938 2050 2008 2086 1934 1898 1790 1691 1622 1626 1545 1560 1498 1447 1504 1434 1439 1392
Leeds &
Grenville 1127 1138 1073 1185 1276 1202 1283 1218 1158 1086 1039 991 968 949 912 882 895 859 856
Lanark 773
701 753 753 774
806 803 716 740 704 652 631 658 599 648 616 552 645 578
874 828
565 564
Figure X24: Proportion of births by age groups of mothers in Southeastern Ontario, 1986-2006
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
15 – 19
20 – 24
25 – 29
30 – 34
35 – 39
40 – 44
35 – 39
40 – 44
Age Group (vertical lines represent years from 1986 – 2006)
Figure X25: Proportion of births by age groups of mothers in LGLDHU, 1986-2006
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
15 – 19
20 – 24
25 – 29
30 – 34
Age Group (vertical lines represent years from 1986 – 2006)
15
Figure X26: Proportion of births by age groups of mothers in KFL&A, 1986-2006
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
15 – 19
20 – 24
25 – 29
30 – 34
35 – 39
40 – 44
35 – 39
40 – 44
Age Group (vertical lines represent years from 1986 – 2006)
Figure X27: Proportion of births by age groups of mothers in HPECHU, 1986-2006
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
15 – 19
20 – 24
25 – 29
30 – 34
Age Group (vertical lines represent years from 1986 – 2006)
Key Findings:
• The overall trend in live births in all
jurisdictions was slightly downward
between 1986 and 2006 (Figure X23).
• Figure X24 breaks down percentages
of live births by age group and year from
1986 to 2006 for Southeastern Ontario.
Percentages of live births for teens have
remained fairly consistent. Percentages
of live births for the 20-24 and 25-29
year age groups have decreased, while
percentages of live births in the 30-34,
35-39 and 40-44 year age groups have
increased over time. These statistics
suggest that women have delayed
becoming pregnant until later in their
reproductive lives over time.
16
• The trends observed in Southeastern
Ontario are similar for all other
jurisdictions (Figures X25-X27)
Low Birth Weight
Figure X28: Proportion of low birth weight births
of all live births in Southeastern Ontario, 1987-2006
7%
6.5%
KFL&A
6%
5.5%
HPECHU
5%
LGLHU
4.5%
4%
3.5%
3%
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
Figure X29: Proportion of low birth weight for all live births
in Southeastern Ontario by age group, 1987-2006
10%
15-19
9%
20-24
8%
25-29
7%
30-34
6%
35-39
5%
40-44
4%
1987–1991
1992–1996
1997–2001
2002–2006
Key Findings:
• The overall trend for low birth weight
births as a proportion of all live births
remained fairly flat over time in KFLA,
HPECHU and LGLDHU between 1986
and 2006 (Figure X28).
• The 15-19 year age group consistently
had the highest proportion of low birth
weight births over time, followed by
the 40-44 year age group. However,
this age group shows more variability
over time due to fewer births.
There was little variation in all other
age groups over time (Figure X29).
17
Pre-term
Births
Key Findings:
• The overall trend for the percentage of pre-term singleton births as a
proportion of all live births for the 15-19, 35-39 and 40-44 year age
groups has been variable over time in Southeastern Ontario between
1986 and 2006 (Figure X30).
• The overall trend for the percentage of pre-term singleton births as
a proportion of all live births for the 20-24, 25-29 and 30-34 year age
groups has remained constant over time in Southeastern Ontario
between 1986 and 2006 (Figure X31).
• The overall trend for the percentage of per-term singleton births as
a proportion of all live births for Southeastern Ontario for all women
of reproductive age (age 10-50) between 1986 and 2009 has been
upward over time (Figure X32).
Figure X30: Percentage of singleton pre-term births in Southeastern
Ontario, age groups 15-19, 35-39, and 40-44, 1986-2006
16%
14%
12%
10%
8%
15–19
6%
35–39
4%
40–44
2%
0%
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2004
2006
2004
2006
Figure X31: Percentage of singleton pre-term births in Southeastern
Ontario, age groups 20-24, 25-29, and 30-34, 1986-2006
16%
14%
12%
10%
8%
20–24
6%
25–29
4%
30–34
2%
0%
1986
1988
1990
1992
1994
1996
1998
2000
2002
Figure X32: Percentage of singleton pre-term births in Southeastern
Ontario, women aged 10-50, 1986-2006
9%
KFL&A
8%
HPECHU
7%
LGLHU
6%
SE
5%
Linear (SE)
4%
3%
1986
18
1988
1990
1992
1994
1996
1998
2000
2002
Key Findings:
14
13
Rate per 1000 population
Therapeutic
Abortion
Figure X33: Rate of therapeutic abortions per 1000 female
population aged 15-44 in Southeastern Ontario, 2001-2007
• The overall trend for the rate of therapeutic
abortions for KFLA, HPECHU and LGLDHU
between 2001 and 2007 was fairly constant
with some year-over-year variability. KFLA
had the highest rates while HPECHU and
LGLDHU had lower and similar rates
(Figure X33).
• Therapeutic abortion rates for LGLDHU
demonstrated similar patterns to those of
KFLA. However, the 20-24 age group had
the highest rates but these rates deceased
over time. Teen (15-19 years) rates showed
a slight decrease over time (Figure X36).
LGLHU
10
9
8
2002
2003
2004
2005
2006
2007
Figure X34: Rate of therapeutic abortions per 1000
female population aged 15-44 for KFL&A, 2001-2007
35
15-19
Rate per 1000 population
30
20-24
25
25-29
20
30-34
15
35-39
10
40-44
5
0
2001
2002
2003
2004
2005
2006
2007
Figure X35: Rate of therapeutic abortions per 1000
female population aged15-44 for HPECHU, 2001-2007
35
15-19
30
Rate per 1000 population
• Therapeutic abortion rates for HPECHU
demonstrated similar patterns as to those of
KFLA. The 20-24 age group had the highest
rates that were slightly increasing over time.
Teens (15-19 years) were consistently in the
15/1000 population range over the 2001
to 2007 time period (Figure X35).
HPEHU
11
2001
20-24
25
25-29
20
30-34
15
35-39
10
40-44
5
0
2001
2002
2003
2004
2005
2006
2007
Figure X36: Rate of therapeutic abortions per 1000
female population aged15-44 for LGLDHU, 2001-2006
35
15-19
Rate per 1000 population
• Therapeutic abortion rates for KFLA
remained fairly consistent over time when
broken down by age group. The 20-24 age
group had the highest rates and the 35-39
and 40-44 year age groups had the lowest.
Teens (15-19 years) were close to the
15/1000 population range over the 2001
to 2007 time period (Figure X34).
KFL&A
12
30
20-24
25
25-29
20
30-34
15
35-39
10
40-44
5
0
2001
2002
2003
2004
2005
2006
2007
19
Teen Pregnancy
Figure X37: Rate of teen pregnancies per 1000 female
population aged 15-19 in Southeastern Ontario, 1986-2006
Rate per 1000 population
40
Key Findings:
• The overall trend for the rate of teen
pregnancy for KFLA, HPECHU and
LGLDHU between 2001 and 2005 was
slightly downward with some year-overyear variability. HPECHU had the highest
rates while KFLA and LGLDHU had lower
and similar rates (Figure X37).
KFL&A
35
HPEHU
30
LGLHU
25
20
15
10
2001
2002
2003
2004
2005
Age of First Time Mothers
Figure X38: Average age of first time mothers in Southeastern Ontario, 1986-2006
Key Findings:
• The trend for the average age of first
time mothers increased steadily in all
jurisdictions in Southeastern Ontario
between 1986 and 2006. KFL&A and
LGLDHU had similar increases in average
age while HPECHU had increases that
were less pronounced (Figure X38).
28.0
27.5
27.0
26.5
26.0
25.5
25.0
24.5
24.0
1986
KFL&A
20
1988
1990
1992
HPECHU
1994
1996
LGLHU
1998
2000
2002
2004
2006
Smoking During
Pregnancy
Figure X39: Mother’s Smoking Status
during Pregnancy for HPECHU, 2005-2008
80%
70%
71.9 68.3 69.0 70.2
60%
HPEHU, 2005
50%
HPEHU, 2006
40%
28.1 31.7 31.1 29.8
30%
HPEHU, 2007
HPEHU, 2008
Key Findings:
• The percentages of mothers who
reported not smoking during pregnancy
remained consistent between 2005
and 2008 for all jurisdictions. However,
percentages in HPECHU were lower
than both KFLA and LGLDHU
(Figures X39-X41).
20%
10%
0%
No Smoking
Smoked during Pregnancy
Figure X40: Mother’s Smoking Status
during Pregnancy for KFL&A, 2005-2008
80%
79.7 77.8 76.7 79.4
70%
60%
KFL&A, 2005
Smoking during pregnancy
and nursing can have many
ill effects in a baby’s health .
In addition, when pregnant
women are exposed to secondhand smoke, harmful chemicals
are passed on to the baby.
Breast milk will also contain
chemicals when nursing mothers
breathe in tobacco smoke.
50%
KFL&A, 2006
40%
KFL&A, 2007
30%
23.3 20.6
20.3 22.2
KFL&A, 2008
20%
10%
0%
No Smoking
Smoked during Pregnancy
Figure X41: Mother’s Smoking Status
during Pregnancy for LGLHU, 2005-2008
80%
78.8 76.8 78.0 77.9
70%
60%
HPEHU, 2005
50%
HPEHU, 2006
40%
HPEHU, 2007
30%
21.2
20%
23.2 22.0 22.1
HPEHU, 2008
10%
0%
No Smoking
Smoked during Pregnancy
21
Intention to
Breastfeed
X42: Proportion of Mother’s who Intend to Breastfeed, 2005-2008
100%
87.2
90%
80%
84.4
81.6
77.2 77.8 78.3 78.5
83.7
83.6
81.5
85.6 84.8
70%
60%
50%
40%
30%
20%
10%
0%
HPECHU
KFL&A
2005
LGLDHU
2006
2008
2007
X43: Proportion of Mother’s who Intend to Breastfeed by Age Group, 2005-2008
100%
91.7
90%
83.8
78.6
80%
70%
68.1
87.4 87.2 86.0
86.4 86.1 86.2
81.0 79.8
72.9
85.0
78.5
76.6
15-19
73.0
69.9
20-24
60%
25-29
50%
30-34
40%
35-39
30%
40-44
20%
10%
0%
HPECHU
Key Findings:
• The percentages of mothers who reported
the intention to breastfeed were fairly
consistent from 2005 and 2008 for all
jurisdictions. However, percentages in
HPECHU were lower than both KFLA
and LGLDHU (Figures X42).
• When broken down by age group,
similar patterns exist between jurisdictions.
Women aged 24 years and under were less
likely to have an intention to breastfeed than
women in age groups above the age
of 24 years (Figures X43).
• There was an inverse relationship between
the proportion of mothers reporting the
intention to breastfeed and the number
of children they had given birth to.
This pattern was similar across all
jurisdictions (Figures X44).
22
KFL&A
LGLDHU
X44: Proportion of mother’s who intend
to breastfeed by number of Babies, 2005-2008
100%
90%
80%
89.1
83.0
87.8
82.0
81.8
79.4
76.2
75.5
71.1
70%
First Baby
60%
Second Baby
50%
Third Baby
40%
30%
20%
10%
0%
HPECHU
KFL&A
LGLDHU
Child Welfare
Child Welfare Total Children Served (Children in Care)
2,500
2,000
1,500
1,000
500
0
2004 – 2005
Violence
Against
Women
2005 – 2006
2006 – 2007
2007 – 2008
2008 – 2009
Frontenac
Lanark
Lennox & Addington
Leeds & Grenville
Hastings
South East Region Total
Prince Edward
South East Region Average
Interval House Days of Residential Care
25,000
20,000
15,000
10,000
5,000
0
2004 – 2005
2005 – 2006
2006 – 2007
2007 – 2008
2008 – 2009
Kingston Interval House – Family Violence
Lennox & Addington Interval House
Three Oaks Foundation – Violence Against Women
Lanark County Interval House – Violence Against Women
Leeds & Grenville Interval House – Family Violence
South East Region Total
South East Region Average
23
Mental Health
Number of Individuals served by
Children’s Mental Health Agencies by County
3,000
2,500
2,000
1,500
1,000
500
0
2004 – 2005
2005 – 2006
2006 – 2007
2007 – 2008
2008 – 2009
Frontenac, Lennox & Addington
Lanark
Hastings & Prince Edward
Leeds & Grenville
Number of Children Receiving Intensive Behavioral Intervention
90
80
70
60
50
40
30
20
10
0
2004 – 2005
2005 – 2006
2006 – 2007
2007 – 2008
2008 – 2009
Children Served by the Autism Intervention
Program in the South East Region
7,500
Frontenac, Lennox & Addington
7,000
Hastings & Prince Edward
6,500
Lanark
6,000
Leeds & Grenville
5,500
South East Region Total
5,000
South East Region Average
4,500
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0
2004 – 2005
24
2005 – 2006
2006 – 2007
2007 – 2008
2008 – 2009
Ontario Early Years Centres
Number of Parents/Caregivers
Served by Fiscal Year
Number of Children Served by Fiscal Year
12,000
12,000
11,500
11,500
11,000
11,000
10,500
10,500
10,000
10,000
9,500
9,500
9,000
9,000
8,500
8,500
8,000
8,000
7,500
7,500
7,000
7,000
6,500
6,500
6,000
6,000
5,500
5,500
5,000
5,000
4,500
4,500
4,000
4,000
3,500
3,500
3,000
3,000
2,500
2,500
2,000
2,000
1,500
1,500
1,000
1,000
500
500
0
0
2004
2005
2006
2007
2008
2004
2005
2006
2007
2008
Children’s Resouces on Wheels Inc. OEYC, Lanark
United Counties of Leeds and Grenville OEYC, L&G
Northern Frontenac Community Services Corporation, OEYC/ The Child Centre, Frontenac
Lennox & Addington Resouces for Children OEYC, L&A
North Hastings Children’s Services, North Hastings
Family Space Quinte, Hastings, Prince Edward
Limestone Advisory for Child Care Programs, Kingston and the Islands
South East Region Total
25
South East Regional Map
Hastings
Highlands
Mississippi
Mills
Bancroft
Carlow
Mayo
Lanark Highlands
Addington
Highlands
Beckwith
Faraday
Drummond/
North Elmsley
North Frontenac
Limerick
Montague
North Grenville
Wolleston
Tay Valley
Tudor
&
Cashel
Merrickville
Wolford
Central Frontenac
Elizabethtown
Marmora
Rideau Lakes
Madoc
Tweed
Stone Mills
Central
Hastings
Tyendinaga
Belleville
Quinte West
Loyalist
Frontenac Islands
Prince Edward
26
Leeds & the
Thousand Islands
Kingston
Greater
Napanee
Brockville
Front of
Yonge
South Frontenac
Stirling
Rawdon
Athens
Edwarsburgh
/Cardinal
Augusta
References
1
Provincial Health Indicators Work group.
“Core Indicators for Public Health in Ontario.”
Retrieved March 16, 2007. www.apheo.ca March 2, 2007.
2
World Health Organization and UNICEF. “Low Birthweight:
Country, Regional and Global Estimates.” 2004. Retrieved
March 16, 2007. http://www.who. int/reproductive-health/
publications/low_birthweight/low_birthweight_estimates.pdf.
3
Public Health Agency of Canada. 1999. “Measuring Up: A
Health Surveillance Update on Canadian Children and Youth.”
4
Best Start. “2002 Pre-term Birth: Making a Difference.”
Retrieved March 16, 2007.
http://www.beststart.org/resources/rep_health/index.html.
5
Health Canada. “Nutrition for a Healthy Pregnancy:
National Guidelines for the Childbearing Years.” 1999.
Ottawa: Minister of Public Works and Government Services.
6
Health Canada. “Exclusive Breastfeeding Duration - 2004
Health Canada Recommendation,” 2004. Retrieved March
16, 2007. http://www.hc-sc.gc.ca/fn- an/nutrition/childenfant/infant-nourisson/excl_bf_dur-dur_am_excl_e.html.
7
8
9
10
11
12
Glossary of Terms
CMH
Children’s Mental Health
DS
Developmental Services
CW
Child Welfare
World Health Organization. “Global Strategy for Infant and
Young Child Feeding, The Optimal Duration of Exclusive
Breastfeeding.” 2001. Geneva. Retrieved March 16, 2007.
http://www.who.int/gb/ebwha/pdf_files/WHA54/ea54id4.pdf.
HU
Health Units
PSL/IH
Preschool Speech and Language / Infant Hearing
Best Start
Best Start
U.S. Department of Health and Human Services. “The Health
Consequences of Smoking: Nicotine Addition.” A Report
of the Surgeon General. 1988. Rockville, Maryland: U.S.
Department of Health and Human Services, Public Health
Service, Centers for Disease Control, Center for Health
Promotion and Education, Office on Smoking and Health.
SB
School Boards
CMSM
Consolidated Municipal Service Managers
VAW
Violence Against Women
U.S Department of Health and Human Services. “Reducing
the Health Consequences of Smoking: 25 years of progress.”
A Report of the Sturgeon General. 1989. Rockville, Maryland:
U.S Department of Health and Human Services, Public Health
Service, Centers for Disease Control, Center for Chronic
Disease and Prevention and Health Promotion, Office on
Smoking and Health.
CC
Child Care
OEYC
Ontario Early Years Centres
CDC
Child Development Centres
SRI
Social Risk Index
EDI
Early Development Instrument
MCI
Multiple Challenges Index
EQAO
Education Quality and Accountability Office
Raloft, J. “Prenatal nicotine: A role in SIDS?” Science News
2003;163:270.
IBI
Intensive Behavioural Intervention
EDI
Early Development Instrument
Stevens-Simon C, White M.M. “Adolescent pregnancy.”
Pediatr.Ann. 1991;20:322-31.
SRL
School Readiness to Learn
Reichman, N.E., Pagnini, D.L. “Maternal age and birth
outcomes: data from New Jersey.” Fam.Plann.Perspect.
1997;29:268-72, 295.
13
Fraser A.M., Brockert JE, Ward RH. “Association of young
maternal age with adverse reproductive outcomes.”
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16
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17
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18
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