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Section 6. Health

Note to Readers: Please note that this section is largely sourced from the Canadian Community Health Survey¹ which has several cycles occurring across various years. Some indicators have been updated in 2003, however, some have not and the latest data available is for 2000-01. The latest possible data has been provided where available. Readers are advised to be cautious when making any comparisons between the indicators.

Although youth have the lowest disease and death rates, this is also the period during which lifestyle patterns of behaviour, such as tobacco, alcohol and other drug use, nutrition, physical activities, are being formed. These behaviours set the stage for future health problems and health care utilization, as risk-taking and health compromising lifestyles are major causal factors for many health problems.

6.1 Perceived Health of Youth

In general, youth had high self-rated health status. Some 29% of youth aged 15 to 19 indicated that their health was excellent². Only 6% of individuals in this age category reported that their health was fair or poor. Men rated their health better than women with 33% of men rating their health as excellent compared to only 25% of men.

The self-rated health of young adults was even higher. Approximately 30% of adults between the ages of 20 and 24 years rated their health as excellent with only 5% rating their health as fair to poor. Again, women rated their health more poorly than men with only 24% rating their health as excellent compared to 36% of men. More women (6%) than men (5%) also rated their health as only fair to poor. Figure 6.1 shows the self-rated health status of youth by age for the years 2000-01.

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Figure 6-1: Self Rated Health Status by age, 2000-01

Source: Statistics Canada, CANSIM Table 105-0022 sourced from: Canadian Community Health Survey, 2000-01

6.2 Self-Esteem

In general, youth aged 15-19 had satisfactory levels of self esteem³. Approximately 74.1% of youth in this age category had high to moderate levels of self esteem. In comparison, approximately 79.3% of youth aged 20 to 24 had high to moderate levels.

6.3 Life and Work Stress

In general, youth experience some daily stress but not as much as older age groups⁴. For example, in 1995, in the 18-24 age group, 66.6% of youth experienced some daily stress and 22.7% of youth experienced a lot of stress. In the 25-34 age category, 64.5% of people experienced some daily stress and 27.9% experienced a lot of stress. In the 35-44 age category, 32.2% of people experienced a lot of stress. Provincially, Quebec youth lead all other provinces with amounts of stress followed by Ontario. Overall, 28.7% of Quebec youth aged 18-24 reported "quite a lot" of life stress followed by 22.9% of Ontario youth in the same age category.

6.4 Mortality Rates

As would be expected, people aged 15 to 19 generally have a lower death rate than those in older adult age ranges. In 1998, there were 51 deaths for every 100,000 people aged 15 to 19 and 63 deaths for every 100,000 people aged 20 to 29⁵. Whereas among groups between the ages of 30 to 49, the figure ranged from 93 to 192 deaths per 100,000. Death rates are considerably higher among males than females in the 15 to 19 age category. In 1998, there were 69 deaths for every 100,000 males which is more than twice the figure for their female counterparts.

Accidents account for almost half of all deaths in the 15 to 19 age category. In 1998, there were 23 accidental deaths for every 100,000 which represents 45% of all deaths in this age range. Young people are particularly at risk of being killed in a motor vehicle accident. In 1998, there were 16 motor vehicle deaths per 100,000 people aged 15 to 19 and 15 motor vehicle deaths per 100,000 people aged 20 to 29. However, this number decreases with older age groups. Among the 30 to 49 age group, the death rate ranged from 8 to 9 per 100,000.

Suicides also account for a relatively large share of deaths of people aged 15 to 19. The suicide rate among young people, however, is lower than that among older age groups. In 1998, there were 12 suicides per 100,000 people aged 15 to 19, while figures in other adult age categories ranged from 17 among the 40 to 49 age category and 14 among the 50 to 59 age category. The suicide rate is also much higher among Aboriginal youth than their non-Aboriginal counterparts. Studies have indicated that the suicide rate among Aboriginal people aged 15 to 19 is as high as five to six times that of non-Aboriginal people in this age range. In addition, suicide rates within the Aboriginal youth population are higher in isolated northern communities than in the rest of the country.

Overall however, male youths are still much more likely to engage in risky behaviour than their female counterparts. Young men, for example, are still twice as likely as young women to be killed in an automobile accident, while males aged 15-19 are almost three times more likely to take their own lives than females.

6.5 Physical Activity

Physical activity is a major indicator of health in all age categories but has become particularly important for youth. Young people tend to be more physically active than those in older age ranges. In 1998-1999, 39% of people aged 15-19 were considered active, compared with 29% of those aged 20 to 24⁶. However, there were just as many inactive youth. While young people are generally more active than their older counterparts, about as many young people are characterized by very low levels of leisure time physical activity as are physically active. In 1998-1999, 39% of youths aged 15 to 19 were active and 38% were considered inactive.

6.5.1 School-aged Youth

Substantial proportions of Canadian youth participate in physical activity twice or more a week outside of school. However the proportions are lower for girls and, for both genders, frequency of physical activity decreased with age⁷. Ironically, it was also found that more students are exercising four or more hours a week outside of school. Boys were nearly twice more likely to exercise regularly out of school than girls, and the rates increased from grade to grade.

6.5.2 Youth at Risk

While physical activity as a means of social intervention has not been widely promoted in Canada, there is growing evidence that sport programs may have an impact on youth at risk, particularly children and youth living in poverty⁸. Sport participation is recognized as a support for the development of individuals, to help them gain a positive identity and overcome personal and social difficulties.

Academic performance can be maintained over time by an increase in a student's level of habitual physical activity even with less curricular or free time for academic study. The likelihood that youth will never smoke is directly related to the level of physical activity. More than 80% of Canadians between the ages of 10 and 24 who were active had never smoked. In Northern Manitoba, there was a 17.3% reduction in crime in communities with a sports program and a 10.6% increase in communities without a program. Girls who were active in sports were 92% less likely to use drugs and 80% less likely to have an unwanted pregnancy.

6.6 Smoking⁹

According to the latest results from the Canadian Tobacco Use Monitoring Survey (CTUMS), for data collected between February and June 2003, an estimated 5.1 million people, representing roughly 20% of the population age 15 years and older, were current smokers, of which 16% reported smoking daily. This is a slight decrease from rate for the first half of 2002 (21%). Approximately 22% of men age 15 years and older were current smokers, slightly higher than the portion of women (18%).

6.6.1 Youth 15 to 19¹⁰

Even lower rates of smoking among youth 15-19 years (18%) have been measured in the first half of 2003 with 11% reporting daily smoking and 7% occasional. This is a continuation of the downward trend seen in recent years and is a slight decrease from 22% in the 2002. Slightly more teen girls reported smoking than boys: (19% vs 16%).

The majority of current smokers who were under the legal age to purchase cigarettes reported obtaining them from someone else (56%). Whereas, at least 90% of smokers of legal age reported buying them from retail stores.

6.6.2 Youth 20 to 24¹¹

The prevalence of smoking among young adults age 20-24 years was reported at 30% for the first half of 2003 (22% daily, 8% occasional), also slightly decreased from the 2002 rate (31%). There was slight difference in the smoking rates between males and females age 20-24 years.

6.7 Alcohol

Close to half of all young people consume alcohol on a regular basis, or have at least one drink per month¹². In 1998-99, 48% of youth aged 15 to 19 had at least one drink per month. In the 20 to 24 age category, 68% had at least one drink per month, the highest in all age categories. In contrast to smoking where young women are more likely than their male counterparts to smoke, young men are more likely than young women to drink regularly. In 1998-99, 51% of males aged 15 to 19 drank at least one drink per month, compared with 44% of females in this age range.

6.8 Drug Use

Youth are the largest group of drug users. The Canadian Youth, Sexual Health and HIV/AIDS Study asked questions on drug use of young people in Grades 9 and 11¹³. Perhaps the most notable trend presented in Figure 6.2 is the usage of hashish/marijuana. Slightly more boys than girls at all grade levels were users. Solvent use has changed little over time, but cocaine and amphetamine use appear to be slowly creeping up.

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Figure 6-2: Drug Use by School Age Youth Once a Month or More, 1999

Source: Health Canada and Council of Ministers of Education Canada. Canadian Youth, Sexual Health and HIV/AIDS
Study: Factors influencing the sexual health of Canadian youth, 2003

The 1999 Children and Youth, Sexual Health and HIV/AIDS Study reported that regular use of marijuana and hashish by students was more prevalent than is the use of other more addictive substances, and increases sharply with age. An increase in use of hashish and marijuana over time is apparent as 27% of Grade 11 students in 2002 indicated the use of these drugs at least once per month, a 5% increase from 1989. Generally speaking, opiates and cocaine use are of greatest concern to public health officials, especially with regard to injection use, and for both there is a small but significant group of youth users.

There is a strong relationship between the use of marijuana and other health-risk behaviours¹⁴. Marijuana users are also likely to use alcohol and smoke cigarettes and spend a great deal of time with other adolescents who engage in the same behaviours. They are more likely to feel pressured at school and home, to skip classes and to bully others. Marijuana use among older adolescents may be more normative and commonly available at parties, but among young adolescents its use is clearly part of a high health-risk lifestyle.

6.9 Sexual Health and Behaviors

The 1999 Children and Youth, Sexual Health and HIV/AIDS Study showed that between the 1989 and 1999 survey responses, the proportion of school aged youth who have had sexual intercourse has decreased since the 1989 study. This decline was much greater for boys than for girls at both Grade 9 and Grade 11 levels. The proportion of boys who reported being sexually active decreased by 8% among Grade 9 students and by 9% for Grade 11 students. In 1989 sexual intercourse was more common among Grade 11 boys, but there was in 1999 a greater proportion of Grade 11 girls who have had sexual intercourse.

One reason for the relatively high incidence of sexually transmitted diseases among youth is that many of those in this age range engage in risky sexual behaviour. In 1996-97, 8% of youth aged 15-17 said they had had at least three different sexual partners in the last 12 months. In the 18-19 age category, 12% of youth had three different sexual partners and 9% of 20 to 24 year olds. Among sexually active youth, males are generally much more likely than their female counterparts to report having had at least three or more sexual partners in the last year. In 1996-1997, 16% of males in the 18-19 age category had three or more sexual partners in the past year, compared to only 8% of females in the same age category¹⁵.

6.9.1 HIV/AIDS

The number of newly reported HIV cases among youth is relatively small. In the period from 1995 through the middle of 2000, there were 173 new HIV cases reported among those aged 15 to 19. This represented only about 1% of all newly diagnosed cases in this period. Additionally, the rate of sexually transmitted infections was highest among 15 to 24 year olds.

The 1999 Children and Youth, Sexual Health and HIV/AIDS Study reported that approximately one half of Grade 9 students did not know that no cure existed for HIV/AIDS. Although the majority of students were aware that condoms do not provide 100% protection from HIV/AIDS, some students were also under the misconception that there was a vaccine available to prevent HIV/AIDS.

While relatively large numbers of youth have contracted other sexually transmitted diseases, few youths have contracted AIDS. As of June 2000, only 58 AIDS cases, just 0.4% of all cases, involved 15 to 19 year olds. Most AIDS cases involve men. Of the 58 AIDS cases involving 15 to 19 year olds, 47 involved males while only 11 involved females. However, most AIDS cases among young men were reported before 1995. Since 1996, there have only been four new cases reported among men in this age group.

6.9.2 Sexually Transmitted Diseases (STDs)

Youth have a particularly high risk of contracting certain types of sexually transmitted diseases (STDs)¹⁶. In 1999, females aged 15 to 19 had the highest rate of gonorrhea infection of any age group in the country with 80 reported cases for every 100,000. There were 63 cases per 100,000 for women aged 20 to 24 and 28 cases for those aged 25-29. At the same time, there were 32 cases of infections per 100,000 for males aged 15 to 19. Between 1991 and 1999, the number of reported cases among females aged 15 to 19 declined 30% from 115 cases to 80 cases per 100,000.

Young women also report the highest rate of chlamydia infections. In 1999 there were 1,139 cases of this disease per 100,000 females aged 15 to 19, 1,066 cases for women aged 20 to 24, and 384 cases for those aged 25-29. The rate of chlamydia infection among females aged 15 to 19 was over six times greater than that for males in this age range, among whom there were 187 cases per 100,000 population. Between 1991 and 1999, the number of reported cases among females aged 15 to 19 declined 27% from 1,550 cases to 1,139 cases per 100,000.

According to national data, of the 32,869 cases of chlamydia reported among Canadian females in 2000, 40% were among young women between 15 to 19 years old. In this age group, the reported rates of chlamydia increased from 1,063/100,000 cases in 1998 to 1,236/100,000 cases in 2000 and rates of chlamydia in Canadian adolescent girls have been up to nine times the national rate¹⁷. Finally, of the 2,368 cases of gonorrhoea reported in the same time period, 41% were among women between the ages of 15 and 19.

6.9.3 Teen Pregnancy

An estimated 42,161 Canadian women aged 15 to 19 gave birth, had an abortion or experienced foetal loss (miscarriage or stillbirth) in 1997¹⁸. The number of teenage pregnancies has declined steadily since 1994, when the estimated total was 46,753. In that same year, the teenage pregnancy rate was 42.7 pregnancies for every 1,000 women aged 15 to 19 in 1997, the lowest in 10 years. The rate reached its most recent high of 48.8 per 1,000 in 1994.

Older teenagers are more likely than their younger counterparts to be sexually active, which is reflected in much higher pregnancy rates. At ages 18 and 19, the 1997 rate was 68.8 pregnancies for every 1,000 women, compared with 25.5 for women 15 to 17. Nevertheless, the pregnancy rate for 18- and 19-year-olds was well below the rate of 100.6 per 1,000 women 20 to 24.

Teenage pregnancy rates tend to be higher in the North and the Prairie provinces than in other regions. In 1997, the rate in the Northwest Territories was 123.3 pregnancies for every 1,000 women aged 15 to 19 and more than 60 per 1,000 in the Yukon and Manitoba. On the other hand, rates in Newfoundland and New Brunswick were less than 35 per 1,000.

Teenage birth rates were relatively high in the territories, Manitoba and Saskatchewan, and low in Quebec, Ontario and British Columbia. In 1998, there were close to 40 live births per 1,000 females aged 15-19 in both Manitoba (39) and Saskatchewan (38), compared with Quebec (15), British Columbia (16) and Ontario (17).

Although the teenage birth rate declined between 1994 and 1997, the abortion rate was stable, fluctuating only slightly between 21.1 and 22.0 abortions per 1,000 women 15 to 19. Among those 18 and 19, the 1997 rate was an estimated 33.1 abortions per 1,000 women, and the rate for those 15 to 17 was 13.9 per 1,000. The higher rate at ages 18 and 19 reflects the larger number of pregnancies among older teenagers.

1 For additional information, please visit the following Web site at: http://www.statcan.ca/english/concepts/health/

2 This paragraph has been sourced by: Statistics Canada. CANSIM: 105-0022 from the Canadians Community Health Survey, 2000-01.

3 All sources for this paragraph have been taken from Statistics Canada. National Population Health Survey, 1994-95. Available: www.statcan.ca/english/freepub/82-221-XIE/00502/tables/html/1131.htm.

4 All sources for this paragraph have been taken from: Statistics Canada, Canadian Community Health Survey, 2000-2001. Available: http://www.statcan.ca/english/concepts/health/index.htm

5 This section has been sourced from: Statistics Canada. Youth in Canada, Third Edition. 2002: Catalogue No. 89-511.

6 This section has been sourced from: Statistics Canada. Youth in Canada, Third Edition. 2002: Catalogue No. 89-511.

7 This section has been sourced from: Statistics Canada. Youth in Canada, Third Edition. 2002: Catalogue No. 89-511.

8 This section has been sourced from: Statistics Canada. Youth in Canada, Third Edition. 2002: Catalogue No. 89-511.

9 This section has been sourced from: Health Canada. Canadian Tobacco Use Monitoring (CTUMS) , results for 2003 Available at : http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/2004/2004_06bk1_e.html

10 This section has been sourced from: Health Canada. Canadian Tobacco Use Monitoring (CTUMS) , results for 2003 Available at: http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/2004/2004_06bk1_e.html

11 This section has been sourced from: Health Canada. Canadian Tobacco Use Monitoring (CTUMS) , results for 2003 Available: http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/2004/2004_06bk1_e.html

12 This section has been sourced from: Statistics Canada. Youth in Canada, Third Edition. 2002: Catalogue No. 89-511.

13 This section has been sourced from: Health Canada and Council of Ministers of Education Canada. Canadian Youth, Sexual Health and HIV/AIDS Study: Factors influencing the sexual health of Canadian youth, 2003. ISBN: 0-88987-149-3.

14 This paragraph has been sourced from: World Health Organization. Trends in the Health of Canadian Youth (Data from 1989-90, 1993-94 and 1997-98 Health Behaviours in School-Aged Children surveys.

15 This section has been sourced from both: Statistics Canada. Statistical Report on the Health of Canadians. 1999: 82-570-XIE and Health Canada and Council of Ministers of Education Canada. Canadian Youth, Sexual Health and HIV/AIDS Study: Factors influencing the sexual health of Canadian youth, 2003. ISBN: 0-88987-149-3.

16 This section has been sourced from both: Statistics Canada. Statistical Report on the Health of Canadians. 1999: 82-570-XIE and Health Canada and Council of Ministers of Education Canada. Canadian Youth, Sexual Health and HIV/AIDS Study: Factors influencing the sexual health of Canadian youth, 2003. ISBN: 0-88987-149-3.

17 Statistics Canada. Youth in Canada, Third Edition. 2002: Catalogue No. 89-511.

18 This section has been sourced by: Statistics Canada. The Daily. October 20, 2000.