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The Chief Public Health Officer's Report on the State of Public Health in Canada, 2011


Chapter 3: The Health and Well-being of Canadian Youth and Young Adults

This chapter presents a demographic profile of youth and young adults, and looks at the current physical and mental health status of this population. It provides details of health risk behaviours, including risky sexual behaviours and substance use and abuse. It also looks at socio-economic determinants of health and their relationship with health status and well-being.

The health status of youth aged 12 to 19 years often differs from that of young adults aged 20 to 29 years. Similarly, the health status of young men often differs from that of young women. For these reasons, when relevant and when data are available, this report compares both sexes and age groups.

Social demographics of the youth and young adult population

Over the past 35 years, the proportion of the Canadian population aged 12 to 29 years has decreased. According to the 2006 Census, of the entire population of 31.6 million, 7.5 million Canadians (24%) were between the ages of 12 and 29 years, down from 33% in 1971.Footnote 179, Footnote 180 Of those 7.5 million, 46% were youth and 54% were young adults (see Table 3.1).Footnote 180 Of the youth and young adults living in Canada, 13% were immigrants (11% of all youth and 16% of all young adults) and 5% Aboriginal peoples (6% of all youth and 4% of all young adults) (see Figure 3.1).Footnote 181

Figure 3.1 Population distribution by age group, Canada, 2006Footnote 180, Footnote 181

Figure 3.1 Population distribution by age group, Canada, 2006

Source: Public Health Agency of Canada using data from 2006 Census, Statistics Canada.

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[Figure 3.1, Text Equivalent]

The proportion of youth and young adults within the Aboriginal population in 2006 was much higher, with almost one-third (31%) between the ages of 12 and 29 years compared to 23% in the non-Aboriginal population.Footnote 181, Footnote 182 Within the Inuit population, 40% were youth and young adults between the ages of 10 and 29 years in 2006 compared to only 26% of the non-Aboriginal population.Footnote 183

Table 3.1 Demographics of Canada's youth and young adult population
Demographics  

Note: More detailed information can be found in Appendix C: Definitions and Data Sources for Indicators.
Source: Statistics Canada.

Population aged 12 to 19 years, 2006 (thousand population)
Population 3,410.1
Aboriginal 193.6
First Nations (single response) 118.5
Inuit (single response) 9.6
Métis (single response) 60.9
Immigrant 360.2
Urban 2,658.9
Population aged 20 to 29 years, 2006 (thousand population)
Population 4,066.0
Aboriginal 175.2
First Nations (single response) 101.5
Inuit (single response) 8.2
Métis (single response) 60.6
Immigrant 636.1
Urban 3,432.0

Residence

In 2006, the large majority (93%) of Canadian youth aged 15 to 19 years lived with their families.Footnote 184 Of these, more than three-quarters (77%) lived with married or common-law parents, while the remainder (23%) lived in lone-parent households, headed mostly (78%) by women.Footnote 185 The remaining 7% were living independently, either on their own (4%), married or in a common-law relationship (2%) or as lone parents (1%).Footnote 184

Many young adults undergo a change in family status during this period in their lives. They move out of their parents' homes and create households of their own. In 2006, more than one-third of young adults were married (15%), living with a common-law partner (18%) or were lone parents (3%).Footnote 184 An additional 22% were living alone or with other non-relations.Footnote 184 However, the number of young adults that live in their parental home appears to be on the rise, from 39% in 2001 to 42% in 2006.Footnote 184, Footnote 186

In 2006, 78% of all youth lived in urban areas – a slight increase from 75% ten years earlier.Footnote 181, Footnote 187 As Canadian youth transition into young adults, many move to urban settings for post-secondary education and employment opportunities.Footnote 188 In 2006, 85% of all young adults were living in urban settings.Footnote 181 For some populations, the urban/rural distribution is quite different. Almost all immigrant youth (96%) and young adults (97%) live in urban areas, while far fewer Aboriginal youth (53%) and young adults (61%) do.Footnote 181

Education, employment and income

As discussed in Chapter 2, education and income have both been cited as key determinants of health across the lifecourse.Footnote 11, Footnote 41, Footnote 189 Indicators of these determinants for youth and young adults are shown in Table 3.2. The education levels of both parents/guardians in the household and the youth and young adults themselves can impact health outcomes. Most youth are in school and, although they may have some personal income, the income levels of their parents or other adult wage earners in the household are the main economic determinant of their health. Personal income levels increase for young adults, with the largest shift taking place when students transition to full-time employment. Income levels associated with full-time employment are largely determined by level of education and sex.Footnote 190, Footnote 191

Table 3.2 Social and economic status of Canada's youth and young adults
Social and economic status  

Note: More detailed information can be found in Appendix C: Definitions and Data Sources for Indicators.
Source: Statistics Canada.

Education, population aged 20 to 29 years, 2009 (percent)
High school graduates 90.7
Some post-secondary education 69.1
Post-secondary graduates 52.9
Labour, population aged 15 to 29 years, 2008
Paid employment rate (percent of population) 66.9
Full-time (percent of employed population) 68.6
Part-time (percent of employed population) 31.4
Income, 2008
Average after tax annual income (population aged 16 to 19 years) $6,200
Average after tax annual income (population aged 20 to 29 years) $23,000

Education

In 2009, nine out of ten of Canada's young adult population had at least a high school education.Footnote 192 In addition, the high school dropout rate, defined as 20- to 24-year-olds without a high school diploma and not in school, decreased from 16.6% in the 1990/1991 school year to 8.5% in the 2009/2010 school year.Footnote 193 Young men however, had consistently higher dropout rates than young women (see Figure 3.2).Footnote 193

Between the 1990/1991 and 2004/2005 school years, the percentage of dropouts choosing to restart their education increased for both young men (10% to 16%) and young women (12% to 22%).Footnote 194 However, returning does not always result in completion for either sex.Footnote 194 Among 18- to 20-year-old dropouts who returned to school during 2000 and 2001, almost 40% had dropped out again by the end of that two-year period.Footnote 194

Figure 3.2 High school dropout* rate, academic years 1990/1991 to 2009/2010Footnote 193

Figure 3.2 High school dropout rate, academic years 1990/1991 to 2009/2010

* Defined as 20- to 24-year-olds without a high school diploma and not in school.

Source: Public Health Agency of Canada using data from Labour Force Survey, Statistics Canada.

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[Figure 3.2, Text Equivalent]

Dropout rates for 20- to 24-year-old immigrant and Aboriginal populations differ from those of the general Canadian population. In the 2009/2010 school year, the immigrant dropout rate of 6% was lower than the overall Canadian dropout rate.Footnote 193 The fact that immigrants are more highly concentrated in large cities, where dropout rates tend to be lower, and the high value that many immigrant families place on education may partly explain these lower rates.Footnote 193 Conversely, the off-reserve Aboriginal population had the highest dropout rates, averaging 23% over the 2007/2008 to 2009/2010 school years – more than two times greater than the rate for the non-Aboriginal population.Footnote 193 Although the reasons why Aboriginal students drop out of school are not known, the fact that a higher proportion of those who dropped out (75%) were employed compared to non-Aboriginal youth (48%) who had dropped out, suggests that socio-economic factors may be one important impetus.Footnote 195

An increasing number of Canada's young adults are pursuing post-secondary education after high school, and completion rates have also been rising both in Canada and internationally (see Figure 3.3).Footnote 114, Footnote 196, Footnote 197 In 2008, 56% of Canadians aged 25 to 34 years had completed post-secondary education, second only to Korea and 21% more than the Organisation for Economic Co-operation and Development (OECD) average of 35%. In that same year, 40% of Canadians aged 55 to 64 years had also completed some form of post-secondary education at some point in their lives.Footnote 197 Assuming all of those in the older cohort completed their studies at least 30 years earlier (i.e. by the time they were within the 25- to 34- year age range of the younger cohort), this would mean that the percentage of Canadians aged 25 to 34 years who completed post-secondary education increased by 16% (from 40% to 56%) between 1978 and 2008.Footnote 197

Figure 3.3 Completion of post-secondary education by select age groups, select OECD countries, 2008Footnote 197

Figure 3.3 Completion of post-secondary education by select age groups, select OECD countries, 2008

* Year of reference 2002 instead of 2008.

Source: Public Health Agency of Canada using data from Education at a Glance, Organisation for Economic Co-Operation and Development.

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[Figure 3.3, Text Equivalent]

Although the difference in proportions of males and females who completed high school was slight, this difference increased when it came to post-secondary education. In 2009, three-quarters (74%) of young women in Canada had at least some post-secondary education, compared to two-thirds (65%) of young men.Footnote 192 Similarly, 58% of young women had completed some form of post-secondary education, compared to 48% of young men.Footnote 192

Post-secondary participation varies by geographic location. The Youth in Transition Survey (YITS) followed a cohort of Canadian youth aged 18 to 20 years over an eight-year period. During that time, two-thirds (66%) of the youth from urban communities completed some form of post-secondary education compared to only 57% of those from rural communities.Footnote 190 The YITS also found that fewer than 10% of off-reserve Aboriginal young adults had a university degree by the age of 26 to 28 years (at the end of the 8-year period) compared to more than 30% of non-Aboriginal young adults.Footnote 190

During the 2009/2010 school year, 40% of young adults aged 18 to 24 years were attending college (15%) or university (25%).Footnote 198 The percentage was much lower for young adults aged 25 to 29 years – only 12% were enrolled in college (4%) or university (8%) – perhaps because of those who pursued post-secondary studies it is likely that many would have already completed them.Footnote 198 These percentages showed an increase from 1995/1996 when 34% of 18- to 24-year-olds and only 9% of 25- to 29-year-olds were enrolled in college or university.Footnote 198

According to the 2006 Census, the top four major fields of post-secondary studies completed by young men aged 20 to 24 years were architecture, engineering and related technologies (35%); business management and public administration (15%); personal, protective and transportation services (8%); and mathematics, computer and information sciences (8%).Footnote 199 Young women of the same age most commonly completed their studies in business management and public administration (21%); health, parks, recreation and fitness (18%); social and behavioural sciences and law (17%); and humanities (10%).Footnote 199

Employment

In 2008, more than two-thirds (67%) of Canadians aged 15 to 29 years – almost half (47%) of all 15- to 19- year-olds and three-quarters (76%) of all young adults – were employed, representing 26% of the total employed population in Canada.Footnote 192, Footnote 200 Of those youth who were employed, more held part-time jobs (70%) than full-time (30%), making up almost one-quarter of the total part-time Canadian labour force but only 2% of the full-time labour force.Footnote 192, Footnote 200 The reverse was true for employed young adults, among whom 80% were in full-time rather than part-time positions (20%), making up 20% and 21% of the full- and part-time labour forces respectively.Footnote 192, Footnote 200 Overall, the proportions of males and females were roughly equal among all employed youth and young adults, but females made up a larger proportion of part-time youth and young adult workers, while males made up a larger proportion of full-time workers.Footnote 192

In 2006, the most common types of employment for youth aged 15 to 19 years and young adults in Canada were sales and services (62% of youth and 30% of young adults); trades, transports and equipment operation (8% and 14%); and business, finance and administration (8% and 17%).Footnote 201

For youth, jobs associated with sales and services were the most common for both adolescent boys and adolescent girls (52% and 72% respectively), followed by trades, transport and equipment operations for adolescent boys (16%) and jobs in business, finance and administration for adolescent girls (9%) (see Figure 3.4).Footnote 201

For young adults, jobs associated with sales and services were still the most common for young women (37%), followed by business, finance and administrative occupations (24%).Footnote 201 Young men however, were mostly working in trades, transport and equipment operations (25%) followed closely by jobs in sales and service (24%) (see Figure 3.4).Footnote 201

Figure 3.4 Occupation by sex, youth and young adults, Canada, 2006Footnote 201

Figure 3.4 Occupation by sex, youth and young adults, Canada, 2006

Sales and services such as food counter attendants, retail salespersons, grocery clerks, protective services, cashiers and cleaners; Trades, transports and equipment operations and related such as construction workers, mechanics and longshore workers; Business, finance and administrative such as clerical workers, finance and insurance workers, customer service and receptionists and switchboard operators; Occupations unique to primary industry such as agriculture, landscaping and ground maintenance labourers; Social science, education, government service and religion such as teachers, professors, paralegals, social service workers and policy and program officers; All other includes occupations related to management, natural and applied sciences, health, art, culture, recreation and sport, and processing, manufacturing and utilities.

Source: Public Health Agency of Canada using data from 2006 Census, Statistics Canada.

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[Figure 3.4, Text Equivalent]

With the completion of education, young adults continue to transition from part-time to full-time employment.Footnote 190 According to the YITS, only 15% of young adults between the ages of 26 and 28 years were still attending school and nearly 70% were working full-time.Footnote 190 Men in this age group were more likely than women to work in a full-time position.Footnote 190

Some youth and young adults would like to be working but are not. Between 1990 and 2009, the overall unemployment rate for Canadian youth aged 15 to 19 years increased from 14% to 20%.Footnote 192 However, after an initial increase from 1990 to 1993, the rate fluctuated without a clear increasing trend over the next 16 years (see Figure 3.5).Footnote 192 Young adults experienced a more consistent trend as the rate of unemployment decreased from a high of 14% in 1993 to a low of 7% in 2008.Footnote 192 Those with fewer years of formal education experienced higher rates of unemployment (see Figure 3.5).Footnote 192 In 2009, across all levels of education, young women experienced lower levels of unemployment when compared to their male counterparts.Footnote 192

As in previous recessions in the 1980s and 1990s, during the recent economic downturn between October 2008 and October 2009 more than half of the nearly 400,000 net jobs lost in Canada were among youth aged 15 to 24 years.Footnote 73 However, during the recovery youth unemployment rates did not change and were still as high as 14.3% in February of 2011.Footnote 202

Figure 3.5 Unemployment rate by highest level of completed education, youth and young adults, Canada, 1990 to 2009Footnote 192

Figure 3.5 Unemployment rate by highest level of completed education, youth and young adults, Canada, 1990 to 2009

Source: Public Health Agency of Canada using data from Labour Force Survey, Statistics Canada.

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[Figure 3.5, Text Equivalent]

Income

Poverty extends beyond monetary earnings to include such concepts as lack of opportunities and an inability to participate fully in society.Footnote 203, Footnote 204 However, in the absence of a standardized indicator to measure the complex mix of factors that define it, income indicators are often used as proxy measures of poverty. The most commonly used indicator within Canada is the low income cut-off (LICO), which considers a family's portion of income spent on food, clothing and footwear, and shelter relative to other families of the same size and in the same geographic location.Footnote 205

Based on the LICO, an estimated 6% of Canada's youth and 5% of young adults were living in low-income households in 2008, an improvement over rates estimated to be as high as 14% for youth and 8% for young adults in 1996 (see Figure 3.6).Footnote 206

While youth income levels are largely linked to parental/ household income levels, this gradually changes for young adults as they become more independent and transition from student to full-time employee. Their personal income is in part influenced by their level of education, sex and even immigration status.Footnote 190, Footnote 191 In 2008, the average after-tax income for youth aged 16 to 19 years was $6,200, while for young adults it was $23,000.Footnote 207 YITS respondents who had completed post-secondary education had, on average, higher incomes than those with high school education or less, with the difference being greater for young women than young men.Footnote 190 On average, young women with a full-time job and a university degree made $18,000 more than young women with the lowest level of education.Footnote 190 For young men with full-time jobs and a university degree, there was a difference of $13,000 between the lowest and highest levels of attained education.Footnote 190 Regardless of education level, the average income of full-time employed young men was higher than that of full-time employed young women with an equivalent level of education.Footnote 190

Figure 3.6 Youth and young adults living in low-income households, after tax, Canada, 1976 to 2008Footnote 206

Figure 3.6 Youth and young adults living in low-income households, after tax, Canada, 1976 to 2008

Source: Public Health Agency of Canada using data from Survey of Labour and Income Dynamics, Statistics Canada.

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[Figure 3.6, Text Equivalent]

Many young adults begin their working lives in debt from their years in post-secondary education. Almost 60% of university students and 45% of college students graduated with some debt in 2009. Looking at all sources of borrowing, including family, government and non-government loans, college graduates owed on average $13,600, while university graduates owed twice as much, an average of $26,680.Footnote 208, Footnote 209 It is more difficult for these young adults to benefit fully from their increased level of income while repaying their debt which may delay or possibly reduce improvements in health outcomes linked to higher levels of income.

The current health of Canada's youth and young adults

Data presented throughout this chapter often come from survey data. Despite the inherent limitations of self-reported data, such as the subjectivity of individual responses and the exclusion of those living in institutions and on reserves, such data can provide information otherwise not available.

This section explores the current health status of youth and young adults including physical health, mental health and health behaviours. It also highlights associated risk factors and identifies groups at greater risk of poor health outcomes or behaviours.

Mental health and mental illness

Mental health is an important aspect of the overall health and well-being of Canadian youth and young adults and most mental illnesses begin to manifest themselves in adolescence and early adulthood.Footnote 210 Mental illness and mental health affect the lives of many young men and women and influence their health throughout the lifecourse. Positive mental health reduces the likelihood of leaving school early and raises attainment levels. It also leads to higher income potential and increases resilience.Footnote 211 Mental illness can increase the risk of certain physical health problems including chronic respiratory conditions and heart disease.Footnote 212-214 In addition, rates of poverty and unemployment are often higher among those with a mental illness.Footnote 212

Mental health is the capacity of each and all of us to feel, think, and act in ways that enhance our ability to enjoy life and deal with the challenges we face. It is a positive sense of emotional and spiritual well-being that respects the importance of culture, equity, social justice, interconnections and personal dignity.Footnote 210

Mental illnesses are characterized by alterations in thinking, mood or behaviour – or some combination thereof – associated with some significant distress and impaired functioning. … Mental illnesses take many forms, including mood disorders, schizophrenia, anxiety disorders, personality disorders, eating disorders and addictions such as substance dependence and gambling.Footnote 210

A considerable body of scientific research now supports the idea that mental health and mental illness are not on opposite ends of a single continuum with mental health increasing only as mental illness decreases.Footnote 210 Rather mental health and mental illness are best conceived as existing on two separate but related continua, therefore, mental health is more than the absence of mental illness.Footnote 215 Positive mental health consists of attributes such as having a purpose in life, positive relations with others, experiencing personal growth, social acceptance, social coherence and making contributions to society.Footnote 215 Consequently, it is very possible for people to have good levels of positive mental health that allow them to live meaningful and productive lives regardless of having a mental illness or mental health problem.Footnote 215-217

Many of the mental health problems and illnesses that concern youth and young adults are the same as those affecting Canadians of all ages. In addition, there exist a number of mental health issues of particular concern for this age group, including eating disorders and suicidal behaviour.

It is difficult to accurately determine the mental health state or rates of mental illness among Canadians because the data are limited. Nevertheless, the data that are available through surveys, studies and databases provide us with some understanding of the mental health of youth and young adults.

Mental health

A number of factors are commonly used as measures of individuals' mental health. These factors consider individuals' self-assessment of their mental health; sense of satisfaction with and control over their lives; sense of belonging; and relationships.Footnote 218 In 2009, more than three-quarters (77%) of Canadian youth and young adults described their mental health as being very good or excellent.Footnote 219 Compared to the overall population, larger proportions of immigrant youth and young adults (80% and 81% respectively) and smaller proportions of off-reserve Aboriginal youth and young adults (66% and 71% respectively) described their mental health as being very good or excellent (see Figure 3.7).Footnote 219 According to the 2008/2010 First Nations Regional Longitudinal Health Survey (RHS), the proportion of on-reserve Aboriginal youth aged 12 to 17 years who described their mental health as very good or excellent was also smaller (65%) than the general population.Footnote 220

While the majority (92%) of all Canadians aged 12 years and older reported that they were satisfied or very satisfied with life in 2009, proportions were higher among the younger populations: 96% of youth and 94% of young adults reported being satisfied or very satisfied with life.Footnote 219, Footnote 221 However, compared to 25% of the overall Canadian population between the ages of 12 and 64 years, 14% of youth and 24% of young adults described most days as being quite a bit or extremely stressful.Footnote 219

Table 3.3 Mental health of Canada's youth and young adults
Mental health  

* Denotes self-reported data.

Note: More detailed information can be found in Appendix C: Definitions and Data Sources for Indicators.
Source: Statistics Canada.

Population aged 12 to 19 years, 2009* (percent)
Perceived mental health, very good or excellent 76.9
Life satisfaction, satisfied or very satisfied 96.4
Perceived life stress, quite a bit or extreme 13.9
Sense of community belonging, somewhat or very strong 74.7
Population aged 20 to 29 years, 2009* (percent)
Perceived mental health, very good or excellent 77.3
Life satisfaction, satisfied or very satisfied 94.4
Perceived life stress, quite a bit or extreme 24.1
Sense of community belonging, somewhat or very strong 56.6

Of all age groups, the highest percentage (75%) of those who reported a somewhat or very strong sense of belonging to their community was among youth, and the lowest (57%) was among young adults.Footnote 219 For youth, feeling a sense of belonging at school can be likened to feeling a sense of belonging to their community. In the 2006 Health Behaviour in School-aged Children (HBSC) national survey of students in Grades 6 to 10 (ages 11, 13 and 15 years), the highest percentages of youth who felt they belonged at their school were in Grade 6 (71% of adolescent girls and 62% of adolescent boys) and the lowest percentages were in Grade 8 (58% of adolescent girls and 48% of adolescent boys).Footnote 45

Figure 3.7 Very good or excellent self-perceived mental health, by origin, youth and young adults, Canada, 2009Footnote 219

Figure 3.7 Very good or excellent self-perceived mental health, by origin, youth and young adults, Canada, 2009

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, 2009, Statistics Canada.

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[Figure 3.7, Text Equivalent]

In a separate survey of current and former Canadian high school students, fewer sexual minority youth (those who identified as lesbian, gay, bisexual, transgender or questioning [LGBTQ]) reported feeling a sense of belonging to their school community. Compared to only 25% of their non-LGBTQ peers, 69% of transgender youth and 45% of LGB youth disagreed or strongly disagreed with the statement "I feel like a real part of my school."Footnote 222

An individual's level of self-confidence can also be a measure of their mental health. The 2006 HBSC survey found that self-confidence varied by grade and sex. Almost half (47%) of Grade 6 adolescent boys reported that they had confidence in themselves, but the proportion dropped to less than a quarter (24%) among those in Grades 9 and 10. Proportions were consistently lower for adolescent girls than for adolescent boys, ranging from 36% in Grade 6 to only 14% in Grade 10.Footnote 45

Youth and young adults living in low-income households may be at higher risk for mental health problems. In an analysis of national longitudinal data, Canadians living in lower-income households were found to have a higher risk of becoming distressed over time. The higher risk was partially accounted for by a higher prevalence of certain stressors in their lives, such as job strain, financial problems, relationship problems and recent life events.Footnote 223 Aboriginal, immigrant and homeless youth and young adults are over-represented among those living on low income in Canada and are thus more likely to experience such stressors.Footnote 224, Footnote 225 In addition, they may experience racism or discrimination harmful to their self-esteem, sense of identity and sense of control, all of which place them at higher risk for mental health problems.Footnote 226, Footnote 227

Similarly, stressors such as stigmatization, harassment, bullying and a lack of appropriate education, services, protective measures and policies may put sexual minority youth and young adults at higher risk of mental health issues.Footnote 228, Footnote 229

Table 3.4 Mental illness of Canada's youth and young adults
Mental illness  

* Denotes self-reported data.

† Data for 2002.

Note: More detailed information can be found in Appendix C: Definitions and Data Sources for Indicators.
Source: Statistics Canada.

Population aged 12 to 19 years, 2009* (percent)
Mood disorder 2.7
Anxiety disorder 4.0
Suicidal thoughts in the past 12 months† (population aged 15 to 19 years) 6.7
Population aged 20 to 29 years, 2009* (percent)
Mood disorder 5.2
Anxiety disorder 5.8
Suicidal thoughts in the past 12 months† 4.3

Mood disorders

Mood disorders include mental illnesses such as depression and bipolar disorder in which a person experiences distinct moods more intensely and for longer periods than normal.Footnote 230 In 2009, the overall percentage of Canadians aged 12 years and older who reported having been diagnosed with a mood disorder was just over 6.3%.Footnote 221 Although youth had the lowest percentage of mood disorders, with only 2.7% reporting a diagnosis (see Table 3.4), there was already a difference between sexes: 2.0% for adolescent boys and 3.4% for adolescent girls.Footnote 219 The overall percentages increased with age thereafter, as did the difference between men and women (see Figure 3.8).Footnote 219 Among young adults, the proportion of young men diagnosed increased to 3.5% and young women to 6.9%.Footnote 219 The percentages were also higher among off-reserve Aboriginal youth (6.6%) and young adults (6.1%), where females in particular had a much larger percentage of self-reported diagnoses with 9.7% of adolescent girls and 9.3% of young women reporting a mood disorder.Footnote 219 Conversely, a smaller proportion of immigrant youth and young adults (0.8% and 2.5% respectively) self-reported being diagnosed with mood disorders.Footnote 219

Mood disorders are distinct from normal moods in their depth and persistence, and in their interference in one's ability to function.Footnote 230

The World Health Organization (WHO) estimated unipolar depression to be the single largest contributor to the burden of disease (a measure of the combined impact of mortality and morbidity a disease has on a population) among Canadians between the ages of 15 and 59 years.Footnote 231 Compared to any other disease, unipolar depression causes the greatest number of years lost to premature death and disability in this population.Footnote 231 When surveyed in 2002, 4.8% of all Canadians aged 15 years and older met all measured criteria for having a major depressive episode in the previous 12 months.Footnote 232 The proportion was highest for young adults, with more than 6.5% meeting the criteria (4.8% of young men compared to 8.2% of young women).Footnote 233 The percentage of all immigrants aged 15 years and older who met the criteria was smaller (3.5%) than in the overall population of the same age, as was the percentage of immigrant young adults (5.8%) compared to the total young adult population.Footnote 233 Among all Canadians aged 15 years or older, the average reported age of onset of a depressive episode was 28 years.Footnote 234

Figure 3.8 Mood disorder by age group and sex, youth and young adults, Canada, 2009Footnote 219

Figure 3.8 Mood disorder by age group and sex, youth and young adults, Canada, 2009

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, 2009, Statistics Canada.

[Click to enlarge]

[Figure 3.8, Text Equivalent]

Anxiety disorders

A certain level of anxiety is a normal reaction to stress. Anxiety disorders, however, occur when the anxiety is exaggerated in degree or duration relative to the stressor and interferes with everyday functioning. Panic disorder, phobias and obsessive-compulsive disorder are all types of anxiety disorders.Footnote 210 In 2009, 5.0% of Canadians aged 12 to 29 years reported being diagnosed with an anxiety disorder.Footnote 219 The proportion of young adults who reported a diagnosis was higher than for youth (5.8% compared to 4.0%) (see Table 3.4) and in both age groups the proportion of females was high than the proportion of males (see Figure 3.9).Footnote 219 The proportions were higher among off-reserve Aboriginal youth (9.1%) and young adults (11.6%), and lower among immigrant youth (1.8%) and young adults (1.9%).Footnote 219

Some people experience extreme anxiety at a level of reaction out of scope to the nature of the trigger in the form of panic attacks. Those who suffer from recurrent and unexpected panic attacks are said to have a panic disorder.Footnote 235 Panic disorders affect Canadians of all ages, but they are most common, and most often begin, in adolescence or early adulthood.Footnote 239 In 2002, the lifetime prevalence of panic disorder among Canadians aged 15 to 29 years was just over 3%.Footnote 233 For all Canadians aged 15 and older, the average age of onset for panic disorder over the lifetime was 25 years – a transitional age when many are completing their education, entering the work force and forming relationships.Footnote 235 The impact of suffering from a panic disorder at such a key point could have long-lasting repercussions, including disruptions to family, work and social life and an increased risk of depression and suicide.Footnote 189, Footnote 235, Footnote 237, Footnote 239

Figure 3.9 Anxiety disorder by age group and sex, youth and young adults, Canada, 2009Footnote 219

Figure 3.9 Anxiety disorder by age group and sex, youth and young adults, Canada, 2009

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, 2009, Statistics Canada.

[Click to enlarge]

[Figure 3.9, Text Equivalent]

Eating disorders

Eating disorders such as anorexia nervosa and bulimia nervosa are characterized by an obsessive preoccupation with food and weight resulting in a serious disturbance in eating behaviour.Footnote 240 Eating disorders can have serious immediate and long-term consequences. Anorexia and bulimia can lead to death as a result of heart conditions and kidney failure. Those who suffer from eating disorders are also at greater risk of depression, alcohol dependence and anxiety disorders.Footnote 210

In 2005/2006, adolescent girls were hospitalized for eating disorders at a rate 2.5 times the rate of young women and more than six times the rate of any other group.Footnote 179, Footnote 241 In 2002, 1.5% of young Canadian women aged 15 to 29 years reported that they had been diagnosed with an eating disorder.Footnote 233 Additionally, just over 3% reported behaviours and symptoms over the previous 12 months that suggested they were at risk of having an eating disorder whether they had been diagnosed or not. The percentages for young men were too low to report.Footnote 233

Although eating disorders are more common among women than men, and affect adolescent and young adult women in particular, adolescent boys and young men are also vulnerable. It is estimated that 5% to 15% of anorexia and bulimia patients are male; however, this estimate may be low since males are less likely to be diagnosed.Footnote 242 Adolescent boys and young men with eating disorders, like adolescent girls and young women, have a distorted body image, often focused on their muscularity.Footnote 242 Males concerned with lack of muscularity are also at greater risk for steroid or other drug use.Footnote 242

When asked about their body image, 34% of adolescent girls and 24% of adolescent boys in Grades 6 to 10 described themselves as too fat. Although the percentage of adolescent boys was consistent across grades, there was a clear increase with age for adolescent girls, from 25% in Grade 6 to 40% in Grade 10.Footnote 45 However, only 15% of those Grade 10 adolescent girls were actually overweight or obese based on their self-reported heights and weights.Footnote 45

Bullying and aggression

Bullying can have a serious, lasting impact on the emotional health of victims. Experiencing interpersonal violence early in life, whether it is in the family, among intimate (dating) partners, or between peers, can contribute to short- and long-term health outcomes. Links have been made between these experiences and a number of public health issues, including substance abuse, aggression and bullying, mental health, and suicide.Footnote 243, Footnote 244 Further, research suggests there may also be associations between early engagement in bullying and later engagement in dating violence, intimate partner violence, child maltreatment and elder abuse.Footnote 45, Footnote 245-247

In the 2006 HBSC survey, 36% of students reported being victims of bullying, 39% reported being bullies and 20% reported being both.Footnote 45 Students with low academic achievement levels or who reported low levels of parent trust or negative feelings about the school environment were more likely to be involved in bullying either as bullies, victims or both.Footnote 45

The most common forms of bullying reported were teasing and indirect bullying (e.g. exclusion or spreading lies about a victim). More than two-thirds of Grade 6 victims (72% of adolescent boys and 69% of adolescent girls) and more than half of Grade 10 victims (64% of adolescent boys and 55% of adolescent girls) reported being teased (see Figure 3.10).Footnote 45 Indirect bullying was slightly less common for adolescent boys ranging from 71% of Grade 6 male victims to 57% of Grade 10 male victims and slightly more common for adolescent girls ranging from 78% of Grade 6 female victims to 71% of Grade 10 female victims.Footnote 45 Electronic bullying through email or cell phone was consistently more common among female victims.Footnote 45

Figure 3.10 Indirect forms of bullying in victim students by grade and sex, Canada, 2006Footnote 45

Figure 3.10 Indirect forms of bullying in victim students by grade and sex, Canada, 2006

* Indirect bullying includes exclusion or spreading lies.

Source: Public Health Agency of Canada using data from 2006 Health Behaviour in School-aged Children study.

[Click to enlarge]

[Figure 3.10, Text Equivalent]

Most forms of direct bullying, such as physical bullying, were more commonly reported by victimized adolescent boys across all grades (see Figure 3.11).Footnote 45 Rates of sexual harassment, while decreasing across most grades for victimized adolescent boys, increased across all grades and nearly doubled for victimized adolescent girls between Grade 6 and Grade 10 (23% to 44%).Footnote 45 Bullying for reasons of race and religion was also reported, but at lower levels – up to 21% and 16% respectively.Footnote 45

Adolescent boys reported significantly more physical fighting than did adolescent girls in 2006, though this behaviour decreased with age. Among adolescent girls, prevalence of fighting was more consistent across grades.Footnote 45 Among adolescent boys, the target of a physical fight was most often a friend or acquaintance (48% of the time), while a greater proportion of adolescent girls targeted a sibling (47% of the time).Footnote 45

Figure 3.11 Direct forms of bullying in victim students by grade and sex, Canada, 2006Footnote 45

Figure 3.11 Direct forms of bullying in victim students by grade and sex, Canada, 2006

Source: Public Health Agency of Canada using data from 2006 Health Behaviour in School-aged Children study.

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[Figure 3.11, Text Equivalent]

The HBSC survey also found that a greater proportion of adolescent boys carried weapons at school, with 17% reporting that they carried a weapon in the previous 30 days, as compared to only 4% of adolescent girls. Of those students that carried weapons, most carried knives (61% for adolescent boys, 72% for adolescent girls). A larger proportion of adolescent boys carried handguns or other firearms (14% compared to 6% for adolescent girls).Footnote 45

Sexual minority youth are at much higher risk of experiencing physical and sexual abuse, harassment and victimization at school or in the community.Footnote 248, Footnote 249 In an online survey of current and former Canadian high school students, 59% of LGBTQ youth reported being verbally harassed at school about their sexual orientation compared to 7% of heterosexual youth, and a higher percentage reported being physically harassed compared to non-LGBTQ students (25% compared to 8%).Footnote 222 LGBTQ students also reported bullying in the form of rumours or lies being spread about them, both at school (55%) and through text-messaging or the Internet (31%).Footnote 222

Police-reported data show that the risk of violent victimization for youth increases with age.Footnote 250 In 2009, 50% of youth who were physically assaulted were assaulted by a close friend.Footnote 251 In the same year, 22% of all police-reported sexual offence and physical assault victims were youth aged 12 to 19 years.Footnote 251, Footnote 252 Although they accounted for a small percentage of all sexual offences and physical assaults, the rate of 1,676 per 100,000 population was more than double the rate of 781 per 100,000 population among adults aged 18 years and older.Footnote 179, Footnote 251, Footnote 252

Police-reported data in 2008 showed the highest rate of dating violence victims was among adults aged 30 to 39 years.Footnote 253 However, self-reported data suggest otherwise, noting that young people aged 15 to 24 years are at the highest risk of being victims of dating violence although they may not report the violence to police.Footnote 253 The offence most frequently reported to police in dating relationships was common assault, such as pushing, slapping, punching and face-to-face verbal threats. Criminal harassment, uttering threats and major assault involving a weapon and/or causing bodily harm were the next three most common offences.Footnote 253 Female youth aged 15 to 19 years were victims of police-reported dating violence at a rate almost 10 times greater than the rate for males the same age.Footnote 253

Although females were more often the victims in dating violence reported to the police, males are also victims, but may not report the violence to police for a number of reasons. In a 2008 survey in British Columbia, 9% of male high school students and 6% of female high school students who were in a relationship in the previous year reported being deliberately hit, slapped or physically hurt by their boyfriend or girlfriend while in a relationship. Among those who reported relationship violence, LGB youth were over three times more likely than their heterosexual peers to be victims.Footnote 254

Intentional self-harm

As will be seen later in this chapter, unintentional injuries are a leading cause of death and hospitalization for youth and young adults.Footnote 241, Footnote 255 However, negative health outcomes and even death can also result from injuries inflicted through intentional self-harm. Intentional self-harm can encompass both non-suicidal and suicidal behaviours.Footnote 256

Non-suicidal self-injury (NSSI) can take many forms, but some of the more common include cutting or burning of the skin, scratching, hitting objects or oneself or pulling out one's hair.Footnote 256-259 In general, these behaviours are used as a coping strategy to deal with overwhelming negative emotions or to produce emotion when it is lacking.Footnote 256, Footnote 257, Footnote 260-263 NSSI is seen in individuals from as young as 5 years old to those older than 65 years. However, it is most common among youth and young adults, and onset usually occurs among youth aged 12 to 15 years.Footnote 256, Footnote 264, Footnote 265

It is difficult to get an accurate indication of the prevalence of NSSI since it is usually hidden.Footnote 256, Footnote 264 Although not extensive enough to be representative of the entire population, surveys of both school- and university-aged youth and young adults produced some estimates. In a survey of youth in Grades 7 to 11 in two Canadian schools, 14% of students had self-injured at some time, with skin cutting being the most common form (41%). The majority of those students (59%) reported that they first engaged in the behaviour in Grade 7 or Grade 8.Footnote 266 In another survey of youth and young adults aged 14 to 21 years in British Columbia, 17% reported that they had intentionally harmed themselves at some point in their lives, most often (83%) through cutting, scratching or self-hitting and starting on average at age 15 years.Footnote 259 At two universities in the United States, 17% of the students surveyed admitted self-injuring and 7% had done so within the previous 12 months.Footnote 267 A survey of first-year students at a Canadian university found that almost three in ten had engaged in deliberate self-harm at least once.Footnote 268

Although the secretive nature of self-inflicted injuries means they most often go unrecorded, at times they are severe enough to require hospitalization, resulting in some episodes being documented. In 2009-2010, self-injuries resulted in more than 17,000 hospitalizations among all Canadians age 15 years and older.Footnote 269 The rate of self-injury hospitalization was highest among adolescent girls aged 15 to 19 years with more than 140 hospitalizations per 100,000 population, compared to approximately 60 per 100,000 for adolescent boys of the same age.Footnote 269

While many self-injuries are not intended as suicide attempts, research shows that those who self-injure are at greater risk of committing suicide later in life.Footnote 256, Footnote 262 In 2002, 7% of youth aged 15 to 19 years and 4% of young adults reported that they had thought about committing suicide in the previous 12 months, compared to less than 4% of all Canadians aged 15 years and older.Footnote 232, Footnote 233 A higher proportion of adolescent girls reported suicidal thoughts than adolescent boys (9% and 5%, respectively), while the proportion of suicidal thoughts was the same among young women and young men (4%).Footnote 233 Each year many youth and young adults actually attempt suicide. While some of those attempts may go unrecognized, in 2005 there were more than 5,000 hospitalizations of Canadian (excluding Quebec, for which comparable data were not available) youth and young adults that were specifically classified as attempted suicides.Footnote 241 Females accounted for two-thirds (66%) of those suicide attempts.Footnote 241

Unfortunately, some of those attempted suicides are completed. As a result, suicide is among the top causes of death for Canadian youth and young adults, second only to unintentional injuries.Footnote 255 In 2007, almost 800 youth and young adults committed suicide in Canada, and 76% of those deaths were among young men.Footnote 255 Within these age groups, the rate of suicide deaths is highest for young men with 20 deaths per 100,000 population – more than double the rate for adolescent boys and four times the rate for young women (see Figure 3.12).Footnote 179, Footnote 255

In 2000, the suicide rate among First Nation youth aged 10 to 19 years was 28 per 100,000 population, more than four times the overall rate for Canada.Footnote 271 Higher rates do not, however, hold true for all First Nation youth and young adults. In a study of suicide in British Columbia, researchers found that although rates among First Nation youth aged 15 to 24 years were significantly higher overall than for non-Aboriginal youth, the rates varied from community to community. Whereas several communities had rates much higher than those of non-Aboriginal people, some communities had no youth suicides during those years. Lower rates of suicide were linked to an increased level of community control such as self-government, land claims, education, health services, cultural facilities and police/fire services.Footnote 58, Footnote 272

Figure 3.12 Suicide rate per 100,000 population, by age group and sex, Canada, 2007Footnote 179, Footnote 255, Footnote 270

Figure 3.12 Suicide rate per 100,000 population, by age group and sex, Canada, 2007

Source: Public Health Agency of Canada using data from Canadian Vital Statistics, Death Database; and Population Estimates and Projections, Statistics Canada.

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[Figure 3.12, Text Equivalent]

Data are limited for Inuit youth and young adults, but rates of suicide in Inuit regions as a whole are much higher than in the general Canadian population. From 1999 to 2003, the age-standardized mortality rate (ASMR) for suicide and self-inflicted injuries among both males and females in Inuit regions was 107 deaths per 100,000 population. In comparison, the ASMR for suicide and self-inflicted injuries in Canada overall was 10 deaths per 100,000 population during those same years.Footnote 273

Sexual minority youth and young adults may be at higher risk for suicide than their heterosexual peers.Footnote 249 The Suicide Prevention Resource Centre in the United States examined a number of studies that suggested that LGB youth and young adults (generally between the ages of 15 and 24 years) are between 1.4 and almost 7 times more likely to attempt suicide than their heterosexual peers and as much as 3 times more likely to consider suicide.Footnote 274 In British Columbia, the 2008 Adolescent Health Survey (AHS) of students in Grades 7 to 12 found that 28% of LGB youth attempted suicide compared to 4% of heterosexual youth.Footnote 254 Based on the 2003 AHS, sexual minority youth were anywhere from two times (gay males) to five times (bisexual males, bisexual females and lesbians) more likely to report having considered suicide than their heterosexual peers.Footnote 275 In an Ontario study of trans (including transsexual, transgender and other gender-variant) youth aged 16 to 24 years, almost half (47%) reported having seriously considered suicide in the previous year and one-fifth (19%) attempted suicide.Footnote 276, Footnote 277

Physical health

According to the 2009 Canadian Community Health Survey (CCHS), 68% of Canadian youth and 70% of young adults perceive their health as very good or excellent.Footnote 219 Although young Canadians experience lower overall mortality rates and fewer chronic conditions than older age groups, they are more prone to injuries and deaths due to injuries (see Table 3.5), have increasing rates of obesity and the highest rates of sexually transmitted infections (STIs) (see Table 3.6).

Table 3.5 Perceived health and mortality of Canada's youth and young adults
Physical health  

* Denotes self-reported data.

Note: More detailed information can be found in Appendix C: Definitions and Data Sources for Indicators.
Source: Statistics Canada and Public Health Agency of Canada.

Perceived health, very good or excellent*, 2009 (percent of population aged 12 to 19 years) 67.7
Perceived health, very good or excellent*, 2009 (percent of population aged 20 to 29 years) 70.0
Mortality
Rate per 100,000 population aged 12 to 19 years, 2007
Injuries and poisonings 22.1
Traffic incidents 10.0
Intentional self-harm 6.1
Other unintentional injuries 3.1
Cancers 2.8
Nervous system diseases 1.7
Rate per 100,000 population aged 20 to 29 years, 2007
Injuries and poisonings 40.2
Traffic incidents 14.5
Intentional self-harm 12.7
Other unintentional injuries 7.3
Cancers 4.7
Circulatory diseases 2.5

Mortality

Deaths among youth and young adults are uncommon, accounting for only 7% of all deaths of Canadians less than 65 years of age in 2007.Footnote 255, Footnote 270 Injuries and poisonings, both intentional and unintentional, were the most common cause of those deaths (70%), followed by cancers (8%).Footnote 255 Nearly three-quarters (72%) of all deaths of youth and young adults in 2007 were among adolescent boys and young men.Footnote 255

As seen in Figure 3.13, although injuries and poisonings are the leading cause of death for all youth and young adults, they account for a much higher proportion of deaths among adolescent boys and young men (75%) than among adolescent girls and young women (56%).Footnote 255 Injuries and poisonings causing death among youth and young adults were most often due to transport incidents (39%), intentional self-harm (30%) and other causes of unintentional injury (17%) including falls and drowning.Footnote 255 For adolescent boys and young men, nearly one-fifth (18%) of transport incidents causing death were associated with the use of all-terrain vehicles, motorcycles and water transport vehicles.Footnote 255

In 2008, approximately 100 young Canadian workers aged 15 to 29 years died in the workplace.Footnote 278 This represents nearly 10% of all workplace deaths in Canada in that year.Footnote 278 Most deaths (96%) were among male workers, and the most common event associated with workplace death of young Canadians was highway collisions (27%), with construction (37%) being the most common industry.Footnote 279 Overall, the number of workplace fatalities experienced by young Canadian workers has remained relatively unchanged over the past five years.Footnote 279

Figure 3.13 Major causes of death by sex, youth and young adults aged 12 to 29 years, Canada, 2007Footnote 255

Figure 3.13 Major causes of death by sex, youth and young adults aged 12 to 29 years, Canada, 2007

Source: Public Health Agency of Canada using data from Canadian Vital Statistics, Death Database, Statistics Canada.

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[Figure 3.13, Text Equivalent]

Ill health and disease

There a number of common physical health issues with clear and immediate short-term health effects for youth and young adults, as well as those known to have longer-term consequences. These issues, while not unique to youth and young adults, are of particular concern for young Canadians given their significance for the current and future health of this age group.

Table 3.6 Physical health of Canada's youth and young adults
Physical health  

* Denotes self-reported data.
‡ Data excludes Quebec.

Note: More detailed information can be found in Appendix C: Definitions and Data Sources for Indicators.
Source: Statistics Canada and Public Health Agency of Canada.

Ill health and disease
Asthma*, 2009 (percent of population aged 12 to 29 years) 11.1
Overweight or obese, 2007-2009 (percent of population aged 12 to 19 years) 29.4
Overweight or obese, 2007-2009 (percent of population aged 20 to 29 years) 42.7
Diabetes prevalence, 2004-2005 (percent population aged 15 to 19 years) 0.5
Diabetes prevalence, 2004-2005 (percent population aged 20 to 29 years) 0.8
Cancer incidence, 2007 (annual age standardized per 100,000 per year for population aged 15 to 29 years) 34.8
Population aged 12 to 19 years
Medically unattended injuries*, 2009 (percent of injured population) 43.9
Hospitalizations due to injuries, 2005/2006‡ (percent of hospitalizations) 18.1
Population aged 20 to 29 years
Medically unattended injuries*, 2009 (percent of injured population) 46.5
Hospitalizations due to injuries, 2005/2006‡ (percent of hospitalizations) 7.7
Sexually transmitted infections population aged 15 to 19 years, 2009
Chlamydia (rate per 100,000 population) 1,041.7
Gonorrhea (rate per 100,000 population) 102.5
Infectious syphilis (rate per 100,000 population) 2.3
HIV (total number of positive HIV tests) 49
Sexually transmitted infections population aged 20 to 29 years, 2009
Chlamydia (rate per 100,000 population) 1,021.2
Gonorrhea (rate per 100,000 population) 116.1
Infectious syphilis (rate per 100,000 population) 9.4
HIV (total number of positive HIV tests) 533

Respiratory conditions

Asthma is one of the more commonly diagnosed respiratory diseases in Canadian youth and young adults.Footnote 280 In 2009, 11% of youth and young adults reported having physician-diagnosed asthma.Footnote 219 Immigrant youth and young adults appear to be less affected, with a prevalence of only 6% that same year.Footnote 219 Early onset of asthma has been linked to low birth weight, exposure to tobacco smoke and genetic predisposition, while later onset has been linked to genetic predisposition, obesity, increased exposure to allergens and environmental factors such as pollution.Footnote 280, Footnote 281

The rate of tuberculosis in Canada is low, and the disease is no longer common in the general population. Nevertheless, it remains a serious problem among First Nations and Inuit communities and immigrants from regions of the world with high prevalence of tuberculosis.Footnote 282, Footnote 283 Between 2000 and 2009, 71% of all tuberculosis cases among Canadians aged 15 to 29 years were in immigrants, 21% in Aboriginal peoples, 8% in Canadian-born non-Aboriginal peoples and 1% in Canadians of unknown origin.Footnote 284 The highest incidence rate of tuberculosis in 2009 was among Aboriginal peoples, which showed a significant increase since 2005 (see Figure 3.14).Footnote 284 Factors influencing the high number of tuberculosis cases in Aboriginal communities are thought to include overcrowded housing and limited access to health-care services in remote areas.Footnote 282, Footnote 285, Footnote 286

Figure 3.14 Tuberculosis incidence rate by origin, youth and young adults aged 15 to 29 years, Canada, 2001 to 2009Footnote 284

Figure 3.14 Tuberculosis incidence rate by origin, youth and young adults aged 15 to 29 years, Canada, 2001 to 2009

Source: Public Health Agency of Canada using data from Canadian Tuberculosis Reporting System.

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[Figure 3.14, Text Equivalent]

Healthy weights

Levels of physical activity, access to healthy foods, educational attainment and income are just some of the influences that can increase the risk of obesity by shaping individual perceptions, knowledge and behaviours about healthy lifestyles and healthy weights.Footnote 287

Canadian children are experiencing higher rates of obesity than in the past, and not surprisingly this also holds true for youth and young adults.Footnote 30 Between 1978/1979 (Canada Health Survey) and 2007-2009 (Canadian Health Measures Survey), rates of measured obesity for youth increased from 3% to 11%.Footnote 288, Footnote 289 Measured obesity rates for young adults more than doubled during the same period (increasing from 6% to 15%).Footnote 288, Footnote 289 Rates in 2007-2009 showed little difference between the percentages of adolescent boys and adolescent girls who were overweight (20% and 18% respectively) and obese (12% and 9% respectively) (see Figure 3.15).Footnote 289 Among young adults, there was a greater difference, with more young men considered overweight (34% compared to 21%), yet more young women considered obese (18% compared to 13%).Footnote 289

Figure 3.15 Measured BMI category by age group and sex, Canada, 2007-2009Footnote 289-291

Figure 3.15 Measured BMI category by age group and sex, Canada, 2007-2009

Note: Underweight, overweight and obesity cut-points for youth can be found in Appendix C: Definitions and Data Sources for Indicators.

Source: Public Health Agency of Canada using data from Canadian Health Measures Survey, 2007-2009, Statistics Canada.

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[Figure 3.15, Text Equivalent]

Lower percentages of immigrant youth and young adults were measured as overweight or obese. Only 17% of immigrant youth were considered overweight and only 5% obese.Footnote 289 More adolescent immigrant boys were measured to be overweight or obese (26%) compared to adolescent immigrant girls (19%).Footnote 289 For young adult immigrants, 36% measured overweight and 3% measured obese.Footnote 289 As with immigrant youth, more young immigrant men were measured to be overweight or obese (46%) compared to young immigrant women (31%).Footnote 289 Length of time since immigration may play a role in immigrant overweight and obesity rates, with those living in Canada longer having higher percentages.Footnote 293

Rates of measured overweight and obesity are even higher for Aboriginal youth and young adults. According to the 2009 CCHS, 20% of off-reserve Aboriginal youth reported being overweight and 7% obese.Footnote 219 There was little difference between the total percentage of overweight and obese off-reserve Aboriginal adolescent boys and girls (29% and 25% respectively).Footnote 219 The 2008/2010 RHS found similar self-reported results among on-reserve First Nation youth aged 12 to 17 years with 30% considered overweight and 13% considered to be obese.Footnote 220 Among off-reserve Aboriginal young adults, 30% measured overweight and 15% measured obese.Footnote 219 Again, a higher percentage of young men measured as overweight or obese (50%) compared to young women (40%).Footnote 219



The body mass index (BMI) is a ratio of weight-to-height calculated as BMI = weight in kilograms/ (height in metres)2.Footnote 292 There are six categories* of BMI ranges in the weight classification system, each of which has an observed level of associated health risk:Footnote 292

Body mass index
Classification BMI Category (kg/m2) Level of Health Risk
Underweight < 18.5 Increased risk
Normal weight 18.5-24.9 Least risk
Overweight 25.0-29.9 Increased risk
Obese ≥ 30.0  
Obese Class I 30.0-34.9 High risk
Obese Class II 35.0-39.9 Very high risk
Obese Class III ≥ 40.0 Extremely high risk

* Underweight, overweight and obesity cut-points for youth under 18 years of age can be found in Appendix C: Definitions and Data Sources for Indicators.

Physical activity plays a key role in achieving and maintaining health weights for all Canadians and increased levels of sedentary activity, including screen time, have been positively associated with obesity.Footnote 294 Between 2000/2001 and 2009, the percentage of youth who spent, on average, 15 or more hours per week participating in sedentary activities increased from 65% to 76%.Footnote 219, Footnote 295 A larger gap was seen in young adults with reported rates increasing from 57% to 75% during the same period.Footnote 219, Footnote 295

Eating habits also play a key role in maintaining or achieving healthy weights.Footnote 296 On the positive side, Canadian youth and young adults have increased their consumption of fruits and vegetables in recent years. Between 2000/2001 and 2009 the percentage of youth consuming fewer than five fruits and vegetables per day decreased from 60% to 51%.Footnote 219, Footnote 295 A similar change was also reported by young adults with reported rates decreasing from 65% to 56% during the same period.Footnote 219, Footnote 295 Nevertheless, it is not uncommon for young Canadians to consume unhealthy foods. In 2004, of all Canadians, fast food consumption was reported to be the highest among young men aged 19 to 30 years, 39% of whom reported consuming something prepared at a fast food restaurant the day before.Footnote 297 Among adolescent boys aged 14 to 18 years, one-third reported consuming something prepared at a fast food restaurant the day before.Footnote 297 Fewer young men (38%) reported eating only home-prepared meals than young women (43%).Footnote 297

Levels of education and income have also been associated with rates of obesity.Footnote 290 Overweight and obesity rates among youth in households where the highest level of attained education was less than high school (34%) were higher than in households where the highest level of attained education was post-secondary (29%).Footnote 298 For young adults the pattern of obesity differs by level of income. As shown in Figure 3.16, overweight and obesity percentages for young women tend to be lower for those with higher levels of income. For young men, overweight and obesity percentages tend to be higher for those with higher levels of income.Footnote 298 While the cause for the inverse gradient between weight and income in men is unclear, some research has shown that men with higher incomes tend to eat out more frequently, possibly leading to a higher percentage being overweight or obese.Footnote 299, Footnote 300 Meanwhile, men with lower incomes tend work in more physically demanding jobs which may contribute to the lower percentages being overweight or obese.Footnote 299, Footnote 301

Being overweight or obese when young can increase the risk of developing chronic health conditions later in life.Footnote 292, Footnote 296, Footnote 302 Unhealthy weights are associated with an increased risk of gallbladder disease, respiratory problems, cardiovascular diseases, hypertension, osteoarthritis, some types of cancer (e.g. breast, endometrial, colon, prostate and kidney), psychosocial problems, functional limitations and impaired fertility.Footnote 292, Footnote 296, Footnote 302

Increasingly diagnosed in younger age groups, diabetes has also been associated with being overweight or obese, as well as physical inactivity.303-307 In 2004/2005 the National Diabetes Surveillance System (NDSS) reported the prevalence of diabetes to be 0.5% for youth aged 15 to 19 years, and 0.9% for young adults.Footnote 304 While self-reported physician-diagnosed diabetes for off-reserve First Nation youth aged 15 to 19 years and for Métis youth (0.6% and 0.8%, respectively) were similar to that of Canadian youth, rates for Inuit youth were higher (1.5%) according to the 2006 Aboriginal Peoples Survey (APS).Footnote 308 Rates of self-reported physician-diagnosed diabetes for young adult Inuit and Métis (aged 20 to 34 years) were similar to the Canadian young adult rate (1.0% and 1.5% respectively) while the off-reserve First Nation rate was noticeably higher (2.8%).Footnote 308

Figure 3.16 Percentage of measured overweight and obesity by income and sex, young adults, Canada excluding territories, 2004Footnote 298

Figure 3.16 Percentage of measured overweight and obesity by income and sex, young adults, Canada excluding territories, 2004

Source: Public Health Agency of Canada using data from Canadian Community Health Survey, 2004, Statistics Canada.

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[Figure 3.16, Text Equivalent]

Cancer

The incidence of cancer among youth and young adults aged 15 to 29 years is much lower than in older age groups.Footnote 309 Overall, adolescent girls and young women aged 15 to 29 years tend to be diagnosed with cancer more often than adolescent boys and young men in this age range.Footnote 309 In 2007, the most diagnosed cancers in young females in this age range were thyroid, skin melanomas, Hodgkin lymphoma, breast and cervical (see Figure 3.17).Footnote 179, Footnote 310 Thyroid cancer was diagnosed twice as often in young women than in adolescent girls (11 per 100,000 compared to 5 per 100,000).Footnote 179, Footnote 310 The most commonly diagnosed cancers in young males were testicular, Hodgkin and non-Hodgkin lymphoma, thyroid and brain.Footnote 179, Footnote 310 Testicular cancer was diagnosed three times more often in young men than in adolescent boys (11 per 100,000 compared to 3 per 100,000).Footnote 179, Footnote 310 In fact, between 1998 and 2007, there were more cases of testicular cancer diagnosed in young men between the ages of 25 and 29 years than in any other age group.Footnote 179, Footnote 310

Youth and young adults diagnosed with cancer have a much better chance of surviving than many other Canadians. The five-year observed survival proportion for youth and young adults, for all cancers diagnosed between 2001 and 2004, was 85% – much higher than the five-year relative survival ratio of 62% in the total Canadian population.Footnote 309 This is also an improvement over the five-year observed survival proportion of 80% for youth and young adults diagnosed almost a decade earlier, between 1992 and 1995.Footnote 309

Figure 3.17 Incidence of select cancers by sex, youth and young adults aged 15 to 29 years, Canada, 2007Footnote 179, Footnote 310

Figure 3.17 Incidence of select cancers by sex, youth and young adults aged 15 to 29 years, Canada, 2007

Sources: Public Health Agency of Canada using data from Canadian Cancer Registry, Public Health Agency of Canada, Canadian Council of Cancer Registries and Statistics Canada.

[Click to enlarge]

[Figure 3.17, Text Equivalent]

Injuries

According to the 2009 CCHS, when asked about specific sporting activities in the past 12 months, 29% of youth aged 12 to 19 years always wore a helmet when cycling and 34% always wore a helmet while in-line skating, while fewer always wore wrist guards (11%), elbow pads (10%), or all protective gear (8%); 62% of youth skiers always wore a helmet compared to only 55% of youth snowboarders, though more than three-quarters (76%) of youth who both ski and snowboard always wore a helmet; 16% of youth always wore a mouth guard while playing hockey.Footnote 219

In contrast, when young adults were asked about specific sporting activities in the past 12 months, 24% of young adults aged 20 to 29 years always wore a helmet when cycling; 16% of young adults always wore a helmet while in-line skating, fewer always wore wrist guards (14%) or elbow pads (6%), while only 4% always wore all protective gear; 20% of young adult skiers always wore a helmet compared to only 31% of young adult snowboarders, more than one-quarter (26%) of youth who both ski and snowboard always wore a helmet; 14% of young adults always wore a mouth guard while playing hockey (3% of women compared to 16% of men).Footnote 219

Not only are injuries the leading cause of death for youth and young adults, every year hundreds of thousands of young Canadians suffer non-fatal injuries of varying degrees.Footnote 219, Footnote 220, Footnote 241, Footnote 255, Footnote 311, Footnote 312 Many of those injuries are not serious enough to require medical attention, while the most severe often necessitate hospitalization.Footnote 219, Footnote 241

According to the 2009 CCHS, 27% of youth (29% of adolescent boys and 24% of adolescent girls) and 18% of young adults (23% of young men and 12% of young women) reported that they had suffered an injury in the previous 12 months that restricted their normal daily activities.Footnote 219 Of those who were injured, a little less than half (45%) of youth and young adults reported that they did not seek medical attention within 48 hours of the injury.Footnote 219 The most common medically unattended injuries were those related to the ankle and foot (34%), knee and lower leg (15%) and the hand (13%).Footnote 219 Most of these medically unattended injuries occurred while engaged in sports (57%) or at home (23%).Footnote 219

More serious injuries may require a visit to the emergency room. The Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP), which has been implemented in 15 hospital emergency departments in major cities across Canada, collected more than 30,000 records associated with youth injuries from emergency departments in 2008.Footnote 311 Overall, more adolescent boys (63%) went to the hospital emergency departments than adolescent girls (37%).Footnote 311 Adolescent boys were primarily seen for minor injuries (37%) and fractures (27%), while adolescent girls were primarily seen for minor injuries (39%) and sprains (19%).Footnote 311

Young adults also frequented emergency departments for their injuries. According to the National Ambulatory Care Reporting System (NACRS), select emergency departments in British Columbia, Ontario, Nova Scotia, Prince Edward Island and Yukon recorded nearly 200,000 visits from young adults due to unintentional injuries (24% of all emergency department visits for young adults) in 2008.Footnote 312 The common causes of injuries seen at these visits were falls (18%), transport incidents (12%) and overexertion (11%) (including strenuous or repetitive movements associated with lifting weight or heavy objects, marathon running and rowing).Footnote 312 Overall, a higher percentage of young men (64%) were seen compared to young women (36%).Footnote 312 For both young men and young women the most common injuries were to the wrist and hand (27% for young men, 20% for young women), the head (19% for young men, 13% for young women) and the ankle and foot (13% for young men, 18% for young women).Footnote 312

According to the 2008/2010 RHS, 30% of on-reserve First Nation youth aged 12 to 17 years experienced some type of injury in the previous year.Footnote 220 The most commonly reported injuries among on-reserve First Nation youth were minor cuts, scrapes or bruises (43% of respondents), major sprains or strains (34% of respondents) and broken bones (30% of respondents).Footnote 220 Injuries were most often reported to be a result of falls (44% of respondents), accidental contact with people or animals (17% of respondents) and bicycle accidents (15% of respondents) and more than half of respondents (59%) experienced an injury while playing sports or during physical exercise.Footnote 220

Severe injuries may require hospitalization. In 2005/2006, more than 35,000 Canadian (excluding Quebec, for which comparable data were not available) youth and young adults were hospitalized for injuries (10% of all youth and young adult hospitalizations).Footnote 241 More than two-thirds (70%) of those hospitalizations were due to unintentional injuries and 27% were due to intentional injuries.Footnote 241 For both youth and young adults, males accounted for more of the hospitalizations than females (66% compared to 34% for youth and 68% compared to 32% for young adults).Footnote 241

Figure 3.18 Hospitalizations due to injuries, youth and young adults aged 12 to 29 years, Canada excluding Quebec, 2005/2006Footnote 241

Figure 3.18 Hospitalizations due to injuries, youth and young adults aged 12 to 29 years, Canada excluding Quebec, 2005/2006

Source: Public Health Agency of Canada, using data from Hospital Morbidity Database, Canadian Institute for Health Information.

[Click to enlarge]

[Figure 3.18, Text Equivalent]

For both males and females, transport incidents and falls were the two most common causes of unintentional injuries resulting in hospitalizations (see Figure 3.18).Footnote 241 Males and females differed in their overall proportions of hospitalizations for intentional injuries. Compared to 22% for males, 36% of all injury hospitalizations among females were for intentional injuries, including 31% as a result of self-harm.Footnote 241

A study of 2004/2005 acute care hospitalizations due to unintentional injuries among youth aged 10 to 19 years showed a difference in the causes of injuries by income. Those living in lower-income neighbourhoods were admitted more often because of cuts or poisonings than those living in higher-income neighbourhoods who were more likely than their lower-income counterparts to be admitted due to injuries as a result of falls or being struck.Footnote 313

The National Work Injury Statistics Program source data originate from administrative records used by the Canadian Workers' Compensation Boards and Commissions to process workers' compensation claims. The information in these records is used to compile work-related injury and disease statistics.Footnote 278

Data are representative of the number of workers covered by compensation, estimated at 80%, but differ from jurisdiction to jurisdiction.Footnote 278

Given that such a large proportion of the youth and young adult population is employed, workplace injuries are a concern for this age group.Footnote 314 According to data collected by the Association of Workers' Compensation Boards of Canada, youth aged 15 to 19 years and young adults sustained nearly 80,000 workplace injuries in 2008 – 25% of all workplace injuries that year.Footnote 278, Footnote 279 The most commonly reported types of workplace injuries were a result of overexertion (20%) and being struck by an object (18%).Footnote 279 Manufacturing (18%), construction (16%) and retail (16%) industries constituted half of all workplace injuries for youth and young adults.Footnote 279 As with workplace-related fatalities, the majority (71%) of workplace-related injuries were experienced by young men.Footnote 279

Sexually transmitted infections

An STI may be evident due to minor physical changes, pain or discomfort, but in many cases there are no symptoms at all and the infection often goes untreated.Footnote 160, Footnote 315, Footnote 316 Untreated STIs, whether they are symptomatic or not, can have long-lasting effects on health. In women, STIs have been linked to pelvic inflammatory disease (PID), ectopic pregnancies, miscarriages and low birth weight babies.Footnote 317 STIs have also been associated with various types of cancers including cervical, anal and penile.Footnote 317, Footnote 318

The Canadian Notifiable Disease Surveillance System allows for the monitoring of reported cases of sexually transmitted infections (STIs). The number of reported cases of STIs and the resulting calculated population rates do not account for all infections in the population. In many cases, an infected individual does not show symptoms and as a result may not be tested.Footnote 160

Changes in rates over time must also be interpreted with caution given that they are subject to changes in both screening practices and lab technology such as improved diagnostic capabilities. In addition, when the number of cases is very small the rates are more prone to fluctuations over time.

From 1994 to 2009, rates of STIs reported to the Canadian Notifiable Disease Surveillance System increased among the overall population. During that time the rate of chlamydia rose from 142.0 to 258.5 cases per 100,000 population, gonorrhea from 21.2 to 33.1 cases per 100,000 population, and infectious syphilis from 0.6 to 5.0 cases per 100,000.Footnote 161-163

Although chlamydia infections have been increasing in all age groups over the past decade, Canadians under the age of 30 continue to have the highest reported rates.Footnote 161 In particular, young women between the ages of 20 and 24 years had the highest rate with 1,871 reported cases per 100,000 population in 2009, more than seven times the overall national rate and more than five times the overall female rate (see Figure 3.19).Footnote 161 Young men between the ages of 20 and 24 years also reported the highest chlamydia infection rates among males, although their rate of 901 cases per 100,000 population was half that of their female peers.Footnote 161 In 2000, First Nation adolescent girls and young women aged 15 to 24 years had a reported chlamydia infection rate of 6,572 cases per 100,000 population, more than five times the reported rates for all 15- to 19-year-old adolescent girls and all 20- to 24-year-old young women (1,234 cases per 100,000 population and 1,176 cases per 100,000 population respectively) in that year.Footnote 161, Footnote 164

Figure 3.19 Rates of chlamydia by select age group and sex, Canada, 2009Footnote 161

Figure 3.19 Rates of chlamydia by select age group and sex, Canada, 2009

Source: Public Health Agency of Canada using data from STI (Sexually Transmitted Infections) Surveillance and Epidemiology.

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[Figure 3.19, Text Equivalent]

Canadians under the age of 30 years also accounted for the majority of reported cases of gonorrhea in Canada in 2009, with more than two-thirds (70%) of all reported cases being among youth and young adults aged 15 to 29 years.Footnote 163 The highest rates of reported infections, as with chlamydia, were in young men and women aged 20 to 24 years, with similar rates of 141 and 149 cases per 100,000 population respectively (see Figure 3.20).Footnote 163 Among youth aged 15 to 19 years, the infection rate was more than twice as high in adolescent girls than in adolescent boys, yet for young adults aged 25 to 29 years, young men had a higher rate than young women of the same age.Footnote 163

Although the reported rates of infectious syphilis have been rising overall since 1996, a sharp increase began in 2000.Footnote 162 The greatest increase in reported rates of infectious syphilis was among young men aged 25 to 29 years with the rate increasing from 1.7 cases per 100,000 population in 1994 to 17.6 cases per 100,000 population in 2009.Footnote 162 Unlike chlamydia and gonorrhea, rates of infectious syphilis in 2009 were higher in men than in women, in all age groups (see Figure 3.21).Footnote 162 The reported rates of infectious syphilis for females were much lower, with the highest rate in 2009 of 3.4 cases per 100,000 population for both 20- to 24-year-old and 25- to 29-year-old young women.Footnote 162

Figure 3.20 Rates of gonorrhea by select age group and sex, Canada, 2009Footnote 163

Figure 3.20 Rates of gonorrhea by select age group and sex, Canada, 2009

Source: Public Health Agency of Canada using data from STI (Sexually Transmitted Infections) Surveillance and Epidemiology.

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[Figure 3.20, Text Equivalent]

More than one-fifth (22%) of all positive human immunodeficiency virus (HIV) tests in Canada were among young adults aged 20 to 29 years in 2009.Footnote 319 Youth aged 15 to 19 years and young adults accounted for a higher proportion of all positive tests among females than among males.Footnote 319 Almost one-in-twenty (4.5%) female case reports were in the 15- to 19-year-old age group (compared to 1.2% for males) and 25% were in the 20- to 29-year-old age group (compared to 21.1% for males).Footnote 319 Among youth and young adults aged 15 to 29 years who tested positive for HIV in 2009, the most commonly reported exposure category was men having sex with men (32%). This was followed by heterosexual contact (15%) and injection drug use (15%).Footnote 319

Street-involved youth are at an elevated risk for STIs. A 2006 survey of Canadian street-involved youth aged 15 to 24 years found that 10% had chlamydia (9% of males and 11% of females) compared to approximately 1% of all youth and young adults aged 15 to 24 years. The same survey found that the gonorrhea infection rate of 1% for street youth was 10 times the rate for youth aged 15 to 24 years in the general population.Footnote 320

Figure 3.21 Rates of infectious syphilis by select age group and sex, Canada, 2009Footnote 162

Figure 3.21 Rates of infectious syphilis by select age group and sex, Canada, 2009

Source: Public Health Agency of Canada using data from STI (Sexually Transmitted Infections) Surveillance and Epidemiology.

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[Figure 3.21, Text Equivalent]

Although the human papillomavirus (HPV) is not a notifiable STI, it is one of the most common. It is estimated that the majority of sexually active Canadians (more than 70%) will contract an HPV infection at some point in their lives.Footnote 318 Although most cases will be asymptomatic and require no treatment, persistent infections of certain types of HPV are a major cause of cervical cancer in women and research suggests they may also be the second leading cause of lung cancer after smoking.Footnote 318, Footnote 321 Other types of HPV have also been linked to genital warts, penile cancer and anal cancer.Footnote 318

Health risk behaviours

It is normal for youth and young adults to engage in risk-taking behaviours. It is a function of the stage of their brain development and their need to develop responsibility and independence.Footnote 322 But not all risks are equal; some youth and young adults partake in riskier behaviours such as smoking, consuming alcohol, drug use or risky sexual behaviours (see Table 3.7). Young Canadians may also be engaging in distracting behaviours that put them at risk while driving, such as talking and texting on cell phones, eating, drinking or using a global positioning system (GPS). In 2007 there were 2,500 collisions involving distracted drivers aged 16 to 19 years – down from 3,100 in 2000.Footnote 100 Among drivers aged 20 to 29 years, the number of collisions involving an inattentive driver remained steady in that time, at about 5,000 per year.Footnote 100

Table 3.7 Health behaviours of Canada's youth and young adults
Health behaviours

* Denotes self-reported data.

Note: More detailed information can be found in Appendix C: Definitions and Data Sources for Indicators.
Sources: Statistics Canada and Health Canada.

Sexual health, 2008
Teen pregnancy rate (per 1,000 female population aged 15 to 19 years) 14.3
Substance use population aged 15 to 19 years, 2009 (percent)
Heavy drinking* (5+ drinks on one occasion at least once a month in the past year) 31.7
Cannabis use in the past year* 27.1
Illicit drug use excluding cannabis in the past year* 6.6
Current smoker* 13.0
Substance use population aged 20 to 29 years, 2009 (percent)
Heavy drinking* (5+ drinks on one occasion at least once a month in the past year) 39.7
Cannabis use in the past year* 24.0
Illicit drug use excluding cannabis in the past year* 7.6
Current smoker* 22.5

Many studies have noted that, compared to young females, young males are more prone to taking risks related to such matters as conflict and sexual behaviour, driving, drugs and outdoor activities.Footnote 323-330 Moreover, they are more likely to take those risks in the presence of their peers.Footnote 331 Their greater number of accidental deaths and injuries can be seen as an outcome of some of this risk-taking.Footnote 332 For example, male drivers are involved in more fatal and injury automobile collisions than female drivers, and drivers aged 20 to 29 years are involved in more collisions than drivers aged 16 to 19 years (most likely due to there being a greater number of young adult drivers than youth drivers).Footnote 100

Youth engaged in extracurricular and community activities are less likely to engage in risky activities. Adolescents with strong connections to their parents and positive school experiences, including relationships with teachers and peers, demonstrate less risk-taking.Footnote 47, Footnote 53 Conversely, major risk-taking occurs among teens with lower social integration.Footnote 333

Risky sexual behaviours

Although sex and sexuality are a natural part of life, they are not without risk. Sexually active youth and young adults may engage in sexual behaviours that could put them at risk for negative health outcomes, such as STIs and their associated consequences, or unplanned pregnancy.Footnote 334, Footnote 335

Early sexual activity may lead to increased risk of additional risky sexual behaviours.Footnote 334, Footnote 335 Young sexually active adolescents may lack maturity, knowledge or understanding of the consequences of their behaviours or may not have access to protection against unplanned pregnancy or STIs.Footnote 334, Footnote 335 The average age of first sexual intercourse reported by youth aged 15 to 19 years and young adults in 2009 was between 16 and 17 years, with 27% reporting that they had had sexual intercourse for the first time before the age of 16 years.Footnote 219 In comparison, the average age of first sexual intercourse reported by street-involved youth in 2006 was 14 years.Footnote 320

While not all youth and young adults are sexually active at such a young age, in 2009, almost half (46%) of all youth aged 15 to 19 years and nine out of ten young adults reported that they had had sexual intercourse at least once in their lives. The proportions increased with age however, with only 15% of 15-year-olds having had sexual intercourse at least once compared to a high of 97% of 27-year-olds.Footnote 219 These numbers are similar to those seen among youth and young adults more than a decade earlier (see Figure 3.22).Footnote 336 In 1996/1997, 47% of youth aged 15 to 19 years and 91% of young adults had had sexual intercourse at least once, ranging from 18% of 15-year-olds to 97% of 27-year-olds. In both years and for all ages, proportions vary slightly between males and females but there is little overall difference (see Figure 3.22).Footnote 219, Footnote 336

Having multiple partners and unprotected sexual intercourse are both risky sexual behaviours. Of those youth and young adults who reported having sex in the 12 months previous, more than one-third (37%) of those aged 15 to 19 years reported having had more than one sexual partner in the past year compared to less than one-quarter (24%) of young adults.Footnote 219 However, of those were not in a monogamous married or common-law relationship, the majority of youth (75%) reported using a condom the last time they had sexual intercourse, whereas only 58% of young adults reported doing so.Footnote 219 In 1996/1997, fewer youth and young adults reported having multiple partners, with 29% of youth and 18% of young adults having more than one partner in the previous 12 months.Footnote 336

Studies have found that sexual minority youth frequently report higher rates of risky sexual behaviours than their heterosexual peers, including early first sexual experience (before age 13 or 14 years), multiple partners, unprotected sexual intercourse, survival sex, and lower rates of condom use.Footnote 337 Street-involved youth also take greater risks associated with sexual behaviour. In 2006, 94% reported having multiple partners in their lifetime, and 43% in the previous three months.Footnote 320 Although condom use was not influenced by age, the sex of the partner contributed to the likelihood of barrier use (condom, female condom or dental dam) during the most recent incidence of sexual intercourse. Although 59% of males reported using a barrier with a female partner, only 23% of females reported barrier use with a female partner. However, reported use of a barrier was more similar between males (55%) and females (47%) when their partner was a male.Footnote 320

Figure 3.22 Percentage of population by age and sex who have had sexual intercourse, youth and young adults aged 15 to 29 years, Canada, 1996-97 and 2009Footnote 219, Footnote 336

Figure 3.22 Percentage of population by age and sex who have had sexual intercourse, youth and young adults aged 15 to 29 years, Canada, 1996-97 and 2009

Source: Public Health Agency of Canada using data from National Population Health Survey, 1996/1997; and Canadian Community Health Survey, 2009, Statistics Canada.

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[Figure 3.22, Text Equivalent]

One potential outcome of risky sexual behaviour, such as unprotected sex, is an unplanned pregnancy. There has been a steady decline in teen pregnancy and birth rates over the 30-year period from 1975 to 2005 (see Figure 3.23).Footnote 107 Despite a slight upward trend in the early 1990s, rates fell from 54 pregnancies and 36 births per 1,000 15- to 19-year-old adolescent girls in 1975, to 29 pregnancies and 13 births per 1,000 15- to 19-year-old adolescent girls in 2005.Footnote 107

When young people do not have the knowledge to make safe choices, they may be more likely to engage in risky behaviours. If they do not fully understand the consequences of their actions they are less likely to take the necessary precautions to prevent negative outcomes.Footnote 334, Footnote 335, Footnote 338 In 2002, the Canadian Youth, Sexual Health and HIV/AIDS Study surveyed youth in Grades 7, 9 and 11 (aged approximately 12, 14 and 16 years) about their sexual health and behaviours. Although the majority correctly answered questions about the means of transmission of HIV, almost two-thirds (64%) of Grade 9 students, almost half (49%) of Grade 11 adolescent boys and more than one-third (37%) of Grade 11 adolescent girls believed there are vaccines to prevent HIV and AIDS.Footnote 339 Additionally, two-thirds (67%) of Grade 7 students, half (52%) of Grade 9 students and one-third (36%) of Grade 11 students believed HIV and AIDS can be cured if treated early.Footnote 339 Students also showed a lack of knowledge concerning complications of other STIs. Approximately two-thirds (64%) of Grade 9 students and half (54%) of Grade 11 students believed chlamydia does not lead to serious complications, and only 6% of Grade 9 students, 6% of Grade 11 adolescent girls and 8% of Grade 11 adolescent boys knew that men and women are not equally likely to have serious problems from an STI.Footnote 339

Figure 3.23 Rates of pregnancy* and live birth, female youth, Canada, 1975 to 2005Footnote 107

Figure 3.23 Rates of pregnancy* and live birth, female youth, Canada, 1975 to 2005

* Pregnancy includes live births, induced abortions and fetal loss.

Source: Public Health Agency of Canada using data from Canadian Vital Statistics, Birth Database, Statistics Canada.

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[Figure 3.23, Text Equivalent]

Substance use

Recent Canadian surveys show that tobacco, alcohol and cannabis are the substances most frequently used by youth and young adults.Footnote 254, Footnote 340-343 Experimentation with these substances may be part of the transition to adulthood for some youth, but for a few it can lead to substance use problems.Footnote 344, Footnote 345

Some populations of youth and young adults are at an increased risk for heavy use of substances and substance abuse. Sex is a strong predictor of substance abuse problems, with men more likely to use substances and to use them heavily.Footnote 343 However, according to some recent surveys, the sex gap may be narrowing and young women are becoming as likely as young men to drink alcohol, binge drink, get drunk, smoke, and use illicit drugs.Footnote 346-348

Substance use is a common response to sexual abuse during childhood or adolescence.Footnote 349 Following sexual violence, youth who experience post-traumatic stress, depression or suicidal thoughts may try to use drugs to manage their moods.Footnote 343, Footnote 350 Many young people in custody reported being diagnosed with substance abuse or dependence disorders and may have been street-involved or homeless.Footnote 351

Runaway, street-involved and homeless teens may use drugs as part of their survival methods on the street and have consistently higher rates of substance abuse and adverse consequences compared with youth in school.Footnote 23, Footnote 352, Footnote 353 Compared to their peers, sexual minority youth are more likely to smoke, drink and use cannabis, and to report problems with substance abuse.Footnote 343 A higher percentage of street-involved youth identify as gay, lesbian or bisexual compared with youth in school, and sexual minority street-involved youth appear to have greater risks of violence and substance abuse than heterosexual homeless teens.Footnote 343 First Nation, Inuit and Métis youth are also at higher risk of substance abuse for similar reasons such as trauma and abuse, discrimination, harassment at school, and being over-represented in the street-involved population and youth in custody.Footnote 343, Footnote 354

Tobacco use

Most smokers begin smoking in adolescence. In 2009, 22% of smokers aged 25 years and older reported having had their first cigarette before the age of 12 years, 59% by the age of 15 years, and 87% before the end of their teens.Footnote 355 Young adults have the highest smoking rate of all age groups in Canada. In 2009, 23% of young adults aged 20 to 29 years were smokers, compared with 13% of youth aged 15 to 19 years.Footnote 355 There has been a gradual decline in the smoking rate among youth aged 15 to 19 years and young adults over the past decade, down from 28% and 34% respectively in 1999 (see Figure 3.24).Footnote 355, Footnote 356

Figure 3.24 Percentage of youth and young adult smokers by sex, Canada excluding territories, 1999 and 2009Footnote 355, Footnote 356

Figure 3.24 Percentage of youth and young adult smokers by sex, Canada excluding territories, 1999 and 2009

Source: Public Health Agency of Canada using data from Canadian Tobacco Use Monitoring Survey, Health Canada.

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[Figure 3.24, Text Equivalent]

Smoking rates are higher among some sub-populations compared to the Canadian average. In 2006, 15% of all Canadian youth aged 15 to 19 years were considered daily or occasional smokers compared to 30% of Métis, 38% of off-reserve First Nations and 68% of Inuit youth in the same year.Footnote 308, Footnote 357 Inuit adolescent girls had the highest overall Aboriginal youth smoking rate at 76%.Footnote 308 In 2008/2010, 33% of on-reserve First Nation youth aged 12 to 17 years reported being daily or occasional smokers.Footnote 220 Similarly, smoking rates for young adults aged 20 to 34 years are also higher in the Aboriginal population. In 2006, 25% of Canadian young adults were considered daily or occasional smokers compared to 43% of Métis, 51% of off-reserve First Nations and 75% of Inuit young adults in the same year.Footnote 308, Footnote 357 In 2006, 79% of street-involved youth smoked every day with no difference between males and females.Footnote 320

Because it is illegal to sell tobacco products to anyone under the age of 18 or 19 years (depending on province/territory), youth must find alternate sources. In the 2008-2009 Youth Smoking Survey (YSS) 60% of smokers aged 12 to 17 years reported obtaining cigarettes from social sources, including family/friends, purchasing them from someone else or having someone purchase them for them.Footnote 358

Even youth who are not smokers themselves may be at risk for the negative health consequences given that they are the age group most at risk of exposure to second-hand smoke. Compared to the older population, youth are less likely to be able to control their exposure to second-hand smoke, placing them at greater risk.Footnote 359 The 2009 Canadian Tobacco Use Monitoring Survey indicated that 10% of children aged 12 to 17 years were regularly exposed to second-hand smoke at home, a significant decrease from 31% in 2000.Footnote 360, Footnote 361

Smoking during pregnancy increases the risk of unhealthy fetal growth and development. In 2009, 21% of young women aged 20 to 24 years who were pregnant in the previous five years reported smoking regularly during their most recent pregnancy, compared with 7% of women aged 25 to 44 years.Footnote 362 According to the 2006-2007 Canadian Maternity Experiences Survey (MES), 29% of adolescent girls aged 15 to 19 years and 24% of young women aged 20 to 24 years smoked daily or occasionally during the last three months of their pregnancy, more than double the rate of any other age group.Footnote 363 Even more indicated that they lived with a smoker during their pregnancy: 62% of adolescent girls aged 15 to 19 years; 43% of young women aged 20 to 24 years; and 23% of young women aged 25 to 29 years.Footnote 363

Alcohol use

Alcohol is the most common substance used by Canadian youth and young adults.Footnote 343 On average, youth first use alcohol at around the age of 16 years – two to three years before the legal drinking age in Canada's provinces and territories.Footnote 364

According to the 2009 CCHS, more than two-thirds (70%) of Canadian youth aged 15 to 19 years had consumed alcohol in the previous 12 months and nearly half (48%) had consumed it regularly (at least two to three times per month).Footnote 219 Overall, nearly one-third (32%) of youth reported heavy drinking (consuming, on average, five or more drinks at least once per month).Footnote 219 Additionally, 14% of adolescent boys and 7% of adolescent girls reported having five or more drinks at least once per week.Footnote 219 Nearly half (47%) of immigrant youth had consumed alcohol in the previous 12 months and one-third were considered regular drinkers.Footnote 219 Similar to the general population, 30% of immigrant youth reported heavy drinking.Footnote 219

In the 2006 APS, two-thirds of off-reserve First Nation (66%) as well as Métis (76%) and Inuit (53%) youth, aged 15 to 19 years, reported consuming alcohol in the previous 12 months and 42% had consumed it regularly (41% of off-reserve First Nation, 46% of Métis and 30% of Inuit).Footnote 308 Overall, one-third of off-reserve First Nation (35%), Métis (32%) and Inuit (38%) youth reported heavy drinking.Footnote 308 According to the 2008/2010 RHS, about 40% of on-reserve First Nation youth (aged 12 to 17 years) reported consuming alcohol in the previous 12 months.Footnote 220 More than half (51%) of those who consumed alcohol reported having five or more drinks on one occasion, at least once per month in the previous 12 months.Footnote 220

Young adults are of legal drinking age in all Canadian provinces and territories, and almost all of them had consumed alcohol to some degree (72% on occasion and 15% regularly) in 2009.Footnote 219 Of those, 15% indicated that they drank, on average, five or more drinks one or more times per week.Footnote 219 Overall, more young men (90%) consumed alcohol than young women (84%).Footnote 219 In comparison, two-thirds of young adult immigrants had consumed alcohol in the previous 12 months and nearly half (49%) were considered regular drinkers.Footnote 219

According to the 2006 APS, 88% of off-reserve First Nation (86%), Métis (89%) and Inuit (79%) young adults, aged 20 to 34 years, had consumed alcohol in the previous 12 months and 65% had consumed it regularly (61% of off-reserve First Nation, 67% of Métis and 57% of Inuit).Footnote 308 Overall, more than one-third (35%) of off-reserve First Nation (37%), Métis (35%) and Inuit (53%) young adults reported heavy drinking.Footnote 308

Regular exposure to large amounts of alcohol can interfere with adolescent brain development. This can result in memory loss and other cognitive problems.Footnote 343 Evidence also points to alcohol as an increased risk factor for chronic diseases such as high blood pressure, stroke and some types of cancer.Footnote 365, Footnote 366 Binge drinking during the teenage years may be linked to depression, anxiety and other mood disorders in adulthood.Footnote 367

Consuming alcohol during pregnancy creates a risk of the child being born with Fetal Alcohol Spectrum Disorder (FASD).Footnote 368 The 2006-2007 MES found that of pregnant adolescent girls aged 15 to 19 years, 4.2% reported consuming alcohol during pregnancy. This proportion increased to 6.3% of pregnant young women aged 20 to 24 years and 8.8% of pregnant young women aged 25 to 29 years.Footnote 363

Alcohol intoxication entails a variety of risks, including drinking and driving and increased likelihood of unprotected sex.Footnote 343 In 2009, 18% of drinkers aged 15 to 29 years reported experiencing at least one harmful outcome as a result of alcohol consumption in the previous year, with the highest percentage (29%) being among adolescent girls aged 15 to 19 years.Footnote 369 These outcomes included harmful effects on physical health, friendships and social life, financial position, home life or marriage, and work, studies or employment opportunities. They were also associated with legal and housing problems and learning difficulties.Footnote 364 Most physical injuries sustained while drinking were unintentional. Violence-related injuries were more common among male youth (23%), while female youth were more likely to experience injuries related to self-harm (14%).Footnote 370

Figure 3.25 Alcohol consumption by smoking status, students Grades 7 to 9 and Grades 10 to 12, Canada excluding territories, 2009Footnote 358

Figure 3.25 Alcohol consumption by smoking status, students Grades 7 to 9 and Grades 10 to 12, Canada excluding territories, 2009

Source: Public Health Agency of Canada using data from Youth Smoking Survey, Health Canada.

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[Figure 3.25, Text Equivalent]

Male drivers have a greater proportion of automobile collisions involving alcohol or drugs. In 2007, 41% of all collisions involving alcohol or drugs involved young male drivers aged 16 to 19 years (10%) and 20 to 29 years (31%).Footnote 100 Adolescent girls and young women together, accounted for 10% of all collisions involving alcohol or drugs.Footnote 100

Data from the 2008-2009 YSS indicated that alcohol consumption was more prevalent among students who smoked. Among current smokers, 90% of those in Grades 7 to 9 and 95% of those in Grades 10 to 12 had also consumed alcohol in the previous 12 months, compared to 54% and 81% of those in each group who did not smoke (see Figure 3.25).Footnote 358 Heavy drinking (at least once per week) in the past year was also more prevalent among students who smoked (36% in Grades 7 to 9, 45% in Grades 10 to 12) than among those who did not smoke (8% in Grades 7 to 9, 16% in Grades 10 to 12).Footnote 358

Drug use

In 2009, the most commonly used illicit drug by youth (aged 15 to 19 years) and young adults was cannabis. More than one-quarter (27%) of youth reported that they had used cannabis in the previous 12 months – a decrease from 38% five years earlier.Footnote 369, Footnote 371 More adolescent boys (30%) than adolescent girls (23%) reported using cannabis and 30% of those who had used it had tried it by age 16.Footnote 369 As with youth, past-year cannabis use among young adults decreased between 2004 and 2009 from 31% to 24% and a larger proportion of young men (31%) than young women (17%) had used cannabis.Footnote 369, Footnote 371

The rates of cannabis use are higher among youth smokers (74%) compared to youth non-smokers (24%).Footnote 369 Conversely, living with both parents and having good trust and communication with them have both been identified as protective factors against cannabis use, as is high academic achievement.Footnote 45

Figure 3.26 Illicit drug use by sex, youth and young adults, Canada excluding territories, 2009Footnote 369

Figure 3.26 Illicit drug use by sex, youth and young adults, Canada excluding territories, 2009

Source: Public Health Agency of Canada using data from Canadian Alcohol and Drug Use Monitoring Survey, Health Canada.

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[Figure 3.26, Text Equivalent]

Other than cannabis, the illicit drugs most commonly used by youth aged 15 to 19 years and young adults in 2009 were ecstasy (4% of youth and 3% of young adults), hallucinogens (4% of youth and 2% of young adults) and cocaine (3% for youth and 5% for young adults) (see Figure 3.26).Footnote 369

Drug use is a particular problem among street-involved youth and 94% of those between the ages of 15 and 24 years reported non-injection drug use (most commonly cannabis) in 2006. More than one in five (23%) in the same age range reported injection drug use in their lifetime – most commonly cocaine (29%) and morphine (28%).Footnote 320 Overall, street-involved youth who used injection drugs were more likely to exhibit high-risk sexual activity than street-involved youth who did not use injection drugs. They were also more likely to have contracted an STI, to have had unwanted or obligatory sex, to have traded sex, and, on average, to have had a higher number of sexual partners in the preceding three months. Sharing injection equipment contributes to the high rate of hepatitis C virus infection among people who use injection drugs, which is seven times higher than the rate among street-involved youth who have never used injection drugs.Footnote 320

The abuse of solvents, by sniffing, huffing or bagging, usually begins and is carried out in adolescence. In the 2004 Canadian Addiction Survey, 67% of those who reported using inhalants used them for the first time when between the ages of 12 and 16 years, and 13% were even younger.Footnote 372 A 2004 Toronto study found that 10% of street-involved youth had inhaled solvents within the previous month.Footnote 372, Footnote 373 Studies in the United States and Canada have shown that rates of solvent abuse are much higher (60% or more) for some First Nation and Inuit youth, particularly for those living in rural and remote communities.Footnote 372, Footnote 374, Footnote 375

Short- and long-term effects of illicit drugs will vary. Cannabis, for example, causes an increase in heart rate and a decrease in blood pressure.Footnote 376 It can interfere with concentration, depth perception and reaction time creating potential issues while driving and studying.Footnote 376 Long-term use of cannabis can lead to respiratory distress, increased risk of lung cancer and may cause impaired memory and information processing.Footnote 376, Footnote 377 Other illicit drugs, such as cocaine, hallucinogens and ecstasy, can have extreme short-term psychiatric effects such as panic attacks, paranoia and risky or violent behaviour, or physical effects such as convulsions and increased blood pressure.Footnote 378-380 Over the long term, these substances can lead to psychosis, impaired brain function affecting memory and lung and nasal tissue damage.Footnote 378-380 The addictive properties can influence behaviours affecting performance at school and work, may lead to isolation and in extreme cases even death.Footnote 381, Footnote 382

Summary

Overall, Canadian youth and young adults are leading healthy lives and are in a position to transition well through adolescence and young adulthood to become healthy adults. Socio-economic factors are key determinants of health and fewer young people are dropping out of school and more are pursuing post-secondary education than ever before. The majority perceive their physical and mental health to be either very good or excellent and chronic illnesses and disease are not the concern for these young people that they are for many older Canadians. However, there are a number of health issues of concern that can negatively impact their health and development as they transition into adulthood, and lead to particular health problems later in life.

Most mental illnesses which can persist throughout life begin to manifest during these years and others, such as eating disorders and intentional self-harm, are of particular concern because they are most prevalent in this age group. Rates of suicidal thoughts and actions among young Canadians are also worrying. Many of the predominantly unintentional injuries, most often due to transport incidents and falls, which account for the most deaths and thousands of hospitalizations each year among both youth and young adults, can be prevented. As individuals transition through adolescence and young adulthood they will naturally take risks. However, some young Canadians are engaging in riskier behaviours such as substance use and abuse and risky sexual behaviours – all of which can have negative impacts on their health and well-being, either through immediate or long-term outcomes. In many instances certain sub-populations such as Aboriginal, immigrant, street-involved or sexual minority youth and young adults may be more vulnerable to particular health or socio-economic issues, putting at risk their individual health and/or ability to cope with negative health outcomes and maintain a healthy lifestyle.

There is also evidence that certain factors have a positive or protective effect on the health or behaviours of youth and young adults. These include such things as positive relationships with parents and peers, academic engagement and involvement in extracurricular activities. Building on the current health status of Canadian youth and young adults and evidence of influential factors associated with health outcomes, Chapter 4 discusses how the varied factors and issues affecting the health of youth and young adults may be addressed to create the conditions to maintain and promote healthy, positive transitions.