Healthy Kids 2021 Survey offers insights into student mental health, substance use

Each year, data from the Healthy Kids Colorado Survey gives local schools and youth organizations a peek into how middle and high schoolers are feeling, acting and viewing the world around them.

The biennial survey was most recently administered to Eagle County students in the fall of 2021. While the survey is given to students across the state, local nonprofit Mountain Youth helps administer it locally, acting as a liaison between the state and the schools.

Earlier this month, the local aggregate data became available, and the process of going through the data and looking for opportunities to utilize it is underway.

---

---

The most recent survey is particularly interesting for local educators and youth organizations as it offers one of the first in-depth looks into students’ actions and feelings amid the COVID-19 pandemic.

However, the 2021 survey also experienced a bit of controversy, with an increased number of parents expressing concern over the content of some of the questions, particularly those around sexual activity and consent. As a result, while historically every single Eagle County public and private middle and high school has participated, three schools opted out entirely.  These schools were St. Clare of Assisi Catholic School, Vail Christian Academy, and Eagle County Charter Academy.

---

---

The survey, however, still had high levels of participation and the impacts of these opt-outs are minimal to the overall data, according to Michelle Stecher, Mountain Youth’s executive director. Overall, the Eagle County survey had 1,346 middle school students participate and 1,961 high school students participate.

“Every year we get a little bit of comments around healthy kids of: Are our students being honest? Is this really an accurate reflection?” Stecher said, adding that the data analysts assisting with interpreting the data are adamant that, “for a community like ours to still have 3,500 students take an assessment like this, even if there are some that are dishonest, that sample is enormous compared to our whole population.”

That, and the state uses the University of Colorado to comb through the data, “clean” it and cross-check across questions to gauge students’ honesty. 

With the three schools opting out, Stecher said that because they were smaller schools, they didn’t impact this overall sample size. She did add that the nonprofit and district officials are “really hopeful to have those schools back on board in the future.”

Mental health

Mental and behavioral health has been not only a growing area of concern for local organizations and schools but also an area of focus. This was particularly true throughout the pandemic as parents, educators and community members worried about the short- and long-term impacts of COVID-19.

“Eagle Valley Behavioral Health, (Your) Hope Center, and our schools — both locally and more broadly — have been focusing on support and being in this endemic phase,” Stecher said. “As such, mental health, behavioral health, and stress has been on a lot of minds.”

The Healthy Kids survey asks numerous questions about mental health, diving into topics such as depression, stress and suicide. Overall, the results show a mixture of positive and negative trends of these factors from previous years.

According to Stecher, one of the “biggest mental health indicators” is the depression indicator. In the survey, this is gauged through students’ responses to the question: “Have you felt so sad or hopeless in the last two weeks or more that you’ve changed some of your behaviors?”

In 2021, 38% of high schoolers responded to this question with “yes.” This does represent a continued increase from previous years where 33% responded yes in 2017 and 35% in 2019.

Twenty-seven percent of middle schoolers, on the other hand, responded yes to this question, a decrease from previous years where 31% responded yes in 2017, 30% in 2019.  This decrease, Stecher added, “is pretty incredible in light of what these kids have gone through the past few years.”

On average, for youth surveyed across the state, 39.6% responded yes to the question in 2021.

The survey also offers some insight into suicide rates, with the survey asking students if they’ve attempted suicide in the past year. This number has declined for high schoolers since 2015; going from about 8% in 2015 down to 6.4% in 2021. For middle schoolers, it decreased from 13% in 2015 down to 7% in 2019. In the most recent 2021 survey, the number increased back to 8.8%.

Statewide, it’s reported that 7.2% of youth attempted suicide in the past year — with no change from 2017 and 2019.

Of the many areas of the survey, Stecher identified this as one “that’s an area that we really need to continue to focus on.”

Going forward, Mountain Youth will be working with Your Hope Center and SpeakUp ReachOut to look at this data in conjunction with the data from local crisis service teams as well as emergency room intakes to not only validate these numbers but also to make sure treatments, interventions and supports are being directed to the right places.

Nearly all of the questions in the survey are created by the state, however, it does allow local administrators to add their own questions. One of the areas that Eagle County has added questions for in recent years is stress and resiliency — and this is an area that has shown some improvement in recent years.

These questions center around how stressed the kids feel as well as how manageable their stress is. Stecher said that this year there was a “pretty significant increase in high schoolers from 2019 to 2021 saying that they can manage their stress.”

In 2021, 53% of high schoolers reported being able to manage their stress, a 10% increase over 2019. This was the first year middle schoolers were asked this particular set of questions and 61% reported that their stress level was manageable most days.

In 2019, the local survey began asking high school students if they felt they could recover from a stressful situation in two days or less. In 2019, 72% reported they felt they could recover in two or fewer days, with that increasing to 78% in 2021. This year was the first year middle schoolers were asked this as well, and 83% reported they could recover in two or fewer days.

“I think that is absolutely incredible, again, in light of a lot of the trauma these young people have gone through the past few years,” Stecher said. 

One of the possible reasons, she added, for the positive trend of these questions around stress was the “district moving toward this streamlined social-emotional curriculum.”

Another is the continued programming in schools by local behavioral education providers, which includes, she said, Mountain Youth, SpeakUp ReachOut, and Bright Future Foundation. This programming has really focused on coping skills in recent years and creating a language and discourse around many of these mental and behavioral health topics.

In looking at this data, the impact of COVID-19 on students’ mental health can’t be overlooked. From the results, 52% of middle schoolers reported that they had poor mental health and 68% of high schoolers reported poor mental health during the pandemic. Among high schoolers, almost 50% said they felt daily stress more often during the COVID-19 pandemic.

Some of this stress came directly from the pandemic directly impacting students’ lives, families and the ability to meet basic needs. 

Among high schoolers, nearly a third of students said they had a parent lose their job during the pandemic and 10% of students said they usually or always went hungry because there wasn’t enough food at home during the pandemic. These numbers are mirrored among the middle school responses.  

This COVID-19 data, Stecher reflected, “reinforces what a lot of us suspected.”

Substance use

Some of the most surprising 2021 results, Stecher said, come from the survey’s biggest topic area: substance use. Students are asked not only about use but also about the risk of use and the ease of access to substances.

However, substance use actually reported a decline from previous years.

In looking at whether high school students used substances in the past 30 days when surveyed:

• 2% reported using alcohol (down from 33% in 2019 and 37% in 2017);
• 19% reported binge drinking, defined as five or more drinks in a two-hour span (down from 21% in 2019 and 25% in 2017);
• 15% reported using marijuana (down from 19% in 2019 and 22% in 2017); and
• 19% reported using vape products (down from 29% in 2019 and 39% in 2017).

With overall use lower, middle school numbers saw a similar decline for past 30-day use:

• 4% reported using alcohol (down from 7% in 2019 and 10% in 2017);
• 2% reported using marijuana (down from 3% in 2019 and 5% in 2017); and
• 5% reported using a vape device (down from 8% in 2019). 

These decreases also went alongside increases in students’ perception of harm of substance use.

“More young people are noticing the harms and risks of their peers or people their age using marijuana, alcohol, and vape devices on a regular basis,” Stecher said, adding that this was the result of schools and community partners working to educate students around risks of use.

However, while community partners have worked to educate, the results were still surprising to many local leaders.

“We were super surprised; during COVID, we heard so many reports from clinicians and others that worked with young people that kids are home alone, they are getting together in areas that are not safe and unsupervised. The risk for substance experimentation was really high,” Stecher said.

“Even back through this very recent school year — working very closely with schools and our community partners — we heard a lot more reports of confiscations of substances on school property. So we were really bracing for an increase,” she added.

Given this surprise, Stecher said this was one area where community partners “still need to uncover more.”

According to Stecher, uncovering more will include engaging with a third-party evaluator to dig deeper into the data, including looking at cross-behavioral correlation. This could include looking for correlations between substance use and mental health or between substance use and extracurricular involvement, and more.

Protective factors

In surveys such as these, the inclination can be to look at a lot of the negatives and areas to improve. However, Stecher noted that equally important is looking at the positives, and the areas local schools and partners are addressing well.

“We tend to focus on what’s going wrong and how can we fix that problem, but trying to also remember that there are things that are going well that this data reinforces for us, the trusted adults, the pro-social opportunities, and we need to stay focused on that as much as the negative,” Stecher said. “From a prevention focus: What’s going well is also what we need to continue to put supports and resources towards.”

One area where local providers are doing well, she said, is in protective factors or things that, when implemented correctly and well, can help students bounce back from challenges.

This includes extracurricular activities. While overall participation in extracurriculars was down from previous surveys  — likely due to the pandemic — they are still significantly higher than the state average,  Stecher said. 

In 2021, 62% of high schoolers and 72% of middle schoolers reported participation in extracurricular activities — compared to a combined average of 59% across the state.

This is important, Stecher added, because “we know that if they’re spending their time keeping busy doing things that are healthy and surrounded by people that also care about health and physical activity or doing positive things, that they’re less likely to engage in some of the risky behaviors.”

A second protective factor where Eagle County excels is in students being able to identify a trusted adult.

“We know that if a young person is scared for themselves, scared for a friend, going through a challenging situation, having at least one trusted adult, someone they could go to for support, is so critical,” Stecher said. “And this could be a parent, coach, pastor, teacher, aunt, friend’s parent, it doesn’t really matter who it is as long as they have that person identified.”

In the survey, students were asked first if they have an adult they can go to with a serious problem — of which 72% of high schoolers and 75% of middle schoolers responded that they did. High school students were also asked if they felt they could ask a parent or guardian for help if they had a personal problem, and 81% said yes.

This represented a significant increase from the previous survey administration where only around 57% of high schoolers reported having an adult to go to with a serious problem.

This increase, Stecher said, could potentially be attributed to the increased focus by local organizations on not only the term “trusted adult,” but also on the training and preparation of adults to become these figures in kids’ lives.

“I think overall having more conversations around it, not necessarily when young people are in crisis, but hopefully all the time, so that, hopefully from a prevention standpoint before they get to like a really traumatic or crisis level situation, they already have that person in mind,” she said.

Utilizing the data

This data is used in a number of different ways by local schools, nonprofits, and even by students and families themselves. Now that the data is out, the hard work of determining what to do with the results begins. 

In years past, this has included Mountain Youth working directly with each school on their building-level data and determining any needed changes to programming or resources. It has also included a “convening” with community partners, Stecher said, where the partners can go through the data together, react and create plans forward. These organizations also are able to go through the data on their own to influence their own programming and services. 

Plus, Stecher added, Mountain Youth also tries to engage students with the data as well. 

“We want them to understand what happens with the data,” she said. “So typically that is through smaller focus groups with students where we share the results.”

From there, students are able to react to the data as well as give ideas for solutions, projects, and opportunities for students to shift behaviors with their peers.

And especially given the controversy surrounding the content of this year’s survey, Stecher added that she also hopes that parents see the survey as a conversation starter within their families.

“We definitely believe in these conversations happening at home first. And we hope that if there hasn’t been a good opportunity for families to talk about these types of behaviors with their children, that this can be another way to encourage that to happen,” she said. “And we want to even provide tips, tools or resources to help parents have conversations about substance use or sex or areas that might not come so naturally or be so comfortable.”

Mountain Youth maintains a dashboard of the local results of the survey dating back to 2017. The 2021 results should be posted within the next month, Stecher said.

To explore previous years’ data, visit MountainYouth.org/HealthyKidsColoradoSurvey