Health Behaviors
Health outcomes for Mesa County residents are directly related to their health behaviors, which are shaped by the local resources available and their opportunities to be healthy. Effective promotion of healthy choices must address the context in which the choice is made.
Increasing Mesa County residents’ access to opportunities to make healthy choices can positively affect health behaviors and subsequent health outcomes.
The health behaviors in this section cover a wide range of both protective and adverse health behaviors. Protective health behaviors like healthy eating, physical activity, and immunizations protect against and mitigate the impact of negative health outcomes. In contrast, adverse health behaviors like high-risk substance use can increase the risk of negative health outcomes. Addressing both protective and adverse health behaviors can directly impact the prevalence of negative health outcomes in Mesa County.
Healthy Activity
Healthy eating, physical activity, and optimal sleep have all been shown to positively impact health factors and outcomes such as weight status and chronic disease.
Healthy Eating
Good nutrition can start early and is vital for healthy development. Breastfeeding not only provides protection against childhood illness and infection but also contributes to improved health outcomes for parents. In Mesa County, three in four women breastfeed their babies for at least nine weeks, similar to the statewide rate.
AMONG WOMEN WHO HAD RECENTLY GIVEN BIRTH (2018-2021)
Ever Breastfed
AMONG WOMEN WHO HAD RECENTLY GIVEN BIRTH (2018-2021)
Breastfeeding duration 9 or more weeks
Source: CDPHE Pregnancy Risk Assessment Monitoring System (PRAMS). Data Request.
Nutrition is a priority for youth who are at an age of rapid growth and development. However, fruit and vegetable consumption is persistently minimal among high school students, both locally and statewide. By comparison, the majority of adults eat fruit and vegetables at least once per day. For more information about how access to grocery stores can affect healthy eating behaviors, see the section on Food Access in Neighborhood and Built Environment
About a third of Mesa County and Colorado students eat fruit at least once per day. Just over a third of Mesa County and Colorado students eat vegetables at least once per day.
High School Students
Percent of students eat vegetables at least once per day (such as a green salad, potatoes, carrots, and other vegetables, excluding french fries and potato chips).
Percent of students eat fruit at least once per day.
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Adults
Fruit consumption at least once per day
Vegetable consumption at least once per day
Consumption of one or more sugary beverages per day
Source: Colorado Department of Public Health and Environment: Behavioral Risk Factor Surveillance System, 2020-2022
Physical Activity
Physical activity, along with a healthy diet, reduces weight gain and lowers the risk of developing many chronic diseases. Less than half of Mesa County high school students report regular physical activity.
The majority of adults report exercising or doing physical activity outside of work, and the rates vary by income level. 73.1% of adults with a household income less than $50,000 reported physical activity outside of work, compared to 90.6% among those with higher incomes.
High School Students
Percent of students active for at least 60 minutes on five or more days in the previous week
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Adults
Adults who get leisure time physical activity outside of work
Leisure-time physical activity by household income
Source: Colorado Department of Public Health and Environment: Behavioral Risk Factor Surveillance System, 2020-2022
Sleep Hygiene
Sleep & Risk
Lack of sleep puts the majority of Mesa County youth at higher risk for obesity, poor mental health, and problems with attention and behavior.
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Insufficient sleep has been linked to the development of various chronic conditions, including type 2 diabetes, cardiovascular disease, obesity, and depression.
Optimal sleep is particularly important for youth. The American Academy of Sleep Medicine has recommended that teenagers age 13 to 18 should sleep 8 to 10 hours per night on average. Only a quarter of high school students report getting at least eight hours of sleep on school nights.
High School Students
Students who get 8+ hours of sleep on school nights on average
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Adults
Adults who get 7+ hours of sleep per night on average
Source: Colorado Department of Public Health and Environment: Behavioral Risk Factor Surveillance System, 2020-2022
Weight Status
Reducing the prevalence of obesity, which is linked to an increased risk for many chronic diseases, will lead to healthier lives for residents in Mesa County.
Weight that is higher than what is considered healthy for a given height is described as overweight or obesity. Obesity rates in Mesa County have remained relatively stable over time. There appear to be changing trends in the prevalence of overweight, decreasing for children and increasing for adults.
The prevalence of well child visits that included a conversation about the child’s overweight or obese BMI has decreased in recent years. The prevalence of adults who are overweight or obese has increased, up to 68% in 2022.
Adult Weight Trend
Rates of adult overweight and obesity increased between 2017 and 2022.
Adults above a healthy weight, Mesa County
Source: Colorado Department of Public Health and Environment: Behavioral Risk Factor Surveillance System, 2017-2022
The Healthy Kids Colorado Survey used to include questions about students’ heights and weights that could be used to determine a student’s weight status based on their BMI. As of 2021, these questions are no longer included, which leaves few robust measures of weight status in Mesa County youth.
The following charts include the prevalence of well child visits at which the pediatrician included codes for overweight and obesity.
These trends are useful in determining the prevalence in the community of weight concerns among children that have been identified according to medical discretion in addition to standard BMI calculations.
Data Note
Often, providers will take a wait-and-see approach with children ages 5 to 13 whose weight isn’t causing additional health concerns, because their weight status can change during and after puberty.
Well child visits mentioning obesity and overweight status from one local practice, 5 to 13 years old, Mesa County
Well child visits mentioning obesity and overweight status from one local practice, 5 to 13 years old, Mesa County
| 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | |
|---|---|---|---|---|---|---|---|
| Overweight | 2.8 | 4.0 | 3.9 | 4.5 | 2.8 | 2.1 | 1.5 |
| Obese | 3.5 | 5.3 | 5.0 | 5.2 | 5.1 | 4.1 | 4.5 |
Source: Local Provider Data Request
WELL CHILD VISITS MENTIONING OBESITY AND OVERWEIGHT STATUS FROM ONE LOCAL PRACTICE, 14 TO 17 YEARS OLD, MESA COUNTY
WELL CHILD VISITS MENTIONING OBESITY AND OVERWEIGHT STATUS FROM ONE LOCAL PRACTICE, 14 TO 17 YEARS OLD, MESA COUNTY
| 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | |
|---|---|---|---|---|---|---|---|
| Overweight | 4.7 | 5.1 | 4.4 | 4.1 | 3.5 | 2.5 | 2.1 |
| Obese | 6.2 | 8.4 | 8.2 | 8.0 | 7.2 | 6.0 | 5.9 |
Source: Local Provider Data Request
School Immunizations
Schools require students to report their immunization status on several communicable childhood diseases:
- DTaP (diphtheria, tetanus, and pertussis)
- Hepatitis B
- MMR (measles, mumps, and rubella)
- Polio
- Varicella (chicken pox)
Having information on immunization status helps schools assess the risk to their student and community population during an outbreak.
According to elementary school records, immunization rates vary by district. In the 2022-2023 school year:
Mesa County school Districts immunization rates
| De Beque School District 49 | Mesa County Valley School District 51 | Plateau Valley School District 50 | |
|---|---|---|---|
| Fully Immunized Students | 90% | 94% | 88% |
| Requested Exemptions | 6% | 2% | 10% |
Source: CDPHE School Immunizations
Target Level
The Healthy People 2030 target for school immunization rates is 95%.
De Beque School District 49JT increased the percent of students who provided information about their vaccination status from 63% in the 2019-2020 school year to 91% in the 2022-2023 school year. Plateau Valley School District 50 and Mesa County Valley School District 51 have maintained reporting rates above 90% since 2017.
Adult Immunizations
From 2020 to 2022, 42% of adults age 18 to 64 years old reported receiving a seasonal flu vaccine. Among adults age 65 and over, that share is higher at 71%.
Both of these rates increased from previous years. Across all adults age 18 and over, flu vaccine participation increased from about 42% in 2019 to about 50% in 2022.
Adults Age 18 to 64 who Received a Flu Vaccine
Adults Age 65 and Over who Received a Flu Vaccine
Source: Colorado Department of Public Health and Environment: Behavioral Risk Factor Surveillance System, 2017-2022
Substance Use
Marijuana
Marijuana use among Mesa County high school students has remained steady around 20% over the last ten years. The local rate had been comparable with the statewide rate, until 2021 when the statewide rate dropped to 13%.
The highest rate of marijuana use is among adults age 18 to 34. However, use among adults age 35 and over is increasing. Among adults age 65 and over, the rate of marijuana use more than doubled in recent years, from 6% to 14%.
High School Students
Marjuana use by students who used once or more in past 30 days
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Marjuana use by students who had first time use before age 13
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Adults
Percent of Adult Marjuana
Current Users
Source: Colorado Department of Public Health and Environment: Behavioral Risk Factor Surveillance System, 2020-2022
Marijuana Use By Age, Mesa County
Source: Colorado Department of Public Health and Environment: Behavioral Risk Factor Surveillance System, 2020-2022
Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Alcohol
Alcohol consumption among high school students has decreased notably in recent years, both locally and statewide. The prevalence of students who had an alcoholic drink in the past month decreased between 2019 and 2021. However, the rate of binge drinking among high school students remains around 13%.
High School Students
Students who had one or more drinks in the past 30 days
Students who binge drank in the past 30 days
Students who had their first drink (more than a few sips) before the age of 13
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Adults
Adults who are heavy drinkers (15+ drinks/week for adult men, 8+ drinks/week for adult women)
Adults who are current binge drinker (5+ drinks on an occasion for men, 4+ for women)
Source: Colorado Department of Public Health and Environment: Behavioral Risk Factor Surveillance System, 2020-2022
Tobacco
Mesa County youth use tobacco at a higher rate than their statewide counterparts.
In Mesa County and Colorado, cigarette smoking among high school students has been slowly and steadily decreasing over recent years. The share of students who regularly use electronic vapor products was slowly increasing through 2019. In 2021 use dropped notably. This trend occurred both locally and statewide.
The decline in vape use measured in the 2021 survey was likely driven by an increase in the legal age to purchase tobacco products from 18 to 21.
Using electronic vapor products is far more prevalent among high school students than cigarette smoking. Currently, Mesa County students are three times more likely to vape than to smoke cigarettes.
In Mesa County, students are more likely to try tobacco products before age 13 compared to the statewide average. Locally, about 15% of students try either cigarette smoking, vaping, or both before age 13.
Tabacco Product Use by Age, Mesa County
Tabacco Product Use by Age, Mesa County
| Tabacco Type | High School Students | Adults 18-34 | Adults 35-64 | Adults 65+ |
|---|---|---|---|---|
| Cigarette Smoking | 5.1 | 12.9 | 16.0 | 12.5 |
| Vaping | 18.3 | 13.7 | 3.8 | NA |
Source: Colorado Department of Public Health and Environment: Behavioral Risk Factor Surveillance System, 2020-2022
Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
High School Students
Youth Tobacco Use, Mesa County
Youth Tobacco Use, Mesa County
| 2015 | 2017 | 2019 | 2021 | |
|---|---|---|---|---|
| Vaping | 9.1 | 8.0 | 7.8 | 5.1 |
| Cigarette Smoking | 29.7 | 30.7 | 31.5 | 18.3 |
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Students who smoked cigarettes on one or more of the past 30 days
Students who used an electronic vapor product in the past 30 days
Students who tried smoking cigarettes before age 13
Students who tried using an electronic vapor product before age 13
Students who were inside a car with a parent who was smoking or vaping one or more times in the past week
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Adults
Current Smoking Rate
Current Vaping Rate - (2021-2022)
Source: Colorado Department of Public Health and Environment: Behavioral Risk Factor Surveillance System, 2020-2022
Drug Use
Mesa County high school students engage in high-risk substance use at similar rates to the statewide average. In 2021, 15% of Mesa County high school students reported having misused prescription pain medication, and 6% reported having used illicit drugs. More than one in five high school students indicated it would be easy to access prescription drugs without a prescription.
Among students who reported significantly struggling with their mental health, 20% had misused prescription drugs and 9% had tried illicit drugs. This was more than twice the rate for students who were not struggling with their mental health.
High School Students
Students who have used a drug one or more times during their life
Prescription pain medicine without a doctor’s prescription
Cocaine
Methamphetamines
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Sexual Health Behaviors
In recent years, the prevalence of high school students who reported having ever engaged in sexual intercourse has decreased statewide, dropping from 35% in 2019 to 25% in 2021. By comparison, the rate in Mesa County has remained around a third of students.
The great majority of students report using some form of birth control, a practice which is likely reflected in the dramatically decreasing teen birth rate.
The annual birth count has been dropping in Mesa County since about 2008, the same year the state began expanding access to long-acting reversible contraception (LARC). Both locally and across the state, this has had a profound impact on decreasing the number of unintended pregnancies, particularly among teenagers and young adults.
Students at risk of pregnancy who used any form of birth control
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Tean Birth Rate
From 2008 to 2022, the birth rate in Mesa County among teens aged 15 to 19 dropped by about 70%. When LARC access began to increase in 2008, there was an average of about 240 births to teens each year. In recent years, the rate has dropped to around 80.
Rate of births to teen mothers per 1,000 women age 15 to 19
Rate of births to teen mothers per 1,000 women age 15 to 19
| Year | 2000 | 2001 | 2002 | 2003 | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 |
| Mesa County | 52.2 | 50.4 | 47.0 | 49.9 | 47.6 | 49.5 | 49.8 | 52.9 | 45.5 | 44.5 | 41.1 | 36.2 | 32.7 | 33.9 | 26.1 | 29.0 | 22.4 | 22.6 | 20.8 | 19.2 | 16.7 | 12.7 | 15.0 |
| Colorado | 50.6 | 46.4 | 46.2 | 42.4 | 42.7 | 41.5 | 41.5 | 40.7 | 40.1 | 37.7 | 33.0 | 28.2 | 24.7 | 22.7 | 19.8 | 18.8 | 17.2 | 15.4 | 13.7 | 13.3 | 11.9 | 11.0 | 10.7 |
Source: COLORADO HEALTH INFORMATION DATASET
In 2021, Colorado youth engaged in less sexual intercourse and waited slightly longer to begin having sex than students in 2017 and 2019. Mesa County students reported similar changes. We will need more years of data to see if this is a measurable downward trend because of the smaller local sample size.
Approximately one in five students who had sexual intercourse in the past three months used drugs or alcohol before doing so. In previous years, male students were more likely to engage in substance use prior to sex, but in 2021, students were doing so at comparable rates regardless of gender.
High School Students
Students who engaged in sexual intercourse
Students who engaged in sexual intercourse
| Region | 2017 | 2019 | 2021 |
|---|---|---|---|
| Mesa County | 37.1 | 37.5 | 33.6 |
| Colorado | 32.7 | 34.6 | 25.4 |
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2017-2021
Students engaged in sexual intercourse before age 13
| Region | 2017 | 2019 | 2021 |
|---|---|---|---|
| Mesa County | 3.6 | 3.9 | 2.9 |
| Colorado | 2.7 | 3.0 | 2.1 |
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2017-2021
Among students who had sexual intercourse in the past three months Who used drugs or alcohol before sex
Students at risk of pregnancy who used any form of birth control (the remaining students either didn’t use contraception or were unsure)
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Firearm Use and Attitudes
As of 2022, half of all adults in Mesa County report having a firearm in their home, compared to 37% statewide. Access to firearms increases the risk of harm due to proximity and lethality, but prevention strategies and safety education can help mitigate that risk.
Safety Classes
75% of Coloradans who personally own a firearm have taken a class on firearm safety.
In 2023, the Colorado Firearm Injury Prevention Survey (COFIPS) was launched to gain a better understanding of the impact and prevention of firearm-involved harm in Colorado. In the survey, Coloradan firearm owners indicated that the top three reasons for ownership include protection of self, family, and property.
75% of firearm-involved deaths in Colorado are suicides. The majority of adults in Colorado believe that homicide is the leading cause of deaths involving firearms. In the survey, only 25% of respondents correctly identified suicide as the leading cause of firearm deaths. This indicates a major misunderstanding of the issue of firearm deaths.:
Access and Storage
Secure storage of firearms can prevent unauthorized access and save lives. The majority of firearm owners in Colorado, 65%, keep all firearms in the home locked and unloaded. However, 25% of Mesa County high school students said that it would be sort of easy or very easy to access a handgun.
While working-age adults are more likely to use a firearm in a suicide death than youth and young adults, it is not an uncommon method for young people. This is an area for impact that can make a difference in the lives of Mesa County youth.
Promoting and increasing access to firearm safety education can help mitigate the risk of firearm harm in the community.
Participation in safety training not only promotes proper usage and storage, but also helps in educating on the importance of firearm safety in preventing injury and death among children and youth.
VA Western Colorado Health System
Gun locks are one way to create space between intrusive thoughts and suicide, giving more time for intervention for someone in crisis.
In 2022, the VA Western Colorado Health System in Mesa County distributed 962 gun locks to the Mesa County community through gun distributors as part of their efforts towards suicide prevention.
Youth Risk and Protective Factors
Risk and protective factors play vital roles in impacting health behaviors and outcomes for children and youth. While protective factors decrease the likelihood of negative outcomes, risk factors increase the likelihood of negative outcomes.
Protective factors like family support and opportunities for social connection empower youth for greater success and resilience. These protective factors also have a strong impact on substance use and mental health.
Definitions
Risk Factors A characteristic that is associated with a higher likelihood of negative outcomes. These characteristics can be biological, psychological, family, community, or cultural.
Examples include:
- Low-self esteem
- Family conflict
- Poverty
Protective Factors A characteristic that is associated with a lower likelihood of negative outcomes. These characteristics can be biological, psychological, family, community, or cultural.
Examples include:
- Emotional self-regulation
- Supportive relationships with family members
- Engagement and connections in school, athletics, employment, religion, or culture.
Source: Youth.gov
Child Welfare
The Department of Human Services (DHS) Child Welfare team in Mesa County is committed to a focus on preventive services that reach families in their homes.
In 2023, their team performed 4,780 family screenings. Just over a quarter of those resulted in an assessment for further work with a DHS case worker. Family screenings occurred at a higher rate in Mesa County than state averages, with about 14.9 per 100 children in the community, compared to 9.5 per 100 children statewide.
71% of allegations of maltreatment were for neglect, and 16% were for physical abuse. These were the most common allegations of maltreatment in Mesa County, a very similar breakdown to statewide allegations of maltreatment.
Regardless of whether a case is opened, the Child Welfare team offers families referrals for providers and services including:
- Hilltop,
- Mind Springs Health,
- Amos Counseling,
- Griffith Center,
- substance use treatment,
- mental health care,
- parenting skills training,
- domestic violence treatment, and
- youth mentoring.
In 2023, the number of Mesa County children in an out-of-home placement varied from 181 to 203. Approximately 84% of those children were in a family-like setting.
High School Students
In 2021, Mesa County high school students participated in the Healthy Kids Colorado Survey. They answered questions related to their mental health and substance use behaviors, as well as various risk and protective factors.
Their answers indicated that protective factors such as strong family support and social connection with friends and with peers at school can have a positive impact on student substance use and mental wellness.
Family Support
Three aspects of family support had a clear positive influence on reducing substance use and mental health challenges:
- students who were confident they could rely on their parents for help,
- students who had lots of chances for family fun, and
- students who said their family rules were clear.
A student’s confidence that they can turn to their parents for help is profoundly correlated with their mental health and the likelihood they’ll engage in high-risk substance use. 18% of students indicated that they aren’t confident they can trust their parents to help them. This is an area where interventions to encourage and facilitate stronger relationships between students and parents can have dramatic effects.
Students who can ask their parents for help with a personal problem.
Students who reported struggling with their mental health according to whether they could ask their parents for help
Students who reported engaging in high-risk substance use according to whether they could ask their parents for help
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
Screen Use
Excessive screen time is common among high school students. 72% of students reported they spent at least three hours each day in front of a TV, computer, smart phone, or other electronic device for something other than schoolwork.
Since this question groups together so many different types of screen use, it isn’t possible to isolate types of screen use that may have different impact on social connection and mental health. For example, some studies show a difference between social media use and online gaming with real-life friends. While these two activities both represent screen time, they represent very different types of social interaction.
Based on the aggregated data available, however, struggling with mental health was somewhat more common among students with excessive screen time at 46%, compared to 36% among students who spent less of their time engaged in electronic activities.
PERCENT OF STUDENTS WHO SPEND AT LEAST 3 HOURS PER DAY IN FRONT OF A SCREEN
PERCENT OF STUDENTS WITH SERIOUS MENTAL HEALTH CHALLENGES BY SCREEN USAGE
Source: Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey 2021
References
1.
Centers for Disease Control and Prevention, Tips for Maintaining Healthy Weight, December 2023
2.
Colorado Department of Public Health and Environment, Behavioral Risk Factor Surveillance System (BRFSS), Data Request, 2015-2022
3.
Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey, Data Request, 2021
4.
Colorado Department of Public Health and Environment, Healthy Kids Colorado Survey Dashboard, 2015-2022
5.
Colorado Department of Public Health and Environment, Pregnancy Risk Assessment Monitoring System (PRAMS), Data Request, 2018-2021
6.
Ramos AR, Wheaton AG, Johnson DA. Sleep Deprivation, Sleep Disorders, and Chronic Disease. Prev Chronic Dis, 2023
7.
Paruthi S, Brooks LJ, D’Ambrosio C, et al. Consensus statement of the American Academy of Sleep Medicine on the recommended amount of sleep for healthy children: methodology and discussion. J Clin Sleep Med, 2016
8.
Primary Care Partners, Syndromic Surveillance Project, Patient Encounter ICD-10 Codes, Data Request, 2017-2023
9.
Colorado Department of Public Health and Environment, Disease Control and Public Health Response Portal - School Immunization Rates, 2017-2023
10.
Colorado Department of Public Health and Environment, Taking the Unintended Out of Pregnancy: Colorado’s Success with Long-Acting Reversible Contraception, 2017
11.
Colorado Department of Public Health and Environment, Colorado Health Information Dataset - Live Birth Statistics, 2000-2022
12.
University of Colorado School of Medicine Firearm Injury Prevention Initiative, Using Data to Prevent Firearm Harms in Colorado: Findings from the 2023 Colorado Firearm Injury Prevention Survey (COFIPS), 2024
13.
VA Western Colorado Health System, Mesa County, Gun Lock Distribution Initiative, Data Request, 2022
14.
youth.gov, Risk and Protective Factors for Youth, Accessed 2024
15.
Colorado Department of Human Services, Community Performance Dashboard, 2023
Social Connection
A student’s sense of belonging among their peers is highly correlated with their health behaviors. Students who disagreed with feeling like they belonged at school were more than twice as likely to struggle with their mental health. They were also more likely to engage in high-risk substance use.
Students were more likely to feel like they belong if they had trusted friends for emotional support or participated in extracurricular activities such as sports, band, drama, clubs, or student government.
Participation in extracurricular activities dropped significantly among high school students from 2019 to 2021, down to only about half of all students. This may be a consequence of the disruption of the COVID-19 pandemic on student life.
For more information on social connectedness trends for youth, see Social & Communuty Contect and sections in Healthy Behaviors for high school students.
AGREEMENT WITH “I FEEL I BELONG AT SCHOOL”
STUDENTS WITH SERIOUS MENTAL HEALTH CHALLENGES BY WHETHER THEY BELONG AT SCHOOL
STUDENTS WITH HIGH-RISK SUBSTANCE USE BY WHETHER THEY BELONG AT SCHOOL