Data from the

NATIONAL HEALTH SURVEY

Skin Conditions of

Youths 12-17 Years

Prevalence of facial acne and other skin conditions of youths in the United States by age, sex,

race, geographic region, and socioeconomic

background as well as in-relation to other selected findings from the Health Examination Survey

of 1966-70.

DHEW Publication No. (H RA) 76-1639

Series 11

Number 157

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Public Health Service

Health Resources Administration

National Center for Health Statistics

Rockville, Md. August 1976
Library of Congress Cataloging Publication Data

Roberts, Jean

Skin conditions of youths 12-17 years, United States

(Vital and health statistics: Series 11, Data from the Nati~>nzdHealth Survey, Data from

the health examination survey, “ no. 157) (DHEW publication; no, (HRA) 76-1 639)

Includes bibliographical references.

Supt. of Dots. no.: HE 20.6209:11/157

1. Pediatric dermatolo~– United States–Statistics. 2. Acne–United States–Statistics.

3. Youth–Diseases–United States–Statistics. 4. Iiealth surveys–United States. I. Ludford,

Jacqueline, joint author. II. United States. National Center for Health Statistics. Division of

Health Examination Statistics. 111, Title. IV. Series: LTnited States. hTational Center for

Health Statistics. Vital and health statistics: Series 11, Data from the National Health

Survey, Data from the health examination survey; no. 157. \’. Series: United States. Dept.

of Health, Education, and Welfare. DHEW publication; no. (HRA) 76-1639. [DNLM: 1.

Acne–In adolescence. 2. Skin diseases–In adolescence. 3. Acne–Occurrence –U.S. 4. Skin

diseases–Occurrence–U.S. W2 A N148vk no. 157]

RA407.3.A347 no. 157 [RJ511] 312’.0973s [312’.36’0973]

ISBN 0-8406 -0060-7 75-619381

For sale by the Superintendent of Documents, U.S. Government Printing Office

Washington, D.C. ZQ40Z- Price $1.S0
NATIONAL CENTER FOR HEALTH STATISTICS

DOROTHY P. RICE, Director

ROBERT A, ISRAEL, Deputy Director

JACOB J. FELDMAN, Ph.D., Associate Director for AnaZ_ysis

GAIL F. FISHER, Associate Director for the Cooperative Health Statistics System

ELIJAH L. WHITE, Associate Director for Data Systems

GEORGE P. FAILLA, Associate Director for Management

PETER L, HURLEY, Associate Director for Operations

JAMES M. ROBEY, Ph.D., Associate Director for pro~am Development

ALICE HAYWOOD, Information Officer

DIVISION OF HEALTH EXAMINATION STATISTICS

ARTHUR J. McDOWELL, Director

JEAN-PIERRE HABICHT, M.D., Ph.D., Special Assistant to Director

PETER V. V. HAMILL, M.D., Medical Adviser

JEAN ROBERTS, Chiej Medical Statistics Branch

ROBERT S. MURPHY, Chief Survey Planning and Development Branch

COOPERATION OF THE BUREAU OF THE CENSUS

In accordance with specifications established by the National Center for Health Statistics, the

Bureau of the Census, under a contractual agreement, participated in the design and selection of

the sample, and carried out the fimt stage of the field interviewing and certain parts of the

statistical processing.

,

Vital and Health Statistics-Series 11-No. 157

DHEW Publication No. (HRA) 76-1639

Libray of Congress Catalog Card Number 75-619381
CONTENTS

Page

Introduction ----------------------------------------------------------

Data Sources -------------- -------- ------- --------------------- -------

Medical Histories --------------------- -----.--- “-------- --------- ---

Physician Examination --------------- “------ ---------------------- --

Findings ------------------------ -----------.”- -------- --------------- .

General Prevalence ------------------------------------------------

Prwiously Known Conditions --------------------------- ------------

Demographic-Socioeconomic Trends --------- -------------- ------------

Relation to Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . ----------------------

Relation to Stress and Health Habits --------------------------- ----

Relation to Physiological Development --------------------------- ---

Comparison With Other Studies -.---------” --------------- ------------

Summary ----.-.”---.--.” ----------- ---------------------------- -“----

References ---------------- “-”.---w ------- --------------- -“----- -----.-

List of Detailed Tables ----------------------- ------- ------- -------- -

Appendix L Statistical Notes ------- . . . . . --------- .“----- --------------

The Survey Design --------------------------- ------ . ------ .----.-”

Reliability --------------------------- ---------- -“------- ------------

Sampling and Measurement Error ----------------------------------

Small Numbers --q---- ---------------------- ------- ----------------

Appendix II. Demographic and Socioeconomic Terms ---------------------

Appendix III. Medical History and Physical Examination Forms --------

Medical History of Youth - Parent’s Questionnaire ---------------%-----

Health Habits and History -Youth ----------------------- -------------

HealthBehavior -Youth ----------------------- ------- ---------------

Supplemental Information from School -------- --------------------- ----

Physical Examination --- . - ”.”----------- “--------- -------------------

1

2

2

3

4

4

6

7

12

13

14

16

17

19

20

57

57

59

59

60

61

62

62

63

64

65

66
SYMBOLS

Datanot available ---------------------------------------- ---

Category not applicable ------------------------------- . . .

Quantity zero ---------------------------------------------- -

Quantity morethan Obutless than0.05----- 0.0

Figure does not meet standards of

reliability or precision ------------------------------ *

iv
SKIN CONDITIONS OF YOUTHS

JeanRobertsandJacqueke Ludford,Division of Health Examination Statistics

INTRODUCTION

This report presents estimates of the prevalence of facial acne and other skin conditions of

youths age 12-17 years in the noninstitutionalized

population of the United States, based on direct

examination findings from the Health Examination

Survey of 1966-70 among a national probability

sample representative of the 22.7 million youths

in that segment of the population. Findings are

analyzed by age, race, sex, geographic region,

size of place of residence, and in relation to other

selected parts of the examination.

The Health Examination Survey is one of the

major programs of the National Center for Health

Statistics which was authorized through the National Health Survey Act of 1956 by the 84th Congress as a continuing Public Health Service responsibility to determine the health status of the

population. 1

The principal health survey programs of

the National Center for Health Statistics include

the Health Examination, Health Interview, Health

Manpower and Facilities, and Health Resources

Utilization. The Health Interview Survey, which

collects health information from samples of

people by household interview, primarily studies

the impact of known illness and disability on the

lives of people. The Health Manpower and Facilities programs obtain information through surveys

of hospitals, nursing homes, and other resident

institutions, and the entire range of personnel

in the health occupations. The Health Resources

Utilization surveys obtain inform ation on the

extent of health facility and service utilization.

In the Health Examination Survey data are collected through direct physical examinations, tests,

and measurements performed on carefully selected nationwide probability samples of the population. This latter system, in addition to providing

the most efficient way of obtaining actual diagnostic data on the prevalence of specified medically defined illness, is the only one of the survey

programs to secure information on unrecognized

or undiagnosed conditions as well as a variety

of physical, physiological, and psychological

measures within the population. Medical history,

demographic, and socioeconomic data are also

obtained on the sample population under study,

making possible the interrelation of these “data

with the examination findings for those examined.

The Health Examination Survey is planned

as a continuous series of separate programs

called “cycles. ” Each cycle is limited to certain

aspects of health within specified segments of

the U.S. population. The first cycle in 1960-62

was designed primarily to provide data on the

prevalence of certain chronic diseases and on

the distribution of various physical and physio.

logical measures in a defined adult population.2’3

For the second cycle in 1963-65 the target

population was the noninstitutionalized children

age 6-11 years. The examination and medical

histories for it were focused primarily on health

factors related to growth and development.4’5

The findings on which this report is based

are from the third cycle which was designed, as

in the preceding children’s program, to obtain

data on the health status of the youth population

with particular emphasis on factors and conditions related to their growth and development.

For this program a probability sample of the

noninstitutionalized youths 12-17 years in the

United States was selected and examined. The

questionnaires, examination content, and procedures were similar to those in the children’s

1
program, so as to obtain comparable information

for the entire age range of childhood through

adolescence, but were supplemented to obtain

data specifically related to adolescent health.

Included were a physical examination given by

a pediatrician assisted by a nurse, an examination by a dentist, tests administered by a psychologist, and a variety of tests and measurements

by laboratory, X-ray, and health technicians.

The survey plan, sample design, examination

content, and operation of this survey program

have been described in a previous report. b

Fieid collection operations for the youths’

cycle started in March 1966 and were completed

in March 1970. Of the 7,514 youths selected in

the national probability sample, 6,768 or 90 percent were examined. This national sample is

representative, and the examined group is closely

representative, of the 22.7 million civilian noninstitutionalized youths 12-17 years in the United

States with respect to age, sex, race, geographic

region, population size of place of residence, and

rate of change in size of place of residence from

1950 to 1960.

As in the preceding program among children,

examinations in the youths’ cycle were done consecutively in 40 different locations throughout the

United States. During his single visit each youth

was given a standardized examination by the medical team in the mobile units specially designed

for use in the survey. The only exception to this

single visit was for girls with urine specimens

found positive for bacteriuria who were brought

back for repeat urine tests. Prior to the examination, demographic and socioeconomic data on

household members as well as medical history,

behavioral, and related data on the youth to be

examfned were obtained from his parents. In

addition, a Health Habits and History form was

completed by the youth before he arrived for ~he

examination and a Health Behavior form was

completed by him while in the examination center.

Ancillary data were requested from the school

last attended by the youth including his grade

placement, the teacher’s rating of his behavior

and adjustment, and health problems known to

his teacher. A birth certificate was obtained for

each youth to verify his age and provide information related to his condition at birth.

Statistical notes on the survey design, reliability of the data, and sampling and measurement error are in appendix I. Definitions of the

demographic and socioeconomic terms are in

appendix II.

DATA SOURCES

Medical Histories

Data as specified below from the four available sources of medical history regarding the

youth’s present health status, dietary habits,

degree of tension or emotional problems, and

probletns with sleep and allergies are considered

in this report as they may relate to examination

findings of acne or other skin conditions.

Parent Questionnaire. —At the time of the

initial visit to the sample household, the census

interviewer left a Medical History of Youth form

with the parent or guardian to be completed for

each eligible youth.

A few days later the Health Examination

Survey representative (HER) visited the household and reviewed the self-administered medical

history for completeness and consistency. If

the form was not completed or only partially so,

the HER attempted, with the parent’s help, to

complete it at that time.

Included in this report as they may relate

to skin findings are data on the parent’s rating

of the youth’s present health status; regular use

of medicine; history of hay fever, asthma, or

other allergies; degree of nervousness; amount

of food eaten; and fussiness of eating habits

(appendix III, Nos. 11, 12, 18,50,53, 54).

Youth Questionnaires .—At the time of the

HER’s visit to the household, she left a Health

Habits and History form with instruction that it

be completed by the eligible youth and returned

to the survey in the envelope provided before the

youth arrives for the scheduled examination.

From this health history form the youth’s

responses to questions on present health status,

regular use of medication, frequency of trouble

sleeping, frequency of nightmares, recent sleepwalking, history regarding acne, and amount of

food eaten are included. (Nos. 4, 6, 30, 31, 32,

33.)

The youth’s rating of his own degree of
tension from the Health Behavior questionnaire

which he completed while in the examination

center is also used. (No. 11.)

School Questionnaires. -At the time the sample youths were picked up from or returned to the

schools attended, the escorts left a Supplemental

Information From School form, for each sample

youth in the school, with the school principal,

who had been asked to have each form completed

by the youth’s teacher or whoever he believed

would be the best informed respondent. In locations visited during the summer months when

school was not in session, the questionnaires

were mailed to the school in the early fall with

a request that they be completed and returned.

Relevant data from that schedule are the

teacher’s assessment of the youth’s need for

special resources for the emotionally disturbed

and the degree of adjustment. (Nos. 8e and 9.)

Physician Examination

The examining physician with the survey team

was either a senior resident or fellow in pediatrics from a selected medical center, school, or

hospital who had been given special training in

the standardized physical examination used in the

survey, including brief training in special areas

of adolescent medicine particularly with respect

to maturation gradirig, otolaryngology, and dermatology. On the day before the scheduled examination, the completed Medical History of

Youth and the Health Habits and History-Youth

were reviewed by the examining physician, who

noted items which might require further followup in the course of the examination.

The physician’s examination included an

eye, ear, nose, and throat examination; check

for goiter; musculoskeletal and neurological evaluation; cardiovascular examination; inspection

for and grading of facial acne; assessment of

sexual maturation; and an appraisal of nutrition.

During the examination the nurse drew a sample

of blood (for later determination of hematocrit

and hemoglobin, levels of cholesterol, uric acid,

serological tests for syphilis, protein-bound

iodine, and genotype determinations of blood

groups), obtained the three blood pressures

(supine and sitting position after the examination),

and for the female examinees compIeted the

menstrual history questionnaire and collected a

urine specimen for culture of bacteriuria.

Then the examining physician made a summary of his findings based on his training and

clinical judgment, the youth’s medical history,

his own examination, and the tests and other data

available to him from the other examination

procedures. From these he decided whether or

not the adolescent was basically healthy, developing satisfactorily, and growing normally, excluding from consideration mild, transient problems such as minor cuts or bruises, fractured

bones that healed without complications, and

colds. Criteria regarding findings affecting normal growth were interpreted broadly to include

all but the minimal and questionable findings

which did not appear to offset normal growth,

development, or function, as previously described. 6*7

In ~he examination of the skin the physician

inspected the face and neck for acne. The following scale from Pillsbury’s Textbook of De-rmatology 8 was used in grading acne found on the

face and neck, without considering body or

trunkal acne:

. Grade O - No acne.

● Grade I - Sparse to profuse comedones

with little or no inflammatory

reaction.

. Grade II . Acne consisting of comedones

and superficial small pustular

and inflammatory lesions at the

follicular orifice. This process

is usually confined to the face.

● Grade III - Acne characterized by comedones, small pustules, and a

tendency to deeper inflamed lesions. These inflammatory nodules are not definitely related

to the follicular pore and apparently result from rupture of

the sebaceous duct, with extrusion of sebum into the skin tissue,

and from inflammation caused

by chemical and bacterial factors. This grade represents a

true disease rather than a passing cosmetic change.

3
● Grade IV - Extensive secondarily infected

cystic acne (acne conglobata).

The face and neck may be severely involved, with extensive

lesions on the upper trunk. Some

extension up into the scalp on

the posterior neck may be noted.

Coalescence of lesions occurs,

with production of boggy canalized sinuses. The resulting scarring may be markedly distorting, with cord-like bands and

hypertropic ridges.

In addition to recoruing the grade of facial

acne, the physician described any other skin

conditions found on the Physical Examination

form. Any of these skin conditions which the

examining physician considered as interfering

with the youth’s normal functions, significant

enough to be cosmetically traumatic, or evidence

of pathology which accounted for a lag in growth

and development such as a scar from heart

surgery, were also recorded on the Summary of

Diagnostic Impressions form (appendix 111).

The other skin findings included extensive

scars and birthmarks as well as active pathologic processes. An adaptation of the Eighth Revision, International Classification of Diseases 9

stressing etiology rather than system was used

for classifying these other skin conditions in

this report.

While the Physical Examination form (appendix III) provided space for the physician to

record a description of other skin findings, field

manual instructions described only the system to

be used in grading facial acne. Hence the recording of other skin findings must be assumed

to be less complete than that for facial acne.

FINDINGS

Among noninstitutionalized youths age 12-17

years in the United States only an estimated 27.7

percent or 6.3 million were found to have essentially normal skin, without significant lesions or

scars, based on physical examinations among the

national probability sample of youths in the Health

Examination Survey of 1966-70.

Skin conditions of any type were identified

80 r

o~

12 13 14 15 16 17

AGE IN YEARS

Figure 1. Percent of youths with no abnormal skin conditions

on examination by age and sex: Unitad States, 1966-70.

among 72.3 percent or 16.4 million youths (table

1 and appendix I). This includes 68.1 percent or

15.5 million youths with facial acne, 0.7 percent

or 0.2 million youths with body acne, and 13.4

percent or 3.1 million youths with nonacne skin

conditions. About one youth in 10 (9.8 percent of

all youths or 13.6 percent of those with some skin

problem) had more than one type of skin condition.

The proportion of youths with essentially

normal skin decreases rapidly with age from 53

percent at age 12 years to 12 percent at age 17

years. The decline is more rapid and consistent

among boys than girls (figure 1).

General Prevalence

The prevalence of fackzl acne, the most

frequently occurring of the skin conditions, increases with age more rapidly among younger

than older youths, from 39.0 per 100 at age 12

years to 86.4 per 100 at age 17 years. Such conditions are slightly more prevalent among girls

(69.8 per 100) than boys (66.4 per 100). However,

the increase in prevalence rates with age is more

rapid and consistent among boys than girls.

Facial acne is substantially less prevalent

among younger boys than girls. At 12 years, only

one-fourth of the boys compared with more than

half (53 percent) of the girls had facial acne

(figure 2). By the midteens—ages 14 and 15

years—the sex difference in the rates is negli-
Boys

FACIAL ACNE

Girls

##

~.

,/

,0’

NONACNE SKIN CONDITIONS

o~

12 13 14 16 16 17

AGE IN YEARS

Figure 2. Prevalence rates for facial acne and nonacne skin

conditions on examination among youths by age and sex:

United States, 1966-70.

gible, while by 16 and 17 years boys are more

likely than girls to have such a condition.

Among youths who have facial acne, the

condition is more likely to be limited to comedones (blackheads) with little or no inflammatory

reaction-nearly three-fifths were classified as

grade I—than more severe inflammatory lesions

(table 2).

The facial acne, when present, tended to be

more severe among boys than girls. In nearly

half of the boys with facial acne (49 percent), compared with about one-third (34 percent) of the

girls, the conditions were moderate to severe

(graded H-IV) with extensive inflammatory lesions. Among boys with facial acne the proportion that had moderate or severe conditions

increased five-fold with age from 12 pelcent at

12 years to 62 percent at 17 years, while among

girls there was less than a two-fold increase

from 23 percent at 12 years to 39 percent at 17

years (figure 3).

For nonacrze skin lesions the prevalence is

sIightly higher among boys than girls (15 per

100 compared with 12 per 100) but shows no

consistent trend with age among either group

(table 1 and figure 2).

The most frequently mentioned of these

nonacne conditions were scars and nevi (table 3).

60

r

FACIAL ACNE-GRAOE I

o~

12 13 15 16

AGE IN YEARS

01 - 1 I I I

12 13 14 16 16 17

AGE IN YEARS

Figure 3. Prevalence rates for mild (grade I) ahd moderatesevere (grades II-IV) facial acne on examination among

youths by age and sex: United States, 1966-70.

The prevalence rates of 5.91 per 100 for scars,

of 1.20 per 100 for nevi, and “the lower rates for

the remainder of the conditions among this 12-17

year old population are probably lower than the

actual prevalence but likely to represent the most

severe of these conditions among adolescents

because the examining physicians, as previously

indicated, were to describe only those which

would be considered as interfering with the youths’

normal functions, significant enough to be cosmetically traumatic, .oi give evidence of pathology which would account for a lag in growth and

development, such as a scar from heart surgery.

Of the scar conditions identified 17 percent

were reported as due to trauma, 14 percent to

burns, and the remaining 69 percent to operations

or other and unspecified causes. About 7 percent

of the scars showed enlarged or raised keloid

formations.

5
The prevalence rate for tumors, growths,

and birthmarks was 2.12 per 100 youths. Nevi

(circumscribed stable malformations of the skin

presumed not due to external causes) accounted

for over half of these conditions. The rates for

the rem ainder of the less prevalent nonacne

skin conditions identified on examination are

included in table 3 because of general interest

in some of them even though the precision of

these national estimates is substantially below

that for the more prevalent conditions.

Previously Known Conditions

In the Health Habits and History form, the

youths indicated whether or not they had acne.

From that history 49.1 percent reported they did,

the proportion being slightly higher among boys

(49.7 percent) than girls (48.5 percent). This is

substantially lower than the rate of 68.1 per 100,

based on examination findings of fa;ial acne, but

exceeds the proportion rated on examination as

having moderate to severe facial acne (28.3 per

100).

Since a variety of factors have been reported

to contribute to the p~oduction of acne including

endocrine, dietary, emotional, traumatic, and

bacterial factors, 10 some lack of agreem ent would

be expected between the physician’s findings at

the time of the examination and the youth’s statement. There was physician confirmation of the

presence of acne for nearly 88 percent of youths

who reported they had this condition. Among youths

who said they did not have acne (table 4), the

physician found and graded the severity of acne

for nearly half (49 percent). In these latter cases

the condition was usually a mild one—limited to

comedones or blackheads with minimal or no

inflammatory reaction (grade I) for nearly 80 percent of youths who said they did not have acne.

The agreement as well as the lack of it was generally similar among boys and girls.

Age of orzseZ-While the examination findings

indicate that the prevalence of facial acne among

youths increases with age, the fact that nearly

half of the 12- year-olds had acne would indicate

that the age of onset for this condition would

frequently occur below 12 years of age.

-In their

at what age

6

medical history the youth was asked

acne started, if he or she said they

had it. More than half stated the condition started

at 12 or 13 years (24 percent and 28 percent,

respectively) with the median age being 13.3 years

(table 5).

The onset tended to be later in boys than

girls. Among boys nearly 55 percent stated their

acne condition had started at 13 or 14 years (29

percent and 25 percent, respectively) with the

median age of 13.7 years, while among girls the

concentration was at 12 and 13 years (about 28

percent in each year) with the median of 12.9

years or about 9 months earlier than for boys.

Effect on youths .—Although 84.2 percent of

youths age 12-17 years who recognized that they

had acne indicated their condition bothered or

worried them, only 58.3 percent said they were

using any treatment for it (presumably mostly

over-the-counter topical preparations) and only

11.4 percent had seen a doctor about it. Boys were

slightly less likely to be bothered by their acne

condition (81.5 percent) than girls (87,0 percent),

to use any treatment for it (54.8 percent of boys,

62.0 percent of girls with acne), or to see a doctor

about it (10.6 percent compared with 12.3 percent

for girls) (figure 4).

As might be expected, there tended to be an

increase in concern about the acne condition with

the increasing severity of the disorder (figure 5).

Among youths reporting they had acne and for

whom the presence of the condition was confirmed

- BotheredW their acne

= Treatingtheir acne

10D r

m SWM.D. about acnecondition

BOYS GIRLS

Figure 4. Proportion of youths 12-17 years of age reporting

they have acne who are bothered by the condition, are

treating it, and have sought medical advice about it: United

States, 1966-70.
Table A. Percent distribution of?degree to which youths age 12-17 years reported being

“bothered” by acne, by grade of facial acne as determined by examining physician:

United States, 1966-70

Number with

Physicians grading acne by both

of facial acne MD and youth

(in thousands)

1

Grade

Grade

Grade

Grade

Grade

Grade

Grade

Grade

.

All grades ------------- I 9,750

--.---- ------- ------- - 4,545

:1--------------------- 4,642

III-------------------- 517

Iv--------------------- 46

Total

Degree acne “bothers” youth

“A “A “Not at

lot” “some” little” all”

I

Percent distribution

100.0 ‘1O.2 34.5 37.2

100.0 17.8 37.1 33.8

100.0 23.1 ;;.: 20.0

100.0 19.1 . 11.6

Standard error

iI~::::E:imK All grades ------------- 1.03

1.74

1.08

3.57

8.39

14.4

18.1

11.3

:::

0.76

1.10

0.97

2.99

4.90

on examination, 14.6 percent stated the acne

bothered them quite alot;36.5 percent indicated

it bothered them some but not too much, 34.5

percent said it bothered them very little, and

14.4 percent were unconcerned about it. The

proportion bothered some or alot generally in100r

Figure 5. Proportion of youths 12-17 years of age who are

bothered “some” or “a lot” by their acne condition by

physician’s grading of facial acne: United Statas, 1966-70.

creased with the severity grade of facial acne

while the proportion bothered very little or not

at all even more consistently decreased with

the severity of the condition (table A).

Demographic-Socioeconomic Trends

Race.-The prevalence of facial acne, as

determined on examination, is slightly greater

among white than Negro youths age 12-17 years

in the United States (table 6). For both racial

groups the proportion with this condition more

than doubled with age during adolescence—from

39 per 100 at 12yearsto87 per 100at17 years

among white youths and from 38 per 100 to82

per 100 forNegro youths.

The increase in the prevalence rates with

age during those particular years (12-17)ismore

rapid among both white and Negro boys than

among girls of either race. At12and13 yearsthe

prevalence of facial acne among girls exceeds

that among boys of both races. Among older

youths—ages 15-17 years for white and 16-17

years for Negro youths—the rates for beys are

the greater.

7
100 BOYS

//’$$-

.

gso white ~----

5

d“

---- Negro

Seo

g

g 40

ill /

: 20 ●’

o~

12 13 14 15 16 17

AGE IN YEARS

10U r

GIRLS

o~

12 13 14 15 lB 17

AGE IN YEARS

Relatively more white than Negro boys are

affected across the 12-17 year age range, except

at age 13, the differences being greater from

15-17 years though not large enough to be considered statistically significant. Among girls

the pattern of racial differences in the rates is

less consistent across the age range (figure 6)

and the rates for the total 12-17 year group are

nearly identical.

White youths are slightly more likely than

Negro youths to have moderate to severe facial

acne and less likely to have mild conditions

limited to comedones. What racial differences

exist in these severity rates are primarily among

boys (figure 7 and tables 7 and 8). The moderate

to severe grades of facial acne are more prevalent among white than Negro boys across the

age range, except at 13 years, and among white

than Negro girls except at the extremes of the

range-12 and 17 years.

Nonacne skin lesions are more prevalent

among Negro than white youths, except at 12 years

where there is a negligible difference (table 6).

This racial pattern is consistent among boys 13-17

years and girls 12-17 years. Among both racial

Figure 6. Prevalence rates tor tecial acne on examination among

white and Negro youths by age and sex: Unitad States,

groups the rates are somewhat lower among girls

1966-70. than boys.

GIRLs

I II Ill Iv

GRADE OF SEVER17Y

BOYS

I II Ill Iv

GRADE OF SEVERITY

Figure 7. Prevalence rates for facial acne on examination among white and Negro boys and girls 12-17 years of age by physician’s

grade of severity: United States, 1966-70.

8
Region. - Facial acne is more prevalent

among youths age 12-17 years in the South and

West than those in the Northeast and Midwest.

The rates based on examination findings range

from 71.0 per 100 youths in the South to 65.8 per

100 in the Midwest. While this regional pattern

is present among both boys and girls, the differences in the rates are not large enough to be

statistically significant and are not consistent

across the individual years of age (table 9). In

each of the regions the prevalence rates for facial

acne among boys are slightly, but not significantly,

lower than those among girls but show a sharper

gradient with age.

Moderate to severe facial acne is more

prevalent and the mild conditions less prevalent

among youths in the South than those in either

the Midwest or West, but these rates (in the

South) do not differ significantly from those in

the Northeast. The prevalence rate for acne of

grades II-IV severity is 38.4 per 100 youths in

the South compared with rates ranging from 21.1

per 100 youths in the Midwest to 29.7 per 100

youths in the Northeast (table 10). This regional

pattern in severity of acne is present among both

boys and girls.

Among white boys and girls, the prevalence

for facial acne of grade II or more severity is

greatest for those in the South across the 12-17

year age range (table 11). The prevalence rate

for moderate-severe facial acne among white

boys in the South is 50.3 per 100 compared with

rates ranging from .24.4 to 36.3 per 100 for

white boys in the other three regions. Among

white girls in the South the prevalence rate for

acne of grade II or more severity is 36.2 per

100 compared with rates ranging from 18.2 to

23.8 per 100 in the other regions.

Among Negro youths the regional pattern in

the prevalence of acne is less consistent for

white youths. Moderate-severe acne is more prevalent among Negro girls in the South than those

in the other regions, with rates ranging from

25.8 per 100 in the South to 14.6 in the Midwest.

However, among Negro boys these more severe

acne conditions are most prevalent in the Northeast (27.8 per 100) and least prevalent in the

West (17.3 per 100).

Facial acne is more prevalent among white

than Negro youths—both boys and girls—in the

60 r

I

NORTHEAST Ml DWEST SOUTH WEST

Figure 8. Prevalence rates for moderate-severe facial acne on

examination among white and Negro boys and girls 12-17

years of age by geographic region: United States, 1966-70.

South. While the difference is these rates is

sizable (74.3 per 100 compared with 61.7) it

is not large enough to be statistically significant

at the 5 percent probability level. In contrast,

the prevalence rates among Negro youths in the

other three regions slightly exceed those for

white youths in the respective regions.

Moderate to severe facial acne is also substantially more prevalent among white than Negro

youths in the South but is just slightly more prevalent also among white than Negro youths in the

other three regions, in contrast to the findings

for all grades of acne (table 11 and figure 8).

Size of place. —Youths age 12-17 years

living in urbanized areas, those in suburban

(other urban places outside of urbanized) areas,

and those in rural areas of the United States

had similar prevalence rates for facial acne, as

determined at examination (tables 12-15).

The prevalence of facial acne is lower among

Negro youths in suburban places than among either

Negro youths in urbanized or rural areas or

white youths in any of the three population density

areas (figure 9). However, this finding needs to

be interpreted with caution since Negro youths

living in suburban areas constitute only 1 percent

of all youths in the sample, were primarily in

the South, and tended to be slightly younger than

youths in other population-size areas.

Neither was there a significant difference

in the prevalence of the moderate-severe acne

by size of place of residence (table 13). Boys

9
260,0W.

3,000,000

m White youths

- Negroyouths’

2,51W249.999

URBANIZED NONURBANIZED

Under

2,500

RURAL

Figure 9. Prevalence rates for facial acne (all grades combined)

on examination among white and Negro youths 12-17

years of age living in urbanized communities, nonurbanized

communities, and rural areas: United States, 1966-70.

show a higher prevalence of facial acne grade

II or more severity than girls regardless of the

size of place in which they live. The prevalence

of moderate to severe acne was lower among

Negro youths in suburban areas than Negro

youths in urbanized or rural areas or white

youths in any of the three population-size areas.

This trend is present among both boys and girls.

However, as previously mentioned, this small

group of suburban Negro youths were represented

in the sample primarily by those in the South

and were a somewhat younger segment of the

youth population.

Family income. —The prevalence of facial

acne among youths shows no consistent pattern

of relationship with size of their family income.

The rates range from 68.8 per 100 among youths

in families with less than $5,000 to 66.0 per 100

among those in the $10,000-$14,999 bracket

(table 16), a difference that could easily be due

to chance alone with the size and design of the

sample used in this national survey. The pattern

of association is inconsistent and differs among

boys and girls. Within each income level, the

prevalence of facial acne among girls slightly

exceeds that among boys.

Moderate to severe facial acne (grades H-IV)

is more prevalent among girls from the lowest

income level families (with less” than $3,000

amual income) than among other girls (31.1 per

100 compared with rates ranging from 20.3 to

24.2 per 100 in the other income level groups).

No consistent pattern is evident among the boys

(table 17).

The tendency for white youths to have slightly

higher prevalence rates for facial acne than

Negro youths was most pronounced for white

boys from families with income under $5,000

(figure 10 and table 18). At the higher income

lCOr

GIRLS

ao

60

40

20

0 I

L&& g,o& yg $7,000- $10,OOO. $15,00+J

$9,999 $14,999 or more

FAMILY INCOME

100

[

BOYS

~ White

ao

~ Neg.

Le&&n $#J& $&& $7,CO0. $10,OOO $lS,IXO

$9,999 $14,999 or mare

Figure 10. Prevalence rates for facial acne on examination among wtite and Negro boys and girls 12-17 years of age by annual family

income: United States, 1966-70.

10
levels Negro youths, especially Negro girls,

show prevalence rates that both increase with

the size of the family income and exceed rates

among white girls in those income brackets

($7 ,000 and over). The differences are not statistically significant, however, until a family

income level of $15,000 and over is reached.

The prevalence of facial acne among Negro boys

also exceeds that for white boys in this highest

income level group but the difference in rates

is too small to be considered statistically significant.

Figure 11 shows the prevalence of facial

acne of grade II or more severity by race, sex,

and family income level. Among white youths,

prevalence rates for this more severe acne

tend to be highest among those in the lowest

family income levels. At levels of $5,000 or more

for white boys and $3,000 or more for white

girls the prevalence rates for acne of grade 11

or more severity is less and remains essentially invariant with increase in family income.

In contrast, among Negro youths the rate

for moderate-severe facial acne (grades II-IV)

is slightly higher among Negro boys from families

with $5,000 or more annual income than Negro

boys from poorer families. Among Negro girls

the prevalence of grade II or more severe acne

is greater among the higher income levels

~ White

m Negro

Lew than $3,00il

$3,0Q3.$4,999

$5,003.$6,999

$7.000.$9,999

$10,030ormorn

Figure 11. Prevalence rates for facial acne of wadas II-IVsavar.

ity on examination among white and Ne~ro boys and girls

12-17 years of age by annual family income: United

States, 1966-70.

I

($7 ,000 or more) but also among those from the

lowest income level (less than $3,000). None of

these differences in rates are large enough to

be statistically significant.

Education of pavent, —A more consistent

association exists between the prevalence of

facial acne among youths and the educa~onal

level of their parent (head of household, usually

father). The prevalence rates decrease from ,

70.6 per 100 among those youths whose parent

had completed less than 9 years of formal edu- .

cation to 65.1 per 100 among those whose parent

had some college education. The trend is evident

among both boys and girls with few exceptions

across the age range in this survey. While the

differences in rates are not generally large

enough to be statistically significant, the trend

is consistent both for all facial acne and for

conditions of grade 11 or more severity (tables

19, 20).

This pattern of association between acne

prevalence among youths and education of their

parents is similar and consistent among white

boys and girls, and among Negro boys but not

Negro gh-ls (figure 12 and table 20). However,

when limited to the moderate-severe acne conditions the decreasing trend in the prevalence

rates with increase in education level is evident

GIRLS BOYS

80 r El White

f7Zl Negro

1-8 ~~d~~ 13 grades+ 1.8

grades grades g~~dzm 13 grades+

EOUCATION OF PARENT

Figure 12. Prevalence rates for facial acne on examination

among white and Negro boys and girls 12-17 yeara of age

by education of parent United States, 1966-70.

11
.

L

o

d

—.——z.

GIRLS BOYS

m white

EZ7 Negro

1-8 9-12 13 grades+ 1-8 ‘“12 13 gra, grades grades grties grades

EDUCATION OF PARENT _Jdes+

Figure 13. Prevalence rates for facial acne of grades II-IV severity on examination among white and Negroboys and girls

12-17 years of age by education of parent: United State$,

1966-70.

among white boys and girls and among Negro

girls but not boys (figure 13).

Relation to Health

The medical histories for the youths given

by their parents and by the youths themselves

included a rating of the youths’ present health

as excellent, very good, good, fair, or poor.

Five percent of the youths rated themselves in

fair or poor health compared with 4 percent

based on their parents’ rating. The extent of

association of these ratings of present health

to the presence of facial acne in the youths as

identified on examination is shown in tables

21-230

Facial acne is slightly more prevalent among

youths—both boys and girls—whose health was

considered fair or poor by themselves or their

parents than among those rated as in good-excellent health (table 21). However, the difference

in acne rates among the two groups (68 percent

among those in good-excellent health and nearly

75 percent among those in poor-fair health) is

not large enough to be considered statistically

significant, nor is the higher acne rate consistent among those in fair-poor health across

the 12-17 year age range among either boys or

girls. The further lack of agreement between

the findings from the parent and youth history

.

statements may reflect the differing attitudes

or knowledge of the respondents concerning the

facial acne condition.

The extent of association between acne findings on examination among white and Negro

youths and their health ratings are shown in

table 22. These data would seem to indicate that

the presence of facial acne in the youth would

be less likely to have influenced the health rating

as given by Negro parents than that” given by

white parents or youths of either race.

When considered in relation to the moderatesevere grades of facial acne, the acne condition

would appear to have influenced (or been associated with another health condition that influenced)

the health rating as given by parents (both white

and Negro) to a slightly greater extent than those

given by the youths (both white and Negro) (table

22 and figure 14).

In each of the four regions, those youths

whose health was rated by their parents as

fair-poor were slightly more likely to have facial

acne than those in good-excellent health. In contrast on the basis of the youths’ own health ratings, the prevalence of facial acne among those

in the Northeast and Midwest Regions is significantly higher among youths in fair-poor health

than those in good-excellent health, while in the

South and West youths in good-excellent health

60

r

Boys Girls Boys Girls Boys Girls Boys Girls

Poor.Fair Gcmd.Excellent Poor-Fair Good-Exmllmt

YOUTH’S OPINION OF PARENT’S OPINION OF

YouTH’s HEALTH YOUTH’S HEALTH

Figure 14. Prevalenw rates for facial acne of grades II-IV severity on examination by youths’ and parents’ rating of health

of white and Negro boys and girls 12-17 years of age:

United States, 1966-70.

12
are about as likely as those in fair-poor health

to have facial acne (table 23).

Allwgies.—Since hypersensitivity may manifest itself in cutaneous lesions ,10the association

of history of hay fever, asthma, and other allergies to the prevalence of facial acne among

youths was considered. The prevalence rate for

facial acne among youths who have ever had hay

fever, asthma, or other allergies is slightly

higher than the facial acne rate for those without

such a history (table 24). However, the difference is too small to be statistically significant

and the direction of the difference is inconsistent

over the 12-17 year age range.

Since most of the allergic skin disorders

identified on the examination occurred in combination with facial acne, the prevalence rate

for these allergic disorders active at the time

of the examination (0.9 per 100 youths) would

probably account for the slightly higher rate

of acne among those with than without an allergy

history.

It is readily apparent that while some 14

percent of youths have a history of such allergies

that might have affected the skin, the proportion

who stiH had an active condition affecting the

skin at the time of the examination was either

very low or not completely identified.

Taking medication. —Only a small proportion of youths (6 percent) were taking medication

(presumably mostly on prescription) regularly

for one or more conditions. Only 8 percent of

these youths (0.4 percent of all youths) were

taking such prescription medication primarily

for a skin condition.

The prevalence of facial acne is significantly

higher among those taking medication for a skin

disorder (92.7 per 100 youths) than among other

youths who were either not taking any medication

regularly or taking medication regularly for other

conditions (68 per 100 youths among both groups)

(table 25).

Relation to Stress and Health Habits

Among the factors which have been identified

as possibly contributing to the production of acne

or causing the exacerbation of acne lesions are

stress (or the effect of it), other emotional, traumatic, and dietary factors. 10 Available data from

the medical history relevant to these factors—

degree of nervousness, degree of adjustment in

school, problems with sleeping and eating habits—

will be considered here as they may relate to

the prevalence of facial acne among youths.

Nervousness. —An association is evident between the prevalence of facial acne among youths

and the youths’ own rating of his degree of nervousness (table 26). The prevalence rate for

facial acne increases with the degree of nervousness of the youths from 62.6 per 100 among

those who rated themselves as “never nervous”

to 77.0 per 100 among those who were “often

nervous.” The difference in acne rates between

those who say they are “never nervous” and the

groups who are “sometimes” or “rarely nervous,” as well as between those middle (’‘some”

and “rarely”) groups and youths who are “very

nervous” are large enough to be statistically

significant for all youths. A similar trend is

present among both boys and girls and generally

across age from 13-17 years.

This pattern of association between degree

of nervousness (youth’s rating) and the prevalence of acne is generally consistent among

white youths and among all youths in each of

the four geographic regions (tables 27 and 28).

Among Negro youths acne also is most prevalent among those who say they are often nervous and least prevalent among the group who

are never nervous.

The association is less strong or consistent

when based on the parents’ rating of the degree

of nervousness for youths.

School behavior. —The prevalence of facial

acne tended to be slightly higher among those

youths—both boys and girls—who were rated as

seriously maladjusted in school than those who

were considered better adjusted. However, the

difference in rates is too small to be of statistical significance and this pattern is not consistent over the age range. (Table 29.) No association was found between the acne rates and

the school evaluation regarding need for special

educational resources for the emotionally disturbed.

Sleep problems. —Youths who said they did

not walk in their sleep were more likely to have

facial acne than those who did. Similarly those

who said they never had nightmares were slight13
Iy more likely to have this condition than those

who had such bad dreams sometimes or often.

However, no association was evident in relation

to reported trouble sleeping, getting to sleep,

orlack of it. (Table 30.)

Elting habits. —While no information was

obtained in this survey among youths concerning their dietary intake of certain foods or the

lack of an adequately balanced diet (factors that

have been suggested as possibly contributing to

the exacerbation of acne lesions l“~ll) the medical history given did contain questions abut

the quantity of food eaten and the youth’s fussiness regarding food.

The amount eaten (as reported by the parent)

shows a significant relationship to the prevalence

of facial acne. There is a consistent decrease

in the prevalence rate for this skin condition

(facial acne) with the amount of food usually

eaten from 74.0 per 100 youths who are said to

eat too much to 62.9 per 100 among those who

eat too little. The acne rate among youths who

eat too much is significantly higher than among

those who eat either t~e right amount or too

little. (Table 31.)

Boys who eat too much are substantially

more likely to have facial acne than those who

80 r

GIRLS BoYS

WI white

Too Right Too Too Right Too

Much Amount Little Much Amount Little

AMOUNT YOUTH EATS - ACCOROING TO PARENT

Figure 15. Prevalence rates for facial acne on examination

among white and Negro boys and girls 12-17 years of age by

parents’ report on amount youths eat: United States, 1966-70,

60

[

GIRLS BOYS

Fussy FUSV FUSSY Fussy Fussy Fusiq

SELECTIVITY IN EATING - ACCOROING TO PARENT

Figure 16. Prevalence rates for grades II-IV swerity of facial

acne on examination among white and Negro boys and girls

12-17 years of age by parents’ report on youths selectivity in

eating: United States, 1966-70.

eat too little, while for girls the prevalence of

acne among those who eat too much is only

slightly greater than among those who eat the

right amount or too little.

This pattern of association is more consistent among white than Negro youths (figure 15)

and among those living in the Northeast and Midwest than those in the South and West. (Table 32.)

With respect to their degree of selectivity

or fussiness with food, facial acne is slightly

more prevalent among girls but not boys rated

as very fussy. This pattern is evident, but not

significant, among white and Negro girls but not

boys (figure 16 and table 31).

Relation to Physiological Development

Acne occurs so frequently among preadolescent and adolescent children as sometimes

to be regarded as physiological rather than pathological.10.12J3 While the pilosebaceous system

is probably conditioned by a genetic factor, 14115

endocrine changes occurring around the time of

puberty also apparently contribute to the production of acne. 14@19 Evidence of the stage of

physiological maturation available from the examination will be considered in relation to the

presence of acne among these youths.

14
Three findings from the physical examination

given by the physician are available for the generation of an index of sexual maturation among

boys and girls: stage of female breast maturation,

the stage of male genital maturation, and the

stage of pubic hair maturation in boys, and girls.

The examining physician graded each in five

stages using Tanner’s Criteria. 20 The index

derived for boys is one-third the sum of the

stage of pubic hair maturation plus twice the

stage of male genital maturation. For girls the

index is one-third the sum of right and left breast

maturation plus the stage of pubic hair development. The resultant index of sexual maturity

ranged from one to five, with the value of one

indicating little or no development of secondary

sex characteristics, and a value of five indicating

full development of secondary sex characteristics.

As in other measures of biological age, maturation, as measured by the development of

secondary sex characteristics, on the average,

starts more slowly or later in males than females. 21 At age 12 years, more than one-third

(37 percent) of the boys show little or no development of secondary sex characteristics (index

stage 1) compared with only 11 percent of the

girls. By age 17 years, however, almost 90 percent of boys were fully mature sexually while

only two-thirds of the girls had progressed to

stage 5 maturity (table 33).

I II Ill w v

STAGE OF MATURATION

Figure 17. Prevalence rates for mild (grade 1) and moderatesevere (grades II-IV) facial acne “& examination among

youths 12-17 years by stage of development of secondary

sex characteristics: United States, 1966-70.

The prevalence of facial acne increases with

the degree of development of secondary sex

characteristics among both boys and girls at

ages 12-15 years and for boys continues to age

16 years. However, within the same stages of

maturity, there is a fairly consistent linear association (increase) with age in the prevalence

of acne except at the extremes of maturity-those

with little or no evidence of sexual development

and those who are apparently sexually mature

(stages 1 and 5). Among youths who have apparently reached sexual maturity the prevalence

rates for facial acne show no age-related trend

among either boys or girls.

The prevalence of facial acne tends to be

greater among girls than boys who are in the

least advanced stages of sexual maturi~ (stages

1 and 2). However, there is a reversal in this

pattern among those who are at or close to maturity (stages 4 and 5) where the acne rate among

boys exceeds that among girls.

The pattern of association of the prevalence

of facial acne to the stage of development of

secondary sex characteristics is similar among

white and Negro youths (table 34).

As shown in figure 17, the severity of facial

acne tended to increase with the degree of development of secondary sex characteristics. The

proportion of youths with acne whose condition

was graded as moderate to severe increased

steadily from 4 percent among those showing

little or no development (index stage 1) to 52

percent among those fully developed (index stage

5). Only in part is this increase age-related.

One further indicator of physiological maturation available that has been suggested as

possibly being related to the development or

exacerbation of acne 12 is the onset of menarche

among girls, as reported to the nurse during

the examination. Acne tends to start after menarche among girls for whom the onset of menarche is before 13 years of age. The extent of

delay in the development of acne in these girls

decreases from a median delay of over 1 year

among those with menarche starting before age

10 to a median delay of about 4 months for those

starting during age 12 years (table 35). However,

among the one-third of the girls whose onset

of menarche is later—age 14-16 years-the

onset of acne generally precedes menarche, with

15
the median time lapse increasing from 4 months

for those starting during age 14 years to over

1 year among those starting during age 16 years.

Hence, the age at which acne starts among girls

would appear to be relatively independent of the

age of onset of menarche.

COMPARISON WITH

OTHER STUDIES

Previous estimates of the incidence or prevalence of skin conditions among youths are mainly

limited to acne and are based primarily on

findings from studies among groups of patients

treated in clinics, physicians’ offices, or hospitals. The criteria used apparently differ and the

basic data from the studies are not readily available for detailed comparison.

Nelson 10 indicates that 85 percent of preadolescent and adolescent children exhibit some

manifestation of plugging of sebaceous glands.

Estimates in Lowry 22 indicate that acne is present to some degree in 75-90 percent of children

before 18 years of age. These previous findings

are not inconsistent with those from the present

cross-sectional study for the U.S. youths which

show a facial acne prevalence rate of 86 per 100

youths at 17 years of age.

Ebling and Rook 12have previously estimated

that papules and pustules are present in 30-50

percent of children at the ages of peak incidence,

14-17 in girls and 16-19 in boys. On the basis of

the findings from the present national study, the

previous estimates for boys are lower and those

for girls somewhat higher than actual. Among

U.S. boys the prevalence of acne grades II-IV at

16 and 17 years has reached rates of 51 and 57

per 100, respectively, and shows no leveling off

within the age range in this study. For U.S. girls

the prevalence of moderate-severe acne ranges

from 24-32 percent at ages 14-17 years and does

appear to have reached a maximum value within

this range.

In the present national study there is some

indication of regional differences in total prevalence and in severity of acne, though the patterns are not statistically

sample too small to make

sessment of any specific

16

significant and the

possible the asarea differences

which previous investigators have indicated

may exist. 23-26

P173W&?tICf2 estimates for chronic Skin conditions among the civilian noninstitutionalized

population of the United States, based on findings

from the Health Interview Survey in 1969, have

also been published. 27 These skin conditions

were identified in response to the question:

“During the past 12 months did anyone in the

family have any of these conditions?-A tumor,

cyst or growth of the skin, eczema or psoriasis,

trouble with dry or itching skin, trouble with

acne, a skin ulcer, any kind of skin allergy,

dermatitis, or any other skin trouble?”

Prevalence rates for skin conditions from

both surveys are shown in table B, together with

crude estimates for the prevalence of acne for

the 12-16 year old group from the Health Interview Survey. These latter estimates were made

assuming that the reported age of onset for acne

from the Health Examination Survey history

which showed about 16 percent as having the age

of onset of acne below the age of 12 years would

apply among that group also.

Some differences in the prevalence rates

for skin conditions among youths as obtained in

the Health Interview and Health Examination

Surveys would be expected. Acne was reported

in the Interview Survey in response to the question of “trouble with acne” while the Examination

Survey was intended to identify all acne. On this

basis it might be expected that the interview

responses would be more likely to correspond to

the conditions graded as moderate-severe in the

examination. The medical history from the Examination Survey further shows that only 51 percent of youths with acne (all grades combined)

and 56 percent of those with moderate-severe

acne were bothered some or a lot by their acne

condition. If this further restriction was applied

to the prevalence rate for moderate-severe acne

from the Examination Survey among the 12-16

year olds a rate of 11.8 per 100 or more than

double the estimated rate of 5.3 per 100 would

have been expected from the Interview Survey.

The higher prevalence rates for the grouping including eczema and dermatitis from the

Interview than the Examination Survey would be

expected because the interview question asked

about conditions existing at any time during the
Table B. Prevalence rates for selected skin conditions among noninstitutionalized

chtldren and youths in the United States from the Health Ihtervi.ew Survey of 1969

and the Health Examination Survey of 1966-70

Condition

Any skin condition --------------

Acne ----------------------------------

Acne, Grades Xl-1??--------------------

Eczema, dermatitis and the like -------

Corns and callosities -----------------

Chronic infections of skin and fungal

conditions ---------------------------

Psoriasis and similar rashes ----------

Hypertropic and atropic diseases ------

.

(In the past 12 months) @t&e~;e::t;he

Health Interview Survey, 1969 Examins_;_7mwey,

Under 17

years

Estimates for 12-17 Estimates for

12-16 years years 12-16 years

Rate per 100

6.4 ! 10.9

1.7

2.;

0.1

0.3

0.2

0.5

5.3

3

0.1

0.3

0.2

0.5

,!Includes acute as well as chronic infections.

~Excludes scars and corns.

No estimate attempted.

preceding 12 months and included a younger age

group more subject to these, while the examination identified such conditions present at the

time of examination and only if they interfered

with normal growth and development. It is also

possible that some of the cases identified as

acne in the 13xamination Survey would have been

reported by the parent as eczemaor dermatitis

in the Interview Survey.

SUMMARY

This report presents national estimates of

the prevalence of facial acne and other skin

lesions among noninstitutionalized youths aged

12-17 yearsby age, race, sex,geographic region,

population size of place of residence, family

income, education of parent, overall health, indications of stress, selected health habits, and

physiological development. The estimates are

based on findings from the Health Examination

Survey of 1966-70.

72.3 I 57.7

I

68.1

28.3

0.9

0.1

11.5

0.3

21.0

53.9

2:.;

0:1

11.5

~o.3

1.0

For this survey, a probability sample of

7,514 youths was selected to represent thenearly

23 million noninstitutionalized youths12-17years

of age in this country at midsurvey point. Of

these, 6,768(90 percent) were examined. The

examined group were closely representative of

the target population from which the sample was

drawn with respect to age, sex, race, geographic

region, population size of place ofresidenqe, and

rate of change insize of place ofresidence from

1950 to1960.

Major findings from this part of the examination include:

● Facial acne (allgrades combined)is about

as prevalent among girls as boys in the

12-17 year age range. However, such conditions start somewhat earlier and tend

to be less severe in girls than boys.

● Nonacne skin conditions which affect normal growth and development are less

prevalent in girls than boys but showno

trend with age.
● A high level of agreement (88 percent) was

found between youths’ report of acne and

the physician’s findings of facial acne on

examination.

● Among youths reporting they had acne,

more than half (51 percent) were kmhered

some or a lot by the condition and (58

percent) were using some treatment for

it but only 11 percent had seen a doctor

about it.

● White youths are slightly more likely

than Negro youths to have moderate to

severe facial acne but less likely to have

mild conditions limited to comedones with

little or no inflammatory reaction. Nonacne skin conditions are more prevalent

among Negro than white youths.

● Facial acne is somewhat more prevalent

among youths living in the South and West

than those in the Northeast or Midwest.

However, no consistent urban-rural differences in prevalence rates were found.

● Some direct or indirect association is

evident between acne prevalence in youths

and the education of their parents but not

their family incbme level. The acne prevalence rates decrease consistently with

increasing education level of parents.

● Facial acne is slightly more prevalent

among youths whose health was rated

fair-poor than among those considered

in good-excellent health by either themselves or their parents.

● Facial acne prevalence increases with the

degree of nervousness of the youth, the

association being stronger and more consistent when based on the youth’s own rating of nervousness than that given by his

or her parent.

● The amount of food eaten particularly

among boys appears to be related, directly

or indirectly, to the prevalence of facial

acne. Acne rates are higher among those

who are said, by their parents, to eat tob

much than those who eat too little.

● The prevalence and severity of facial acne

increases with the degree of development

of secondary sex characteristics among

boys 12-16 years and girls 12-15 years

of age.

●Among girls acne tends to start after the

onset of menarche for girls who reach

this stage of physiological development

before 13 years of age but to precede this

point of development for those whose menarche onset is 14 years or later.

000

18
1National Center for Health Statistics: C)righ, program,

and operation of the U.S. National Survey. Vital and Health

Statistics, PHS Pub. No, 1000-Series l-No. 1. Public Health

Scrvke. Washington. U.S. Government Printing Office, Aug.

1963.

2Natiomd Center for Health Statistics: Phin and initial

program of the Health Examination Survey. Vital and Health

Statistics. PHS pub. No. 1000-Series l-No. 4. Public Health

Service. Washington. U.S. Government Printing Office, Jtdy

1965.

3National Center for Health Statistics: Cycle I of the

Health Examination Survey, sample and response, United

States, 1960-62. Vital and Health Statistics. PHS pub. No.

1000 -Swics 1l-No. 1. Public Health Service. Washington. U.S..

Government Printing Office, Apr. 1964.

4N~tional Center for Health Statistics: Plan, operation

and respcmsc results of a program of children’s examinations.

t’ital and Heulth Statistics. PHS pub. No. 1000-Series l-No. 5.

Public Health Service. Washington. U.S. Government Printing

Office, Oct. 1967.

5National Center fcu Health Statistics: Sample design and

estimation procedures for a National Health Examination of

children, ~~ital and Health Statistics. PHS Pub. No. 1000-Series

2-No. 43, Public Health Service. Washington, U.S. Government

Printing Office, Aug. 1971.

6National Center for Health Statistics: Plan and operation

of a Health Examination Survey of U.S. youths 12-17 years of

age. Vital tmd Health Statistics. PHS Pub. No. 1000-Series

1-No. 8, public Health Service. Washington. U.S. Government

Printing Office, Sept. 1969.

7Natiomd Center for Health Statistics: Examination and

health history findings among children and youths, 6-17 years,

United States. Vital and Health Statistics. PHS. pub. No.

1000-Series 11-No. 129. Public Health Service. Washington.

U.S. Government Printing Office, Nov. 1973.

8pillsbury, D, M., Shelley, W. B., and I@rnan, A. M.:

Dermutolo~. Philadelphia. W. B. Saunders Company, 1961.

9Nation~ ~nter for Health Statistics: Eighth Revision

International Classification of Diseaws, Adapted for Use in the

Crnited st~te~. pHS pub. No. 1693. ~blic He&h se~ce.

Washington. U.S. Government Printing Office, 1967.

10Nelson, W. E. (Ed.): Textbook of Pediatrics. 8th Edition.

Philadelphia. W. B. Saunders Co., 1964.

11 Rcisner, R, M,: Acne vulgaris. Symposium of Ado&scent.

Alcdicine, The Pediatric Clinics of North America. 20(4):851-

864. Nov. 1973. (W. B. Saunders Co., Philadelphia.)

12 Ebling, F. J. G., and Rook, A,: The Sebaceous Gland.

Textbook of Dermatology. Chapter 54. Vol. II, 2d edition. Ed.

Arthur Rook, D. S, Wdkinson, and F. J. G, Ebling. oxford.

Blackwell Scientific publications, 1972. pp. 1545-53.

13 Fireinkel, R. K.: Medicd irdhgence - current concepts,

pathogenesis of acne vnlgaris. N Engl ] Med. 280(21):1161-3,

May 22,1969.

14 H~ilton, J, B.: Male hormone substance; prime factor

in acne. J Clin Endom”nol Metab. 1:570-592, Jtdy 1941.

15 Niermmn, H.: z. math. Verer&. - ~. ~o~tit.~efire,

34:483,1958.

16~ok, T. J., and Lorincz, A. L.: Absence of steriod acne

in children. A clinical study. Arch Dermato~. (Chicago).

89:442-5, Mm. 1964.

17 Gartmann, H.: Die Schambehaarnng bei Akne vrdgaris.

(Pubic hair in acne vulgaris). .Zschr. Haut and Geschikr.

18(10 ,285-294, May 1955.

k

1 Hamilton, J. B., and Mestler, G. E.: Effects of

orchiectomy and oophorectomy upon existent potential acne.

J Invest Dermatol. 41:249-53, Nov. 1963.

19 Hmilton, J. B-, Terada, Ha, ad Mestl~, G. E.: (&eater

tendency to acne in white American than Japanese populations. J Clin Endom”nol. 24:267-272,1964.

20 Tanner, J. M.: Growth at Adolescence 2nd. ed. oxford.

Blac!iwefl Scientific Publications, 1962.

21 National Center for Health Statistics: Skeletal maturity

of children 6-11 years, United States. Vital and Health Statistics. PHS Pub. No. 1000-Series 1l-No. 140. public Health Service. Washington. U.S. Government Printing Office, Nov. 1974.

22 ~W, G. H.: Growth and Development of ChiHren,

6th ed. Chi&go. Year Book Medical Publishers, Inc., 1973.

23 Am~n, W.: Statistics on the incidence of acne vdgtis

in 2,523 men at age 21. Z. Haut Geschlechtskr. 30:124-9, Feb.

1961.

24 Bloch, B.: Metabokjm, endocrine glands and SkiSIdiseases with special reference to acne vulgar% and xanthoma. Br -7

Dermatol. 43:61-87, Feb. 1931.

25Cohen, E. L.: Incidence and loc&xation o~ acne. Br -1

Dermato~, 57:10-14, Jan.-Feb., 1945.

26Hinrichsen, J. and Ivy, A. C.: Incidence in Chicago region of acne wtdgaris. Arch Derrnatol and Syph. 37:975-982,

June, 1938.

27 Nation~ Center for He~th Statistics: prevalence and

chronic skin and musculoskeletal conditions, United States,

1969. Vital and Health Statistics. Series 1O-NO. 92. DHEW Pub.

No. (HRA) 75-1519. Health Resources Administration. Washington. U.S. Government Priiting Office, Aug. 1974.

Z8Nation~ Center for Health Statistics: Quality control in

a Natiomd Health Examination Survey. Vital and Health Statistics. Series 2-No. 44. DHEW Pub. No.(HRA) 74-1023. Health

Resources Adminktration. Washington. U.S. Government Printing Office, Aug. 1973.

29 National Center for Health Statistics: Replication: An

approach to the analysis of data from complex surveys. Vital

and Health Statistics. PHS Pub. No. 1000-Series 2-No. 14.

Public Heakh Service. Washington. U.S. Government Printing

Office, Apr. 1966.

1?
LIST OF DETAILED TABLES

Table 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

Number and percent of youths with examinationfindingsof normal skin, acne, or

other skin lesions,by age and sex, with standarderrors for totals: United

States, 1966-70-----------------------------------------------------------------

Prevalencerates for facial acne at examinationamong youths, by grade of severity, age, and sex, with standarderrors: United States, 1966-70-----------------

Prevalencerates for nonacne skin lesions at examinationamong youths age 12-17

years by type of conditionand sex,with standarderrors:UnitedStates, 1966-70--

Percent of youths age 12-17 years reporting having acne by examinationfindings

of grade of acne and sex: United States, 1966-70--------------------------------

Percent of youths reportinghaving acne, by age of onset of acne, sex, and age

on examination,with standarderrors for totals: United States, 1966-70---------

Prevalencerates for skin lesions (all types combined),facial acne, and nonacne

skin lesions at examinationamong white and Negro youths, by age and sex, with

standarderrors: United States, 1966-70-----------------------------------------

Prevalencerates for facial acne at examinationamong white and Negro youths, by

grade of acne, age, and sex, with standarderrors for totals: United States,

1966-70-------------------------------------------------------------------------

Prevalencerates for facial acne at examinationamong youths age 12-17 years, by

grade of acne, race, end sex, with standarderrors: United States, 1966-70------

Prevalencerates for facial acne at examinationamong youths, by geographic region, age, and sex, with standarderrors: United States, 1966=70----------------

Prevalencerates for gradationsof facial acne end for nonacne skin lesions at

examination among youths age 12-17 years, by geographicregion and sex, with

standarderrors: United States, 1966-70-----------------------------------------

Observed and expected prevalence

facial acne,

rates for all facial acne, moderate-severe

and nonacne skin lesionsat examinationamong white and Negro youths

age 12-17 years, by geographic region and sex, with standard errors: United

States, 1966-70-----------------------------------------------------------------

Prevalencerates for facial acne at examinationamong youths? by populationsize

of place of residence,age,and sex,withstandarderrors:United States, 1966-70--

Observed and expected prevalencerates for facial acne at examination among

youths age 12-17 years, by grade of severity and population size of place of

residence,with standarderrors: United States, 1966-70-------------------------

Obsemed and expected prevalencerates for moderate-severefacial acne at exmnination among youths age 12-17 years in urbanized,nonurbanized,and rural areas,

by geographicregion and race, with standarderrors: United States, 1966-70-----

Prevalence rates for facial acne and for nonacne

among white

skin lesions at examination

and Negro youths age 12-17 years, by population size of place of

residence and sex, with standarderrors: United States, 1966-70-----------------

Prevalencerates for facial acne at examinationamong youths, by annual family

income, age, and sex, with standarderrors:United States, 1966-70--------------

Prevalencerates for gradationsof facial acne and for nonacne skin lesions

at examination among youths age 12-17 years, by annual family income and sex,

with standarderrors: United States, 1966-70------------------------------------

Prevalencerates for facial acne and nonacne skin lesions at examinationamong

white and Negro youths age 12-17 years, by annual family income and sex, with

standarderrors: United States, 1966-70-----------------------------------------

Page

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

x!
LIST OF DETAILEDTABLES-Con.

Table 19.

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

Prevalencerates for facial acne at examinationamong youths, by educationof

parent (head of household),and age and sex of youth,withstandarderrors: United

states, 1966-70-----------------------------------------------------------------

prevalencerates for all facial acne and moderate-severefacial acne at examinationamong youths age 12-17 years, by years of formal schooling comple~ndJ~

parent (head of household) and race of youth, with standard errors:

States, 1966-70-----------------------------------------------------------------

prevalencerates for faci~l acne at examination among youths by youths’ and

parents’ rating of youths present health, end by age and sex of youth, with

standarderrors: United States, 1966-70-----------------------------------------

Prevalencerates for all facial acne and moderate-severefacial acne at examination among white and Negro youths age 12-17 years by youths’ and parents’rating

of youths’ presenthealth, and by sex of youth, with standard errors: United

States, 1966-70------------------------------------------------------ -----------

Prevalencerates for facial acne at examinationamong youths age 12-17 years by

youths‘ and parents’rating of youths’ present health, and by geographicregion

and sex of youth, with standarderrors: United States, 1966-70------------------

Prevalencerates for facial acne at examinationamong youths age 12-17 years by

presence or absence of allergies,and by type of allergy, age, and sex, with

standarderrors: United States, 1966-70-----------------------------------------

Prevalence rates for facial acne among youths takingmedication regularly for

skin or other disorder and those not takingmedication by their parents’ statement regarding medication, and by age and sex of youth, with standarderrors:

United States, 1966-70----------------------------------------------------------

Prevalence rates for facial acne at examination among youths by youths’ and

parents’rating of youths’ degree of nervousness, and by age and sex of youth,

with standarderrors: United States, 1966-70------------------------------------

Prevalencerates for,facialacne at examination among youths age 12-17 years by

youths’ and parents rating of youths’ degree of nervousness,and by race and

sex of youth, with standarderrors: United States, 1966-70----------------------

Prevalencerates for facial acne at examinationamong youths age 12-17 years, by

youths’ own rating of degree of nervousnessand geographicregion, with standard

errors: United States, 1966-70--------------------------------------------------

Prevalencerates for facial acne at examinationamong youths by teachers’ratin s

of youths’ adjustmentin school and need ‘ofspecialresources for the emotionalfy

disturbed,age, and sex, with standarderrors: United States, 1966-70-----------

Prevalence rates for facial acne (all grades) at examination among youths age

12-17 years by youths’ report of problemswith sleep, and by race and sex of

youth, with standarderrors: United States, 1966-70-----------------------------

Prevalencerates for facial,acneat examinationamong youths age 12-17 years, by

eating habits of youths (as reported by parents),race, and sex, with standard

errors: United States, 1966-70--------------------------------------------------

Prevalencerates for facial acne at examinationamong youths age 12-17 years, by

eating habits of youths (as reported by parents),geographic region, and sex,

with standarderrors: United States, 1966-70------------------------------------

Prevalencerates for facial acne at examinationamong youths, by age, sex, and

index-stage of sexual maturity,with percent distribution of index-stage of

sexual maturity at each year of age, and with standard errors: United States,

1966-70-------------------------------------------------------------------------

Prevalencerates for facial acne and expected rates among white and Negro youths

age 12-17 years, by index-stageof sexualmaturity and seqwith standarderrors:

United States, 1966-70----------------------------------------------------------

Percent distributionof age at onset of menarche by age at which acne started

among girls age 12-17 years, with standardetrors: United States, 1966-70-------

Page

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

21
skin, acne, or other

States, 1966-70

Table 1. Number and percent of youths with examination findings of normal

standard errors for totals: United

skin lesions, by age and sex, with

Type of skin problem

I I I I I I I Total _L_L Total Total

All with with

youths nc.k.:l ~Y

skin

lesions

Total Total

with with

body other

acne %X%

.

N::;:.. Fac.sl F::l ~cne

.-———

Body

Facial Body All with

three facial

acne acne lesions body ad and condi- acne

only only only acne other other

lesions lesiOns tions

Age and sex

Both sexes

12-17 years------

Percent of youths

72.3

—

46.8

61.1

74.3

B2.6

84.5

88.5

71.2

35.7

54.8

75.2

83.5

90.8

92.9

73.4

58.3

33.1

:;.;

:3::

73;5

55.2

20.5

39.7

56.6

67.6

75.6

76.8

61.3

0.1

o.;

0.1

0.0

.

o.;

0.1

T

4.1 0.5

0.1

;::

4.5 0.;

0.7

::?

1.8 t :

9.2 0,0

—

o. i

0.0

o.;

+ -l—0.7 13.4

12 years---------------

13 years---------------

14 years---------------

15 years---------------

16 years---------------

17 years---------------

100.0

100.0

100.0

100.0

100.0

100.0

53.2

38.9

25.7

17.4

15.5

11.5

:::

1%;

10.7

11.5

39.0

56.0

69.8

0.i 79.1

0.3 82.5

0.5 86.4

0.1 13.6

13.4

0.i 1302

0.8 14.3

1.5 12.7

1.7 13.8

Boys

—

12-17 years------ T

4.8 0.6

10.2 -

6.4

5.2 0.;

N !?:$

1.2 1.6

10.4

-

12 years---------------

13 years---------------

14 years---------------

15 years---------------

16 years---------------

17 years---------------

100.0 64.3

100.0 ;;.;

100.0

100.0 16:5

100.0 9.2

100.0 7.1

5.0

1::;

12.1

12.1

12.2

25.5

48,4

70.0

0.i 80.3

0.5 89.4

0.6 91.2

15.2

. 15.1

17.9

8:z 15.5

1.7 14.0

2.7 14.0

12-17 years------ T

3.5 0.4

5.3 0.2

3.8

3.7 0.:

3.9 0.9

2.0 0.8

2.3 0.4

8.0

52.S

63.8

69.6

77.8

75.6

0.1 81.7

12 years---------------

13 years---------------

14 years---------------

15 years---------------

16 years---------------

17 years---------------

100.0 41.9

100.0 32.4

100.0 26.7

100.0 18.3

100.0 21.9

100.0 16.0

58.1

67.6

73.3

81.7

78.1

84.0

::.;

64;8

67.6

65.5

70.1

0.2 11.8

11.7

0.i

0.9 $:

1.3

0.8 13:5

0. i

Standard error of percentages

1.88

1.81

2.14

Both sexes, 12-17

years-----------------

Boys, 12-17 yeazs------

Girls, 12-17 years-----

...

II 1.75 1.75 1.53

... 1.72 1.72 1.47

... 1.99 1.99 1.83

0.04 0.3s 0.16 0.82

0.04 0.45 0.20 0.87

0.07 0.50 0.15 0.92

0.05

0.08

0.04

32

0,22 0.98

0.26 1.12

0.20 1.00

Both sexes Number in thousands

10

m

942 115 2,089

312 3 230

202 329

172 337

131 x 401

; 62 36 388

3 63 35 404

12-17 yeare------ ----1 22,692 6,280 I 16,406 ( 13,221

I I

15,457 1601 3,066

w

12 years---------------

13 years---------------

14 years---------------

15 years---------------

16 years---------------

17 years---------------

1,559

2,212

2,689

2,966

2,994

3,037

3 542

531

1; 509

535

:: 461

59 488

22
Table 2. Prevalence rates

severity, age, and

for facial acne at

sex, with standard

examination among youths, by grade of

errors: United States, 1966-70

Age and sex

12

13

14

15

16

17

12

13

14

15

16

17

12

13

14

15

16

17

Both sexes

12-17 years--------------------

years-----------------------------

years-----------------------------

years--------------------..--------

years-----------------------------

years-----------------------------

years-----------------------------

Boys

12-17 years--------------------

years-----------------------------

years-----------------------------

years-----------------------------

years-----------------------------

years-----------------------------

years-----------------------------

Girls

12-17 years--------------------

years-----------------------------

years-----------------------------

years-----------------------------

years-----------------------------

years-----------------------------

years-----------------------------

Severity grade of

facial acne

Rate per 100 youths

39.8

31.3

39.3

42.4

42.1

42.6

42.0

33.8

22.3

33.5

38.9

36.4

37.8

34.5

~

40.6

45.3

&5.9

48.0

47.5

49.6

25.7

7.6

16.1

25.7

33.0

36.4

38.1

29.0

3.2

14.3

29.3

39.3

46.2

46.0

22.3

12.2

18.0

22.0

26.5

26.4

30.2

2.4

0.5

1.7

3.8

3.2

6.0

3.4

0.6

1.7

4.6

4.6

10.2

1.4

0.5

1.6

2.9

1.7

1.7

0.2

0.1

0.2

0.3

0.6

0.3

0.1

0.7

1.1

0.1

0.1

0.4

0.1

Severity grade of

facial acne

~

1.20

Standard error

2.00

1.69

1.69

1.91

2.08

1.95

1.52

2.18

2.29

2.72

3.20

2.78

2.45

1.30

2.60

2.58

1.66

1.72

2.66

2.55

1.70

0.99

2.21

1.75

2.63

2.76

2.43

1.97

0.99

2.61

2.39

3.87

3.38

3.36

1.66

1.68

2.21

2.14

2.21

2.86

2.92

0.36

0.36

0.47

0.75

0.52

1.24

0.41

0.28

0.63

0.91

0.64

1.84

0.36

0.53

0.50

1.03

0.73

0.84

0.04

0.07

0.15

0.17

0.25

0.07

0.10

0.33

0.46

0.05

0.10

0.31

0.14

23
Table 3. Prevalence rates for nonacne skin lesions at examination among youths age 12-17

years by type of condition and sex, with standard errors: United Statea, 1966-70

Type of condition E

Rate per 100 youths

Both

sexes IIBoys Girls

II I

Standard error

0.30

—

0.12

0.17

0.07

0.03

0.13

0.37

-

0.19

0.18

0.11

0.03

0.19

0.06

0.14

0.02

0.77

0.33

0.12

0.21

0.12

0.05

0.15

0.07

0.15

0.53

0.50

:.::

0:18

0.18

0.18

2.12 2.29 1.93 —

0.44

1.06

0.32

0.11

0.80

Tumors, growths, and birthmarks---------------

Caf&au lait spots--------------------------------

Nevi----------------------------------------------

Hemangioma----------------------------------------

Other t~ors~ growths> etc------------------------

Allergic and nutritional disorders------------

0.57

1.34

0.32

0.06

1.02

0.14

0.86

0.02

7.96

0.51

1.20

0.32

0;09

0.92

Poison ivy, oak, or sumac-------------------------

Allergic reaction, eczema, contact dermatitis

(except plant)-----------------------------------

Other allergic or nutritional---------------------

Hypertropic or atropic skin conditions--------

0.15

0.76

0.01

7.02

5.91

0.05

0.23

0.62

0.21

0.72

0.15

0.65

6.05

0.05

0.11

0.01

0.53

Scars---------------------------------------------

Corns and callosities-----------------------------

Icthyoais, keratosis Polaris----------------------

Dry skin, asteatosis------------------------------

Other hypertropic or atropic----------------------

Abrasions, burns, and other results of

accidenta or violence------------------------

7.09

0.04

0.25

0.46

0.12

0.92

4.70

0.06

0.21

0.78

0.30

0.50

0.49

0.03

0.12

0.14

0.11

0.12

0.09

0.04

0.04

0.02

0.24

0.68

0.04

0.16

0.12

0.06

0.25

Abrasions, lacerations, bruises, ecchymoses,

andjor hematoma----------------------------------

Animal or insect bites----------------------------

Burns---------------------------------------------

Other results of accident or violence-------------

Infective, fungal, or viral skin disease------

0.51

0.09

0.10

0.02

1.60

0.62

0.07

0.19

0.04

1.87

0.39

0.11

1.31

0.17

0.04

0.08

0.04

0.23

0.17

0.07

0.25

Impetigo------------------------------------------

Herpes simplex------------------------------------

Other herpes--------------------------------------

Plantar’s wart------------------------------------

Other warts---------------------------------------

Boils and carbuncles------------------------------

Athlete’s foot------------------------------------

Tinea corpus-ringworm-----------------------------

Tinea versicolor-pityriasis-----------------------

All other infective or fungal---------------------

Other skin, hair, or nail disorders-----------

0.06

0.13

0.03

0.09

0.60

0.05

0.21

0.07

0.12

0.24

2.11

0.09

0.13

0.04

0.07

0.62

0.06

0.33

0.11

0.17

0.25

2.41

0.02

0.13

0.01

0.11

0.58

0.04

0.09

0.02

0.07

0.24

1.81

0.03

0.03

0.01

0.04

0.14

0.02

0.07

0.03

0.06

0.06

0.26

0.05

0.05

0.03

0.05

0.18

0.05

0.12

0.05

0.10

0.05

0.51

0.02

0.05

0.02

0.05

0.20

0.03

0.05

0.03

0.04

0.10

0.38

Neurodermatitis and ‘rashes’----------------------

Seborrheic dermatitis-----------------------------

Paoriaais-----------------------------------------

Other maculo-papular scaly lesions----------------

Vitiligo------------------------------------------

Other disorders resulting in changes in

pigmentation-------------------------------------

Ingrown toenails----------------------------------

All other-----------------------------------------

0.43

0.10

0.07

0.25

0.14

0.93

0.07

0.42

0.21

0.10

0.12

0.09

0.30

0.58

0.12

0.29

0.08

0.03

0.04

0.06

0.07

0.17

0.04

0.08

0.14

0.05

0.04

0.10

0.06

0.23

0.04

0.12

0.08

0.08

0.06

0.05

0.11

0.14

0.06

0.10

0.32

0.10

0.09

0.17

0.22

0.76

0.09

0.36

24
Table 4. Percent of youths age 12-17 years reporting having acne by examination findings of grade of acne and sex: United States, 1966-70

Health history from

youth and sex

Both sexes ---------------------

Boys-----------------q---------

Girls--------------------------

Both sexes

12-17 years--------------

Have acne----------------------

Do not have acne---------------

Did not answer-----------------

Boys

12-i7 years----------------

Have acne----------------------

Do not have acne---------------

Did not answer-----------------

Girls

12-17 years----------------

Have acne----------------------

Do not have acne---------------

Did not answer-----------------

Examination findings

All

youths No Grade Grade Grade Grade Not

acne examinedl

Percent of youths

Eil :: i: 1: ‘i: ;3 :

100.0

49.1

50.7

0.2

100.0

49,7

50.1

0.2

100.0

48.5

51.3

0.2

100.0

18.7

80.8

0.5

100.0

17.9

81.6

0.5

100.0

19.7

79.8

0.5

Percent distribution

100.OI1OO.OI 100.0

50.4 79.8 93.8

49.3 20.1 4.9

0.3 0.1 1.3

100.0 \ 100.0 ] 100.0

49.4 80.4 95.7

50.3 19.4 3.3

-1---L 0.3 0.2 1.0

100.0 100.0 100.0

51.1 78.9 89.0

48.6 21.0 9.0

0.3 0.1 2.0

I I

100.0

100.0

100.0

100.0

100.0

100.0

100.0

76.9

23.1

100.0

70.1

29.9

100.0

*

*

*

~No estimate was made of the gradeofacne for the7boys whose skin was not examined.

Rather ithas been assumed that the distributionofthese findings among them is similar

to that among those boys who were given this part of the examination.

25
of onset of acne, sex,

United States,1966-70

Table 5. Percentof youths reportinghavingacne, by age and age on examination,with

standarderrors for totala:

Age acne startedl

Total

Under 10 11 12 13 14 15 16 17

10 years years years years years years years years years

.fedianage

in yeara

13.3

11.7

12.5

13.3

13.7

14.1

14.3

13.7

11.9

12.7

13.4

14.0

14.4

14.6

12,9

Age and sex

Both sexes Percent of youths

12-17 years----

yeers-------------

years-------------

years-------------

yeara-------------

yeara-------------

years-------------

~

12-17 yeara------

yeara-------------

years-------------

years-------------

yeara-------------

years-------------

years-------------

Girls

12-17 yeara------

years-------------

yeare-------------

years-------------

yeara-------------

years-------------

yeara-------------

23.8

33.5

50.1

25.0

17.8

15.3

11.6

19.8

100.0 10.9 28.4

-

25.2

50.1

33.0

27.1

23.5

29.4

19.6 2.6

-

2.9

10.7

3.3

0.5

-

2.7

0.7

— 1.8 3.8 8.6

12

13

14

15

16

17

12

13

14

15

16

17

12

13

14

15

16

17

100.0

100.0

100.0

100.0

100.0

100.0

100.0

-

100.0

100.0

100.0

100.0

100.0

100.0

100.0

4.2

1.5

1.9

1.3

1.7

1.3

1.4

6.8

0.3

1.3

0.6

1.3

1.2

2.2

15.5

5.3

2.5

2.0

1.2

1.7

2.3

46.8

17.9

7.2

3.6

2.5

4.5

5.9

13.3

34.4

31.2

25.3

25.2

7.9

18.1

18.7

12.0

12.2

3.1

2.0

1.1

0.9

0.9

5.4

33.9

11.9

4.3

1.3

0.7

3.4

16.1

47.1

49.7

21.4

12.7

10.5

6.9

28.1

-

35.0

53.7

34.2

21.3

19.8

27.5

17.3

39.9

39.5

27.4

13.7

10.2

22.7

23.8

5.0

.

.

3.1

13.0

1.8

3.6

0.2

100.0

100.0

100:0

100.0

100.0

100.0

2.7

2.4

2.5

2.0

2.3

1.4

17.4

7.0

2.9

3.’1

1.6

2.6

54.0

22.6

10.3

6.2

5.1

5.8

25.9

50.4

28.9

23.5

22.1

17.4

-

2.7

7.8

0.28

0.49

0.40

11,5

12,3

13.1

13.5

13.5

13.8

17.6

46.4

31.7

35.6

28.2

9.0

28.3

19.0

23.1

5.2

11.6

12.3 1.4

0.14

0.20

0.14

Standarderror

Both sexes, 12-17

yeara---------------

Boya, 12-17 years----

Girls, 12-17 yeare---

0.61

0.60

0.90

0.61

0.88

1.17

0.83

1.03

1.29 -1- 0.85 0.55

1.13 0.98

0.87 0.45 ilLEl_x

lAge at last birthday.

26
Table 6. Prevalencerates for skin lesions (all types combined), facialacne, and nonacne akin lesionsat

examinationamong white and Negro youths,by age and sex, with standarderrors:United States,1966-70

Total with

any skin

lesions

ElzE’

Type of skin problem

t

Age and sex Facial acne I

Nonacne

lesions

I I

White Negro White Negro White Negro

1

White Negro White Negro

Both aexea

12-17 years---

years------------

yeara------------

years------------

years------------

years------------

years------------

I&?&

12-17 yeara-----

years------------

years------------,

years------------

years------------

years------------

yeara------------,

Girls

12-17 yeara------

years-------------

years-------------

years-------------

years-------------

years-------------

yeara-------------

Rate per 100 youths Standarderror

1.03

-

1.30

1.81

1.10

1.19

1.75

1.73

1.08

2.15

2.10

1.57

1.83

2.03

2.41

1.12

65.5

38.4

54.1

67.4

79.6

7’8.1

81.7

61.8

19.8

50.4

68.8

71.9

82.6

87.6

69.1

72.5 70.9 68.5 13.1 15.9 7.29 1.57 8.23 1.91

-

46.8

60.9

74.4

82.6

85.0

88.9

71.6

36.7

53.9

75.0

84.4

91.7

93.0

73.4

1.59

12

13

14

15

16

17

12

13

14

15

16

17

12

13

14

15

16

17

46.9

62.0

72.6

83.4

81.0

84.9

68.6

30.5

60.8

75.1

78.4

84.2

91.2

73.2

13.7

13.3

12.4

13.6

;2.2

13.4

15.2

15.6

15.2

17.6

14.8

13.8

13.7

11.0

13.1

14.7

17.1

17.8

16.0

17.1

2.76

2.29

2.03

2,13

1.95

1.46

4.52

9.51

11.35

7.47

7.41

6.11

7.00

4.32

13.81

10.54

10.40

5.78

4.48

7.98

2.65

2.33

1.85

2.13

1.97

1.44

1.55

2.62

2.80

2.09

2.69

1.55

1.87

1.87

7.33

9.00

11.80

8.24

8.43

6.88

7.21

4.67

11.22

10.97

11.28

5.47

5.30

9.59

3.43

3.54

3.89

3.05

4.03

3.66

3.11

4.04

6.62

5.94

4.61

4.66

5.15

1.:9

4.49

2.26

4.08

3.53

4.73

4.82

39.1

56.2

70.1

79.1

83.2

87.1

67.1

26.5

48.0

70.0

81.7

90.5

91.7

69.9

16.4 1.54

13.1

16.1

18.3

19.0

14.7

18.0

2.95

2.80

2.03

2.70

1.47

1.71

15.3 1.91

57.3

68.2

73.8

80.6

78.0

84.7

63.8

63.2

70.3

88.5

78.0

78.9

52.1

64.8

70.2

76.3

75.8

82.4

57.7

57.6

66.0

87.5

73.8

76.2

11.8

11.4

7.1

12.4

10.4

13.1

13.0

13.4

16.0

16.7

17.2

16.2

3.67

2.73

7.53

8.06

13.10

6.48

10.84

7.99

3.41

2.74

2.99

2.19

3.20

2.62

11.01

9.93

13.79

6.68

12.81

9.28

1.56

2.25

1.29

1.84

2.27

1.73

3.00

2.00

3.29

2.50

27
Table 7. Prevalence rates for facial acne at examination among white and Negro youths,

by grade of acne, age, and

1966-70

sex, with standard errors for totals: United States,

Severity grade of facial acne

I I 1

Age and sex

White Negro White Negro White Negro White Negro

Both sexes Rate per 100 youths

12-17 years------------ 0.5 0.2 0.1

years---------------------

years---------------------

years---------------------

years---------------------

years---------------------

years---------------------

Boys

39.3 42.2 26.2 22.7 2.7

12

13

14

15

16

17

31.2

39.7

41.9

40.4

42.3

41.2

33.0

22.9

34.0

38.1

34.9

37.7

31.0

45.9

39.9

45.5

45.9

46.1

47.1

51.5

31.8

36.4

44.6

52.4

44.7

45.9

38.3

19.0

29.0

43.7

47.4

40.3

55.0

46.1

7.8

15.9

26.5

34.1

37.0

38.6

29.9

6.6

17.7

20.3

27.2

33.0

35.3

23.3

0.7

21.3

23.4

24.5

42.4

32.5

22.2

12.8

14.3

17.3

30.0

24.0

37.9

0.6

1.6

4.3

3.5

6.8

3.9

0.7

1.8

5.3

5.1

11.8

1.5

0.6

1.5

3.4

1.9

1.8

2.1

0.4

0.5

0.3

1.7

0.7

2.4

0.8

1.0

0.1

0.2

0.4

0.7

0.3

-

-

0.1

0.8

1.2

0.1

0.4

12-17 years--------------

years---------------------

years---------------------

years---------------------

years---------------------

years---------------------

years---------------------

Girls

12

13

14

15

16

17

3.6

13.3

30.2

41.6

46.9

48.3

12-17 years-------------- 22.4 0.1

years---------------------

years---------------------

years ---------------------

years---------------------

years---------------------

years---------------------

12

13

14

15

16

17

Both sexes, 12-17 years------

Boys, 12-17 years------------

Girls, 12-17 years -----------

45.0

43.3

45.5

57.4

49.0

37.3

12.2

18.6

22.8

26.3

26.8

28.9

.

0.5

0.2

0.8

Standard error

1.07

1.45

1.30

5.24

4.70

5.96

1.67

2.03

1.61

4.34 0.41

4.61 0.47

4.84 0.40

0.20 0.05

0.21 0.09

0.25 0.06

0.06

0.13

28
Table 8. Prevalence rates for facial acne at examination among youths age 12-17 years,

by grade of acne, race, and sex, with standard errors: United States, 1966-70

Race and sex

Both sexes

All races----------------------

WMte -------- ------------------------

Negro--------------------------------

Other--------------------------------

Boys “

All races------------------------

White--.---------------------.--.--.-

Negro--------------------------------

Other--------------------------------

Girls

All races------------------------

White--------------------------------

Negro--------------------------------

Severity grade of

facial acne

Rate per 100 youths

39.8

~

39.3

42.2

56.7

33.7

33.0

38.3

44*3

46.0

45*9

46.1

71.7

25.7

26.2

22.7

12.7

29.0

29.9

23.3

17.1

22.3

22.4

22.2

7.5

2.4

2.7

0.5

3.4

3.4

3.9

0.3

6.2

1.4

1.5

0.7

0.2

0.2

0.1

0.3

0.3

0.l

0.1

0.1

Severity grade of

facial acne

IEEE

Standard error

1.25

1.26

2.53

6.03

1.54

1.62

3.05

9.33

1.24

1.32

2.74

6.69

1.26

1.27

2.51

4.59

1.59

1.66

3.03

6.72

1.22

1.26

2.77

6.75

0.34 0.04

0.16 0.10

3.60 -

0.44 0.08

0.19 -

6.59 -

*

0.37 0.04

29
Table 9. Prevalence rates for facial acne at examination among youths, by geographic

region, age, and sex, with standard errors: United States, 1966-70

Geographic region

I I I

Geographic region

EEI!zEE

Age and sex

North- Mideast

I I I

Both sexes Rate per 100 youths

12-17 years --------------

years -----------------------

years -----------------------

years -----------------------

years -----------------------

years -----------------------

years -----------------------

Boys

12-17 years ----------------

years -----------------------

years -----------------------

years ---------------------- -

years -----------------------

years -----------------------

years -----------------------

Girls

12-17 years ----------------

years -----------------------

years-----------------------

years -----------------------

years -----------------------

years -----------------------

years -----------------------

Standard error

66.2 65.8 71.0 69.9 2.57 4.14 5.21 1.74

12

13

14

15

16

17

12

13

14

15

16

17

12

13

14

15

16

17

36.7

57.1

70.1

77.5

80.7

82.9

64.3

39.0

54.5

66.7

72.5

81.3

85.4

63.2

42.3

60.3

69.9

83.2

82.8

87.7

70.6

38.1

52.8

73.1

83.6

85.1

90.3

68.0

4.85

3.77

2.39

~.97

4.37

3.85

3.82

5.58

5.78

5.02

5.65

3.92

3.06

3.47

4.47

6.07

6.66

4.86

5.46

4.53

4.63

6.30

3.36

3.33

1.08

1.94

1.94

3.55

20.2

50.8

73.2

84.8

84.4

85.3

68.0

53.3

64.1

66.5

70.2

77.1

80.6

23.0

48.5

63.6

69.3

87.7

94.6

68,3

54.6

60.4

69.8

76.2

74.6

77.4

33.6

49.9

69.7

84.2

91.7

94.5

71.3

51.4

71.3

70.1

82.2

71.8

80.6

26.2

44.4

74.4

86.0

92.9

91.1

71.4

51.4

61.2

71.7

81.3

78.1

89.2

6.12

4.89

4.17

3.07

3.99

6.44

1.98

3.70

4.81

2.23

5.53

6.31

3.08

4.53

6.96

3.84

7.58

2.69

2.32

4.93

4.52

7.07

7.69

5.74

3.29

2.32

5.95

7.01

6.48

6.85

4.54

8.43

6.95

4.79

6.00

4.84

3.87

3.61

3.30

2.82

6.69

5.59

8.60

4.08

7.81

4.92

9.04

7.25

4.67

2.85

4.86

3.12

30
Table 10, Prevalence rates for gradations of facial acne and for nonacne skin lesions at examination among youths age

12-17 years, by geographic region and sex, with standard errors: United States, 1966-70

Both sexes

Northeast------------------

Midwest--------------------

south----------------------

Weat-----------------------

BOYS

Northeast------------------

Midwest--------------------

South----------------------

West-----------------------

Girls

Northeast------------------

Midwest--------------------

South----------------------

West-----------------------

I 11 111 IV

Observed rate per 100 youths

36.5

44.71

32.6

43.9’

29.0

39.0

27.41

38.0

44.1

50.5

38.0

50.0

27.0

20.1

35.1

22.1

31.2

22.8

38.3

25.2

22.7

17.4

31.6

18.9

2,4

1.0

2.9

3.7

3.6

1.5

4.5

4.5

1.2

0.4

1.2

2.8

0.3

0.4

0.2

0.5

0.4

0.3

0.5

—

14.1

11.5

17.8

11.3

16.2

13.2

19.7

12.9

12.0

9.7

15.7

9.7

Severity grade of

facial acne

I II ITS IV

Expected rate per

100 youths

39.7

39.9

39.9

39.8

33.6

33.8

34.0

33.6

46.01

46.0,

46.1

46.1

25.1

25.6

26.2

25.7

28.1

29.0

29.8

29.0

22.1

22.2

22.5

22.4

2.3

2.4

2.5

2.5

3.3

3.4

3.6

3.5

1.4

1.3

1.4

1.4

0.2

0,2

0.2

0.2

0,3

0.3

0.3

0.3

0.1

0.1

0.1

0.1

Standard error

2.12

2.31

3.16

3.51

2.15

2.34

3.59

2,74

2.47

2.43

3.23

5.72

4.03

3.49

3.63

2.75

5.29

3.68

3.87

2.84

2.98

3.83

3.73

3.56

0.66 0.10

0.24 -

0.42 0.14

1.71 0.11

0.97 0.20

0.29 -

0.59 0.10

L

2.10 0.23

0.57 -

0.32 -

0.37 0.21

1.37 -

2.52

1.96

1.63

2.13

3.46

1.88

2.16

1.98

1.75

2.44

1.42

2.51

31
Table 11. Obsemed snd expected prevalence rates for all facial acne, moderate-severe facial acne, and rmnacne skin

lesicme at examinstim amen white and Negro youths

?

age 12-17 years, by geographic region and sex,

errors: United States, 1966- 0

with standard

All grades of facial acne:

white----------------------

Negro----------------------

Grades II-IV facial acne:

White----------------------

Negro----------------------

Ncmacne skin lesions:

White----------------------

Negro----------------------

All grades of facial acne:

White----------------------

Negro----------------------

Grades II-IV facial acne:

White----------------------

Negro----------------------

All grades of facial acne:

White----------------------

Negro----------------------

Nonacne skin lesions:

White----------------------

Negro----------------------

Northeast I Midwest I south I West

loth

Iexes Boys Girls :;:, BOYS Girls J&gs B.ya Girls :::’

Observed rate per 100 youths

65.8

69.0

30.3

25.8

13.9

15.0

67.7

64,9

28.6

23.0

3.05

3.63

2.29

5.27

64.5

63.0

36.3

27.8

15.7

18.8

65.9

59.9

33.0

23.0

4.34

3.11

2.82

10.35

67.2 65.6 63.1 68.1

73.6 67.0 64.4 70.0

23.8 21.3 24.4 18.2

24.2 19.3 23.5 14.6

12.0 11.4 13.2 9.5

12.1 12.7h 15.1 10.0

74.3

61.7

43.4

24.8

17.5

18.6

75.0 73.6

58.1 65.2

50.3 36.2

23.8 25.8

20,5 14.2

17.5 19.6

Expected rate per 100 youths

69.6 68.2 66.7 69.8 69.7

68.7 67.2 65.3 69.4 65.3

23.8 28.8 33.8 23.8 30.2

23.0 24.4 25.5 23.0 23.1

J- 2.49 4.29

4.90 5.17

1.98 2.00

2.00 1.95

Standard error

3.28 5.44 1.50

7.95 3.88 17.00

69.2 70.2

61.1 69.4

35.9 24.2

23.2 23.0

1

1.46 1.75

14.46 19.98

2.02 1.77

6.54 2.55

69.6 67.8

71.8 69.6

26.6 31.2

19.0 17.3

11.3 13.0

11.8 11.4

68.5

65.2

29.2

22.9

1.58

10.94

2.26

3.91

67.0

62.2

34.2

22.8

3.37

15.11

2.26

4.36

71.4

74.3

21.9

21.0

9.6

12.2

70.0

68.6

24.1

23.0

3.01

10.18

2,49

5.34

32
Table 12. Prevalence rates for facial acne at examination among youths, by population size of place of residence, age, and sex, with standard errors: United States, 1966-70

Age and sex

Urbanized area / Not in urbanized area

Urban

) million 1-2.9 250,000 - Less than

or more million 999,999 250,000 Rural

25,000 lo,ooo- 2,500 -

or more 24,999 9,999

Both sexes

12-17 years --------------

Rate per 100 youths

72.5 70.6 55.6 77.3

;;,;

77;8

83.0

88,4

88.2

7’0.1

60.4 65.0 68.7

r

39.8

55.6

67.5

81.3

85.9

86.2

66.9

70.2

12

13

::

16

17

Hi

14

H

17

12

13

14

15

:;

39,2

48.5

61.0

66.2

73.6

80.4

57,7

38.5

;$:

81:0

79.8

90.3

69.4

21.8

41.2

62.5

60.1

69.0

81.2

55.4

3%:

56.5

68.4

77.4

90.4

55.9

53.6

69.0

73.0

90.9

86.2

92.2

78.7

55.3

66.6

72.4

93.5

95.4

93.6

76.0

51.8

71.2

73.6

88.2

80.4

90.8

24.9

52.1

78.8

81.3

81.8

69.0

58.9

20.2

26.1

69.8

72.2

85.2

63.2

71.9

28.2

71.6

88.4

100.0

77.8

78.9

6.17

—

14.08

16.45

9.76

6.80

19.26

20.98

10.19

17.17

22.92

19.72

7.51

20.74

24.35

9.23

13.10

17.76

20.72

31.62

23.53

37.44

33.8

58.6

70.7

86.8

82.9

94.9

72.4

26,0

54.9

74.4

90.9

84.0

100.0

68.3

38.6

62.4

67.5

83.5

81.9

88.0

3.11

years -----------------------

years -----------------------

years -----------------------

years -----------------------

years-----------------------

yeara -----------------------

Boys

12-17 years ----------------

24.0

46.0

69.9

81.8

91.9

91.8

70.8

56.3

66.8

65.2

80.8

78.3

80.0

2.26

24.3

59.8

75.0

86.3

89.5

94.0

75.0

27.0

35.2

66.9

63.1

88,3

85.2

63.2

27.7

56.1

69.8

86.3

89.6

91.4

71..7

years -----------------------

years -----------------------

years -----------------------

years -----------------------

years -----------------------

years -----------------------

Girls

12-17 years ----------------

59.1

65.7

80.5

80.0

87.0

82.9

1.18

57.0

60.6

53.7

69.6

59.7

76.9

7.19

52.9

63.0

77.3

75.1

72.3

89.1

33.2

“44.0

68.7

50.5

62.0

74.0

years -----------------------

years -----------------------

years -----------------------

years -----------------------

years -----------------------

years -----------------------

Both sexes Standard error

12-17 years -------------- 3.80 14.60 6.56

3.67

3.12

2.79

2.92

2.63

2.53

2.71

3.28

3.78

3.48

3.92

2.56

3.01

2.48

4.88

4.02

:.:;

4:39

4.94

12 years -----------------------

13 years -----------------------

14 years -----------------------

15 years -----------------------

16 years -----------------------

17 years -----------------------

Boys

12-17 years ----------------

3.32

2.83

2.51

3,53

2.48

2,76

1.32

5.97

1;.;:

10:66

8.32

5.55

6.57

9.47

5.69

3.23

6.00

3.85

3.40

1.87

10.26

13.19

14.71

20.57

14.02

16.03

12.18

8.52

4.14

:.:;

7:78

4.61

6.05

9.39

9.07

12.43

4.93

4.30

6.44

7.84

14.03

5.23

8.75

8.45

10.35

6.74

6.41

3.53

:.;;

;:::

.

3.50

8.59

5.49

8.7L

4.63

7.22

3.84

7.79

9.35

4.55

4.92

6.04

5.25

12 years -----------------------

13 years -----------------------

14 years -----------------------

15 years -----------------------

16 years -----------------------

17 years -----------------------

Girls

12-17years ----------------

4.99

3.16

3.67

3.71

1.95

2.28

1.67

7.13

12.97

6.14

14.23

4.96

10.99

8.21

9.73

11.64

3.94

4.02

5.15

3.99

6.16

4.73

16.57

11.72

28.07

9.29

8.69

18.20

6.28

8.90

1:.g

14:42

5.01

16.51

13.30

20.36

14.04

29.77

23.73

12 years -----------------------

13 years -----------------------

14 years -----------------------

15 years -----------------------

16 years -----------------------

17 years -----------------------

2.27

;.;;

4:01

4.10

3.88

13.78

10.92

5.52

10.58

5.56

5.45

33
Table 13, Obsened and expected prevalence rates for facial acne at examination among youths age 12-17

years, by grade of severity and population size of place of residence

States, 1966-70

, with standard errors: United

Severity grade

of acne

Grade I

Observed------------

Expected------------

Grade II

Observed------------

Expected------------

Grade III

Observed------------

Expected------------

Grade IV

Observed------------

Expected------------

Grade I-------------

Grade II------------

Grade III-----------

Grade IV------------

Size of place of residence

II Urbanized area

39.8

25.7

2.4

0.2

1,20

1.70

0.36

0.04

45.4

39.8

25,7

25.4

1.3

2.4

0.1

0.2

2.96

2,49

0.30

0.08

39.0

39.6

18.9

25.1

2.3

2.3

0.2

0.2

4.30

4.08

0.93

0.11

Not in urbdnized area

Urban

Less than

250,000 Rural

25,000 1o,ooo- 2,500-

or more 24,999 9,999

Rate per 100 youths

39.1

40.0

27.4

26.0

4,1

2.5

0.2

S’C2

27.6

40.1

24.6

25.6

3.1

2.3

0.3

0.2

lard error

m

45.5

40.1

25.7

25,6

5.5

2.4

0.6

0.2

37.0

39.9

26.2

26.6

1.8

2.5

0.2

6.34 8.38

3.98 7.96

1.56 2.12

0.58

37.2

40.3

30.1

25.5

2.7

2.4

0.2

0.2

1

2.80

2.98

0.52

0.22

39.7

39.7

26.9

25.9

2.0

2,5

0.3

0.2

1.61

2.53

0.33

0,09

34
Table 14, Observed and expected prevalence rates for moderate-severe facial acne at examina~

tion among youths age 12-17 years in urbanized, nonurbanized, and rural areas,by geographic

region and race, with standard errors: United States, 1966-70

Race and type of area

of residence

All racesl

Urbanized:

Observed----------------

Expected----------------

Nonurbanized:

Observed----------------

Expected----------------

Rural:

Observed----------------

Expected----------------

White

Urbanized:

Observed----------------

Expected----------------

Nonurbanized:

Observed----------------

Expected----------------

Rural:

Observed----------------

Expected----------------

Negro

Urbanized:

Observed----------------

Expected----------------

Nonurbanized:

Observed----------------

Expected----------------

Rural:

Observed----------------

Expected----------------

Geographic region

Northeast Midwest South West

Rate per 100 youths

29.8

26.7

38.7

30.2

26.3

27.6

30.9

27.9

39.4

32.0

25.9

27.8

25.2

23.1

10.0

40.8

26.7

20.6

26.;

24.6

31.C

20.5

29.8

21.0

26.8

24.7

33.0

20.4

29.8

18.1

24.8

49.0

10.2

32.8

31.9

37.1

27.4

35.6

32.6

40.0

29.6

44.6

29.3

43.9

34.9

42.8

29.9

27.2

22.9

7.8

8.8

27.9

27.6

24.2

27.1

31.2

31.6

25.7

28.6

25.0

27.9

31.4

33.2

25.9

28.8

19.8

23.2

6.8

18.3

26.1

I

Northeast Midwest South West

Standard error

4.10

---

4.68

---

11.59

---

4,92

---

4.79

---

12.15

--_

3.36

---

---

20.5

---

3.41

---

7.44

---

6.06

---

3.84

---

8.19

---

6.03

---

2.90

---

34.75

---

23.16

---

9.38

---

3.31

---

3.68

---

5.47

---

3.28

---

2.57

---

12.74

---

2.06

---

11.24

---

5.56

---

8.12

---

3.08

---

5.27

--q

8.02

---

3.20

---

.2.12

---

.

-.-

.2.93

--.

1

Includes all racial groups. Data not shown separately for racial groups other than white

and Negro because the number in the sample is too small to provide reliable population estimates for them.

3s
Table 15. Prevalence rates for facial acne and for nonacne skin lesions at examination among

white and Negro youths age 12-17 years, by population size of place of residence and sex,

with standard errors: United States, 1966-70

Size of pl~n~ ;~xresidence

Both sexes

Urbanized:

3 million or more-----------------

1-2.9 million---------------------

250,000-999,999-------------------

Less than 250,000-----------------

Nonurbanized:

25,000 or more--------------------

10,000-24,999---------------------

Less than 10,000------------------

Rural-------------------------------

Boys

Urbanized:

3 million or more-----------------

1-2.9 million---------------------

250,000-999,999-------------------

Less than 250,000-----------------

Nonurbanized:

25,000 or more--------------------

10,000-24,999---------------------

Less than 10,000------------------

Rural-------------------------------

Girls

Urbanized:

3 million or more-----------------

1-2.9 million---------------------

250,000-999,999-------------------

Less than 250,000-----------------

Nonurbanized:

25,000 or more--------------------

10,000-24,999---------------------

Less than 10,000------------------

Rural-------------------------------

I

Facial acne I

Nonacne skin

lesions

Ra

73.0

58.9

68.4

61.9

77.6

66.1

73.3

68.9

70.4

56.1

68.9

63.5

73.4

60.0

74.4

67.2

75.6

61.8

68.0

60.5

75.9

73.0

72.2

70.8

per 100 you

71.1

70.1

82.2

34.4

55.8

53.3

41.9

66.1

68.4

68.0

72.9

33.1

46.6

45.8

50.7

63.0

73.4

72.8

90.0

36.2

67.6

60.9

35.7

69.3

14.8

9.1

13.3

12.3

15.8

9.0

12.7

13.9

17.5

11.6

13.9

15.5

20.0

13.5

13.8

15.4

11.9

6.7

12.6

9.5

11.9

3.9

11.6

12.2

E

13.5

7.6

12.9

20.6

42.5

25.3

22.1

21.0

15.7

6.7

10.2

24.3

49.3

27.8

25.2

18.9

11.5

8.6

15.2

15.6

33.8

22.7

19.8

23.1

Facial acne

Nonacne skin

lesions

White Negro

1.11

7.26

2.88

6.61

7.19

6.43

3.21

1.70

1.21

6.13

1.73

7.79

7.41

10.81

3.79

2.33

2.01

8.88

4.58

12.17

7.86

10.45

4.05

1.99

Standa

2.87

9.56

7.41

31.15

6.14

28.81

16.25

16.36

3.37

12.37

9.86

26.28

12.68

33.74

12.79

14.54

4.09

10.49

17.20

38.56

23.05

34.54

18,68

19.71

I

errol

2.26

2.29

3.28

5.51

2.83

2.93

2.75

1.75

2.66

2.69

4.39

5.60

8.89

3.79

4.06

1.75

2.98

2.06

4.39

7.22

1.84

2.45

3.15

1.99

3.42

4*27

6.29

9.63

10.3.5

15.67

5,87

4.33

6.12

3.25

6.90

12.19

12.54

33.27

11.21

7.72,

1.55

6.26

6.38

6.91

11.52

16.57

1.33

2.49

36
Table 16. prevalence rates for facial acne at examination among youths, by annual family inceme, age, and

sex, with standard errors: United States, 1966-70

Family income

Age and sex

Less than &WJ:- g,;;;- $7,000 - $lO,OQO-

$3,000 ,

$15,000

, $9,999 $14,999 or more

Both sexes

12-17 years ------------------

Rate per 100 youths

68.8 68.8 68,7 68.4 66.0 67.4

41.5

54.1

73.6

80.8

87.7

85.4

67.4

25.3

:;.;

79:7

92.8

92.2

70.1

40.8

55.7

73.2

76.7

85.6

84.2

36.9

58.9

76.6

80.4

80.0

86.3

36.4

56.4

61.0

75.6

85.5

85.5

39.5

::.:

77:4

83.3

84.7

12

ii

15

H

i:

~:

16

17

12

13

14

H

17

12

13

14

15

H

12

13

14

15

16

17

12

ii

15

16

17

38.0

58.3

67.9

81.9

76.0

91.4

67.4

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

Boys

12-17 years -------------------- 64.3 67.0 65.8 65.3

27.9

$:.;

70:7

88.7

90.6

25.8

::,;

82:6

84.0

93.6

70.1

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

Girls

12-17 years -------------------- 73.0 70.0 66.1 69.8

46.4

69.3

71.0

81.3

69.5

88.5

4.45

59.8

58.4

70.7

81.8

79.4

77.2

3.51

53.3

63.4

78,6

75.8

72.7

81.0

48.4

58.8

58.3

73.9

79.4

80.2

56.9

57.5

69.7

72.5

72.2

81.8

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

Both sexes

12-17 years ------------------

Standard error

2.48 2.21 2.02 2.10

4.51

;.!3;

3:85

3.12

2.91

6.42

5.08

8.70

4.73

6.00

3.73

4.70

8.04

8.00

11.12

5.94

4.63

4.29

4.95

4.15

5.29

4.20

;.:;

4:38

3.56

4.17

3.34

2.84

2.92

3.2P

3.19

4.17

3.83

:.::

2:99

3.05

3.83

4.32

4.14

4.22

years---------- +---------------

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

Boys

12-17 years --------------------

3:34

5.44

3.14 2.42 1,92 3.37

4.63

7.61

4.48

7.70

3.04

3.55

4.41

4.85

3.77

3.25

4.35

3.35

3.43

6.15

5.48

7.52

8.28

4.17

5.99

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

Girls

12-17 years -------------------- 2.76 2.46 2.61 2.03

8.74

6.46

5.46

6.06

5.97

7.80

9.01

5.77

8.13

4.86

8.17

4.63

7.27

7.26

6.43

4.53

6.12

6.76

5.45

6.26

3.84

3.77

5.61

5,43

4.62

4.05

4.66

3.67

4.54

4.46

6.51

4.47

9.35

5.37

;.;;

.

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

years ---------------------------

37
Table 17: Prevalence rates for gradations of facial acne and for nonacne skin lesions at examination among youths age 12-17 years, by annual family

errors: United States, 1966-70

income and sex, with standard

Fami&ydi;;.me

Both sexes

Less than $3,000----------

$3,000-$4,999-------------

$5,000-$6,999-------------

$7,000-$9,999-------------

$10,000-$14,999-----------

$15,000 or more-----------

Boys

Less than $3,000----------

$3,000-$4,999-------------

$5,000-$6,999-------------

$7,000-$9,999-------------

$10,000-$14,999-----------

$15,000 or more-----------

Girls

Less than $3,000----------

$3,000-$4,999-------------

$5,000-$6,999-------------

$7,000-$9,999-------------

$10,000-$14,999-----------

$15,000 or more-----------

Nonacne

skin

lesions

Severity grade of

facial acne

I I I

I II III IV

Rate per 100 youths

18.2

12.8

12,8

12.5

13.5

11.9

21.0

14,1

14.5

13.4

16.0

14.5

15,8

11.5

11.2

11.4

11.1

9.0

37.2

40.2

41.0

39.5

38.5

42.3

35.1

33.2

33.1

33.8

31.7

35.9

39.0

47.4

48.8

46.2

44.8

49.5

28.6

25.6

25.0

26.0

25.6

22.4

28.6

30.6

27.0

28,9

31.0

25,9

28.7

20.6

23,0

22.5

20.4

18.7

2.6

2.6

2.5

2.8

1.7

2.6

3,3

3.2

3.9

4.2

2.6

3.4

2.0

2.1

1.2

1,2

0.8

1.6

0.4

0.4

0.2

0.1

0.2

0.1

0.4

0,7

0.3

0.4

0.2

0.4

0.1

0.1

0.1

Nonacne

skin

lesions

2.06

1.24

1.64

1.32

1.40

1.19

3.26

1.67

1.96

1.72

1.77

2.06

1.46

1.48

2.02

1.36

1.56

1.63

Severity grade of

facial acne

I

I

II III IV

Standard error

3.03

2.11

1.62

1.41

1.91

2.52

3.64

2.37

2.60

1.75

2.61

3.51

3.28

3.63

2.13

1.87

2.20

3.15

3.04

1.93

2.31

1.85

1.55

3,31

3.81

2.40

2.32

2.30

2.09

4,31

3.38

2.24

3.08

2.26

1.73

3.21

1.39

0.63

0.50

0.41

0.54

0.62

1.79

0.75

0.85

0.63

0.73

0.99

1.26

0.75

0.25

0.49

0.50

1.20

0.23

0.12

0.11

0.06

0.14

0.10

0.29

0.19

0.24

0,23

0,20

0.37

0.14

.

0.13

0.10

38
Table 18. prevalence rates for facial acne and nonacne skin lesions at examination

among white and Negro youths age 12-17 years, by annual family income and sex, with

standard errors: United States, 1966-70

Family income and sex

Both sexes

All incomes------------

Less than $3,000-------------

$3,000-$4,999----------------

$5,000-$6,999----------------

$7,000-$9,999----------------

$10,000-$14,999--------------

$15,000 or more--------------

Boys

All incomes--------------

Less than $3,000-------------

$3,000-$4,999----------------

$5,000-$6,999----------------

$7,000-$9,999----------------

$10,000-$14,999--------------

$15,000 or more--------------

Girls

All incomes--------------

Less than $3,000-------------

$3,000-$4,999----------------

$5,000-$6,999----------------

$7,000-$9,999----------------

$10,000-$14,999--------------

$15,000 or more--------------

Facial acne Nonacne

lesions

EIEzE3E

Rate per 100 youths

68.5

71.2

70.5

69.2

68.3

65.5

67.2

67.1

71.9

70.1

64.3

67.0

65.8

65.3

69.9

70.5

70.9

74.0

69.7

65.2

69.3

65.5

64.7

64.4

66.7

67.5

73.8

81.3

61.8

60.2

60.6

65.3

63.0

63.7

73.0

69.1

69.2

68.2

67.9

73.3

80.8

89.2

13.1

17.4

12.0

12.6

12.3

13.5

12.0

15.2

22.6

13.2

14.4

13.2

15.7

14.7

11.0

13.1

10.9

10.8

11.2

11.5

9.0

15.9

19.6

14.8

13.6

14.6

13.5

12.3

16.4

18.5

16.1

13.8

15.8

25.5

13.1

15.3

20.7

13.4

13.4

13.1

5.1

11.8

?acial acne I

Nonacne

lesions

Thite Negro White .Negro

Standard error

1.57

2.22

2.11

2.54

2.26

2.07

2.21

1.55

2.25

3.15

2.95

2.57

1.83

3.48

1.87

3.61

3.12

3.01

2.44

2.90

2.05

8.23

10.11

10.66

8.21

5.41

7.36

16.07

7.21

9.65

9.67

10.89

6.90

10.26

39.08

9.59

11.31

12.45

8.40

9.01

11.26

8.50

1.03

2.71

1.35

1.69

1.34

1.52

1.28

1.08

4.34

1.53

1.65

1.72

1.92

2.17

1.12

2.09

1.88

2.23

1.33

1.71

1.71

1.91

3.46

2.22

3.30

3.98

3.49

10.21

3.11

5.78

3.06

6.37

5.98

7.28

12.97

1.19

2.98

3.11

4.03

4.37

3.76

8.96

39
Table 19. Prevalence rates for facial acne at examination among youths, by education

of parent (head of household), and age and sex of youth, with standard errors: United

States, 1966-70

Education of parent Education of parent

Age and sex of youth

8 grades

or less

9-12

grades

13 grades

or more

8 grades

or less

9-12

grades

13 grades

or more

Both sexes

12-17 years--------

years-----------------

years-----------------

years-----------------

years-----------------

years-----------------

years-----------------

Boys

Rate per 100 youths Standard error

70.6 67.9 65.1

36.9

51.3

64.6

77*O

84.0

83.5

61.5

2.97

3.23

4.35

3.83

4.25

3.48

2.54

2.94

3.76

5.87

5.23

4.83

2.07

2.42

3.50

2.10

3*13

2.91

2.65

2.28

2.85

1.72

2.04

3.22

3.08

2.98

4.43

2.43

2.14

2.45

1.66

3.65

3.76

3.37

2.93

2.46

3.88

2.44

12

13

14

15

16

17

12

13

14

15

16

17

12

13

14

15

16

41.3

60.2

67.1

80.8

86.3

90.3

68.5

39.2

55.9

73.1

78.3

79.1

86.4

12-17 years---------- 67.0

years-----------------

years-----------------

years-----------------

years-----------------

years-----------------

years-----------------

Girls

12-17 years----------

years-----------------

years-----------------

years-----------------

years-----------------

years-----------------

25.8

49.9

65.6

82.2

92.7

93.6

72.5

26.7

47.8

74.3

79.6

86.4

92.9

68.9

23.0

48.4

63.1

79.4

90.5

84.5

68.7

52.4

55.1

66.4

74.3

78.6

82.8

3.95

4.55

4.35

3.28

3.11

4.34

1.71

5.51

6.47

4.46

4.12

3.79

5.06

54.3

70.4

68.4

79.6

79.6

86.6

53.0

63.8

71.8

76.8

71.2

79.0

5.18

5.50

4.06

4.54

5.92

4.40

4.08

3.66

4.19

2.54

4.38

17 years----------------- 3.09

40
Table 20. Prevalencerates for all facial acne and moderate-severefacial acne at examination

among youths age 12-17 years, by years of formal schoolingcompletedby parent (head of household) and race of youth, with standard errors: United States, 1966-70

Highest grade completed

by parent and sex

of youth

Both sexes

8 grades or less-----------

9-12 grades----------------

13 grades or more----------

Boys

8 grades or less-----------

9-12 grades----------------

13 grades or more----------

~s

8 grades or less-----------

9-12 grades----------------

13 grades or more----------

Both sexes

8 grades or less-----------

9-12 grades----------------

13 grades or more----------

Boys

8 grades or less-----------

9-12 grades----------------

13 grades or more----------

Girls

8 grades or less-----------

9-12 grades----------------

13 grades or more----------

Facial acne-all Facial acne-grades

grades II-IV

All

racesl White Negro r:::sl White Negro

Rate per 100 youths

70.6

67.9

65.1

68.5

67.’b

61.5

72.5

68.9

68.7

2.97

2.10

1.66

2.94

2.04

2.44

3.50

2.45

1.71

71.4

68.3

65.2

69.9

67.8

62.0

72.7

68.8

68.4

2.01

2.01

1,72

2.27

1.94

2.55

2.85

2.46

1.75

67.3

65.2

63.1

62.9

61.3

51.6

71.7

68.9

76.2

10.84

6.89

6.99

10.19

6.33

8.38

11.92

8.05

11.11

30.8

28.8

23.7

35.0

33.3

28.2

26.7

24.0

19.0

33.2

29.2

24.1

39.5

34.2

28.5

27.4

23.9

19.6

Standard error

21.5

26.4

16.6

18.7

28.2

24.1

24.4

24.6

8.1

1.82

2.13

1.96

2.00

2.39

2.78

2.17

2.28

2.00

1.83

2.09

2.01

2.52

2.37

2.98

2.10

2.28

1.93

5.64

4.60

4.99

6.11

4.81

8.51

6.45

5.37

6.95

Facial acne-all

grades

~

Expected rate

68.6

68.0

67.1

67.5

66.4

64.0

69.7

69.8

70.3

2.97

2.10

1.66

2.94

2.04

2.44

3.50

2.45

1.71

69.1

68.3

67.4

68.8

67.1

64.5

69.4

69.6

70.3

2.01

2.01

1.72

2.27

1.94

2.55

2.85

2.46

1.75

65.9

66.2

64.2

61.1

62.0

59.1

70.9

70.4

70.1

10.84

6.89

6.99

10.19

6.33

8.38

11.92

8.05

11.11

lIncludesall racial groups. Data not shown separatelyfor racial groups other than white and

Negro because the number in the sample is too.small to provide reliable population estimates for

them.

41
Table 21. Prevalencerates

rating of youths’ present

States, 1966-70

for facial acne at examinationamong youths by youths’ and parents’

health, and by age and sex of youth, with standard errors: United

“

Youth’sratingof ;:u’:t,sr;:g:n:f

present health health

Good- Poor- Good- Poorexcellent fair excellent fair

Age and sex

I

~

Both sexes Facial acne rate per 100 youths Standard error

12-17 years-------

years----------------

years----------------

years----------------

years----------------

years----------------

years----------------

Boys

12-17 years---------

years----------------

years----------------

years----------------

years----------------

years----------------

years----------------

Girls

12-17 years---------

years----------------

years----------------

years----------------

years----------------

years----------------

1.91 1.91

2.53

2.56

2.32

2.41

2.19

1.63

1.89

67.8 74.6 67.9 73.6

37.9

59.6

69.3

92.9

93.1

83.1

73.1

3.40

8.90

9.31

7.32

2.73

3.57

7.51

4.45

3.56

9.57

9.49

9.70

5.00

5.28

7.22

3.61

12

13

14

15

16

17

12

13

14

15

16

17

12

13

14

15

16

39.0

55.8

69.9

78.3

82.1

86.8

66.2

38.6

56.3

69.6

78.7

82.3

86.6

66.1

54.1

44.9

70.3

84.3

93.7

87.0

73.2

2.63

2.51

s 2.28

2.41

2.23

1.65

1.88

25.3

48.0

70.0

80.1

89.2

91.4

69.6

33.6

56.9

67.9

86.3

100.0

92.0

75.8

25.0

48.4

69.9

80.3

89.2

91.3

69.7

50.9

43.8

67.6

78.6

93.3

94.7

73.9

2.55

3.14

2.64

3.15

1.78

1.87

2.17

7.15

12.19

10.86

8;62

7.05

3.54

2.39

3.08

2.71

3.16

1.79

2.03

2.16

12.26

11.54

11.44

8.74

6.34

5.91

4.70

53.2

64.0

69.7

76.4

74.7

82.2

41.9

61.5

71.0

95.5

89.8

73.0

52.8

64.5

69.4

77.0

75.1

82.0

●

56.9

45.9

73.0

88.2

94.1

74.5

3.28

2.94

3.06

2.28

3.46

2.82

13.79

11.88

9.37

2.94

5.36

13.40

3.27

2.92

3.09

2.34

3.34

2.62

19.37

14.59

12.37

5.95

8.89

17 years---------------- 16.67

42
Table 22. Prevalencerates for all facial acne and moderate-severe facial acne at examination among white and Negro youths age 12-17 years by youths’ and parents’ rating of youthsl present health, and by sex of youth, with standard errors: United

States, 1966-70

ExaminW&e$ind ing

Facial acne-all grades

Both sexes-------------------

Boys-------------------------

Gi~ls ------------------------

Facial acne-grades II-IV

Both sexes-------------------

Boys-------------------------

Girls------------------------

Facial acne-all grades

Both sexes------------------

Boys ----------------------- --

Girls------------------------

Facial acne-grades II-IV

Both sexes-------------------

Boys-------------------------

Girls------------------------

Facial acne-all grades

Both sexes-------------------

Boys-------------------------

Girls------------------------

Facial acne-grades II-IV

Both sexes--------------------

Boys-------------------------

Girls ------------------------

Youth’s rating of Parent rating of

present health present health

I I

Good1

Poor-fair I

Goodexcellent excellent I

Poor-fair

White

68,3

66.9

69.7

29.1

34.2

23.8

1.63

1.64

1.90

1.79

2.14

1.77

67.9

66.3

69.6

28.3

32.9

23.6

Negro White Negro White Negro White Negro

Observed rate per 100 youths

64.6

60.9

68.3

23.0

23.8

22.1

8.53

7.32

10.38

4.56

4.98

5.29

76.0

76.0

76.0

31.4

36.7

27.5

3.37

4.13

4.18

4.09

5.22

5.36

72.4

69.0

75.1

25.9

19.0

31.4

68.2

66.8

69.8

28.9

33.7

23.9

Standard error

7,33

9.59

6.95

5.04

5.63

7.60

1.64

1.63

1.94

1.77

2.14

1.76

65.5

62,0

69.0

22.8

23.3

22.2

8.39

7.32

9.96

4.53

4.80

5.30

Expected rate per 100 youths

67.4 75.4 74.0 68.0 67.4

65.4 74.7 72.0 66.2 65.5

69.3 75.8 75.6 69.7 69.4

27.8 30.0 29.4 28.1 27.6

32.2 31.7 31.0 32.4 31.8

23.4 28.7 28.i 23.6 23.4

75.5

77.4

73.6

37.4

48.5

26.5

3.17

3.62

5.10

3.96

7.84

4.59

74.7

75.2

74.3

35.8

43.8

27.9

68.6

62.3

73.4

30.3

25.1

34.3

9.70

9.95

11.27

6.89

10.99

9.05

71.3

70.2

72.1

34.6

42.3

28.5

43
Table 23. Prevalence rates for facial acne at examination among youths age 12-17 years

by youths’ and parents’ rating of youths’ present health, and by geographic region

and sex of youth, with standard errors: United States, 1966-70

Type of history and geographic region

Youth’s own rating

Northeast----------------------------------

Midwest--.---------------------------------

South--------------------------------------

West---------------------------------------

Rating by parent

Northeast----------------------------------

Midwest------------------------------------

South--------------------------------------

West---------------------------------------

Youth’s own ratina

Northeast----------------------------------

Midwest------------------------------------

South--------------------------------------

West---------------------------------------

Rating by parent

Northeast----------------------------------

Midwest------------------------------------

South--------------------------------------

West---------------------------------------

Youth’s own rating

Northeast----------------------------------

Midwest------------------------------------

South--------------------------------------

West--.------------------------------------

Rating by parent

Northeast----------------------------------

Midwest------------------------------------

South--------------------------------------

West---------------------------------------

Youth’s present health

Good-excellent Fair-poor

Both

sexes Boys Girls ::;;s Boys Girls

Facial acne rate per 100 youths

65.6

65.3

70.9

69.9

66.0

65.5

70.9

69.6

2.75

4.30

5.22

1.88

2.86

4.17

5.24

1.78

67.1

67.7

68.6

67.9

67.3

67,8

68.7

67.8

64.0

62.6

70.9

67.8

64.3

62.7

70.5

67.6

4.05

3.67

4.49

3.80

67.4

68.0

71.0

72.1

67.7

68.3

71.3

71.7

80.7

82.7

71.2

68.4

75.1

76.8

71.4

74.0

Standard error

4.19

3.53

4*73

3.67

Expected

65.0

66.0

67.6

66.2

65.1

66.0

67.4

66,0

2.05

5.08

6.22

2.62

2.25

5.00

5.98

2.88

4.72

5.75

6.39

9.58

9.~2

6.04

6.63

6.77

76.7

83.6

65.2

73*3

66,0

84.6

70,6

73.9

7.85

5.81

9.49

10.04

LO.51

5.41

5.81

9.42

rate per 100 youths

69.4

69.4

69.8

69.7

69.5

69.6

70.0

69.8

72.4

78.2

73.1

75.6

70.4

76.8

71.7

76.5

70.9

79.5

69.7

73.5

64.6

80.4

70.7

77.0

83.0

81,8

76,0

65.4

82.4

68,4

72.5

74.1

5.39

9.63

6.80

9.63

10.05

19.54

8.29

10.18

73.4

76.8

75.8

76.8

74.9

73.0

72.5

76.6

44
Table 24. Prevalence rates for facial acne at examination among youths age 12-17 years by presence or absance of allergies, and by type of allergy, age, and sex, with standard errors: United States, 1966-70

Type of allergiesl

I I

~

Facial acne rate per 100 youths

No

allergies

Allergies,

any type Age and sex

Both sexes Standard error

12-17 years--

12 years-----------

13 years-----------

14 yeare-----------

15 years-----------

16 years-----------

ti7years-----------

BOYS

12-17 years----

12 yea~,g ----------

13 years-----------

14 years -----------

15 years-----------

16 years-----------

17 years-----------

Girls

12-17 year.e----

12 years-----------

13 yeara-----------

14 years-----------

15 years-----------

16 years-----------

17 years-----------

67.5 69.8 2.87

38.9

56.1

68.9

78.8

82.7

86.8

65.8

24.5

48.9

69.5

80.6

88.8

91.7

69.3

71.3

—

39.7

55.8

76.6

75.5

86.5

82.5

70.0

69.9 67.1 2.03 2.25 2.61 2.58

39.4

55.4

72.4

79.5

82.6

85.2

68.0

27.7

52.4

71.6

79.7

81.1

82.1

65.7

41.1

53.5

69.9

80.4

81.2

89.6

67.5

2.82

2.65

2.57

2.47

2.52

1.82

2.08

3.94

3.77

3.42

2.95

2.92

2.93

5.58

5.17

4.52

3.43

3.07

3.86

2.97

6.14

5.87

6.32

4.76

5.50

6.90

3.07

5.31

5.18

4.40

3.74

4.70

2.95

2.55

6.82

5.49

6.50

4.90

4.99

2.71

3.30

2.23

4.98

4.61

3.97

4.79

2.95

2.58

7.38

7.79

6.05

6.17

3.17

3.97

3.50

8.47

8.76

6.08

7.94

5.03

3.95

4.81

30.5

45.6

71.4

78.5

91.3

89.8

71.8

29.7

45.7

79.1

78.1

94.0

85.2

73.0

19.7

44.6

62.5

77.4

91.2

92.9

69.0

34.4

42.9

67.1

77.7

91.1

94.2

71.8

2.37

3.39

3.17

3.18

2.00

2.34

2.20 3.09

53.5

63.3

68.4

76.9

76.3

81.8

49.8

66.5

73.3

80.5

74.3

80.9

56.6

69.6

74.3

72.6

77.4

79.4

41.6

61.5

85.4

82.6

67.6

68.4

47.9

63.7

72.4

82.9

73.7

85.6

3.63

2.96

3.47

2.52

3.91

2.77

6.49

4.84

4.15

2.95

5.31

4.57

10.62

7.05

6.23

6.92

6.49

7.72

L2.45

8.94

8.04

5.45

10.99

L3.04

6.25

6.91

5.05

3.68

7.23

5.41

1Some youths have more than one type of allergy.

45
Table 25. Prevalencerates for facial acne among youths taking medicationregularly for skin or

other disorder and those not taking medication by their parentsf statementregardingmedication, and by age and sex of youth, with standarderrors: United States, 1966-70

Age and sex

Both sexes

12-17 years-------

years----------------

years----------------

years----------------

years----------------

years----------------

years----------------

Boys

12-17 years---------

years----------------

years----------------

years----------------

years----------------

years----------------

yeard----------------

Girls

12-17 years---------

years ----------------

years----------------

years----------------

years----------------

years----------------

years----------------

Treating Tr;;~g

Vot treating

my condition di;:~er d~yr:~

Facial acne rate per 100 youths

68.C

38.8

56.4

69.2

79.1

82.8

86.4

66.2

24.6

48.3

69.7

80.3

89.4

90.9

69.9

53.1

64.8

68.7

77.9

75.9

82.0

92,7

100.0

48.8

100.0

100.0

88.0

100.0

94.2

100.6

100.0

100.0

91.5

100.0

100.0

100.0

80.0

80.0

100.0

67.8

40.8

47.9

78.4

75.5

75.5

88.0

68.2

38.0

50.9

73.6

78.7

85.4

93,9

67.3

45.5

44.6

83.0

73.1

68.6

80.9

Standard error

1.85

2.40

2.54

2.38

2.10

2.16

1.69

1.88

2.17

3.09

2.71

2.89

1.75

2.07

2.06

3.20

2.92

3.32

2.17

3.20

2.69

5.21

70.71

42.99

70.71

11.3;

5.22

50.6

-

8.00

70.71

70.71

70.71

21.9;

31.62

Treating

other

nonskin

disorder

3.39

6.48

9.20

4.15

7.98

6,56

4.31

2.97

9.22

12.05

6.74

9.03

8.35

3.99

4.65

11.42

1;.;;

8:38

13.25

8.09

44
Prevalencerates for

degreeOf nervousnesss,

Table 26.

youths‘

facialacne at examinationamong youthsby youths’ and parents’

and by age and sex of youth,with scanaarderrors:United States,

rating of

1966-70

Youth’sown rating Parent rating of youth

Age and sex I I

Often ScnnetimesRarely I

Never

nervous nervous nervous nervous

Very Somewhat Not

nervous nervous nervous

Facial acne rate per 100 Both sexes

12-17 years-----------------------

youths “

77.0 69.4 68.4 62.6 71.3 I 68.5 67.4

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

Boys

12-17 years--------------------------

34.4

64.7

72.9

86.6

85.9

91.8

76.1

35.7

57.8

69.2

80.0

82.8

S6.0

67.7

41.8

54.2

69.8

77.3

81.5

85.8

67.9

40.3

54:1

70.4

78.7

S2.6

83.3

60.6

47.3 40.0

44.6 55.8

68.6 70.1

78.1 79.5

87.0 83.4

95.7 87.8

37.6

56.9

;;.:

81:5

84.6

70.8 ! 64.4 67.8

46.4

40.5

68.7

72.0

96.2

95.1

24.5

47.0

67.1

79.9

89.4

94.4

26.S

62.0

70.1

91.6

91.2

93.8

77.6

41.3

67.4

74.8

83.0

83.4

90.2

2.34

22.2

49.3

68.0

80.2

91.5

90.6

70.8

47.9

65.0

70.2

79.9

75.2

82.2

2.03

31.8

44.5

72.5

76.8

90.0

91.6

69.0

53.2

64.8

67.2

77.8

72.0

79.3

22.0

49.6

69.0

84.3

83.9

89.6

65.5

25.0

49.7

72.5

81.2

88.9

89.1

67.0

&

66:3

75.7

72.4

79.8

2.31

years ---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

Girls

12-17 years-------------------------- --1-- 72.5

48.5

48.4

68.4

85.8

80.2

96.6

58.4

64.6

72.9

79.3

78.1

81.8

years ---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

Both sexes

12-17 years------------------------

Standarderrcm

2.11 2.35 2.84 1.67

6.76

5.87

5.94

3.11

5.24

2.34

3.58

7.08

10.45

9.45

4.61

5.34

3.96

2.28

9.84

7,44

7.70

;.;;

2:87

3.45

3.13

2.94

2.65

2.37

2.29

2.24

3.72

3.60

3.83

3.71

1.42

3.03

2.23

4.53

$:;

2:54

4.51

3.96

3.74

2.39

3.67

2.99

2.50

2.04

2.38

3.53

4.15

4.02

4.15

1.87

1.91

2.21

4.49

2.84

:.:;

3:85

3.58

3.41

3.85

4.16

4.16

3.85

5.32

2.53

8.17

:.;:

7:37

5.37

2.68

4.17

12.89

11.03

9.46

8.77

3.97

4.62

3.26

12.17

12.16

13.40

10.62

7.12

3.64

3.30

2.19

2.40

2.33

2.26

2.19

2.02

3.43

3.44

3.72

3.40

1.96

1.76

1.76

3.79

2,51

3.20

2.64

3.36

3.98

2.83

3.25

3.26

2.74

2.78

2.41

2.14

years ---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

Boys

12-17 years--------------------------

3.71

4.67

4.47

4.13

4.86

4.30

3.34

4.30

5.14

6.86

5.76

4.92

10.13

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

Girls

12-17 years--------------------------

2.86

3.61

3.32

3,51

2.49

2.55

2.84

3.56

4.07

4.37

2.91

4.70

3.24

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

years---------------------------------

47
Table 27. Prevalence rates for facial acne at examination among youths age 12-17 years by

youths‘ and parents’rating of youths’ degree of nervousness, and by race and sex of youth$

with standard errors: United States, 1966-70

Race and sex

Both sexesl---------

White---------------------

Negro---------------------

Boysl-----------------

White---------------------

Negro---------------------

GirlsI----------------

White---------------------

Negro---------------------

Both sexeal---------

White---------------------

Negro---------------------

Boys~-----------------

White---------------------

Negro---------------------

Girlsl----------------

White---------------------

Negro---------------------

Youth’s own rating Parent rating of youth

Often Sometimes Rarely Never Very Somewhat Not

nervous nervous nervous nervous nervous nervous nervous

Facial acne rate per 100 youths

77.0 69.4 68.4 62.6 71.3 68.5

———.

77.4 69.7 67.9 63.7 71.4

73.3

68.7

67.5 73.0 59.5 70.7 67.3

76.1 67.7 67.9 60.6 70.8 64,4

77.0 68.2 67.7 62.2

69.0

73.0

64.8

64.9

69.4 55.9 60.0 60.2

77.6 70.8 69.0 65.5 71.8 72.5

77,7 71.0 68.2 65.9 69.6

76.6 69.7

72.4

76.4 63.9 84.2 72.7

Standard error

2.34 I 2.03

2.43

11.62

3.58

3.86

15.92

2.28

2.46

9.24

1.56

9.49

2.24

1.98

9.36

2.23

1.82

10.82

67.4

68.0

63.9

67.8

68.6

63.2

67,0

67.4

64.6

2.11 2.35 2.84 1.67 2.31

2.15 1.46 3.23 1.59 1.78

5.02 8,13 8.20 6.92 9*93

2.38 2.53 4.17 I 2.02 I 2.14

I I I [

2.30 2.31 4.47 1.95

5.43

1.82

7.35 10.25 7.81 7.83

2.21 I 3.34 I 3.26 I 1.76 ] 2.84

2.30 I

3.05 3.64 1.63

8.69

2.39

9.67 10.87 7.59 12.69

lIncludes all racial groups—white, Negro, and other,

48
Table 28. Prevalence rates for facial acne at examination among youths age 12-17years,

by youths’ own rating of degree of nervousness

errors: United States, 1966-70

and geographic region, with standard

—.— .—

Youth’s own rating

Geographic region

Often Sometimes Rarely Never

nervous nervous nervous nervous

All youths I Rate per 100 youths

Northeast --------------------------------------

Midwest -------------.---------- ----------------

South------------------ a-----------------------

West-------- ----------..--------------------- ---

All youths

75.2

74.4

75.7

82.7

69.0 66.6 59.4

66.5 65.6 59.9

72.6 73.0 65.1

69.9 70.0 65.1

Standard error

Northeast -------------------------------------- I 3.351 3.35 I 2.57 ] 2.33

Midwest ---------------------------------------- 5.07 3.02 6.39 3.73

South-------- -------------------------------- -- 6.07 5.82 3.29 7.13

West ------------------------------------------- 3.04 2.63 2.61 4.85

49
Table 29. Prevalencerates for facialacne at examinationamong youths,by teachers’ratings of youths’adjustmentin schooland need of specialresourcesfor the emotionallydisturbed,age,and sex, with standard

errors:United States,1966-70

I I

Schoolrating of INeeds

adjustment special I Does

Schoolrating of Needs

adjustment special

resources

Some- Seri- for

Well what Ously emotionad- mal- mal- ally

justed ad- ad- disjusted justed turbed

Does

not

need

such

special

resource8

1.90

re -

sources

for

emotionally

disturbed

not

need

such

special

resources

Age and sex SomeWell what

ad- maljusted adjusted

SeriOusly

maladjusted

I I I I

Both sexes Facial acne rate per 100 youths Standarderror

12-17 years--- 67.7 66.0 4.61

—

34.6

57.8

67.4

77.5

86.6

87.9

63.5

25.0

51.7

66.8

76.2

93.4

95.4

69.8

53.3

66.9

68.5

78.9

78.0

74.5

73.6 60.0 67.6 —

1.96 —

2.00 4.80

_

12 years-----------

13 years -----------

14 years-----------

15 years-----------

16 years -----------

17 years-----------

41.2

54.8

69.1

79.2

82.5

86.3

65.9

27.8

46.4

68.0

81.2

89.8

89.5

69.4

25.0

63.8

81.9

78.9

90.8

91.8

72.6

12.0

61.7

86.6

81.0

80.1

100.0

75.4

46.1

69.0

68.8

74.6

100.0

77.6

26.1

45.0

75.2

81.4

75.2

100.0

59.1

30.6

40.4

81.6

79.1

40.8

100.0

62.0

38.9

56.4

69.4

78.7

82.9

86.4

65.8

25.8

48.8

69,2

79.8

89.8

91.2

69.5

52.6

64.0

69.6

77.5

75.7

81.7

2.77

2.77

2.73

2.33

2.26

1.93

2.00

2.78

3.45

3.48

3.33

1.84

2.65

2.23

-..——

3.47

3.27

3.51

2.25

3.57

3.05

4.1.7

3.42

3.09

3.60

3.89

3.52

2.37

4.06

5,38

4.20

5.74

2.32

2.43

2,82

8.04

5.19

6.87

6.39

6,93

9.92

13.11

13.29

12.78

7.27

10.85

7.62

5.58

11.31

14,92

14.38

6.56

17.49

7.49

11.63

11.76

11.90

12.23

21.92

4.14

15.97

12.50

12.96

15.41

41.33

22.36

12,53

2.73

2.46

2.57

2.06

2.16

1,69

L 86

2.52

3.06

2.87

2.96

1.88

2.09

2.17

Boys

12-17 years----

12 years-----------

13 years -----------

14 years-----------

15 years-----------

16 years-----------

17 years -----------

Girls

12-17 years----

12 years-----------

13 years-----------

14 years-----------

15 years-----------

15 years-----------

17 years-----------

53.3

62.6

70.1

77.0

75.3

83.3

14.2

60.6

41.7

85.7

88.0

100.0

35.40

35.32

33.82

17.61

22.36

30.96

30.79

39.97

41.45

24.10

45.92

70.71

3.58

2.85

3,.23

2.09

3.28

2.78

50
Table 30. Prevalencerates for facial acne (all grades) at examinationamong youths age 12-11

years by youths’ report of problems with sleep, and by race and sex of youth, with standard

errors: United States, 1966-70

:

Both sexesl---------

White---------------------

Negro---------------------

Boys1-----------------

White---------------------

Negro---------------------

GirlsI----------------

White---------------------

Negro---------------------

Both sexesl---------

WMte---------------------

Negro---------------------

Boys1-----------------

White---------------------

Negro---------------------

Girlsl----------------

WMte---------------------

~egro---------------------

Youth reports trouble Youth reports having

sleeping nightmares

I I I I

Often Sometimes Never Often Sometimes Never

I I I I I

Rate per 100 youths

67.5] 69.6[ 67.0I 63.2 I 65.61 70.4

, 1

67.6

66.3

69.8 67.5 63.7

68.0 63.7 61.2

66.1 70.7

61.7 68.5

70.1 66.91 65.7 I 61.9 I 60.9 I 70.3

I I I I I

70.9

63.8

67.3 66.6 61.0

63.4 60.4 65.1

62.2 70.7

52.0 68.0

65.2 71.9 68.5 64.4 69.6 70.4

I I I I I

64.6

68.4

71.9 68.6 I

66.1

71.8 . 67.3 56.6

69.5 70.6

70.1 69.1

2.16

12.97

2.13 1.33

6.94 8.73

w

3.14 I 2.201 2.54

!!!_D!@

Youth reports:

B

X

59.2 68.6

::.; 69.1

. 65.2

58.1 67.0

57.2

67.9

61.0

67.9

61.3

70.2

60.0 70.4

69.3 69.0

Standard error

3.21 I 2.281 1.771 3.27

3.76 2.04 1.40

9.00 7.96 9.30

4.81 2.50 1.61

3.42

7.22

2.52

7.27 2.38 1.20 I

2.58

11.49 6.98 8.90 10.57

6.81 2.31 2.42 7.12

I I I

8.01

11.07

2.08 2.24

10.13 10.11 I

7.11

15.37

1.92

1.60

8.38

1.89

1.62

7.41

2.19

1.90

9.71

lIncludesall racial groups—white, Negro, and other.

4U
Table 31. Prevalence rates for facial acne at examination among youths age 12-17 years, by eating habits of

youths (as reported by parents), race, and sex, with standard errors: United States, 1966-70

Facial acne-all grades I

Moderate-severe facial acne

Parent states Parent states Parent states

youth’s eating

habits are: youth eats youth’s eating

habits are:

Not little ;g;y ;:h ‘ight Too Not A

fussY fussy

little ::;y amount little fussy ~u55y

Parent states

youth eats Race and sex

Rate per 100 youths

Both aexesl --

White --------------

Negro -------------- 1

67.6 62.9

67.9 62.7

65.4 64.0

66.5 54.8

74.0

75.8

67.2

71.5

69.0 _

:;.:

.

68.4

67.1

67.1

67.4

64.4

68.4 29.8

i68.4 29.8

68.2 30.5

65.6 31.1

63.4 33.9

73.4 20.3

71.1 28.7

28.4

29.3

21.9

33.4

34.7

24.2

22.9

T

23.7 29.4

24.8 30.5

19.8 22,4 T

26.4 31.6

27.1 31.8

21.5 31,5

Boysl ---------- T

24.0 34.1

24.4 35.5

21.9 25.3

White --------------

Negro-- ------------

74.3

60.8

76.2

77.1

72.9

2.52

67.0 54.7

63.0 55.1

69.8

59.5

69.6

64.7

61.6

Girlsl--------- 68.8 \ 69.1 69.8 23.6 24.5

White -------------- =--w

Negro --------------

68.8 68.9

68,0 69.7

69.7

67.6

2.29

69.5

72.4

73.1 26,5

62.6 39.5

23.5

19.4

25.0 25.4

18.3 19.4

21,1 32.9

24.4 31,1

Standard error

Both sexesl -- 1.85 2.59 1.79

1.72

6.34

1.88w

2.11

—

2.23

3.90

3.41

1.98

1,96

6.31

2.32

3,17

—

2.95

6.56

4.16

1.73

1.88

3.20

2,10

_

Nhite --------------

Negro.-------------

2.07

9.18

3.00

1.63

8.57

1.85

2.19

7.32

3.68

1.75

10.72

Boysl ---------- 2.51 3.261 3.111 2,06

2.92 3.65 2.11

6.80 5.60 5.57

White --------------

Negro --------------

2.93

6.42

3.53

2.48

.3.50

1.56

8.43

2.06

1.84

5.45

2.19

3.81

9.30

3.72

1.96

10.83

2.51

3.71

7.18

2.46

2.50

7.07

1.92

2.29

4.19

1.69

3.59

9.15

Girls l--------- 2.63 ---H-- 3.82 3.94 1.65

4.01 3.35 1.70

11.65 7.42 4.48

Nhite --------------

Negro --------------

2.01

9.14

3.61

9.63

2.15

11.43

2.13

7.79

2.98

3.90

1.74

6.31

1.78

4.58

3.47

4.89

1

Includes all racial groups—white, Negro, and other.

52
Table 32. Prevalence rates for facial acne at examination among youths age 12-17 year%

by eating habits of youths (as reported by parents), geographic region,and sex, with

standard errors: United States, 1966-70

Region and sex

Both sexes

Northeast ------------------- -------------

Midwest ----------------------------------

South ---------------------------- --------

West -------------------------------------

Boys

Northeast --------------------------------

Midwest ----------------------------------

South ------------------------------------

West ----------------------------------- --

Girls

Northeast --------------------------------

Midwest ----------------------------------

South ------------------------------------

West ----------------------------- --------

Parent states

youth eats

Too

much

Right

amount

Too

little

Rate per 100 youths

71.7

75.1

70.1

78.2

67.5

73.9

62.4

79.2

75.4

76.0

76.1

77.2

66.2

64.7

71.4

68.6

65.2

62.1

72.5

66.8

67.3

67.5

70.1

70.5

52.0

60.8

66.9

68.4

44.6

61.2

55.9

56.0

58.9

60.4

74.8

75.3

Parent states

youth eats

*

Standard error

3.42

4.17

9.04

3.12

6.23

3.05

8.64

4.22

2.65

5.48

3.65

6.34

2.66

4.38

4.68

1.85

3.63

3.48

4.62

3.65

2.29

5.53

4.79

2.86

4.95

3.71

6.90

4.30

7.77

6.02

6.91

13.91

6.87

4.66

7.23

6.03

53
Table 33. Prevalence rates for facial acne at examimtion among youths, by age, sex, and index-stage

of sexual maturity, with percent distribution of index-stage of sexual mturity at each year of age,

and with standard errors: United states, 1966-70

.

Index-stage of sexual maturity I Index-stage of sexual maturity

Age and sex II I I I I

1 2 3 4 5

All

stages 1 2 3 4 5

Both sexes I ~acial acne rate per 100 youths Percent distribution

12-17 years-------------- 13.0

12 years----------------------- 13.0

13 years----------------------- 10.2

14 years----------------------- 16.4

15 years----------------------- 43.7

16 years----------------------- -

17 years----------------------- -

Boys

12-17 years---------------- 11.1

12 years----------------------- 10.2

13 years----------------------- 10.5

14 years----------------------- 14.7

15 years----------------------- 43.7

16 years----------------------- -

17 years----------------------- -

Girls

12-17 years---------------- 22.0

33.1 56.8 74.6 86.1

—.

69.7

;;.;

76:4

74.0

82.6

78.4

100.0 14.3

16.5 3.3

33.5 11.8

44.8 27.5

42.0 46.3

35.3 61.2

21.1 77.2

28.6

35.6

40.8

48.2

61.1

31.0

50.7

54.4

62.2

59.4

76.6

84.2

56.5

;;. :

80:4

87.0

88.0

87.6

90.0

———

100.0

82.4

83.8

89.0

93.0

90.9

81.5

100.0

100.0

100.0

100.0

100.0

100.0

100.0

24.8

26.0

18.5

9.6

2.9

1.7

10.OI 15.4 11.5 23.91 39.2

I

26.0

32.3

40.2

45.0

61.1

38.8

43.7

54.3

67.9

53.2

75.2

100.0

57.0

::.:

76:7

78.0

81.4

93.1

72.3

100.0

100.0

100.0

100.0

100.0

100.0

100.0

37.0

1:.:

0:8

42.5

30.4

11.2

3.0

1.3

14.3

23.9

17.8

8.0

2.8

0.5

17.2

0.5

2:::

39.5 2;:+

37.9 50.3

23.8 72.1

11.9 87.6

*

*

27.6

42.9 1::?

50.4 28.3

46.1 42.2

47.1 49.9

30.4 66.7

12 years----------------------- 23.5

13 years----------------------- 7.3

14 years----------------------- 30.9

15 years----------------------- -

16 years----------------------- -

17 years----------------------- -

Both sexes

12-17 years---------------- 1.77

12 years----------------------- 2.41

13 years----------------------- 3.16

14 years----------------------- 5.71

15 years-----------------------29.27

16 years----------------------- -

17 years----------------------- -

Boys

12-17 years---------------- 1.79

12 years----------------------- 2.75

13 years----------------------- 3.41

14 years----------------------- 6.03

15 years-----------------------29.27

16 years----------------------- -

17 years----------------------- -

Girls

12-17 years---------------- 4.99

;: ~r;----------------------- 5.72

-----------------------11.20

14 years-----------------------23.83

15 years----------------------- -

16 years----------------------- -

17 years----------------------- -

34.4

45.2

44.5

68.7

2.33

53.5

54.5

56.8

63.8

78.0

81.7

69.7

70.9

71.3

75.0

70.1

78.4

82.9

77.7

77.1

84.6

80.6

83.1

100.0

100.0

100.0

100.0

100.0

100.0

10.6 20.0

1.5 10.7

0.6

M

35.5

28.2

19.1

11.2

3.0

2.9

0.78

1.72

1.53

1.89

1.16

0.69

0.48

0.71

1.59

2.28

2.31

1.35

0.89

0.27

1.21

Standard error

0.391 0.52

I

3.031 2.251 1.691 ...

I I I

1.27 0.56

1.66 1.52

1.69 2.70

2.77 3.22

2.77 2,82

1.20 1.48

2.38

3.71

6.78

14.02

35.96

-

3.19

3.47

4.09

7.87

14.69

35.96

3.71

;.;; :.:; 5.66

3.00

4:09 2:85 3.85

6.69 2.35 2.39

6.54 3.46 2.23

12.34 2.67 1.75

. . .

. . .

. . .

. . .

.,.

.,.

1.38 2.31

1.20 1.15

0.40 0.89

0.17 0.41

- 0.32

3.85/ 2.611 1.651 ...

I I *

1.28[ 1.67

I

6.64 6.41 31.62 ,..

4.13 5.57 5.45 ...

5.27 3.98 3.69 ...

10.05 2.33 3.78 ,..

13.59 3.79 1.82 ...

50.00 4.11 1.98 ...

2.49 2.83

2.00 1.59

0.80 1.63

0.3: :.;:

.

3.121 2.531 2.091 ... 1.481 1.87

1.06 2.51

0.59 1.43

0.40 0.54

- 0.28

4.01

7.75

13.65

40.15

5.48

4.41

5.15

6.28

8.36

14.58

5.80

3.82

3.54

3.30

$$;

.

6.07

3.61

5.95

2.46

3.74

3.23

. . .

. . .

. . .

. . .

. . .

. . .

2.25

2.00

2.97

1.89

1.00

0.91 1

2.44 1.14

2.89 2.27

2.47 3.14

2.95 3.68

3.79 ;.;:

1.80 .

54
Table 34. Prevalence rates for facial acne and expected rates among white and Negro

youths age 12-17 years, by index-stageof sexual maturity and sex, with standard errors: United States, 1966-70

Index-stagea;~~sual maturity

Stage

Stage

Stage

Stage

Stage

Stage

Stage

Stage

Stage

Stage

Stage

Stage

Stage

Stage

Stage

Both sexes

1---------------------------- ---

2------------------------------

3------------------------------

4-----------------.------------

5-----------------------.------

Boys

1-----------------------.------

3------------------------------

4------------------------------

5------------------------------

Girls

2------------------------------

3------------------------------

4------------------------------

5------------------------------

Race

=

Rate per 100

youths

12.3

34.0

58.0

75.4

86.8

10.2

32.4

57.7

79.4

90.9

21.7

38.1

58.3

72.9

81.7

20.1

27.9

46.7

69.1

82.3

18.8

23.2

48.2

71.8

84.5

28.7

51.7

45.5

67.5

80.3

Race

White Negro

Expected rate

13.0

33.2

56.7

74.6

86.3

11.0

30.9

56.5

78.4

90.1

21.8

38.9

56.8

72.4

81.5

13.4

32.5

57.2

74.3

85.2

11.8

31.3

56.6

78.4

89.6

23.5

38.4

57.6

71.9

81.3

Race

White Negro

Standard error

1.84

2.38

2.96

1.65

1.62

1.76

3.14

3.92

2.38

1.53

5.21

4.03

3.08

2.06

2.21

4.72

7.67

10.27

11.31

5.84

4.70

7.84

12.33

10.75

5.13

16.57

16.96

9.85

12.00

7.05

55
Table 35. Percent distributionof age at onset of menarcheby age at which acne startedamong girls age 12-

17 years,with standardexrors:United States,1966-70

i

Percent

distributicm

of age

17 of onyears set of

menarAge acne started

iedian

Ige of

3tart

of

I

Age at onset of

menarche 13 14

years years

15 16

years years

9

years 10 11 12

years years years

1:s

Total

acne

I I I ~~

Percentdistribuc~on Year

13.3

T&l.78irls,

years------ 100.O

100.0

100.0

100.0

100.0

100.0

100.0

100.0

“IOO.O

...

...

...

...

...

...

...

...

...

2.2 5.4 16.1 28.1 27.5 1.8 0.2: 100.0

4.9

5.8

3.9

N

31.1

20.4

12.3

2.6

1.4

15.3

19.9

;:.;

4:8

M

9.81

;.::

1:40

1.03

1.42

8.23

20.9

28.0

28.5

UJ.;

11:6

18.1

14.28

5.08

2.38

2.28

2.16

4.46

12.43

15.7

13.4

12.9

23.8

48.4

28.7

18.4

Stand

10.65

5.13

2.28

2.33

2.25

3.60

7.03

6.2

8.3

1;:2

20.7

37.2

11.5

33.0

5.9

4.2

i::

1%:

24.5

37.7

M

19.7

36.4

28.9

7.0

:::

---

---

---

---

---

---

---

---

---

11.9

12.1

12.1

12,8

13.5

14.2

14.4

15.4

---

---

---

---

---

---

---

---

---

9 years or less----

10 years-----------

11 years-----------

12 yeara-----------

13 years-----------

X4 year~-----------

15 years-----------

16 years-----------

17 years-----------

1.Z

1.2

2.3

3.3

18.7

29.3

0.7;

0.54

0.72

1.58

10.12

22.38

0.;

0.2

0.5

o.3i

0.18

0.35

-1

d error

9 years or less----

10 years-----------

11 years-----------

12 years-----------

13 years-----------

14 years-----------

15 years-----------

16 years-----------

17 years-----------

5.75 13.56

1.92 4.01

1.67 2.03

0.95 0.84

0.37 0.62

6.68 6.52

3.00 2.54

1.75 0.90

1.88 1.07

2.23 1.43

3.83 2.09

6.48 9.82

24.78 44.37 _E -1 -

56
APPENDIX 1

STATISTICAL NOTES

The Survey Design

The sample design for the first three ptograms

or Cycles I-III of the Health Examination Survey has

been essentially similar in that each has been a multistage, stratified probability sample of clusters of households in land-based segments. The successive elements

for this sample design are primary sampling units,

census enumeration district, segment (a cluster of

households), eligible persons, and finally, the sample

person.

The 40 sample areas and the segments utilized in

the design of Cycle HI were the same as those in Cycle

II. Previous reports describe in detail the sample design used for Cycle 11and in addition discuss the problems and considerations given to other types of sampling frames, cluster versus random sampling, and

whether or not to control the selection of siblings. 4~5

Requirements and limitations placed on the design for Cycle III, similar to those for children in

Cycle II, were that:

1.

2.

3.

4.

5.

The target population be defined as the civilian

noninstitutional population of the United States,

including Alaska and Hawaii, between the ages

of 12 and 17 years for Cycle III, with the special

exclusion of children residing on reservation

lands of the American Indians. The latter exclusion was due to operational problems encountered on these lands in Cycle I.

The time period of data collection be limited

to about 3 years for each cycle and the length

of the individual examination within the specially constructed mobile examination center be

between 2 and 3 hours.

Ancillary data be collected on specially designated households, from medical history and

school questionnaires and from birth certificate copies.

Examination objectives be primarily related

to factors of physical and intellectual growth

and development.

The sample be sufficiently large to yield reliable findings within broad geographic regions

and population density groups as well as age,

sex, and limited socioeconomic groups for the

total sample.

The sample was drawn jointly with the Bureau of

the Census starting with the 1960 decennial census

list of addresses and the nearly 1,900 primary sampling units (P SLPS) into which the entire United States

was divided. Each PSU is either a standard metropolitan statistical area (SMSA), a county, or a group

of two or three contiguous counties. These PSU’S were

grouped into 40 -strata, with each stratum having an

average size of about 4.5 million persons, in such a

manner as to maximize the degree of homogeneity

within strata with regard to the population size of the

PSLPS, degree of urbanization, geographic proximity,

and degree of industrialization. The 40 strata were’

than classified into 4 broad geographic regions of 10

strata each and then, within each region, cross-classified by four population density classes and classes

of rate of population change from 1950 to 1960. Using

a modified Goodman-Kish controlled-selection technique, one PSU was drawn from each of the 40 strata.

Further stages of sampling within PSU’S required

first the selection of census enumeration districts

(ED’s). The ED’s are small well-defined areas of about

250 housing units into which the entire Nation was

divided for the 1960 population census. Each ED was

assigned a “measure of size” equal to the rounded

whole number resulting from a “division, by nine” of

the numkr of children, aged 5-9, in the ED at the time

of the 1960 census. A sample of 20 ED’s in the sample

PSU were selected by systematic sampling with each

ED having a probability of selection proportional to

the population of children 5-9 years at the time of the

1960 census date. A further random selection by size

of segments (smaller clusters of housing units) within

each ED was then made.

Because of the 3-year time interval between

Cycle II and Cycle III, the Cycle III frame had to be

supplemented for new construction and to compensate

for segments where housing was partially or totally

demolished to make room for highway construction or

urban redevelopment.

57
Advanced planning for the examinations at the

various locations or stands provided for about 17 days

of examinations which limited the number of examinees

per location to approximately 200. When the number

of eligible youths in the sample drawn for a particular

location exceeded this number, subsampling was done

by deleting from the master list of eligible youths

(ordered by segment, household order within segment,

and age within household) every n th name on the list

starting with the Y th name, Y being a number between

I and n selected randomly and n being the extent

of oversampling in the original draw.

In Cycle III, as in Cycle II, twins who were deleted

in the sample selection were also scheduled for examination, time permitting, as were youths deleted

from the Cycle 111sample who had been examined in

Cycle IL

The sample was selected in Cycle 111, as it had

been for the children in Cycle II, so as to contain the

correct proportion of youths from families having

only one eligible youth, two eligible youths, and so on

to be representative of the total target population.

However, since households were one of the elements

in the sample frame, the number of related youths in

the resultant sample is greater than would come from

a design which sampled youths 12-17 years without

regard to household. The resultant estimated mean

measurements or rates should be unbiased but their

sampling variability will be somewhat greater than

those from more costly, time-consuming systematic

sample design in which, every kth youth would be

selected.

The total probability sample for Cycle III included

7,514 youths representative of the approximately 22.7

million noninstitutionalized United States youths of

12-17 years. The sample contained youths from 25

different States with approximately 1,000 in each

single year of age.

The response rate in Cycle III was 90 percent,

with 6,768 youths examined out of the total sample.

These examinees were closely representative of those

in the samples as well as the population from which

the samples were drawn with respect to age, sex,

race, region, population density, and population growth

in area of residence. Hence it appears unlikely that

nonresponse could bias the findings appreciably. The

number of examinees and the population which the

sample was selected to represent are shown by age

and sex in table “I.

Measures used to control the quality of the data

from these Surveys have been cited previously; 5’29

those additional measures specifically related to the

Table 1. .Number of exaini.nees and estimsted U.S. population frequency distribution of youths Ln

the noninstitutional population of the United States, by race, age, and sex: Health Examination

Survey, 1966-70

Age and sex

H

14

15

16

17

Both sexes

12-17 years -------------------

Boys

12-17 years -------------------

years ----------------------------

years ----------------------------

years ----------------------------

years ----------------------------

years ----------------------------

years ----------------------------

Girls

12-17 years -------------------

12 years ----------------------------

13 years ----------------------------

14 years ----------------------------

15 years ----------------------------

16 years ----------------------------

17 years ----------------------------

Number of examinees

6,768

3,545

643

626

618

613

556

489

3,223

547

582

586

503

536

469

5,735

3,047

540

542

527

525

496

417

2,688

455

490

484

425

441

393

999

479

101

80

88

84

57

69

520

88

1::

;:

74

34

~

Population in thousands

22,692 19,552

T11,489 9,92S

2,032 1,747

2,006 1,72S

1,951 1,686

1,900 1,646

1,836 1,594

1,764 I,52E

=311--

1,970 1,685

1,946 1,667

1,901 1,633

1,851 ;,::;

1,789

1,746 1 ;502

II

3,024

1,496

280

262

256

241

231

225

1,527

272

275

266

235

243

237

116

64

1:

1?

11

11

53

1:

2?

5

7

5-8
particular examinations, tests, or measurements are

outlined in the analytic reports describing and presenting the respective initial findings.

Reliability

While measurement processes in the Surveys were

carefully standardized and closely controlled, the correspondence between the real world and Survey results

cannot be expected to be exact. Survey data are imperfect for three major reasons: (1) results are subject

to sampling error, (2) the actual conduct of a survey

never agrees perfectly with the design, and (3) the

measurement processes themselves are inexact even

though standardized and controlled.

The first report on Cycle III 5 describes in detail

the faithfulness with which the sampling design was

carried out.

Data recorded for each sample youth are inflated

in the estimation process to characterize the larger

universe of which the sample youth is representative.

The weights used in this inflation process are a product of the reciprocal of the probability of selecting

the youth, an adjustment for nonresponse cases, and

a poststratified ratio adjustment which increases precision by bringing survey results into closer alignment with known United States population figures by

color and sex within single years of age 12 through

17 for the youths’ survey.

In the third cycle of the Health Examination Survey (as for the children in Cycle II) the samples were

the result of three principal stages of selection—the

single PSU from each stratum, the 20 segments from

each sample PSU, and the sample youth from the eligible persons. The probability of selecting an individual youth is the product of the probability of selection at each stage.

Since the strata are roughly equal in population

size and a nearly equal number of sample youths were

examined in each of the sample PSU’S, the sample

design is essentially self-weighting with respect to

the target population; that is, each youth 12 through

17 years had about the same probability of being

drawn into the sample.

The adjustment upward for nonresponse is intended to minimize the impact of nonresponse on final

estimates by imputing to nonrespondents the characteristics of “similar” respondents. Here “similar”

respondents were judged to be examined youths in a

sample PSU having the same age (in years) and sex

as youths not examined in that sample PSU.

The poststratified ratio adjustment used in the

second and third cycle achieved most of the gains

in precision which would have been attained if the

sample had been drawn from a population stratified

by age, color, and sex and makes the final sample,

estimates of pomtlation agree exactly with independent controls prepared by the Bureau of the Census

for the U.S. noninstitutionalized population as of March

9, 1968–(approximate midsurvey point for Cycle III),

by color and sex for each single year of age 12-17.

The weights of every responding sample youth in each

of the 24 age, color, and sex classes are adjusted

upwards or downwards so that the weighted total within’ the class equals the independent population control

for each survey.

Sampling and Measurement Error

In the present report, reference has been made to

efforts to minjmize bias and variability of measurement techniques.

The probability design of the Survey makes possible the calculation of sampling errors. The sampling error is used here to determine how imprecise

the survey test results may be because they come from

a sample rather than from the measurements of all

elements in the universe.

The estimation of sampling errors for a study of

the type of the Health Examination Survey is difficult

for at least three reasons: (1) measurement error and

“pure” sampling error are confounded in the data— it

is not easy to find a procedure which will either completely include both or treat one or the other separately, (2) the survey design and estimation procedure

are complex and accordingly require computationally

involved techniques for the calculation of variances,

and (3) are coming from the survey thousands of statistics, many for subclasses of the population for

which there are a small number of cases. Estimates

of sampling error are obtained from the sample data

and are themselves subject to sampling error which

may be large when th( number of cases in a cell is

small or even occasio,lally when the number of cases

is substantial.

Estimatea of approximate sampling variability

for selected statistics used in this repor~ are included

in the detailed tables. These estimates have been

prepared by a replication technique which yields overall variability through observation of variability among

random subsamples of the total sample. 29 The method

reflects both “pure” sampling variance and a part of

the measurement variance.

In accordance with usual practice, the interval

estimate for any statistic may be considered the range

within one standard error of the tabulated statistic,

with 68 percent confidence; or the range within two

standard errors of the tabulated statistic, with 95 percent confidence. The latter is used as the level of

significance in this report.

An approximation of ~he standard error of a difference d. x -< of two statistics x and Yis given by the

formula ti~=(SX +Sf~~ where S, andSY are the sampling

errors, respectively, of x and y. Of course, where the

59
two groups or measures are positively or negatively error may be several times as great as the statistic

correlated, this will give an overestimate or under- itself. Obviously in such instances the statistic has no

estimate, respectively, of the actual standard error. meaning in itself except to indicate that the true quantity is small. Such numbers, if shown, have been inSmall Numbers eluded in the belief that they may help to convey an

impression of the overall story of the table.

In some tables magnitudes are shown for cells for

which the sample size is so small that the sampling

am

60
APPENDIX II

DEMOGRAPHIC AND SOCIOECONOMIC TERMS

Age. —The age recorded for each youth was the

age at last birthday on the date of examination. The

age criterion for inclusion in the sample used iri this

survey was defined in terms of age at time of interview. Since the examination usually took place 2 to 4

weeks after the interview some of those who were 17

years old at the time of interview became 18 years

old by the time of examination. There were 23 such

cases. In the adjustment and weighting procedures

used to produce national estimates these 23 were included in the 17 year group.

Race:—Race was recorded as “white,” “Negro,”

or !IotherC!t llOtherll included American Indians, Chinese, Japanese, and all races other than white or

Negro. Mexican persons were included with “white”

unless definitely known to be American Indian or of

other nonwhite race. Negroes and persons of. mixed

Negro and other parentage were recorded as “Negro.”

Geographic re@”on.— For purposes of stratification

the United States was divided into four geographic

regions of approximately equal population. These regions, which correspond closely to those used by the

Bureau of the Census, were as follows:

Region Sfutes Included

Northeast ------- Maine, Vermont, New Hampshire

Massachusetts, Connecticut, Rhode

Island, New York, New Jersey,

and Pennsylvania

Midwest -------- Ohio, Illinois, Indiana, Michigan,

Wisconsin, Minnesota, Iowa, and

Missouri

South ---------- Delaware, Maryland, District of

Columbia, West Virginia, Virginia,

Kentucky, Tennessee, North

Carolina, South Carolina, Georgia,

Florida, Alabama, Mississippi,

Louisiana, and Arkansas

West ----------- Washington, Oregcm, California,

Nevada, New Mexico, Arizona,

Texas, Oklahoma, Kansas, Nebraska,

North Dakota, South Dakota, Idaho,

Utah, Colorado, Montana, Wyoming,

Alaska, and Hawaii

Urban-Rural. -The definition of urban-rural areas

was the same as that used in the 1960 Census.

According to this definition, the urban population was

comprised of all persons living in (a) places of 2,500

inhabitants or more incorporated as cities, boroughs,

villages, and towns (except towns in New England, New

York, and Wisconsin); (b) the densely settled urban

fringe, whether incorporated or unincorporated of urbanized areas; (c) towns in New England and townships in New Jersey and Pennsylvania which contained

no incorporated municipalities as subdivisions and

had either 2,500 inhabitants or more, or a population

of 2,500 to 25,000 and a density of 1,500 persons or

more per square mile; (d) counties in States other

than the New England States, New Jersey, and Pems ylvania that had no incorporated municipalities within their boundaries and had a density of 1,500 persons

or more per square mile; and (e) unincorporated

places of 2,500 inhabitants or more not included in

any urban fringe. The remaining population was classified as rural.

Urban areas are further classified by population

size for places within urbanized areas and other urban

places outside urbanized areas.

Family income. —The income recorded was the

total income of the past 12 months received by the

head of the household and all other household members

related to the head by blood, marriage, or adoption.

This income was the gross cash income (excluding

pay in kind) except in the case of a family with their

own farm or business, in which case net income was

recorded.

* U.S. GOVERNMENT PRINTING OFFICE 1976- 210-981:39
APPENDIX Ill

MEDICAL HISTORY AND PHYSICAL EXAMINATION

11.

12.

18.

50.

53.

54.

DEPARTMENT OF

HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

NATIONALHEALTN SURVEY

MEDICAL HISTORY OF YOUTH

Parent’s Questionnaire

How would you describe his or her present health?

1 ~ Poor 2 ~ Fair 3 ❑ Good 4 ❑ Very Good 5 ❑ Excellent

IF POOh OR FAIR: What is the matter?

Does he or she now use any medicine regularly (rwt counting oitarnins)?

1

9

Yes 20No s ❑ Don’t know

-

a. What is the name of the medicine? z ❑ Don’t, know

b. What ie it for? 2 ❑ Don’t know

c. Did a doctor say he or she should use it?

I ❑IYes 2 ❑ NO j ❑ Don’t know

d. How long has he or she been using it?

Has he or she ever had (CHECK Y= OR JQ IN EVERY LINE).

f. Asthma I •l Yee ,DNo

g. Hay fever I •l Yes ,DNO

h. Other allergies 1 ❑ Yes ZDNO

Some people are calm, others are nervous (tense, A;gh.strrmg). Which describes him or

her best?

I Q Not nervous at all

z ❑ Somewhat nervous

3 •l Very nervous

Would you say be or she eats:

1 ❑ Too much

2 n About the right amount

3 ❑ Too little

How fussy an eater is he (she):

I ❑ Not fussy at all

* ❑ A little fussy

3 ❑ Very fussy
HEALTH HABITS AND HISTOW - Youth

4. How would you describe your present health?

1 ❑ Poor 2 H Fair 3 ❑ Oood 4 ❑ Very good 5 ❑ Excellent

a. IF POOR OR FAIR: What is wrong?

6. Do you now use any medicine regularly, not counting vitamins?

1 •l Yes 20No 3 ❑ Don’t know

IF YES

a. What is its name? ❑ Don’t know

b. What is it for?

❑ Don’t know

c, Did a doctor say you should use it?

1 •l Yes 20No

d. How long have you been using it?

30. How often do you have trouble getting to sleep or staying asleep?

1 •l Very often 2 ❑ OnIy from time to time 3 u Never

31. How often do you have bad dreams or nightmare?

1 ❑ Quite frequently 2 ❑ Only from time to time 3 n Never

8$2. As far ae you know, have you walked in your sleep in the last year or so?

1 Cl Yes 2i3No

93. Do you have acne (pimples or blackheads)?

1 ❑ Yes XDNO

IF YES:

a. At what age did it start? years

b. Do you use any treatment for it? 1 •l Yes 20No

c. Have you seen a doctor about it? 1 •l Yes 20No

d. How much does it bother or worry you?

1 ❑ Quite a lot 2 ❑ Some but not too much 3 •l Very little

4 ❑ Not at all

63
DEPARTMENT OF

HEALTH, EDUCATION,AND WELFARE

PUBLIC HEALTH SERVICE

NATIONAL HEALTH SURVEY

HEALTH BEHAVIOR- Youth

11. Do you ever feel tense, nervous, or fidgety?

1 •l Yes, often

2 •l Yes, sometimes

a ❑ Yes, but rarely

4 ❑ Never

64
.

DEPARTMENT OF

HEALTH, EDUCATION, AND WELFARE

PUBLIC HEALTH SERVICE

NATIONAL CENTER FOR H!SALTH STATISTICS

HEALTH EXAMINATION SURVEY

SUPPLEMENTAL INFORMATION FROM SCHOOL

8. ARE SPECIAL RESOURCES NEEDED OR CURRENTLY BEING USECI FORTHISSTUDENT?

z ❑ NO (SKIP TO WEST10N9)

f ❑ YES~l F YES, complete the following only forthosespeciaI resources needed orcurrently being used

bv this Youth:

RESOURCE NEEDED REASON FOR NON-USE

(Check one) (Check primary rsa.an)

SPECIAL

RESOURCE ❑EING NOT

AVAILABLE

❑UT

OVER- STUDENT PARENTS

USED

OTHER (s@djy)

‘VA’ LABLE NOT USED cROwD ED

OBJECTS OBJECT

d. For emotionally disturbed 1111111

9, IN TERMS OF ADJUSTMENT, WHICH OFTHEFOLLOWING BEST DESCRIBES THIS STUOENT7

I ❑ SEEMS WIZLL ADJUSTED.

2 ❑ SEEMS SOMEWHAT MALADJUSTED.

S ❑ SEEMS SERIOUSLY MALADJUSTED.

4 •l NO ❑ASIS FOR JUDGING WHICH OF 7HE ABOVE FITS THIS STUDENT.

65

/
PHYSICALEXAMINATION

SKIN

FACIAL ACNE-GRADE

OTHER SKIN FINDINGS: 1 ❑ NO FINDINGS 2 ❑ FINDINGS (Cwcriboh

0111 Ill w

on 10 au 30 40

I

66

,.
series1.

Series 2.

Series 3.

Series 4.

Sert”es10.

Sert”es11.

Sen”es 12.

VITAL AND HEALTH STATISTICS PUBLICATIONS SERIES

Formerly l%blic Health Sm”ce fiblicatwn No. 1000

Programs and Collectt”on fiocedures. –Reports which describe the general programs of the National

Center for Health Statistics and its offices and divisions, &ta collection methods used, definitions, and

other material necessary for understanding the data.

Data Evaluation and Methods Research. –Studies of new statistical methodology including experimental

tests of new survey methods, studies of vital statistics collection methods, new analytical techniques,

objective evaluations of reliability of collected data, contributions to statistical theory.

Analytical Studies. –Reports presenting analytical or interpretive studies based on vital and health

statistics, carrying the analysis further than the expository types of reports h the other series.

Documents and Committee Reports. –Final reports of major committees concerned with vital and

health statistics, and documents such as recommended model vital registration laws and revised birth

and death certificates.

Data from the Health Intervt”ew Survey .–Statistics on illness; accidental injuries; disability; use of

hospital, medi$al, dental, and other services; and other health-related topics, based on data collected in

a continuing national household iriterview survey.

Data from the Health Examination Survey. –Data from direct examination, testing, and measurement

of national samples of the civilian, noninstitutionalized population provide the basis for two types of

reports: (1) estimates of the medkally defined prevalence of specific diseases in the United States and

the distributions of the population with respect to physical, physiological, and psychological characteristics; and (2) analysis of relationships among the various measurements without reference to an

explicit finite ‘hniverse of persons.

Data from the Institutionalized Po@dation Surveys. –Discontinued effective 1975. Future rermrts from

these- surveys will be in Series 13. “

.

Series 13. Data on Health Resources Utilisation. –Statistics on the utilization of health manpower and facilkies

providing long-term care, ambulatory care, hospital care, and family planning services.

Series 14. Data on Health Resources: Manpower and Facilities. –Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health occupations, hospitals, nursing homes, and outpatient facilities.

Series 20. Data on Mortality. –Various statistics on mortality other than as included in regular annual or monthly

reports. Special analyses by cause of death, age, and other demographic variables; geographic and time

series analyses; and statistics on characteristics of deaths not available from the vital records, based on

sample surveys of those records.

Series 21. Data on Natality, Marn”age, and Divorce. –Various statistics on natality, marriage, and divorce other

than as included in regular annual or monthly re~rts. Special analyses by demographic variables;

geographic and time series analyses; studies of fertility; and statistics on characteristics ef births not

available from the vital records, based on sample surveys of those records.

Series 22. Datu j+om the National Mortality and Natality Surueys. –Discontinued effective 1975. Future reports

from these sample surveys based on vital records will be included in Series 20 and 21, respectively.

Series 23. Data j%om the National Survey of Family Growth. –Statistics on fertility, family formation and dissolution, family planning, and related maternal and infant health topics derived from a biennial survey of

a nationwide probability sample of ever-married women 1544 years of age.

For a list of titles of reports published in these series, write to: Scientitlc and Technical Information Branch

National Center for Health Statistics

r Public Health Service, HRA

Rockville, Md. 20852