FEDERAL SECURITY AGENCY Paul V. McNutts Administrator National Youth Administration Aubrey Williams, Administrator United States Public Health Service Thomas Parran, Surgeon General THE HEALTH STATUS OF NYA YOUTH A Nation-Wide Survey of Youth on the Out-of-School Work Programs of the National Youth Administration Frontispiece—Map Showing Census Regions. FEDERAL SECURITY AGENCY Paul V. McNutt, Administrator National Youth Administration Aubrey Williams, Administrator United States Public Health Service Thomas Parran, Surgeon General THE HEALTH STATUS OF NYA YOUTH A Nation-Wide Survey of Youth on the Out-of-School Work Programs of the National Youth Administration UNITED STATES GOVERNMENT PRINTING OFFICE WASHINGTON ; 1942 THE HEALTH STATUS OF NYA YOUTH Prepared jointly by National Youth Administration Division of Finance and Statistics Vernon D. Northrop, Director United States Public Health Service National Institute of Health Division of Phblic Health Methods George St. J. Perrott, Chief For Bale by the Superintendent of Documents, Washington, D. C. Price 25 cents FOREWORD This report deals with the health status of youth employed or seeking employment on out-of-school work programs of the National Youth Administration in the United States. It is based upon the findings of complete physical examinations of NYA youth and analyzes the nearly 150,000 examinations made during the first three-quarters of 1941 throughout the entire United States. No subsequent reports by separate census regions will be published, but sets of tables presenting the most important findings have been prepared for each such region and are available to those interested, upon request to the United States Public Health Service. This study was undertaken as a part of the Nation-wide health program for NYA youth employees. This program was conducted by the National Youth Administration under the general direction of Dr. Carl E. Rice, national health director of that organiza- tion. The United States Public Health Service cooperated in the development and conduct of the NYA health program and sponsored the tabulation of the examination records. Its Division of Public Health Methods of the National Institute of Health worked with the Division of Finance and Statistics of the National Youth Administration in planning this study and in tabulating and analyzing the data. Acknowledgments are made to the following individuals who are (or were) connected with the National Youth Administration: Mr. Irving Swerdlow, former Chief of the Statistics Section of the Division of Finance and Statistics, under whose general direction the study was conducted; Mr. James S. Fitzgerald, of his office, who rendered valuable assistance in the important work of drawing up the examination form and punch card; Miss Irma Ringe and Miss Helen Hollingsworth, who assisted in planning the tabulation and preliminary analysis; and Mr. Maurice Lipian and Dr. Neil J. Van Steenberg, under whose direction the analysis of the data was completed. Further acknowledgments are made to Mr. Rollo H. Britten and Dr. Selwyn D. Collins, both of the Division of Public Health Methods, National Institute of Health, whose advice and suggestions were of great value throughout the study. This manuscript was prepared by Mr. Arthur J. McDowell of the National Institute of Health and Mr. Thomas N. Meroney of the National Youth Administration, The responsibility for the conclusions presented herein is that of these authors. The work of processing and tabulating these data was done by an NYA work project in the State of Illinois. This work was directed by Mr. McDowell, with the assistance of Mr. Meroney. A word is in order concerning the arrangement of the present paper. The entire discus- sion of the type of examination made, the manner in which the sample was selected, and a number of related matters, all of definite importance in any detailed consideration of the findings, has been placed in the appendix. This was done to facilitate reading of the report by persons concerned with the general health needs of groups within the popula- tion. Those interested in methodology might well read appendix A first and then the text proper. CONTENTS Page Foreword m I. Introduction 1 II. The General Health Level of NYA Youth 3 Evaluation Procedures; Health Status and Employability Classifications; Recommendations Made by Examiners. HI. Specific Physical Findings and Corresponding Recommendations (with Consideration of Geographic and Rural-Urban Variations) 15 Dental and Oral Defects; Eye Defects; Ear-Nose-Throat Defects; Weight and Nutritional Status; Condition of Heart and Circulatory System; Orthopedic Defects; Tuberculosis; Venereal Diseases; Hook- worm Infection; Urinalysis Findings; Other Diseases and Defects. IV. Summary and Conclusions 43 Appendix A; The Methodology of This Study 45 The Examination Procedure; the Tabulation Procedure; the Selection of the Sample; Appraisal of the Sample Obtained. Appendix B: The Health Examination Record Form 55 Appendix C: Basic Tables 55 I. INTRODUCTION Twenty-five years ago, when this country fought in the First World War, literally millions of young men received physical examinations to determine whether they were physically fit to serve in the armed forces. Nearly one-third of those examined were disqualified for unlimited military service because of some physical defect.1 Now a new generation has grown up and—in the emergency of a war—the health of this new generation is being appraised. And from this appraisal it becomes clear that here is one more unlearned lesson of that previous war. The Nation is shocked to discover that this time far more than one-third—perhaps even one-half—of the young men examined have been disqualified for un- limited military service because of physical de- fects.2 Without considering the effects of changes in standards or in examining procedures, it is evident that a serious state of ill health still exists. Very many of these defects can be cor- rected. Still more of them could have been prevented or corrected if community machinery had existed for handling the problem earlier. Medical scientists have been extremely success- ful in their search for the knowledge necessary to solve our health problems. Diseases have been traced to causes, causes have been matched by preventive techniques, and diseases matched by cures. Whether our country loams to apply this knowledge successfully remains to be seen. One of the most important of our health problems is physically impaired youth. It is certain that this problem will not be solved until its existence is recognized and its nature examined. Any pro- gram of rehabilitation, any plan for matching the incidence of defects with measures to correct them, must be based on information as to the extent of existing defects, their nature and dis- tribution among various population groups, their rate of incidence, and their effect on youth. It is hoped that the present study furnishes some of this needed information. It is hoped even more that the matter will not end with the discovery of the facts but that this and other information will be used to help build a healthier people. The present study consists of the analysis of nearly 150,000 health examination records of NYA youth. They are boys and girls from 16 to 24 years of age who are from low-income fami- lies. The examinations, made between January and October 1941, by private physicians paid by the National Youth Administration, have already served useful purposes. They have been used— and are being used—in the placement of NYA youth at work that will not aggravate any existing health defects or endanger fellow workers. They have also been used as a basis for health counseling and guidance in referring youth to physicians, clinics, hospitals, and other health agencies for treatment. The analysis of these examination records will serve several immediate purposes in connection with the program of the National Youth Administration. It provides a necessary foimdation for any plans toward meeting the health needs of the youth. It has great potential value as an aid in program planning, in deter- mining what additional steps in recreational activities, nutrition guidance, health counseling, or referral service are necessary to improve the health status, and so the occupational prospects of NYA youth. In addition to the importance to the National Youth Administration of an analysis of these health examination records, the findings have broader implications and significance. Research workers in the field of health are keenly aware of the lack of adequate information on the health of youth. Previous studies have furnished some information on the problem but have had various shortcomings. Some of them, based on ex- aminations of school children, concern a younger age group than NYA youth. Some of the studies have suffered from the necessity of being based on examinations already made under conditions that did not insure comparability. Others, such as the National Health Survey, have had a somewhat different aim in that they have sought primarily to determine incidence and duration of disability over a time period. They have there- fore used the technique of visits to family members 1 Britten, Hollo EL and Perrott, George St. L: Summary of Physical Find- ings on Men Drafted in the World War. Public Health Reports, vol. 56, No. 2, January 10, 1941, pp. 41-62. See also, Second Report of the Provost Marshal General to the Secretary of War on the Operations of the Selective Service System to December 20, 1918, Washington, D. C„ Government Printing Office, 1919. And, Love, Albert G. and Davenport, Charles B.: Defects Found in Drafted Men, Government Printing Office, Washington, 1940. 2 National Headquarters, Selective Service System: Analysis of Reports of Physical Examination; their bulletin, Medical Statistics Bulletin No. 1. November 10, 1941. See also, Rowntree, L. G., McGill, K. H., and Folk, O. H.: Health of Selective Service Registrants, Jour. Amer. Med. Ass’n, vol. 118, 1223 (April 1942). 2 THE HEALTH STATUS OF NYA YOUTH whose statements were the source of most of the data. Studies of this sort yield much informa- tion that cannot be obtained from the cross- sectional picture given by single thorough medical examinations. On the other hand, the accuracy and the completeness of the data must depend on the ability of the informant to give accurate and detailed information. For such information as can be obtained at one particular time, then, the reliability of the data should be greatly increased when those data consist of the recorded findings of a doctor who has the individual before him at the time. In relatively small studies, or in studies focussed upon a particular defect, standardized physical examinations have frequent- ly been used, but no comprehensive data are available which picture the general health level of youth. These data for NYA youth consist of findings recorded on a standard form at the time of the examination. Moreover, all the examinations were made during a relatively limited time period by physicians and dentists employed for the specific purpose and with a definite view to the analysis of comparable data. It is believed, therefore, that the findings yield important information on the physical condition and health defects of American youth. To what extent may the health findings of NYA youth be used to estimate the health needs of all youth? Certain limitations must be placed on any generalizations made from these data. Probably the most important limitation comes as a result of the economic status of the youth studied. These NYA youth are out of school and are from low-income families. Generalizations based on their health conditions might not hold for college students, for example. On the other hand, it should be remembered that the NYA youth group is not a relief group (although it includes some youth from relief families). The health conditions of NYA youth may not be the same as those of youth in the lowest economic class. These youth most nearly represent that unfortunately large portion of the population whose low incomes deprive them of adequate housing, food, clothing, and medical care. Other limitations result from the age of NYA youth and from the fact that they are all un- married. Conclusions made from these data can only be applied to the unmarried population from 16 to 24 years of age; moreover, the distribution within this age group is not the same for these NYA youth as for the general population. More than two-thirds of the NYA youth who were ex- amined were between the ages of 17 and 20. In addition to the above factors, the employ- ability status of NYA youth limits their representa- tiveness with respect to the general population. For, on the one hand, these youth were all em- ployed or seeidng employment, and so the study might not include a large enough representation of severely handicapped youth; on the other hand, it might include a comparatively large representa- tion of youth with defects which limit but do not prevent employment, since such young people might have been drawn to NYA because of the opportunities there for worK experience and training often unavailable to them in industry and trade. The exclusion of defects present in severely handicapped youth would not have a great effect on the rates of specific defects found in this study, but the importance of these relatively few youth as a health problem is greater than their numbers would reveal. The possible over rep- resentation of youth who are less severely handi- capped, as well as the other limitations mentioned, must be Kept in mind in applying the findings of this study to a broader population group. How- ever, if these factors are recognized, the facts about NYA youth furnished much information on the health status of all American youth. II. GENERAL HEALTH LEVEL OF NYA YOUTH Evaluation procedures Evaluating the health status of any group is especially difficult because of the lack of accepted criteria of various “degrees of health.” Not only are there no comprehensive indices which make it possible to summarize the presence or absence of various defects and to obtain a total measure of an individual’s health, but there is not always even agreement as to what constitutes a defect. Thus, one is unable to say, for example, at exactly what point blood-pressure readings are so low as to constitute “defects,” let alone to assign comparative weights to these and other defects. As a result of this lack of standardization, an appraisal of the health of a group is frequently presented in terms of a scries of prevalence rates for specified defects—the percent of the group that have heart disease, the percent that have hernia, the percent that have carious teeth, and so on. In this way it is quite possible to obtain a series of pictures of different aspects of the health of the group, each picture showing the group from the standpoint of a particular defect. How- ever, the defects are not mutually exclusive (e. g., some of the youth who have carious teeth also have heart disease, etc.). Therefore, it is not possible to get from these rates a single summary picture that will tell what proportion of the group was free from all defects and what proportions had certain numbers of defects. This method does serve to indicate the total prevalence, in the group studied, of specific defects. The health status of a group can be evaluated where the evaluation is made with a specific purpose in mind. When this is done the examining physician not only records each of the separate observed defects of a particular person, but re- cords also his evaluation of the total effect of these defects with a view to the specific purpose. Thus, the Selective Service induction examina- tion only not records each defect but includes the judgment of the examiner as to whether the indi- vidual is physically fit for unlimited or specifi- cally limited military service. Likewise, the life- insurance medical examiner appraises the examinee in terms of how good an insurance risk the person is. It is essential in such methods that the standards of classification be objectified and standardized insofar as possible for all examiners. The examinations of the present study included classification of each youth on the basis of em- ployability as determined by health status. The classifying was done by the examining physician according to agreed standards. Every effort was made to insure uniformity in applying the criteria so established. All classifications were reviewed at the central tabulating unit by physicians thoroughly familiar with the standards, and examination records in which classifications did not agree with the findings were returned to the State health director for review with the examining physician. The health status of these NYA youth can be summarized, therefore, in terms of the percentage of all youth examined who were classified at each of the several levels of em- ployability. Health status and employability classification The examination form (see appendix B) listed six health status and employability classes. The examining physicians classified the youth accord- ing to the agreed standards 3 and checked the prop- er class for each youth. For purposes of analysis, the six classes have been combined into three, as shown below; Class checked by examiner Combined here, into— Includes youth who were— Class I _ _ jdass A Fit for any work. Limited, by their health, in the work they could do. Unfit for NY A employment, tempo- rarily or permanently. Class IT Class III jciassB Class V jdass C It must be realized that youth in class A may have had many health defects (carious teeth, 3 These standards could not attempt to cover all the possible defects and combinations of defects which would be found. The final classification of the youth was the responsibility of the examining physician. The standards did, however, list the more frequent defects and suggested the probable classification of youth with these defects only. The standards may be sum- marized as follows: Classes I and II (class A here) included youth whose only defects were such ones as dental pathology, underweight, defective unassisted vision not worse than 20/40 if improvable to 20/20 in each eye, diseased tonsils, hemorrhoids, and slightly abnormal blood pressure (not above 140 or below 105 systolic); classes III and IV (class B here) included youth with such defects as certain heart lesions, high blood pressure (145 or over), loss or paralysis of members, defective hearing, more than a trace of sugar or albumin in the urine, and visual and other defects worse than those indicating class I or II but not completely incapacitating; classes V and VI (class C here) included youth having communicable diseases, severe infestation of intestinal parasites, severe heart lesions, tuberculosis in an active stage, marked orthopedic impairments, and marked mental abnormalities. 4 THE HEALTH STATUS OF NYA YOUTH diseased tonsils, etc.), but none which limited their employability; youth in class B may have had some of the same defects as those found in class A, but in addition had defects (defective vision, non- severe heart lesions, etc.) which limited their employability; while youth placed in class C most frequently had communicable diseases (including venereal diseases in communicable stages) or severe infestations of intestinal parasites. General Findings Sixty-seven percent of all NYA youth examined were classified as “class A”—fit for any work or athletic activity. Thirty percent had health de- fects which limited their employability to some degree and they were placed in “class B.” Three percent were found to be either temporarily or permanently unfit for NYA employment, as indi- cated by their being placed in “class C.” The relative numbers of youth placed in each health status and employability classification are shown in table 1 separately for all youth, for white and Negro youth, male and female youth, and for male under 21 and male youth 21 and over. These percentages of youth who were limited in employability are remarkably similar to those reported in a similar study made of nearly 3,000 youth (not NYA youth) who sought vocational and industrial training for defense industries in Rochester, N. Y, Using slightly different classes as to employability, that study found that about 33 percent were disqualified for employment until their health defects were corrected.4 Sex, Color, and Age Differences The most marked difference found between the health status classifications of white and Negro youth was that a larger percentage of the Negroes was placed in class C—physically unfit for NYA employment. This is probably a result of the higher prevalence of veneral diseases among Negroes. This relatively high proportion of Negro youth in class C was found regardless of the size of the community in which the youth lived. Almost the same percentages of males as of females were in each of the three classes. For all youth, the proportion of the males who were placed in class C was slightly higher than the similar proportion for females. However, while this differential was true for both white and col- ored youth, it did not hold true in all of the urbanization groups (groupings by population of the communities in which the youth lived). In the large cities (500,000 and over in population) a slightly higher relative number of females than of males was placed in class C. While the differences found in employability status among the various sex and color groups were slight except for the color difference noted, there was a definite and pronounced relationship be- tween age and health status as measured by employability. Among males 16 to 20 years of age, 69 percent were fit for any work, 28 percent were fit for limited employment, and less than 3 percent were unfit for NYA employment. Males in the older group, 21 to 24 years of age, showed a consistently worse health picture. Only 59 per- cent of the older group were in class A, over 36 percent were in class B, and over 4 percent were in class C. These differences between the two age groups were found among both white and Negro males, and, while no separate tabulations by age were made for females, it is safe to assume that they would hold for females too. The difference in health status between youth in these two age groups is perhaps not unexpected, but it is striking in magnitude. Less than 4 years’ difference in median age separates these two groups. Therefore, if the two groups were strictly comparable, these data would indicate that during the next 4 years of life, about one-seventh (14.5 percent) of the youth in the younger group fit for any work might expect to acquire additional health defects that would limit their employability. However, it has been shown 5 that the prevalence of physical impairments is higher among relief than among nonrelief persons, thus indicating that physical impairments are an important cause of Table 1.—Number and percent oj youth classified by health status and employability classes, by sex and color, and—-for males—by age groups. NY A health examinations. United States Health status and employability classification Total number of youth Class A Class B Class C All clas- sifica- tions Total White Negro Females Males Males, 16-20 Males, 21-24 Total number of youth >. 67.1 29.9 3.0 100.0 146, 567 67.1 67.4 30.3 27.8 2.6 4.8 100.0 100.0 120,357 26, 210 67.3 67. 1 69.2 59.2 29.9 29.8 28.0 36.5 2.8 3.1 2.8 4.3 100.0 100.0 100.0 100.0 71,096 75, 471 59, 728 15, 743 98, 459 43, 764 4,344 146, 567 i Excludes 1,096 youth for whom health status and employability classifi- cation was unknown. * Sawyer, W. A.: Medical Aspects of Vocational and Industrial Training, Jour. A. M. A., vol. 118, No. 8, p. 641 (February, 1942). Paper concerning cooperative program between Health Bureau, Tuberculosis Health Ass’n, Medical Society, and Board of Education, presented at Fourth Annual Meeting yf the Congress on Industrial Health. 5 Perrott, G. St. J., and Griffin, Helen C. An Inventory of the Serious Disabilities of the Urban Relief Population. Milbank Memorial Fund Quarterly, vol. XIV, No. 3 (July 1936). THE HEALTH STATUS OF NY A YOUTH 5 unemployment and of remaining on relief. Simi- larly, the youth who are still in need of NYA employment when they are 21 to 24 years of age may include a larger relative number of handi- capped youth than the group of youth at ages of 16 to 20 who need NYA employment. Thus a part of the difference noted here, and later in this paper, between the two age groups may result from this selective factor rather than from in- creased age. Nevertheless, since many health defects are cumulative with age, there is a ten- dency—in the absence of efforts toward rehabilita- tion—for the health level of the population to decline rapidly with increasing age during these years. The importance of beginning a health program among youth at ages before this decline has had a severe effect is evident. Regional Differences Since this study included all census regions and all sizes of communities, data are available on the relation between health status and geographic area, on the one hand, and between health status and size of community (urbanization), on the other. The two factors of geographic area and urbaniza- tion are interrelated, the South being rural to a greater extent than the Middle Atlantic area, etc. Therefore, it is necessary to hold one factor con- stant while studying the effect of the other. The following discussion presents data for a specific urbanization group and only for white males between the ages of 16 and 20 in that group. However, the other sex and color groups and other size of community groups were examined, and the conclusions stated concerning the one specific group arc true of all the other groups as well. The bar graph in chart I, based on table 2, shows the relative numbers placed in each em- ployability class for the total United States and for each census region, based only on white male youth between the ages of 16 and 20 and living in communities of from 2,500 to 25,000 population. Considering first the proportions of these youth placed in class C—unfit for any NYA work—it appears clear that there were certain significant differences among the various regions. While for six of the regions the percentages were very nearly the same (all approximately 1 percent), the figures for the East South Central, the West South Cen- tral, and, to a lesser extent, the Rocky Mountain region, differed markedly from the six, each show- ing a higher proportion of youth in class C. In the case of the East South Central region this per- centage was 11.6—10 times as high as that for the six more uniform regions. These high proportions of youth unfit for NYA employment were found, upon investigation, to consist of unusually large numbers of youth classed as “temporarily unfit for work.” In the case of the two southern regions with high proportions in class C, the explanation is, in part, the large number of youth with hook- worms (see p. 38), since severe infestations of these parasites placed the youth in this class. The prevalence of venereal diseases was higher in each of these three regions than in the country as a whole. Moreover, in each of these three regions relatively more cases of active tuberculosis were disclosed by these examinations than for other census regions. These factors also influenced the proportion of youth placed in class C. The percentages of these white male small-city youth placed in class A—fit for any work—varied among the respective regions from about 64 per- cent in the East South Central to 77 percent in the South Atlantic region. Since class A youth include all youth not placed in class B or C, these percentages may be looked upon as residuals that are affected by two factors, the percentages of youth placed in class B and the corresponding percentages for class C. That is to say, if the percentage placed in class A is'relatively low for a particular region, it means that an unusually large proportion of the youth in that region were placed in class B or in class C or in each of these classes. Consequently, since the variations by regions for youth placed in class C have been pointed out, only the variations found among youth placed in class B remain to be discussed here. Since the percentages in class C are so small, they could have had little effect on'the percentages in class B and so it is possible to discuss class B youth separately. The one region which may be an exception is considered below. The Middle Atlantic and East North Central regions had the largest proportions’of these youth whose employability was limited without being completely restricted (class B youth). In each of those regions over 30 percent of these youth (white males living in cities of 2,500 to 25,000 population) were classified as limited employa- bles—class B. At the other extreme, three regions had less than 25 percent of their white male youth (both in cities of 2,500 to 25,000 and in all sizes of communities) in class B. These were the South Atlantic, East South Central, and West South Central regions. In only one of these regions, the East South Central, was the percentage of youth in class C large enough to account for at least some of the smallness of class B. If class C had not been unusually large in that region, it seems likely that class B would have been near the aver- age for the United States, rather than low. The other regions fell between these two groups. Thus, even when the size of the community in which the youth resides is eliminated as a factor, 6 THE HEALTH STATUS OF NYA YOUTH CHART I WHITE MALE YOUTH AGED 16-20, LIVING IN CITIES FROM 2,500 TO 25,000 POPULATION. BY "HEALTH STATUS AND EMPLOYABILITY CLASSIFICATION". AND BY CENSUS REGION NYA Health Examinations, United States, 1941 National Youth Administration SC-155 THE HEALTH STATUS OF NYA YOUTH 7 there were relatively more youth with limited employability (class B) in the northern and western regions than in the regions usually grouped together as constituting the South. A word of caution should be given against the interpretation of the differences found in these classifications as absolute indications of whether one region’s youth have “better health” than another. When it is realized, for example, that the region which had the second highest per- centage of youth in class A also had the second highest percentage in class C, then it becomes clear that unqualified conclusions should be guarded against. Certainly it appears clear that the picture of the impact of health defects upon youth’s employability shows differences in different census regions. Further, it seems safe to say that the East and West South Central and Rocky Mountain regions are “worse off” insofar as the percentage of youth who are unfit for employment is concerned. The data also indicate that certain regions have relatively low percentages of youth who are limited in the work they can do. It should be kept in mind, however, that the evaluations made by the examining physicians are the stuff of which these percentages are made, and those evaluations were made with the specific problem of employability in mind. Unfortunately, in spite of efforts to standardize the definition, there may have been some differences in the concepts of employability in the several regions. employability was classed as “partially limited” (class B), the percentage so classed increasing as the size of community increased. Thus in the South Atlantic region the percentage of the specified male youth in class B increased with the size of the community from 19 percent in rural areas to 38 percent in cities of 500,000 and over. In the Pacific region the rise was from 26 to 34 percent, and in the East North Central region, from 29 percent to 32 percent. This relationship was also true for other census regions and for all regions combined. For all regions combined the percentage of white males in class B was 25.5 for rural areas, 28.6 in communities of 2,500 to 25,000, 32.3 for cities 25,000 to 100,000, 34.2 for cities 100,000 to 500,000, and 39.9 for cities of 500,000 and over. Similar differences appeared for white females. Whether the above differences between rural and urban communities in the relative numbers of youth who are limited in their employability reflect actual differences in the state of health of the youth is not certain. Every effort was made to have the same examination procedure and health status standards used by all the examining physicians. Nevertheless the examinations in rural and in urban communities were made by different physicians. Each community or locality, regardless of size, usually had a different examiner. Moreover, in the larger cities examinations were frequently made by examining teams composed of a general practitioner, a dentist, and one or more specialists, while in the rural areas examinations were more frequently made by one physician only. Therefore, the possibility of a difference in standards of the examination cannot be over- looked. It is known that rural physicians were sometimes less likely to recommend certain highly specialized medical services for the youth examined because they knew that those services were not available in the community. Similarly, there may have been differences in subjective standards of employability, the rural or small-community physician thinking in terms of occupations less exacting than, for example, employment as a crane operator or at some such highly mechanized work with stringent physical requirements. For these reasons it is uncertain whether a real dif- ference in health level exists between rural and urban youth. In the judgment of the physicians in the respective communities, more city youth than country and small-town youth had health defects which limited the kind of work they could do but did not prevent them from working. There seems to be no clear relationship between size of community of youth’s residence and per- centage of youth found to be unfit for NYA employment (class C), except among white youth Table 2.—Number and percent oj white male youth, 16 to 20 years of age, living in cities of 2,500 to 25,000 population, with designated classification. NY A health examinations. United States Census region Health status and employability classification Total num- ber of youth Class A Class B Class C All classi- fica- tions Total, United States New England Middle Atlantic East North Central West North Central South Atlantic East South Central West South Central Rocky Mountain Pacific 70.9 26.6 2.5 100.0 8,304 73.7 67.3 67.4 70.0 77.2 63.8 75.8 68.1 71.1 25.1 31.7 31.4 28.9 21.4 24.6 19.8 28.9 28.1 1.1 1.1 1.2 1.1 1.4 11.6 4.4 3.0 .8 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 354 379 1, 763 1,376 947 439 1,488 789 769 Urbanization Differences Examination of the data for white male youth 16 to 20 years of age in certain specific census regions shows there is a correlation between size of community and the proportion of youth whose 8 THE HEALTH STATUS OF NYA YOUTH in the South. For the entire country, the rural white males did show a higher percent of youth in class C than was found in any of the other sized communities, and this percentage decreased with increasing size of community. However, this seeming correlation is partly the result of the relation between census region and size of com- munity. The southern areas with the high per- centage in class C tend to weight the smaller sized communities disproportionately. In addi- tion, in the three southern regions the percentages of white male youth placed in class C varied inversely with the size of the community in which the youth lived. Except for these southern regions, no clear relationship between percent of youth in class C and size of community is dis- cernible. In each of the three southern regions, South Atlantic, East South Central, and West South Central, the relative number of white male youth placed in class C was highest for youth in rural communities, and decreased as size of community increased. This relationship held for white fe- males but did not hold for Negro youth. It was seen most clearly in the East South Central region, where 12 percent of white rural males were in class C as compared with only 2.5 per- cent of white males in large cities. It is believed that this relationship is an effect of the prevalence of hookworms in these regions. Youth with severe infestations of hookworms were generally classified as temporarily unfit for work. Since the prevalence of hookworm infection was highest in the rural areas and decreased with increasing size of community, the percentage of youth placed in class C would be expected to show a similar variation. This explanation is consistent with the fact that the rural-urban variation did not hold for Negroes. As will be pointed out later (see p. 39) the prevalence of hookworm infection is relatively low among Negro youth. Recommendations made by examiners The examination form (see appendix B) enu- merated a number of the specific kinds of medical or dental services that were expected to be most frequently needed by the youth. The examining physicians and dentists then indicated by checking the appropriate spaces which, if any, of these services they recommended for the particular youth examined. Space was provided for writing in additional recommendations. Thus, as final steps in the individual examination, the examiners recorded two kinds of data giving a summary picture of the health of the youth examined. They recorded the health status and employability classification already discussed, and indicated the recommendations which they regarded as neces- sary to the correction of the health defects dis- covered. For example, if for a particular youth the examiner discovered diseased tonsils, decayed teeth, and hernia as the conditions which he felt required attention, he would check the three recommendations dental care, tonsillectomy, and hernia repair. It was pointed out earlier that a difficulty in the way of tabulating the number of defects was in the lack of agreement as to what constituted a defect. The recommendations made by the examiners provide a more meaningful measure of the health needs of the group. In effect the examiners de- fined the various defects by stating whether or not in their opinion the conditions called for correc- tion. It becomes possible, therefore, to tabulate the recommendations that were made for the youth and in doing this to have a measure of the extent of their defects. It is recognized that this procedure does not guarantee uniformity of mean- ing for the condition that called for a particular recommendation. One physician might recom- mend, say, tonsillectomy where another would not. But it does afford a means for measuring the extent of defects as determined by those conditions for which the examining physicians and dentists recommended correction. Number of Recommendations There were 166 recommendations per 100 youth examined. That number is based upon all of the youth, some examined by a physician only and others by physician(s) and dentist. If dentists had been available to make the dental examina- tions in all cases, the average number of recom- mendations would have been higher, since dentists are known to be better able to detect dental defects. Assuming for all youth examined the same frequency of dental care recommendations as found for the youth examined by a dentist, the number of recommendations so adjusted (both dental and nondental) was 185 for each 100 youth. Youth with Recommendations Recommendations were not confined to youth whose employability was limited. About one- third of the youth had health defects which limited their employability, but about nine-tenths of them had some defect for which the examiner recommended medical or dental care or correction. For 84 percent of all youth examined and 93 per- cent of those examined by a dentist, one or more recommendations were made. Thus, only about ten youth out of each hundred examined had no defect for which the examiner made a recom- THE HEALTH STATUS OF NYA YOUTH 9 mendation. It seems reasonable to suppose that had the examinations all been as thorough as those which involved the services of a dentist, re- commendations would have been made for 93 percent of the youth. Relative Frequencies of Specific Recommendations The most frequent recommendation was for dental care. Recommendations for dental care accounted for 46 percent of the 185 (adjusted) recommendations per 100 youth. (Even when all youth examined are considered, regardless of dentist participation in the examination, dental care made up 40 percent of all recommendations.) The next two most frequent recommendations were for eye refractions and tonsillectomies, each of which constituted about 11 percent of all recom- mendations. The three next most frequent re- commendations; namely, additional diagnostic procedures, special diets, and study by specialists, each accounted for about 7 percent of the total. Thus these six recommendations accounted for about 90 percent of all recommendations made. The other 10 percent included circumcision, hook- worm treatment, venereal disease treatment, other repetitive medical therapy, other surgery (major and minor), minor nonsurgical procedures, and recommendations for “treatment, type unspeci- fied.” Some of the above-named statistical categories need explanation.6 Almost half of the “addi- tional diagnostic procedures” group consisted of requests for rechecks of items included in the orig- inal examination or for tests which should have been included in that examination (urinalyses, blood-pressure readings, blood serologies, etc.). The only other diagnostic procedure recommended with relative frequency was chest X-ray, which was coded here only where that procedure was indicated as a result of tuberculin test, family history, exposure, or some factor other than physi- cal findings on chest examination. The special diet recommended was high caloric in over half, and low caloric in about one-fifth of all such recom- mendations. The “study by a specialist” recom- mendation most frequently called for an ear, nose, and throat specialist (about one-fifth of all such recommendations), while specialists in eye, heart, skin, or female genital diseases, respectively, were each called for in about one-tenth of the cases where a specialist was indicated. About one-half of the “other repetitive medical therapy” recommen- dations called for treatment of skin diseases. The recommendations for “other major surgery” were for appendectomies in about one-third of the cases, for hydrocele repair in about one-sixth, and for plastic repair in over one-sixth. Recommenda- tions for “other minor surgery” were largely made up of requests for varicocelectomies, submucous resections, fittings of surgical appliances, and minor growth removals, each of these constituting about one-fourth of the group. “Minor nonsurgi- cal procedures” recommended were vaccinations or inoculations in about three-fourths of the cases, with removal of ear cerumen (wax) the only other frequent recommendation in this group. The residual category, “recommendations for treat- ment, type unspecified,” was made up of recom- mendations naming the disease or defect but not specifying which of several possible treatments was recommended. The most frequent defects with this recommendation were high and low blood pressures. Table 3 shows the percentage distribution of all recommendations according to the nature of the specific recommendation. It also shows the num- ber of times each specific recommendation was made per 100 youth examined. These same find- ings are presented graphically in charts 2 and 3. The frequency of each of the various recommenda- tions will be discussed later in this paper in con- nection with the related defects. Table 3.—Percentage distribution of specific recommendations, and the number of recommendations per 100 youth. NYA health examinations. United States Specific recommendation Percentage distribution of recom- mendations Number of recommenda- tions per 100 youth ex- amined 100.0 184.7 45.7 84.5 10.7 19.7 10.5 19.4 7.5 13.8 6.6 12.1 6.0 11.0 3.0 5.5 1.8 3.3 1.7 3.2 1.6 2.7 1.2 2.3 1.1 2.1 .9 1.7 .6 1.2 .6 1.0 .3 .5 .3 .5 .1 .2 (4) (4) (<) (4) (4) («) i The figure for number of dental care recommendations per 100 youth is based upon the findings for 60,127 youth examined by dentist. All other figures are based on 147,663 youth. 1 See text above for contents of this category. 3 Based on both sexes. Calculated on the basis of male youth only, recom- mendations for circumcision made up 3.9 percent of all recommendations, and were made for 6.6 males per 100. * Less than 0.06. 3 While the various entries that were combined into these categories were not coded and punched separately, a hand tabulation was made of all the spe- cific entries which went to make up these general groups for about 45,000 of the 150,000 records. This serves to indicate the composition of each category, although it does not, of course, make it possible for specific rates to be calcu- lated for the precise conditions that were so grouped. 10 THE HEALTH STATUS OF NYA YOUTH CHART 2 COMPOSITION OF RECOMMENDATIONS MADE FOR CORRECTION OF HEALTH DEFECTS NOTED NYA Health Examinations, United States, 1941 Notional Youth Administration SC-156 THE HEALTH STATUS OF NYA YOUTH 11 CHART 3 NUMBER OF RECOMMENDATIONS PER IOO YOUTH EXAMINED, FOR SELECTED SPECIFIC RECOMMENDATIONS NYA Health Examinations, United States, 1941 AMONG EVERY 100 YOUTH EXAMINED needed 85 dental CARE q needed L-'J REFRACTIONS | Q needed I -7 TONSILLECTOMIES needed 4 ADDITIONAL DIAGNOSTIC PROCEDURES needed 2 SPECIAL DIETS needed STUDY BY A SPECIALIST Each figure represents 5 youth 480993—42 2 Notional Youth Administration SC-157 12 THE HEALTH STATUS OF NYA YOUTH Sex, Color, and Age Differentials in Recommenda- tions Made The recommendations made by the examiner have been used above in three ways to measure the general health level of NYA youth: (1) The percent of youth having one or more recommenda- tions; (2) the total number of recommendations per 100 youth examined; and (3) the distribution of those recommendations among the various specific ones made. In discussing the variations by sex, color, and age, only the first two of these measures will be used. This is not to imply that the composition of the recommendations group does not shift with some or all of these factors. In fact, later in this paper, these variations will be considered. It will suffice here to point out that this pattern does shift sharply with respect to the relative importance of certain recommenda- tions, but that in all groups the most frequent was for dental care. Moreover, in all groups, refrac- tions, tonsillectomies, additional diagnostic pro- cedures, special diets, and study by specialists each ranked near the top in relative numbers. tions is adjusted so that dental care figures are based only on these same youth, in order to avoid the understatement of the need for dental care that would result from the use of all examinations. While some differences appear in table 4 amonS the different sex, color, and age groups, these differences were slight. Moreover, the sex and color differences did not hold when urbanization was considered. (See table 5, later in this paper.) The only difference in number of recommendations that was found in all sizes of communities and in all census regions was that between males of the ages 16 to 20 and males 21 to 24. The older group consistently had a higher number of recom- mendations per 100 youth examined. Rural-Urban Differentials in Recommendations Made The entire 150,000 NYA youth examined were classified according to size of community in which the youth lived in order to compare the average number of recommendations per 100 youth. Definite and apparently consistent differences among the various rural-urban groups appeared upon preliminary examination. The youth in the rural areas had received fewer total recommenda- tions than those in larger cities. Likewise, a smaller percentage of rural than of urban youth received one or more recommendations. However, den- tists were involved in a much higher percentage of urban than of rural examinations, and youth whose oral examinations were made by dentists had more recommendations for dental care and so averaged more total recommendations. To de- termine whether any rural-urban differences exist in the quantity of medical care needed, it was neces- sary to eliminate the effect of varying proportions of dentist examinations among the several urbani- zation groups. Table 5 shows an “average number of recom- mendations per 100 youth” obtained by using the findings of the 60,000 dentist examinations for the frequency of dental care recommendations and the findings of the entire 147,000 youth for all other recommendations. Thus, a theoretical average number of recommendations, corresponding to what might have resulted had dentists partici- pated in all examinations, was obtained for youth in each sex and color group, and for the size of community of youth’s residence. Since the data were found to vary by census region, similar aver- ages were obtained for white males in each of five of the nine census regions. Table 4.—Percent of youth for whom recommendations were made, for 60,000 youth examined by physicians and dentists, and adjusted1 number of recommendations per 100 total youth; separate by sex, color, and, for males, by age. NY A health examinations. United States Sex, color, and age groups Percent for whom one or more recom- mendations were made Adjusted num- ber of recom- mendations per 100 youth examined 1 93.3 184.7 92.7 180.9 Females 94.0 188.7 White males 92.9 180.1 91.6 184.9 White females 93.7 184.8 Negro females___ ... - 95.1 204.8 Males aged 16 to 20 92.7 179.4 Males aged 21 to 24 ___ 92.6 187.0 1 The adjusted number of recommendations per 100 youth listed here is the sum of the number of recommendations exclusive of ones for dental care made per 100 youth for all youth examined including youth not seen by a dentist (147,663), plus the number of dental care recommendations per 100 youth for those youth seen by a dentist. Table 4 shows the variations by sex, color, and age in the percent of youth affected by recom- mendations and the number of recommendations made per 100 youth. The percentages are based only upon youth whose dental examination was made by a dentist, and the number of recommenda- THE HEALTH STATUS OF NYA YOUTH 13 Table 5.—Average number of recommendations made per 100 youth examined by physicians and dentists1 in various sizes of communities, by designated sex, color, and selected census region groups. NY A health examinations. United States Group of youth Average number of recommendations > per 100 youth—Population of community in which youth lived Under 2,500 2,500 to 25,000 25.000 to 100.000 100,000 to 500,000 500,000 and over Total Total . 187.8 184.6 175.8 186.7 186.9 184.7 Males 188.1 186. 7 178.1 179 6 164.6 205.6 163 9 180.9 188.7 180.1 184.9 184.8 204.8 172.3 174.0 201.3 179.5 Females ... ._ 187.4 181. 9 173. 6 192.9 175. 5 White males.. _ 187.9 182. 2 180. 0 Negro males .. 187.1 215.6 166.8 198.0 167 1 White females . 187.3 180.2 173. 6 178.1 209.6 201.1 3 153.4 175.3 159.3 Negro females 185.3 202.1 173. 3 237. 2 White males in selected census regions: Middle Atlantic East North Central- South Atlantic. ... West South Central. 226.7 168.1 205.0 189.6 240.5 170.8 190.6 180.9 243.8 172.0 210.6 168.8 162.4 193.9 201.5 145.0 Pacific 144.3 138.4 139.6 182.2 185.3 159.9 1 The average numbers of recommendations shown here are composites of data for 60,000 youth examined by dentists, and for the total 147,663 youth examined (regardless of who made the dental examinations). The averages represent the sum of the number of recommendations exclusive of ones for dental care that were made per 100 total youth, and the number of dental care recommendations made per 100 youth examined by dentists. 3 Low primarily because of exceptionally low number of dental care recom- mendations in New York City. Table 6.—The percentage of youth who received one or more recommendations, among those examined by both physician and dentist. NY A health examinations, United States. Percent of youth with one or more recommendations Census region Total Males Females White males Negro males White females Negro females Total United States.. 93.3 92.7 94.0 92.9 91.6 93.7 95.1 New England... 95.4 95.1 95.7 95.0 i 96. 5 95.4 98.4 Middle Atlantic 88.9 87.0 92.2 87.1 86.4 91.2 94.7 East North Central 94.8 94.7 95.0 95.1 92.5 94.9 95.6 West North Central 92.0 91.9 92.1 91.3 96.9 90.5 98.4 South Atlantic.. 92.6 94.0 89.8 95.6 81.9 91.4 86.5 East South Central.. 98.8 98.6 99.0 98.9 97.5 99.0 99.2 West South Central.. 93.2 92.3 95.4 92.1 94.1 95.9 89.5 Mountain.. ... 95.2 94.2 96.1 94.1 » 94.7 91.5 2 100.0 Pacific _ 95.3 93.7 96.3 93.4 i 96.3 96.3 96.3 1 Based on less than 100 youth examined by a dentist. 2 Based on less than 50 youth examined by a dentist. Table 7.—The adjusted average number of recommendations per 100 youth examined in each census region, by sex, color, and urbanization groups Number of recommendations per 100 youth in specified groups In cities of 2,500 Census region to 25,000 pop- Total Total ulation Total Total white white Negro Negro males females males females White White males females New England 168.3 168.4 139.0 158.9 176.3 190.1 Middle Atlantic 172.3 185.4 240.5 214.6 166.6 211.7 East North Central. 174.0 183.6 170.7 165.9 159.7 175.6 West North Central. 173.4 180.3 178.2 185.9 246.7 299.8 South Atlantic. 201.3 175.6 190.6 174.8 167.5 181.9 East South Central.. 214.7 207.4 239.6 219.6 217.8 232.8 West South Central. 179.6 185.8 181.0 197.9 184.0 195.1 Rocky Mountain 186. 3 199.0 198.3 191.4 239.5 250.0 Pacific 162.1 183.9 138.4 164.4 174.4 196.2 There was no consistent relationship between size of community and number of recommenda- tions. For total male youth there appeared to be an inverse relationship between size of community and number of recommendations, but this was not true for Negro males nor for white or Negro females. The figures for separate census regions show such inconsistent variations as to indicate the absence of any real rural-urban differences in health needs as measured by total recommenda- tions. Regional Differentials in Recommendations Made Table 6 shows for each census region the per- centage of youth examined by both physicians and dentists, and found to need some medical or dental service. These percentages of youth are shown by sex and color. Table 7 shows for each census region the adjusted average number of total recommendations made per 100 youth for each sex-color group and for white males within a particular size of community, 2,500 to 25,000 population. It is thus possible to compare the various census regions as to the relative numbers of youth for whom recommendations were made and as to the relative quantity of recommenda- tions made. It is clear that there were differences among the regions in the average numbers of recommenda- tions made and lesser differences in the propor- tions of youth affected by these recommendations. These differences were not eliminated by holding sex, color, or urbanization constant and so were not produced by varying sex, color, and rural- urban composition of the populations in the separate regions. The differences, however, were not the same in all of these groups. It is believed that the variations in average number of recommendations made in the separate census regions are made up of differences in the frequencies of specific recommendations, not all 14 THE HEALTH STATUS OF NYA YOUTH ot which vaiy in the same way. Regional varia- tions in the frequencies of specific recommenda- tions will be discussed along with specific physical findings. In general, the average number of recommenda- tions made was relatively high in the Southern and Rocky Mountain regions. This was largely true of males and of females, of white and of Negro youth. Exceptions to this general picture were certain urbanization groups in the Middle Atlantic region and the Negro youth in the West West North Central region, which had high rates. In connection with these high Negro rates, it is worth noting that a very large proportion (over two-thirds) of all the Negro youth examined in the West North Central region were from Missouri, the southernmost State in that region. Specified Urgent Recommendations Made by the Examiner The examining physicians were requested to designate, on the health examination record, which of the recommendations made for each youth examined were of an urgent nature. These “urgent recommendations” were, of course, in- cluded in the total number of recommendations already discussed, but because they were con- sidered so important, they merit separate con- sideration. Approximately 1 youth in every 7 examined was in urgent need of some kind of medical or dental treatment or service. The percentage of youth with 1 or more urgent recommendations was 13 for both males and females among white youth, 15 percent for Negro males, and 20 percent for Negro females. Some youth received more than 1 urgent recommendation; there were 16 urgent recom- mendations per 100 youth, although only 14 per- cent of the youth examined had 1 or more such urgent recommendations. The most frequent urgent recommendation made was for dental care. Of all youth examined (whether or not by a dentist), 9 percent were indicated as urgently needing dental care. It is safe to assume that this figure would be much higher for youth examined by a dentist. For about 3 percent of all youth examined, refraction was urgently recommended. Tonsillectomies were urgently needed for 2 percent of the youth; hook- worm treatment and study by a specialist, each were urgently needed by about half of 1 percent. In the three census regions which make up the South, the rate of urgent recommendations for treatment of hookworms varied between 2 and 11 percent of all youth examined. In general, the urgent recommendations made varied by sex, color, size of community, and census region, much the same as did the total recom- mendations made. The ratio of urgent to total recommendations differed widely with the sort of treatment being recommended. Thus there was one urgent recommendation to every five total recommendations for venereal disease treatment, and over one urgent recommendation to every five hookworm treatment recommendations. For re- fractions, however, the ratio was 1 to 7.7; for hernia repair, 1 to 8.3; and for special diet recom- mendations it was 1 to 33. Thus the recommenda- tions for treatment of less serious conditions tended to be urgent in a smaller proportion of the cases. Table 7 in the appendix shows the number of urgent recommendations made, separate by type of service requested and by sex, color, and age groups. III. SPECIFIC PHYSICAL FINDINGS AND CORRESPONDING RECOMMENDATIONS Dental and other oral defects Since examinations by dentists were regarded as giving a more dependable indication of the actual extent of dental defects than the oral ex- aminations by physicians, the following discussion concerns itself only with some 60,000 youth who were examined by dentists. The section of the examination form devoted to the oral examination called for two categories of information. (See appendix B.) Space was pro- vided for recording, first, the condition of each tooth as to previous or present dental caries (tooth decay), and second, information concern- ing the general mouth condition, including con- ditions such as pyrrohea and dental calculus (tartar). In addition, the examining dentist indicated whether the youth needed dental care. Thus, six different measures of dental and oral health are available: (1) Untreated carious teeth, that is, teeth with present unfilled cavaties regard- less of fillings in the same teeth; (2) filled teeth, used here as meaning teeth which have undergone previous attacks of caries and which have been repaired or crowned or replaced; (3) extracted teeth, teeth once present in the mouth but now missing, presumably because of past attacks of caries; (4) decayed, missing, or filled teeth, a summation which measures the total caries ex- perience; (5) other oral defects and diseases; and (6) need of dental care of any kind, as indicated by the dentist’s recommendation. Dental Defects—Age, Sex, and Color Differences Just as the recommendation most frequently made was for dental care, the defect recorded most frequently was dental caries, or tooth decay. Eighty-three percent of all the youth examined by dentists had one or more untreated carious teeth. This percentage is almost exactly the same for males and females and for white and Negro youth. Obviously, the proportion of youth with one or more carious teeth is not a very exact measure of the actual numbers of decayed teeth to be found among NYA youth, since this proportion does not take into account whether the youth has 1 such tooth or 10 of them. Since the data included information as to the condition of each one of the 32 teeth, it is possible to use a more precise measure of dental condition, namely, the average number of carious teeth per 100 youth examined. There were 472 carious teeth per 100 youth ex- amined. Expressed in another way, these NYA youth had, on the average, between 4 and 5 teeth in some stage of decay at the time of the exami- nation. White males had a higher average number of carious teeth than Negro males (492 compared with 448), but the average for white females was lower than that for Negro females (452 and 472). White males had relatively more carious teeth than white females, but Negro males had less than Negro females. These rather inconsistent variations arise from the fact that the number of teeth that are carious at a given time is a function of the number that have ever become carious and of the number that have been extracted or filled. Thus the variation is affected by the amount of dental care which has been received. However, the average number of carious teeth per 100 youth does measure the present extent of dental decay. To understand the meaning of the differences found, it is necessary to investigate the prevalence of extracted and of filled teeth. Table 8 presents, by sex, color, and age group (for males only), the percent of the youth examined who had one or more carious teeth and the averages per 100 youth examined, for carious teeth, extracted teeth, and filled teeth. From table 8 it appears that in over half of the youth examined each youth had at least one extracted tooth and at least one filled tooth. Relatively more white than Negro youth had extracted teeth and the same is true of filled teeth. Likewise, there were more extracted and more filled teeth per 100 among white than among Negro youth. Moreover, larger percentages of females than males had extracted teeth and repaired teeth; females also averaged more extracted and more repaired teeth per person than males. The apparent inconsistency brought out above, then, is explained by the fact that, while white females had relatively more teeth that had ever been carious as compared with white males, a higher proportion of past extractions and fillings left them with relatively fewer teeth carious at the time of examination. Among the Negro youth, less dental care had been received and so the female Negro youth were higher than the 16 THE HEALTH STATUS OF NYA YOUTH males in carious teeth as well as in extracted and repaired teeth. youth. This was true among both males and females and was so great (average number of DMF teeth over 40 percent higher for white youth) as to constitute a clear-cut difference in caries experience. It must be remembered that this does not mean that there are fewer dental defects now present among Negro youth—in fact, the percent having carious teeth and the average number of carious teeth per 100 youth was found to be about the same for both white and Negro youth. The present extent of the defect, how- ever, was high for both white and colored youth because a larger proportion of the teeth that had become carious among Negro youth have not been repaired. If the same amount of dental care had been received by Negro and white youth, proportionate to their needs, there would have been a relatively lower prevalence of remaining caries among the Negro youth. Two other differences in the prevalence of tooth defects appear in table 8. The average number of teeth that were then, or had been, carious (DMF teeth) was higher for females than for males and, since dental caries accumulate with age, the num- ber of DMF teeth was necessarily higher for male youth 21 to 24 years old than for ones between the ages of 16 and 20. It is significant to note that the average number of DMF teeth was about 20 percent greater in the older age group. That female youth have undergone more caries experi- ence than male youth of the same chronological age has been pointed out in other studies. The explanation for this sex differential has been shown 8 to be that permanent teeth erupt earlier in females and so the teeth of females at a given age have have been exposed to the risk of caries for more years than those of male youth of the same chronological age. Comparison of Dental Defects Among NYA and Other Youth There are some data available on the dental health of certain groups of the population with ages approximating those of NYA youth. It therefore becomes possible to compare the NYA youth with other groups. Table 9 shows certain relevant information on dental defects among three different groups; NYA youth in this study; school youth, as studied in high school and college; and young adult male workers in certain occupa- tions. Since the number of DMF teeth increases regularly with age and since the various groups of Table 8.—The percent of youth who had specified dental conditions, and the average number of teeth in the specified condition per 100 youth examined by dentists, by sex, color, and for males—age groups. NYA health examinations. United States Sex and color Percent of youth ex- amined having any number of (one or more)— Average number of teeth in speci- fied condition per 100 youth examined Carious teeth Ex- tracted teeth Filled teeth Carious teeth Ex- tracted teeth Filled teeth DMFi teeth Total youth. 83.0 66.3 51.7 471.9 155.3 291.1 918.0 White youth... 83.1 68.2 56.0 474,2 164.1 327.9 965.8 Negro youth... 82.9 47.4 30.2 460.6 111.4 107.2 678.6 Male youth 82.8 53.6 45.9 485.7 145.0 239. 5 869.5 Female youth.. White male 83.3 69.6 58.5 455.5 167.6 352.6 974.6 youth 16-20years of 83.2 55.4 49.2 492.1 153.0 265.6 909.7 age 21-24 years of 83.7 53.2 47.5 489.4 138.5 245.2 872.1 age Negro male 81.5 63.4 65.2 502.3 205.9 340.1 1,047.6 youth 16-20 years of 80.5 43.5 26.5 447.9 97.9 85.7 631.8 age 21-24 years of 79.9 40.0 25.4 443.5 84.0 80.4 608.3 age White female 82.5 56.8 30.6 464.3 149.2 105.2 718.6 youth .. ... Negro female 82.9 61.8 64.5 451.6 178.1 406.5 1,036. 5 youth 85.0 50.9 33.5 472.0 123.5 126.5 720.5 decayed, missing, and filled, as explained in the text. The figures here given differ very slightly from the sum of the preceding 3 columns. This discrepancy (in no case more than 1.5 teeth per 100 youth) arises from the fact that the number of DMF teeth was derived independently and is based on all youth examined by a dentist, while youth for whom size of community of youth’s residence was unknown were excluded from the calculations of number of carious teeth. There is a better index of dental decay, one which is not affected by the amount of dental care received. The number obtained by counting the numbers of teeth that are decayed, missing, or filled has been used7 as a measure of total caries experience, past and present. Klein and Palmer have called this measure “the number of DMF teeth” and that terminology will be used here. The last column in table 8 shows the number of DMF teeth per 100 youth for each sex, color and age group. There were 918 DMF teeth per 100 NYA youth examined. Thus, on the average, each youth had nine teeth that had at some time been attacked by caries. Comparison of the number of DMF teeth for white and Negro youth shows that the white youth had a much higher average number of teeth that were then, or had once been, carious than Negro 7 Klein, Henry and Palmer, C. E.: Dental Caries in American Indian Children. Public Health Bulletin No. 239. U. S. Government Printing Office (1937). See also Collins, Selwyn D.: The Health of the School Child. Public Health Bulletin No. 200. U. S. Government Printing Office (1931). And Stoughton, A. L. and Meaker, V. T.: Sex Differences in the Prevalence of Dental Caries. Public Health Reports. Vol. 47, p. 26. (1932). 8 Klein, Henry, and Palmer, C. E.: Studies on dental caries, VII. Sex differences in dental caries experience of elementary school children. Public Health Reports 53: 1685 (1938). See also Stoughton, A. L., and Meaker, V. T.: (op. cit., see footnote 7), where this same explanation is put forth tentatively. THE HEALTH STATUS OF NYA YOUTH 17 youth shown in Table 9 differ somewhat in age range and mean ages, any comparison of the respective numbers of DMF teeth is necessarily somewhat rough. Consequently the age differ- ences must be taken into account in comparing these data. relatively low economic status. Earlier studies have likewise found greater need for dental care among persons in low income groups.9 A comparison of male NYA youth between the ages of 21 and 24 with the selectees of these ages examined under the Selective Service System would afford a measure of the differences between these NYA youth and the general population. Un- fortunately a number of circumstances combine to make such a comparison difficult. The Selective Service data so far available are based upon an older group than these NYA youth. Moreover, the dental requirements of the Selective Service have been changed, and were never such that the NYA examinations would yield exactly comparable data. It has been possible, however, by a special tabula- tion to determine how many of the NYA males 21 to 24 years of age would fail to meet the original Selective Service requirements 10 on the assump- tion that all teeth present among these NYA youth were “serviceable.” Since some of the carious teeth present in these youth needed extraction and since extractions in some cases would have resulted in a youth’s disqualification, the number of NYA youth estimated to have insufficient teeth to meet Selective Service requirements is an understate- ment. In spite of this, the tabulation revealed that 4.2 percent of all male youth between the ages of 21 and 24 who were examined by a dentist had too few teeth to meet the original dental require- ments of Selective Service. For white NYA youth this figure was 4.7 percent, and for Negro youth it was 1.4 percent. These figures are con- siderably lower than those for Selectees. A report of the National Headquarters of the Selective Service System showed that about 9 percent of the males examined by the local examiners had an in- sufficient number of serviceable teeth.11 If a cor- rection be made for the additional number later rejected for this reason at the induction centers, it would seem that a total of about 11 percent of the persons examined were or would have been re- jected for this reason.12 A special investigation into the dental status of some 600 males between the ages of 21 and 35 showed an even higher per- centage (15 percent) whose teeth failed to meet Table 9.—A comparison of the prevalence and extent of dental caries among NY A youth, high-school and college youth, and young male workers: Data from selected studies. NY A health examinations. United States BOTH SEXES COMBINED Group of youth studied Age range Mean age (years) Num- ber of youth Per- cent with caries Cari- ous teeth per 100 youth DMF teeth per 100 youth NY A youth, total Unit- 16- 13-19 18-19 317-25 17- 19.1 15.7 18.2 19.3 60,030 1, 841 180 2,700 8,770 83.0 74.1 73.9 70.0 471.9 285.8 277.2 180.9 918.0 708.0 881.1 High-school children: Hagerstown, Md.L. Hagerstown, Md.L. College students, Stan- ford University 2 . .. Metropolitan Life In- surance Co., employ- ees 4 1,425. 3 MALE YOUTH NY A youth, total Unit- 16- 13-19 18-19 17- 15-24 15-24 15-24 21-24 19.0 15.8 18.3 32, 611 855 101 1,441 83 70 113 6,994 82.8 80.2 78.2 485.7 323.0 282.2 869.5 722.3 905.9 1,423. 9 1,071. 0 977.0 1,150. 0 1,000.1 High-school children; Hagerstown, Md.1.. Hagerstown, Md.L. Metropolitan Life In- surance Co., employ- ees4___ ... Metal-mine workers, Utah 2 363.0 389.0 414.0 496.8 Coal mine workers, Smelter workers, Utahs. NYA youth, total Unit- ed States. 22.1 81.7 1 Data from Klein and Palmer, Studies on Dental Caries IX, PHR: 55, p. 1258 (1940). 2 Data from Stanford Men Students’ Health Service, quoted in Diehl and Shepard, The Health of College Students. (1939) Amer. Council on Educ., Wash., D. C. 3 Approximately. 4 Data from Hollander and Dunning. A Study by Age and Sex of the Incidence of Dental Caries in over 12,000 persons. J. Dent. Res., 18:43 (1939). 3 Data from Brinton et al., Dental Status of Adult Male Mine and Smelter Workers. PHR: 57, p. 218 (1942). If allowances are made for the variations in the ages of the different youth, no striking differences appear in the total caries experience, as measured in terms of DMF teeth, but there is a marked difference in the relative amounts of present caries. The NYA youth had more than twice as many untreated carious teeth per 100 persons as the college students, and nearly three-fourths more than the high-school youth. They were also appreciably higher than the male workers in mines and smelters. This excess in unrepaired carious teeth with no corresponding excess of DMF teeth reflects a lesser amount of dental care received by NYA youth. That is probably a result of their * Klein, Henry and Palmer, Carroll E.: Medical Evaluation of Nutri- tional Status. X. Susceptibility to Dental Caries, and Family Income. Milbank Memorial Fund Quart. Vol. XX No. 2, April 1942. Klein and Palmer show that the prevalence of untreated caries is higher in low-income groups solely as a result of less past treatment. The susceptibility to caries is independent of income class. 10 Briefly, the principal requirement was that the person have at least three pairs (upper and lower) of serviceable incisor teeth and at least three pairs of serviceable masticating teeth. See Selective Service Regulations, Vol. Six. Physical Standards, MR 1-9, 21-32, Section VII. 11 Analysis of Reports of Physical Examinations. Medical Statistics Bulletin No. 1; National Headquarters, Selective Service System (Nov- 1941). The exact percentage is not available since this bulletin does not show how many of the 1.8 percent who had partial dentures were rejected for that reason. 12 The correction for additional rejections was based on the figures for total selectees rejected for dental reasons by local boards and by induction centers. Medical Statistics Bulletin No. 1, Selective Service System. 18 THE HEALTH STATUS OF NYA YOUTH the requirements of Selective Service standards.13 That the percentage of NYA youth with teeth below these standards should be much lower than the above figures is to be expected in view of their lower mean age and the lack of any adjustment for carious teeth that should be extracted. Comparison of Dental Defects by Rural-Urban Groups It might be argued, a priori, that because of the relatively greater numbers of dentists in cities, there would be an inverse relationship between the prevalence of untreated dental caries and the size of community of the youth’s residence. The data do not bear out such an assumption. Table 10 shows by size of community for all youth examined by a dentist, and for white male youth so examined, the average number of carious teeth per 100 youth and the percent of youth affected. These data reveal no significant differences in prevalence of untreated caries among youth living in rural areas, in towns from 2,500 to 25,000 population and in cities from 25,000 to 100,000 population. For youth in cities of 100,000 to 500.000 the average number of carious teeth is somewhat lower (although the percent of youth affected remains the same) and in all cities of 500.000 and over both the percent of youth affected and the average number of carious teeth are decidedly lower. But this lower prevalence of caries is not characteristic of the NYA youth in all cities of 500,000 and over. In fact, the low rate was found to result entirely from a remarkably low rate for cities in the Middle Atlantic Region. When the measures were computed for all cities of 500,000 and over, exclusive of those in the Middle Atlantic Region, they were much the same as for communities of other sizes. It is known that youth from New York City made up a very large part of the Middle Atlantic youth in cities of 500,000 and over, and it is believed that local factors in this city operate to make the NYA youth there atypical of NYA youth in general. Better provision for their needed dental care results in a rate of untreated caries that is not so much a result of size of city as of the dental care program of the particular city of residence. For these reasons Table 10 presents figures for cities of 500,000 and over both inclusive of and exclusive of the Middle Atlantic Region. On the basis of youth exclusive of this Middle Atlantic large city group, it appears that untreated dental caries prevail to about the same extent among NYA youth of various sized communities. Certainly areas with relatively more dentists could attain a more favorable prevalence than areas with fewer dentists, but—except where positive action is taken as among New York City youth—it appears that the mere presence of dentists in the area does not insure the utilization of dental services. Table 10.—A comparison of the prevalence and extent of untreated dental caries among NY A youth living in com- munities of different sizes. NYA health examinations. United States Population of community in which youth lived Rural under 2,500 2,500 to 25,000 25.000 to 100.000 100,000 to 600,000 500,000 and over 500,000 and over, except Middle Atlantic Region Average number of carious teeth per 100 total youth Percent of total youth with at least one carious 601.1 84.7 504.5 85.2 494.2 84.8 467.2 85. 2 (409.4) (77.2) (375.3) (70.6) 490.0 86.0 544.0 87.2 Average number of carious teeth per 100 white male 523.8 527.6 531.4 479.5 Percent of white male youth with at least one cari- ous tooth 85.5 86.6 86.2 85.8 Table 11.—A comparison of the prevalence and extent of dental caries among NY A youth in different geographic areas (census regions, all examinations by dentists). NYA health examinations. United States Census region Total youth White male youth Per- cent with at least one carious tooth Aver- age num- ber of carious teeth per 100 youth Aver- age num- ber of DM Fi teeth per 100 youth Per- cent with at least one carious tooth Aver- age num- ber of carious teeth per 100 youth Aver- age num- ber of DMFi teeth per 100 youth New England.. 87.2 533.7 1,095.1 88.6 563.2 1,068.2 (Middle Atlantic) (71.6) (371. 7) 978.4 (69.9) (373.3) 977.9 Middle Atlantic, ex- cept cities 500,000 and over 90.0 577.1 92.0 608.4 East North Central 88.5 545.7 1, 031. 2 90.0 600.4 1,043. 2 West North Central 81.6 432.4 918.2 82.2 451.0 950.7 South Atlantic 85.7 493.7 793.9 88.9 544.2 853.4 East South Central 86.1 613.1 708.1 83.7 483.5 597.5 West South Central 76.2 365.8 621.7 76.4 362.0 494.8 Rocky Mountain 80.1 387. 1 643.7 78.2 353.8 511.0 Pacific 83.6 452.4 955.4 82.5 444.2 918.9 1 Decayed, missing or filled, as defined in the text. Comparison of Dental Defects by Census Regions Variations in prevalence of untreated caries among the various census regions, if real varia- tions occur, might be the result of either (or both) of the following factors: Actual differences in the extent to which youth in the different 13 Klein, Henry: The Dental Status and Dental Needs of Young Adult Males, Rejectable or Acceptable for Military Service, According to Selective Service Requirements. Public Health Reports: 56:1369-1387. THE HEALTH STATUS OF NYA YOUTH 19 CHART 4 THE AVERAGE NUMBER OF DMF TEETH PER 100 TOTAL YOUTH AND PER 100 WHITE MALE YOUTH EXAMINED BY A DENTIST IN EACH CENSUS REGION, BY WHETHER PREVIOUSLY OR PRESENTLY CARIOUS NYA Health Examinations, United States, 1941 Previous Caries Present Caries Total Youth White Mate Youth If cities of over 500,000 are excluded from the Middle Atlantic Region, the overage numbers of carious teeth would be 577 and 608 National Youth Administration SC-158 20 THE HEALTH STATUS OF NYA YOUTH regions are affected by caries; differences in the proportion of dental caries that remain untreated (i. e., in certain regions relatively more of the carious teeth become filled teeth). The number of DMF teeth, however, should vary by region only of there is a difference in the rate at which youth are affected by caries, regardless of whether or not care has been received. Table 11 shows by census region the percent of youth affected by present dental caries and the average num- bers of carious teeth and of DMF teeth per 100 youth. There are definite differences among the census regions in the prevalence of untreated caries recorded by dentists during these examinations. Attention has already been called to the Middle Atlantic region, where the prevalence of un- treated caries was unusually low due to the low rate for cities of 500,000 and over. Table 11 and chart 4 show that not only was this region fairly high in untreated caries prevalence if the cases from these large cities be excluded, but the entire region was relatively high in average num- ber of DMF teeth. The youth examined in the West South Cen- tral and in the Rocky Mountain regions showed a low average number of untreated carious teeth per 100 youth and likewise fewer DMF teeth. These same two regions were the lowest ones (except for the atypical Middle Atlantic region, including large cities) in percent of youth with untreated dental caries and in average number of untreated carious teeth per 100 youth examined. The five regions that were highest in total caries experience, past and present, were New England, East North Central, Middle Atlantic (excluding cities of 500,000 or more), Pacific, and West North Central. The first three of the five were also highest in percent of youth with present caries and in average number of untreated cari- ous teeth per 100 youth examined. The other two census regions, South Atlantic and East South Central, occupy an intermediate position with respect to the two “low prevalence” and five “high prevalence” regions when total youth are considered. When the DMF rate is based on white male youth only, the East South Central region is nearly as low as the West South Central and Rocky Mountain regions, while the South Atlantic is more nearly the same as the five higher regions. Whether the recorded regional differences repre- sent real regional differences is not known. Since all of these examinations were made by dentists, it is felt that variations in standards of the exam- iners will not explain the wide differences in find- ings, and that a relatively low rate of caries prevalence and incidence exists in the West South Central and Rocky Mountain regions. There is, however, a possibility that differences in thoroughness or in exacting nature of stand- ards of the examing dentists in the several regions were responsible for at least part of the vari- ations. Other Oral Defects The oral examination obtained information as to the presence of dental caries, filled teeth, etc.; it also revealed the presence of a number of other mouth defects. Among the defects specifi- cally looked for were tartar of medium or marked degree (slight tartar was not coded as a defect), gingivitis (inflammation of the gums), and pyor- rhea (pus expressible from about the teeth). In addition, space was provided for recording other oral defects such as malocclusion, Vincents angina (“trench mouth”), other abnormal tooth conditions (tooth stained, tooth chipped or crooked tooth, mottled enamel, etc.), and other mouth abnormalities. Over one-third of all the youth examined by dentists had one or more oral defect other than carious teeth. Some youth had more than one such defect. Oral defects were found in 36 out of every 100 NYA youth examined by dentists, and there were 49 such defects among the 36 youth. These defects occurred more frequently among males than females and more frequently among Negro than white youth. Gingivitis, the most common of these defects, was reported for 24 youth out of every 100 and was of moderate or severe degree in 5 of those 24 cases. Tartar of moderate or severe degree was reported for nearly 13 youth out of every 100. The more serious condition, pyorrhea, was found in 4.4 per- cent of the youth examined. Among Negro males, pyorrhea was reported for 8.3 percent; among white males 21 to 24 years old, 7.2 percent suffered from this condition. The percentages of youth reported as having various specific oral defects, along with the actual numbers reported, are shown by sex and color in table 13 of appendix C. The frequency of other mouth defects showed some variations among the various census regions. One census region (Rocky Mountain) reported other mouth defects for 46 percent of its youth as compared with 36 percent for the total United States and 31 percent for the lowest region (East North Central). These variations do not cor- respond with differences found for dental 'caries. The five regions with the highest frequencies of other oral defects included the West South Central and Rocky Mountain, the two lowest regions in prevalence of both total caries experience and untreated carious teeth. The specific abnormal THE HEALTH STATUS OF NY A YOUTH 21 conditions that were unusually high in these five regions were: in the Rocky Mountain region, pyorrhea (16 percent, compared with only 4 per- cent for the total United States) and gingivitis; In the West North Central and Pacific regions, tartar; in the New England region, other abnormal tooth conditions; and in the West South Central region, other abnormal tooth conditions and pyorrhea. Recommendations for Dental Care It was pointed out in the discussion of total recommendations that dental care was called for more frequently than any other corrective service or treatment. The frequency of this recommenda- tion depended largely upon whether or not a dentist participated in the examination. Table 12 shows for each sex and color group the per- centage of youth examined by dentists who were found to need dental care along with the cor- responding percentages for youth examined only by a physician. 2,500 to 25,000 population, 86.6 in cities of 25,000 to 100,000 population, and 85.8 in cities having a population over 100,000 but less than 500,000. The only possible exception to the above lack of relationship was among Negro females, where there may have been slightly higher percentages needing dental care in larger cities. The percentages of youth needing dental care did vary among the youth examined by dentists in the several census regions. Table 13 shows these percentages for total youth, white males, and white females. The Middle Atlantic region is shown both including and excluding the cities of 500,000 and more, and the rate is comparable with that for the other regions if those cities are excluded. The number of dental care recommen- dations was lowest in the West South Central (where, it will be recalled, the prevalence of un- treated dental caries was lowest) and in the South Atlantic regions. The East South Central region reported the largest percentage of youth in need of dental care. Table 13.—The percentages of youth who were found to need dental care in each census region, by sex and color; based on youth examined by a dentist. NYA health examinations. United States Percent of youth examined by dentist who were found to need dental care Census region White Negro White Negro males males females females New England - 88.5 89.2 92.9 87.7 88.8 (Middle Atlantic) - (73. 2) (70. 5) (73.4) (74.9) (82.1) Middle Atlantic (excluding cities 500,000+) 89.0 90.0 89.9 85.8 91.3 East North Central 88.2 89.4 84.4. 87.6 89.4 West North Central 85.8 85.6 94.3 82.6 95.0 South Atlantic 81.0 85.4 65.9 77.4 76.7 East South Central, __ 94.3 93.9 95.1 94.3 95.8 West South Central .. , 80.3 79.5 77.7 82.8 78.1 Rocky Mountain 85.7 84.2 80.3 87.6 81.5 Pacific 88.4 86.0 92.7 89.3 90.9 Table 12.—The percentages oj youth recorded as needing dental care among youth examined by both physicians and dentists, by sex and color. NY A health survey. United States Percentage needing dental care Sex and color group Youth ex- amined by a dentist Youth not examined by a dentist All exami- nations 84.5 62.8 65.7 83.8 53.7 66. 7 85.2 51.9 64.7 84.3 50.7 64. 6 85.2 61.9 70.7 84.1 52.3 66.3 82.2 60.4 68. 6 84.6 49.2 62.8 Negro females- _ - _ 87.8 63.3 72.6 No significant differences in need for dental care were observed among the different sex-color groups. The marked differences that appear between youth examined by dentists and youth examined by physicians are indicative of a much more precise determination, by dentists, of the existing dental needs. An examination of the percentages of youth needing dental care in communities of various sizes showed no relationship between need for dental care and size of city. Aside from cities of 500,000 and over—, which group showed an extremely low percentage because of the atypical situation in New York City—there was almost no variation. For all youth examined by dentists the percentages needing dental care were 86.5 in rural areas, 85.4 in towns and small cities of Eye defects Visual Acuity Snellen chart tests of vision were a part of every health examination. The words “vision” and “visual acuity” are used here to refer to the results of that test. All youth were tested with- out glasses. In most cases, youth with defective vision were also tested with some form of visual aid.14 These data were tabulated for each eye separately and also cross-tabulated.15 The fig- ures presented in this paper are based on unas- sisted vision, and indicate the extent of visual 14 Assistance was by the youth’s own glasses, by trial lenses, or by looking through a pinhole punched in a card. 15 The better eye in case both were equal was taken to be the right eye. The Snellen chart reading recorded was the designation of the smallest line that could be read completely. THE HEALTH STATUS OF NYA YOUTH impairment among NYA youth. In many cases the youth already had glasses; the prevalence of youth with uncorrected visual defects is discussed later in this section in terms of “Recommendations for Refraction.” cent of the youth had normal unassisted vision in both eyes, that is, vision of 20/20 or better; 75 percent had normal vision in at least one eye. In 23 percent, vision was worse than 20/20 in at least one eye but no worse than 20/40 in the poorer eye, so that 86 percent had vision no worse than in the poorer eye. Including the 0. 4 percent who were blind in one eye, 7. 8 percent had vision of 20/100 or worse in at least one eye and 5. 0 percent tested 20/200 or worse. Considering the better eye, 7. 7 percent had vision of 20/50 or worse; 5. 9 percent had 20/70 or worse; and 4. 1 percent tested 20/100 or worse. A measure of the correlation of visual acuity in the two eyes is presented for white male youth aged 16 to 20 in table 15. It will be noted that almost 69 percent of these youth had vision of 20/20 in both eyes. Almost 94 percent (93.6) had vision of 20/40 or better in their better eye and 87.8 percent had vision of 20/40 or better in their poorer eye as well. On the other hand, about 4.8 percent of the youth had vision of 20/70 or worse in both eyes; 3.3 percent had vision of 20/100 or worse; and for 1.9 percent the readings for both eyes were 20/200 or worse. Only three youth (less than 0.01 percent) in this age group were reported blind in both eyes. It will be noted from table 15 that when vision in the poorer eye is below normal, the better eye frequently has the same degree of defect. Thus, for visual acuity of 20/40 or worse in the poorer eye more youth had vision as defective or almost so in the better eye than had normal vision in that eye. But those youth who are blind in one eye are about as likely to have normal vision in their “good” eye as youth with both eyes effective. Table 14.—Percent of youth having specified Snellen chart readings in each eye by sex and race. NY A health examina- tions, United States Snellen chart reading Total White Negro (unassisted) youth Male Female Male Female BETTER EYE 1 146, 562 63,070 57, 235 12,429 13,828 100.0 100.0 100.0 100.0 100.0 20/20 - 76.3 78.7 70.4 80.8 74.8 20/25-20/40 16.9 14.3 19.8 14. 5 19.4 20/50-20/70 3.6 3.2 4.4 2.4 3.3 20/100 - - - 1.7 1.5 2.1 1.0 1.0 20/200 2.4 2.2 3.2 1.2 1.4 Reading unknown but vision . 1 .1 . 1 . 1 . 1 Blind (2) (2) (2) POORER EYE 146, 224 62,892 57,128 12, 396 13,808 100.0 100.0 100.0 100.0 100.0 20/20 . 63.9 67.1 69.1 70. 7 63.3 20/25-20/40 - 22. 5 19. 7 25.1 20. 5 26.4 20/50-20/70 5.6 5.2 6.4 3.9 5.4 20/100. 20/200 2.8 4. 6 2.7 4. 5 3.4 5.6 1.6 2. 5 1.8 2.6 Reading unknown but vision .2 .2 .2 .2 .2 Blind .4 .6 .2 .6 .3 1 The right eye was taken as the better if both were equal. 2 Less than 0.05. A summary of the more important visual acuity findings is presented in table 14. Sixty-four per- Table 15.—Percentage of the 49,908 NY A white male youth, aged 16—20, tested by Snellen charts and jound to have the indicated readings for each eye when vision was unassisted. NY A health examinations. United States Snellen chart reading, poorer eye Snellen chart reading, better eye All read- ings 20/20 20/25 20/30 20/40 20/50 20/70 20/100 20/200+ Unknown but ab- normal Blind All readings 100.0 68.6 6.0 9.2 4.0 2.4 2.5 2.6 4.0 0.17 0.63 20/20 79.9 68.6 3.1 4 3 1 0 . 6 . 5 5 8 .06 .01 .01 .01 (') 01 .38 .03 .06 .01 01 20/25 4.4 2.9 8 3 . 1 . 1 . l 1 20/30 6.7 4.1 1. 4 . 4 . 3 . 2 2 20/40 2.6 1.3 .6 .3 . 2 2 20/50 1.6 .7 .4 .2 . 2 20/70 1.5 .9 .4 . 2 01 20/100 1.4 1.0 . 4 . 01 .01 20/200+ 1.9 1.9 01 .01 0) .01 Unknown but abnormal . 1 .05 Blind (>) 1 Less than .01 of 1 percent. One might ask, “Given a particular Snellen chart reading for the better eye (or for the poorer eye), what is the probability of finding each one of the possible readings in the other eye?” Such questions as this can be answered for NYA youth aged 16 to 20 by consulting the data of table 15. Thus from the row entitled “All readings,” one can obtain the relative number of youth having any 23 THE HEALTH STATUS OF NYA YOUTH specific reading for their poorer eye and by follow- ing the particular reading from this row through in the column below it, one may determine the fractional part of the youth with that reading who have the same or better vision in their better eye. For example, given the vision of 20/40 in the poorer eye, the “All readings” entry in that column show that 4 youth in every 100 had a reading of 20/40 in their poorer eye. Of these youth, one-fourth had normal vision (20/20) in their better eye; one- twelfth had vision of 20/25; one-third had vision of 20/30; and almost one-third had a rating of 20/40. Thus the probability of having 20/20 vision in the other eye is, in this case, about one in four* and so on. Since vision of 20/40 is often used as a point beyond which vision is definitely considered handi- capped, the relative number of youth with vision of 20/50 or worse is used here to compare age, sex, and color groups; variation from 20/20 vision is also used. Female youth had defective vision, in some degree, slightly more frequently than males. About 41 percent of the white females had defec- tive vision (i. e., worse than 20/20) in at least one eye, compared to 33 percent of the white males (see table 14). For Negroes the figures were approx- imately 37 percent of the females and 29 percent of the males. Table 16 shows the relative number of youth in each of these sex and color groups with vision of 20/50 or worse. It will be noted there, also, that female youth were more often defective in both the better and poorer eye, but this was not as true for Negro youth as for white. 14.3 as compared to 9.4 percent for the poorer eye. This would seem to indicate that when Negro youth have visual defects they tend to be less severe than those occurring among white youth. Though the two age groups of male youth studied here are separated by a difference in median age of only 3.8 years, the relative number of youth with vision of 20/50 or worse was 6.0 compared to 9.0 percent for the better eye and 11.4 compared to 15.8 for the poorer eye for youth aged 16 to 20 and 21 to 24, respectively. It will be noted that the difference between the two age groups is more pronounced in the poorer eye than in the better eye for both races. The distribution of this difference in acuity be- tween the age groups is given in detail for white male youth in table 17. It is shown to have existed among youth with all different degrees of defect. The relative numbers of youth in the two age groups with some degree of defect were 20.1 as compared to 25.9 percent for the better eye, and 31.4 compared to 38.6 percent for the poorer eye. Table 17.—Percent of white male youth having specified Snellen chart readings for two age groups and for the better and the poorer eye. NYA health examinations. United States Age groups Snellen chart reading 16-20 21-24 16-20 21-24 Better eye Poorer eye Number of youth examined1 50,041 13,029 49,099 12,983 All readings.-. 100.0 100.0 100.0 100.0 20/20 79.9 74.1 68.6 61.4 20/25 4.4 4.5 6.0 5.8 20/30 6.7 8.5 9.2 10.7 20/40 2.6 3.3 4.0 5.2 20/50 1.5 1.9 2.4 2.7 20/70 1.5 2.1 2.5 3.3 20/100 1.4 2.1 2.6 3.5 20/200+ 1.9 3.4 4.0 6.3 Blind (2) (J) .5 .9 Unknown but abnormal .1 .1 .2 .2 1 Excluded from the figures used here are youth whose Snellen chart read- ings were unknown. The number of youth with unknown reading was higher for the poorer eye than for the better eye. 2 Only 3 cases. Table 16.—Percent of youth having vision of 20/50 or worse in the better and the poorer eye for white and Negro youth, by age groups for mates, and by sex. NYA health examina- tions, United States Age and sex group Better eye Poorer eye Total White Negro Total White Negro Males 16-20 6.0 6.4 4.1 11.4 12.1 7.8 Males 21-24 9.0 9.6 6.4 15.8 16.7 11.4 Male youth 6.6 7.0 4.6 12.3 13.0 8.6 Female youth 8.9 9.7 5.7 14.6 15.6 10.1 All groups 7.7 8.3 5.2 13.4 14.3 9.4 Visual acuity varied considerably from region to region. Since at least part of the variation might be attributed to the presence of a larger number of eye specialists among the examiners in some regions, the comparison of regional variation has been made in terms of youth with visual acuity worse than 20/40. It was thought there would be less variation among examiners in determining the relatively severe impairments than in measuring slight variations from normal. These comparisons are made in table 18 for both the better and the poorer eye. The northern and Less Negro youth, then, had some degree of visual defect (i. e., reading worse than 20/20) by the Snellen chart test than white youth. For male and female youth combined the percentages of youth with any better eye defects were 25.3 for white and 22.4 for Negro, and with poorer eye defects, 36.7 for white and 33.2 for Negro. But among youth with visual acuity of 20/50 or worse, the figures for white and Negro youth were 8.3 as compared to 5.2 percent for the better eye, and 24 THE HEALTH STATUS OF NYA YOUTH western regions had a greater percentage of youth with defective visual acuity than southern regions. Vision among Negroes was less frequently defec- tive than among white youth in every instance except in New England, where the number with poorer eye vision of 20/50 or worse was almost the same for Negro and white, 18.1 compared to 17.7. Table 19.—Relative number of youth receiving recommenda- tions for refractions, by size of community of youth's resi- dence, in each census region. NYA health examinations. United States Census region Under 2,500 2,500 to 25,000 25.000 to 100.000 100,000 to 500,000 500,000 and over Total United States.— New England. 16.8 19.0 19.5 22.0 24.2 14.6 25.0 19.3 16.8 17.5 15.4 15.5 20.9 15.0 14.4 26.2 20.4 20.0 21.4 16.8 14.3 23.7 15.5 24.0 31.1 19.8 18.4 22.9 19.1 13.8 27.5 13.7 23.5 22.0 24.4 24.3 20.7 23.6 16.0 30.9 21.0 Middle Atlantic.. East North Central West North Central South Atlantic East South Central West South Central Rocky Mountain 26.7 22.0 27.1 20.0 27.3 Table 18.—Percent of youth having vision of 20/50 or worse in the better and the poorer eye, jor white and Negro youth by census region. NY A health examinations. United States Better eye Poorer eye Census region — White Negro White Negro Total United States,. 8.3 6.2 14.3 9.4 New England 11.2 10.5 17.7 18.1 Middle Atlantic... ... 17.5 13.5 26.9 20.5 East North Central 10.1 6.5 17.4 11.8 West North Central.. 8.5 4.2 14.8 8.4 South Atlantic . 6.1 4.3 10.1 8.6 East South Central 3.9 1.5 8.5 3.7 West South Central 3.4 1.7 7.2 3.7 Rocky Mountain.. .. _. 9.1 6.6 14.6 11.5 Pacific 10.1 5.6 16.0 9.9 Defective Color Vision Color vision impairment is recognized as im- portant because of the limitations it places on the affected individuals in certain occupations and in traffic signal recognition. Not only the fact of impairment but the degree of impairment is of importance in a study of color perception. Two types of color vision tests were used by examining physicians, either the matching of yarns according to colors (Holmgren test) or the reading of Ishihara plates. The Ishihara test is the more exacting. It is composed of a series of plates on which are dots of various colors arranged into patterns that will be discernible to the normal eye but not to one with defective color vision. The Ishihara test was given to 31.3 percent of the youth, the Holmgren yarn test to 63.3 percent, and 5.4 percent were given either both tests or some other test not listed for specific tabulation. By the yarn test 1.2 percent of the youth had defective color vision, and by the Ishihara test 3.2 percent had this abnormality, with 1.0 percent classified as markedly abnormal. Imperfections of the color sense may be acquired through disease, injury, or drugs, or they may be present at birth by heredity. Hereditary color blindness is said to be the more common cause. More than four times as many males as females are hereditarily color blind.17 This is due to the manner of its inheritance, it being transmitted to the male through the female who is herself not usually affected.18 Since a racial difference also occurs, the figures for each sex will be discussed separately for white and Negro youth. By the Ishihara test, 5.2 percent of the white males had some degree of impairment compared Recommendations were made by the examiner that the youth have a refraction for glasses in approximately 20 percent of the youth examined. These recommendations were either to correct a present improper fitting or to secure their first glasses. White youth were in slightly greater need of such fittings than Negro youth. More females needed glasses than males. The percent- ages are 17.6 for white males compared to 22.5 for white females, and 15.9 for Negro males com- pared to 21.3 for Negro females. The relative numbei of recommendations for refraction differed between the two male age groups. For white males this was the difference between 16.8 percent for youth aged 16 to 20 and 20.6 percent for youth aged 21 to 24. Negro youth likewise differed for these two age groups by 15.2 percent compared to 18.4 percent. Youth in larger urban centers were recommend- ed for refractions more frequently 16 than those living in smaller places, the rate increasing for the total United States from 16.8 percent for rural communities to 24.2 percent in cities of 500,000 and over. In southern regions the figures tended to be lower than in the North and showed less rural-urban difference in number of youth needing refractions. The different regions are compared in table 19. 17 Collins, George L. Color Blindness. Pub. Health Bull. No. 92. U. S. Public Health Service, 1918. 78 Conklin, Edwin Q. Heredity and Environment. Princeton Univ. Press, 1929, p. 191. 18 It must be remembered that at least part of the recorded rural-urban variation in visual requirements may be due to differences in the number of eye specialists available in the respective areas. 25 THE HEALTH STATUS OF NYA YOUTH to 1.2 percent of the females, or a ratio of about 4 males to every female. For those markedly abnormal by this test, the proportions were 1.7 percent for males and 0.3 percent for females. The Holmgren yarn test, on the other hand, showed 1.5 percent of the white males abnormal as compared to 0.2 percent of the females, and 0.4 percent of the males were markedly abnormal but less than 0.1 percent of the females. The Ishihara test showed only 3.5 percent of the Negro males and 1.4 percent of the Negro females to have abnormal color vision. Only 1.0 percent of the males and 0.2 percent of the females were markedly color blind by this test. The results of the Holmgren yarn test among Negro youth were found to differ considerably from the findings for white youth, but most of this difference was limited to the West North Central region. Exclu- sive of that region, 2.1 percent of the Negro males and 0.9 percent of the females were color blind; only 0.5 percent of the males and 0.2 percent of the females were markedly abnormal. In the West North Central region 11.7 percent of the Negro males and 14.8 percent of the females were reported as abnormal. Since these figures are out of line with all other findings, it is highly probable that this variation was due to ignorance of color names rather than lack of ability to dis- cern color differences. In the yarn test youth might have been erroneously required to name colors rather than match various shades. Diseases of the Eye The most frequent disease of the eye, blepharitis, or inflammation of the eyelids, occurred in 1.4 per- cent of the white youth and 0.7 percent of the Negroes. This defect is often of more importance as a symptom than as an actual impairment. Strabismus, or squint, was present in some degree in 1.4 percent of the white youth and 0.8 percent of the Negroes. An early diagnosis of this defect is of importance in the possible saving of the sight of the deviating eye. Conjunctivitis in some form (inflammation of the membrane covering the eye- ball and of the lining of the eyelid) was reported in 0.8 percent of the white youth and 0.5 percent of the Negroes. The more serious trachoma and pterygium, diseases which tend, unless checked, to cause blindness, were reported for 0.1 percent and 0.3 percent, respectively, of all youth examined. Eye defects and diseases other than the above were reported among 1.5 percent of the white youth and 2.3 percent of the Negro youth. A table present- ing these facts in greater detail will be found in appendix C. The relative number of youth with diseases of the eye varied from 4.3 percent in the East South Central region to 7.1 percent in the Pacific region. The Northern and the Western regions were higher than the Southern, except for New England where only 4.1 percent had these defects. Eye surgery was recommended for about 0.3 per- cent of the males, but only 0.2 percent of the females, for both Negro and white youth. A hand tabulation of the youth recommended for study by a specialist showed about 1.1 percent of all youth required an eye specialist. Ear, nose, and throat defects Hearing Auditory acuity of NYA youth was recorded for each ear separately in the following manner. Twenty feet was regarded as the distance at which a normal conversational voice should be audible. Deviations from normal were recorded as fractions with 20 as the denominator and the actual dis- tance at which the examiner’s voice was under- stood as the numerator. It is not assumed that such a method yields accurate quantitative re- sults. The normal conversational voice of one examiner may bo more audible than that of an- other. In coding, therefore, no distinctions were made between the various entries that were above 17/20, all such entries being coded 20/20. Thus “20/20” was used for hearing of 18/20 and 19/20 as well as recordings of extra-acuity, such as 25/20. Similarly, 5/20 here indicates all degrees of hearing below 7/20, except deaf; 10/20 includes values from 8/20 through 12/20; and|15/20 includes val- ues from 13/20 through 17/20. These hearing tests indicated that 98.7 percent of the youth could hear a conversational voice at least 18 feet with their better ear and 97.2 percent could hear that well with their poorer ear. These data would not measure slight degrees of impair- ment in hearing because of the rough nature of the test given. It is probably safe to conclude that ratings as low as 10/20 indicate some degree of impairment and that ratings of 5/20 denote definitely impaired hearing. Using these limits, 0.9 percent of the youth had some impairment (10/20) in at least one ear, and 0.4 percent had some impairment in both ears. Ratings of 5/20 or worse in at least one ear were recorded for 0.4 percent of the youth; only 0.1 percent had hearing so defective in both ears. Two youths in every 1,000 (0.2 percent) were deaf in one ear only; and one per 1,000 was deaf in both ears. The relative number of male youth having audi- tory impairment increased slightly with advancing age. Hearing defects occurred so seldom that sex and race differences are not meaningful. No re- gion had more than 4.1 percent of the youth with impaired hearing. 26 THE HEALTH STATUS OF NY A YOUTH Condition of Ear Drums, and Presence of Cerumen Of the 143,080 youth for whom both ear drums were examined, 94.4 percent were normal. De- fects of the ear drum were classified as to degree or extent of defect considering the progressive stages as reddened, dull, retracted, perforated, and ab- sent. The presence of any of these stages does not necessarily indicate any impairment of hear- ing. A reddened or dull drum usually indicates some stage of infection. “Retracted” indicates that a previous infection has caused a scar to form thus causing a change in the shape of the drum. “Drum perforated” and “drum absent” are self- explanatory terms. Persons having these latter conditions are thought to be more subject to infec- tions of the inner ear. The relative number of youth having each of the above conditions is shown in table 20. (the common “cold in the head”), the percentage having defects might be very high solely because of a high prevalence of head colds. This is not the case as is evident from the fact that coryza was reported for only 0.7 percent of the youth. Chronic sinus infection was reported for 3.3 percent of the youth; 2.8 percent were classed as slight infections, and 0.5 percent as moderate or severe. The relative number of older male youth with slight infections was higher than the number of younger males, but the difference was small (2.8 percent for the 16 to 20 age group and 3.4 percent for 21 to 24 years). No consistent variation with sex was evident. A slight racial difference was apparent, 3.4 percent of the white youth having chronic sinus infection as compared to 2.4 percent of the Negroes. Except for the New England region, which reported 0.8 percent of the white youth infected, chronic sinus infec- tion was lowest in the South and highest in the North and West. Among white youth, the South Atlantic region reported 2.0 percent infection and the Rocky Mountain region 5.5 percent. It must be remembered that mild cases of chronic sinus infection would not always be detected by routine physical examinations. The small dif- ferences noted are given here because they are consistent in the data and seem logical.20 A few cases (less than 0.1 percent) of acute sinus infection were reported. The second most frequent nasal defect tabu- lated was deviated septum. While slight devia- tions are common and of little importance, those tabulated here were severe enough that the physician wrote in the defect on the youth’s examination record, as it was not among those printed for checking. A marked difference was observed in the relative frequency of deviated septum among white and Negro youth, the rate among Negroes being 0.7 percent as compared to 3.0 percent for white youth. A substantial sex difference was present among white youth, the rates being 3.8 percent for males and 2.2 for females. Negro youth showed no significant difference between males and females in the prev- alence of deviated septum. The rates among white males tended to increase slightly with advancing age, being 3.6 percent for 16 to 20 years and 4.6 percent for 21 to 24 years of age. Perforated septum was recorded for 0.1 per- cent of the youth. Among male youth the per- centage varied from 0.1 for 16 to 20 years to 0.3 for 21 to 24 years of age. This difference between the two age groups was found in every census Table 20—Percentage of youth having specified condition of the ear drums. NYA health examinations. United States Condition of drum Better ear Poorer ear1 143,548 143,080 100.0 100.0 Normal - - 95.1 94.4 .1 .1 .7 .9 1.7 1.9 Dull 2.3 2.5 Abnormal, except above (including reddened, etc.). .1 .2 i If both ears were of equal auditory acuity, the left ear was designated as “poorer.” Age, sex, and race .differences were not suffi- ciently large to deserve mention. Regions varied in relative number of youth with defects of the drum of the poorer ear from 3.2 percent in the East South Central to 8.9 percent in the Rocky Mountain region, and from 2.5 to 7.4 percent for the better ear.19 In general, lower percentages of drum abnormalities were recorded in the Southern than in the Northern regions. Ear cerumen (or wax), filling the external canals, was recorded for 4.5 percent of all youth examined. The percentage with wax varied among the census regions from 2.3 in the East South Central to 8.6 in the New England region. Nose and Accessory Sinuses Almost 1 youth in 10 had some defect of the nose or connecting sinuses. There were 11.5 defects for every 100 youth examined, some youth having more than one such defect. Since the classification of defects used here includes coryza 20 Diehl and Shepard in their report to the American Youth Commission on the health of college students (ibid.) found 19.4 percent of the 4,679 college students examined in 34 colleges had deviated septum, 13.4 percent had chronic sinus infection, and 2.7 percent had nasal spurs or polyps. is Tho better ear was taken to be the ear with the better hearing. Where both ears were equal the right was designated as “better.” THE HEALTH STATUS OF NYA YOUTH 27 region. Perforated septum was recorded rela- tively twice as often among white youth as among N egroes. The presence of nasal polypi was noted in 0.5 percent of all youth. This defect was almost twice as common among Negroes (0.9 percent) as among white youth (0.5 percent); this difference between white and Negro youth was greater in the South than in the North. Allergic rhinitis, or hay fever, was recorded for 0.8 percent of all youth, there being no particular difference with respect to age, sex, or race. Because of the nature and seasonality of this disease, many cases would be unrecorded. The recorded cases were less frequent in the South than in the North and West. Thus, allergic rhinitis was recorded for 0.3 percent of the youth in the East South Central and for 1.7 percent in the Rocky Moun- tain region. Other abnormalities of the nose, including epistaxis (nose bleed), inflamed mucous mem- branes, post-nasal drip, etc., were recorded for 3.4 percent of the youth. Tonsils An" evaluation of the data on prevalence of diseased tonsils, and their meaning in a program of rehabilitation is made difficult by lack of specific information as to the extent of impairment and the complex question of when tonsils should be removed. It may be assumed that infected tonsils are often related to infections in adjacent tissues such as of the ear, nose, sinuses, and other parts of the throat. There is evidence21 that tonsillectomy reduces the susceptibility of chil- dren to diphtheria, infections of the middle ear, and possibly other diseases. However, Forsythe 22 could find no outstanding difference in the health of university students with and without their tonsils removed. Regrowth of tonsils is known to occur only in cases of incomplete removal. Physicians at one time considered partial removal as sufficient but it is now generally agreed that complete removal should be done in cases where an operation is indicated. But conditions gov- erning the decision to operate involve factors of age, general health, and extent of infection, and the decision is further complicated by lack of complete information as to possible later effects of the operation. In coding defective tonsils those recorded on the examination form as both diseased and partially removed were regarded as diseased. If the physi- cian entered the condition as hypertrophied or enlarged, this was coded as diseased in those cases in which he recommended a tonsillectomy. Physicians differ considerably in their judgment as to what constitutes diseased tonsils. The present data are offered as representing a com- posite of the judgments of a large number of indi- vidual physicians. Tonsils have been classified according to whether they were normal, diseased, completely removed, or partially removed. But the relative number of youth having diseased tonsils in any group is necessarily affected by the number of tonsilecto- mies that have been performed in that group. When comparing one group with another this must be kept in mind. In terms of the definition given above, diseased tonsils occurred in 22.8 percent of the 145,913 youth with known tonsil condition. The per- centages decreased somewhat with age, at least partially due to the effect of more tonsillectomies in the older-age group. No sex difference was evident but the percentage was 22.1 for white youth and 25.9 for Negroes. This difference is at least partially due to more frequent removals among the white. Table 21.—Relative number of youth with of tonsils, separate by race. NYA hea United States pecified condition th examinations. Condition of tonsils Percent of youth having the tonsillar condition indicated White Negro Total known youth 119,783 26,130 All conditions 100.0 100.0 Normal 47.9 56.7 Diseased-,. 22.1 25.9 26.2 14.7 Partially removed 3.8 2.7 Rural-urban differences are shown in table 22. The small number with partially removed tonsils are combined with completely removed. It must be remembered that operating facilities are more accessible in large cities. The data are presented by color for youth in each urbanization group. It will be noted from the table that the prevalence of diseased tonsils among white youth increases progressively with decrease in size of the commu- nity of the youth’s residence; also that the relative number of all youth with previous tonsillar oper- ations is progressively lower as the size of the city decreases. It is likewise true that the number of youth with normal tonsils is somewhat larger in 21 Doull, James A. A Note on the Relationships of Tonsillectomy to the Occurrence of Scarlet Fever and Diphtheria. Public Health Keports August 1, 1924, pp. 1833-1839. 22 Forsythe, Warren E. The Health Eecord of University Students as Kelated to Tonsillectomy. Public Health Reports, March 9, 1928, pp. 560- 563. 480993—42 3 28 THE HEALTH STATUS OF NY A YOUTH cities under 100,000 population but quite low in those urban centers over 500,000. Among Ne- groes, only in cities of over 500,000 population, where the number of tonsillectomies was highest, did the relative number of these youth with diseased tonsils drop noticeably. examining physicians as to what constitutes diseased tonsils. Relatively more removed tonsils were recorded in the northern regions than in the South and, as would be expected, rural areas showed fewer past tonsillectomies than the larger cities. Removed tonsils were much less frequent among Negro youth than among white, both in rural areas and in larger places. Pharynx Although the examining physician was asked to specify the condition of the pharynx, it was found impractical to tabulate the various impairments listed. A tabulation was made, however, as to whether the pharynx was normal or abnormal, and 5.8 percent of the youth were discovered to have some pharynx abnormality. Entries here included abnormal condition of the adenoids, inflamed or infected pharynx, and so forth. Recommendations for ENT Defects It will be recalled that a considerable number of youth were found to have excessive ear wax (cerumen). About one-fourth of the recommenda- tions for minor nonsurgical procedure were for ear wax removal. This was thus recommended for about 1.4 percent of all youth examined. Mastoid operations were recommended for only 43 youth in 100,000 (0.043 percent). Submucous resections of the nose made up about one-fifth of the recommendations for “Other minor surgery”; approximately 0.2 percent of the youth examined needed this operation. Tonsillectomy was recommended for about 19 percent of all youth examined. The rate was only slightly higher for Negro youth (18.8 percent for white; 22.1 percent for Negro). White males and females received this recommendation at about the same rate, 19.1 and 18.4 percent, but Negro males were a little lower than females, 20.9 com- pared to 23.2 percent. This operation was recom- mended considerably more frequently as the size of community decreased, varying from 11.8 per- cent for all youth in cities of 500,000 and over, to 23.5 percent in communities of under 2,500 popula- tion. When the recommendation rate for tonsillec- tomies is based only on youth known to have tonsils (i. e., total youth minus youth whose ton- sils had been partially or completely removed), the race and urbanization differences were less marked. No appreciable difference is present between white and Negro youth, about 27 percent of all youth with tonsils being recommended for tonsillectomy. The corrected rate for white males and females remained at approximately 27 percent (26.6 for males and 26.7 for females) but for Negro youth Table 22.—Percent of youth having specified condition of tonsils, according to size of community in which the youth lived, separate by color. NY A health examinations. United States Condition of tonsils Total youth Rural under 2,600 2,500 to 25,000 25.000 to 100.000 100,000 to 500,000 500,000 and over Total, white youth 119, 783 46, 771 19,199 16, 508 21,766 15, 539 100.0 100.0 100.0 100.0 100.0 100.0 Normal 47.9 22.1 30.0 54.2 27.1 18.7 49.3 24.2 26.5 51.0 21.7 27.3 43.0 16.6 40.4 34.0 13.5 62.5 Diseased 26,130 5, 948 2,393 3,194 5,987 8,608 100.0 100.0 100.0 100.0 100.0 100.0 56.7 25.9 17.4 67.7 28.0 4.3 62.0 30.5 7.5 65.9 24.2 9.9 46.7 32.2 21.1 51.1 19.5 29.4 1 Includes partially removed. Table 23.—Percent of youth in each census region having diseased tonsils and removed tonsils, for communities of under 2,500 population and for cities of 100,000 population and over. NYA health examinations. United States Region White Negro Under 2,500 100,000 and over Under 2,500 100,000 and over Diseased Removed Diseased Removed Diseased Removed Diseased Removed Total. United States 27.1 18.7 15.3 45.5 28.0 4.3 24.7 26.0 New England 9.9 37.5 7.3 50.6 (0 0) 9.4 40.9 Middle Atlantic 31.1 30.9 5.7 61.5 0) 01 13.5 39.6 East North Central -. 23.9 19.5 19.9 40.6 26.6 14.8 22.4 25.2 West North Central--- 24.9 21.9 15.2 38.6 16.4 3.5 52.5 22.1 South Atlantic 28.5 16.7 17.5 45.1 31.6 6.1 16.5 20.6 East South Central 30.4 10.6 16.4 33.5 27.0 2.3 41.0 17.8 West South Central—- 32.1 12.6 25.3 25.5 29.7 1.9 36.3 14.5 Rocky Mountain 27.8 25.0 16.7 52.7 i1) 0) 0) 0) Pacific 17.3 39.0 17.1 60.0 16.0 28.0 27.1 37.0 1 Too few cases on which to base a percent. Although the general rural-urban pattern given above was present in every region, the regional variation was in some cases extreme. The rela- tive number of youth with diseased and with re- moved tonsils in each region is given separately for rural areas and for cities over 100,000 in table 23. It will be noted that among Negroes in some regions relatively more urban youth had diseased tonsils than Negroes in rural areas. It must be remembered that at least a part of the variation evident here is due to differences in opinion of the THE HEALTH STATUS OF NYA YOUTH 29 the male rate was 24.1 percent and the female rate 29.1. Urban centers with populations of 500,000 and over had a recommendation rate based on tonsils present of 21.1 percent compared to 28.1 percent for rural areas. The corrected rates are given in table 24 for each size of community. and so was used in three groups, 16 to 17, 18 to 19, and 20 to 24 years of age. Thus, it was possible to tabulate how many of the youth fell within the weight limits of their particular weight standard, how many fell above these standards, how many fell below, and how far above or below. It is not intended that these deviations be considered as absolute indications of degree of “overweight” or “underweight.” Nor are the average weights, or weight standards, intended to be set up as optimum weights. Studies by the United States Public Health Service have shown that these two are frequently not the same. Nevertheless, these standards do furnish convenient reference points to use in getting the composite picture of weight in relation to age, sex, and height. In cases with large deviations in either direction from the standard, it is probable that the actual weight is above or below the optimum. Out of every 100 youth examined, over 11 were 15 percent or more below the weight standard for their age, height, and sex. While slight variations in weight may be accounted for by such factors as fashion, body-build, etc., it is probable that wide variations below normal most frequently result from nutritional factors. The individual who varies by as much as 15 percent below a standard of, say, 120 pounds, weighs no more than 102 pounds, and the variation (18 or more pounds) would seem to be so great as to suggest poor nutrition. If variations of less than this percent below the standard be disregarded, then 11.7 per- cent of the NYA youth had weights which in- dicated they may have been suffering from mal- nutrition in some degree. While no space on the examination form specifically called for an entry as to nutritional status, in 5 percent of the examina- tions the physician had noted under “Remarks” that the youth suffered from malnutrition or was considerably underweight. Since this information was not specifically requested, it is probable that the condition was underreported. This suggests that the 11 percent figure may be a fair approxi- mation of the extent of clinically detectable undernourishment. A further indication of this is afforded by the tabulation of recommendations made by the examiner. For 12.1 percent of the youth examined a recommendation was made for special diet. Of course, not all of these recom- mendations were to increase weight, but a special hand tabulation of entries for this item indicated that over half of them were recommendations to “bring weight up to normal.” The proportion of youth examined whose weight varied above the preselected weight standard by at least 15 percent was 11.2 percent. Moreover, for 5.5 percent of the youth weights were recorded that were 25 percent or more above average, or Table 24.—Percent of youth known to have the tonsils present who wete recommended for tonsillectomy by size of community of residence. Separate by race. NYA health examinations. United States Size of community Total White Negro All communities 26. 7 26.7 26. 7 Under 2,500. 28.1 28.7 26.0 2,500 to 25,000 28.9 28. 8 29. 9 25,000 to 100,000 24.5 25.3 21.3 100,000 to 500,000.. 26.4 23.1 35. 2 500,000 and over 21.1 20.5 21.9 Weight and nutritional status Extreme variations from average body weight usually result from improper nutrition, glandular dysfunction, or disease. While the amount of variation caused by each separate factor cannot be easily determined in a general study of health, the combined effect on the population being studied is of considerable interest. The respec- tive weights of the individuals in the group studied were not difficult to secure. The inter- pretation of this information, however, is much more difficult. Obviously weight has almost no meaning except in relation to age, sex, and height. More recently it has been recognized that no very exact study of weight as a factor in health status can exclude a consideration of the type of body- build (thin and tall, heavy set, etc., are among the popularly used designations of this charac- teristic). Due to the lack of accepted standards for this factor, howrever, it is very difficult to obtain measurements which will make it possible to take body-build into account. For this reason no attempt has been made in this study to allow for the relationship between body-build and weight, but age, sex, and height have been taken into account. The findings of the 1929 Supplementary Medical Impairment Study made by the Actuarial Society of America and the Association of Life Insurance Medical Directors, give average weights by sex, age, and height of a sufficiently large number of persons to wrarrant use of these averages as arbitrary weight standards, or bases from which to measure variation. In processing the data of this study, the percentage by wdiich each indi- vidual varied above or below the average weight for persons of his age, sex, and height was recorded; height was used in single mches while age, though available by single years, showed little variation 30 THE HEALTH STATUS OF NYA YOUTH standard weight. While slight overweight in young people is not considered deleterious to health, persons markedly overweight are handicapped both physically and functionally. Obesity, or overweight to more than a slight degree, was noted on the examination form under ‘ ‘Remarks’ ’ for 2.8 percent of the youth examined. Some kind of special diet was recommended for 12.1 percent of the youth. Since between one-fifth and one-sixth of the recommendations for special diet were recommendations for a reducing diet, this particular diet recommendation was made for about 2 youth in every 100 examined. Although overweight may be caused by bad eating habits, there is often a glandular disturbance and the condition may require special study. standard were 2.6 percent of the Negro males and 3.6 percent of white males. Among females, however, the Negro youth were less often below weight standards than white females, but more often above standard. Thus, 11.1 percent of them compared to 14.6 percent of the white females were 15 percent or more below standard. About 16 percent of the Negro females were at least 15 percent above weight standard, compared to 14 percent of the white females. Females 25 percent or more above their weight standard included 8.7 percent of the Negro females and 7.6 percent of the white. An analysis of variation from the weight standard in communities of different sizes revealed an increasing percentage below weight standard as the size of community decreased. About 33 white male youth in every 100 were 5 percent or Table 25.—Percentage of male and female youth examined, by percentage variation from tveight standard. NYA health examinations. United States Variation from weight standard 1 Total Male Female Total known youth - 145, 297 74, 730 70, 567 All degrees. 100.0 100.0 100.0 25 percent or more below standard 1.0 .6 1.4 15 to 24 percent below 10.7 9.0 12. 5 6 to 14 percent below. 31.3 32.4 30.1 Less than 5 percent above or below ... 30.5 34.0 26.8 5 to 14 percent above 15.3 15.8 14.7 15 to 24 percent above 5.7 4.8 6.7 25 to 34 percent above 2.5 1.7 3.3 36 percent or more above. 3.0 1.7 4.5 i A preselected weight, specific for age, sex, and height, representing the average previously found for a large number of cases. See text for source. Table 26.—Percentages of white male youth variation from tveight standard in each size NY A health examinations. United States with specified of community. Variation from weight 500,000 100,000- 25,000- 2,500- Under Standard or over 500,000 100,000 25,000 2,500 Total white males examined 7,669 10,626 7,891 10,093 26,340 All variations. 100.0 100.0 100.0 100.0 100.0 15 percent or more below... 6.8 10.1 11.3 10.5 11.0 5 to 14 percent below Less than 6 percent above 25.8 31.5 35.1 34.7 34.8 or below 32.2 33.8 31.7 32.9 33.7 5 to 14 percent above 19.5 16.2 14.0 14.6 14.1 8.7 4.8 4.4 3.9 4.0 25 to 34 percent above 3.4 1.7 1.6 1.9 1.3 35 percent or more above... 3.6 1.9 1.9 1.6 1.1 White males aged 16-20— 5,637 8,733 6,511 8,207 20,611 All variations 100.0 100.0 100.0 100.0 100.0 15 percent or more below... 6.8 9.2 10.6 9.8 10.6 6 to 14 percent below Less than 5 percent above 25.3 31.1 34.3 35.0 34.8 or below 33.2 34.9 32.8 33.4 33.9 5 to 14 percent above 20.5 16.5 14.3 14.6 14.4 16 to 24 percent above 8.1 4.8 4.5 3.8 3.9 25 to 34 percent above 3.4 1.6 1.7 1.9 1.3 35 percent or more above... 3.7 1.9 1.8 1.5 1.1 White males aged 21-24 2,154 1, 793 1,380 1,886 5,729 All variations. 100.0 100.0 100.0 100.0 100.0 15 percent or more below... 9.4 14.3 14.4 13.9 12.2 6 to 14 percent below Less than 6 percent above 27.2 33.5 39.3 33.7 34.9 or below 29.6 28.6 26.2 30.8 32.8 5 to 14 percent above 17.0 14.5 13.0 13.8 13.0 16 to 24' percent above 10.2 4.6 4.1 4.2 4.2 25 to 34 percent above 3.2 2.2 1.2 2.0 1.3 35 percent or more above... 3.4 2.3 1.8 1.6 1.6 It will be noted in table 25 that females tend to deviate more than males from their weight stand- ards throughout the range. Approximately 10 percent of the males compared to 14 percent of the females were 15 percent or more below their respective weight standards; 0.6 percent of the males, but 1.4 percent of the females, were 25 percent or more below. Likewise, females varied more above their standards. About 8 percent of the males and 15 percent of the females were at least 15 percent above average weight. It will be noted, also, that females were almost three times as frequently recorded among youth 35 percent or more above standard, there being 1.7 percent of the males compared to 4.5 percent of the females in that class. Racial variations from the weight standards were different for males and females. It should be realized that the same weight standards were used for both white and Negro youth. Negro males tend to vary less from the standard than white males. Only 6.1 percent of the Negro males were 15 percent or more below the average weights, compared to 10.2 percent of the white males. At 25 percent or more above weight more below average weight in cities of 500,000, as compared to 46 in rural communities. This was true for male youth in the 16 to 20 age group as well as those in the 21 to 24 age group, as shown in table 26. It will be noted also that the older group tended to have more youth below standard than did the younger. Male youth 25 percent or more above standard were recorded more than THE HEALTH STATUS OF NYA YOUTH 31 twice as frequently in cities of 500,000 and over as in rural areas. No variation with age is apparent. below standard than Northern or Western re- gions and fewer youth in the group above weight standard. Negro youth did not vary regionally in these respects as much as white youth. Females in every instance showed greater variation from weight standard than males. This sex differ- ence was about the same for all regions. Table 27.—Percentages of female youth with specified variation from weight standard in each size of community. NY A health examinations. United States Variation from weight 500,000 100,000- 25,000- 2,500- Under standard or over 500,000 100,000 25,000 2,500 Total white females exam- ined 7,829 11,055 8,636 9,050 20,246 All variations.. 100.0 100.0 100.0 100.0 100.0 15 percent or more below... 11.9 13.7 15.8 15.4 15.0 5 to 14 percent below 28.0 30.2 30.7 31.1 30.5 Less than 5 percent above or below. 26.5 26.9 25.7 26.2 27.6 5 to 14 percent above 15.5 14.2 13.9 13.6 14.6 15 to 24 percent above 7.8 6.7 6.3 6.2 6.0 25 to 34 percent above 4.1 3.6 3.0 3.1 2.7 35 percent or more above... 6.2 4.7 4.6 4.4 3.6 Total Negro females exam- ined 5,348 3, 602 1,673 819 2,309 All variations.. 100.0 100.0 100.0 100.0 100.0 15 percent or more below... 10.6 12.5 12.6 13.6 8.2 5 to 14 percent below 28.8 30.1 31.6 28.4 29.7 Less than 5 percent above or below 26.7 25.4 26.7 28.4 30.3 5 to 14 percent above 16.2 16.1 13.8 15.4 17.2 15 to 24 percent above 8.2 7.4 6.7 7.2 6.7 25 to 34 percent above 4.4 3.2 3.7 2.7 3.3 35 percent or more above... 5.1 5.3 4.9 4.3 4.6 Table 28.—Percentage oj youth in each census region who were 15 percent or more below, or 25 percent or more above weight standard: Separate by sex and race. J\YA health examina- tion. United States 15 percent or more below 25 percent or more above standard standard Census region Male Female Male Female aiPlAV Negro White Negro | White Negro White Negro Total United States 10.2 6.1 14.6 11.1 3.6 2.6 7.6 8.7 New England 7.3 5.6 11.8 8.1 4.7 4,9 10.0 10.9 Middle Atlantic 5.9 6.8 9.8 11.2 6.9 3.0 10.9 9.1 6. 9 East North Central.__ 10.0 5.7 14.0 10.9 3.8 3.3 10.7 West North Central... 9.5 6.3 13.6 12.2 3.5 3.5 8.6 10.4 South Atlantic 15.0 7.6 18.3 10.5 2.3 1.6 6.2 7.7 East South Central... 15.7 6.2 20,3 12.0 1.6 1.4 5.3 7. 1 West South Central... 9.9 5.1 15.6 11.7 2.6 2.8 4.8 7.2 Rocky Mountain 11.8 3.4 13.0 8.0 2. 1 2.7 6.3 10.2 Pacific 7.3 4.6 10.7 12.4 4.2 5.3 7.9 5.8 A comparison of white and Negro females in communities of different sizes (table 27) reveals the same general situation as was found for males. More females were above weight standards in the larger cities. The percentage of youth more than 15 percent under the weight standards increased with decreasing size of city, for white but not for Negro females. Among rural Negro females there were 8.2 percent who were 15 percent or more below the weight standards, as compared to 10.6 percent in cities of 500,000 and over and approximately 13 percent in those cities between these two extremes. But among white females the relative number of youth 15 percent or more below weight standard increased from 11.9 per- cent in the largest to 15 percent in rural areas. Negro females varied only slightly by size of community in relative numbers above weight standard. There were approximately 10 per 100 in cities of 500,000 and over and 7 to 9 per 100 in smaller places who weighed as much as 25 percent above their weight standard. "White females with this much variation ranged from about 10 to 6 per 100 between larger and smaller places. A comparison of the relative amount and direc- tion of variation in weight among NYA youth in the various census regions is given in table 28. Southern regions had a larger percentage of youth Condition of the heart and circulatory system Heart disease is one of the chief causes of disa- bility and death in persons past middle age. The onset of this disease is usually gradual and often unnoticed. Many cases have their beginnings in youth. The most common heart pathology in this age group can usually be detected by intelli- gent questioning, inspection, and stethoscopic ex- amination. But determination of the degree of impairment and the prognosis often entails further study and observation. Heart murmurs are called functional if no changes in the organ have occurred. Some of the underlying causative fac- tors commonly given for functional murmurs are cardiac displacement, anemia, or goiter, but they may be caused by recent vigorous exercise. Rhythm irregularities may or may not indicate heart involvement of a serious nature. Thus it will be seen that a complete diagnosis of heart impairment requires special study of the individual case. Physicians were asked to decide whether the youth had organic heart disease. WTiere a deci- sion was not reached as to whether a heart mur- mur or irregularity indicated the presence of heart disease or if the record submitted for tabulation had conflicting entries not clarified by subsequent 32 THE HEALTH STATUS OF NYA YOUTH correspondence, the condition of the youth was coded as “unclear.” Organic heart disease was found present in 25 per 1,000 of the 147,813 youth examined; this should be considered a minimum figure. While more detailed study might have revealed that a few of the cases so diagnosed were not organic lesions, probably at least as many new cases would have been discovered by additional diagnostic studies. Among white male youth the rate was 20 per 1,000 for the 16 to 20 age group, as compared with 28 per 1,000 for 21 to 24 years. Negro males had a rate of 23 per 1,000 for the younger group and 29 for the older. The prevalence of heart disease for Negro youth was somewhat higher than for white. For all Negro males the rate was 24 and for white males 22 per 1,000. Among females this race difference was greater, being 40 for Negro females as compared to 24 per 1,000 for white females. It is clear from the above rates that female youth had slightly more impairment of the heart than males, the rates per 1,000 white youth being 24 for females and 22 for males, and for Negro youth, 40 for females and 24 for males. however, a decided possibility that there was more frequent use of heart specialists’ services in cer- tain regions with consequent more complete case finding. This is a possible explanation of the higher rates noted in the Middle Atlantic region, since a large part of those examinations were from New York City, where specialists participated in a relatively large number of examinations. Con- versely, the lower rates in Southern regions may be partly due to the smaller number of specialists used in rural areas. Regardless of the race, sex, and regional varia- tion present, it is significant that 25 NYA youth in every 1,000 were found to have some organic heart lesion. An early diagnosis of this malady often enables the youth to make adjustments that lead to a fairly long life of reasonably good health. Table 30.—Relative number of youth with organic heart disease, per 100 youth examined, in each census region, as diagnosed by clinical examination, separate by race and sex. NY A health examinations. United States White Negro Census region Total Male Female Male Female Total United States 2.5 2.2 2.4 2.4 4.0 New England 2.2 2.0 2.1 1.8 4.0 Middle Atlantic— 3.7 3.3 3.5 3.8 5.2 East North Central. 2.5 2.3 2.7 2.0 2.6 West North Central 2.4 2.3 2.2 1.2 4.4 South Atlantic 2.7 1.6 2.0 3.3 6.2 East South Central 1.7 1.5 1.5 2.5 1.6 West South Central 1.8 1.6 2.0 1.7 2.9 Rocky Mountain . 2.8 3.0 2.6 1.3 4.5 Pacific 3.0 2.6 3.4 2.0 1.8 Table 29.—Percent of youth having specified heart condition, separate by race and sex. NY A health examinations. United States Heart condition Total Male Female youth White Negro White Negro Total known youth - 147,813 63,652 12, 532 57,760 13, 969 All conditions 100.0 100.0 1000 100.0 100.0 Normal 93.4 94.5 94.1 92.9 90.1 Organic heart disease 2.5 2.2 2.4 2.4 4.0 Functional murmur 2.9 2.3 2.2 3.5 4.3 Rhythm irregularity Functional murmur and rhythm .4 .3 .6 .4 .5 irregularity .1 .0 .1 .1 .1 Heart condition unclear .7 .7 .7 .7 1.0 Blood Pressure Blood pressure—the pressure of the blood on the walls of the arteries—is important as a partial index of the degree to which the heart, vessels, and related organs are functioning properly. High or low readings may also be important symptoms of other physical abnormalities. Knowl- edge of the systolic (maximum) pressure is es- pecially valuable, being more easily and exactly determinable than diastolic (minimum) pressure. But diastolic pressure is less likely to be affected by such factors as excitement, recent physical exertion, etc., and so both readings will be dis- cussed here. Blood pressures are measured in terms of the height of a column of mercury sus- tained by the pressure, and among youth the pressures most commonly found are from about 110 mm. (millimeters) to 130 mm. for systolic pressure, and from about 65 to 85 mm. for diastolic. Unusually low pressures (below 95 mm. systolic; below 55 mm. diastolic) are important as possible Regions varied considerably in the relative number of youth diagnosed as having organic heart disease. The extent of this variation is shown in table 30. The sex and race differences mentioned in the paragraph above are present in most regions but considerable variation occurs from the figures given for the country as a whole. This recorded regional variation is probably due in part to actual differences but variations in the diagnostic facilities available and the conse- quent variations in the judgments of the examiners are too great to permit any definite statement. Southern regions have a lower rate of rheumatic fever, the most common cause of heart disease among youth. The lower rates found in the South in this study thus seem reasonable. There is, THE HEALTH STATUS OF NYA YOUTH 33 indications of such abnormal conditions as tuber- culosis, malnutrition, focal infection, and anemia. Among the causes of high systolic and diastolic pressures are nervous disturbances, kidney dys- function, positive blood serology, heart abnormal- ities, focal infections, and overweight. Selective Service requirements for class A (unlimited mili- tary service) are that the systolic pressure must not persist above 150 mm. or the diastolic above 90 mm. Pressures slightly below average have been found to be associated with lower mortality than those above average. The optimal pres- sures are probably lower than the average pressures.22 The median systolic blood pressure among the 147,317 NYA youth for whom pressures were taken was 119 mm. Ninety-five percent of the youth had systolic pressures between 95 and 144 mm. Eighty percent had pressures between 105 and 134 mm. The median diastolic pressure was at 74.4 mm. with 96.4 percent of the readings falling between 55 and 94 mm. and 87.8 percent falling between 55 and 84 mm. Blood pressures are said to increase about one millimeter for each two years increase in age.23 Among NYA males the median systolic reading was 120.2 mm. for youth aged 16 to 20 and 122.0 mm. for those 21 to 24 years of age. In the younger age group 4.7 percent of the males had systolic pressures outside of the 95 to 144 mm. limits, and in the latter age group 6.5 percent of the readings were outside. Diastolic pressure varied with age in about the same manner as systolic. Males aged 16 to 20 had a median diastolic pressure of 74.2 mm.; for those 21 to 24 years of age the median was 76.4 mm. II limits of 55 to 94 mm. are considered normal, 3.7 percent of the males in the lower age group fell outside this range; 4.3 percent of the older group were outside. table 31 giving median systolic and diastolic pressures by race and sex. The percent of youth falling outside of various given limits are also shown (table 32), and these figures likewise indi- cate a clear tendency to lower pressures among females at the NYA age level. The variation with race is not sufficiently marked to draw definite conclusions. Table 32.—Percent of youth outside given limits of systolic and diastolic blood pressure. NYA health examinations. United States White youth Negro youth Limits of pressure (in mm. of mercury) Male Female Male Female Systolic: Outside 95-144 5.0 3.9 5.0 4.4 Below 95 1.2 2.1 1.9 2.5 145 and above 3.8 1.8 3.1 1.9 155 and above 1.3 .6 1.2 .7 Diastolic: Outside 55-94 3.7 3.2 4.7 3.8 Below 65 2.2 1.9 2.3 1.8 95 and above... 1.5 1.3 2.4 2.0 105 and above .2 .2 .5 .4 A comparision of the various census regions with respect to the relative number of NYA youth having systolic pressures above and below given limits appears in tables 33 and 34. The variation shown for the limits set does not appear to give results with a consistent pattern. Such would not be expected since the factors associated with high and low blood pressure are not known to be related to geographic factors, and the variation in their effect on blood pressure is an unknown quantity. It is perhaps of some value, however, to know where these youth with abnormal pressures were found. Again, one must keep in mind the possible effect on these percentages of variation in technique among examiners. Table 33.—Percent of youth in each census region with systolic blood pressure 145 and above, separate by race and sex. NY A health examinations. United States Male Female Census Region1 White Negro White Negro 3.9 3.0 1.8 2.0 4.1 3.1 1.4 1.0 Middle Atlantic - 3.9 2. 2 1.9 1. 3 4. 4 2.8 2.3 2.1 4.7 3.0 1.4 1. 3 3.0 2.2 1. 7 1.9 3.1 4.1 2.0 1. 8 3.1 4.1 1.6 3.0 Rocky Mountain 2.6 2.7 .9 1.1 4.5 3.3 1.6 2.0 1 The total youth examined in each region is shown by race and sex in table l.of appendix C. Table 31.—Median systolic and diastolic blood pressure in mm. of mercury, of NY A youth, separate by race and sex. NY A health examinations. United States Pressure White youth Negro youth Male Female Male Female Systolic 120.8 74.7 117.3 73.9 119.3 75.1 116.5 74.5 Diastolic Female youth have distinctly lower blood- pressure readings than males. This is shown in 23 Report of Joint Committee on Mortality of the Association of Life In'1 surance Medical Directors and the Actuarial Society of America, 1925. 33 Norris, G. W., and Landis, H. R.: Diseases of the Chest and Principles of Physical Diagnosis. (W. B. Saunders and Co.) p. 164. 34 THE HEALTH STATUS OF NYA YOUTH Table 34.—Percent of youth in each census region with systolic blood pressure below 95, separate by race and sex. NYA health examinations. United States Male Female Census region 1 White Negro White Negro 1.2 1.9 2.1 2.5 .7 1.2 1.0 1.7 2.0 2.2 4.6 1.6 2.2 2.4 2.8 1.2 4.5 2.4 4.0 1.1 1.9 1.8 2.0 1.5 1.1 1.4 1.9 .8 1.4 1.2 1.2 Rocky Mountain - 1.1 2.0 2.3 1.1 Pacific 1.1 1.2 2.6 2.0 1 The total number of youth examined in each region is shown by race and sex in table 1 of Appendix C. about five times as much skeletal-neuro-muscular impairment by their physical examination of NYA youth as was indicated by some family member reporting on a group reasonably comparable as to age and income. This difference probably is partly due to the selective factor in the youth examined mentioned above, but certainly it is also due to the manner in which the data were obtained, that is, by physical examination as opposed to interview. Such defects as spinal curvature, barrel chest, and pigeon breast, often included in the physician’s report on NYA youth would have been entirely omitted from the heatlh survey report. Orthopedic defects of most types are permanent and thus cumulate with age. At about the NYA age level the incidence of lost members is at its highest rate,25 and crippling and paralyzing defects are also rapidly increasing in numbers. This is reflected in the present study in the difference be- tween the two age groups for males: Among white males, 7 per 1,000 in the 16 to 20 age group as compared to 18 for the ages 21 to 24 had lost parts; 52 compared to 97 had impaired parts. Among Negro males 5 as compared to 12 per 1,000 had lost members in the two age groups; impaired mem- bers were reported for 38 as compared to 57. It seems probable, however, that some of this differ- ence between these two age groups results from a selective factor in the older group, rather than from incidence of new cases with increasing age. The effect of selection by industry and trade is probably such that the youth seeking NYA em- ployment at the ages of 21 to 24 have more ortho- pedic impairments (both severe and slight) than the youth 16 to 20 who turn to NYA for work experi- ence. (See discussion on pp. 4 and 5 of this paper.) Male youth, partly because they are more often employed at machine trades, are subject to a higher rate of orthopedic defect by loss of members than are female youth. Only 2 females per 1,000 were reported with any lost members, but 9 males per 1,000 had one or more missing members. Sex dif- ferences in number of crippled or paralyzed mem- bers were less striking, the comparison being 58 male to 40 female youth per 1,000 examined. Racial differences in prevalence of orthopedic defects were not pronounced. Prevalence rates were slightly higher for white youth. This is best seen, perhaps, in the data for male youth, there being 9 white males compared to 6 Negro males per 1,000 with one or more lost members, and 62 white males compared to 43 Negro males with crippled or paralyzed members. Some orthopedic defects are obviously much greater handicaps than others; also, some types can be corrected or treated, while for others such Orthopedic defects When a person lacks the natural use of some portion of the skeletal-neuro-muscular system, he is said to have an orthopedic defect. Orthopedic defects are usually either the loss (partial or com- plete) of a hand, an arm, a foot, a leg, or the impairment by a weakening or paralysis of some such part of the body or of the trunk or spine. Examining physicians were specifically requested to note on the reporting form the presence of any of these defects. Arising congenitally or, more commonly, by accident or disease, orthopedic defects are usually more or less handicapping but may or may not be incapacitating. If a defect were severe enough to keep the youth from working, he ordinarily would not have been examined under the NYA health program. On the other hand, a number of youth with less severe handicaps may find difficulty in obtaining private employment and so frequently turn to the NYA to gain the advantage of some special skill. Thus these rates of orthopedic impairment may not hold for other low-income youth. Orthopedic defects were reported for 50 out of every 1,000 NYA youth examined. This rate is over twice as large as that estimated from the National Health Survey for youth 15 to 24 years of age in families with incomes below $1,000.24 The discrepancy largely occurs in the number of youth reported with impairment, rather than loss, of one or more skeletal members. While the number of comparable youth with lost members was about 5 per 1,000 for the National Health Survey and 7 per 1,000 for the NYA data, the figure for youth having crippled or paralyzed members was less than 9 per 1,000 for the health survey population compared with 48 per 1,000 for NYA youth. In other words, physicians found m National Institute of Health, The Prevalence and Causes of Orthopedic Impairments. U. S. Public Health Service. National Health Survey Preliminary Reports, Sickness and Medical Care Series Bulletin 4,1938. 25 National Institute of Health, op. cit. (see footnote 24). THE HEALTH STATUS OF NYA YOUTH 35 a procedure is unnecessary or even impossible. The relative numbers of youth having one or more orthopedic defects are given below according to the type of defect. The frequency of more than one defect per youth is indicated by the figure of 55 defects per 1,000 youth, as compared to 50 youth with one or more defects per 1,000 youth examined. monly referred to as a chest X-ray. When combined with a physical examination the X-ray furnishes a powerful adjunct for obtaining com- plete information on chest defects. Although it would have been desirable to include a chest X-ray as a part of every examination, variation in available facilities made such a procedure impos- sible. Hence, in many areas, efforts to obtain chest X-rays were concentrated especially on those youth who had a positive reaction to an intra- dermal tuberculin test or those youth whom the physician referred for X-ray owing to other physical findings. In a few areas, particularly in those that include large cities, an effort was made to provide youth with chest X-rays as a routine measure. Chest X-ray examinations were recorded for 13,224 NYA youth. In view of the ways in which youth were selected for testing, it can not be assumed that all the youth X-rayed were positive reactors to the tuberculin test or that other physical findings indicated the necessity of an X-ray. Nor can it be assumed that all of the youth not X-rayed had no indications for X-ray. Furthermore, the X-ray procedure alone does not always reveal early infections of tuberculosis or other impairments because some may not have advanced sufficiently to show on a single X-ray film. In some areas, notably in one county in Califor- nia, chest fluoroscopic examinations were used instead of X-ray examinations. Although this method utilizes the roentgen ray, no permanent record on a film is made. Less opportunity for some kinds of detailed study is afforded by these tests, but it is felt that the results give a depend- able indication of the presence or absence of tuber- culosis of the lung.26 Since the coding procedure did not lend itself to keeping these areas separate, they were included as a part of the youth given X-ray examinations. Findings are presented in table 36 in dual terms of percentages of total youth X-rayed having each defect listed, and corresponding percentages based upon the total youth examined in this study. It is hoped that this double type of presentation will lend some value to data otherwise rather difficult to interpret. The actual prevalence rate must lie somewhere between the two rates given. About one-half of all the youth examined received the tuberculin test and more than one-fourth of the total youth X-rayed are known to have reacted positively. But the exact effects of the physician’s choice and of tuberculin testing on the results are unknown. Table 35.—Percent of youth having specified orthopedic defect, separate by sex and race. NY A health examinations. United States Orthopedic defect1 All youth W1 Male ute Female No Male gro Female Total known youth 147,813 63,552 57,760 12, 532 13,969 Total all conditions 100.0 100.0 100.0 100.0 100.0 Any defect or defects 5.0 6.3 4.1 4.5 3.1 Defects per 100 youth 5.5 7.1 4.4 4.9 3.3 Hands or arms: 1 lost .1 .1 .1 .1 (a) 1 impaired .5 .7 .3 .5 .2 Feet or legs: 1 lost . 1 . 1 (2) .1 (a) 1 impaired .9 1.2 .7 .9 . 0 Fingers (1 or more): Lost .4 .6 . 1 .4 . 1 Impaired ... .3 .6 .2 .5 .2 Toes (1 or more): Lost .. . 1 . 1 (a) (a) (a) Impaired .. .5 .4 .8 .2 .4 Hands, arms, feet, or legs; 2 or more lost - (a) (a) (’) (a) (a) 2 or more im paired .. .6 .8 .5 .6 .5 Spine or back impaired 3 1.3 1.4 1.2 1.1 1.1 Trunk impaired 3 .7 1.1 .5 .5 .3 1 Flat feet (pes planus), reported for 2.2 percent of the youth examined, are not included here. 3 Less than 0.05 percent. 3 This condition sometimes occurred along with some other impairment. Thus, the rate of orthopedic defects per 100 youth examined was 5.5 compared with 5 percent of youth involved. It will be noted that the most frequent loss was of one or more fingers, reported for about 4 youth per 1,000; that the loss of a hand or an arm was reported for about 1 youth per 1,000, and 1 youth per 1,000 was reported with a foot or a leg missing. That such a large number of youth were reported with spine, back, or trunk impairments, 20 youth per 1,000 being so affected, is probably due to the frequency with which certain slight deformities were reported by examining physicians. As was pointed out above, these included many cases of curvature of the spine (scoliosis and lordosis) which were not considered at all crippling, and also included such items as barrel chest and pigeon breast, chest deformities which are not infrequent. Tuberculosis A photographic record of the presence and extent of tubercular lesions and other abnormalities affecting the lungs, heart, vessels, and other parts of the chest, obtained by roentgen ray, is com- 33 Tuberculosis as used in this section refers only to tuberculosis of the lung. Tuberculosis of all other sites was reported for less than one youth per 1,000, and is shown in table 34 of appendix C. THE HEALTH STATUS OF NYA YOUTH Table 36.—Number and percent of total youth and given X-ray examinations, by specified X-ray NY A health examinations. United States oj youth findings. Chest X-ray findings Total number of Percentage distri- bution for youth by chest X-ray results youth Total youth Youth given X-ray 147,663 134, 439 13, 224 100.00 Youth not X-rayed ... 91.04 Total youth X-rayed 8. 96 100.00 X-ray unreadable 60 .04 .38 Lungs clear ... __ . ._ 11, 713 7. 93 88. 57 Inactive tuberculosis 786 .53 5.94 Active tuberculosis; all stages .. 220 . 15 1.66 Minimal 77 .05 .58 Moderate 33 .02 .25 Far advanced 44 .03 .33 Stage unknown 66 .05 .50 Positive lung findings except definite tuber- culosis 377 .26 2.85 Positive findings in heart or vessels 1 133 .09 1.01 Positive findings other than above 1 99 .07 .75 1 Sometimes recorded in addition to some one of the above conditions. among the general NYA population. The 16 per 1,000 figure, therefore, represents a maximum, somewhere above the true prevalence. These same data make it possible to establish a minimum rate somewhere below the true prevalence. For if all of the youth had been selected on the basis of tuberculin tests and physical findings and if these methods had succeeded in including every potential case in the group to be X-rayed, then the 220 cases revealed by X-ray would be all the cases there were in the entire 147,000 youth. If this were true, the rate of prevalence of active tuberculosis would be the percent of all NYA youth examined (147,000) who were found to have tuberculosis on chest X-ray (220). This minimum statement of prevalence is 1.5 youth per 1,000. The true prevalence must lie somewhere between these two rates. A better approximation of the actual preva- lence rate of tuberculosis is made possible by a special tabulation of some 14,000 examinations from 6 States, all the examinations available from those States at the time the special tabulation was made. In these 6 States an effort had been made to give all youth an X-ray examination and this was being done as rapidly as facilities permitted. At the time of the tabulation about 40 percent of these youth had been X-rayed. Thus, the group is believed to be essentially a random sample of NYA youth in these particular States. However, these youth are not properly distributed by census region and it is not contended that they constitute a representative sample of all NYA youth on this or other bases. For this group of youth (see table 37) the rate of positive findings for active tuberculosis was 11 Sixteen out of every one thousand youth given an X-ray examination showed evidence of some stage of active tuberculosis. Three of these six- teen youth had far advanced tuberculosis. If the 13,224 youth on whom these percentages are based all had been selected at random from among the total 147,000 NYA youth, this rate—16 per 1,000— might be expected to represent the actual prev- alence of tuberculosis among the entire group. But it is known that many of the youth X-rayed were selected on the basis of indication that they might be likely to have the disease. Thus, pro- portionately more youth with tuberculosis must have been included in the group tested than exist Table 37.—Number and percent of youth, examined in six selected states 1 by results of chest X-ray, separate by race NY A health examinations. United States and sex. Total youth White Negro Results of Chest X-ray Male Female Male Female Number Number Percent Number Percent Number Percent Number Percent 14,256 4,848 5,755 1,517 2,136 Total youth not X-rayed ... .. 6,083 2,539 2,270 576 698 Total youth X-rayed 8,173 100.0 2,309 100.0 3; 485 100.0 941 100.0 1,438 100.0 X-ray unreadable 23 .3 4 .2 6 .2 4 .4 9 .6 Lungs clear,. ... 6,991 86.5 1,992 86.3 2,963 85.0 767 81.5 1,269 88.2 Inactive tuberculosis- ... _ 474 5.8 133 5.8 138 4.0 113 12.0 90 6.3 Active tuberculosis, all stages. 92 1. 1 20 .9 44 1.3 11 1.2 17 1.2 Minimal... ... . 33 .4 5 .2 13 .4 7 .8 8 .6 Moderate.. 19 .2 6 .3 8 .2 1 .1 4 .3 Far advanced ... _ 8 . 1 2 .1 6 .2 Stage unknown 32 .4 7 .3 17 .5 3 .3 5 .3 Positive lung findings except definite tuberculosis.. 136 1.7 29 1.3 42 1.2 29 3.1 36 2.5 Positive findings in heart or vessels 3_. 91 I. 1 12 .5 20 .6 28 3.0 31. 2.2 Positive findings other than above 3_. ... 77 .9 8 .3 37 1.1 8 .9 24 1.7 1 The States included are: Vermont, Rhode Island, Michigan, Maryland, Arizona, and California, each being included on the basis of information avail- able indicating that routine testing was being done. This special tabulation was made previous to receipt of all the health records from these States. 3 Sometimes recorded in addition to some one of the above conditions. THE HEALTH STATUS OF NY A YOUTH 37 per 1,000 youth X-rayed. For white male youth the figure is 9 and for white female 13 per 1,000, while the figures for Negro males and females are 11 and 12 per 1,000, respectively. Total X-ray findings of tuberculosis, including active and inactive lesions, are cumulative with age. These lesions among white male youth in- creased between the two age groups 16 to 20 and 21 to 24 from 8.2 percent of the youth X-rayed in the former to 11.5 percent in the latter. The figures for Negro males were about the same, 8.4 percent being increased to 10.2, But the number of white male youth with active lesions increased from 1.4 to 3.7 percent, while for Negroes no in- crease in relative number of youth with active lesions was registered, there being 1.4 percent active in the 16 to 20 age group compared to 1.1 percent in the 21 to 24 age group. This discrep- ancy can be laid, at least in part, to the inade- quacy of the sample, there being less than 200 Negro males X-rayed who were 21 to 24 years of age. A comparison by urbanization groups in data as diverse as these must be interpreted with caution. The rural-urban findings were investi- gated and it was decided that the lower rates recorded for the larger cities were due to routine testing in many such places and more accessible use of the X-ray. This was indicated by the increasing proportion of youth X-rayed as the size of community increased. A detailed consid- eration of urbanization is therefore not justified. Furthermore, although X-ray findings will be presented in the appendix tables and in the sup- plemental tables being made available for each region, they should not be used for comparison of different sections of the country. Such compari- sons are unjustified and will lead to erroneous con- clusions. In view of the lack of data on this sub- ject and the need for some basis for regional action, these tables are presented for use by those persons familiar with the practices followed during the survey with respect to X-ray procedures in their respective areas. Venereal Disease Results of the Blood Serologic Tests for Syphilis Of the 147,813 NYA youth examined, results on blood serology are known for 96 percent. In most cases only one such test was given to each youth examined, although some of the positive or doubtful tests were followed with additional tests. It was realized that all cases would not be uncov- ered by a single test, but in testing on so large a scale it is difficult to do more, expecially when the first test is negative. Over one-fourth of the cases reported as doubtful had received two or more tests at the time of reporting. One or more positive tests was reported for 16 in every 1,000 youth tested. Doubtful tests were reported for 3 youth per 1,000. A few cases (about 1 per 1,000 youth) were reported in which syphilis was definitely known to be present and no confirming test was necessary. Thus, 98 percent of the total youth examined were reported as negative on at least one test. Statements on prevalence of syphilis in the population as a whole inevitably lead to questions on other factors such as sex, age, and race. These are known to present differences which complicate the problem of control. The importance of age as a factor in the control of syphilis, especially in these ages, is well known. It is demonstrated in the relatively short age period of these data, 16 to 24 years, by an increase in the number of white male youth with syphilis from 4 per 1,000 in the 16 to 20 age group to 8 in the 21 to 24 age group, and from 42 to 95 per 1,000 among Negroes for the two age groups. The marked racial difference in prevalence of syphilis is immediately evident from the preceding statement. While only 6 white youth per 1,000 were found to have syphilis, the rate among Negroes was 68 positive results on one or more tests and 3 additional cases in which youth were known to have syphilis, making 71 found to have syphilis in every 1,000 Negro youth. The sex differences in prevalence rate of syphilis among NYA youth were not great. For both races females had slightly higher rates than males. The rates for white youth were 7 per 1,000 females and 5 per 1,000 males; the Negro rates were 87 per 1,000 females and 53 per 1,000 males. It is not certain that these differences represent the actual sex differences in the NYA youth population. In the general population males are said to have a higher rate, in the ratio of 3 males to 2 females with syphilis.27 Moreover, the differences in age distribution of these males and females may be masking the real sex difference in the data, since the rate is increasing rapidly during this age period. Syphilis is known to be more prevalent in the South, both among Negro and white youth. In addition, the fact that a larger proportion of the population in the South is Negro increases the rates there. Regional differences were thus ex- pected, and the relative number of known cases is presented by sex and race for each region in table 38. 27 Parran, Thomas, and Vonderlehr, R. A. Plain Words About Venereal Disease, p. 37. 38 THE HEALTH STATUS OF NYA YOUTH Table 38.—Number of youth per 1,000 examined in each census region with one or more positive blood serology tests or other- wise known to |have syphilis; separate by sex and color. NY A Health Examinations, United States White Negro Census region Male Female Male Female 6 7 53 87 2 4 18 64 3 2 26 27 4 5 41 64 4 7 91 144 4 9 61 111 9 5 68 103 6 9 55 90 8 15 35 45 6 6 37 18 fection, especially with the advent of treatment with sulfanilamide drugs, has become very short. The prevalence rate for gonorrhea may therefore be lower than the rate for syphilis. Present inadequate methods of diagnosis of gonorrhea, as well as lack of sufficient facilities for laboratory testing, make difficult if not impossible the com- piling of accurate data on prevalence. The find- ings presented below can only be interpreted as the number of cases uncovered by routine physical examinations with confirmation by laboratory tests in those cases where youth were thought to be infected. One white youth per 1,000 and 10 Negro youth per 1,000 were reported as having gonorrhea with- out a confirming laboratory test being made. Physicians reported about 1 white male per 1,000 and 2 white females per 1,000 to have gonorrhea, but 14 Negro males as compared to only 6 Negro females with this disease. Confirming laboratory tests were reported on 4 additional white youth and 12 additional Negro youth per 1,000. The comparative sex rates for the laboratory test results were 2 white males to 6 white females per 1.000 and 11 Negro males to 13 Negro females per 1.000 tested. In all, then, physicians in routine physical examinations, with occasional laboratory tests, uncovered 5 cases of gonorrhea in every 1.000 white youth examined and 22 Negro youth per 1,000 with this infection. The actual number of youth infected is unknown. Since laboratory testing for gonorrhea was done for only a very small percentage of the youth, the true prevalence is certainly understated here. Only 18 cases of venereal disease other than syphilis or gonorrhea were reported. These in- cluded chancroid, Vincent’s infection of the gen- itals, and lymphogranuloma venereum. Recommendations About 17 youth per 1,000 were recommended as needing treatment for some venereal disease. These were mostly among the Negro youth, there being 5 recommendations per 1,000 white youth compared to 73 per 1,000 Negroes. Females were recommended for treatment a little more fre- quently than males. Venereal disease treatment was recommended for only 13 youth per 1,000 in places of under 2,500 population, while 23 per 1.000 youth in cities of 500,000 and over received this recommendation. There was, however, con- siderable variation in the rural-urban figures for the two races. Hookworm infection The most frequent of the pathogenic intestinal parasites, the hookworm, is found, in this country, Two unexpected findings shown in the regional table need to be examined. First, the rate among white females of the Mountain States was about twice as high as that for the country as a whole. On further analysis this was found to be largely due to the high prevalence rate in a single coimty in Arizona. The rate among white females in this county was 114 per 1,000. Eighty percent of these youth were Mexican but the rate was as high among the 20 percent of non-Mexican females as among the Mexican females tested. Most of these youth were positive by more than one test. The rate for the region, exclusive of these youth, was only 7 per 1,000. Secondly, in the West North Central region among Negroes there were 126 positive tests reported for every 1,000 youth tested. This at first appeared high for that area, but it was found that the Negro youth were practically all from Missouri, the most Southern State of the region. Furthermore, three-fourths of the cases of Syphilis among Negro youth of that region occurred in females, most of whom were in cities of 100,000 and over. Since two-thirds of these youth were positive by two or more tests, it would seem that the testing program of the State was as good as or better than that in other places, and the higher rate found reflects the actual conditions in the larger cities of the Southern part of the West North Central region. It should again be pointed out that the rate among Negroes was also high in other Southern States, especially in the South Atlantic, East South Central, and West South Central regions. Gonorrhea It is believed that the attack rate for gonorrhea is two to five times greater than for syphilis.28 But the number of syphilis cases is relatively cumulative while the duration of gonorrheal in- 88 Parran, Thomas, and Vonderlehr, R. A., op. eit., pp. 61, 64. THE HEALTH STATUS OF NYA YOUTH 39 almost entirely in the Southern States. This re- sults from the peculiar cycle by which the hook- worm perpetuates its infection of human beings. This cycle may be thought of as beginnmg with the eggs and larvae in the intestinal tract of an infected individual. The larvae are discharged from the body and develop in the ground. Where sanitary facilities are inadequate, the worms re- turn to their human host, possibly directly to the stomach in contaminated food or water, but usually through penetration of the skin of the foot or leg, whence they travel through the blood stream to the lungs, ascend the trachea, and are swallowed. Thus the worm returns to the intes- tine and the cycle is complete. Warm climates are necessary for the perpetuation of hookworm infection, since the worm spends one phase of its life in the soil and cannot live at low temperatures. The South not only meets this condition but in addition has much soil of the sandy or sandy-loam kind that is most favorable to the hookworm. Moreover sanitary facilities are poor in large parts of the rural South, and the relatively frequent habit of going barefooted—a result, probably of economic status as much as of climate—provides the necessary exposure. Although some doctors and public health offi- cials minimize the importance of slight infections of hookworm, no one denies the seriousness of hookworm disease, the condition that results from more severe infections (infestations). This con- dition is characterized by progressive anemia be- cause the adult worms suck blood from the intes- tinal walls, the quantity of blood so removed being proportionate to the number of worms in the intestine. The presence of hookworm infection on a large scale in certain areas is especially challeng- ing since there are well-established methods of control through improved sanitary facilities and caution against exposure. Much has been done in the last 30 years to control hookworms, and the prevalence has been greatly lowered.29 Much remains to be done as is indicated by the findings of these examinations. In the Southern States a laboratory examination of feces was made as a part of each youth’s health examination. In all, over 34,000 youth were so tested. The laboratory tests were positive for hookworm infection in 9.5 percent of the tests. The prevalence of infection varies sharply with sex and color and from one area to another even within States. Thus 13.9 percent of the white male youth tested were found to have hookworms, while 9.7 per cent of the white female youth showed positive results. Only 6.1 percent of Negro males and 1.3 percent of Negro females showed laboratory evidence of infection. The variations by census region were even more pro- nounced than those by sex and color. In the East South Central region, 23.6 percent of the white male youth tested showed hookworm infec- tion ; in the South Atlantic region the correspond- ing figure was 14.1 percent, and in the West South Central region 7.0 percent. In some few of the States in each of these regions no routine fecal examinations were made because they were known to be out of the area of high infection. The per- centages are based only upon those youth tested. Table 38 shows the findings of fecal examina- tions for hookworm infection for each of the three regions in which testing was done. It is seen that the sex and color differences, as well as the regional variations, hold throughout. Similar differences have been noted in other studies of hookworm infection and various theories have been advanced. The higher rate for males is thought to be due to greater exposure, both through wider outdoor activity and more frequent barefootedness. One explanation offered for the color differential is that the thicker epidermis of the Negro offers more resistance to penetration by hookworms, while another theory attributes to Negroes an inherited greater resistance to the worm, acquired through generations of exposure to it.30 (The disease is said to have been introduced into this country through the importation of Negroes as slaves.) Table 39.—The numbers and percentages of youth given a fecal examination, who tvere found to have infections of hookworms; by sex, color, and census region. NY A health examinations United States Census region Number of youth tested and percentage with positive result White males Negro males White females Negro females Num- ber test- ed Per- cent posi- tive Num- ber test- ed Per- cent posi- tive Num- ber test- ed Per- cent posi- tive Num- ber test- ed Per- cent posi- tive Total, 3 regions 11,744 13.9 4,873 6.1 13,288 9.7 4,313 1.3 East South Central. ... 3, 376 3,563 4,805 23.6 14.1 7.0 2,460 1,322 1,091 8.0 5.7 2.2 5,704 4,279 3,305 14.2 7.4 5.1 1, 269 2,274 770 1.7 1.3 .4 West South Central Most physicians examining these youth felt that youth with infections of hookworm should receive treatment for that condition. Of the youth reported with hookworm the percentages for whom recommendations for treatment were made are as follows: In the East South Central region, treat- m Keller, Alvin E., Leathers, W. S., and Densen, Paul M. The Results of Recent Studies of Hookworm in Eight Southern States. Am. Jour. Trop. Med., 20, 4:493,509 (1940). 30 Smillie, W. G., and Augustine, D. L., Intensity of Hookworm Infesta- tion in Alabama: Jour. Amer. Med. Ass’n., Vol. 85, p. 1959 (1925). 40 THE HEALTH STATUS OF NYA YOUTH ment was recommended in 98.7 percent of all known cases of hookworm; in the West South Central region, 99.1 percent; and in the South Atlantic region, 80.5 percent. A direct comparison of the frequencies of positive hookworm findings by communities of various sizes was not made. The relative frequency with which recommendations for hookworm treatment were made varied inversely with size of com- munity. Thus, the relative number of these recommendations made in rural areas was about 20 times as great as the number made in the largest cities, and the frequency of this recommendation decreased regularly with each increase in size of community. Urinalysis For almost 98 percent of the NYA youth examined, a urinalysis was performed. About 8 youth in each 100 examined were found to have some abnormality of the urine. Although minor deviations from normality in content of sugar, albumin, and other matters are not of special significance when considered sepa- rately from other physiological conditions, data on gross physical findings are of some help in in- terpreting specific results of these tests. Albumin Five youth in every one hundred were reported to have albumin in the urine to some degree. But only 0.7 percent had a medium amount, and 0.5 Eercent a marked condition of albuminuria, ince only one test was reported, these findings would ordinarily suggest little more than the need of a careful health check-up to be certain that no correctable kidney impairment was present. Male youth between the ages of 21 and 24 years were observed to have albuminuria less frequently than youth aged 16 to 20. This was true for white males and, to a very slight extent, for Negro males. Females tended to have a slight degree of al- buminuria a little more frequently than males, 4.4 percent compared to 3.2 percent. Race differences in amount of albumin were insignifiacant. Sugar Sugar was present in the urine of 2.6 percent of the youth. No variation with age and sex was noted, but Negro youth tended to have sugar in the urine a little more frequently than white youth, the total for all degrees being 3.5 percent of the Negroes compared to 2.4 percent of the white youth. Other Urinalysis Findings Other pathological findings, principally casts, pus, or blood, were reported in 0.9 percent of the tests, but for only 0.2 percent of the youth to more than a slight degree. Here too, Negro youth more frequently had positive findings. More findings were reported for female youth than for males. There was a slight decrease in other pathological findings with increasing age among males so tabulated. Table 41.—Percent of youth with other pathological findings (blood, pus, casts, etc.) on urinalysis, separate by sex and race. NY A health examinations. United States Other findings Male Youth Female Youth White Negro White Negro Total known youth All degrees 62,290 12,123 66,484 13,328 100.0 99.2 .7 .1 100.0 99.0 .7 .3 100.0 99.0 .8 .2 100.0 98.6 1.0 .6 More than slight Other diseases and dysfunctions A wide variety of diseases, impairments, and conditions other than those discussed in the previous pages was noted among this group of NYA youth. Only brief mention of the more important .ones can be made, but a fairly com- plete summary is presented in tabular form in appendix C. Inguinal hernia, more common among males, was reported for 16 in every 1,000 males and 1 per 1,000 females. For males between the ages of 16 and 20 years the rate was 14 per 1,000 youth; 23 per 1,000 males 21 to 24 had this condition. The rates for Negro youth were slightly lower than those for white. Other types of hernia affected 4 youth in each 1,000, the most common being umbilical hernia, which was present in 3 per Tablk 40.—Percent of male youth in two age groups having speci- fied amount of albuminuria, separate by race. NYA health examinations. United States Albuminuria White Negro 16-20 21-24 16-20 21-24 Total youth given uri- nalysis All conditions None ... . 49,413 12, 877 9,478 2,645 100.0 95.1 3.6 .8 .6 100.0 97.0 2.3 .5 .2 100.0 95.7 3.1 .7 .5 100.0 96.1 3.4 .4 .1 Slight ... Medium Marked THE HEALTH STATUS OF NYA YOUTH 41 1.000. Umbilical hernia was a more frequent defect of Negro youth, their rate being 8 per 1,000, as compared to 2 per 1,000 for white youth. Hemorrhoids were present in 14 males per 1,000 and 26 females per 1,000. More than three- fourths of all cases were slight. For males the prevalence rate increased from 12 per 1,000 in youth 16 to 20 years of age to 24 in youth aged 21 to 24, and it is probable that this increase with age was as great or greater for females. The rate of prevalence of hemorrhoids for Negro youth was slightly higher than for white, 27 as compared to 18 per 1,000. Other ano-rectal disorders, includ- ing ulcerations, fistula, fissure, and other less common conditions were reported among NYA youth at a combined rate of about 3 cases per 1.000 youth examined. Defects of the skin were noted among 182 NYA youth per 1,000. The most frequently reported was acne; there were 150 acne cases per 1,000 white youth and 104 cases per 1,000 Negro youth. Only about 7 percent of the acne cases among white youth and 3 percent among Negroes were considered severe by the examiners. Fungus skin diseases (including ringworm) occurred on about 10 youth per 1,000; skin diseases of bacterial origin on 3; and skin parasites were found on only 2 youth in each 1,000. Functional and allergic skin conditions were present on about 4 youth per 1.000. The reader is referred to the appendix tables for greater detail. Examinations of over 90 percent of the youth for genito-urinary disorders other than venereal disease revealed such defects among 135 youth per 1.000. Abnormal prepuce occurred in 108 white males and 161 Negro males per 1,000 examined; varicocele in 43 white males per 1,000 compared to 17 Negro males; and hydrocele in about 4 per 1.000 white and less than 3 per 1,000 Negro males. Urethral discharge was noted in 3 white males per 1.000 but for Negro males the rate was 23. Among females, urethral discharge was present in 12 white and 39 colored youth in each 1,000 examined. Menstrual disorders were reported for about 37 female youth per 1,000; no difference was noted between the races. Vaginal or cervical dis- charge was reported for 26 white females per 1,000; 57 Negro females in each 1,000 had such a discharge. Other genital defects (including un- descended and atrophic testes, ulcerations, etc.) occurred in about 15 youth per 1,000. Defects of the kidneys and urinary system were reported for only 3 youth in each 1,000. Many of the above conditions were reported more frequently in Southern States both for Negro and white youth. Menstrual disorders, however, were relatively more frequent in the North, reaching an average of 82 cases per 1,000 females in the New England region. Some nervous condition or mental defect was present in 34 youth in every 1,000 examined. Ten youth per 1,000 were reported as extremely nervous, but this figure may be somewhat exag- gerated due to a fear of the examination. These rates were slightly higher for females than males and higher for white youth than Negro youth. Some degree of mental retardation was reported in about 12 youth per 1,000, but in only 3 per 1,000 was the deficiency considered marked. Again, only slight sex and race variation was noted, but such deviation as occurred pointed consistently to higher rates for white youth than colored and higher rates for males than females. Speech defect (other than mutism) was present in 4 youth in every 1,000 examined; epilepsy in 2 per 1,000; and some form of neurosis in 1 per 1,000. A number of other more or less specific nervous and mental conditions were tabulated and together were present in about 10 youth per 1,000, but none was separately recorded as present among all youth to the extent of 1 in 1,000. The appropriate appen- dix table will show the number of youth recorded with each of these nervous defects. Numerous other defects in addition to the ones mentioned above or ones specifically provided for on the examination form were written in by the examiner under the heading of “Other Defects.” These were tabulated in 35 separate classes and are presented in appendix table 34. The two largest of these classes, “underweight” (5.0 per- cent of the youth) and “overweight” (2.8 percent of the youth) have already been mentioned under the discussion of variation from weight standard. The only others containing as much as one percent of the youth were severely flat feet (2.2 percent), postural defects (1.7 percent), and dysfunctions and complaints of the digestive tract (1.2 percent). The remaining classes, each including less than 1 youth in 100, are reported only in tabular form. Flat feet were reported twice as frequently among males as females, 30 compared to 14 per 1,000 and slightly more frequently among Negro than white youth. Postural defects were noted relatively less frequently among Negro youth, 11 per 1,000 compared to 19 per 1,000 for whites; no consistent sex differences were evident. In both races, dysfunctions of the digestive tract were over three times more frequently reported among females than males, averaging about 19 per 1,000 for the former as compared to 5 per 1,000 for the latter. Recommendations Recommendations were made for hernia repair for about 17 males per 1,000 in both races. The rate increased from about 15 per 1,000 for male youth aged 16 to 20 to 25 per 1,000 for those 42 THE HEALTH STATUS OF NYA YOUTH aged 21 to 24. Only about 2 females per 1,000 needed herniotomy. Rural youth and those from smaller cities were almost twice as likely to need this operation as youth from cities of 500,000 and over; the comparative rates for total males were 20 per 1,000 for the rural and 12 per 1,000 for the largest urban centers. Of the 20 youth per 1,000 with hemorrhoids, only about one-fourth were recommended for hemorrhoidectomy. This operation was con- sidered necessary for only 4 males and 6 females per 1,000 examined. It was recommended twice as frequently among Negro youth as among white, 9 compared to 4 per 1,000. For most of the cases of skin defects noted during health examinations, treatment was not considered necessary by the examining physi- cians. About half of the recommendations coded under “Other Repetitive Medical Therapy” were for treatment of the skin, giving a rate of about 14 youth per 1,000. It is probable that most cases of acne, the item of greatest frequency among skin defects, were not considered to need treatment, since this defect often disappears as the youth matures. Circumcision was recommended for 6.5 per- cent of the males, 5.7 percent of the white males, and 10.5 percent of the Negro. Among youth in cities of 500,000 and over the rate was only 1.7 percent for white males, and 4.4 percent for Negro males, but in all other urbanization groups the rate was higher. It increased to 5.9 percent for white males in communities under 2,500, but among Negroes the variation by size of commun- ity was not regular, the highest rate being 16.6 percent for cities of 2,500 to 25,000 population. Varicocelectomies made up about one-fourth of the “Other Minor Surgery” recommendations, or, for males, a rate of 6 per 1,000 youth, Hydro- celectomies constituted 15 percent of the “Other Major Surgery” recommendations, i. e., a rate of almost 2 per 1,000 males. About 2 youth per 1,000 were in need of an appendectomy. In the discussion above on recommendations, and in the previous discussions under each specific type of defect, most of the recommenda- tions made by physicians, dentists, and other specialists conducting the examinations have been covered. The appendix tables on specific recommendations and on urgent recommenda- tions will be helpful to those wishing more detail on this subject. IV. SUMMARY AND CONCLUSIONS The findings of nearly 150,000 complete physical examinations of youth between the ages of 16 and 24 are analyzed in the present paper. These youth were employed or seeking employment on out-of-school work projects of the National Youth Administration, and are believed to be representative of all NYA out-of-school youth. They constitute about one-sixth of the total num- ber of such youth employed during the 9 months period from January to October 1941, during which time these examinations were made. Further- more, they are believed to be fairly representative of the much larger group of all American youth of their age and low economic status. Both rural and urban youth from all but one of the 48 States are included in this study. An evaluation of the representativeness of the sample appears in appendix A, and the limitations that must be placed on generalizations drawn from these data are discussed there. About one-third of the youth examined had some health defect that placed a restriction on the sort of work they could do. Two-thirds were physically fit for any kind of work. Most of the one-third whose employability was limited by health defects were fit for almost any type of work but were handicapped for certain especially exacting employment (such, for example, as work requiring unassisted vision no worse than a 20/40 Snellen chart reading). Three percent of all the youth examined were judged to be either tempo- rarily or for a prolonged period unfit for any reg- ular NYA employment. The ratings of the em- ployability of the NYA youth examined represent a summary of evaluations made for individual youth by the examining physicians. The proportion of youth for whom health de- fects placed some limitation on employability (whether a slight, severe, or absolute limitation) was about the same for male and female youth, and much the same for Negro and white youth. However, more Negro than white and more male than female youth were classed as absolutely limited in employability, i. e., as temporarily or permanently unfit for NYA employment. Like- wise, in the southern and southwestern census regions, relatively more youth were classed as unfit for NYA employment. Variations in prev- alence of communicable diseases are thought to have caused these differences. The examining physicians in rural areas generally classified a larger proportion of youth as fit for any employ- ment than did examiners in cities. While only one-third of the youth were limited in their employability, about nine-tenths of all the youth examined had one or more health defects. This is shown by the number of youth for whom the examining physicians and dentists recommended some sort of medical or dental service. Some such recommendation was made for 84 percent of all youth examined, and, where dentists participated in the examinations, the number receiving at least one recommendation rose to 93 percent. There were 166 recommendations made for every 100 youth examined. But for the 60,000 youth whose oral examination was by a dentist, there were 185 recommendations per 100 youth. It is believed that the latter figure is probably a more accurate measure of the health needs of the NYA youth. The most frequent recommendation was one for dental care, needed by over 84 youth out of every 100 examined by a dentist. Refractions and tonsillectomies were each needed by about 19 youth per 100 examined, and recommendations for additional diagnostic procedures, special diets, and study by specialists ranked next in relative frequencies. The number of recommendations made by the examiners varied by sex, color, age, size of com- munity, and census region much the same as did the health status and employability classifications; the number of recommendations was high where health placed greater limitations on employability. The most frequent abnormality recorded was untreated dental caries. At least one untreated carious tooth was reported for 83 percent of all youth examined by a dentist. The average num- ber of untreated carious teeth per 100 NYA youth was found to be 472, while about 918 teeth per 100 youth were or had once been carious. Comparisons of NYA youth with high school and college youth and with other groups of employed youth indicate that while the total caries ex- perience, past and present, is much the same for all these groups, the NYA youth have a larger relative number of untreated carious teeth, indi- 480993—42 4 44 THE HEALTH STATUS OF NYA YOUTH eating less dental care received. No differences were found between the dental health of youth in cities and youth in rural areas. There were marked variations by census region in caries prev- alence, the West South Central and Rocky Moun- tain regions being unusually low. Negro youth were recorded as needing about the same relative amount of dental care for untreated caries as needed by white youth. However, Negro youth had a very much lower rate for total caries experi- ence, past and present, indicating that the attack rate is correlated with race. Females had about the same present extent of caries and need for dental care as males, but their total caries experi- ence was higher than that of males. Vision below normal (20/20 Snellen chart read- ing taken as normal) was recorded for over one- third of the youth, but most of the defects were slight. However, 7.8 percent of the youth had Snellen chart readings of 20/100 or worse in at least one eye, and 5.0 percent had vision of 20/200 or worse in their poorer eye. For 86.4 percent of the youth vision was 20/40 or better in both eyes. Defective vision was recorded more fre- quently for white than for Negro youth and more frequently for female than for male youth. More than 11 percent of the youth had recorded weights at least 15 percent below the average for their age, sex, and height; over 5 percent weighed at least 25 percent more than average. More females than males had weights differing widely from average. Organic heart lesions were found in 2.5 percent of the youth examined. This percentage was about the same for total, male, and white female youth; 4.0 percent of the Negro females had this disease. It is not possible to summarize in a few words the prevalences recorded and the differentials dis- covered for the many other separate defects that are discussed in the text of the paper. Every abnormal condition noted by the examining physician was tabulated and all defects reported with any appreciable frequency are discussed individually. In addition to the discussion in the text, the methodology of the study and the basic tables from which the conclusions were drawn are presented in the appendices. To state the conclusions that must be drawn from these findings on the health of youth seems almost superfluous. The bald facts that nine- tenths of these low-income youth were found to be in need of medical or dental attention, and that one-third of them were unable to do certain kinds of work because of health defects—these facts speak more loudly than hortatory sentences of the great health needs of youth. Perhaps now, when the complete mobilization of the human resources of our country is so important, these needs will be recognized and action will be taken toward meeting them. APPENDIX A APPENDIX A: THE METHODOLOGY OF THIS STUDY The examination procedure As has been indicated elsewhere in this paper, a standard examination form was used in all States and by all examining physicians and den- tists. (A copy of the examination form appears in appendix B.) Standard instructions on pro- cedure to be used in filling out the form were issued to all examiners. The form and the instruc- tions provided that the following be done routinely: serologic blood test for syphilis; urinalysis; tuber- culin test; stethoscopic examination; dental ex- amination ; Snellen chart vision test; eye, ear, nose, and throat examination; and examination for various other conditions or defects as, for example, skin diseases, hernia, and hemorrhoids. Space was also provided for recording any defects or dis- eases found in addition to the ones specified on the examination form. A record was made of the youth’s disease history, smallpox and typhoid immunizations, and recency of the last visit to a physician and to a dentist. Provision was made for chest roentgenograms wherever facilities were available. In some localities this testing was done routinely, in others, only where indicated by physical findings or tuberculin test, and in still others was not done at all. Certain other labora- tory tests (blood counts, smears for gonococci, etc.) were made where deemed necessary, and fecal examinations were made where geographi- cally and epidemiologically indicated. In all cases the physical appraisals were made by practicing physicians and dentists licensed in the State where the examinations were conducted. The medical examiners were usually appointed with the advice of the local medical societies. State and local health departments cooperated with the NYA by making blood serological tests, fecal examinations, and, in some instances, by supplying smallpox vaccine, typhoid vaccine, and tuberculin. State and local tuberculosis associa- tions frequently assisted in the tuberculin testing and chest X-ray phases of the examination. Examinations were conducted in clinics, hos- pitals, NYA centers, or in the private offices of physicians and dentists. Some examinations, particularly in the larger urban centers, were made by examining teams composed of physicians with certain specialties of practice, a dentist, and a nurse. Each physician was instructed to discuss the results of the examination with the youth, answer any questions which the youth might have regard- ing his physical condition, and encourage him to obtain needed care. In addition to recording the findings of the examination, each physician was required to indicate his recommendations as to correction of defects and to submit a statement regarding the youth’s physical capacity for cer- tain types of work. These statements were used by the placement office as well as by the health supervisors (in most cases public health nurses) in an extensive program of counselling and referral service for the correction of the defects noted. The tabulation procedure The records of all health examinations made in the various States were forwarded immediately (without being delayed for any corrective treat- ment or further study of the patient) to the central tabulating office established for that purpose at Chicago, 111. They remained in that office for a short time (the “average stay” of a record in the tabulation office was less than 10 days) during which time the statistical information they con- tained was edited and coded, and the codes punched in Hollerith-type sorting machine cards. The original record was then returned to the State health supervisor and consultant for use in con- nection with the individual youth. In the tabulation office the work of processing the records was performed by a staff composed of physicians, senior medical students, machine oper- ators, supervisors, and NYA out-of-school youth. All records were reviewed by the medical section, manned by physicians and senior medical students supervised by a full-time licensed physician. In this section all entries that did not lend themselves to routine handling were coded and verified. Here too, the comparison of health status and employ- ability classification with findings was made. Every step in the processing procedure—whether assigning codes, transcribing codes, punching cards, or whatever—was paralleled by a repeat step to verify the accuracy of the work. Re- peated spot-checks of completed work were made against the original records to make certain that errors were being corrected by the verifiers and that the final result was as accurate as possible 48 THE HEALTH STATUS OF NYA YOUTH Verification of the card punching was done, using verifying key punch machines, which provide a reasonably certain mechanical check against error. The final spot checking of several hundred thou- sand individual verified codes failed to reveal more than a small fraction of a percent of them to be in error. Selection of the sample When plans were first projected for the present study it was realized that administrative diffi- culties, along with lack of sufficient basic data on the socio-economic characteristics of NYA em- ployed youth, would prevent the use of a pre- selected stratified sample. Instead, as rapidly as State health programs got under way during and after January 1941, the supervisors in the several States were instructed to forward all completed examinations to the tabulation unit. Further instructions provided that all youth newly assigned to NYA work be given the standard examination. It was urged that, as rapidly as possible, youth already employed also be examined, using the standard form, and that their examination records be forwarded for tabulation along with those of newly assigned youth. Every effort was made to insure that all examinations—regardless of physi- cal findings—were sent to the tabulating unit as soon as they were made. Thus, no control was maintained over the relative proportions of ex- aminations of different sex, color, rural-urban, and age groups to be submitted, except for the se- quence in which examinations were scheduled locally. Nevertheless, since this sequence was either that in which youth were being assigned or else was such as to include all the youth employed on first one and then another project, the sample might be expected to be reasonably random. Finally, when the number of examination records that had been received from certain States had become clearly adequate for their representation in the desired total number of records—set at ap- proximately 150,000—forwarding of schedules from these States was discontinued. Appraisal of the sample obtained A careful evaluation of the representativeness of the sample obtained is made difficult by the lack of the necessary detailed information con- cerning the universe from which the sample was drawn—the total group of NYA employed youth. Distributions by age, urbanization groups, etc. are not available for total NYA employed youth and so comparisons on these bases of the sample, and the group it represents are not possible. It will, however, be possible to investigate the resi- dence, sex, race, and age characteristics of the sample and to compare some of these character- istics with the total NYA youth population. Region The examining procedure was not instituted at the same time in all of the States; in fact, some States were just getting their health programs well organized at the time it was necessary to tabulate the data received in order not to delay the report beyond its most useful time period. For this reason certain of the regions were not as well represented as others. However, with the excep- tion of the New England and Middle Atlantic regions, which are admittedly underrepresented, the relative number of youth examined and in- cluded in the sample compares favorably with the number of NYA youth employed in each region. The exact regional relationships are presented below. Youth em- ployed 1 Youth exam- ined Percent of em- ployed youth exam- ined Num- ber Per- cent Num- ber Per- cent Total United States New England.. Middle Atlantic... East North Central West North Central South Atlantic East South Central West South Central 885,389 100.0 147,813 100.0 16.7 52,495 153,887 174, 097 97,458 125,999 77,827 117,446 5.9 17.3 19.7 11.0 14.2 8.8 13.3 3.3 6.5 5,262 13, 075 30,607 19,759 21,159 15,785 21,445 5,993 14,728 3.6 8.8 20.6 13.4 14.3 10.7 14.5 4.1 10.0 10.0 8.5 17.6 20.3 16.8 20.3 18.3 20.8 25.7 Rocky Mountain.. 28,832 57,348 1 These figures represent the unduplicated count of the total different youth employed on NY A out-of-school work projects at any time during the nine-month period January through September 1941. A table showing the number of youth examined in each State will be found in appendix C (table 1). Reference to this table will show that the Middle Atlantic region is not only underrepresented but consists of a disproportionately great number of examinations from New York City, examinations probably somewhat atypical of the region. More- over, the underrepresentativeness of the New Eng- land region is seen to result largely from the fact that no examinations were tabulated for Massa- chusetts, the most populous State in that region. It is difficult to determine the extent to which the underrepresentation and the atypical internal compositions of these two regions affect the total national picture. It seems probable that the poorest represented portion of the Middle Atlantic region is not unlike certain other regions (e. g., the East North Central) which was well represented, perhaps even overrepresented. It must be real- ized that too few cases from any region would not distort the resultant findings unless the cases THE HEALTH STATUS OF NYA YOUTH 49 which were not obtained differed from the 150,000 cases which were tabulated. It seems not over- optimistic to hope that the deficiencies from these two regions do not seriously affect the total findings. Sex and Race About one-half of the NYA youth examined were male. Almost 18 percent were Negro, but among the females 19.5 percent were Negro, as compared to 16.5 percent of the males. (In- cluded with youth classed as “white” were a small proportion, less than one-half of 1 percent, who were of other races, primarily Chinese, Japanese, or Filipino.) When compared to the number of youth employed during the same period, the rela- tive number examined in each sex and color group is quite similar despite no direct effort to control the representation of each group. The compara- tive numbers and percentages follow. NYA population, then, are not a serious drawback since they have no effect on rates that are specific for sex and race. Age Eligibility for employment on NYA out-of- school work projects is limited to youth aged 17 to 24, inclusive, and, under certain conditions, youth aged 16. (Youth 16 years of age could be employed by arrangement with school authorities.) The examinations tabulated did not include supervisors. The median age for all youth examined was 19.3 years. Over 70 percent were 17 to 20 years of age, about 42 percent being either 18 or 19. The median age for each of the sex and race groups varied between 19 and 20 years, females tending to be slightly older than males and Negroes older than white youth. (See appendix C, table 3.) Size of Community in Which Youth Lived Out-of-school work projects were available through NYA in practically every county in the United States; only about 5 percent of the counties failed to have youth on the program in 1940 (1941 data not available) and these were in the most sparsely settled regions. Youth examined lived in communities ranging in size from rural farm to urban centers of 500,000 or more persons. About 36 percent of them lived in cities of 100,000 or more, 28 percent in cities between 2,500 and 100,000, and 36 percent on farms or in rural com- munities of less than 2,500 persons. No data are available for comparison of the sample with total NYA youth by size of community. Census figures for 1940 showing the total number of youth in the United States in the age group 15 to 24, living in farm communities and cities under 2,500, give some indication of how well these data repre- sent youth on this basis for the country as a whole. This comparison is made below. A word of cau- tion should be given to the effect that considerable regional variations were found in rural-urban dis- tribution. The data would seem to indicate that rural white youth of both sexes are only slightly underrepresented in the sample. Negro youth in rural areas, and especially Negro females, are considerably underrepresented. There are rela- tively only about half as many rural males and a third as many rural females included as are found in the general Negro population.1 Again it must be remembered that the disproportionate numbers of urban Negroes will not affect rates that are specific by race and size of community, and in the present paper such specific rates have been pre- Youth employed Youth examined Percent of em- ployed youth examined Number Percent Number Percent Total youth 885,389 100.0 147,813 100.0 16.7 Male youth 525,636 59.4 76,084 51.5 14.5 White 465, 897 51.5 63, 552 43.0 13.9 Negro 69,738 7.9 12,532 8.5 18.0 Female youth 359,754 40.6 71,729 48.5 19.9 White 309,146 34.9 57,760 39.1 18.7 Negro 50,608 6.7 13, 969 9.4 27.6 Females are somewhat overrepresented, the sample including about 20 percent of the number employed as compared to only 15 percent for males. Negro youth are slightly overrepresented for both sexes but more especially for females. It should be pointed out that the race distributions of the above employment figures are estimates. Exact figures were available by State and by sex for the entire 9-month period, but separate figures by race were not available for the period January through June. The total youth, by sex, were distributed by race on the basis of the data for July through September. Thus, it is not possible to evaluate precisely the race distribution of the sample. It seems unlikely, however, that the disproportions are great enough and the differen- tials in health sharp enough to affect markedly this picture of the health of total NYA youth. More- over, the accompanying discussion presents data, on almost every aspect of the examination, not only for total youth but also separately for male and female and for white and Negro youth. The differences noted between this sample and the total i But Negroes are overrepresented—with respect to the census population- in the sample as a whole, constituting 17.9 percent of the sample as compared to only 10.5 percent of the census population, in this age group. 50 THE HEALTH STATUS OF NYA YOUTH sented wherever the disease seemed likely to be related to these factors. and the NYA population, but the age distribution differs from that of the general population within the same limits. On the basis of geographic dis- tribution, the sample is deficient in the numbers of examinations obtained from the New England and Middle Atlantic census regions, but includes a fairly good representation of all other regions. Data by size of community of residence are not available for the total NYA population and so the sample cannot be evaluated on this basis. However, compared with the 1940 census popula- tion in the age group 15 to 24, the sample would seem to be fairly well distributed between rural and urban groups, for white youth. Negro youth in rural areas were underrepresented. It is believed that the sample was sufficiently representative to provide a valid picture of the general health level of NYA youth. Certain limitations which must be placed on generaliza- tions drawn from these data are discussed else- where (see p. 4). It must be kept in mind that the present analysis presents the findings by specific sex, race, and region groupings and fre- quently by size of community groupings. Any deficiencies of the sample in these respects would have no effect on these specific findings. Total numbers Percent in urban communities (over 2,600) Percent in rural communities (under 2,500) 1940 census (15-24) Health exami- nation sample 1940 census (15-24) Health exami- nation sample 1940 census (15-24) Health exami- nation sample Total youth 23,921,358 147,663 65.4 63.9 44.6 36.1 Males 11,872,545 75,998 53.3 60.0 46.7 40.0 Females 12,048,813 71,665 67.5 68.0 42.5 32.0 White youth ... 21,421, 625 121,192 56.6 60.9 43.4 39.1 Males 10, 692,273 63,485 54.5 57.8 45.5 42.2 Females 10, 729,252 67, 707 68.6 64.3 41.4 35.7 Negro youth 2,499,833 26,471 45.2 77.2 54.8 22.8 Males 1,180, 272 12,513 42.0 70.7 58.0 29.3 Females 1,319, 561 13,958 47.9 83.2 52.1 16.8 Summary of Appraisal The sample studied is believed to be much the same in sex and color composition as was the total NYA youth population. No data are available to make age comparisons between this sample APPENDIX B EXAMINATION FORM THE HEALTH STATUS OF NY A YOUTH 53 NY A Form 120 FEDERAL SECURITY AGENCY National Youth Administration W. P. No. THIS RECORD IS CONFIDENTIAL HEALTH EXAMINATION RECORD I (City or town) (County) Fill in every blank space; record all deviations from normal physical status; enter recommendations for follow-up on NYA Form 121 (Last name) (First name) (Middle name) (Present age) (Color) (Sex) (Identification No.) (Home address; Street and number or R. F. D.) (City or town) (County) (State) PAST MEDICAL HISTORY Last time hospitalized: Reason for: ! years ago x= never Last visit to (or from) a physician: Reason for: ; years ago 0= within last 12 months Last regular visit to a dentist (exclusive of emergency visits necessitated by toothache); years ago over * enter actual number Illnesses experienced: (0=no; Pleurisy Asthma or hay fever Epilepsy Dis. of genito-urinary sys. Pneumonia Tuberculosis Disease of nervous system Rheumatic heart disease Sinus infection Pellagra Bone or muscle disease Fractures Disabling head colds _ Digestive disturbances Disease of the skin Operations Disabling chest colds Arthritis, rheumatism Disease of the mouth Other (specify) Extent of contact with tuberculosis Present complaints IMMUNITY STATUS—SMALLPOX AND TYPHOID . , Smallpox: □ no; □ yes, yrs.'ago Last previous Smallpox: Dno; □ yes, yrs. ago Date vaccinated by or, Smallpox. ttac , vaccination _ , „ at request of examiner Typhoid: □ no; □ yes. yrs. ago Typhoid: Dno; □ yes, yrs. ago Typhoid .. Last previous smallpox vaccination scar: Location: Color ut? at tu t'VATuiTMATtnM *Enter“0” to mean function or organ normal or symptoms of stated affection not present: or for slight. “4—p” for medium, or “4—1—h” HEALTH LXAMINA11UN for extreme degree of abnormality, dysfunction or symptoms. APPEARANCE Encircle applicable term(s): Normal Pallid Cyanotic Jaundiced Emaciated Other (specify).. ' ~ p, . [r- ii ■ - (To nearest J4 , MEASUREMENTS Standing height in. Weight lb. cmS Jence ! 1?w,brea?ts',or (Without shoes) (To nearest H) (Without clothes) (To nearest H) (unassisted: R: 20/ L: 20/ f0"™ (Reaction Distant vision/ Type of assistance < Pinhole Color sense < (encircle) _. ,. Tested with /Yams .Assisted: R: 20/ L: 20/ {Trial lenses {, (encircle) \Ishihara EYES Evidence of: Blepharitis* Discharge* Trachoma* Pterygium* Strabismus* Other (specify) EARS Hearing (ordinaryJr. /20 ft ExternalfR. Dnim:!R: Normal Perf°rated RetraCteJ Dul1 conversation) U /20ft cana's |l. .. IE: Normal Absent Perforated Retracted Dull! NOSE Evidence of: Chronic Polypi* Perforated septum* . Tonsils: Encircle applicable term: • Normal Diseased Completely removed Partially removed Pharynx (specify) .— ----- THROAT ( |J , 0=Normal | = Unerupted Upper 8 7 6 5 4 3 2 1 Right j Left 12 3 4 5 6 7 8 — = Carious only += Extracted Lower 8 7 6 5 4 3 2 1 Right 3 Left I 2 3 4 5 6 7 8 ==Repaired only 0=Replaced < » == = Both carious and repaired MOUTH Tartar* Gingivitis* Pyorrhea* Other (specify! Inspection Palpation Percussion Auscultation Ausc. cough .. Tuberculin test (old tuberculin used intracutaneously): Negative Positive (encircle) □ Not taken □ Inactive pulmonary tuberculosis □ Plate unreadable □ Active pulmonary tuberculosis □ Lungs clear Active cases: □ Minimal □ Moderately advanced □ Far advanced Other x-ray findings: □ All negative □ Described under “Remarks” □ Described in separate report, which is attached hereto. Chest x-ray LUNGS . Pleurisy* Bronchitis* - Tentative or final diagnoses Other (specify) Because of physical findings is chest x-ray indicated? Yes No__(encircle)^ 54 THE HEALTH STATUS OF NYA YOUTH Stetboscopic examination is required. {fn Functional Heart irregularity Organic heart disease: □ Vest n. • (encircle) □ No I ° °rgamC Present Not present CIRCULATORY SYSTEM I„ j, [Before exercise /min. Exercise: Keeping one foot on chair seat, step up onto and down off oys. mm. Mg. Pulsej Just after exercise /min. ’ of chair seat with other foot 15 times in 30 seconds. If examinee Dia. mm. Hg. ilwo minutes later /min. is excused from exercise g‘ve reasons under ‘'Remarks" ABDOMEN Tenderness* Liver* Spleen* If spleen is enlarged, how much Other (specify) HERNIA Record only existing hernias (i. e., exclude potential hernias). Inguinal hernia exists when inguinal ring is enlarged and there is felt a definite visceral impulse on coughing, which follows the examining finger on withdrawal Hernia (specify site) , GENITO-URINARY ANO-RECTAL Urethral discharge* Ulcerations* Varicocele* Hydrocele* ... Prepuce* Other . Hemorrhoids* ...j Prolapse* Ulcerations* Fistula* Other (specify) NERVOUS AND MENTAL Describe any nervous or mental abnormality noted SKIN Acne* Edema* Other (specify) . ORTHOPEDIC IMPAIRMENTS Enumerate lost parts (fingers, toes, hands, etc.) .. Enumerate deformed, crippled or paralyzed parts OTHER Describe any other defect noted Urinalysis: Date Sugar* Albumin* 6ther .. Fecal: Date Type of test. Result .. Other (give details); LABORATORY Blood serologic test: Date Name of test ... Result* REMARKS RECOMMENDATIONS Recommended; + = Urgent.) □ Refraction □ Dental care □ Tonsillectomy □ Circumcision □ Hernia repair □ Other (specify) □ Mastoid operation □ Hemorrhoidectomy □ Malaria treatment □ Hookworm treatment □ Surgery of eye or adnexa □ Venereal disease treatment □ Posture correction exercises □ Special diet (specify) .. □ Study by a specialist □ Additional diagnostic procedures (specify) HEALTH STATUS CLASSIFICATION: (Check classification recommended for this youth) □ Class I. Fit for any work or athletic activity: no defects, or only very slight defects. □ Class IT. Fit for any work or athletic activity: abnormal conditions present can be corrected by proper measures (medical, dental, exercise, diet). □ Class III. Fit for almost any kind of employment or recreational activity; minor defects not thought to be amenable to correction but not severely handicapping. (Physician to indicate types of work to be avoided or to approve assignment.) □ Class IV. Fit only for certain kinds of employment or recreational activity. (Physician to approve assignment and to state whether there is necessity for medical supervision of the youth during employment.) □ Class V. Temporarily unfit for any employment or recreational activity; classification in this class implies subsequent reclassification to Class I, II, III, or IV after the termination of the temporary period of unemployability. (This form is not to be delayed pending such reclassification.) □ Class VI. Permanently, or for a prolonged period, unfit for any employment or recreational activity. (Signed) (Physician) (Dentist) (Rocntgenogoiist) (Physician) (Dentist) 0. 8* GOVERNMENT PRINTING OFFICE 16—19537 (Specialist) (Specialist) (Date of completion of record) APPENDIX C LIST OF TABLES IN APPENDIX C All tables show number and percent of NYA youth separately by sex, race, and—for white males—by age, for the United States. Youth of unknown sex and color totaling 276 were excluded from all tabulations. Males of unknown age totaling 331 were included in the 16 to 20 age group. “Other Races”—Chinese, Japanese, etc.— making up less than 0.5 percent of all NYA youth, were included as white. Certain of these tables present conditions which are not mutually ex- clusive since some youth had more than one of the specified defects or recommendations, as the case may be. In these tables the number of defects add to more than the number of youth with defects. Similarly, the percentages of youth having each of the specific defects plus the per- centage having no defects add to more than 100 percent. The tables of which this is true have been designated by asterisks (*) in the list below. Table No. Title Abbreviated 1. Youth examined in each State and region. 2. Size of community of youth’s residence. 3. Age of youth examined. 4. Health status and employability classification. *5. Recommendations specified by the examining phy- sician. Table No. Title Abbreviated 6. Recommendations for dental care, by whether dentist or physician performed oral examination. *7. Recommendations specified as urgent. 8. Variation from weight standard. 9. Number of carious teeth (found by dentists). 10. Number of DMF teeth (found by dentists). 11. Number of repaired teeth (found by dentists), 12. Number of extracted teeth (found by dentists). *13. Abnormal mouth conditions (found by dentists). 14. Snellen chart readings with vision unassisted. *16. Diseases of the eye. 16. Findings of color sense examination. 17. Results of auditory acuity tests. 18. Condition of the ear drums. *19. Condition of the nose and accessory sinuses. 20. Condition of the throat. *21. Chest X-ray findings, 22. Findings of stethoscopic examination of the heart. 23. Blood pressure readings, systolic and diastolic. 24. Pulse rates. 25. Results of blood serologic tests for syphilis. *26. Findings of genito-urinary examination. *27. Findings of ano-rectal examination. *28. Findings of examination of hernia. *29. Findings of examination of abdomen. *30. Orthopedic defects recorded. *31. Nervous and mental condition. *32. Condition of the skin. 33. Findings of urinalysis. *34. Other diseases and dysfunctions. 58 THE HEALTH STATUS OF NYA YOUTH Table 1. —Number and percent of NY A youth examined in each State and region Male Female Total White State and region Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined .. 147,813 100.0 63,552 100.0 13,158 100.0 12, 532 100.0 57,760 100.0 13,969 100.0 New England 6,262 3.6 2,451 3.9 339 2.6 163 1.3 2,350 4.1 298 2.1 Maine 872 .6 560 .9 61 .5 1 310 .6 1 New Hampshire 100 .1 66 .1 17 . 1 34 .1 Vermont..'. 597 .4 304 .5 100 .8 292 .5 1 Rhode Island 1, 647 1.0 707 1.1 75 .6 72 .6 654 1.1 114 .8 Connecticut 2,146 1.6 814 1.3 86 .6 90 .7 1, 060 1.8 182 1.3 Middle Atlantic 13,075 8.8 6,508 10.2 1,810 13.8 1,453 11.6 3,862 6.7 1,252 9.0 New York City 8,381 5.7 4,427 6.9 1,404 10.7 1, 219 9.7 1,970 3.4 765 5.5 New York. 1,210 .8 304 .5 26 .2 10 . 1 855 1.6 47 .3 New Jersey 936 .6 541 .9 93 .7 53 .4 236 .4 106 .8 Pennsylvania 2,542 1.7 1,236 1.9 287 2.2 171 1.4 801 1.4 334 2.4 East North Central 30,607 20.6 12,230 19.3 2,127 16.1 2,995 23.9 11,783 20.4 3,599 25.7 Ohio 9,142 6.2 3,881 6.1 702 5.3 1,097 8.8 2,949 6.1 1,215 8.7 Indiana 1,673 1.1 702 1.1 119 .9 365 2.9 417 .7 189 1.4 Illinois 8,064 5.5 2,966 4.7 496 3.8 692 5.5 3,065 5.3 1,351 9.6 Michigan 8,768 5.8 3,561 6.6 686 6.2 835 6.7 3, 577 6.2 795 5.7 Wisconsin 2,960 2.0 1,130 1.8 124 .9 6 1,775 3.1 49 .3 West North Central 19,759 13.4 8,851 13.9 2,126 16.2 740 5.9 8,750 15.1 1,418 10.2 Minnesota ... 4,360 3.0 2,409 3.8 523 4.0 62 .5 1,832 3.1 67 .4 Iowa 5,923 4.0 2,812 4.4 707 6.4 78 .6 2,892 5.0 141 1.0 Missouri. 5, 588 3.8 1,807 2.9 342 2.6 528 4.2 2,084 3.6 1,169 8.4 North Dakota 1,069 .7 392 .6 125 1.0 677 1.2 South Dakota . '573 .4 271 .4 109 .8 300 .5 2 Nebraska 1,846 1. 2 853 1.3 241 1.8 32 .3 921 1.6 40 .3 Kansas 400 .3 307 .5 79 .6 40 .3 44 .1 9 .1 South Atlantic.. 21,159 14.3 8,044 12.7 1,460 11.1 2,170 17.3 7,132 12.3 3,813 27.3 District of Columbia. 1,370 .9 168 .3 41 .3 202 1.6 241 .4 759 5.4 Florida 1,066 .7 485 .8 58 .4 50 .4 385 .7 146 1.0 Delaware 565 .4 138 .2 25 .2 37 .3 299 .6 91 .7 Maryland 1,968 1.3 291 .5 39 .3 241 1.9 605 .9 931 6.7 Virginia 1,463 1.0 880 1.4 133 1.0 41 0.3 437 .8 105 .8 West Virginia 3,071 2.1 2,273 3.5 536 4.1 148 1.2 686 1.0 64 .6 North Carolina 3,872 2.6 1,247 2.0 211 1.7 389 3.1 1,840 3.1 396 2.8 South Carolina 2,383 1.6 589 .9 97 .7 212 1.7 1,118 1.9 464 3.3 Georgia 5,401 3.7 1,973 3.1 320 2.4 850 6.8 1,721 3.0 857 6.1 East South Central 15, 786 10.7 4,650 7.3 1,108 8.4 2,671 21.3 6,985 12.1 1,479 10.6 Kentucky.. 2,786 1.9 1,148 1.8 221 1.7 177 1.4 1,256 2.2 205 1.5 Tennessee 325 .2 118 .2 25 .2 6 201 .3 Alabama 9,044 6.1 2,187 3.4 534 4.0 1,786 14.3 3,962 6.9 1,109 7.9 Mississippi.. 3,630 2.5 1,197 1.9 328 2.6 702 5.6 1,566 2.7 165 1.2 West South Central 21,446 14.5 11, 566 18.2 2,140 16.3 1,944 15.5 6,307 10.9 1,628 11.7 Arkansas 3,318 2.2 2,075 3.3 501 3.8 194 1.5 976 1.7 73 .5 Louisiana 3, 550 2.4 1,230 1.9 229 1.7 489 3.9 1, 221 2.1 610 4.4 Oklahoma. 3,305 2.2 2, 076 3.3 584 4.5 203 1.6 940 1.6 86 .6 Texas 11, 272 7.7 6,185 9.7 826 6.3 1,058 8.5 3,170 5.5 859 6.2 Rocky Mountain 5,993 4.1 3,064 4.8 635 4.8 150 1.2 2,690 4.7 89 .6 Montana._ 625 .4 292 .5 63 .5 2 329 .6 2 Idaho 125 .1 32 6 . 1 93 .2 Wyoming 372 .3 110 .2 18 . 1 1 261 .5 Colorado. 1,240 .8 609 1.0 125 .9 25 .2 581 1.0 25 .2 New Mexcio 1,668 1.1 1,077 1.6 260 2.0 8 . 1 481 .8 2 Arizona 1, 542 1.0 '627 1.0 103 .8 114 .9 741 1.3 60 .4 Utah 371 .3 295 .6 56 .4 76 . 1 Nevada 150 .1 22 4 128 .2 Pacific 14,728 10.0 6,188 9.7 1,413 10.7 246 2.0 7,901 13.7 393 2.8 Washington.. 4,882 3.3 2,130 3 3 484 3.7 28 .2 2,698 4.7 26 .2 Oregon. 2,413 1.6 1,258 2.0 267 2.0 6 . 1 1,137 2.0 12 . 1 California 7,433 5.1 2,800 4.4 662 5.0 212 1.7 4,066 7.0 355 2.5 THE HEALTH STATUS OF NYA YOUTH 59 Table 2.—Number and percent of NY A youth examined in the United States according to size of community of youth's residence Size of community of youth’s residence Total Male Female White Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined 147,813 63, 652 13,158 12,532 57,760 13,969 Unknown 150 67 12 19 53 11 Total known youth 147,663 100.0 63, 485 100.0 13,146 100.0 12,513 100.0 57, 707 100.0 13,958 100.0 Rural (under 2,500 population). 53,363 36.1 26,760 42.2 5,817 44.3 3,662 29.3 20, 598 35.7 2,343 16.8 2,500 to 4,999 5,331 3.6 2,538 4.0 462 3.5 366 2.9 2, 204 3.8 223 1.6 5,000 to 9,999 7,557 5.1 3,850 6.1 700 5.3 326 2.6 3,107 5.4 274 2.0 10,000 to 24,999 9,034 6.1 3,885 6.1 759 5.8 889 7.1 3,925 6.8 335 2.4 25,000 to 29,999 2,152 1.5 908 1.4 157 1.2 185 1.5 996 1.7 63 .5 30,000 to 49,999 7,607 5.2 3, 357 6.3 618 4.7 381 3.1 3, 400 5.9 469 3.4 50,000 to 99,999 10, 233 6.9 3,716 6.8 630 4.8 1,006 8.0 4,349 7.5 1,162 8.3 100,000 to 249,999... 9, 413 6.4 3,707 5.8 645 4.9 638 5.1 4,215 7.3 853 6.1 250,000 to 499,999 18, 644 12.6 7,026 11.1 1,204 9.1 1,775 14.2 7,007 12.2 2, 837 20 3 500,000 and over 24,329 16.5 7,739 12.2 2; 154 16.4 3,285 26.2 7,906 13.7 5,399 38.6 Table 3.—Number and percent of NY A youth examined in the United States by age of youth Male Female Total White Age, in years Negro White Negro All ages 21 -24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent 147,813 63,552 13,158 12,532 57,760 13,969 '785 331 43 '362 49 Total—known age 147,028 100.0 63, 221 100.0 13,158 100.0 12,489 100.0 57,398 100.0 13,920 100. 16 8,108 6.5 4,845 7.6 868 7.0 2,046 3.7 349 2. 17 22, 762 15.5 11, 858 18.8 2,020 16.2 7,636 13.3 1,238 8. 18 969 22.4 Hi 077 22.3 2,889 23.1 13, 234 23.0 2,769 19.! 19 29, 240 19.9 11,307 17.9 2,311 18.5 12, 694 22.0 2,928 21. 20 20,633 14.0 7' 976 12.6 1,686 13. 5 8,584 15.0 2; 387 17. 21 13; 772 9.4 5; 269 8.3 5,269 40.1 1,176 9.4 5, 575 9.7 1,752 12. 22 9,000 6.1 3,529 5.6 3, 529 26.8 713 5.7 3,537 6.2 1,221 8. 23 6,398 4.4 2, 556 4.0 2, 556 19.4 524 4.2 2,487 4.3 831 6. 24 4,156 2.8 1, 804 2.9 1,804 13.7 302 2.4 1,605 2.8 445 3. Median age... 19.33 19.07 22.37 19.20 19.46 19.89 480993—42 5 60 THE HEALTH STATUS OF NYA YOUTH Table 4.—Number and percent of NY A youth examined in the United States by health status and employability classification assigned by the examining physician Health Status and employability classification ‘ Total Male Female White Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent 147, 663 1,096 63,485 393 13,146 83 12,513 134 57,707 442 13,958 127 Total known youth Class I— Class II Class III Class IV. Class V-- Class VI 146, 667 100.0 63,092 100.0 13,063 100.0 12,379 100.0 57, 265 100.0 13,831 100.0 20,109 78,350 33,114 10,660 3,947 397 13.7 53.4 22.6 7.3 2.7 .3 8,628 33, 548 14,014 5,188 1,491 223 13.7 53.1 22.2 8.2 2.4 .4 1,544 6,142 3,091 1,801 396 90 11.8 47.0 23.7 13.8 3.0 .7 1,754 6,746 2,362 893 591 33 14.2 54.4 19.1 7.2 4.8 .3 8,235 30,403 13,743 3,523 1, 272 89 14.4 53.0 24.0 6.2 2.2 .2 1,492 7,653 2,995 1,046 593 52 10.8 65.2 21.7 7.6 4.3 .4 1 Class I—Fit for any work or athletic activity; no defects, or only very slight defects. Class II—Fit for any work or athletic activity; abnormal conditions present can be corrected by proper measures (medical, dental, exercise, diet). Class III—Fit for almost any kind of employment or recreational activity; minor defects not thought to be amenable to correction but not severely handi- capping. (Physician to indicate types of work to be avoided or to approve assignment.) Class IV—Fit only for certain kinds of employment or recreational activity. (Physician to approve assignment and to state whether there is necessity for medical supervision of the youth during employment.) Class V—Temporarily unfit for any employment or recreational activity; classification in this class implies subsequent reclassification to class I, II, III, or IV after termination of the temporary period of unemployability. Class VI—Permanently, or for a prolonged period, unfit for NYA employment ar recreational activity. * 150 youth for whom size of community of residence was unknown are excluded from this table. Table 5.—Number and percent of NYA youth examined in the United States by the recommendations specified by the examining physician, exclusive of dental care recommendation Male Female Total White Specific recommendations made by examiner Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined1 147,663 100.0 63,485 100.0 13,146 100.0 12,613 100.0 67,707 100.0 13,958 100.0 Refraction 29,096 19.7 11,159 17.6 2,714 20.6 1,993 15.9 12,969 22.5 2,975 21.3 Tonsillectomy 28,592 19.4 12,110 19.1 2,207 16.8 2,613 20.9 10, 634 18.4 3,235 23.2 Circumcision .. 4,898 3.3 3, 582 5.7 674 4. 4 1.316 10.5 Hernia repair 1,457 1.0 i; 103 1.7 333 2.5 '220 1.8 70 .1 64 .5 Mastoid operation 63 35 . 1 3 2 23 3 Hemorrhoidectomy 766 .5 262 .4 98 .7 66 .6 275 .5 163 1.2 Malaria treatment 49 25 8 . 1 2 19 3 Hookworm treatment.. 3,069 2.1 1,548 2.4 340 2.6 280 2.2 1,193 2.1 48 .3 Surgery of eye or adnexa 338 .2 168 .3 51 .4 35 .3 106 .2 29 .2 Venereal disease treatment 2,683 1.7 258 .4 95 .7 765 6.1 391 .7 1,169 8.4 Posture correction exercise 3, 392 2.3 1,752 2.8 367 2.8 183 1.5 1,175 2.0 282 2.0 Special diet 17,818 12.1 6,149 9.7 1,167 8.9 1,052 8.4 8,214 14.2 2,403 17.2 Study hy a specialist— 16,212 11.0 6,504 10.2 1,707 13.0 1,135 9.1 6, 391 11.1 2,182 15.6 Additional diagnostic pro- cedure 20,334 13.8 7,377 11.6 1,719 13.1 1,800 14.4 8,631 15.0 2,526 18.1 Other major surgery 819 .5 418 .7 112 .9 51 .4 293 .5 57 .4 Other minor surgery 1,757 1.2 1,023 1.6 223 1.7 109 .9 516 .9 109 .8 Minor nonsurgical procedure.. 8,115 5.5 4,256 6.7 1,006 7.6 516 4.1 2,942 5.1 402 2.9 Radiation therapy 17 7 3 1 8 1 All other repeated medical therapy 4,008 2.7 1,647 2.4 319 2.4 246 2.0 1,910 3.3 305 2.2 Unspecified type of treatment. 4,663 3.2 1, 676 2.6 355 2.7 458 3.7 2,060 3.6 470 3.4 1160 youth for whom size of community of residence was unknown are excluded from this table. THE HEALTH STATUS OF NYA YOUTH Table 6.—Number and percent of NY A youth examined in the United States by whether or not dental care was recommended, separate for youth examined by a physician and youth examined by a dentist Examiner and recommen- dation Total Male Female White Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total: Examination by phy- sician or dentist: Number of youth exam- ined i Dental care recommended. Dental care not recom- mended Examination by dentist: Number of youth exam- ined Dental care recommended. Dental care not recom- mended Examination by physician: Number of youth exam- ined Dental care recommended. Dental care not recom- mended 147,663 100.0 63,485 100.0 13,146 100.0 12,513 100.0 57,707 100.0 13,958 100.0 97,039 50,624 65.7 34.3 42,084 21,401 66.3 33.7 8,884 4,262 67.6 32.4 8,590 3,923 68.6 31.4 36,236 21,471 62.8 37.2 10,129 3,829 72.6 27.4 60,107 100.0 27,926 100.0 6,003 100.0 4,738 100.0 22,161 100.0 5, 282 100.0 50,775 9.332 84.5 15.5 23,487 4,439 84.1 15.9 4,969 1,034 82.8 17.2 3,896 842 82.2 17.8 18,752 3,409 84.6 15.4 4, 640 642 87.8 12.2 87,556 100.0 35,559 100.0 7,143 100.0 7,775 100.0 35, 546 100.0 8,676 100.0 46,264 41, 292 52.8 47.2 18,597 16,962 52.3 47.7 3,915 3,228 54.8 45.2 4,694 3,081 60.4 39.6 17,484 18,062 49.2 50.8 5,489 3,187 63.3 36.7 i Excludes 150 youth for whom size of community of residence was unknown, 17 of whom were examined by a dentist. Table 7.—Number and percent of NYA youth examined in the United States by the recommendations specified examining physician as urgent by the Specific urgent recommen- dations Total Male Female White Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined L 147,663 100.0 63,485 100.0 13,146 100.0 12, 513 100.0 57,707 100.0 13,958 100.0 Refraction 3,759 2.5 1,333 2.1 319 2.4 283 2.3 1,701 2.9 442 3.2 Dental care (based on all youth examined) 12,630 8.6 5,300 8.3 1,227 9.3 1,103 8.8 4,676 8.1 1,551 11.1 2,477 1.7 993 1.6 161 1.2 279 2.2 885 1.5 320 2.3 380 .3 269 .4 34 .3 111 .9 175 .1 137 .2 44 .3 29 .2 6 3 11 6 1 1 4 43 15 5 6 9 14 . 1 6 3 1 3 713 .6 352 .6 88 .7 35 .3 322 .6 4 29 19 6 2 6 2 Venereal disease treatment 475 .3 44 . 1 16 .1 173 1.4 90 . 2 168 1.2 Posture correction exercise 182 . 1 68 .1 19 .1 15 . 1 81 .2 18 . 1 Special diet 541 .4 167 .3 34 .3 24 .2 282 .5 68 .5 Study by a specialist 644 .4 292 .5 76 .6 42 .3 258 .5 52 .4 Additional diagnostic proce- dure 403 .3 146 .2 33 .3 22 .2 198 .3 37 .3 70 . 1 30 9 . 1 9 .1 25 6 .1 84 . 1 51 . 1 12 .1 6 .1 24 3 62 27 8 .1 2 30 .1 3 4 1 1 1 1 All other repeated medical therapy 285 .2 121 .2 18 .1 27 .2 105 .2 32 .2 Unspecified type of treatment. 122 .1 52 .1 13 .1 17 .1 46 .1 7 . 1 i Excludes 160 youth for whom size of community of residence was unknown. 62 THE HEALTH STATUS OF NYA YOUTH Table 8. Number and percent of NY A youth examined in the United States by variation from weight standard Variation from standard weight1 Total Male Female W1 All ages lite 21-24 Negro White Negro Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined s. Unknown _ 147,663 63,485 13,146 12, 513 57,707 13,958 2, 366 145, 297 966 62,519 226 12,920 302 12,211 891 56,816 841 7,420 17,171 15,223 8,165 3,668 1,802 1,025 1,501 207 13,751 Total known youth 25 percent or more below 20 percent (15-24) below 10 percent (5-14) below 4 percent below to 4 percent above 10 percent (5-14) above 20 percent (15-24) above 30 percent (25-34) above 40 percent (35-44) above 45 percent and more above 100.0 100.0 100.0 100.0 100.0 100.0 1,448 16, 503 45,451 44,383 22,180 8,304 3,586 1,926 2, 516 1.0 10.7 31.3 30.5 15.3 6.7 2.5 1.3 1.7 410 6,004 20,746 20,718 9,481 2,961 1,098 548 553 .6 9.6 33.2 33.1 15.2 4.7 1.8 .9 .9 132 1,485 4, 365 3,970 1,809 675 235 130 129 1.0 11.5 33.7 30.8 14.0 5.2 1.8 1.0 1.0 50 697 3,462 4,715 2,330 641 179 69 68 .4 5.7 28.4 38.6 19.1 6.2 1.5 .6 .5 1.6 13.1 30.2 26.8 14.4 6.4 3.2 1.8 2.6 147 1,382 4,072 3,727 2,204 1,034 507 284 394 1.1 10.0 29.6 27.1 16.0 7.6 3.7 2. 1 2.9 \ T£e ?£an*a[d weights selected were specific for height, sex, and age. They were based on the findings of the 1929 Supplementary Medical Impairment Study by the Actuarial Society of America and the Association of Life Insurance Medical Directors. .impairment * Excludes 150 youth for whom size of community of residence was unknown. Table 9.—Number and percent oj NYs i youth examined by dentists in the United States by the number of carious teeth found Male Female Total White Number of carious teeth j\egro wmte Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined 60,030 100.0 27,885 100.0 6,987 100.0 4,726 100.0 22,139 100.0 5,280 100.0 Youth with no carious teeth.. 10,178 17.0 4,680 16.8 1,107 18.5 922 19.5 3,782 17 1 794 4,486 15.0 85.0 Youth with carious teeth 49,862 83.0 23,205 83.2 4,880 81.5 3,804 80.5 18,357 82.9 One. 6,382 10.6 2,874 10.3 612 485 10.3 2,511 11.4 512 Q 7 Two 6,357 10.6 2,760 9.9 610 10.2 499 10.6 9.1 2, 521 2,127 11.4 9.6 577 10.9 5, 596 9.3 2, 503 9.0 532 8.9 429 Four 537 10.2 6, 383 9.0 2,407 8.6 470 7.9 434 9.2 2,035 9.2 Five 507 9.6 4, 629 7.7 2,129 7.6 407 6.8 347 7.3 1,687 7.6 Six 466 8.8 4,292 7.1 2,034 7.3 398 6.6 335 7.1 1,517 6.9 Seven.. 406 7.7 3, 573 6.0 1,714 6.2 352 5.9 266 5.6 1,259 5.7 Eight 334 6.3 3,172 5.3 1,465 5.3 281 4.7 265 5.6 1,170 5.3 Nine 272 5. 2 2,401 4.0 1,144 902 4.1 241 4.0 183 3.9 870 3.9 Ten 3.9 1,858 3.1 3.2 160 2.7 134 2.8 2.0 647 487 2.9 2. 2 175 Eleven . 1,471 2.5 761 2.7 175 95 Twelve 1,181 2.0 623 2.2 131 2.2 84 1.8 1. 1 379 300 1.7 1.4 95 1.8 Thirteen 858 1.4 435 1.6 98 1.6 Fourteen 72 1.4 722 1.2 387 1.4 98 1.6 58 1.2 226 1.0 Fifteen 51 1.0 524 .9 279 1.0 67 38 .8 161 Sixteen 46 .9 382 6 203 163 107 90 61 44 36 53 47 41 34 17 13 13 .9 .8 .7 .6 .3 32. 111 105 73 58 26 28 20 Seventeen 310 ’ 5 . 5 36 .7 Eighteen 211 4 . 5 23 .4 Nineteen 166 3 9 9 8 2 . 3 16 .3 Twenty 100 .3 .1 .1 . 1 9 .2 Twenty-one 88 .i .i 4 . 1 Twenty-two .. 61 .1 .2 8 3 .2 Twenty-three .. Twenty-four Twenty-five . . Twenty-six Twenty-seven Twenty-eight . Twenty-nine 41 29 20 12 8 7 6 .i 24 21 13 5 4 6 3 . 1 .1 .1 7 5 6 2 3 2 1 .1 . 1 .1 .1 3 1 1 .1 13 5 6 5 4 1 2 .1 1 2 1 1 Thirty-one Thirty-two Average number of cari- 4 6 3 3 2 3 .1 2 1 1 1 ous teeth per 100 youth 471 9 4Q9 1 401.0 472.0 1 Excludes 77 youth for whom dental condition was not recorded, and 17 youth for whom size of community of residence was unknown. THE HEALTH STATUS OF NYA YOUTH 63 Table 10.—Number and percent of NYA youth examined by dentists in the United States by the number of D. M. F. teeth reported Male Female Total White Number of D. M. F. teeth > Negro White Negro All ages 21- -24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined hy dentista 60,047 100.0 27,893 100.0 5,988 100.0 4,729 100.0 22,145 100.0 5,280 100.0 Number D. M. F. teeth 3,515 5.9 1,660 6.0 285 4.7 583 12.3 858 3.9 414 7.8 One 2,351 3.9 1,103 4.0 183 3.0 307 6.5 653 3.0 288 5.5 Two 2,935 4.9 1,365 4.9 260 4.3 358 7.6 874 4.0 338 6.4 Three 3,029 5. 1 1,399 5.0 253 4.2 356 7.5 872 4.0 402 7.6 Four 3,478 5.8 1,688 5.7 295 4.9 409 8.6 1,047 4.7 434 8.2 Five 3, 521 5.9 1,628 5.8 280 4.7 351 7.4 1,125 5.1 417 7.9 Six 3, 740 6.2 1,774 6.4 317 5.3 373 7.9 1,204 5.4 389 7.4 Seven 3, 769 6.3 1,851 6.6 352 5.9 316 6.7 1,240 5.6 362 6.8 Eight 4,164 6.9 1,970 7. 1 372 6.2 333 7.0 1,489 6.7 372 7.0 Nine 3,860 6.4 1,822 6.5 390 6.5 259 5.5 1,443 6.5 336 6.4 Ten --- 3,550 5.9 1,688 6. 1 358 6.0 201 4.2 1,369 6.2 292 5.5 Eleven 3,232 5.4 1.488 5.3 307 5.1 174 3.7 1,350 6.1 220 4.2 2,899 4.8 1,311 4.7 283 4. 7 141 3.0 1,243 5.6 204 3.9 Thirteen 2, 543 4.2 174 4.2 276 4.6 117 2.5 i;069 4.8 183 3.5 Fourteen 2,141 3.6 1,006 3.6 234 3.9 93 1.9 913 4.1 129 2.4 Fifteen - — 1,911 3.2 865 3.1 213 3.6 77 1.6 881 4.0 88 1.7 Sixteen 1,692 2.8 759 2.7 213 3.6 67 1.4 777 3.5 89 1.7 Seventeen 1,441 2.4 615 2.2 180 3.0 52 1.1 694 3.1 80 1.5 Eighteen 1,196 2.0 543 1.9 157 2.6 36 .8 561 2.5 56 1. 1 Nineteen 1,027 1.7 428 1.5 139 2.3 27 .6 517 2.3 55 1.0 Twenty 795 1.3 357 1.3 111 1.9 28 .6 380 1.7 30 .6 Twenty-one 688 1.2 315 1.1 91 1.5 24 .5 327 1.5 22 .4 Twenty-two 535 .9 259 .9 77 1.3 13 .3 244 1.1 19 .4 Twenty-three 444 .7 198 .7 63 1. 1 9 .2 222 1.0 15 .3 Twenty-four 358 .6 164 .6 62 1.0 5 . 1 180 .8 9 . 2 Twenty-five 273 .5 126 .5 46 .8 3 . 1 132 .6 12 .2 Twenty-six —- - 245 .4 no .4 45 .8 4 .1 120 .6 11 .2 Twenty-seven 162 .3 69 .3 28 .5 3 .1 86 .4 4 . 1 141 .2 65 .2 25 .4 3 . 1 72 .3 1 101 .2 52 .2 22 .4 1 47 .2 1 82 . 1 36 . 1 13 .2 1 45 .2 55 . 1 26 . 1 12 .2 27 . 1 2 Thirty-two -- 93 .2 45 .2 27 .5 4 . 1 40 .2 4 . 1 24 12 . 1 5 . 1 1 11 . 1 19 6 1 13 .1 11 5 6 . 1 6 6 3 i 3 4 4 2 4 1 i 1 7 4 4 .1 3 6 3 2 3 Average number of D. M. F. teeth per 100 youth 918.0 909.7 1047.5 631.8 1036.5 720.5 1 The number of D. M. F. teeth, a measure of the total caries experience, past and present, is the summation of the numbers of teeth that are decayed, miss- ing, or filled. 1 Excludes 77 youths for whom dental condition was not recorded. 64 THE HEALTH STATUS OF NYA YOUTH Table 11.—Number ar id percent oj NY A youth examined by dentists in the United States by the number oj repaired teeth found Male Female Total White Number of repaired teeth Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined by dentist1 60,047 100.0 27,893 100.0 5,988 100.0 4,729 100.0 22,145 100.0 5,280 100.0 No repaired teeth 29,014 48.3 14,170 60.8 2,680 44.8 3,474 73.6 7,860 35.5 3| 510 66.5 One or more repaired teeth 31,033 51.7 13, 723 49.2 3,308 55.2 1,255 26.5 14,285 64.6 1,770 33.5 One 6, 163 8.6 2,392 8.6 499 8.3 416 8.8 1,824 8.2 531 10.0 Two... 4,185 7.0 1,912 6.9 393 6.6 290 6.1 1,629 7.3 354 6.7 Three 3,276 5.5 1,519 5.4 339 5.7 159 3.4 1,389 6.3 209 4.0 Four 3,023 5.0 1,431 5.1 326 5.4 114 2.4 1,300 5.9 178 3.4 Five 2,370 3.9 1,099 3.9 249 4.2 73 1.5 1,087 4.9 111 2.1 Six 2,259 3.8 958 3.4 248 4.1 65 1.4 1,161 6.2 75 1.4 Seven 1,954 3.3 844 3.0 206 3.4 35 .7 993 4.8 82 1.5 Eight— 1,739 2.9 768 2.8 190 3.2 22 .5 896 4.0 53 1.0 Nine ... 1,442 2.4 586 2.1 147 2.5 21 .5 792 3.6 43 .8 Ten 1,253 2.1 497 1.8 131 2.2 17 .4 710 3.2 29 .6 Eleven 1,019 1.7 426 1.5 133 2.2 11 .2 556 2.5 26 .5 Twelve 827 1.4 3C0 1.1 94 1.6 11 .2 496 2.2 20 . 4 Thirteen 599 1.0 222 .8 61 1.0 4 .1 356 1.6 17 3 Fourteen 515 .9 219 .8 73 1.2 5 .1 277 1.3 14 . 3 Fifteen . 371 .6 130 .6 38 .6 3 .1 229 1.0 9 .2 Sixteen 345 .6 139 .5 53 .9 3 .1 194 .9 Q Seventeen 221 .4 85 .3 34 .6 123 .1 Eighteen 135 .2 55 . 2 25 4 2 Nineteen 108 .2 35 1 14 Twenty 56 .1 22 . 1 n .2 i 32 Twenty-one 42 .1 14 .1 8 .1 27 1 Twenty-two 33 19 .1 10 .2 14 Twenty-three 17 11 4 .1 6 Twenty-four 20 9 6 .1 ii Twenty-five 6 5 3 .1 1 Twenty-six 8 5 2 i 2 Twenty-seven 2 1 1 Twenty-eight 8 4 2 4 Twenty-nine Thirty 2 2 1 Thirty-one 1 1 Thirty-two 34 14 .1 8 . 1 19 .1 1 paired teeth per 100 youth 291.1 265.6 340.1 85.7 406.5 126.5 1 Excludes 77 youths for whom dental condition'-was notjrecorded. THE HEALTH STATUS OF NYA YOUTH 65 Table 12.—Number and percent oj NY A youth examined by dentists in the United States by the number of extracted teeth noted Male Female Total White Number of extracted teeth Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined by 60,047 100.0 27,893 100.0 5,988 100.0 4,729 100.0 22,145 100.0 5,280 100.0 Youth with no extracted teeth. 26,166 43.7 12, 447 44.6 2,188 36.6 2,667 56.5 8,459 38.2 2,593 49.1 Youth with one or more extracted 33,881 56.3 IS, 446 55.4 3,800 63.4 2,062 43.5 13, 686 61.8 2,687 50. 9 10,869 18.1 4,959 17.8 1, 022 17.1 873 18.5 4, 016 18.1 1, 021 19.4 9; 112 15.2 4,075 14.6 899 15.0 591 12.5 3,661 16.5 785 14.9 5,355 8.9 2,531 9.1 666 11.1 270 6.7 2,190 9.9 364 6.9 Four 3,559 5.9 1,644 5.9 431 7.2 148 3.1 1, 529 6.9 238 4. 5 2,008 3.4 857 3.1 253 4.2 81 1.7 959 4.3 111 2.1 1,139 1.9 522 1.9 178 3.0 38 .8 522 2.4 57 1.1 648 1.1 307 1.1 97 1.6 19 .4 284 1.3 38 .7 Eight 418 .7 187 .7 70 1.2 14 .3 188 .9 29 .6 251 .4 125 .5 56 .9 14 .3 97 .4 15 .3 164 .3 75 .3 42 .7 6 .1 76 .4 7 . 1 105 .2 46 .2 26 .4 1 49 .2 9 .2 69 . 1 29 .1 14 .2 1 27 .1 2 Thirteen. 52 .1 18 .1 7 .1 4 .1 23. .1 7 .1 23 9 6 .1 13 .1 1 9 4 .1 8 19 8 5 .1 1 9 .1 1 11 8 6 .1 1 2 16 6 2 10 .1 12 9 5 .1 3 3 3 .1 8 8 4 3 i 2 1 1 3 2 2 1 4 1 3 1 1 2 2 10 5 5 . 1 5 Average number of ex- tracted teeth per 100 youth 155.3 153.0 205.9 97.9 » Excludes 77 youth for wh 3m dental condition was not recorded. 66 THE HEALTH STATUS OF NYA YOUTH Table 13.—Number and percent of NYA youth examined by dentists in the (except carious teeth) United States by abnormal mouth conditions found Male Female Total White Abnormal mouth conditions White All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined i 60,124 38, 710 100.0 27,934 17, 553 100.0 6,004 3, 435 100.0 4,741 2,656 100.0 22,167 15, 274 100.0 5,282 3,227 100.0 Youth with no defects 64.4 62.8 67.2 56.0 68.9 61.1 Youth with defects _ ... 21, 414 7,667 35.6 12.7 10, 381 4,323 6,042 1,772 37.2 15.5 2,569 1,170 1,207 477 42.8 19.5 2,085 677 44.0 14.3 6,893 2,116 3,917 889 31.1 9.5 2,055 551 38.9 10.4 Slight gingivitis. T. . lli 215 3,185 2,634 18.6 18.0 20.1 1,136 289 24.0 17.7 1,120 235 21.2 Gingivitis, except slight. 5.3 6.3 8.0 6.1 4.0 4.4 Pyorrhea ,1 1 4.4 lj 255 4.5 432 7.2 395 8.3 671 3.0 313 5.9 Oral abscess .. ' 299 .5 116 .4 20 .3 35 .7 87 .4 61 1.2 Malocclusion 1,117 1.9 405 1.4 92 1.6 96 2.0 481 2.2 135 2.6 ' 149 .2 70 .3 24 . 4 12 .3 60 .3 7 . 1 All other abnormal conditions of lips 18 13 .1 3 . 1 4 1 All other abnormal conditions 3,047 321 5.1 1, 288 156 4.6 284 4.7 372 7.8 955 4.3 432 8. 2 All other abnormal conditions of the Buccal cavity .6 .6 45 .7 29 .6 95 .4 41 .8 Total defects per 100 youth 49.3 51.7 62.5 64.1 41.8 54.8 1 Based only upon those youth whose oral examination was performed by a dentist. Table 14.—Number and percent of NYA youth examined in the United States by Snellen Chart readings with vision unassisted Snellen Chart reading, unassisted Total Male Female White Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined. 147,813 63,552 13,158 12,532 57,760 13,969 POORER EYE Unknown reading 1,589 660 175 136 632 161 Known reading 146,224 100.0 02, 892 100.0 12, 983 100.0 12,396 100.0 57,128 100.0 13,808 100.0 20/20, or under 93,438 63.9 42,188 67.1 7,973 61.4 8,768 70.7 33, 744 59.1 8,738 63.3 20/25.... 9, 408 6.4 3, 732 5.9 748 5.8 720 5.8 3,952 6.9 1,004 7.3 20/30 16, 497 11.3 5,977 9.5 1, 395 10.7 1,327 10.7 7,252 12.7 1, 941 14.1 20/40 6,996 4.8 2,674 4.3 669 5.2 500 4.0 3,127 5.5 695 5.0 20/50.. 3,900 2.7 1, 556 2.6 347 2.7 236 1.9 1, 731 3.0 377 2.7 20/70 4,227 2.9 1,689 2.7 428 3.3 251 2.0 1,916 3.4 371 2.7 20/100 4,135 2.8 1, 731 2.7 453 3.5 195 1.6 1,967 3.4 242 1.8 20/200 or over 6,688 4.6 2,834 4.5 818 6.3 308 2.5 3,179 5.6 367 2.6 Blind 641 .4 393 .6 120 .9 72 .6 135 .2 41 .3 Abnormal, degree un- known 294 .2 118 .2 32 .2 19 .2 125 .2 32 .2 BETTER EYE Unknown reading 1, 251 482 129 103 525 141 Known reading 146,562 100.0 63, 070 100.0 13, 029 100.0 12,429 100.0 57, 235 100.0 13,828 100.0 20/20, or under 110, 297 75.3 49, 611 78,7 9,653 74.1 10, 040 80.8 40, 299 70.4 10, 347 74.8 20/25 7,639 5.2 2,809 4.5 688 4.5 600 4.8 3,388 6.9 842 6.1 20/30 12, 686 8.6 4,450 7.1 1,102 8.6 925 7.4 5,848 10.2 1, 363 9.9 20/40 4, 580 3.1 1, 719 2.7 424 3.3 291 2.3 2,094 3.7 476 3.4 20/50 2,663 1.8 1, 026 1.6 254 1.9 158 1.3 1,250 2.2 229 1.7 20/70. 2,666 1.8 1,021 1.6 276 2.1 140 1.1 1,277 2.2 228 1.6 20/100 2, 436 1.7 973 1.5 273 2.1 117 1.0 1, 207 2.1 139 1.0 20/200, or over 3, 666 2.4 1, 411 2.2 440 3.4 153 1.2 1,806 3.2 197 1.4 Blind 7 6 3 1 Abnormal, degree un- known 122 .1 44 ,1 17 .1 5 .1 66 .1 7 .1 THE HEALTH STATUS OF NYA YOUTH Table 15.—Number and percent of NY A youth examined in the United States by specified diseases or dejects of the eye Male Female Total White Disease or defect of the eye Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined.. 147,813 100.0 63,552 100.0 13,158 100.0 12,532 100.0 57,760 100.0 13,969 100.0 Youth with no defects 140,128 94.8 60,011 94.4 12,195 92.7 11,967 95.5 64,852 95.0 13,298 95.2 Youth with defects. ... 7,685 6.2 3,541 5.6 963 7.3 565 4.6 2,908 5.0 671 4.8 Slight blepharitis 1, 574 1.1 755 1.2 192 1.5 66 .5 672 1.2 82 .6 Blepharitis, except slight 303 .2 145 .2 35 .3 15 .1 135 .2 8 .1 Slight discharge 253 .2 148 .2 44 .3 15 . 1 76 .1 15 .1 Discharge, except slight 55 35 . 1 7 . 1 7 . 1 9 4 Trachoma * 1 104 .1 81 . 1 17 .1 2 20 1 Pterygium 471 .3 245 .4 95 .7 72 .6 99 .2 65 .4 Slight strabismus 1,489 1.0 654 1.0 193 1.5 66 .6 669 1.2 100 .7 Strabismus, except slight 488 .3 223 .4 63 .4 41 .3 186 .3 38 .3 Nystagmus 232 .2 137 .2 55 .4 17 .1 69 .1 9 .1 Conjunctivitis 1,043 .7 567 .9 121 .9 61 .5 350 .6 65 .6 All other eye diseases. 2, 517 1.7 990 1.6 280 2.1 256 2.1 921 1.6 350 2.4 Total defects per 100 youths 6.8 6.3 8.3 4.9 5.5 5.2 Table 16.—Number and percent of NY A youth examined in the United States by finding s of color sense examination and type of tests Type of color sense test and result Total Male Female White Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent 147,813 63,652 13,168 12,532 57,760 13,969 Si 275 i; 218 '292 '449 i; 243 365 ALL TESTS GIVEN Total known youth 144, 638 100.0 62,334 100.0 12,866 100.0 12,083 100.0 66, 517 100.0 13,604 100.0 Normal reaction 141,757 98.1 60,638 97.1 12,471 96.9 11, 711 96.9 56,215 99.5 13,293 97.7 Abnormal, slight degree .. 2,016 1.4 1,226 2.0 273 2.1 283 2.4 231 .4 276 2.1 Abnormal, except slight .. 765 .5 570 .9 122 1.0 89 .7 71 .1 35 .2 ISHIHARA TEST Total known youth 45,199 100.0 20,824 100.0 4,087 100.0 3,280 100.0 17,384 100.0 3,711 100.0 Normal reaction 43, 747 96.8 19, 747 94.8 3,866 94.6 3,167 96.5 17,174 98.8 3,659 98.6 Abnormal, slight degree 1,007 2.2 718 3.5 146 3.6 81 2.5 163 .9 45 1.2 Abnormal, except slight 445 1.0 359 1.7 75 1.8 32 1.0 47 .3 7 .2 HOLMGREN YARN TEST Total known youth 91, 556 100.0 37,876 100.0 8,023 100.0 8,352 100.0 35,806 100.0 9,522 100.0 Normal reaction 90,416 98.8 37,294 98.5 7,881 98.2 8,117 97.2 36, 732 99.8 9, 272 97.4 Abnormal, slight degree 876 .9 415 1.1 101 1.3 183 2.2 64 .2 224 2.3 Abnormal, medium or marked 265 .3 167 .4 41 .5 62 .6 20 26 .3 OTHER TEST(s) * Total known youth 7,783 100.0 3,634 100.0 756 100.0 451 100.0 3,327 100.0 371 100.0 Normal reaction 7,595 97.6 3,497 96.2 724 95.8 427 94.7 3,309 99.6 362 97.6 Abnormal, slight degree 133 1.7 93 2.6 26 3.4 19 4.2 14 .4 7 1.9 Abnormal, except slight 55 .7 44 1.2 6 .8 6 1.1 4 .1 2 .5 1 Includes any other test given as well as youth given more than one type of tesi , or unspecified type of test. THE HEALTH STATUS OF NYA YOUTH Table 17.—Number and percent of NY A youth examined in the United States by results of auditory acuity test Male Female Auditory acuity1 better ear— Total White White poorer ear All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent 147,813 63,552 13,158 12,632 57,760 13,969 POORER EAE 2,406 145,407 1,053 62,499 242 294 843 216 100.0 100.0 12,916 100.0 12,238 100.0 56,917 100.0 13, 753 100.0 141,389 1,752 1, 240 97.2 60,604 794 97.0 12,345 95.6 11,980 106 97.9 55,344 698 97.3 13,461 154 97.9 16/20 1.2 1.3 '205 1.6 .9 1.2 1.1 10/20 .9 687 .9 171 1.3 110 .9 442 .8 101 .7 7.4/20 or less ' 639 .4 286 .4 94 .7 21 .2 211 .4 21 .1 26 6 2 3 17 309 .2 160 .3 79 .6 13 .1 128 .2 8 . 1 Abnormal, degree un- 152 .1 62 .1 20 .2 5 77 .1 8 . 1 BETTER EAR 4,350 143,463 3, 206 60,346 188 266 689 189 Known rating 100.0 100.0 12,970 100.0 12, 266 100.0 57,071 100.0 13,780 100.0 141,652 876 98.7 59, 512 391 98.6 12,699 95 97.9 12,117 50 98.8 56,394 347 98.8 13,629 88 98.9 15/20 .6 .6 .7 .4 .6 .6 10/20 607 .4 222 .4 73 .6 79 .7 152 .3 54 .4 7.4/20 or less 193 .1 97 .2 36 .3 9 . 1 82 . 1 6 . 1 20 12 2 7 1 157 .1 89 .2 68 .4 6 60 . 1 2 Abnormal, degree un- 58 .1 23 7 .1 6 29 .1 1 1 This rating is expressed as a /ration with 20 as the denominator and the distance in feet at which an ordinary conversational voice could be heard as the numerator. The numerators (distances) thus recorded were here grouped into 5-foot intervals so that 10/20 includes values from 7.5/20 to 12.4/20, etc. A few youth, not rated on this scale, were reported as “slightly deaf,” “deaf,” or as having some abnormality the effect of which was not indicated. They are re- corded separately above. Table 18.—Number and percent of NY A youth examined in the United States by condition of the ear drums Male Female Total White Condition of ear drums Negro White Negro All ages 21- -24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent “poorer” ear 1 Total youth examined 147,813 63,552 13,158 12,532 57,760 13,969 Unknown because of wax 2,527 1,139 '258 185 1,018 185 Other unknown 2,206 991 203 193 '826 196 Total unknown . _ 4,' 733 2,130 461 378 1,844 381 Total known youth 143,080 100.0 61,'422 100.0 12,697 100.0 12,154 100.0 55,916 100.0 13,688 100.0 Youth with normal drum 135,014 94.4 58,019 94.5 11,849 93.3 11, 656 95.9 52,678 94.0 12,761 93.9 Drum absent 155 .1 77 .1 27 .2 7 .1 62 .1 9 .1 Drum perforated 1,252 .9 605 1.0 177 1.4 52 .4 627 1.0 68 .5 Drum retracted 2,732 1.9 1,145 1.8 277 2.2 116 1.0 1,273 2.3 198 1.4 Drum dull 3, 661 2.5 1,464 2.4 339 2.7 308 2.5 1,352 2.4 637 4.0 Drum, abnormal except aboveJ. 266 .2 112 .2 28 .2 16 .1 124 .2 15 .1 “better” ear Total youth examined ... 147,813 63,652 13,158 12,532 57, 760 13,969 Unknown because of wax 2,451 1,089 '272 184 ' 990 188 Other unknown 1,814 '834 175 150 689 141 Total unknown . 4,265 1,923 447 334 1,679 329 Total known youth. 143,548 100.0 61,629 100.0 12,711 100.0 12,198 100.0 56,081 100.0 13.640 100.0 Youth with normal drum 136, 637 95.1 68,755 95.3 12,006 94.5 11, 748 96.3 53,153 94.8 12,881 94.4 Drum absent 91 . 1 48 . 1 14 .1 4 33 6 Drum perforated ... 970 .7 427 .7 116 .9 45 .4 429 .8 69 .5 Drum retracted 2,418 1.7 1,030 1.7 256 2.0 108 .9 1,108 2.0 172 1.3 Drum dull. .. 3,312 2.3 1.270 2.1 297 2.3 277 2.3 1, 262 2.2 603 3.7 Drum, abnormal except above. 220 .1 99 .1 22 .2 16 .1 96 .2 9 .1 1 “Poorer ear” is ear with poorer auditory acuity, except that when both ears were equal the left ear was designated as “poorer.” 3 Includes “drum reddened,” etc. THE HEALTH STATUS OF NYA YOUTH 69 Table 19.—Number and percent of NYA youth examined in the United States by condition of the nose and accessory sinuses Male Female Total White Condition of nose Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined.. 147,813 100.0 63,552 100.0 13,158 100.0 12,532 100.0 57,760 100.0 13,969 100.0 Youth with no defects 133,232 90.1 56,405 88.8 11, 453 87.0 11,544 92.1 52,439 90.8 12,844 91.9 Youth with defects 14, 581 9.9 7,147 11.2 1,705 13.0 988 7.9 5,321 9.2 1,125 8.1 Chronic sinus infection, slight. 4,093 2.8 1,979 3.1 483 3.7 232 1.9 1,579 2.7 303 2.2 Chronic sinus infection, ex- cept slight 720 .5 321 .5 76 .6 42 .3 294 .5 63 .5 Polypi .. 788 .6 285 .4 75 .6 93 .7 264 .5 146 1.0 Perforated septum 222 .1 125 .2 46 .3 6 .1 80 .1 11 .1 Deviated septum 3,847 2.6 2,429 3.8 606 4.6 80 .6 1,248 2.2 90 .6 Coryza or acute rhinitis 1,013 .7 452 .7 86 .6 88 .7 396 .7 77 .6 Allergic rhinitis 1,180 .8 487 .8 93 .7 80 .6 510 .9 103 .7 Acute or unqualified sinus 47 19 7 . 1 6 . 1 17 5 Epistaxis 103 .1 40 .1 11. .1 8 .1 45 .1 10 .1 All other nose abnormalities.. 5,015 3.4 2,205 3.5 491 3.7 482 3.8 1,794 3.1 534 3.8 Total defects per 100 youth 11.5 13.1 15.0 8.9 10.8 9.6 Table 20.- -Number and percent oj NY A youth examined in the United States by condition of the throat Male Female Total White Condition of throat Negro White Negro All ages 21- -24 Number Percent Number Percent Number Percent Number Percent Number Percefat Number Percent 147,663 63,485 13,146 12, 513 57,707 13,958 Unknown as to tonsils _ - 1,750 718 150 159 691 182 Total known youth, as to tonsils. 145,913 1CO.O 62, 767 100.0 12,996 100.0 12,354 100.0 57,016 100.0 13, 776 100.0 Tonsils normal. 72,195 49.5 30,698 48.9 6,485 49.9 7,685 62.2 26,686 46.8 7,126 61.7 Tonsils diseased .. 33,313 22.8 14,128 22.5 2,596 20.0 2,983 24.2 12, 409 21.7 3, 793 27.5 Tonsils completely removed.. 36,174 24.1 15,740 25.1 3,411 26.2 1,425 11.5 15,597 27.4 2,412 17.5 Tonsils partially removed 5,231 3.6 2,201 3.5 504 3.9 261 2.1 2,324 4.1 445 3.3 Total youth examined.. 147,663 100.0 63,485 100.0 13,146 100.0 12,513 100.0 67,707 100.0 13,958 100.0 Pharynx normal 139,146 94.2 59,513 93.7 12,193 92.8 11,918 95.2 54,426 94.3 13,289 95.2 Pharynx abnormal 8,517 5.8 3,972 6.3 953 7.2 595 4.8 3,281 6.7 669 4.8 1 Excludes 150 youth for whom size of community of residence was unknown. THE HEALTH STATUS OF NYA YOUTH Table 21.- -Number and percent of NY A youth examined in the United States by chest X-ray findings Male Female Total White Chest X-ray findings Negro White Negro All ages 21 -24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth1 147,663 63,485 13,146 12,513 67,707 13,958 Youth not X-rayed.. 134,439 58,795 12,182 11, 388 52,416 11,841 Total youth X-fayed 13; 224 100.0 4,690 100.0 964 100.0 1,125 100.0 5,292 100.0 2,117 100.0 Youth with unreadable X-ray. 50 .4 14 .3 3 .3 10 .9 21 .4 5 .2 Youth with readable X-ray... 13,174 99.6 4,676 99.7 961 99.7 1,115 99.1 5, 271 99.6 2,112 99.8 Lungs clear 11,713 88.6 4,101 87.4 801 83.1 970 86.2 4, 737 89.5 1, 905 90.0 Inactive tuberculosis 786 5.9 326 7.0 75 7.8 83 7.4 292 5.5 85 4.0 Active tuberculosis, minimal.. 77 .6 30 .6 12 1.2 5 .4 25 .5 17 .8 Active tuberculosis, moderate. 33 .2 12 .3 3 .3 14 .3 7 .3 Active tuberculosis, far ad- 44 .3 18 .4 11 1.1 3 .3 22 .4 1 Active tuberculosis, stage un- known 06 .5 29 .6 10 1.0 7 .6 20 .4 10 .5 Positive lung findings, except definite tuberculosis. 377 2.9 139 3.0 38 3.9 35 3.1 124 2.4 79 3.7 Positive findings in heart or vessels 133 1.0 35 .7 13 1.3 20 1.8 42 .8 36 1.7 Positive findings other than above 99 .7 18 .4 4 ,4 12 1.1 30 .6 39 1.8 1 Excludes 150 youth for whom size of community of residence was unknown. Table 22.—Number and percent of NY A youth examined in the United States by findings of stethoscopic examination of the heart Male Female Total White Condition of heart from stethoscopic examination Negro White Negro All ages 21- -24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined.. 147,813 100.0 63,552 100.0 13,158 100.0 12,532 100.0 57,760 100.0 13,969 100.0 Youth with no defects 138,065 93.4 60, 061 94.5 12, 379 94.1 11, 787 94.1 S3, 630 92.9 12,587 90.1 Organic heart disease 3, 653 2.5 1,388 2.2 374 2.8 305 2.4 1,408 2.4 552 4.0 Functional murmur only ... 4,347 2.9 1,428 2.3 258 2.0 280 2.2 2,037 3.5 602 4.3 Rhythm irregularity only 564 .4 215 .3 56 .4 59 .5 221 .4 69 .5 Functional murmur with 88 .1 25 4 9 . 1 36 .1 18 . 1 Unclear as to heart condition. 1,096 .7 435 .7 87 . 7 92 .7 428 .7 141 1.0 THE HEALTH STATUS OF NYA YOUTH 71 Table 23.—Number and percent of NY A youth examined in the United States by systolic and diastolic blood pressure readings Blood pressure (mm. of mercury) Total Male Female White Negro White Negro All ages 21- -24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined.. 147,813 63,552 13,158 12,532 67,760 13,969 Unknown as to blood pressure. 496 246 54 61 149 50 Total known youth 147,317 100.0 63,306 100.0 13,104 100.0 12,481 100.0 67,611 100.0 13,919 100.0 Systolic blood pressure: Below 75 . . 53 23 5 10 . 1 16 4 75 to 84 245 .2 81 .1 14 .1 26 .2 111 .2 27 .2 85 to 94 2,255 1.5 680 1.1 124 .9 197 1.6 1,062 1.9 316 2.3 95 to 104 11,659 7.9 3,449 5.5 557 4.3 856 6.9 5.831 10.1 1,523 10.9 105 to 114 37,607 25.5 13,187 20.8 2,315 17.7 3,114 24.9 16,946 29.4 4,360 31.3 115 to 124 54,979 37.3 24,404 38.5 4,856 37.1 4,751 38.1 20,923 36.3 4,901 35.2 126 to 134 26,495 18.0 13,501 21.3 3,067 23.4 2, 268 18.2 8,823 15.3 1,903 13.7 135 to 144 9,890 6.7 5,647 8.8 1,446 11.0 869 7.0 2,858 5.0 616 4.4 145 to 154 2,688 1.8 1,587 2,5 457 3.5 231 1.8 692 1.2 178 1.3 155 to 164 937 .7 567 .9 176 1.3 91 .7 230 .4 49 .4 165 and over 509 .4 280 .5 87 .7 68 .6 119 .2 42 .3 Diastolic blood pressure: Under 26 44 16 5 3 21 4 25 to 34 91 .1 37 .1 12 .1 15 .1 32 .1 7 .1 35 to 44 417 .3 217 .3 37 .3 40 .3 126 .2 34 .2 45 to 54 2,445 1.6 1,130 1.8 168 1.3 224 1.8 890 1.6 201 1.4 65 to 64 19,537 13.3 8,238 13.0 1, 349 10.3 1,619 13.0 7,796 13.5 1,884 13.5 65 to 74 54, 490 37.0 22,770 36.0 4,184 31.9 4,309 34.5 22,323 38.8 5,088 36.6 76 to 84 65, 274 37.5 24,410 38.6 5,492 41.9 4,669 37.4 21, 089 36.6 5,106 36.7 85 to 94 12,739 8.6 5,564 8.8 1,541 11.8 1,302 10.5 4,559 7.9 1,314 9.4 95 to 104 1,890 1.3 778 1.2 263 2.0 243 2.0 637 1.1 232 1.7 105 to 114 316 .2 121 .2 47 .4 41 .3 118 .2 36 .3 115 and over 74 .1 25 6 16 .1 20 13 . 1 Table 24.—Number and percent of NY A youth examined in the United States by pulse rate, without special exercise Male Female Total White Pulse rate (beats per minute) Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined.. 147,813 63,552 13,158 12,532 57,760 13,969 Unknown 1,238 470 96 112 539 117 Total known youth 146,575 ioo.6 63,082 100.0 13,062 100.0 12,420 100.0 57,221 100.0 13,852 100.0 66 and under . .. 8,060 5.5 4,529 7.2 967 7.4 1,346 10.8 1,804 3.2 381 2.8 67 to 70 11,928 8.1 5, 887 9.3 1, 264 9.7 1,495 12.0 3,675 6.4 871 6.3 71 to 74 26,553 18.1 12,675 20.1 2,721 20.8 2,883 23.2 8,915 15.6 2,080 15.0 75 to 78 21,880 14.9 9,862 15.6 2,061 15.8 1,898 15.3 8,004 14.0 2,116 15.3 79 to 82 27,518 18.8 11,144 17.7 2,237 17.1 2,060 16.6 11, 205 19.6 3,109 22.4 83 to 86 15,686 10.7 5,892 9.3 1,124 8.6 1,006 8.1 6,998 12.2 1,790 12.9 87 to 90 14,329 9.8 5,412 8.6 1,069 8.2 836 6.7 6,536 11.4 1,545 11.2 91 to 94 4,320 2.9 1,644 2.6 317 2.4 212 1.7 2,008 3.5 456 3.3 95 to 98 5, 723 3.9 2,129 3.4 425 3.3 262 2.1 2,765 4.8 567 4,1 99 to 102... 5, 202 3.6 1,981 3.1 462 3.4 219 1.8 2,512 4.4 490 3.5 103 and over 5,376 3.7 1,927 3.1 425 3.3 203 1.7 2,799 4.9 447 3.2 Median rate 79.71 78.43 78.06 76.02 81.22 80 90 Percent 67 to 90.. 80.4 80.6 80.2 81.9 79 2 83.1 Percent 71 to 82.. 51.8 53.4 53.7 55.1 49.2 52.7 THE HEALTH STATUS OF NYA YOUTH Table 25.—Number and percent oj NY A youth examined in the United States by results oj blood serologic tests jor syphilis Male Female Total White Results of test Negro White Negro All ages 21 -24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth 147,813 63,552 13,158 12,532 57,760 13,969 Unknown . .. 5,226 2,195 537 287 2,311 433 Total youth with known results 142, 587 100.0 61,357 100.0 12,621 100.0 12,245 100.0 55,449 100.0 13, 536 100.0 Negative 139,739 98.0 60,983 99.4 12, 501 99.1 11, 552 94.3 54,951 99.1 12,253 90.5 Doubtful, 1 test 252 .2 56 . 1 13 . 1 33 .3 86 .2 77 .6 Doubtful, 2 or more tests 93 . 1 12 .0 5 .0 10 . 1 45 . 1 26 .2 Positive, 1 test 1, 786 1.2 219 .4 67 .5 511 4.2 259 .4 797 5.9 Positive, 2 or more tests 594 .4 62 . 1 20 .2 100 .8 90 .2 342 2.5 Syphilis stated present though no test 123 .1 25 .0 15 .1 39 .3 18 .0 41 .3 Table 26.—Number and percent of NY A youth examined in the United States by findings of the genito-urinary examination Genito-urinary diseases (except venereal) Total Male Female White Negro White Negro All ages 21- -24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent 147,813 63, 552 13,158 12,532 57,760 13,969 Youth not examined 10,717 523 144 56 8,076 2,062 Youth examined 137,096 100.0 63,029 100.0 13,014 100.0 12,476 100.0 49,684 100.0 n; 907 100.0 Youth with no defects 118, 595 86.5 52,582 83.4 11,022 84.7 9,922 79.6 45,904 92.4 10,187 85.6 Youth with defects 18, 501 13.5 10,447 16.6 1,992 15.3 2,654 20.6 3, 780 7.6 1,720 14.4 Urethral discharge 1,505 1.1 180 .3 40 .3 288 2.3 580 1.2 457 3.9 Vaginal or cervical discharge.. 1,971 1.4 1,289 2.6 682 5.7 Ulcerations no . 1 25 4 28 .2 32 .1 25 .2 2,914 2.1 2,707 4.3 548 4.2 207 1.7 Menstrual disorders . 2,301 1.7 1,839 3.7 462 3.9 287 .2 256 .4 66 .4 31 .3 8,802 6.4 6,791 10.8 1,186 9. 2 2,011 16.1 Other genital defects 1,863 1.4 1,055 1.7 ’277 2.1 167 1.3 350 .7 301 2.5 57 32 . 1 2 3 19 3 Other defects of kidney or 78 . 1 22 8 . 1 3 46 . 1 7 0.1 Other defects of urinary sys- tern 274 .2 69 .1 13 .1 27 .2 126 .2 62 .5 Total defects per 100 youth 14.7 17.7 16.4 22.1 8.6 16.8 THE HEALTH STATUS OF NY A YOUTH Table 27.—Number and percent of NY A youth examined in the United States by findings oj ano-rectal examination Condition of ano-rectal system Total Male Female White Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth 147,813 63, 552 13,158 12, 532 67,760 13,969 Youth not given ano-rectal examination 5,372 142,441 388 63,164 62 13,096 58 12,474 4,098 63,662 828 13,141 Youth examined Youth with no defects.. Youth with defects Hemorrhoids, slight Hemorrhoids, except slight Ulcerations . 100.0 100.0 100.0 100.0 100.0 100.0 139,367 3,074 2,407 367 142 46 168 14 58 17 25 97.8 2.2 1.7 .3 .1 62,206 958 778 102 20 14 35 8 10 11 7 98.5 1.5 1.2 .2 12,750 346 266 49 6 6 17 2 6 1 2 97.4 2.6 2.0 .4 .1 12,267 207 160 25 9 7 7 98.3 1.7 1.3 .2 .1 52, 279 1,383 1,068 142 105 16 113 4 34 6 13 97.4 2.6 2.0 .3 .2 12,615 626 401 98 8 9 13 2 5 96.0 4.0 3.1 .7 .1 .1 .1 Fistula Abscess.. .1 .1 .1 .2 Fissure .1 .1 9 .1 .1 All other ano-rectal abuormal- 5 Total defects per 100 youth 2.3 1.5 2.7 1.7 2.8 4.1 Table 28.—Number and percent of NY A youth examined in the United States by findings of examination for hernia Type of hernia Total Male Female White Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth 147,813 63, 552 13,158 12,632 57,760 13,969 185 147, 628 10 63,542 4 13,164 3 12,529 131 57,629 41 13,928 Youth examined for hernia Youth with no hernia Youth with hernia Inguinal hernia . Double inguinal hernia 100.0 100.0 100.0 100.0 100.0 100.0 145,745 1,883 1,166 106 19 92 401 98.7 1.3 .8 .1 62,328 1,214 966 86 11 39 76 98.1 1.9 1.5 .1 12, 792 362 277 40 3 16 15 97.2 2.8 2.0 .3 12,272 257 146 18 3 1 77 97.9 2.1 1.2 .2 57,426 203 46 2 5 22 106 99.7 0.3 .1 13,719 209 8 98.6 1.5 . 1 Ventral hernia --- Umbilical hernia Diaphragmatic hernia .1 .3 .1 .1 .1 .1 .6 .2 30 142 .2 1.0 7 60 55 4 38 2 2 10 1 1 11 10 Hernia of unknown site .1 14 1 .1 .1 1 42 .3 THE HEALTH STATUS OF NYA YOUTH Table 29.—Number and percent of NY A youth examined in the United States by findings of abdominal examination Findings on abdominal examination Total Male Female White Negro White Negro All ages 21- -24 Number Percent Number Percent Number Percent Number Percent N umber Percent Number Percent Total youth. 147,813 63,552 13,158 12,532 57,760 13,969 No abdominal examination... 6 2 3 / 1 Total youth examined... 147,807 100.0 63,550 100.0 13,158 100.0 12,532 100.0 57,757 100.0 13,968 100.0 Youth with no defect 143,367 97.0 62, 975 99.1 12,999 98.8 12,433 99.2 54, 807 94.9 13,152 94.2 Youth with defects 4, 440 3.0 575 .9 169 1.2 99 .8 2,950 5.1 816 5.8 Tenderness 3,780 2.6 396 .6 111 .8 68 .6 2,596 4.5 720 5.2 Abnormality of liver 294 .2 95 .2 26 .2 13 . 1 162 .3 24 .2 Spleen slightly enlarged 186 .1 58 .1 11 . 1 8 . 1 107 .2 13 . 1 Spleen enlarged, except slight. 26 14 6 . 1 2 9 1 Other abdominal dysfunction or complaint1 450 .3 51 .1 17 .1 17 .1 280 .5 102 .7 Total defects per 100 youth 3.2 1.0 1.3 0.9 6.5 6.2 1 Except those definitely referable to the digestive system. Table 30.—Number and percent of NY A youth examinee in the United States by orthopedic dejects recorded Male Female Total White Orthopedic Impairments Negro White Negro All ages 21-24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined 147,813 100.0 63, 552 100.0 13,158 100.0 12,532 100.0 57,760 100.0 13,969 100.0 Youth with no defects 140,445 95.0 69,630 93.7 11,839 90.0 11,966 95.5 55,417 95.9 13,632 96.9 Youth with defects 7,368 5.0 4,022 6.3 1,319 10.0 566 4.5 2,343 4.1 437 3.1 One hand or arm lost 113 . 1 75 . 1 45 .3 10 . 1 27 . 1 1 One hand or arm impaired 724 .6 438 .7 135 1.0 63 .6 193 .3 30 .2 One foot or leg lost 108 . 1 84 . 1 39 .3 17 . 1 6 1 One foot or leg impaired- 1,318 .9 744 1.2 288 2.2 109 .9 396 .7 69 .5 Fingers (any number) lost 521 .4 374 .6 128 1.0 61 .4 80 .1 16 .1 Fingers (any number) im- paired 580 .3 358 .6 115 .9 58 .5 139 .2 25 .2 Toes (any number) lost 94 . 1 61 .1 21 .2 8 24 1 Toes (any number) impaired— 751 .5 229 .4 54 .4 23 .2 438 .8 61 .4 Two or more major members1 lost 4 3 2 1 Two or more major members1 impaired— 948 .6 515 .8 222 1.7 71 .6 297 .5 65 .5 Spine or back impaired 1,849 1.3 879 1.4 280 2.1 137 1.1 683 1.2 150 1.1 Trunk impaired 1,109 .7 721 1.1 189 1.4 63 .5 280 .5 45 .3 Total defects per 100 youth 5.6 7.1 11.5 4.9 4.4 3.3 1 Hands, feet, arms, or legs. THE HEALTH STATUS OF NYA YOUTH 75 Table 31.—Number and percent of NYA youth examined in the United States by nervous and mental condition Nervous and mental condition Total Male Female White Negro White Negro All ages 21- 24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined 147, 813 100.0 63, 552 100.0 13,158 100.0 12, 532 100.0 57,760 100.0 13,969 100.0 Youth with no defects 142,758 96.6 61,114 96.2 12,325 93.7 12, 243 97.7 55,804 96.6 13, 597 97.3 Youth with defects . . 5,055 3.4 2,438 3.8 833 6.3 289 2.3 1,956 3.4 372 2.7 Epilepsy 245 .2 158 .2 61 .5 11 . 1 63 .1 13 . 1 Extreme nervousness 1,451 1.0 488 .8 147 1.1 49 .4 787 1.4 127 .9 Tic 66 38 11 . 1 4 22 2 Speech defect (except mutism). 615 .4 422 .7 164 1.3 46 .4 133 .2 14 . 1 Slight mental deficiency. 1,323 .9 806 1.3 275 2. 1 95 .8 356 .6 66 .5 Marked mental deficiency 492 .3 255 .4 97 .7 15 .1 198 .4 24 .2 Dyskinesias . 76 53 . 1 19 . 1 6 16 2 Psychoses . . 25 13 7 . 1 3 2 81 . 1 27 11 . 1 5 41 . 1 8 1 All other definitely neurolog- ical diseases, abnormalities, or dysfunctions 886 .6 362 .6 137 1.0 58 .5 351 .6 115 .8 All other nervous and mental abnormalities (including ill- defined) 429 .3 181 .3 54 .4 27 .2 189 .3 32 .•2 Total defects per 100 youth. 3.8 4 4 7.5 2.5 3 7 2.9 Table 32.- —Number and percent of NY A youth examined in the United States by condition oj the skin Male Female Total White Condition of skin Negro White Negro All ages 21- -24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined 147,813 100.0 63, 552 100.0 13,158 100.0 12,532 100.0 57,760 100.0 13,969 100.0 Youth with no defects 120,904 81.8 51,665 81.3 10,906 82.9 11,033 88.0 46,431 80.4 11,775 84.3 Youth with defects 26,909 18.2 11,887 18.7 2, 252 17.1 1,499 12.0 11,329 19.6 2,194 15.7 Acne, except marked 19,982 13.5 8,880 14.0 1,601 12.2 1,043 8.3 8,434 14.6 1,625 11.6 Marked (extreme) acne 915 .6 500 .8 100 .8 29 .3 335 .6 51 .4 201 . 1 70 . 1 28 .2 6 94 .2 31 .2 Functional and/or allergic skin diseases 644 .4 225 .4 72 .5 21 .2 363 .6 35 .3 Bacterial skin diseases 357 .3 223 .4 49 .4 24 .2 94 .2 16 . 1 Toxic eruptions, dermatitis, 197 , 1 115 .2 31 .2 6 68 . 1 8 Fungus and/or yeast skin disease .. 1,493 1.0 724 1.1 150 1.1 66 , 5 623 1.1 80 .6 257 .2 152 . 2 45 .3 13 . 1 87 .2 5 Etiologically ill-defined skin 262 .2 106 .2 33 .3 6 139 .2 11 . 1 Hyperplastic, benign neo- plastic pigmentary, and noninflammatory vascular disturbances of skin . 2,410 • 1.6 908 1.4 224 1.7 168 1.4 1,099 1.9 235 1.7 All other skin diseases (in- eluding ill-defined ones) 2,028 1.4 731 1.1 195 1.5 186 1.5 890 1.5 221 1.6 Total defects per 100 youth 19.4 19.9 19.2 12.5 21.2 16.6 480993—42 6 THE HEALTH STATUS OF NYA YOUTH Table 33.— -Number and percent of NY A youth examined in the United States by findings of urinalysis Male Female Total White Results of test Negro White Negro All ages 21- -24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth 147,813 63,552 13,158 12. 532 57,760 13,969 Unknown, including not tested 3, 588 1,262 281 409 1, 276 641 Total youth with known results _ 144, 225 100.0 62, 290 100.0 12,877 100.0 12,123 100.0 56,484 100.0 13,328 100.0 Youth with no defects 132,883 92.1 67, 845 92.9 12,125 94.2 11.144 91.9 51,844 91.8 12,050 90.4 Youth with defects 11,342 7.9 4, 445 7. 1 752 5.8 979 8.1 4,640 8.2 1,278 9.6 Slight degree of sugar 3,164 2.2 1,282 2.0 273 2.1 396 3.3 1,119 2.0 367 2.8 Medium degree of sugar 335 .2 137 .2 33 .3 31 .2 123 .2 44 .4 Marked degree of sugar 235 .2 115 .2 34 .3 22 .2 79 .1 19 . 1 Slight degree of albumin 5,442 3.8 2,010 3.2 294 2.3 381 3.1 2,474 4.4 577 4.3 Medium degree of albumin. _. 1,084 .7 489 .8 70 .5 78 .6 398 .7 119 .9 Marked degree of albumin 712 .5 324 .5 31 .2 49 .4 268 .5 71 .5 Slight degree of other patho- logical findings 1,048 .7 414 .7 59 .5 80 .7 419 .8 135 1.0 Other pathological findings except slight degree,. 272 .2 44 .1 10 .1 33 .3 128 .2 67 .5 Total defects per 100 youths , 8.5 7.7 6.3 8 8 8.9 10.5 Table 34.—Number and percent of NY A youth examined in the United States by certain "Other diseases and dysfunctions’’'’ “Other” diseases or dysfunc- tions Total Male Female White Negro White Negro All ages 21- -24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Total youth examined - 147,813 100.0 63,552 100.0 13,158 100.0 12,532 100 0 57, 760 100.0 13,969 100.0 No “other” disease 121,858 82.4 53,685 84.5 10,813 82.2 10, 842 86.5 46,435 80.4 10, 896 78.0 One or more “other” _ 25,955 17.6 9,867 15.5 2,345 17.8 1,690 13.5 11,325 19.6 3,073 22.0 Infectious or parasitic dis- eases 1 67 32 8 . 1 3 31 . 1 x Disease or dysfunction of breast2 199 . 1 27 7 . i 10 1 124 Tuberculosis3 28 15 7 .1 5 6 2 Gonorrhea4-- 413 .3 46 .1 19 .1 174 1.4 104 .2 89 .6 Abnormality of larynx 5 30 9 1 5 15 1 Malignant neoplasms 3 1 2 Nonmalignant neoplasm, cysts or other tumors 6 _ 498 .3 186 .3 55 .4 39 .3 197 .3 76 .6 Acute rheumatic fever 11 4 1 5 2 Diabetes Mellitus 178 . 1 98 .2 42 . 3 4 67 1 Goitre or hyperthyroidism 892 .6 92 .1 25 .2 12 .1 637 1.1 151 1.1 Other diseases of endocrine glands • 585 .4 250 .4 73 .5 19 .2 262 .5 54 .4 Malnutrition or underweight h 7,381 5.0 3,601 5.7 642 4.9 410 3.3 2,648 4.6 722 5.2 Other nutritional diseases 96 . 1 38 . 1 8 .1 9 . 1 32 . 1 17 . 1 Upper respiratory infection A. 287 .2 117 .2 26 .2 33 .3 100 .2 37 .3 Other diseases of blood or blood-forming organs .. 17 10 3 1 5 1 Chronic poisoning, or intoxi- cation ... ._ 2 1 1 Diseases of the arteries 9 5 1 1 3 Varicose veins 9 .. ... 268 .2 142 . 2 62 .5 15 . 1 101 .2 10 .1 Other disease or dysfunction of circulatory system 10.. ... 13 5 2 5 3 Ulcer of stomach or duodenum- 27 13 10 .1 1 12 1 Diarrhea or enteritis 23 5 2 1 12 5 Appendicitis... . 393 .3 67 . 1 16 . 1 5 2Q2 28 Digestive dysfunctions 11 1,326 .9 236 .4 95 .7 63 .5 718 1.3 309 2.2 Complications of pregnancy, childbirth, or the puer- Derium 7 4 3 See footnotes at end of table. THE HEALTH STATUS OF NYA YOUTH Table 34.—Number and percent of NYA youth examined in the United States by certain "Other diseases and dysfunctions Con. Male Female “Other” diseases or dysfunc- Total White tions—Continued' All ages 21- -24 Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent Arthritis 12 125 0.1 45 0.1 16 0.1 8 0.1 63 0.1 9 0.1 Other diseases of bones or 231 .2 134 .2 49 .4 16 . 1 63 . 1 18 . l Flat foot 3,288 227 2.2 1,843 107 2.9 436 3.3 445 3.6 784 1.4 216 1.6 Other diseases or dysfunctions of organs of movement or .2 .2 32 .2 19 . 1 87 .2 14 . l 2,545 4,116 16 1.7 1,326 842 2.1 240 1.8 87 .7 941 1.6 192 1.4 Obesity or overweight18 2.8 1.3 271 2.1 86 .7 2,649 4 4.6 539 3.9 Venereal disease 16 3 1 6 3 172 . 1 85 . 1 87 .6 Adenopathy, cause unspeci- 508 .3 251 .4 39 .3 81 .7 131 .2 45 .3 Otitis media and other dis- eases of the ear 17 666 .5 378 .6 105 .8 21 .2 253 .4 14 .1 5,425 3.7 1,431 2.3 421 3.2 284 2.3 2,811 4.9 899 6.4 Total “other” diseases 20.3 17.9 20.6 14.9 23.0 25.7 ' Except tuberculosis, venereal diseases, and skin diseases. 2 Except tumors, or conditions accompanying pregnancy. 3 Except of the lung. 4 Except on laboratory findings. 8 Except tuberculosis or tumors. 6 Except skin conditions. 7 Except “thin,” “slightly underweight,” etc. 8 Including “cold,” unqualified. 8 Except hemorrhoids or varicocele. i° Except organic heart disease, irregularity or murmur. n Including all complaints definitely referable to the digestive system, and excluding conditions specifically listed above. 12 Except crippling. 13 Except deforming, crippling, or paralyzing, and except sprains or strains. 14 Including correctable weakness, sprains or strains. 45 Except “slightly overweight.” 18 Except gonorrhea or syphilis. 17 Except deafness or abnormalities of the canal or drums. 18 Including ill-defined.