Colorado high school students were significantly more likely to die in 2020 than in 2010, despite signs that, in many ways, teens are now better off.

In 2010, there were about 47 deaths for every 100,000 people between the ages of 15 and 19 in Colorado. By 2020, that had risen to a rate of 76 per 100,000, a 62% increase, according to the annual Kids Count report. At the same time, deaths dropped over that decade among infants and children younger than 15.

Drug overdoses, suicide deaths and homicides all contributed to the decade-long rise in the mortality rate among Colorado teenagers.

During the same period, though, the percentage of kids and teens who lived in poverty themselves or in-high poverty areas dropped. Fewer were uninsured, and their parents were less likely to report insecure employment or difficulty paying for housing. Measures of academic success were a mixed bag, but more teens graduated from high school on time, fewer gave birth and a lower percentage were “disconnected,” meaning they were neither in school nor working.

Sarah Hughes, research director at the Colorado Children’s Campaign, said there’s no obvious explanation for why teens are doing better in some key ways, yet are more likely to die by suicide or homicide than they were a decade ago.

“We were sort of struck by that,” she said of the latest Kids Count data.

Colorado’s death teen rate was roughly on par with the rest of the country in 2010, but since then, it’s seen the second-largest increase, Hughes said. Only Arizona saw death rates among teens rise faster over the last decade.

It’s not clear why Colorado would see a sharper increase than almost all states, given that teens everywhere can struggle with the pressure to achieve or fit in, a lack of social support and economic instability in their families, Hughes said. The shortage of beds for youth who need mental health treatment may be a factor, she said, though many states have reported a similar problem.

“That’s sort of the million-dollar question,” she said.

Nationwide, about 59 out of every 100,000 people between 15 and 19 died in 2020. That was a roughly 20% increase compared to a decade earlier. However, teen death rates in Colorado and the country as a whole were still below the highs set in the early 1990s, when homicide rates were much higher.

The reduction in teen pregnancies and dropout rates show that progress is possible, Hughes said, though it may require new ways of thinking about kids’ mental, social and material needs.

“We have proven that we can improve conditions for them in other areas,” she said.

Overdoses jump suddenly

Drug overdoses had the highest increase of the major causes of death among teens. The rate more than tripled, from 3.8 per 100,000 in 2010 to 14.9 per 100,000 in 2020. They had been slowly increasing until 2019, then more than doubled in a single year.

The age-adjusted rate of overdose deaths for all Coloradans nearly doubled from 2018 to 2021, as methamphetamine overtook prescription opioids as the top killer, then was eclipsed by illicit fentanyl.

It doesn’t appear that teenagers are taking more drugs. Use of heroin and methamphetamine were both down from 2013 to 2021, according to the Healthy Kids Colorado survey. The survey didn’t ask about fentanyl.

Prescription drug misuse is a little harder to track, because the state changed how it asked the question. In 2021, about 14.5% of high school students said they had misused prescription pain medication. In 2013, about 14% said they had taken any type of prescription pill in a different way than a doctor directed.

Dr. Sam Wang, a pediatric toxicologist who treats kids who’ve been poisoned by any substance, said teens typically overdose when using drugs recreationally or during a suicide attempt. In recent years, fentanyl has crept into the drug supply, sometimes mixed into fake prescription pills. For people who don’t already have a high tolerance to opioids, it can be deadly.

“The teenage or adolescent population is not immune to that,” he said.

Parents need to talk to their children about the dangers of illicitly purchasing drugs, Wang said, and they should restrict teens’ access to lethal means if they could be considering suicide. While opioids may be the first threat that comes to mind, some medications for chronic conditions can cause an overdose, as can over-the-counter painkillers, he said.

“If you have an adolescent struggling at home, don’t leave your guns out, don’t leave your dangerous medications out,” he said.

Stressors pile up

The rate of teen deaths by suicide increased about 88%, from 11.5 per 100,000 in 2010 to 21.6 per 100,000 in 2020. Interestingly, the biggest jump happened in 2015, and the rate has bounced around that higher level since.

About 40% of Colorado high school students surveyed in 2021 reported they had felt so sad or hopeless over the past two weeks that they stopped doing usual activities — a rough proxy for depression. About 24% said the same thing in 2013.

The percentage of teens reporting they had seriously considered suicide increased, though not as sharply, from 14.5% in 2013 to about 17% in 2021.

Dr. Jessica Hawks, clinical director of the Pediatric Mental Health Institute at Children’s Hospital Colorado, said many factors are likely involved in the rise in suicide deaths, including reluctance to seek mental health care, and an inability for those who want care to get it because of cost or other barriers. Only about one-quarter of youth with mental health needs get any type of care, and not all of them get services that have been shown to work, she said.

Another factor is that young people are facing stressors on all sides, Hawks said: they’re worried about school shootings, the cost of college, the need to excel in school, climate change, their families’ financial situations and the pressures that can follow them everywhere via social media. The pandemic piled onto that, by disrupting routines that can give kids needed structure, she said.

“Our youth experience a level of stress today that is unlike anything experienced by any generation before,” she said.

Increased gun purchases may also be a factor, said Jonathan MacMillan, director of gun violence prevention for the Colorado Department of Public Health and Environment. About three-quarters of all suicide deaths in the state involve a firearm, which typically leaves no option to intervene after an attempt in the hope of preventing another, he said.

The most effective ways to prevent youth suicide involve schools and families, Hawks said. Better screening in school can get kids help faster, especially if mental health professionals are available on campus, she said. Parents can model healthy ways of coping with stress and walk their kids through how to get help, even calling the Colorado Crisis Line with them to develop a safety plan.

“Asking those questions and having those discussions can be quite protective,” she said.

Violence steadily increasing

The rate of death by homicide rose by about 82%, from 5 per 100,000 in 2010 to 9.1 per 100,000 in 2020. Unlike drug overdoses and suicide deaths, there was no year with a clear jump: violent deaths have been rising gradually since 2016, though, fortunately, they haven’t yet reached the heights seen in the early 1990s.

“The early 2010s were about the safest period on record for adolescents,” said David Pyrooz, an associate professor of sociology at the University of Colorado Boulder. “There’s been a bit of an unwinding of this since 2015.”

There’s likely no one explanation for the increase in homicides, but a rise in gun ownership meant that more young people had access to lethal weapons, Pyrooz said. Another factor is that communities relate to police differently — they’re less likely to call if they see something suspicious, and officers do less proactive targeting of areas with more crime, he said.

The difficulty is that while calling law enforcement might be the right choice when someone is on their way to commit a violent crime, police encounters can also be dangerous, especially for young Black men — the group that’s also most at risk of being killed by other youth — Pyrooz said. Some neighborhoods have set up watches to respond when something seems off, but those interactions have also escalated to violence in some cases, he said.

In communities that trust law enforcement more, having police focus on the small number of people committing most of the violence may be acceptable, Pyrooz said. In others, it might make sense to have trusted people, such as those who were previously involved in violence, intervene before disagreements escalate to killing. And of course, keeping young men busy with something healthy after school limits their time to get into conflicts, he said.

“Keeping youth busy is a very positive thing,” he said. “We don’t want to return back to the 1990s.”

Police have a role to play in keeping communities safe, especially if they can reduce access to weapons via safe storage laws or “red flag” orders when a person is deemed dangerous to themselves or others, MacMillan said. But first, they have to build trust, and even then, law enforcement isn’t equipped to address the root causes of violence, he said.

The city of Denver has approached violence as a public health problem that’s best solved with programs to help meet basic needs — like economic opportunities and safe spaces for youth to have fun — while also teaching young people the social and emotional skills they need to solve problems without resorting to violence, MacMillan said.

“Very few people wake up one morning and say, ‘I’m going to go hurt someone,’” he said.

The common thread between overdoses, suicide and violence against others is that a person doesn’t know how to solve a problem or cope with strains in their life, MacMillan said. Relationships with caring adults and the ability to have open conversations about when they’re struggling are going to be key to addressing all three problems in youth, he said.

“When people don’t have what they need to be happy, healthy and hopeful, violence often comes out of that stress,” he said.

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