Search

HIV incidence remains high among US youth, especially among sexual minority youth. However, only half of youth with HIV are aware of their status. One potential explanation for low HIV testing rates is that restrictive policies may prevent minors from access HIV testing due to parental consent requirements. Using pooled data from the local Youth Risk Behavior Survey, we assessed whether state HIV testing laws, including age restrictions and explicit inclusion of HIV in STI testing consent laws, were associated with differences in HIV testing rates; differences by sexual behavior were also examined. Among female youth, policies were not associated with HIV testing. However, among male youth, both the presence of age restrictions and explicit inclusion in STI services were significantly associated with increased odds of HIV testing. Results indicate that policy changes may be effective at increasing testing among male youth who have sex with other males.

Purpose This study examined associations between student sexual behaviors and both school-level socioeconomic status and metropolitan status. Methods National Youth Risk Behavior Survey data from 2017 (N = 14,765, response rate = 60%) and 2019 (N = 13,677, 60%) were combined. School-level socioeconomic status (low-, mid-, and high-poverty based on the percentage of students eligible for free or reduced-price meals) and metropolitan status (urban, suburban/town, or rural) were identified for students attending public high schools. Sexual behaviors included currently sexually active, four or more lifetime sexual partners, condom use during the last sexual intercourse, hormonal birth control use during the last sexual intercourse, condom and hormonal birth control use during the last sexual intercourse, and drank alcohol or used drugs before the last sexual intercourse. Adjusted prevalence ratios were calculated using logistic regression models, controlling for sex, race/ethnicity, and grade. Results Compared to students attending low-poverty schools, high-poverty school students were significantly more likely to be currently sexually active (adjusted prevalence ratio = 1.4 [95% confidence interval = 1.1–1.8]) and have four or more lifetime sexual partners (1.6 [1.0–2.5]), but were significantly less likely to have drank alcohol or used drugs before the last sexual intercourse (.7 [.5–.9]) and have used hormonal birth control during the last sexual intercourse (.7 [.6–1.0]). Compared to students attending rural schools, urban school students were significantly less likely to be currently sexually active (.8 [.7–.9]) and have four or more lifetime sexual partners (.7 [.5–.9]). Conclusions School-level socioeconomic status and metropolitan status were associated with differential risk in sexual behaviors.

Limited health literacy (HL) and alcohol use increase teens' risk for preventable disease burden and adverse outcomes. In the current study, relationships between HL and alcohol use were explored in 39 secondary school students sheltering-at-home during the coronavirus disease 2019 pandemic. HL was assessed using the Newest Vital Sign. Alcohol use was assessed with questions from the Youth Risk Behavior Survey (YRBS). Most students (76.9%) had adequate HL. Males had higher HL than females. Many teens (42.9%) reported drinking and recent alcohol use (18.2%). Drunk driving and riding with someone under the influence were comparable to the YRBS. Lifetime and recent alcohol use and positive alcohol expectancies were comparable among teens with adequate and limited HL. More teens with adequate HL had negative expectancies. Only teens with adequate HL reported recent binge drinking (10.3%), drunk driving (10.5%), or riding with someone under the influence (17.9%). Adequate HL does not protect teens from alcohol use and misuse. [ Journal of Psychosocial Nursing and Mental Health Services, 59 (12), 13–21.]

Objective This study used representative data to examine the impact of changes in contraceptive coverage policies (contraceptive insurance mandates and pharmacy access to emergency contraception) on contraceptive use and risky sexual behavior among adolescent girls. Study design Using 2003–17 Youth Risk Behavior Survey data on 116 180 adolescent girls from 34 states, we conducted difference-in-differences models to examine changes in contraceptive use and unprotected sexual intercourse with the implementation of contraceptive coverage policies. We also tested interactions between age and pharmacy access to emergency contraception. Results Findings indicate that contraceptive insurance mandates and pharmacy access to emergency contraception were not associated with changes in contraceptive use or unprotected sexual intercourse among adolescent girls, although some changes were observed in specific age groups. Despite this, our results show an overall increase in reported use of birth control pills and longer-acting methods from 2003 through 2017. Conclusions Using representative data, this study lends support to existing evidence that increased access to emergency contraception does not impact contraceptive method used or unprotected sexual intercourse among adolescent girls. The results underscore the need for expanding access to a wide range of contraceptive options for adolescents, with a focus on safer and more effective longer-acting methods.

Background: There is limited literature available showing the mental health burden among adolescents following cyberbullying. Objective: The aim was to evaluate the association between low mood and suicidality among cyberbullied adolescents. Method: A cross-sectional analysis of the data was performed among adolescents from the National Youth Risk Behavior Surveillance System. Responses from adolescents related to cyberbullying and suicidality were evaluated. Chi-square and mix-effect multivariable logistic regression analysis was performed to determine the association of cyberbullying with sadness/hopelessness and suicide consideration, plan, and attempts. Results: Of a total of 8274 adolescents, 14.8% of adolescents faced cyberbullying past year. There was a higher prevalence of cyberbullying in youths aged 15, 16, and 17 years (25%, 26%, 23%, respectively), which included more females than males (68% vs. 32%, p &lt, 0.0001). Caucasians (53%) had the highest number of responses to being cyberbullied compared to Hispanics (24%) or African Americans (11%, 0.0001). There was an increased prevalence of cyberbullied youths, feelings of sadness/hopelessness (59.6% vs. 25.8%), higher numbers considering suicide (40.4% vs. 13.2%), suicide plan (33.2% vs. 10.8%), and multiple suicidal attempts in comparison to non-cyberbullied (p &lt, 0.0001). On regression analysis, cyberbullied adolescents had a 155% higher chance of feeling sad and hopeless [aOR = 2.55, 95%CI = 2.39–2.72] and considered suicide [aOR = 1.52 (1.39–1.66)] and suicide plan [aOR = 1.24 (1.13–1.36)]. Conclusion: In our Study, cyberbullying was associated with negative mental health outcomes. Further research is warranted to examine the impact of cyberbullying among adolescents and guiding the policies to mitigate the consequences.

INTRODUCTION: There is an established link between non-medical use of prescription drugs (NMUPD) and heroin use among adults; however, little is known about this relationship among adolescents. We investigate this association among a nationally-representative sample of U.S. high school students. METHODS: Using data from the 2013 Youth Risk Behavior Survey (n = 13,462), we ran logistic regression models with multiple imputation to examine the association between NMUPD and heroin use, while controlling for other risk behaviors and mental health problems. RESULTS: In the final adjusted model, compared to high school students reporting never misusing prescription drugs, those reporting NMUPD 1–9 times in their lives had a 1.90 times greater odds of heroin use and those reporting ≥10 times had a 5.59 times greater odds. Additionally, the following variables were significantly associated with heroin use: being male, carrying a weapon in the past 30 days, history of sexual intercourse, dating violence victimization, and reporting other drug use. CONCLUSION: NMUPD was associated with increased odds of heroin use among high school students. Future studies should investigate what other factors increase the risk of heroin use longitudinally, which is crucial to understanding how to best intervene among this population to prevent NMUPD and heroin use.

Background: Physical activity is associated with greater odds of sunburn in adults, increasing harmful sun exposure and skin cancer risk. The authors sought to investigate parallel associations between sunburn and physical activity among US high school students. Methods: The authors examined pooled cross-sectional data from the 2015 and 2017 Youth Risk Behavior Survey. A nationally representative sample of 21,894 US high school students who responded to the sunburn question was included. Results: Prevalence of sunburn was 56.6% between 2015 and 2017. Sunburn prevalence was higher in physically active students (88.3%; 95% confidence interval [CI], 86.7%–90.0%; P P P P P P Conclusions: Many US high school students are affected by sunburn, and the odds of sunburn are elevated during physical activity and team sports participation. Efforts are needed to improve sun safety regulations, education, and resources for youth during school and physical activity.

Background: Few studies have used a multi-item approach to measure diet when examining its relationship with physical activity (PA) in youth. Design and Methods: Data came from the 2019 Youth Risk Behavior Survey (YRBS). Item response theory (IRT) was applied to develop the Poor Diet Scale (PDS). Ten items were dichotomized to indicate poor diet: fruit juice, fruit, green salad, potatoes, carrots, other vegetables, milk, water, breakfast, and soda. Six variables were dichotomized to indicate PA risk: active for 5+ days (PA5d), active all 7 days (PA7d), 3+ days of muscle strengthening exercise (MSE3d), physical education all 5 days (PE5d), participation in 1+ sport teams (ST1), and combined PA.MSE. Logistic regression was used to model PA using the IRT-derived PDS scores (theta) while controlling for age, sex, race, BMI percentile, and sedentary time. Results: All items significantly fit (ps < .001) the IRT model except for soda, which was dropped from the scale. In fully adjusted regression models, odds of PA risk increased significantly (ps < .05) with every 1 z-score (theta) increase in poor diet for PA5d (OR = 1.74), PA7d (OR = 1.53), MSE3d (OR = 1.85), PE5d (OR = 1.15), ST1 (OR = 1.73), and PA.MSE (OR = 1.81). Additionally, students not trying to lose weight had significantly (p = .004) greater odds as theta increased for PA7d risk (OR = 1.68), as compared to their counterparts (OR = 1.34). Conclusions: Results highlight the utility of using multiple items to measure a complex health risk behavior.

OBJECTIVES: Suicide is the second leading cause of death in youth. We tested whether having a mentoring relationship associated with lower risks for suicidality, particularly among youth at higher risk due to cyberbullying. METHODS: This study pooled the 2017 Youth Risk Behavior Survey (YRBS) data from 5 jurisdictions that asked students if there was at least one teacher or other adult in their school that they could talk with, if they have a problem (mentorship). Students self-reported cyberbullying exposure and suicidality in the past 12 months. Odds of suicidal ideation, planning, and attempts were estimated using multivariable weighted logistic regression in overall and sex-stratified stepwise models. Interactions between mentorship and cyberbullying were also tested. RESULTS: Of the 25,527 student respondents, 87% reported having a mentoring relationship. Mentoring relationships were associated with lower odds of suicidal ideation (aOR, 0.44; 95% CI, 0.33-0.57), planning (aOR, 0.59; 95% CI, 0.41-0.85), and suicide attempts (aOR, 0.42; 95% CI, 0.31-0.56). Stratified analyses showed a significant interaction between cyberbullying and mentorship with suicidal attempts among males, and a near significant association between cyberbullying and mentorship with suicidal thoughts among females. Compared to male students with no cyberbullying and no mentorship, odds of attempting suicide were lower for males with no cyberbullying and mentorship (aOR, 0.55, 95% CI, 0.32-0.92), higher for males with cyberbullying and no mentorship (aOR, 7.78, 95% CI:3.47-17.47), but not significantly different for males with cyberbullying and mentoring relationships (aOR, 1.49, 95% CI, 0.86-2.48). Similarly, compared with females with no cyberbullying and no mentorship, odds of having suicidal thoughts were lower for females with no cyberbullying and mentorship (aOR, 0.40, 95% CI, 0.28-0.57), and higher for females with cyberbullying and no mentorship (aOR, 2.54, 95% CI:1.59-4.07). CONCLUSIONS: School-based mentoring may mitigate risk of suicidality among adolescents and limit the toxic effects of cyberbullying.

Objectives: This study investigated the smoking behavior and its association with the availability of tobacco products purchases among Korean adolescents. Methods: The data of the 2019 Korea Youth Risk Behavior Survey were used (N =57,303). This study assessed 3 tobacco products: cigarettes, e-cigarettes, and heated tobacco products. Smoking behavior including lifetime, current, daily, heavy smoking, and attempting to quit and its association with the availability of tobacco products for purchase was assessed. Results: Overall, 92.9% did not try to purchase tobacco products during the past 30 days, 2.2% found it impossible to purchase, 0.8% could buy with a lot of effort, 1.7% could buy with little effort, and 2.3% could buy easily without any effort. Lifetime smokers were 13.8% (12.7% for cigarettes, 7.4% for e-cigarettes, and 4.9% for heated tobacco products). Among lifetime smokers, the current smoking rates for cigarettes, e-cigarettes, and heated tobacco products were 48.5%, 22.9%, and 19.0%, and the rates were lower in adolescents who responded that it was impossible to buy tobacco products. Among current smokers, the daily smoking rates were lower in adolescents who were found it impossible to buy tobacco products. Conclusions: The ease of access to tobacco products was associated with higher use of cigarettes, e-cigarettes, and heated tobacco products and lower attempts to quit smoking in Korean adolescents.

Introduction Few studies have examined the factors associated with HIV testing, specifically among U.S. high-school girls. Methods Investigators analyzed 2015 and 2017 Youth Risk Behavior Survey data to calculate the prevalence ratios and the corresponding 95% CIs for the association of HIV-related risk behaviors and other factors with HIV testing. Analyses were completed in March 2020. Results Approximately 1 in 10 high-school girls reported ever having had an HIV test. Ever having had an HIV test was most common among girls who had ≥4 lifetime sexual partners and those who had ever injected illegal drugs. Conclusions High-school girls who engage in behaviors or experience other factors that put them at higher risk for HIV are more likely to have ever gotten tested. However, the prevalence of having ever had an HIV test remains relatively low, indicating that continued efforts may be warranted to reduce risk behaviors and increase testing among high-school girls.

Background Prescription opioid misuse and suicide among adolescents are significant health challenges. Purpose This study investigated whether effects of prescription opioid misuse on depressive symptoms and suicidality are greater among female than male students. Methods Using the 2017 Youth Risk Behavior Survey (N = 14,765), this research estimated additive interactions using risk differences as well as multiplicative interactions using odds ratios. Discussion Results showed prescription opioid misuse was associated with significantly greater risks among females than males for depressive symptoms (31.1% vs. 20.8%), suicidal ideation (27.3% vs. 19.1%), suicide attempts (18.1% vs. 11.9%) and suicide attempts requiring treatment (8.5% vs. 4.4%). In contrast, multiplicative interactions using odds ratios were all nonsignificant. Conclusions Among students who misused prescription opioids, females compared to males had much higher average predicted margins of depressive symptoms, suicidal ideation, suicide attempts, and suicide attempts requiring treatment. Screening for depression and suicidality among adolescents who misuse prescription opioids, and vice versa, is paramount.

This study examined whether e-cigarette/cigarette use status would differ by student race/ethnicity. Using the 2017 Youth risk behavior survey (YRBS), weighted Chi-square tests with Rao-Scott adjustments and adjusted weighted multinomial logistic regression analysis were conducted to examine the relationship. Weighted Chi-square tests showed that American Indian/Alaska Native (AI/AN) students had the highest prevalence rates among dual users (16.2%) and e-cigarette only users (11.3%), while White peers had the highest prevalence rates among cigarette only users (3.5%). The results of weighted multinomial logistic regression indicated that AI/AN students had higher odds than White peers of being dual users (Relative risk ratio (RRR), 2.10, 95% CI, 1.01, 4.39), while Black, Hispanic, Asian and multi-racial groups had lower odds than White peers of being dual users. Additionally, Asian students had lower odds than White students of being e-cigarette only users, whereas Black and Asian students had lower odds than their White peers of being cigarette only users. Given that AI/AN students are most vulnerable to e-cigarette/cigarette use, there should be comprehensive tobacco prevention and intervention approaches that could narrow racial/ethnic differences among both youths and adults at population level.

An epidemiologic and modeling study found that condom use remained relatively low and stable among US adolescent sexual minority males from 2011 to 2017 and moderate increases may reduce human immunodeficiency virus transmission. Supplemental digital content is available in the text., Background We examined condom use patterns and potential population-level effects of a hypothetical condom intervention on human immunodeficiency virus (HIV) transmission among adolescent sexual minority males (ASMM). Methods Using 3 data sets: national Youth Risk Behavior Survey 2015 to 2017 (YRBS-National), local YRBS data from 8 jurisdictions with sex of partner questions from 2011 to 2017 (YRBS-Trends), and American Men's Internet Survey (AMIS) 2014 to 2017, we assessed associations of condom use with year, age, and race/ethnicity among sexually active ASMM. Using a stochastic agent-based network epidemic model, structured and parameterized based on the above analyses, we calculated the percent of HIV infections averted over 10 years among ASMM ages 13 to 18 years by an intervention that increased condom use by 37% for 5 years and was delivered to 62% of ASMM at age 14 years. Results In YRBS, 51.8% (95% confidence interval [CI], 41.3–62.3%) and 37.9% (95% CI, 32.7–42.3%) reported condom use at last sexual intercourse in national and trend data sets, respectively. In AMIS, 47.3% (95% CI, 44.6–49.9%) reported condom use at last anal sex with a male partner. Temporal trends were not observed in any data set (P > 0.1). Condom use varied significantly by age in YRBS-National (P < 0.0001) and YRBS-Trends (P = 0.032) with 13- to 15-year-olds reporting the lowest use in both; age differences were not significant in AMIS (P = 0.919). Our hypothetical intervention averted a mean of 9.0% (95% simulation interval, −5.4% to 21.2%) of infections among ASMM. Conclusions Condom use among ASMM is low and appears to have remained stable during 2011 to 2017. Modeling suggests that condom use increases, consistent with previous interventions, have potential to avert 1 in 11 new HIV infections among ASMM.

Suicide is the second leading cause of death among youth in the United States. Data from the 2015 Youth Risk Behavior Survey of 9th-12th grade students in New Hampshire (N = 14,837) were utilized. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using logistic regression models to evaluate associations between suicidal ideation, adverse childhood experiences (ACEs), and other risk factors including using opioids/drugs without a prescription and food insecurity. We also examined whether potentially protective behaviors may attenuate the relationship between ACEs and suicidal ideation. The prevalence of suicidal ideation was 15.4% (girls 20.15; boys 10.67). In unadjusted models, the crude odds ratio reflecting the relationship between suicidal ideation and higher ACE scores was 1.85 (95% CI 1.76-1.94). In adjusted models, suicidal ideation remained positively associated with higher ACE scores (aOR 1.61, 95% CI 1.52-1.70). Risk and protective behavioral factors identified in relation to suicidal ideation and ACEs are discussed within the context of community-academic partnerships and policy.

Many adolescents and young adults (AYAs; ages 13 – 24) are unaware of their HIV status despite participating in behavior that places them at risk for contracting HIV. This study examined possible predictors of self-reported HIV testing for high school students (grades 9 to 12) who completed the Youth Risk Behavior Survey (YRBS). Three sex-stratified, stepwise multivariable logistic models were used to estimate odds of having received a HIV test being associated with student characteristics and substance use. The likelihood of being tested for HIV was associated with students who were a racial/ethnic minority and age 18 and older. HIV testing was also associated with male students who reported same sex partners (males) or same sex partners (males) and different sex partners (females). Female students who reported same sex partners (females) and different sex partners (males) were more likely to have been tested for HIV. Male and female students were more likely to have been tested for HIV if they reported illicit drug and/or marijuana use, while prescription drug use was also associated with HIV testing for female students. Knowledge of the predictors of HIV testing for adolescents can guide efforts for the effective scale up of testing for this vulnerable population.

Introduction Sports and physical activities are an important cause of traumatic brain injury among adolescents. Childhood traumatic brain injury has been associated with cognitive impairment, emotional problems, and impaired behavior control, and these neuropsychological changes may place these youth at increased risk for engagement in violence-related behaviors. Methods Data from the 2017 National Youth Risk Behavior Survey (N=14,765), a nationally representative survey of U.S. high school students, were analyzed in 2019 to examine the associations between sports- and physical activity–related concussion and violence-related behaviors occurring in the community and at school. Multivariable logistic regression models were used to calculate sex-stratified, adjusted (for race/ethnicity, grade, athlete status, impaired cognitive functioning, feeling sad/hopeless, and current substance use) prevalence ratios. Prevalence ratios were considered statistically significant if p Results Male students (17.1%) were more likely than female students (13.0%) to experience a sports- and physical activity–related concussion during the 12 months preceding the survey. Compared with students who did not have a concussion, those who experienced ≥1 sports- and physical activity–related concussion were more likely to be in a physical fight (male students, adjusted prevalence ratio=1.45; female students, adjusted prevalence ratio=1.55), carry a weapon (male students, adjusted prevalence ratio=1.24; female students, adjusted prevalence ratio=1.79), and fight at school (male students, adjusted prevalence ratio=1.40; female students, adjusted prevalence ratio=1.77). In addition, male students were more likely to carry a gun (adjusted prevalence ratio=1.62) and carry a weapon at school (adjusted prevalence ratio=1.73). Conclusions Although the direction of these associations is unknown, return-to-school programs may benefit from inclusion of assessment and counseling around issues of psychological and social functioning, conflict resolution, and coordination with violence prevention programs.

Purpose Exchange sex, the exchange of money or nonmonetary items for sex, is associated with sexually transmitted diseases and HIV. We sought to identify prevalence and characteristics associated with exchange sex among District of Columbia (DC) high school students. Methods We used the 2017 DC Youth Risk Behavior Survey, a cross-sectional survey of students in grades 9–12 (n = 8,578). We performed multivariable logistic regression to examine associations between exchange sex and demographic, home environment, and substance use measures. Results In 2017, a total of 7.4% (95% confidence interval [CI]: 6.6–8.2) of students reported ever having engaged in exchange sex. Odds of exchange sex were higher among males (adjusted odds ratio [AOR]: 2.5; 95% CI: 1.6–4.0) and students who had sexual contact with partners of both sexes (AOR: 2.4; 95% CI: 1.2–4.9), compared with students having sexual contact with partners of opposite sex only. Exchange sex was also associated with having been kicked out, run away, or abandoned during the past 30 days (AOR: 10.7; 95% CI: 7.0–16.3]); going hungry during the past 30 days (AOR: 2.2; 95% CI: 1.1–4.5); and ever using synthetic marijuana (AOR: 2.6; 95% CI: 1.3–5.0) or cocaine, heroin, methamphetamines, or ecstasy (AOR: 2.9; 95% CI: 1.6–5.3]), compared with those who had not. Conclusions Approximately one in 14 DC high school students engaged in exchange sex. Programs providing services to youth with unstable housing, food insecurity, or who use drugs should incorporate sexual health services to address exchange sex practices.

Background Studies of the patterns of polytobacco use have increased. However, understanding the patterns of using multiple tobacco products among Black adolescents is minimal. This study identified the patterns of polytobacco use among U.S. Black adolescents. Methods Latent class analysis (LCA) was used to identify patterns of adolescent polytobacco use among a representative sample of Black youth from the 2017 Youth Risk Behavior Survey (n = 2782). Ever and recent (past 30 day) use of cigarettes, electronic cigarettes, cigars, and dip or chewing tobacco were used as latent class indicators. Multinomial regression was conducted to identify the association if smoking adjusting for sex, age, grade, and marijuana use. Results Most students were in the 9th grade (29%), e-cigarette users (21%) and were current marijuana users (25%). Three profiles of tobacco use were identified: Class 1: Non-smokers (81%), Class 2: E-cigarette Users (14%), and Class 3: Polytobacco Users (5%). Black adolescent Polytobacco users were the smallest class, but had the highest conditional probabilities of recent cigarette use, e-cigarette use, ever smoking cigars or chewing tobacco. Ever and current use of marijuana were associated with increased odds of being in the e-cigarette user versus non-smoker group, and current marijuana use was associated with increased odds of polytobacco use (aOR = 24.61, CI = 6.95–87.11). Conclusions Findings suggests the need for targeted interventions for reducing tobacco use and examining the unique effects of polytobacco use on Black adolescents. Findings confirm a significant association of marijuana use with tobacco use.

Introduction. The World Health Organization (WHO) revealed that in 2016 more than 1.9 billion adults, 18 years and older, were overweight. Over 650 million of them were obese. Diet quality in university students is determined by factors such as family, food availability and meals in student canteens. The purpose of this study was to investigate frequency of obesity and its relation to dietary habits, gender and age/year of study among medical students at the Faculty of Medicine of the University of Banja Luka. Methods. This is a prospective and descriptive study conducted among 1-6 year student population at the Faculty of Medicine of the University of Banja Luka. The study includes a validated survey instrument Youth Risk Behavior Survey Questionnaires. The study was approved by the Ethics Committee of the Faculty of Medicine and carried out as an anonymous survey during the winter term of the academic year 2017/2018. Results. Out of the total 601 students, the research sample included 543 students: 327 female (60.2%) and 216 (39.8%) male students. The majority of them (62.1%) fell within healthy weight range, and 2.4% were class 1 obesity. Most of female students (75.7%) had healthy weight while their male counterparts (73.2%) were overweight. To sum up, 57.5% of them consumed breakfast every day: female students significantly more (60.6%) than male students (51.9%). Third-year students (59.4%) had breakfast most frequently compared to the fifth-year students (55.0%) who ate it the least. Conclusion. The study found a high prevalence of overweight among male respondents compared to their female counterparts, who had predominantly healthy weight.

BACKGROUND In this case study, multiple participants in a large urban school district used the Whole School, Whole Community, Whole Child (WSCC) model to guide development of a district wellness policy. The model's health education component is highlighted, focusing on concerns for special needs students and ones speaking English as a New Language (ENL). METHODS Organizational structure was developed around the WSCC model and district wellness policy implementation through coordination, collaboration, and communication (3Cs) of programs, policies, and processes/practices (3Ps). RESULTS The WSCC approach guided the creation of a district wellness policy that influenced programming for students with special needs and required Youth Risk Behavior Survey (YRBS) data collection. Using YRBS and School Health Index (SHI) data in planning sexual health education illustrated improvements over time. Formation of the School Health and Wellness Collaborative under WSCC improved family engagement in sexual health education programs and practices. Relationships were established with community partners to impact student's sexual risk behaviors. Finally, the district co‐created and implemented an evidenced‐based sexual health curriculum, modifying it for special education and ENL students. CONCLUSIONS The WSCC approach is system changing. It takes time to develop the relationships vital to improve the 3Cs and 3Ps. Success is enhanced with a district wellness coordinator, the right people at the table, valid health data, and administrative and board support.

Knowledge about the health consequences of e-cigarette use in adolescence remains limited. Available studies of asthma among adolescents are based on data collected five or more years ago, and evidence from more recent generations of e-cigarette products is needed.We analyzed data from the 2017 Youth Risk Behavior Survey, a cross-sectional study with a representative U.S. national sample of high school students. Multivariable analyses tested for associations of ever and 30-day e-cigarette use with asthma controlling for cigarette smoking, marijuana use, demographics, and obesity.A significant association with asthma was found for ever use of e-cigarettes, adjusted odds ratio (AOR) = 1.15 (confidence interval [CI], 1.02-1.30; p = .02) and for currently using e-cigarettes, AOR = 1.30 (CI, 1.10-1.53; p = .002). Also related to asthma were current cigarette smoking, AOR = 1.24 (CI, 1.03-1.51; p = .03) and obesity, AOR = 1.48 (CI, 1.30-1.68; p.0001). E-cigarettes had an additive effect for asthma beyond smoking (p = .03). Differentials in asthma prevalence by race/ethnicity were found, with lower prevalence of asthma for non-Hispanic Asian (p = .02) and Hispanic (p = .03) and higher prevalence for non-Hispanic black (p.0001) and non-Hispanic multirace (p.0001) relative to non-Hispanic white populations.E-cigarette use was significantly associated with asthma in recent data on adolescents, controlling for several disease-relevant covariates. The results are consistent with studies based on previous generations of e-cigarettes and support the significance of e-cigarettes as a continuing public health concern.

Tobacco product use is the leading cause of preventable disease, disability, and death in the United States. This report used data from the 2019 Youth Risk Behavior Survey to assess the following among U.S. high school students: ever use of cigarettes and electronic vapor products, current use (≥1 day during the 30 days before the survey) of tobacco products, frequent use (≥20 days during the 30 days before the survey) among current users of tobacco products, trends in use over time, and usual source of electronic vapor products among current electronic vapor product users. In 2019, a total of 50.1% of U.S. high school students had ever used electronic vapor products, and 24.1% had ever tried cigarette smoking. Current electronic vapor product use was 32.7%, current cigarette smoking was 6.0%, current cigar smoking was 5.7%, and current smokeless tobacco use was 3.8%. Approximately 36.5% of students were current users of any tobacco product, and 8.2% were current users of two or more tobacco products. Frequent use among users of individual products was 32.6% for electronic vapor products, 28.5% for smokeless tobacco, 22.2% for cigarettes, and 18.4% for cigars. Among current electronic vapor product users who were aged ≤17 years, the most commonly reported source was borrowing them from someone else (42.8%). Significant decreases occurred in current cigarette smoking (1991: 27.5%; 2019: 6.0%), cigar smoking (1997: 22.0%; 2019: 5.7%), and smokeless tobacco use (2017: 5.5%; 2019: 3.8%). However, significant increases occurred in current electronic vapor product use (2015: 24.1%; 2019: 32.7%) and any tobacco product use (2017: 19.5%; 2019: 36.5%). Although current cigarette smoking, cigar smoking, and smokeless tobacco use has decreased among high school students, the increased prevalence of electronic vapor product use among youths is concerning. Continued surveillance for all tobacco product use is warranted for guiding and evaluating public health policy at the local, state, tribal, and national levels.

For this study, we explored the association between high school students’ reported history of sport- or physical activity–related concussions and persistent feelings of sadness or hopelessness. Data from the 2017 national Youth Risk Behavior Survey (YRBS; N = 14,765) was used for this analysis. YRBS is administered to high school students throughout the country every 2 years. Findings from this study demonstrate that the prevalence of persistent feelings of sadness or hopelessness was 36.4% among students who reported sustaining one or more concussions. Compared to students who did not report having sustained a concussion, the odds of persistent feelings of sadness or hopelessness were significantly higher among students who had sustained one or more concussions (AOR = 1.41). These findings support the need for continued efforts by school nurses and other health care providers to identify students with a history of concussion and assess their mental health needs.

Preventing unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection, among adolescents is a public health priority. This report presents prevalence estimates for condom and contraceptive use among sexually active U.S. high school students from the 2019 Youth Risk Behavior Survey. Behaviors examined included any condom use, primary contraceptive method use, and condom use with a more effective contraceptive method, all reported at last sexual intercourse. Analyses were limited to sexually active students (i.e., those who had sexual intercourse with one or more persons during the 3 months before the survey). Except for any condom use, students reporting only same-sex sexual contact were excluded from analyses. Weighted prevalence estimates were calculated, and bivariate differences in prevalence were examined by demographic characteristics (sex, race/ethnicity, and grade) and other sexual risk behaviors (age of sexual initiation, previous 3-month and lifetime number of sex partners, and substance use before last sexual intercourse). Nationwide, 27.4% of high school students reported being sexually active (n = 3,226). Among sexually active students who reported having had sexual contact with someone of the opposite sex (n = 2,698), most students (89.7%) had used a condom or a primary contraceptive method at last sexual intercourse. Prevalence of any condom use at last sexual intercourse was 54.3%, and condoms were the most prevalent primary contraceptive method (43.9% versus 23.3% for birth control pills; 4.8% for intrauterine device [IUD] or implant; and 3.3% for shot, patch, or ring). Approximately 9% had used condoms with an IUD, implant, shot, patch, ring, or birth control pills. Using no pregnancy prevention method was more common among non-Hispanic black (23.2%) and Hispanic (12.8%) students compared with non-Hispanic white students (6.8%); compared with Hispanic students, using no pregnancy prevention method was more common among non-Hispanic black students. Prevalence of condom use was consistently lower among students with other sexual risk behaviors. Results underscore the need for public health professionals to provide quality sexual and reproductive health education and clinical services for preventing unintended pregnancy and STDs/HIV and decreasing disparities among sexually active youths.

Adolescence is an important period of risk for substance use initiation and substance use-related adverse outcomes. To examine youth substance use trends and patterns, CDC analyzed data from the 2009-2019 Youth Risk Behavior Survey. This report presents estimated prevalence of current (i.e., previous 30-days) marijuana use, prescription opioid misuse, alcohol use, and binge drinking and lifetime prevalence of marijuana, synthetic marijuana, cocaine, methamphetamine, heroin, injection drug use, and prescription opioid misuse among U.S. high school students. Logistic regression and Joinpoint analyses were used to assess 2009-2019 trends. Prevalence of current and lifetime substance use by demographics, frequency of use, and prevalence of co-occurrence of selected substances among students reporting current prescription opioid misuse are estimated using 2019 data. Multivariable logistic regression analysis was used to determine demographic and substance use correlates of current prescription opioid misuse. Current alcohol, lifetime cocaine, methamphetamine, heroin, and injection drug use decreased during 2009-2019. Lifetime use of synthetic marijuana (also called synthetic cannabinoids) decreased during 2015-2019. Lifetime marijuana use increased during 2009-2013 and then decreased during 2013-2019. In 2019, 29.2% reported current alcohol use, 21.7% current marijuana use, 13.7% current binge drinking, and 7.2% current prescription opioid misuse. Substance use varied by sex, race/ethnicity, grade, and sexual minority status (lesbian, gay, or bisexual). Use of other substances, particularly current use of alcohol (59.4%) and marijuana (43.5%), was common among students currently misusing prescription opioids. Findings highlight opportunities for expanding evidence-based prevention policies, programs, and practices that aim to reduce risk factors and strengthen protective factors related to youth substance use, in conjunction with ongoing initiatives for combating the opioid crisis.

Establishing healthy dietary and physical activity patterns among youths is an important public health strategy for improving health and preventing chronic diseases; however, few adolescents meet U.S. government recommendations for dietary or physical activity behaviors, and disparities by sex and race/ethnicity exist. CDC analyzed data from the 2019 Youth Risk Behavior Survey to update estimates of dietary and physical activity behaviors among U.S. high school students overall and by sex and race/ethnicity. In addition, 2-year comparisons (2017 and 2019) and trends in prevalence of these behaviors during 2009-2019 were examined. In 2019, overall, during the 7 days before the survey, 41.8% of students had eaten fruit or drunk 100% fruit juices

Objectives: To determine the prevalence of current tobacco use and its association with sociodemographic factors and risk behaviors among adolescents and young students, according to gender. Methods: The sample consisted of students from the state public school network aged between 12 and 24 years, who answered the Brazilian version of the Youth Risk Behavior Survey questionnaire. The data were analyzed in SPSS software (v. 20.0), using Poisson regression to evaluate the prevalence ratio (PR) of the independent variables in relation to the outcome. p < 0.05 was established as the significance level. Results: The final analysis consisted of 1275 adolescents, of whom 716 (56.2%) were girls and 559 (43.8%) were boys. The prevalence of current tobacco use was 6.6% among girls and 9.7% among boys. In females, consuming alcohol in the last 30 days (3.91 [1.54-9.94]) and being 14 years old or younger (0.50 [0.26-0.96]) influenced current tobacco use. In the male gender, tobacco use in the last 30 days was influenced by current alcohol consumption (2.92 [1.21-7.08]) and involvement in physical fighting in the last 12 months (2.32 [1.32-4.09]). Conclusion: Although the prevalence of current tobacco use was low in both genders, the assessed population still presents a risk, since male involvement in physical fighting and current consumption of alcohol in both genders increased the probability of this population becoming regular tobacco users. Resumo Objetivos: Determinar a prevalência de uso atual do tabaco e sua associação com fatores sociodemográficos e comportamentos de risco entre adolescentes e jovens escolares, segundo o sexo. Métodos: A amostra foi composta por estudantes da rede estadual entre 12 e 24 anos, que responderam a versão brasileira do questionário Youth Risk Behavior Survey. Os dados foram analisados no SPSS (versão 20.0), por meio da Regressão de Poisson para avaliar a Razão de Prevalência (RP) das variáveis independentes em relação ao desfecho. Foi adotado p < 0,05. Resultados: A análise final foi composta por 1.275 adolescentes, dos quais 716 (56,2%) eram meninas e 559 (43,8%) meninos. A prevalência de consumo atual do tabaco foi de 6,6% entre as meninas e 9,7% entre os meninos. No sexo feminino, consumir álcool nos últimos 30 dias (3,91 [1,54-9,94]) e ter 14 anos ou menos (0,50 [0,26-0,96]) influenciaram o uso atual de tabaco. No sexo masculino, o uso de tabaco nos últimos 30 dias foi influenciado pelo consumo atual de álcool (2,92 [1,21-7,08]) e envolvimento em luta corporal nos últimos 12 meses (2,32 [1,32-4,09]). Conclusão: Embora a prevalência de consumo atual do tabaco tenha sido baixa em ambos os sexos, a população estudada ainda exibe risco, pois o envolvimento em luta corporal no sexo masculino e o consumo atual de álcool em ambos os sexos aumentaram a probabilidade da população se envolver com uso atual do tabaco.

This study examined associations between the prevalence of HIV testing and factors or behaviors that influence HIV testing in U.S.A. 9th to 12th graders using the 2017 Youth Risk Behavior Surveillance Survey (YRBSS) data. Selection criteria was based on a positive report of sexual debut (Ever had sex? Yes/No). Outcome of interest was having ever tested for HIV. Independent risk factors included age, sex, grade, race, condom use, age at first sexual intercourse, number of lifetime sexual partners, use of contraceptives, use of drug or alcohol before last sexual activity and several other factors. Chi-square and logistic regression analyses were conducted to evaluate factors associated with HIV screening participation. HIV testing prevalence was 20.34%. Females (53.97%) were more likely to participate in HIV screening test than males (67.37% females versus 32.63% males) and had higher odds of testing (OR: 2.229

Purpose This study utilized data from the Korea Youth Risk Behavior Survey to examine gender differences in the impact of sexual initiation, and age at sexual initiation, on depressive symptoms among Korean adolescents. Design and methods This study performed a secondary analysis of cross-sectional data from the 14th Korea Youth Risk Behavior Survey (2018). Data from 60,040 adolescents aged 12–18 were included in this study. The relationship between sexual experience, age at initiation, and depressive symptoms was analyzed with complex sample multiple logistic regression. Results Overall, 5.7% of participants declared having had sexual experience. Sexual initiation tended to occur from grade 7 and above. In addition, 33.6% of girls and 21.1% of boys reported having depressive symptoms. Depressive symptoms were associated with sexual initiation experience, but depression symptoms were not associated with the timing of sexual initiation. Conclusions This study provides preliminary evidence of a relationship between sexual experience and depressive symptoms among adolescents; however, this relationship appeared independent of the timing of sexual initiation. These findings suggest that sexually active adolescents should be screened for depressive symptoms, regardless of gender. Practice implications This is the first study to examine the impact of sexual initiation and its timing on depressive symptoms among Korean adolescents. Sexual behaviors of Korean adolescents should be accounted for during the development of mental health policies aimed at young people. In addition, sexually active adolescents should be screened and monitored for depressive symptoms.

Adolescent sexual minority males (ASMM) are among the highest risk groups for suicide in the United States, with substance use as a significant risk factor. We tested for an association between substance use and suicidality among ASMM from the 2015 and 2017 Youth Risk Behavior Survey (n = 849). We compared several approaches to synthesizing measures of marijuana, cocaine, heroin, ecstasy, methamphetamines, synthetic marijuana, and prescription drug abuse, including several categorized and continuous indices, latent class analysis based on any use of each substance, and latent profile analysis based on use frequency. Using all approaches, substance use was positively associated with suicide attempts independent of covariates. A continuous cumulative index was the best fit to our data (quasi-information criterion = 853.9969) and detected the largest association, with the highest prevalence of suicide attempts among ASMM who used all substances compared with those who used none (adjusted prevalence ratio = 3.35, 95% confidence interval: 2.41, 4.66). A 3-latent-class model had the second best fit to the data (quasi-information criterion = 878.4464), with the highest prevalence of suicide attempts (adjusted prevalence ratio = 2.54, 95% confidence interval: 1.80, 3.57) among the high-substance-use class compared with the low-use class. Substance use is an especially important focal point for targeted interventions reducing suicidality among ASMM.

Background Smartphone usage is indispensably beneficial to people's everyday lives. However, excessive smartphone usage has been associated with physical and mental health problems. This study aimed to evaluate the association of smartphone usage with depressive symptoms, suicidal thoughts, and suicide attempts in Korean adolescents. Methods This cross-sectional study was conducted in 54,603 Korean adolescent participants (26,930 male and 27,673 female) in the Korea Youth Risk Behavior Survey in 2017 who reported their smartphone use. We performed multiple logistic regression analysis to evaluate the association of smartphone use with mental health after adjusting for relevant covariates. Results Among the participants, 25.6% of male students and 38.4% of female students reported using their smartphone for at least 30 hours per week. As time duration of smartphone usage increased, the risk of experiencing depressive symptoms, suicidal thoughts, and suicide attempt tended to increase, with odds ratios (95% confidence interval) of 1.18 (1.10-1.26), 1.18 (1.08-1.29), and 1.34 (1.11-1.60), respectively, for high smartphone usage compared with low smartphone usage. These associations remained significant with only slight change in odds ratios after consideration of problems that may be caused by smartphone usage, such as conflicts with family members or peers, or disturbance in school work. Conclusion Smartphone overuse was independently associated with an increased risk of mental health problems, which did not seem to be mediated by the problems caused by smartphone usage.

Background Death by suicide is the second leading cause of death among adolescents globally. Healthy People 2020 set a goal to reduce by 10% the rate of suicide attempts that required treatment and designated the Youth Risk Behavior Survey (YRBS) to measure this objective. Objectives This study used cross-sectional YRBS data (2009-2017) to (a) investigate whether gender moderates the linear time trend for the rate of depressive symptoms, suicidal ideation, and suicide attempts among high school students within the United States; (b) estimate these same measures stratified by gender; and (c) investigate whether the Healthy People 2020 goal for reduction in suicide attempts was met in 2017 for males and females. Methods Secondary analysis of nationally representative high school students using YRBS data 2009-2017 were analyzed using R and the R survey package. Based on Strengthening the Reporting of Observational Studies in Epidemiology guidelines (STROBE), additive interactions using rate difference were compared to multiplicative interactions using odds ratios. Results Additive interactions were identified between female gender and linear trends for depressive symptoms, suicidal ideation, and suicide attempts requiring treatment. Females, but not males, had positive linear trends for depressive symptoms, suicidal ideation, and suicide attempts requiring treatment. Suicide attempts requiring treatment among females was 36% higher in 2017 than in 2009 but decreased 13% in males during the same period. Discussion The Healthy People 2020 goal to reduce suicide attempts requiring treatment by 10% has not been met among females. The divergent trends by gender highlight the importance of surveillance measures by gender. Future research is needed to identify better suicide prevention strategies that address underlying factors and are gender specific.

Objective To compare the prevalence of sexual behaviors and experiences between Asian high school students in the U.S. and students of other race/ethnicities. Study Design We pooled the 2013, 2015 and 2017 rounds of the Youth Risk Behavior Survey (N = 42,854). Logistic regression was used to identify differences between racial/ethnic groups and by sex. Results Compared to their peers, a smaller proportion of Asian students reported engaging in sexual behaviors or using contraception, including prescription methods, at last sex. Asian students also reported fewer experiences of forced sexual intercourse compared to their peers. Conclusions These findings demonstrate distinct patterns in Asian students’ sexual health behaviors compared to their peers. Future research should examine determinants of these differences. Implications Filling a gap in the literature, these data can inform education and health practices that support the sexual and reproductive health needs of Asian and all adolescents in the country.

Objectives The purpose of this study was to examine the associations between lifestyle behavior variables such as physical activity, television watching, computer use, and school night sleep duration with body mass index percentile (BMI%) using quantile regression within a representative sample of adolescents who completed the 2017 US National Youth Risk Behavior Survey. Study design The study design was a cross-sectional study. Methods A multistage cluster sampling procedure obtained a representative sample of US adolescents. The number of sampled adolescents submitting questionnaires with BMI% data was 13,146. To examine the associations between lifestyle behaviors and BMI%, simultaneous quantile regression was used. Results When relationships were modeled at every 10th percentile, more precise parameter estimates were observed at higher percentiles. Across the interquartile range, physical activity associated with lower BMI% at the 50th and 75th percentiles (brange = −2.27% to −5.24%, P Conclusions Higher levels of physical activity associated with lower BMI% and longer time watching television, school night sleep durations less than 8 h, and school night sleep durations of 10 h or more at higher quantiles associated with higher BMI% in adolescents. Estimates of association were more precise within higher quantiles.

OBJECTIVE: The purpose of this study was to examine the associations of sleep duration and socioecological protective factors with patterns of adolescent risk behaviors in Fairfax County, VA - one of the largest public-school districts in the United States. METHODS: A total of 21,360 and 20,330 students in 10(th) and 12(th) grades who completed the youth risk behavior survey were included in this cross-sectional analysis. Sleep duration was measured by self-report of the average number of hours of sleep on a school night. Ten socioecological protective factors included individual-peer, family, school, and community domains. Latent class analysis was used to classify 7 risk behaviors (alcohol use, cigarette use, illicit drug use, inappropriate prescription drug use, risky sexual behavior, deviant behavior, and academic failure) into 4 class-memberships (Low, Some, Moderate, and High). Multinomial regression models were adjusted for age, gender, and race. RESULTS: Adolescents who reported sleeping the recommended 8–9 hours were significantly less likely to belong to the class-memberships of greater risk behaviors compared to those who reported short and longer sleep duration after controlling for age, gender, race, and survey year. There was a significant inverse relationship between the number of socioecological protective factors and risk behaviors for both 10th and 12th graders. Potential risks of age, sex, and race on risky behaviors were observed. No significant interaction between sleep duration and protective factors was found in both grades. CONCLUSIONS: This study highlights the significant associations between sleep duration and risk behaviors in adolescents with diverse socioecological protective factors. Prioritization of prevention-focused resources should consider sleep duration in addition to the socioecological protective factors commonly cited in the literature when addressing adolescent risk behaviors.

OBJECTIVE Subgroups of adolescent single and dual e-cigarette and cigarette users have been identified, but usage patterns have changed in recent years, and there has been an increase in marijuana use. Research is needed with current data to identify subgroups of use including marijuana and determine their behavioral correlates. METHODS We cross classified ever and recent use of e-cigarettes, combustible cigarettes, and marijuana among US high school students in the 2019 Youth Risk Behavior Survey (YRBS), providing 8 different groups. Levels of 14 risk and protective factors were compared across groups in general linear models with demographic covariates using omnibus tests, pairwise comparisons, and planned contrasts. Replicability was tested through identical analyses for 2017 YRBS data. RESULTS The nonuser group was 43.9% of the sample. The most frequent user groups were triple users (ever-use proportion: 16.9%), dual (e-cigarette and marijuana) users (15.8%), and exclusive e-cigarette users (13.2%). For risk profiles on levels of psychosocial variables, the triple-user group was typically elevated above all other groups. Exclusive e-cigarette users were above nonusers in risk profile but below dual users (both cigarettes and marijuana). Results were similar for ever use and recent use. The patterning of results in 2019 YRBS data were closely replicated in 2017 YRBS data. CONCLUSIONS Co-occurrence of e-cigarette, cigarette, and marijuana use is currently substantial among adolescents and is associated with an elevated psychosocial risk profile. This has implications for both epidemiology and prevention studies. Further research is needed to study prevalence and identify pathways to triple use.

STUDY OBJECTIVE: Concussion is highly prevalent in adolescents and associated with a higher risk of substance use. With the rising use of opioids among adolescents, one form of substance use of concern is misuse of prescription opioids. This study aimed to examine the association between history of sports-related concussion in the past year and current prescription opioid misuse among high school students in the United States (US). SETTING: Secondary data analysis from the 2019 Youth Risk Behavior Survey. PARTICIPANTS: Nationally representative sample of high school students (n = 7,314). DESIGN: Cross-sectional study MAIN MEASURES: Participants were asked whether they experienced any concussions related to sports or being physically active during the past 12 months; and whether they had any prescription opioid misuse within the past 30 days. RESULTS: Amongst this cohort, 14.0% reported sustaining a concussion in the past 12 months and 6% reported current prescription opioid misuse. Prevalence of prescription opioid misuse was higher among those with history of concussion (9.9%) compared to those without concussion (5.5%, p = 0.0015). Controlling for covariates (sex, race/ethnicity, other substance use, depressive symptoms), the odds of prescription opioid misuse was 1.5 times higher for adolescents with concussion compared to those without (adjusted odds ratios [OR] = 1.5; 95% confidence interval 1.0, 2.3; p = 0.029). CONCLUSION: Concussion was associated with prescription opioid misuse among US youth, even after accounting for depressive symptoms and other substance use. Longitudinal studies are needed to test causal relationships and understand biobehavioral mechanisms that underlie associations between concussion and opioid misuse in adolescents.

BACKGROUND Rates of adolescent sexual activity have long been declining in the United States. We sought to estimate the number of cases of gonorrhea and chlamydia averted over 1 decade associated with these declines and associated costs saved. METHODS We analyzed data from the Centers for Disease Control and Prevention's Youth Risk Behavior Survey of US high school students from 2007 to 2017 and combined it with epidemiological estimates drawn from the literature to parameterize a dynamic population transmission model. We compared transmissions from observed behavioral trends with a counterfactual scenario that assumed sexual behaviors from 2007 remained constant for 10 years. We calculated outcomes by age and for 3 racial/ethnic groups (Hispanic, non-Hispanic Black, and non-Hispanic White adolescents) who vary on underlying burden and amount of behavioral change. RESULTS We estimated 1,118,483 cases of chlamydia and 214,762 cases of gonorrhea were averted (19.5% of burden across all ages). This yielded $474 million (2017 dollars) savings in medical costs over the decade. The largest number of averted cases (767,543) was among Black adolescents, but the largest proportion (28.7%) was among Hispanic adolescents. CONCLUSIONS Whatever its origins, changing sexual behavior among adolescents results in large estimated reductions in STI burden and medical costs relative to previous cohorts. Although diagnoses among adolescents have not declined at this rate, multiple explanations could make these apparently divergent trends consistent. Efforts to continue supporting effective sex education in and out of school along with STI screening for adolescents should reinforce these gains.

OBJECTIVE Suicidal ideation and plans are increasing among US adolescents. Changing prevalence of online victimization is frequently hypothesized as an explanation for this increase. We tested trends in online and offline victimization and whether they contribute to recent trends in adolescent suicidal outcomes. METHODS Youth Risk Behavior Survey data (2011–2019, N = 73 074) were collected biennially through national cross-sectional surveys of US school-attending adolescents. We examined trends in past-year victimization. We also examined whether the relationship between victimization and past-year suicidal ideation, plans, attempts, and injury changed over time using survey-weighted logistic regressions that adjusted for sex and race and ethnicity. We also sex-stratified results to examine sex differences. RESULTS Although suicidal ideation and plans increased among US adolescents (mainly girls), online and offline victimization prevalence did not increase over time (offline: 20.0% in 2011, 19.5% in 2019; online: 16.2% in 2011, 15.7% in 2019). Online and offline victimization were associated with suicidal outcomes, especially co-occurring online and offline victimization (eg, adjusted odds ratio [co-occurring online and offline victimization versus none, outcome: suicidal injury] = 8.37; 95% confidence interval: 7.06–9.91). The magnitude of the associations between victimization and suicidal outcomes largely remained stable over time. CONCLUSION Peer victimization prevalence has not sufficiently changed over time in concert with suicidal outcomes to explain increased suicidal outcomes. The prevalence of victimization has remained relatively invariant across time despite growing awareness and programming, making online and offline victimization consistent, socially-patterned risk factors that warrant further monitoring and interventions. Research must examine risk factors beyond victimization to explain increasing suicidal outcomes.

Dual use of e-cigarettes and cigarettes has become common among Korean adolescents but has decreased among adults. Dual use refers to using two tobacco products, however, in this study, it is defined as using both e-cigarettes and cigarettes. We assessed the prevalence of dual use among Korean adolescents and its relationship with socio-demographic, smoking-related characteristics, and other risk behaviors. The 2019 Korea Youth Risk Behavior Survey’s data on 57,303 adolescents were analyzed using logistic regression. Overall, 13.8% had recently (in the past 30 days), used some type of cigarette, 3.3% were dual users, 3.4% exclusively smoked conventional cigarettes, and 0.6% exclusively vaped e-cigarettes. After adjusting for socio-demographic and psychological factors, substance use, smoking initiation by 13 years, secondhand smoke in school and public, and amount of cigarette consumption proved significant for all cigarette user types. Dual use was strongly associated with younger age (≤15 years), cigarette smoking initiation before 13 years, secondhand smoke exposure at school, and heavy cigarette smoking. Limited smoking cessation attempts, secondhand smoke exposure in public, and ease of cigarette purchases decrease the odds of adolescents becoming dual users. Thus, surveillance and enforcement of the juvenile protection measures need updating to prevent a shift into dual use.

Background Although studies have investigated the association between alcohol use and violent behaviors such as weapon carrying, few studies have examined the association between age at first alcohol use and weapon-carrying among adolescents. The objective of this study was to investigate the association between age at first alcohol use and weapon carrying among adolescents. Methods Data for this study came from the 2019 Youth Risk Behavior Survey. An analytic sample of 13,442 adolescents aged 14–18 years old (51% female) was analyzed using binary logistic regression. The outcome variable investigated in this study was weapon carrying during the past 30 days, and the main explanatory variable investigated was age at first alcohol use. Results Of the 13,442 adolescents, 13.5% carried a weapon during the past 30 days, and 15.4% reported having their first alcoholic drink before age 13. In the multivariable logistic regression, adolescents who reported having alcohol before age 13 had more than double the odds of carrying a weapon when compared to those who never had alcohol before age 13 (AOR = 2.32, p < .001, 95% CI = 1.87-2.89). Other significant factors associated with weapon carrying include male gender, victim of bullying, teen dating violence, sexual violence, suicidal ideation, and history of substance use. Adolescents who self-identified as Black/African American or Hispanic were significantly less likely to carry a weapon when compared to adolescents who self-identified as non-Hispanic White. Conclusion The findings of this study underscore the importance of developing age appropriate intervention strategies to curb early initiation of alcohol use and weapon carrying among adolescents., Highlights • Adolescents alcohol use and weapon carrying are major public health concerns in the United States. • About 13.5% of adolescents carried a weapon during the past 30 days. • About 15.4% of adolescents reported having their first alcoholic drink before age 13. • Adolescents who had their first alcohol before age 13 had more than double the odds of carrying a weapon.

Purpose: Suicide is the second leading cause of death among high school aged students in the United States. Significant risk factors for suicidal behaviors among youth include diagnoses of depression or other mental illnesses. The association between self-reported sad feelings and suicidal behaviors has been understudied in the literature among United States high school students.Methods: The 2019 National Youth Risk Behavior Survey (YRBS) school-based questionnaire, coordinated by the CDC, captured a nationally-representative sample (N = 13,677) of students' responses to health-related behaviors. National sex-stratified prevalences of sad feelings and suicidal behaviors were calculated. Adjusted weighted logistic regression was used to examine the association between self-reported sad feelings and suicidal behaviors.Results: Out of 13,677 high-school students, 35.8% of students self-reported sad feelings. Suicidal behaviors in the overall sample included 18.2% had seriously considered suicide, 15.2% made a plan on how they would attempt suicide, and 7.3% attempted suicide within the past 12 months. There was an 8–11-fold increased odds of all suicidal behaviors among those who reported sad feelings among both females and males.Conclusions: This study reveals a remarkably high prevalence of sad feelings among US youth, and underscores a significant association between self-reported sad feelings and suicidal behaviors among this population. The YRBS survey, routinely administered across US high school students, should be better leveraged to target interventions toward these high-risk youth in order to decrease the significant burden of suicidal behaviors among adolescents.

Background: During the past decade, guidelines for youth aerobic and muscle-strengthening physical activity remained unchanged. Active People, Healthy NationSM highlighted school and youth strategies (eg, sports and physical education [PE]) to increase physical activity. Sex, grade, and race/ethnicity disparities exist. This study examines sex-specific trends and differences by grade and race/ethnicity for the prevalence of 5 youth physical activity behaviors from 2009 to 2019. Methods: The national Youth Risk Behavior Survey assesses adolescents (grades 9–12) meeting the aerobic, muscle-strengthening, and both guidelines (2011–2019) and sports participation and daily PE (2009–2019). Sex-stratified logistic regression assessed trends and 2009 or 2011–2019 differences by grade and racial/ethnic subgroups. Results: Decreases in meeting the aerobic, muscle-strengthening, and both guidelines were observed for nearly all male subgroups by grade and race/ethnicity, whereas female subgroups exhibited declines or no change to low prevalence. Sports and PE participation remained mostly constant; select subgroups showed decreases (ie, Hispanic males [sports]; Black males and ninth-grade females [PE]). Conclusions: Past decade prevalence and patterns suggest that school-based and other strategies for all adolescents and tailored interventions for sex-specific subgroups may be needed to supplement sports and PE in promoting high school youth physical activity.

ObjectiveTo compare adolescents’ reports of sexual and contraceptive behaviors between the National Survey of Family Growth (NSFG) and the Youth Risk Behavior Survey (YRBS).MethodsFor each survey, we estimated the year- and sex-specific prevalence of sexual and contraceptive behaviors among a comparably defined sample of US respondents ages 15–19 currently attending high school. We used logistic regression to test for changes in prevalence from 2007–2019 and conducted sensitivity analyses to investigate between-survey differences.ResultsWe found differences in both prevalence and trends between the YRBS and NSFG when limited to a comparably defined sample. Compared to the NSFG, adolescents in the YRBS were more likely to report being sexually experienced, less likely to report use of prescription methods for both sexes, and less likely to report condoms among males. Only the YRBS estimated significant declines in sexual experience for both sexes, and significant increases in prescription methods and declines in condom use among males. Differences between surveys in the prevalence of specific contraceptive methods reflected greater combined use of methods in the NSFG. We identified differences in question-wording and other aspects that may influence these differential patterns.ConclusionsThe NSFG and YRBS produced inconsistent prevalence estimates and trends for sexual and contraceptive behaviors among in-school adolescents. Further efforts to improve these national surveillance systems are critical to inform policy and research efforts that support adolescent sexual and reproductive health and wellbeing.

The objective of this study was to investigate the association between first sexual intercourse and sexual violence victimization, symptoms of depression, and suicidal ideation among sexually active adolescents in the United States. Data for this study came from the U.S. 2017 and 2019 iterations of the National Youth Risk Behavior Survey. An analytic sample of 6252 adolescents aged 14–18 years old (49.5% female) who reported ever having sexual intercourse was analyzed using Poisson regression. The outcome variables investigated in this study were sexual violence victimization, symptoms of depression, suicidal ideation, a suicide plan, and suicide attempts, and the main explanatory variables were age at first sexual intercourse and forced sexual intercourse. We also analyzed differences by gender and race. Of the 6252 adolescents who reported ever having sexual intercourse, 7.1% had their first sexual intercourse before age 13, and 14.8% experienced forced sexual intercourse. About 16% of adolescents experienced sexual violence during the past year, 42.6% reported symptoms of depression, 23.9% experienced suicidal ideation, 19.3% made a suicide plan, and 11.1% attempted suicide during the past year. In the regression analysis, early sexual intercourse was significantly and positively associated with suicidal ideation (relative risk (RR) = 1.15, 95% Confidence Interval (CI) = 1.02–1.30), suicide plan (RR = 1.18, 95% CI = 1.00–1.38), and suicide attempts (RR = 1.36, 95% CI = 1.15–1.61). Controlling for the effects of covariates, history of forced sexual intercourse was positively associated with the five outcomes examined with the relative risk ranging between 1.59 and 6.01. Findings of this study suggest that history of early or forced sexual intercourse is associated with poor mental health outcomes among adolescents and underscores the importance of developing interventions that offer psychological support in reducing the adverse impact of early sexual intercourse and forced sexual intercourse on adolescent health.

BACKGROUND Sleep deprivation adversely impacts cognitive performance. A nutritious diet is one strategy that can prevent sleep deprivation and its adverse effects. However, few data exist regarding the influence of diet on sleep duration among adolescents. Hence, it is important to assess whether dietary habits are linked to adequate sleep among adolescents. METHODS The 2013 Youth Risk Behavior Survey data were used in the analysis. Nationally representative samples of adolescents were obtained using a 3-stage cluster design. Selected survey items included number of hours slept on a school night, fruit and vegetable intake, soda and milk intake, breakfast consumption, and demographic variables. Data were analyzed with SAS 9.4 using a logistic regression model. RESULTS Holding other variables constant, an increase in total daily consumption of vegetables, milk, and breakfast increased the odds of sleeping ≥8 hours among participants (p