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This paper presents baseline data on health behaviors and protective factors among junior middle school students aged 13-15 years old in China for the purpose of developing priorities, establishing programs and policies for school health and youth health and also establishing trends in the prevalence of these behaviors. The 2003 CHINA GSHS employed a two-stage cluster sample design to produce a representative sample of junior middle school students in Grades 1-4 in Beijing, Hangzhou, Wuhan and Urumchi. A World Health Organization (WHO) developed survey was used to collect the data among 7,393 students. Results showed that 14.6% of students drank at least one alcohol drink on one or more of the past 30 days, 7.1% were at risk of becoming overweight, 25.9% did not have habit of washing hands before eating, 17.8% seriously considered attempting suicide during the past 12 months, and only 12.2% of students were physically active 7 days during a typical week for a total of at least 60 minutes per day. Additionally, 6% of students missed classes or school without permission on one or more of the past 30 days, 48.1% of students had been taught about HIV or AIDS during the school year, 6.2% of students smoked cigarettes during the past 30 days, 18.4% of students were involved in a physical fight and 20.6% were seriously injured during the past 12 months. Finally, 93% of students were taught how to prevent Sudden Acute Respiratory Syndrome (SARS) during the past school year. Results also indicated there were many different problems on health behaviors and protective factors of school students among four cities. This was the first Global School-based Student Health Survey (GSHS) conducted in China and it is expected the results will be helpful in providing data for program development and making policies concerning school health and health education. Additionally, the data will be helpful for international comparisons between countries. (Contains 11 tables.)

Background: School-based risk behavior surveys traditionally have been administered via paper-and-pencil. This study assessed the feasibility of conducting in-class online surveys in US high schools. Methods: A paper-and-pencil questionnaire assessing computer availability and perceptions of online surveys was mailed to a nationally representative sample of public and private high school principals in fall 2008. Completed surveys were returned by principals from 580 of 704 selected schools. Prevalence and 95% confidence intervals were computed. Results: Most high schools have at least 1 computer lab, most computers in computer labs are connected to the Internet, and just under half of schools with a stationary computer lab had a sufficient number of computers to accommodate an in-class online survey administration. The 2 most common problems associated with online surveys were logistics of providing enough computers for an entire class and rotating classes into computer labs. Nearly two thirds of principals preferred online to paper-and-pencil surveys when administered to 4 randomly selected classes that met at different times during the school day, but less than half reported this preference when administered to 4 randomly selected classes that met at the same time during the school day. Conclusion: Many schools do not have sufficient computer capacity to participate in a voluntary in-class online survey. An online survey could impose significant perceived and actual burden on schools and therefore could result in unacceptably low school participation rates. Online administration for in-class surveys of students in US high schools are not recommended. (Contains 4 tables.)

The authors examined whether paper-and-pencil and Web surveys administered in the school setting yield equivalent risk behavior prevalence estimates. Data were from a methods study conducted by the Centers for Disease Control and Prevention (CDC) in spring 2008. Intact classes of 9th- or 10th-grade students were assigned randomly to complete a survey via paper-and-pencil or Web. Data from 5,227 students were analyzed using logistic regression to identify associations of mode with reporting of 74 risk behaviors. Mode was associated with reporting of only 7 of the 74 risk behaviors. Results indicate prevalence estimates from paper-and-pencil and Web school-based surveys are generally equivalent. (Contains 1 note and 2 tables.)

Background: Nearly 10% of students enrolled in US public schools are absent daily. Although previous research has shown associations of school absenteeism with participation in risk behaviors, it is unclear if these associations vary by whether the absence was excused. The purpose of this study was to examine the associations of health risk behaviors with being absent from school with and without permission among high school students. Methods: During spring 2004, questionnaires similar to the Youth Risk Behavior Survey questionnaire were completed by 4517 ninth- and eleventh-grade students. Responses to items assessing frequency of school absences during the past 30 days for any reason and without permission were combined to create a variable coded as absent on: 0 days; greater than or equal 1 day, all with permission (WP); and greater than or equal 1 day, at least 1 day without permission (WOP). Logistic regression analyses controlling for gender, grade, and race/ethnicity examined the association of risk behaviors with absenteeism. Results: Controlling for demographic variables, compared to students who were absent 0 days, students who were absent WP had significantly higher odds of engaging in 25 of 55 risk behaviors examined and students who were absent WOP had significantly higher odds of engaging in 43 of the 55 behaviors. Students who were absent WOP also had approximately twice the odds of engaging in risk behaviors compared to students who were absent WP. Conclusions: School absenteeism, with and without permission, is associated with risk behaviors. Schools should recognize absenteeism for any reason as a warning sign for a variety of risk behaviors. (Contains 3 tables.)

Background: The School Health Policies and Programs Study (SHPPS) 2006 is the largest, most comprehensive assessment of school health programs in the United States ever conducted. Methods: The Centers for Disease Control and Prevention conducts SHPPS every 6 years. In 2006, computer-assisted telephone interviews or self-administered mail questionnaires were completed by state education agency personnel in all 50 states plus the District of Columbia and among a nationally representative sample of districts (n = 538). Computer-assisted personal interviews were conducted with personnel in a nationally representative sample of elementary, middle, and high schools (n = 1103) and with a nationally representative sample of teachers of classes covering required health instruction in elementary schools and required health education courses in middle and high schools (n = 912) and teachers of required physical education classes and courses (n = 1194). Results: SHPPS 2006 describes key school health policies and programs across all 8 school health program components: health education, physical education and activity, health services, mental health and social services, nutrition services, healthy and safe school environment, faculty and staff health promotion, and family and community involvement. SHPPS 2006 also provides data to monitor 6 "Healthy People 2010" objectives. Conclusions: SHPPS 2006 is a new and important resource for school and public health practitioners, scientists, advocates, policymakers, and all those who care about the health and safety of youth and their ability to succeed academically and socially. (Contains 1 table and 1 figure.)

This study analyzed data from the School Health Policies and Programs Study (SHPPS) 2000 to examine the relationship between school health councils and selected school health policies and programs. SHPPS 2000 collected data from faculty and staff in a nationally representative sample of schools. About two-thirds (65.7%) of US schools have school health councils. Schools with councils were significantly more likely than schools without councils to report policies and programs related to health services, mental health and social services, faculty and staff health promotion, and family and community involvement. Schools with councils were as likely as schools without councils to report policies and programs related to health education, physical education, and food service. Although school health councils are associated with the presence of some key school health policies and programs, a council does not guarantee a school will have all important school health policies and programs in place. (Contains 3 tables.)

Lesbian, gay, and bisexual (LGB) youth are at risk for many negative behaviors associated with teen dating violence victimization (TDVV). This study describes the prevalence of physical and sexual TDVV by sexual identity and quantifies the increased risk for TDVV among LGB youth compared with heterosexual youth. The participants for this study were students in Grades 9 to 12 participating in the 2015 national Youth Risk Behavior Survey (YRBS) who responded to questions ascertaining sexual identity and both physical and sexual TDVV. Data were analyzed by sexual identity, stratified by sex, and controlled for race/ethnicity and grade in school. Frequencies of physical and sexual TDVV and prevalence of TDVV from a combined TDVV measure were calculated. Associations between these behaviors and sexual identity were identified. Generally, LGB youth had greater prevalence and frequency of TDVV compared with heterosexual youth. Prevalence of TDVV within sexual identity subgroups further differed by sex. Students who were not sure of their sexual identity had the highest risk of most categories of TDVV when adjusting for sex, race/ethnicity, and grade in school. These results are the first to use a nationally representative sample to describe frequency of TDVV and to determine prevalence of a combined physical and sexual TDVV measure by sexual identity among youth. Schools, communities, and families can help prevent teen dating violence and ameliorate the potential impacts of these victimizations. [ABSTRACT FROM AUTHOR]

Objectives. To compare changes over time in prevalence of school victimization among lesbian, gay, and bisexual (LGB) students compared with heterosexual students. Methods. We analyzed data from 11 Youth Risk Behavior Surveys conducted among representative samples of students in grades 9 through 12 in Massachusetts during 1995 to 2015. Weused multivariable logistic regressionmodels to identify trends over time by sexual identity. Results. During 1995 to 2015, the prevalence of missing school decreased overall (from 5.6% to 4.8%) and among heterosexual (from 4.3% to 3.8%) and LGB (from 25.0%to 13.4%) students. The prevalence of having been threatened decreased overall (from 7.8% to 4.1%) and among heterosexual (from 6.5% to 3.5%) and LGB (from 32.9% to 6.7%) students. Conclusions. We identified evidence of a significant decrease in victimization among all students regardless of sexual identity and a steep decline among LGB students. Additional actions to improve school climate may help eliminate the disparities and decrease victimization for all youths. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to estimate the prevalence of current alcohol use and its association with cigarette and drug use among 13-15-year-olds in Africa and the Americas. Method: Cross-sectional data of the WHO Global School-based Student Health Survey from nine countries in the WHO African Region and seven countries/territories in the WHO Region of the Americas were analysed. Single and joint prevalence rates, and prevalence odds ratios were computed. Results: In the majority of countries, alcohol was the most often consumed psychoactive substance, with the prevalence of current alcohol use outweighing the prevalence of current cigarette and lifetime drug use. Gender differences for alcohol were not marked. The use of alcohol was strongly associated with cigarette or drug use, indicating clustering. Conclusions: For the bulk of countries in the Americas and for single countries in Africa, current alcohol use is as high as prevalence rates occurring in other parts of the world. It is imperative to monitor psychoactive substance use among adolescents in these countries to be able to prevent future health and social harm with the information gained. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Professional development ( PD) and collaboration help ensure the quality of school health education. The purpose of this study was to examine trends in the percentage of lead health education teachers ( LHETs) receiving PD on health topics and collaborating with other school staff on health education activities. METHODS This study analyzed representative data from 41 states participating in School Health Profiles surveys between 2000 and 2010. Logistic regression examined linear trends in the percentage of LHETs who received PD on 12 topics and who collaborated on health education activities. RESULTS Significant increases in the percentage of LHETs receiving PD on nutrition and physical activity and significant decreases in the percentage of LHETs receiving PD on alcohol- and other drug-use prevention and human immunodeficiency virus prevention were seen. Significant increases in the percentage of LHETs who collaborated with physical education staff and nutrition services staff were seen in 29 and 39 states, respectively. CONCLUSIONS Although 10-year increases in PD and collaboration in the areas of nutrition and physical activity are encouraging, PD and collaboration in other topic areas still need improvement. These results will help states target more resources toward PD and collaboration in areas where they have been decreasing. [ABSTRACT FROM AUTHOR]

Abstract: This study examined whether the prevalence of self-reported health risk behaviors among high school students varied by survey setting (school versus home) and mode of administration (paper and pencil versus computer). Students in grades 9 and 11 were assigned randomly to one of four conditions--school paper-and-pencil instrument (PAPI), school computer-assisted self-interview (CASI), home PAPI, and home CASI. During the spring of 2004, 4,506 students completed identically worded questionnaires based on the Youth Risk Behavior Survey questionnaire. Logistic regression analyses controlling for sex, grade, and race/ethnicity revealed that setting was associated significantly with the reporting of 30 of the 55 risk behaviors examined, and mode was associated significantly with the reporting of 7 of the 55 behaviors. For all behaviors with a significant setting main effect, the odds of reporting the behavior were greater among students who completed questionnaires at school than among students who completed questionnaires at home. For all behaviors with a significant mode main effect, PAPI mode students had lower odds of reporting the behavior than CASI mode students. Because social measurement research assumes that higher prevalence estimates are more valid than lower estimates, methodological factors shown to increase estimates, such as setting and mode, should be considered when planning surveys. [ABSTRACT FROM AUTHOR]

Purpose: To examine the effect of data collection setting on the prevalence of priority health risk behaviors among adolescents.Methods: Analyses were conducted using data from two national probability surveys of adolescents, the 1993 national school-based Youth Risk Behavior Survey (YRBS) and the 1992 household-based National Health Interview Survey (NHIS/YRBS). Forty-two items were worded identically on both surveys.Results: Thirty-nine of the 42 identically worded items (93%) showed that the YRBS produced estimates indicating higher risk than the NHIS. Twenty-four of these comparisons yielded statistically significant differences. The prevalence estimates affected most were those for behaviors that are either illegal or socially stigmatized.Conclusions: School-based surveys produce higher prevalence estimates for adolescent health risk behaviors than do household-based surveys. Each has advantages and disadvantages, and both can play a role in assessing these behaviors. [Copyright &y& Elsevier]

The article examines trends in rates of self-reported HIV-related instruction and behaviors among high school students in the United States. Data used in the article were obtained from self-administered questionnaires completed anonymously in the classroom by three independent samples of high school students surveyed in 1989, 1990, and 1991. The authors used T-tests to assess significant bivariate associations. To determine significant changes over time, they used multiple logistic regression to calculate the effect of time on each HIV-related measure. Sex, race/ethnicity, and age group were included as control variables in each model. Because the surveys were conducted during the same months of each year, the authors made no additional time adjustments. After controlling for age group, race/ethnicity, and sex, they found that the proportion of students who had received HIV instruction in school increased significantly, from 1989 to 1991. School-based HIV instruction, which is reaching greater numbers of U.S. students, might be contributing to the decline in reported risk behavior.

Background. The prevalence of HIV-related behaviors and determinants of these behaviors among adolescents in the United States have not been well studied. Methods. To determine the prevalence of HIV-related drug behaviors and to assess the effects of HIV-related school-based instruction and HIV knowledge on these behaviors, data were analyzed from a 39-item, self-administered questionnaire completed by a probability sample of all students in grades 9 through 12 in the United States. Results. Usable responses were obtained from 8098 students. Of these, 2.7% (95% confidence interval [CI] = 2.3-3.2) and 1.7% (95% CI = 1.3-2.1) reported injecting illicit drugs ever and during the past year, respectively. Corresponding prevalences of needle sharing were 0.8% (95% CI = 0.5-1.1) and 0.5% (95% CI = 0.3-0.7). Regression analysis revealed that students with higher knowledge scores were less likely and males more likely to have ever injected drugs. HIV knowledge was similarly associated with other outcome measures of drug-injection behavior. Although HIV instruction did not directly influence drug-injection behavior independently of demographic characteristics, it was positively associated with HIV knowledge. Conclusions. While these results do not establish a causal relationship, they suggest that HIV knowledge and school-based instruction may play a role in maintaining low levels of drug-injection behavior among high school students. [ABSTRACT FROM AUTHOR]

Background: Recent declines in current cigarette smoking among youth are encouraging, but less is known about the trends in the number of cigarettes smoked per day among youth. Purpose: This study examined trends in the number of cigarettes smoked per day among U.S. high school students during 1991–2009. Methods: Nationally representative data from the 1991–2009 national Youth Risk Behavior Surveys (YRBS) were analyzed in 2010. The YRBS is a biennial, school-based survey representative of 9th- through 12th-grade students in the U.S. Each survey year, students completed anonymous, self-administered questionnaires that included identically worded questions about cigarette use. The number of cigarettes smoked per day on smoking days was categorized as light smoking (<1–5 cigarettes per day); moderate smoking (6–10 cigarettes per day); and heavy smoking (≥11 cigarettes per day). Sample sizes ranged from 10,904 to 16,410. Overall response rates ranged from 60% to 71%. Results: During 1991–2009, among current cigarette users overall, light smoking increased from 67.2% to 79.4% and heavy smoking decreased from 18.0% to 7.8%. These trends were found among female and male students overall and white students. Among Hispanic students, light smoking remained stable, but heavy smoking significantly increased from 3.1% in 1991 to 6.4% in 2009. The prevalence of light, moderate, and heavy smoking did not change during 1991–2009 among black students. Conclusions: The finding that during 1991–2009 light smoking increased and heavy smoking decreased among current cigarette users is encouraging; however, even light smoking is detrimental to health and efforts to reduce all cigarette use should continue. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine if body mass index (BMI) is associated with behaviors that may increase risk for HIV and other sexually transmitted diseases (STDs) among US high school students.We analyzed nationally representative data from the 2005-2011 national Youth Risk Behavior Surveys (YRBS) to examine associations of BMI categories with sexual risk behaviors and injection drug use among sexually active high school students, using sex-stratified logistic regression models. Controlling for race/ethnicity and grade, among female and male students, both underweight (BMI < 5th percentile) and obesity (BMI ⩾ 95th percentile) were associated with decreased odds of being currently sexually active (i.e., having had sexual intercourse during the past 3 months). However, among sexually active female students, obese females were more likely than normal weight females to have had 4 or more sex partners (odds ratio, OR = 1.59), not used a condomat last sexual intercourse (OR = 1.30), and injected illegal drugs (OR = 1.98). Among sexually active male students, overweight (85th percentile ⩽ BMI < 95th percentile) was associated with not using a condom at last sexual intercourse (OR = 1.19) and obesity was associated with injection drug use (OR = 1.42). Among sexually active students, overweight and obesity may be indicators of increased risk for HIV and other STDs. [ABSTRACT FROM AUTHOR]

Abstract: The Youth Risk Behavior Surveillance System (YRBSS) monitors priority health-risk behaviors among US high school students. To better understand the ramifications of changing the YRBSS from paper-and-pencil to Web administration, in 2008 the Centers for Disease Control and Prevention conducted a study comparing these two modes of administration. Eighty-five schools in 15 states agreed to participate in the study. Within each participating school, four classrooms of students in grades 9 or 10 were randomly assigned to complete the Youth Risk Behavior Survey questionnaire in one of four conditions (in-class paper-and-pencil, in-class Web without programmed skip patterns, in-class Web with programmed skip patterns, and “on your own” Web without programmed skip patterns). Findings included less missing data for the paper-and-pencil condition (1.5% vs. 5.3%, 4.4%, 6.4%; p <.001), less perceived privacy and anonymity among respondents for the in-class Web conditions, and a lower response rate for the “on your own” Web condition than for in-class administration by either mode (28.0% vs. 91.2%, 90.1%, 91.4%; p <.001). Although Web administration might be useful for some surveys, these findings do not favor the use of a Web survey for the YRBSS. [Copyright &y& Elsevier]

Introduction: Studies among adults have documented association between sexual orientation discordance and some suicide risk factors. However, studies examining sexual orientation discordance and nonfatal suicidal behaviors in youth are rare. This study examines the association between sexual orientation discordance and suicidal ideation/suicide attempts among a nationally representative sample of U.S. high school students.Methods: Using sexual identity and sex of sexual contact measures from the 2015 national Youth Risk Behavior Survey (n=6,790), a sexual orientation discordance variable was constructed describing concordance and discordance (agreement and disagreement, respectively, between sexual identity and sex of sexual contacts). Three suicide-related questions (seriously considered attempting suicide, making a plan about how they would attempt suicide, and attempting suicide) were combined to create a two-level nonfatal suicide risk variable. Analyses were restricted to students who identified as heterosexual or gay/lesbian, who had sexual contact, and who had no missing data for sex or suicide variables. The association between sexual orientation discordance and nonfatal suicide risk was assessed using logistic regression. Analyses were performed in 2017.Results: Approximately 4.0% of students experienced sexual orientation discordance. High suicide risk was significantly more common among discordant students compared with concordant students (46.3% vs 22.4%, p<0.0001). In adjusted models, discordant students were 70% more likely to have had suicidal ideation/suicide attempts compared with concordant students (adjusted prevalence ratio=1.7, 95% CI=1.4, 2.0).Conclusions: Sexual orientation discordance was associated with increased likelihood of nonfatal suicidal behaviors. Discordant adolescents may experience unique stressors that should be considered when developing and implementing suicide prevention programs. [ABSTRACT FROM AUTHOR]

Background. Physical activity (PA), sedentary behaviors, and dietary behaviors are each associated with overweight and obesity among youth. However, the associations of PA and sedentary behaviors with dietary behaviors are complex and not well understood. Purpose. To describe the associations of PA and sedentary behaviors with dietary behaviors among a representative sample of US high school students. Methods. We analyzed data from the 2010 National Youth Physical Activity and Nutrition Study (NYPANS). Using logistic regression models which controlled for sex, race/ethnicity, grade, body weight status, and weight management goals, we compared dietary behaviors among students who did and did not meet national recommendations for PA and sedentary behaviors. Results. Students who participated in recommended levels of daily PA (DPA) and muscle strengthening PA (MSPA) were more likely than those who did not to eat fruits and vegetables. Students who exceeded recommended limits for television (TV) and computer/video game (C/VG) screen time were less likely than those who did not to consume fruits and vegetables and were more likely to consume fast food and sugar-sweetened beverages. Conclusions. Researchers may want to address PA, sedentary behaviors, and dietary behaviors jointly when developing health promotion and obesity prevention programs for youth. [ABSTRACT FROM AUTHOR]

Objective: To describe electronic media exposure and its associations with beverage intake among United States high school students. Methods: School-based survey data from a nationally representative sample of 9th- through 12th-grade students from the National Youth Physical Activity and Nutrition Study were analyzed using chi-square and multivariate logistic analyses. Results: On an average school day, 23.5% of students used a computer or played video/computer games ≥ 3 h/d, 28.3% watched television (TV) ≥ 3 h/d, 79.9% had ≥ 3 TVs in the home, 70.2% had a TV in their bedroom, and 41.0% most of the time or always had a TV on while eating dinner at home. Students with high media exposure were more likely to drink sugar-sweetened beverages ≥ 3 times per day and less likely to drink water ≥ 3 times per day and drink ≥ 2 glasses of milk per day. Conclusions and Implications: Efforts to reduce sugar-sweetened beverage intake among adolescents may include limiting exposure to electronic media. [ABSTRACT FROM AUTHOR]