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Adolescents with food allergies (FA) face unique challenges, including an increased risk of bullying, yet comprehensive national studies on this intersection are lacking. Our study examines the prevalence and association between FA and bullying among US high-school adolescents, utilizing Youth Risk Behavior Survey (2015-2019) data. Analyzing responses from 27,781 adolescents, we found that 19.1% reported on-campus bullying, and 14.9% reported electronic bullying, while 15.8% reported FA. Food allergy was significantly more common among those who reported bullying (23% vs. 13.9%, p < 0.001). Logistic regressions revealed that adolescents with FA were more likely to experience on-campus (adjusted odds ratio [AOR] 1.51, 95% CI 1.35-1.69) and electronic bullying (AOR 1.42, 95% CI 1.27-1.58) compared to their peers without FA. These findings underscore the vital role of school nurses in identifying and addressing bullying among FA adolescents, thereby ensuring supportive environments, promoting well-being, and fostering academic success.

Despite well-established health disparities between transgender and cisgender youth, state bills restricting gender-inclusive school supports and health care have dramatically expanded since 2019. While parental support for transgender youth strengthens healthy development, unsupportive parents contribute to suicidality and homelessness. This study examines (1) whether school climate and health gender inequities hold in Wisconsin, a politically contested state without nondiscrimination or bullying legislative protections for transgender youth, and (2) gender differences among adolescents who sought help when depressed or anxious.

Cyberbullying is a serious problem, and research on associations between different types of interpersonal violence and cyberbullying victimization is limited. The purpose of this study was to examine how the frequency of physical dating violence (PDV), sexual dating violence (SDV), and forced sexual intercourse (FSI) is associated with cyberbullying, and whether sex modified these associations among a nationally representative sample of US youth. 2017 and 2019 Youth Risk Behavior Surveillance System (YRBSS) survey data from 14,655 students were used. Youth reported the frequency of PDV, SDV, and FSI in a self-administered questionnaire, with aggregate categories of 0 times, 1 time, 2-3 times, or 4 or more times. Cyberbullying was also self-reported using a single-item measure. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of the PDV, SDV, FSI-cyberbullying associations. Stratified analyses were used to determine if sex was an effect modifier of the PDV, SDV, and FSI-cyberbullying associations. Approximately 16% of students reported having been cyberbullied in the last 12 months. After adjustment, there was a statistically significant dose-response relationship between the frequency of SDV and cyberbullying (1 time: OR = 2.97, 95% CI: 2.30, 3.84; 2-3 times: OR = 3.53, 95% CI: 2.54, 4.93; [greater than or equal to] 4 times: OR = 4.46, 95% CI: 2.86, 6.95; referent 0 times). A similar dose-response relationship was observed for both PDV and FSI. Stratified analysis results suggest that sex may modify these associations. These results underscore the need to address youth dating violence as early as possible, with special attention to sex, as this may also prevent other types of victimization, like cyberbullying.

Little is known about the implications of cannabis legalization on adolescent health behaviors. This study sought to examine the relationship between recreational cannabis legalization and adolescent sexual risk behaviors. Data on 371,487 respondents who have ever had sexual intercourse from 41 states in the 2005 to 2019 Youth Risk Behavior Survey was linked with data on state-level cannabis policies. Difference-in-differences logistic regression models were conducted. Recreational cannabis legalization was associated with a reduced likelihood of respondents having 2+ sexual partners (adjusted OR [aOR] 0.63, 95% CI [0.47, 0.84]), but had no association with condom use (aOR 0.94, 95% CI [0.80, 1.11]). Changing social norms around cannabis is a potential pathway linking cannabis legalization to a reduction in sexual risk behaviors.

Background: The COVID-19 pandemic negatively affected adolescent mental health due to school closures, isolation, family loss/hardships, and reduced health care access. Methods: We compared adolescent mental health in Rhode Island before versus during the pandemic, separately among middle and high schoolers. This serial cross-sectional study used Youth Risk Behavior Survey data from 2019 and 2021 (N = 7403). Multivariable logistic regression models estimated the association between year and mental health status, adjusting for sociodemographics. Results: Middle schoolers in 2021 had higher odds of ever seriously considering suicide (22.6% vs 16.7%) and ever attempting suicide (9.3% vs 6.1%) compared to 2019. Among high schoolers, those in 2021 had higher odds of experiencing persistent sadness/hopelessness in the past year (37.4% vs 32.0%). However, high schoolers in 2019 and 2021 had similar odds of considering suicide in the past year, while those in 2021 had lower odds of having attempted suicide in the past year (8.5% vs 14.6%). Conclusion: The COVID-19 pandemic may have worsened multiple aspects of adolescent mental health in Rhode Island, particularly among middle schoolers. Implications for school health policy, practice, and equity: Promoting school connectedness, creating supportive environments, and diversifying the mental health workforce may help overcome adverse pandemic effects.

This study examined how changes in cumulative peer victimization are associated with depressed mood and suicidality among adolescents over time, as well as whether certain protective factors (e.g., school mattering) moderate these associations. Middle and high school students (N = 2,539) from a small city in the Great Plains responded to five surveys across three years. Multilevel logistic regression analyses were conducted to examine within-person changes in cumulative peer victimization (i.e. number of victimization types experienced), depressed mood, suicidality, and several protective factors. Within-person increases in cumulative peer victimization were associated with within-person increases in depressed mood and suicidality. The effect of cumulative peer victimization on both depressed mood and suicidality was attenuated at higher levels of school mattering, highlighting the importance of this protective factor against depressed mood and suicidality.

Objective: This study examined associations among discrimination, mask-wearing behavior, and self-harming thoughts among international students in the United States during COVID-19. Participants: Undergraduate and graduate international students enrolled in universities during the 2020 summer semester participated in the online survey (N = 103). Methods: Perceived discrimination, mask-wearing behavior, and self-harming thoughts during COVID-19 were assessed by self-reports. Multivariable logistic regressions examined the association among discrimination, mask-wearing behavior, and self-harming thoughts and explored the potential moderation effect of discrimination on the association between mask-wearing and self-harming thoughts. Results: 18.6% of participants reported self-harming thoughts. Increased discrimination was significantly associated with increased odds of self-harming thoughts. Discrimination significantly moderated the association between mask wearing and self-harming thoughts. Conclusions: The findings highlight the importance of increased availability of culturally appropriate mental health services for international students and the need for increased advocacy to decrease discrimination against international students in the current societal context.

Youth who are lesbian, gay, bisexual, and who identify with other sexual orientations (LGB +) are at higher risk for illicit drug use and have higher rates of mental illness. The current study examined the prevalence of illicit drug use among LGB+ persons and assessed the moderating effect of mental illness. Cross-sectional data from the 2015, 2017, and 2019 Youth Risk Behavioral Surveillance System were aggregated. The outcome was any reported use of cocaine, inhalants, heroin, methamphetamines, ecstasy, or hallucinogens. The primary exposure was self-reported sexual orientation category (i.e. heterosexual, gay/lesbian, bisexual, and not sure). Self-reported depressive symptoms were tested as a moderator. Logistic regression models assessed main and interactive effects. Gay or lesbian students [AOR = 1.87 95% CI: 1.45, 2.43], bisexual students [AOR = 2.07 95% CI: 1.77, 2.42], and those unsure of their sexual orientation [AOR = 1.99 95% CI: 1.65, 2.39] had increased odds of illicit drug use. Odds were higher among LGB+ youth who did not have depressive symptoms (p < 0.001). Odds of illicit substance use was significantly greater in youth identifying as gay and lesbian, bisexual, and students who were not sure about their sexual orientation and among LGB+ youth without depressive symptoms. Targeted, but non-stigmatizing, prevention programs are needed.

Background: While more than 2.5 million U.S. high students worked in 2020, data to assess how work affects this group are sparse. To facilitate such research, a set of occupational safety and health questions for inclusion on the Youth Risk Behavior Surveillance System (YRBSS) and other youth-focused surveys was developed. Methods: Survey questions about occupational experiences of young workers were adapted from other surveys or created de novo. Key audiences were engaged to define priority topic areas and develop draft questions, which were further refined through cognitive interviews with working youth. Results: Twenty-one resulting questions spanned multiple work-related topics: employment status; health outcomes; psychosocial exposures; and safety climate. Cognitive testing revealed that youth (aged 14-19) had difficulty with temporal concepts. Some difficulties reflected the propensity of youth to engage in multiple, online, and informal jobs. During 3 rounds of interviews, questions were adjusted to better reflect youth employment circumstances and language. Four states added at least 1 work-related question to their 2023 Youth Risk Behavior Survey questionnaire, and the full set of questions has been disseminated to federal agencies and partners. Conclusion: Including tailored questions about employment in surveys of youth will facilitate occupational health surveillance for this group. Analysis of resulting data can help to close knowledge gaps, provide current prevalence data, inform policy, and allow development of focused prevention and intervention strategies to reduce adverse outcomes among young workers.

The increase in youth's self-identification as trans in the United States and Canada has created new urgency in schools to meet the needs of these students, yet education survey researchers have yet to find ways to assess their educational outcomes based on sex and gender. In this critical systematic review, I provide an overview of surveys from 2009-2019 that have been utilized to assess the sex and gender identity of trans youth. Findings suggest a range of measurement approaches and types of research interests, as well as important aspects that were absent from the surveys. Recommendations for those who currently or plan to engage with survey research that includes gender identity are included.

Background: Children with asthma are often marginalized at school, including bullying victimization. The purpose of this study is to estimate the association between asthma and school or electronic bullying victimization among US high school students, and test whether the association varies significantly by sex. Methods: Pooled data from five waves of the Youth Risk Behavior Survey (N = 73,074) were used. Additive interactions were estimated in R software as per STROBE guidelines. Results: Asthma increases the risk of bullying victimization among female and male adolescents. The risk of school bullying was significantly greater among female students with asthma (7.3%) compared to males (4.0%, p = 0.002). Similarly, the increased risk for electronic bullying victimization associated with asthma was significantly greater among female (7.2%) than among male students (3.4%, p < 0.001). Conclusions: Targeted educational interventions to decrease bullying victimization among adolescents with asthma are needed to mitigate its negative impacts.

Background: Sexting is common among adolescents and is associated with numerous health risk behaviors and negative psychosocial constructs. This study examined the relationships between high school students' experiences with sexual violence victimization, dating violence victimization, and engagement in risky sexual behaviors with experiences of receiving sexts. Methods: Cross-sectional data from the 2014 to 2016 data from Pennsylvania Youth Risk Behavior. Participants were selected using an independent 2-stage cluster sample design to produce a statewide population-based sample. The pencil and paper surveys were conducted in school. Participants included 6734 Pennsylvania high school students in grades 9-12. Results: Overall, 29.0% of Pennsylvania high school students had received a sext, which varied by sex, race/ethnicity, school grade, and sexual identity. Students who engaged in sexual risk behaviors, experienced dating violence, or experienced lifetime sexual violence outside of the dating context had a significantly higher prevalence of receiving a sext than students who did not engage in those behaviors or have those experiences. Conclusions: Early screening and prevention efforts that include discussions about sexting behaviors may help prevent other negative outcomes, such as risky sexual behaviors and interpersonal violence. Addressing sexting in the education and health sectors may help to prevent other related harmful health and violence experiences during adolescence.

The original Social Emotional Distress Survey--Secondary (SEDS-S) assesses adolescents' past month's experiences of psychological distress. Given the continued need for and use of brief measures of student social-emotional distress, this study examined a five-item version (SEDS-S-Brief) to evaluate its use for surveillance of adolescents' wellness in schools. Three samples completed the SEDS-S-Brief. Sample 1 was a cross-sectional sample of 105,771 students from 113 California secondary schools; responses were used to examine validity evidence based on internal structure. Sample 2 consisted of 10,770 secondary students who also completed the Social Emotional Health Survey-Secondary-2020, Mental Health Continuum--Short Form, Multidimensional Student Life Satisfaction Scale, and selected Youth Risk Behavior Surveillance items (chronic sadness and suicidal ideation). Sample 2 responses examined validity evidence based on relations to other variables. Sample 3 consisted of 773 secondary students who completed the SEDS-S-Brief annually for 3 years, providing response stability coefficients. The SEDS-S-Brief was invariant across students based on sex, grade level, and Latinx status, supporting its use across diverse groups in schools. Additional analyses indicated moderate to strong convergent and discriminant validity characteristics and 1- and 2-year temporal stability. The findings advance the field toward comprehensive mental health surveillance practices to inform services for youth in schools.

Background: Early sexual reproductive health (SRH) education is linked to a reduction in risky sexual behaviors. Sexually transmitted infections (STIs) are rising at alarming rates. Risky sexual behaviors, including initiation of sex before age 13, having more than four sexual partners, and lack of use of condoms, increase the chance of infection and cancer. Informing students about the link between risky behaviors and cancer is vital to reduce morbidity and mortality. Methods: A trend analysis of the Youth Risk Behavior Surveillance System (YRBSS) data between 2001 and 2019 was conducted. Results from four survey responses related to sexual risk behaviors among 9th to 12th grade in Mississippi students are compared with their US peers. Results: Between 2001 and 2019, favorable declines in 3 out of 4 sexual risk behaviors were observed. Declining prevalence was reported for "ever had sexual intercourse," "age of sexual initiation at age 13 or younger," and "having 4 or more sexual partners in their lifetime" are promising. However, fewer students report using condoms. The adjusted prevalence rates for Mississippi students in all 4 measures were higher than the national responses. Conclusions: Our analysis supports the need for early skill-based sex education to promote health. States with increased behavioral risk among students should consider trends in data to improve education and policy.

Transgender individuals are disproportionately affected by HIV in the United States. Given increased risk of HIV among youth, there is a need to understand HIV risk and protective factors among transgender individuals who are 18 years and younger. Patterns of HIV testing, HIV education, and condom use have known associations with HIV outcomes among youth in general, but are understudied among transgender youth. This study assessed these outcomes by developing a series of sex-stratified multivariable logistic regression models using pooled Youth Risk Behavior Survey data. Results indicate female and male transgender youth as well as males who were not sure they were transgender were more likely have tested for HIV compared with their not transgender peers. Male transgender youth were significantly less likely to have received HIV education compared with not transgender males. Females not sure if they were transgender and male transgender youth were significantly less likely to have used condoms compared with, respectively, not transgender female and not transgender male counterparts. In sum, condom use and HIV education both remain lower among transgender individuals relative to their not-transgender peers. This highlights the need for the promotion of culturally appropriate HIV education and HIV prevention supports among transgender youth.

Objective: To examine prospective associations between physical and mental self-rated health (SRH), college generation status and college adjustment among first-year college students. Participants and methods: Eighty-seven first-year college students (41 first-generation college students) reported their SRH when starting college, and then, reported on psychosocial and academic adjustment and health behaviors midway through each semester. Results: Better physical and mental SRH were associated with better psychosocial adjustment in both semesters and academic adjustment in the fall but were generally not predictive of health behaviors. Specifically, better physical SRH was associated with less loneliness (fall: B = -0.192, p = 0.048; spring: B = -0.233, p = 0.008) and fewer anxiety symptoms in both semesters (fall: B = -0.236, p = 0.011; spring: B = -0.210, p = 0.014) and fewer depressive symptoms (fall: B = -0.134, p = 0.016) and more fall semester credits (B = 0.965, p = 0.002). Better mental SRH was associated with greater sense of belonging (fall: B = 0.317, p < 0.001; spring: B = 0.242, p = 0.009), less loneliness (fall: -0.210, p = 0.008; spring: B = -0.181, p = 0.012), and fewer anxiety symptoms (fall: -0.193, p = 0.011; spring: -0.195, p = 0.006) in both semesters and higher fall semester grade point average (B = 0.129, p = 0.032). Independent effects of physical and mental SRH are also discussed. Largely, college generation status did not matter for college adjustment within this sample. Conclusions: Physical and mental SRH when starting college may be important indicators of psychosocial adjustment over the first year and academic adjustment in the fall.

Objective: To determine the association between screen time and physical activity with quality of life among Chilean university students. Methods: Cross-sectional and analytical study conducted on 726 first-year university students who replied three questionnaires: Youth Risk Behavior Survey, WHO Quality of Life-BREF scale, and the International Physical Activity Questionnaire. Results: There were differences in overall quality of life (p < 0.001) and level of satisfaction in health (p < 0.01) according to screen exposure time. These results follow a linear trend for all the quality of life domains (p < 0.01), and they indicate that there is an inverse association between screen time and quality of life. Conclusion: There is an inverse association between screen time and quality of life in university students. Students with a longer screen exposure time showed a lower quality of life, specifically in the domains of social relationships and psychological health, regardless of sex, physical activity, or socioeconomic level.

Suicide continues to be a considerable health risk among adolescents and is the second leading cause of death among adolescents between the ages of 10 and 24. Middle school-aged adolescents may be at a heightened risk for suicide, as middle school can be rife with intrapersonal and interpersonal stressors. One such stressor may be sexual activity and navigating sexual relationships. Past research has shown that parents can play an important role in helping adolescents cope with stressors at this age, but there is no identified research assessing whether parental conversations about sex are associated with suicidality among adolescents. The current study addressed this gap via secondary data analysis using logistic regression with a sample of 3,568 middle school students (mean age = 12.74; SD = 1.08). Results suggest that parental conversations about sex are a significant protective factor against suicidality, but only among adolescents who report having engaged in sexual activity.

For this study, we operated with a critical theoretical understanding of schools as sites of (cis)heteronormativity, which led us to question the impact of heteronormative schooling environments. We used data from the 2017 national Youth Risk Behavior Surveillance System to examine the self-reported experiences and feelings of high school students with gay or lesbian, bisexual, or questioning identities. Additionally, we used a quantitative intersectional approach to juxtapose the lived experiences of queer youth in the data with our own counternarratives. Our findings indicate that queer students experienced sadness and/or hopelessness, which was predicted by unsafe schooling experiences and signs of mental health trauma and exacerbated by intersecting marginal identities (i.e., race, ethnicity, gender). Our counternarratives suggest that LGBTQIAA+ youth may experience dissonance among their sense of belonging, home, and identity that is caused by the oppressive cis-heteronormative structures of their schooling systems, which may negatively impact their mental health. Although this dissonance is ever-present, we argue that queer and trans students resist these cis-heteronormative structures through homing, which allows these students to create a more equitable environment for themselves and others.

For lesbian, gay, bisexual, and questioning (LGBQ) youth of color, the intersection of identifying as both LGBQ and a person of color results in not only managing racial stereotypes, but also heterosexism and genderism. Developing a critical understanding of oppressive social conditions and ways to engage in social action is a form of resistance for these youth. Research is needed among LGBQ youth of color that examines the range of predictors and outcomes related to civic engagement, development, and empowerment. Drawing on data derived from a sample of urban youth of color (N = 383; 53.1% Female; 75% Hispanic; Age range = 14 to 18 years; 15% identify as LGBQ), this study will: (1) examine the relationship between community-based perceptions (e.g., psychological sense of community), ethnic identity, behaviors (e.g., community civic participation) and awareness of social justice concerns with dimensions of psychological empowerment; and (2) assess differences that these relationships have between LGBQ and non-LGBQ youth of color. Findings indicate that main predictors have a positive impact on intrapersonal and cognitive dimensions of psychological empowerment through social justice orientation, with noted variations between LGBQ and non-LGBQ youth of color.

BACKGROUND: Research shows associations between bullying victimization and substance use for teens. However, more research about this relationship for younger adolescents and across race/ethnicity is needed. METHODS: Prevalence and pooled logistic regression analyses of 2019 Middle School Youth Risk Behavior Survey data from 13 states (N = 74,059 students) examined associations between self-reported bulling victimization (at school, electronically, and both) and having ever tried cigarette smoking, alcohol, or marijuana; used an electronic vapor product; or misused prescription pain medicine. Regression analyses were adjusted by age and sex/race/ethnicity. RESULTS: All 3 measures of bullying victimization were significantly associated (p < 0.05) with the 5 substance use behaviors examined (adjusted prevalence ratios ranged from 1.29 to 2.32). These associations held across sexes. Significant associations were found within all 7 race/ethnicity categories, with the most associations reported for the non-Hispanic (NH) white, NH black or African American, Hispanic/Latino, and NH Asian groups. CONCLUSION: The association between bullying and substance use by middle school is a highly relevant issue to consider as students return to classrooms.

Background: Few studies have attempted to define clusters of chronic disease predictors with additional focus on racial/ethnic differences. The purpose of this study was to highlight differences in predictors of chronic diseases among American high school students by identifying subgroups using latent class analysis (LCA). Methods: The chronic disease predictor variable used in the analysis was created from 5 modified items in the 2019 Youth Risk Behavior Surveillance that were identified to be critical to healthy lifestyles in Healthy People 2020. Descriptive, bivariate, multinomial logistic regression and LCA were performed using SAS 9.4 and Mplus in 9th to 12th grade students, using data from the Youth Risk Behavior Survey (N = 13,677). Results: Three distinct classes emerged for US high school students and were characterized as high, moderate, and low risk of chronic disease (38%, 33%, and 29%, respectively). Black and Asian students had a higher chance of being in the high-risk class of chronic diseases. Implications for School Health Policy, Practice, and Equity: Emphasis should be placed on sociocultural and socio-environmentally structured prevention programs for at risk/students, ensuring that policy formation reflects the language, identity, and needs of the populations at risk. Conclusions: The behavioral similarities of the classes identified highlight the need for continued research, novel interventions, and culturally sensitive strategies and policies in US high schools.

Adolescents often practice unhealthy behaviors to lose weight or keep from gaining weight. Centers for Disease Control and Prevention has conducted biennial Youth Risk Behavior Survey (YRBS) of various health risk behaviors since 1991 using U.S. representative samples of high school students and is therefore best for us to identify risk/preventive factors associated with unhealthy weight control behaviors (UWCB). We quantitatively assessed the association between various health risk behaviors with UWCB by gender using YRBS data. Due to the absence of UWCB items since 2015, we analyzed the latest (2013) data using binary multiple logistic regression. Among the 13,583 participants, 22.7% of girls and 10.1% of boys engaged in UWCB. Among girls and boys separately, the common significant factors included suicidal behaviors, alcohol drinking, misused prescription drug, feeling depressed, skipping breakfast, and attending physical education class. School nurses are suggested to have knowledge about the aforementioned risk factors and provide assessment, consultation, and education to help reduce UWCB.

History of concussion is associated with substance use. Data from the 2017 National Youth Risk Behavior Survey (N = 14,765) were used in this study to examine associations between sports- or physical activity-related concussions and current cigarette, alcohol, and marijuana use among high school students, and whether other factors moderate those associations. In addition to having played on a sports team, potential moderators examined included persistent feelings of sadness or hopelessness, hours of sleep, and serious difficulty concentrating, remembering, or making decisions. The association between sports- or physical activity-related concussions and current cigarette, alcohol, and marijuana use was significant when controlling for sex, grade, and race/ethnicity and the potential moderators with the exception of cigarette smoking while controlling for hours of sleep. Those involved in the care of high school students after a concussion may consider assessing current cigarette, alcohol, and marijuana use.

The aim of this study was to identify independent risk and protective factors associated with self-reported suicidal thoughts and behaviors (STB) among young adolescents by examining self-report data on mental health, substance abuse, violence involvement, social and economic challenges and supports, physical health and demographics in relation to STB. Data from nearly 27,000 students who completed the 2018-19 Maryland Middle School Youth Risk Behavior Survey/Youth Tobacco Survey (YRBS/YTS) were used to identify independent risk and protective factors associated with STB among middle school students (grades 6-8; ages 11-14). Twenty-three percent of students reported lifetime suicidal ideation and nine percent reported lifetime attempt(s). Independent risk factors associated with STB include depression, substance abuse or misuse, violence involvement, bullying victimization at school or electronically, sexual activity, and sleep deprivation. Protective factors include having an adult outside of school to confide in and feeling that teachers care and provide encouragement. Interactive effects by gender and/or race/ethnicity were observed for some factors in relation to STB. These results suggest that evidence-based programs and policies at the universal and selective/indicated levels in school settings are needed and should be introduced earlier on to address the widespread prevalence of STB in young adolescents. Program planners should take into consideration social, cultural and language needs when implementing and developing intervention strategies.

Family- and neighborhood-level poverty are associated with youth violence. Economic policies may address this risk factor by reducing parental stress and increasing opportunities. The federal Earned Income Tax Credit (EITC) is the largest cash transfer program in the US providing support to low-income working families. Many states have additional EITCs that vary in structure and generosity. To estimate the association between state EITC and youth violence, we conducted a repeated cross-sectional analysis using the variation in state EITC generosity over time by state and self-reported data in the Youth Risk Behavior Surveillance System (YRBSS) from 2005 to 2019. We estimated the association for all youth and then stratified by sex and race and ethnicity. A 10-percentage point greater state EITC was significantly associated with 3.8% lower prevalence of physical fighting among youth, overall (PR: 0.96; 95% CI 0.94-0.99), and for male students, 149 fewer (95% CI: -243, -55) students per 10,000 experiencing physical fighting. A 10-percentage point greater state EITC was significantly associated with 118 fewer (95% CI: -184, -52) White students per 10,000 experiencing physical fighting in the past 12 months while reductions among Black students (75 fewer; 95% CI: -176, 26) and Hispanic/Latino students (14 fewer; 95% CI: -93, 65) were not statistically significant. State EITC generosity was not significantly associated with measures of violence at school. Economic policies that increase financial security and provide financial resources may reduce the burden of youth violence; further attention to their differential benefits among specific population subgroups is warranted.

Background: Food insecurity (FI) rates in the United States are particularly high among households with children. This research set aims to analyze if high school students experiencing FI had higher risk for mental health and suicidal behaviors. Methods: Using combined data from 11 states that conducted the 2017 Youth Risk Behavior Survey, a total of 26,962 and 24,051 high school students were used to estimate race/ethnicity and sex-stratified prevalence ratios (PRs) from Poisson regression models. A single-question was used to measure the exposure of FI and outcomes of mental health and suicidal behaviors. Results: Overall, 10.8% of students reported FI. Students experiencing FI had increased risk for all mental health and suicide behavior outcomes, regardless of their race/ethnicity or sex. PRs ranged from 1.9 (95% confidence interval [CI]:1.8, 2.0) to 3.1 (CI: 2.7, 3.6). Among males, PRs for the association between FI and all outcomes were highest among non-Hispanic black students (PRs ranged from 2.4 [CI: 1.7, 3.2] to 5.5 [CI: 2.3, 13.3]). Among females, PRs were highest among non-Hispanic white students (PRs ranged from 1.9 [CI:1.7, 2.1] to 3.6 [CI:2.9, 4.5]). Conclusions: FI is consistently associated with mental health and suicidal behaviors among different subgroups of students.

Sexual minority youth have a higher risk of suicidal behaviors than their straight peers. Despite this alarming trend, there is limited information on how health-risk factors are systematically associated with suicidal outcomes in relation to the intersection of sex and sexual orientation identity. Data from the 2017 Youth Risk Behavior Survey (Grades 9-12, N = 14,108) were analyzed to examine three distinct suicidal outcomes (i.e., suicidal ideation, suicide planning, and suicide attempt). Separate hierarchical logistic regression models were performed to gradually adjust for influencing factors in examining the association between suicidal outcomes and sexual orientation identity (i.e., heterosexual, gay/lesbian, bisexual, and unsure), stratified by self-reported sex. There exist significant differences in youth suicidal behaviors based on sexual orientation identity and sex: lesbians (adjusted odds ratio [AOR] = 2.7, 95% CI [1.5, 5.0]), bisexual girls (AOR = 1.9, 95% CI [1.3, 2.6]) and bisexual boys (AOR = 2.6, 95% CI [1.3, 5.2]) had higher odds of suicide attempts than their straight peers. Unsure boys and girls also reported higher risks of suicidal ideation and suicide plan as compared with their straight peers. Having a very short sleep duration, reporting ever use of illicit drugs, being bullied, and feeling sad/hopeless were associated with elevated risks of suicidality across males and females. This study identified potential disparities in suicidal outcomes by sexual orientation identity as well as factors that attenuate or strengthen this relationship in a representative sample of adolescents across the United States. An improved understanding of the differences in suicidal outcomes will serve as an opportunity to ameliorate any potential inequalities and improve sexual minority youth' health outcomes.

Although adolescent females with asthma are at increased risk for bullying, relationships between bullying at school and electronic bullying and demographics, mental health issues, and substance use have not specifically been studied in these young women. The purpose of this research was to examine such relationships among adolescent females with asthma. Complex sampling software was used to extrapolate frequencies and X[superscript 2] analyses to adolescent females with asthma. In this U.S. sample of adolescent females with asthma (n = 1,634), younger age, mental health issues, and substance use were significantly related to bullying at school and electronic bullying, while race/ethnicity and grade in school were significantly related only to bullying at school. In general, findings are consistent with previous research regarding relationships between bullying and risk factors among all U.S. adolescent females. Guidance by school nurses is needed to create effective supports for victimization reduction in this vulnerable group.

Background: Since the inception of the Youth Risk Behavior Surveillance System in 1991, all surveys have been conducted in schools, using paper and pencil instruments (PAPI). For the 2019 YRBSS, sites were offered the opportunity to conduct their surveys using electronic data collection. This study aimed to determine whether differences in select metrics existed between students who completed the survey electronically versus using PAPI. Methods: Thirty risk behaviors were examined in this study. Data completeness, response rates and bivariate comparisons of risk behavior prevalence between administration modes were examined. Results: Twenty-nine of 30 questions examined had more complete responses among students using electronic surveys. Small differences were found for student and school response rates between modes. Twenty-five of 30 adolescent risk behaviors showed no mode effect. Conclusions: Seven of 44 states and DC participated electronically. Because survey data were more complete; school and student response rates were consistent; and minor differences existed in risk behaviors between modes, the acceptability of collecting data electronically was demonstrated.