School-Based Protective Factors for HIV Prevention in the United States: Secondary Analysis of the Youth Risk Behavior Survey 2015–2019

School-Based Protective Factors for HIV Prevention in the United States: Secondary Analysis of the Youth Risk Behavior Survey 2015-2019.

The aim of this study was to estimate the association between insufficient sleep and prescription opioid misuse among US high school students. Participants were 6,884 high school students who self-reported on sleep duration and prescription opioid misuse in the 2019 Youth Risk Behavior Survey. Sleep duration was categorized by the Youth Risk Behavior Survey according to the American Academy of Sleep Medicine guidelines as follows: recommended sleep duration (8-9 hours) vs insufficient sleep (< 8 hours). Participants also reported whether they had any prescription opioid misuse during their lifetime and whether they had prescription opioid misuse within the past 30 days. Most (79.4%) participants reported sleeping less than 8 hours per night. Among all youth, 12.9% reported lifetime prescription opioid misuse and 6.2% reported current prescription opioid misuse. Prevalence of both lifetime and current opioid medication misuse was higher among those also reporting insufficient sleep compared to those reporting recommended sleep duration (14.3% vs 7.7%, P < .0001 for lifetime misuse and 6.6% vs 4.3%, P = .0091 for current misuse). In multivariate models, insufficient sleep was associated with an increased odds of lifetime prescription opioid misuse (adjusted odds ratios = 1.4; 95% confidence interval, 1.1-1.2; P = .006); however, we did not find an association between sleep duration and current prescription opioid misuse in multivariate analysis. Sleep duration is associated with lifetime opioid misuse among US youth. Longitudinal studies are needed to test whether causal relationships exist, and to understand biobehavioral mechanisms that underlie associations between sleep deficiency and opioid misuse in adolescents. Groenewald CB, Rabbitts JA, Tham SW, Law EF, Palermo TM. Associations between insufficient sleep and prescription opioid misuse among high school students in the United States. J Clin Sleep Med. 2021;17(11):2205-2214.

Health risk behaviors practiced during adolescence often persist into adulthood and contribute to the leading causes of morbidity and mortality in the United States. Youth health behavior data at the national, state, territorial, tribal, and local levels help monitor the effectiveness of public health interventions designed to promote adolescent health. The Youth Risk Behavior Surveillance System (YRBSS) is the largest public health surveillance system in the United States, monitoring a broad range of health-related behaviors among high school students. YRBSS includes a nationally representative Youth Risk Behavior Survey (YRBS) and separate state, local school district, territorial, and tribal school–based YRBSs. This overview report describes the surveillance system and the 2019 survey methodology, including sampling, data collection procedures, response rates, data processing, weighting, and analyses presented in this MMWR Supplement. A 2019 YRBS participation map, survey response rates, and student demographic characteristics are included. In 2019, a total of 78 YRBSs were administered to high school student populations across the United States (national and 44 states, 28 local school districts, three territories, and two tribal governments), the greatest number of participating sites with representative data since the surveillance system was established in 1991. The nine reports in this MMWR Supplement are based on national YRBS data collected during August 2018–June 2019. A full description of 2019 YRBS results and downloadable data are available (https://www.cdc.gov/healthyyouth/data/yrbs/index.htm).Efforts to improve YRBSS and related data are ongoing and include updating reliability testing for the national questionnaire, transitioning to electronic survey administration (e.g., pilot testing for a tablet platform), and exploring innovative analytic methods to stratify data by school-level socioeconomic status and geographic location. Stakeholders and public health practitioners can use YRBS data (comparable across national, state, tribal, territorial, and local jurisdictions) to estimate the prevalence of health-related behaviors among different student groups, identify student risk behaviors, monitor health behavior trends, guide public health interventions, and track progress toward national health objectives.

Purpose: Lung cancer is the highest cause of cancer related death in the United States. Its development is attributed to environmental and genetic factors. Smoking, diet, and occupation are environmental factors that can affect its development. Besides the environmental elements, the genetic aspect of this risk has also been identified as a major factor. Polymorphism in an individual's genotype has been recognized as a possible risk for lung cancer. GSTM1 has been one of the genes being studied with regards to genetic polymorphism affecting lung cancer development. A meta-analysis was conducted to examine the association of GSTM1 human genome as a risk factor for lung cancer. Procedure: Literature searches were completed by searching at three different times using keyword related to human GSTM1 and lung cancer. The searches generated 326 papers. The preliminary count includes 138 case-control studies. Quality rating of the literatures included will be based on Quality of Reporting of Meta-analysis (QUOROM). GSTM1 genes are categorized into present and null deletion genotype. Each category will be grouped by country and ethnicity. Inter-rater evaluation will be done for quality rating and gene count to ensure accurate appraisal of data collected. Pooled relative risks will be computed for each genotype and ethnicity to determine association with lung cancer. Findings: With the total cases of 12,288 and control subjects of 16,836, this meta-analysis is able to ascertain the association of GSTM1 with lung cancer risk. The present genotype of GSTM1 has been established as protective in nature (P &amp;lt; 0.05). In addition, the relative risk for the null genotype showed significance (P &amp;lt; 0.05) affirming its association to increased risk of developing lung cancer. In examining the subgroups for the study, only the Asian group shows a significant relative risk for both present and null genotype. Additionally, among the three Asian countries in the group, only China showed a significant relative risk for lung cancer development in the null genotype and it did not show significant relative risk for the protective genotype. On the contrary, Japan showed significance in association with the protective genotype. Further reviews confirmed that dietary factor such as intake of cruciferous vegetables, fruits, and green teas affect the development of lung cancer. Conclusion: The association between GSTM1 and lung cancer has been established through this meta-analysis. The results from this meta-analysis prompt the need for further studies that examine GSTM1 genotypes with inclusion of more studies for various race-ethnicity groups and countries. GSTM1 present genotype has an essential role in preventing lung cancer. There is a need to identify ways to enhance or maintain this GSTM1 genotype in future studies. Dietary intake of cruciferous vegetables is a promising factor in preventing lung cancer. Citation Format: Maria Suarez, S. Pamela Shiao, Mildred Gonzales, Amanda Lie, Ching-Yi Chiu. A meta-analysis of GSTM1 human genome as risk factor in lung cancer prevention. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B07.

Sexual identity and sex of sexual contacts can both be used to identify sexual minority youth. Significant health disparities exist between sexual minority and nonsexual minority youth. However, not enough is known about health-related behaviors that contribute to negative health outcomes among sexual minority youth and how the prevalence of these health-related behaviors compare with the prevalence of health-related behaviors among nonsexual minorities. September 2014-December 2015. The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-related behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma and other priority health-related behaviors. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. For the 2015 YRBSS cycle, a question to ascertain sexual identity and a question to ascertain sex of sexual contacts was added for the first time to the national YRBS questionnaire and to the standard YRBS questionnaire used by the states and large urban school districts as a starting point for their YRBS questionnaires. This report summarizes results for 118 health-related behaviors plus obesity, overweight, and asthma by sexual identity and sex of sexual contacts from the 2015 national survey, 25 state surveys, and 19 large urban school district surveys conducted among students in grades 9-12. Across the 18 violence-related risk behaviors nationwide, the prevalence of 16 was higher among gay, lesbian, and bisexual students than heterosexual students and the prevalence of 15 was higher among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. Across the 13 tobacco use-related risk behaviors, the prevalence of 11 was higher among gay, lesbian, and bisexual students than heterosexual students and the prevalence of 10 was higher among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. Similarly, across the 19 alcohol or other drug use-related risk behaviors, the prevalence of 18 was higher among gay, lesbian, and bisexual students than heterosexual students and the prevalence of 17 was higher among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. This pattern also was evident across the six sexual risk behaviors. The prevalence of five of these behaviors was higher among gay, lesbian, and bisexual students than heterosexual students and the prevalence of four was higher among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. No clear pattern of differences emerged for birth control use, dietary behaviors, and physical activity. The majority of sexual minority students cope with the transition from childhood through adolescence to adulthood successfully and become healthy and productive adults. However, this report documents that sexual minority students have a higher prevalence of many health-risk behaviors compared with nonsexual minority students. To reduce the disparities in health-risk behaviors among sexual minority students, it is important to raise awareness of the problem; facilitate access to education, health care, and evidence-based interventions designed to address priority health-risk behaviors among sexual minority youth; and continue to implement YRBSS at the national, state, and large urban school district levels to document and monitor the effect of broad policy and programmatic interventions on the health-related behaviors of sexual minority youth.

The Youth Risk Behavior Surveillance System (YRBSS) is the largest public health surveillance system in the United States, monitoring a broad range of health-related behaviors among high school students. The system includes a nationally representative Youth Risk Behavior Survey (YRBS) and separate school-based YRBSs conducted by states, tribes, territories, and local school districts. In 2021, these surveys were conducted during the COVID-19 pandemic. The pandemic underscored the importance of data in understanding changes in youth risk behaviors and addressing the multifaceted public health needs of youths. This overview report describes 2021 YRBSS survey methodology, including sampling, data collection procedures, response rates, data processing, weighting, and analyses. The 2021 YRBS participation map, survey response rates, and a detailed examination of student demographic characteristics are included in this report. During 2021, in addition to the national YRBS, a total of 78 surveys were administered to high school students across the United States, representing the national population, 45 states, two tribal governments, three territories, and 28 local school districts. YRBSS data from 2021 provided the first opportunity since the onset of the COVID-19 pandemic to compare youth health behaviors using long-term public health surveillance. Approximately half of all student respondents represented racial and ethnic minority groups, and approximately one in four identified as lesbian, gay, bisexual, questioning, or other (a sexual identity other than heterosexual) (LGBQ+). These findings reflect shifts in youth demographics, with increased percentages of racial and ethnic minority and LGBQ+ youths compared with previous YRBSS cycles. Educators, parents, local decision makers, and other partners use YRBSS data to monitor health behavior trends, guide school health programs, and develop local and state policy. These and future data can be used in developing health equity strategies to address long-term disparities so that all youths can thrive in safe and supportive environments. This overview and methods report is one of 11 featured in this MMWR supplement. Each report is based on data collected using methods presented in this overview. A full description of YRBSS results and downloadable data are available (https://www.cdc.gov/healthyyouth/data/yrbs/index.htm).

Migration, Acculturation, and Sexual and Reproductive Health of Latino Adolescents

Priority health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults. Population-based data on these behaviors at the national, state, and local levels can help monitor the effectiveness of public health interventions designed to protect and promote the health of youth nationwide. September 2014-December 2015. The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma and other priority health behaviors. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results for 118 health behaviors plus obesity, overweight, and asthma from the 2015 national survey, 37 state surveys, and 19 large urban school district surveys conducted among students in grades 9-12. Results from the 2015 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 41.5% of high school students nationwide among the 61.3% who drove a car or other vehicle during the 30 days before the survey had texted or e-mailed while driving, 32.8% had drunk alcohol, and 21.7% had used marijuana. During the 12 months before the survey, 15.5% had been electronically bullied, 20.2% had been bullied on school property, and 8.6% had attempted suicide. Many high school students are engaged in sexual risk behaviors that relate to unintended pregnancies and STIs, including HIV infection. Nationwide, 41.2% of students had ever had sexual intercourse, 30.1% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 11.5% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 56.9% had used a condom during their last sexual intercourse. Results from the 2015 national YRBS also indicated many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. During the 30 days before the survey, 10.8% of high school students had smoked cigarettes and 7.3% had used smokeless tobacco. During the 7 days before the survey, 5.2% of high school students had not eaten fruit or drunk 100% fruit juices and 6.7% had not eaten vegetables. More than one third (41.7%) had played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day and 14.3% had not participated in at least 60 minutes of any kind of physical activity that increased their heart rate and made them breathe hard on at least 1 day during the 7 days before the survey. Further, 13.9% had obesity and 16.0% were overweight. Many high school students engage in behaviors that place them at risk for the leading causes of morbidity and mortality. The prevalence of most health behaviors varies by sex, race/ethnicity, and grade and across states and large urban school districts. Long-term temporal changes also have occurred. Since the earliest year of data collection, the prevalence of most health-risk behaviors has decreased (e.g., riding with a driver who had been drinking alcohol, physical fighting, current cigarette use, current alcohol use, and current sexual activity), but the prevalence of other behaviors and health outcomes has not changed (e.g., suicide attempts treated by a doctor or nurse, smokeless tobacco use, having ever used marijuana, and attending physical education classes) or has increased (e.g., having not gone to school because of safety concerns, obesity, overweight, not eating vegetables, and not drinking milk). Monitoring emerging risk behaviors (e.g., texting and driving, bullying, and electronic vapor product use) is important to understand how they might vary over time. YRBSS data are used widely to compare the prevalence of health behaviors among subpopulations of students; assess trends in health behaviors over time; monitor progress toward achieving 21 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; provide comparable state and large urban school district data; and help develop and evaluate school and community policies, programs, and practices designed to decrease health-risk behaviors and improve health outcomes among youth.

Dear Editor-in-Chief, Recently, Fu et al (JE, 2015;25:261–74)1 conducted a meta-analysis based on prospective cohort studies and clarified the association of prostate cancer (PCa) onset with dietary intake and blood concentrations of individual omega-3 fatty acids (or n-3 polyunsaturated fatty acids [PUFAs]). However, they could not find consistent dose-response relationships between PUFA intake/blood levels and PCa risk. Although the authors mentioned possible reasons for this lack of an observed relationship, I would like to add several more. Their review was based on literature reported from Western countries, largely from the United States, where n-6 PUFA intake is much higher, n-3 PUFA intake much lower, and the ratio of n-6 PUFAs:n-3 PUFAs (or arachidonic acid [AA]:long-chain [LC] n-3 PUFAs) is much higher than in Asian countries/areas (including Japan), as discussed by the researchers.2,3 The results appear to be most generalizable to the people of Western countries where the population shares a common genetic background and lifestyle factors with Western populations. Furthermore, the authors’ observations may not be biologically plausible. As is well-known, n-6 PUFAs (mainly linoleic acid) are upstream chemicals of the cyclooxygenase pathway, including AA and prostaglandin E2.4,5 On the other hand, n-3 PUFAs (including α-linolenic acid) are precursor substances of LC n-3 PUFAs, such as eicosapentaeoic acid, docosapentaenoic acid, and docosahexaenoic acid. n-6 PUFAs act as inflammatory and carcinogenic chemicals, while n-3 PUFAs are anti-inflammatory and anti-carcinogenic. In addition, not only absolute consumption and blood concentrations of fatty acids but also ratios of n-6 PUFAs:n-3 PUFAs and AA:LC n-3 PUFAs seem crucial for the onset of cancers,6–8 including PCa.9 Several epidemiologic aspects of primary prevention should be taken into account. We need to clearly hypothesize etiologic factors in terms of cancer initiators or promoters. Because PCa has a long natural history, it is very difficult to obtain information on etiologic factors from the distant past; this information bias may therefore unduly influence epidemiologic research (case-control studies in particular). Subjects with latent cancer could be misclassified into a control group due to the fact that it is prevalent not only in industrialized countries but also worldwide. Age and family history are clear risk factors for PCa, but no definite modifiable preventive or risk factors are available to date.10 Probable/limited-suggestive (according to the World Cancer Research Fund/American Institute for Cancer Research [WCRF/AICR]) preventive factors are foods containing lycopene, selenium and foods containing selenium, α-tocopherol and foods containing α-tocopherol, and legumes; in contrast, diets high in calcium, milk/dairy products, and processed meat are potentially modifiable risk factors. Relevant antioxidant vitamins and minerals are not specific to PCa but may be applicable for prevention of cancers in general. Legumes are of interest because they contain polyphenols, including isoflavones and daizein (and its metabolite, equol, in particular, which is a biologically active phytoestrogen.)11 Milk/dairy products appear critical, not because they are major sources of calcium, but because they contain various growth or promotion factors, including insulin-like growth factor 1 and estrogen. Processed meat appears to be a food representative of an Americanized/Westernized diet and is one of the main sources of not only animal proteins but also iron (a redox radical) and cholesterol (a precursor of steroids, testosterone, and estrogen).12 Smoking should not be overlooked, as it is a single potent multi-targeting carcinogen.13 Alcohol acts as a carcinogen via alcohol dehydrogenase 1B and acetaldehyde dehydrogenase 2 genetic polymorphisms (GPs).14 Physical activity/exercise and participation in sports reduce insulin levels and insulin sensitivity, as well as the risk of diabetes mellitus. Both alcohol consumption and physical activity/sports modify syntheses of steroids, testosterone, and estrogen from cholesterol and change testosterone and estrogen levels and the testosterone:estrogen ratio by way of 5α-reductase GPs.15 Intake of vitamin D and sunlight exposure with vitamin D receptor GPs, including Fok-I, may modulate PCa carcinogenesis via cell cycle regulation and apoptosis. For secondary prevention, controversial findings have been reported among several randomized controlled trials (RCTs) investigating possible PCa mortality-reducing effects of prostate-specific antigen (PSA)-based screening in the European countries16 and in the United States.17 The conflicting, inconclusive nature of these findings may be due to biases, including selection and information biases, based at least in part on the higher prevalences of PCa and PSA testing in these countries compared to Asian countries. An RCT or case-control study should be conducted to assess the effectiveness and test performance (including sensitivity, specificity, and positive predictive value) of PSA-based screening in Asian countries, which have a similar genetic background and lifestyle factors as well as lower prevalences of PCa and PSA test compared to Western countries.

Priority health-risk behaviors, which are behaviors that contribute to the leading causes of morbidity and mortality among youth and adults, often are established during childhood and adolescence, extend into adulthood, and are interrelated and preventable.September 2010-December 2011.The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results from the 2011 national survey, 43 state surveys, and 21 large urban school district surveys conducted among students in grades 9-12.Results from the 2011 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 32.8% of high school students nationwide had texted or e-mailed while driving, 38.7% had drunk alcohol, and 23.1% had used marijuana. During the 12 months before the survey, 32.8% of students had been in a physical fight, 20.1% had ever been bullied on school property, and 7.8% had attempted suicide. Many high school students nationwide are engaged in sexual risk behaviors associated with unintended pregnancies and STDs, including HIV infection. Nearly half (47.4%) of students had ever had sexual intercourse, 33.7% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 15.3% had had sexual intercourse with four or more people during their life. Among currently sexually active students, 60.2% had used a condom during their last sexual intercourse. Results from the 2011 national YRBS also indicate many high school students are engaged in behaviors associated with the leading causes of death among adults aged ≥ 25 years in the United States. During the 30 days before the survey, 18.1% of high school students had smoked cigarettes and 7.7% had used smokeless tobacco. During the 7 days before the survey, 4.8% of high school students had not eaten fruit or drunk 100% fruit juices and 5.7% had not eaten vegetables. Nearly one-third (31.1%) had played video or computer games for 3 or more hours on an average school day.Since 1991, the prevalence of many priority health-risk behaviors among high school students nationwide has decreased. However, many high school students continue to engage in behaviors that place them at risk for the leading causes of morbidity and mortality. Variations were observed in many health-risk behaviors by sex, race/ethnicity, and grade. The prevalence of some health-risk behaviors varied substantially among states and large urban school districts.YRBS data are used to measure progress toward achieving 20 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; to assess trends in priority health-risk behaviors among high school students; and to evaluate the impact of broad school and community interventions at the national, state, and local levels. More effective school health programs and other policy and programmatic interventions are needed to reduce risk and improve health outcomes among youth.

The Youth Risk Behavior Surveillance System (YRBSS) is a set of surveys that tracks a broad range of behaviors, experiences, and conditions that can lead to poor health among high school students. The system includes a nationally representative Youth Risk Behavior Survey (YRBS) and separate school-based YRBSs conducted by states, tribes, territories, and local school districts. For the 2023 national YRBS, CDC made changes to the sampling method, survey administration mode, and questionnaire. Specifically, the sampling design added an American Indian or Alaska Native (AI/AN) supplemental sample so that separate, precise estimates could be made for AI/AN high school students, in addition to the usual sample designed to provide nationally representative data for the population of students in grades 9-12. To decrease the time needed to collect and process data, CDC changed the survey administration mode from paper-and-pencil scannable booklets to a tablet-based electronic survey. To provide national data on topics of emerging interest, CDC added new questions to the questionnaire. These new questions assessed social media use, experiences of racism at school, adverse childhood experiences, transgender identity, consent for sexual contact, and unfair discipline at school. Public health practitioners and researchers can use YRBSS data to examine the prevalence of youth health behaviors, experiences, and conditions; monitor trends; and guide interventions. This overview report describes 2023 YRBSS survey methodology, including sampling, data collection, data processing, weighting, and data analyses. The 2023 YRBS participation map, survey response rates, and a detailed examination of student demographic characteristics are included in this report. During 2023, in addition to the national YRBS, 68 site-level surveys were administered to high school students in 39 states, three tribal governments, five territories, and 21 local school districts. These site-level surveys use site-specific questionnaires that are similar to the national YRBS questionnaire but are modified to meet sites' needs. This overview and methods report is one of 11 featured in this MMWR supplement, which reports results from the 2023 national YRBS but does not include data from the 68 site-level surveys. Each report is based on data collected using methods presented in this overview report. A full description of YRBSS results and downloadable data are available (https://www.cdc.gov/yrbs/index.html).

Discovered Dead While Asleep in Causal Pathway of Mortality Among Children With Cerebral Palsy

Why Abstinent Adolescents Report They Have Not Had Sex: Understanding Sexually Resilient Youth* The sample in this study consisted of 697 students from 20 schools in Missouri who indicated on a survey of attitudes and behaviors that they had not had sex. The subjects completed the 18-item Reasons for Abstinence Scale and identified those items that were reasons why they had not had sex. The most frequent reasons for not having sex were related to fears of pregnancy and disease (including HIV/AIDS). The least frequent reasons were related to problems concerning the cost and availability of birth control and protection. Principal components factor analysis revealed three factors that were labeled fear-based postponement, emotionality and confusion, and values. Factor scores differed by gender, grades, alcohol consumption, family structure, father's education, and urbanicity. The discussion centers on the need to design different prevention strategies to build protective factors that result in sexual resilience in target groups of adolescents. Key Words: adolescents, resilience. abstinence. The debate over what messages to give adolescents about the prevention of transmitted diseases (including HIV/AIDS) and pregnancy has proven to be confusing to youth and has proven conflictual and polarizing in manv communities. The diverse messages that U.S. adolescents receive can be summarized as: (a) remain abstinent until marriage; (b) remain abstinent until emotionally and development;ally ready to become active; (c) remain abstinent but, if not able to, have accurate information about birth control and protection; and (d) have accurate and factual information on how to use birth control and protection effectively because abstinence is not a realistic expectation. While many adults feel strongly about promoting one of the above positions with youth, it is not well understood how adolescents understand and incorporate these disparate admonitions into personal behavior patterns. In the battle over the most appropriate approaches to reduce adolescent high risk behaviors in the United States, more emphasis has been placed on understanding adolescents who report they have had sex than on understanding adolescents who report they have remained abstinent. For example, the Centers for Disease Control administered the Youth Risk Behavior Survey (YRBS) to a national sample of more than 16,0(O high school students in 1997 and reported that 48% of the students had engaged in intercourse. This figure was a significant decline from 54% in 1991 (MMWR, 1998) and generated great interest on the part of politicians, researchers and practitioners. However, there were little empirical data on which to explain this decline. Both supporters of conservative abstinence-only and more liberal comprehensive sex education programs claimed responsibility. No research was found that asked the adolescents who have not had sex why they have remained abstinent. Therefore, the present study used a protective factor model of resiliency to address why diverse groups of adolescents report they have not had sex and to examine how to support youth who make the decision to remain abstinent to become sexually resilient. Literature Review While much research and discussion has occurred in the last decade about fostering both abstinent youth and resilient youth, few researchers have attempted to merge the two areas to provide direction for adolescent HIV, transmitted disease, and pregnancy prevention. Although none of them specifically examined abstinence, Brooks-Gunn and Paikoff (1993), Small and Luster (1994), and Perkins, Luster, and Villarruel ( 1998) were unique in applying the concept of resilience, originally developed in the field of developmental psychopathology, to understanding adolescent well-being. Brooks-Gunn and Paikoff (1993) explored the roles of cultural (moral standards, gender, culture, and media), individual (biology and social cognition), and environmental (peers, family, and school) factors in understanding how to promote well-being among adolescents. …

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events occurring before age 18 years. Data on ACEs among adolescents in the United States have primarily been collected through parent report and have not included important violence-related ACEs, including physical, sexual, and emotional abuse. This report presents the first national prevalence of self-reported ACEs among U.S. high school students aged <18 years, estimates associations between ACEs and 16 health conditions and risk behaviors, and calculates population-attributable fractions of ACEs with these conditions and behaviors using cross-sectional, nationally representative 2023 Youth Risk Behavior Survey data. Exposures were lifetime prevalence of individual (emotional, physical, and sexual abuse; physical neglect; witnessed intimate partner violence; household substance use; household poor mental health; and incarcerated or detained parent or guardian) ACEs and cumulative ACEs count (zero, one, two or three, or four or more). Health conditions and risk behaviors included violence risk factors, substance use, sexual behaviors, weight and weight perceptions, mental health, and suicidal thoughts and behaviors. Bivariate analyses assessed associations between individual and cumulative ACEs and demographics. Adjusted prevalence ratios assessed associations between cumulative ACEs and health conditions and risk behaviors, accounting for demographics. Population-attributable fractions were calculated to determine the potential reduction in health conditions and risk behaviors associated with preventing ACEs. ACEs were common, with approximately three in four students (76.1%) experiencing one or more ACEs and approximately one in five students (18.5%) experiencing four or more ACEs. The most common ACEs were emotional abuse (61.5%), physical abuse (31.8%), and household poor mental health (28.4%). Students who identified as female; American Indian or Alaska Native; multiracial; or gay or lesbian, bisexual, questioning, or who describe their sexual identity in some other way experienced the highest number of ACEs. Population-attributable fractions associated with experiencing ACEs were highest for suicide attempts (89.4%), seriously considering attempting suicide (85.4%), and prescription opioid misuse (84.3%). ACEs are prevalent among students and contribute substantially to numerous health conditions and risk behaviors in adolescence. Policymakers and public health professionals can use these findings to understand the potential public health impact of ACEs prevention to reduce adolescent suicidal behaviors, substance use, sexual risk behaviors, and other negative health conditions and risk behaviors and to understand current effects of ACEs among U.S. high school students.

Depression symptoms and substance abuse in adolescents with asthma