CDC Youth Risk Behavior Survey Research Articles

Behavioral Factors For Adolescents' Obesity And Overweight: Physical Activity, Sleep, Sedentary Behavior, And Diet

PURPOSE: To investigate the risk factors in weight status among adolescents regarding dietary habits and movement behavior. METHODS: Primary data were derived from the CDC Youth Risk Behavior Survey (YRBS), a nationally representative sample of 40,130 grade 9-12 students (N=20,340 boys and 19,790 girls) from 2011 to 2017. The prevalence of overweight and obesity was examined using by BMI percentile and then compared based on various demographics (i.e., sex, age, race) and behavioral factors (i.e., physical activity, sedentary time, sleep, soda consumption). Logistic regression analysis was conducted to illustrate the differences in weight status within each group of physical activity levels after control the behavioral and demographic factors. RESULTS: Overall, African-American adolescents had the highest prevalence of overweight or obesity (36%), followed by Hispanics (35%), others (29%), and White (27%). Female students had significantly lower obesity rate than male students (-6.4 ± 0.2%), but also spend less time for behavioral activities (e.g., sedentary time: -0.372 ± 0.015 hours, MVPA -20.4 ± 0.4%, and strength training -20.9 ± 0.3%). The self-diagnosis was relatively accurate, with 69% of true positive and 13% of true negative in comparison to actual overweight and obesity status. For the PA group, students who satisfied both PA recommendations had less likely to be obese compared to non-PA group: Odds Ratio (OR) for PA = 0.89, 95% CI [0.825, 0.961], p = 0.003; OR for strength training = 0.92, 95% CI [0.865, 0.996], p = 0.039). Students who consumed soda on more than one day were more likely to be obese (OR = 1.13, 95% CI [1.049, 1.223]), and students who had more sedentary time tended to be obese (OR=1.03, 95% CI [1.011, 1.041]). CONCLUSIONS: Students who were meeting PA recommendations were less likely to be obese, while students who had more sedentary time and higher levels of soda consumption were more likely to be obese. In addition, African American and Hispanic students were more likely to be overweight and obese.

Evaluating the Impact of the Synar Program: Tobacco Access and Use among Youth in Mississippi, the South, and the U.S.

(1) Background: This study examines the impact of Synar policy adoption on youth commercial access to tobacco products in Mississippi, the South, and the remaining U.S. The principal focus on youth commercial access is complemented by analyses of Synar’s impact on minors’ non-commercial access to tobacco and tobacco use patterns. Mississippi has been especially aggressive in implementing Synar, as evidenced by its unusually low retailer violation rates (RVRs). Synar, a mandatory, enforceable regulation meant to limit youth’s retail access to tobacco, was implemented nationwide in 1997. This study is governed by a combination of conceptual insights from a diffusion of health innovation perspective and structuration theory. (2) Methods: Repeated cross-sectional data from 1995 to 2011 from the CDC Youth Risk Behavior Survey are analyzed using a pre/post-implementation, quasi-experimental analytic strategy. Tobacco access and use in the pre-Synar era (1995–1997) are compared with two post-Synar periods (1999–2005 and 2007–2011), thereby highlighting diffusion effects related to this policy innovation within Mississippi, the South, and the remaining U.S. (3) Results: Analyses of temporal trends reveal that Mississippi and other study regions effectively restricted commercial access to tobacco. Positive outcomes associated with Synar adoption were observed several years after initial implementation, thus supporting a diffusion of innovation perspective. However, results also reveal that Mississippi youth were more inclined than their counterparts elsewhere to gain access to tobacco through non-commercial means after Synar implementation, and that declines in tobacco use among Mississippi youth were less robust than those observed elsewhere. Such variegated effects are in line with expectations linked to structuration theory. (4) Conclusions: Synar policy implementation has been generally effective at deterring youth access to tobacco and, in many cases, has yielded declines in tobacco use. However, there is no evidence that especially aggressive retailer compliance checks in Mississippi have yielded distinctive benefits for youth in this state.

A Summer Health Program for African-American High School Students in Baltimore, Maryland: Community Partnership for Integrative Health

Physical inactivity, poor nutrition, and chronic stress threaten the health of African-American youth in urban environments. Conditions often worsen in summer with diminished access to healthy foods and safe venues for physical activity. A public-private partnership was formed to develop and evaluate an integrative health intervention entitled "Mission Thrive Summer" (MTS). The MTS setting was an urban farm and adjacent school in a low-income community in Baltimore, Maryland. The intervention included farming, nutrition education, cooking, physical activity, yoga, mindfulness, and employment. Mixed-methods outcomes evaluation was conducted. Quantitative measures included accelerometry and self-reported health behaviors, using the Child and Adolescent Mindfulness Measure, Perceived Stress Scale, Physical Activity Questionnaire for Adolescents (PAQA), CDC Youth Risk Behavior Survey, and Block Kids Food Screener (BKFS). Outcomes were compared pre- and post-intervention using paired t-tests. Qualitative evaluation was based on participant and parent interviews. In total, 36 African-American 9th- and 10th-grade students joined MTS (17 in 2013, 26 in 2014, and 7 participating both years). In total, 88% of participants completed MTS. Accelerometry revealed that participants took 7158 steps and burned 544 calories per day during MTS. Participants experienced statistically significant improvements in self-reported physical activity (PAQA) and dietary habits (BKFS). Surveys did not detect changes in stress or mindfulness (P > .05). Qualitative data demonstrated new knowledge and skills, increased self-efficacy, health behavior change, and program enjoyment. MTS was feasible among African-American high school students in Baltimore. Mixed-methods outcomes evaluation provided preliminary evidence of health behavior change during the summer and at follow-up.

School bullying, cyberbullying, or both: Correlates of teen suicidality in the 2011 CDC youth risk behavior survey

While school bullying has been shown to be associated with depression and suicidality among teens, the relationship between these outcomes and cyberbullying has not been studied in nationally representative samples. Data came from the 2011 CDC Youth Risk Behavior Survey (YRBS), a nationally representative sample of high-school students (N=15,425). We calculated weighted estimates representative of all students in grades 9–12 attending school in the US. Logistic regression was used to calculate adjusted odds ratios. Overall, girls are more likely to be report being bullied (31.3% vs. 22.9%), in particularly to be cyberbullied (22.0% vs. 10.8%), while boys are only more likely to report exclusive school bullying (12.2% vs. 9.2%). Reports of 2-week sadness and all suicidality items were highest among teens reporting both forms of bullying, followed by those reporting cyberbullying only, followed by those reporting school bullying only. For example, among those reporting not being bullied 4.6% reported having made a suicide attempt, compared to 9.5% of those reporting school bullying only (adjusted odd ratio (AOR) 2.3, 95% C.I. 1.8-2.9), 14.7% of those reporting cyberbullying only (AOR 3.5 (2.6-4.7)), and 21.1% of those reporting victimization of both types of bullying (AOR 5.6 (4.4-7)). Bullying victimization, in school, cyber, or both, is associated with higher risk of sadness and suicidality among teens. Interventions to prevent school bullying as well as cyberbullying are needed. When caring for teens reporting being bullied, either at school or in cyberbullying, it’s important to screen for depression and suicidality.

Association Between Adolescent Suicide Ideation, Suicide Attempts and Emotional Self-Efficacy

This cross-sectional study investigated relationships between suicide ideation, suicide behavior and emotional self-efficacy in a sample of high school adolescents in grades 9–12 with an age range of 12–18 (n = 3,836) in South Carolina. The hypothesis of the study proposed that low levels of emotional self-efficacy would be significantly associated with higher levels of suicide ideation and suicide attempts for study participants. A brief emotional self-efficacy scale was added to the CDC Youth Risk Behavior Survey to investigate associations with suicide ideation and suicide attempts. Unadjusted and adjusted logistic regression analysis and multivariate models constructed separately for sex and race were employed. Tobacco, alcohol, marijuana, and cocaine use; relationship violence; depressed mood; socioeconomic status; and weapon/gun access were included as covariates in the adjusted models. Nearly all suicide variables were significantly related to emotional self-efficacy in the unadjusted models for the four race/sex groups. In adjusted models, suicide ideation, planning a suicide attempt, attempting suicide and a suicide attempt resulting in injury were associated (α ≤ .05) with reduced emotional self-efficacy for black females. For white males, suicide ideation, attempting suicide and a suicide attempt resulting in injury were associated (α ≤ .05) with reduced emotional self-efficacy. Suicide ideation for black males was associated (α ≤ .05) with reduced emotional self-efficacy. No significant associations were established for white females. Results have implications for health services and suicide prevention programs for adolescents. Measures of emotional self-efficacy as a part of adolescent mental health assessments might be useful for field work, intervention, and program evaluation efforts.

Relationships between Adolescent Sexual Risk Behaviors and Emotional Self-Efficacy

Relationships between sexual risk behaviors and emotional self-efficacy among high school adolescents (N = 2,566), with the exclusion of some respondents, were explored via cross-sectional study in South Carolina. The CDC Youth Risk Behavior Survey sexual risk-taking items and an adolescent emotional self-efficacy scale were utilized. Adjusted logistic regression analyses revealed significant race/gender differences. Findings suggest that ever having sexual intercourse, early age of first sex, number of recent and lifetime sexual partners, non-condom use/non-contraceptive use, alcohol use before intercourse and being forced to have sex were associated (α ≤ .05) with reduced emotional self-efficacy for specific race/gender groups. Results have implications for sexual risk reduction interventions for adolescents.

74: Prevalence of Substance Use Among Detained Youth: A Midwestern Experience

Public perception of youth in detention is that they are more likely than their peers to engage in use and abuse of alcohol and other drugs (AOD). This study sought to profile the AOD use of adolescents detained in a short-term detention center and compare it to patterns of use reported by a representative sample of adolescents. Between 1996 and 2005, all youth aged 9-18 years were administered the Substance Abuse Subtle Screening Inventory A-2 (SASSI A-2) within 24-72 hours of admission to a Midwestern juvenile detention center that serves a community that is 82% White, 14% Black, and 4% other ethnicity. Informed consent was obtained for all participants from their legal guardians, with assent of the adolescents. Results of the CDC Youth Risk Behavior Survey (YRBS) for the State of Ohio from 1997-2005 were utilized for comparisons. Our sample (n = 793) was 46.1% White, 43.9% Black, and 10% other. A total of 72.4% were male. Modal age of participants was 16 years. A total of 54.1% had completed ninth grade. Though 42.3% of those surveyed reported no current AOD use, 17.4% of AOD users reported use > 2 times/week. Modal age of first use was 13 years. A total of 29.6% of the detained youth had their first drink prior to age 13, comparable to YRBS findings of first use ranging from 30% (1999) to 22% (2005). A total of 57% of those surveyed had a high probability of substance abuse disorder. A total of 20.9% reported never using, comparable to the 15% (1999) to 23.5% (2005) who reported never having a drink in their lives to the YRBS. Significant racial differences were found. Whites were more likely to have a high probability of AOD abuse disorders compared to Blacks (p = 0.003), but Blacks use alcohol more frequently (p = 0.036). Significant racial differences were noted in 9 of the 10 SASSI subscales, with Whites scoring higher than Blacks on 6 of these, lower on the other 3. Significant gender differences were also found. Males used more frequently than females; however, females were more likely to have a high probability of AOD abuse disorders. Significant gender differences were also noted on 6 of the 10 SASSI subscales. Females scored higher on 5 subscales. Youth in detention did not demonstrate AOD use significantly different from their peers statewide. However, the detained population is not uniform in AOD use rates or patterns. Significant racial and gender differences have implications for public policy and service delivery. Further study which examines trends in use over time by youth in short-term detention will elucidate information important to the juvenile detention system.

Adolescent distinctions between quality of life and self-rated health in quality of life research

BackgroundIn adult quality of life (QOL) research, the QOL construct appears to differ from self-rated health status. Although increased QOL continues to be recognized as an important outcome in health promotion and medical intervention, little research has attempted to explore adolescent perceptual differences between self-rated health and QOL.MethodsCorrelational analyses were performed between self-rated health, physical health days and mental health days, and QOL. Data were collected from two different public high school adolescent samples during two different time periods (1997 & 2003) in two different geographic regions in the USA (a southern & midwestern state) with two different sample sizes (N = 5,220 and N = 140, respectively) using the CDC Youth Risk Behavior Survey (YRBS). The Centers for Disease Control and Preventions' health-related quality of life scale (HRQOL) provided estimates of self-rated health, physical health days and mental health days, and QOL.ResultsAll correlation coefficients were significant in both samples (p ≤ .0001), suggesting sample size was not a contributing factor to the significant correlations. In both samples, adolescent QOL ratings were more strongly correlated with the mean number of poor mental health days (r = .88, southern sample; r = .89, midwestern sample) than with the mean number of poor physical health days (r = .75, southern sample; r = .79, midwestern sample), consistent with adult QOL research. However, correlation coefficients in both samples between self-rated health and the mean number of poor physical health days was slightly smaller (r = .24, southern, r = .32, midwestern) than that between self-rated health and the mean number of poor mental health days (r = .25, southern, r = .39 midwestern), which is contrary to adult QOL research.ConclusionSimilar to adults, these results suggest adolescents are rating two distinct constructs, and that self-rated health and QOL should not be used interchangeably. QOL, in the context of public high school adolescents, is based largely upon self-reported mental health and to a lesser extent on self-reported physical health. Conversely, although self-reported mental health and self-reported physical health both contribute significantly to adolescent self-rated health, mental health appears to make a greater contribution, which is contrary to observations with adults. Health promoting efforts for adolescents may need to focus more on mental health than physical health, when considering population needs and type of micro or macro intervention.

Associations Among Family Structure, Demographics, and Adolescent Perceived Life Satisfaction

Relationships between perceived life satisfaction and family structure were examined among 5,021 public high school adolescents using the self-report CDC Youth Risk Behavior Survey (YRBS). Adjusted multiple logistic regression analyses and multivariate models (via SUDAAN) constructed separately, revealed significant race by gender effects. Living with other relatives, non-relatives, or guardians was significantly related (p < .01) to reported life dissatisfaction for all race and gender groups, except black males. However, white females and males living with both parents were significantly less likely (p < .001) to report dissatisfaction with life. Black females living with their mothers only were also significantly less likely (p < .001) to report dissatisfaction with life while black males living with their fathers only and white females living with their mother and another adult/adults were significantly more likely (p < .01) to report dissatisfaction with life. Differing family structures appear to exert disparate effects for life satisfaction on adolescents as a function of race and/or gender. Thus, a particular health promotion intervention may not benefit all adolescents. Intervention efforts must be tailored to adolescents’ specific race and gender characteristics.

Physical Activity Behaviors and Perceived Life Satisfaction Among Public High School Adolescents

This study explored relationships between perceived life satisfaction and physical activity behaviors in a statewide sample of adolescents in South Carolina (n = 4,758) using the CDC Youth Risk Behavior Survey (YRBS) and the Brief Multidimensional Student Life Satisfaction Scale (BMSLSS). Adjusted logistic regression analyses and multivariate models constructed separately revealed significant race by gender results. Not exercising for 20 minutes over the past 7 days (sweating and hard breathing), not performing stretching exercising (past 7 days), not exercising to strengthen or tone muscles (past 7 days), spending < 20 minutes actually exercising or playing sports in PE class, not playing on sport teams run by school, and not playing on sport teams run by outside school organizations were associated (p = .05) with reduced life satisfaction for specific race/gender groups. Results suggest implications for school and community-based physical activity programs. Future research should consider measures of life satisfaction as a component of comprehensive assessments of adolescent physical activity behaviors in fieldwork, research, and program evaluation.

Association Between Life Satisfaction and Sexual Risk-Taking Behaviors Among Adolescents

Relationships between perceived life satisfaction and sexual risk-taking behaviors were examined in a statewide sample of public high school students (n = 4,758) using the self-report CDC Youth Risk Behavior Survey (YRBS). Adjusted polychotomous logistic regression analyses and multivariate models (via SUDAAN) constructed separately, revealed a significant race by gender interaction for each race-gender group. Age of first intercourse (≤13), two or more lifetime sexual intercourse partners, alcohol/drug use before last intercourse, no use of contraception at last intercourse, being forced to have sex, forcing someone to have sex, and having beaten up a date in the last 12 months and having been beaten up by a date (in last 12 months) were associated (p = .05) with reduced life satisfaction. Measures of life satisfaction as a component of comprehensive assessments of adolescent sexual risk-taking behaviors in fieldwork, research, and program-evaluation efforts should be considered.

A Study of Suicide-Related Behaviors among Colombian Youth: Reflections on Prevention and Implications for Health Education

This study examined risk behaviors related to depression and suicide among adolescent students enrolled in public schools in Bogota, Colombia. Data were collected from 1,692 respondents who completed a modified version of the CDC Youth Risk Behavior Survey. Measures of central tendency, chi-square, and analysis of variance tests were used to analyze the data. Findings from this study revealed that 21% of the participants expressed suicidal ideation; fantasizing about suicide transcended to an actual plan in 19% of the cases; and 16% reported at least one attempt in the 30 days preceding the study. This article presents selected literature on the relationship between culture and suicidal risk behavior, methodological considerations in cross-cultural research, and implications for suicide prevention for Colombian adolescents and U.S. health educators.

Association Between Employment and Sexual Risk-Taking Behaviors Among Public High School Adolescents

We examined the relationship between adolescent after school and weekend employment and sexual intercourse behavior in a cross-sectional sample of public high school students in South Carolina. The CDC Youth Risk Behavior Survey was used to secure usable data from 4,800 subjects. Thirty-nine percent of the sample worked at a job for pay during the academic year of the study. The majority of all race/gender groups reported having sexual intercourse in their lifetime and during the past 3 months prior, with the exception of Caucasian females. For Caucasian males employment ranging from 1-5 to 31+ hours per week was associated with sexual risk-taking. Caucasian female employment was associated with sexual risk-taking at 16-20 and 21-25 hours of work per week. For African American males, the relationship between employment and sexual risk-taking was evidenced at the 1-5 and 26-30 hours of work per week levels. Similar trends were determined for Caucasians (males and females) regarding sexual intercourse in the past 3 months prior and working for pay during the academic year. Youth working above 10 hours per week during high school may have an increased risk for unintended pregnancy and sexually transmitted infections, including HIV.

The association between weapon carrying and the use of violence among adolescents living in and around public housing

To test the hypothesis that adolescents who carry lethal weapons are more likely to engage in violent behavior than adolescents who do not carry weapons. Cross-sectional Survey. Black adolescents (N = 225) from a lower socioeconomic (SES) background living in or around nine Housing and Urban Development housing projects. An anonymous questionnaire containing scales from the CDC Youth Risk Behavior Survey and Self-Reported Delinquency Questionnaire was administered. Data were analyzed with Spearman rho correlation coefficients (r), followed by partial correlation coefficients controlling for age and gender. Thirty-five percent of males and 16% of females reported carrying a weapon during the previous 30 days. Frequency of weapon-carrying was correlated (r = .33, p < or = 0.0001). with the frequency of physical fights in the last month, but the relationship was stronger among males than females. Weapon-carrying was also associated (r = .20, p < or = 0.003) with frequency of receiving a serious injury during a fight and the frequency of attacking someone with a weapon with the idea of seriously hurting or killing them (r = .48, p < or = 0.0001). Although males were more likely to carry a hidden weapon than females, the frequency of weapon-carrying was more highly correlated with the frequency of carrying a hidden weapon by females (r = .63, p < or = 0.0001) than males (r = .49, p < or = 0.0001). Females who carried weapons were more likely than males to be involved in gang fights. Among males (r = .27, p < or = 0.008), frequency of weapon-carrying was correlated with frequency of attacking someone with whom they lived. This was not so among females (r = .02). These data support the hypothesis that the lower SES black adolescents in this sample who carried weapons were more likely to engage in violent behaviors than those who did not carry weapons.

Relationship between physical activity level and cigarette, smokeless tobacco, and marijuana use among public high school adolescents.

This study analyzed the association between physical activity level and cigarette, smokeless tobacco, and marijuana use among a selected group of public high school students from South Carolina (N = 4,800). The 1993 CDC Youth Risk Behavior Survey was used to collect self-report information on physical activity, substance use, and other risk-taking behaviors. Multiple logistic regression analysis for weighted data (SUDAAN) was used for data analysis. Adjusted analysis showed significant associations (p < .05) among White males for use of cigarettes, smokeless tobacco, and marijuana, where higher levels of physical activity were inversely associated to use of these substances. Results from the study substantiate the importance of physical activity for adolescents, and demonstrate the need for future research to clarify the causal relationship between physical activity and substance use behaviors.