National Youth Risk Behavior Survey Research Articles

Association Between Bullying Victimization and Health Risk Behaviors Among High School Students in the United States.

Childhood exposure to adverse experiences has been associated with adult asthma, smoking, sexually transmitted disease, obesity, substance use, depression, and sleep disturbances. Conceptualizing bullying as an adverse childhood experience, 2011 Youth Risk Behavior Survey (YRBS) data were used to examine the relationship between in-person and electronic bullying victimization among US high school students and health risk behaviors and conditions related to violence, substance use, sexual risk, overweight and physical activity, sleep, and asthma. Data were from the 2011 national YRBS among students who answered questions about in-person and electronic bullying (N = 13,846). The YRBS is a biennial, nationally representative survey of students in grades 9-12 (overall response rate = 71%). Logistic regression analyses, stratified by sex and controlling for race/ethnicity and grade, examined the association between bullying victimization and health risk behaviors or conditions. Rates of victimization varied; 9.4% of students reported being bullied in-person and electronically, 10.8% only bullied in-person, 6.8% only electronically bullied, and 73.0% uninvolved. Bullying was associated with nearly all health risk behaviors and conditions studied. Assessing the broad functioning and behaviors of victims of bullying could enable educators and health practitioners to intervene early and promote the long-term health of youth.

Withdrawal as pregnancy prevention and associated risk factors among US high school students: findings from the 2011 National Youth Risk Behavior Survey

PurposeWithdrawal is less effective for preventing pregnancy than other contraceptive methods and offers no protection against sexually transmitted infections including HIV. Little is known from a national perspective about adolescents who primarily use withdrawal. This study describes the prevalence of withdrawal as their primary method of pregnancy prevention at last sexual intercourse among sexually active US high school students and associations with sexual risk and substance use. MethodsData from the 2011 National Youth Risk Behavior Survey were used to estimate sexually active students' most recent contraceptive method. Logistic regressions examined sexual behaviors and substance use, comparing students who used withdrawal to those who used no method, a condom and a highly effective method. ResultsAmong 4793 currently sexually active students, 10.2% used withdrawal only, 12.4% used no method, 53.6% used a condom and 23.8% used a more effective method as their primary form of pregnancy prevention during last sexual intercourse. Students who used withdrawal were less likely than those who used no method to have had sexual intercourse before age 13 years (Adjusted Prevalence Ratio (APR) =.56) and currently use cocaine (APR=.36). Among females, students who used withdrawal were more likely to engage in risky behaviors than those who used a condom and those who used a highly effective method of pregnancy prevention in a number of ways (e.g., having multiple sex partners during the past 3 months, current alcohol use, binge drinking, current marijuana use, drank alcohol or used drugs before last sexual intercourse). ConclusionsApproximately 1 in 10 sexually active students used withdrawal only, about the same percentage as those who used no method. Health care providers and others who serve adolescents may want to discuss its pros and cons with their clients and help ensure that they have information about and access to other contraceptive methods that are more effective at preventing pregnancy and sexually transmitted infections. Health care professionals should not consider young people who use withdrawal similar in risk to those that use no method.

Combustible and Smokeless Tobacco Use Among High School Athletes - United States, 2001-2013.

Athletes are not a typical at-risk group for smoking combustible tobacco products, because they are generally health conscious and desire to remain fit and optimize athletic performance (1). In contrast, smokeless tobacco use historically has been associated with certain sports, such as baseball (2). Athletes might be more likely to use certain tobacco products, such as smokeless tobacco, if they perceive them to be harmless (3); however, smokeless tobacco use is not safe and is associated with increased risk for pancreatic, esophageal, and oral cancers (4). Tobacco use among youth athletes is of particular concern, because most adult tobacco users first try tobacco before age 18 years (5). To examine prevalence and trends in current (≥1 day during the past 30 days) use of combustible tobacco (cigarettes, cigars) and smokeless tobacco (chewing tobacco, snuff, or dip [moist snuff]) products among athlete and nonathlete high school students, CDC analyzed data from the 2001–2013 National Youth Risk Behavior Surveys. Current use of any tobacco (combustible or smokeless tobacco) significantly declined from 33.9% in 2001 to 22.4% in 2013; however, current smokeless tobacco use significantly increased from 10.0% to 11.1% among athletes, and did not change (5.9%) among nonathletes. Furthermore, in 2013, compared with nonathletes, athletes had significantly higher odds of being current smokeless tobacco users (adjusted odds ratio [AOR] = 1.77, p<0.05), but significantly lower odds of being current combustible tobacco users (AOR = 0.80, p<0.05). These findings suggest that opportunities exist for development of stronger tobacco control and prevention measures targeting youth athletes regarding the health risks associated with all forms of tobacco use.

Past 15-year trends in adolescent marijuana use: Differences by race/ethnicity and sex

BackgroundThe potential for increases in adolescent marijuana use is an important concern given recent changes in marijuana policy. The purpose of this study was to estimate trends in marijuana use from 1999 to 2013 among a national sample of US high school students. We examine changes over time by race/ethnicity and sex. MethodsData are from the National Youth Risk Behavior Survey (YRBS), which involves biennial, school-based surveys that generate nationally representative data about 9th–12th grade students in the United States. Students self-reported sex, race/ethnicity, and marijuana use (i.e., lifetime use, past 30-day use, any use before age 13). We generated national estimates of the prevalence of marijuana use for the time period, and also tested for linear and quadratic trends (n=115,379). ResultsThe prevalence of lifetime marijuana use decreased modestly from 1999 to 2009 (44% to 37%), and has increased slightly since 2009 (41%). Other marijuana use variables (e.g., past 30-day use) followed a similar pattern over time. The prevalence of past 30-day use from 1999 to 2013 for all groups and both sexes was 22.5%, and it was lowest among Asians and highest among American Indian/Alaska Natives. Although boys have historically had a higher prevalence of marijuana use, results indicate that male–female differences in marijuana use decreased over time. ConclusionDespite considerable changes in state marijuana policies over the past 15 years, marijuana use among high school students has largely declined. Continued surveillance is needed to assess the impact of policy changes on adolescent marijuana use.

Physical Activity, Sadness, and Suicidality in Bullied US Adolescents

The consequences of bullying are well described, yet little is known about protective factors that may diminish the negative sequelae. One possible factor, physical activity (PA), improves mental health in general and clinical populations. The purpose of this study is to examine relationships among PA, sadness, and suicidality in bullied US adolescents. We hypothesized that physically active students would be less likely to feel sad or to report suicidal ideation or attempts, including bullied students. Using the 2013 National Youth Risk Behavior Survey (N= 13,583), regression models adjusted for age, sex, and race estimated the odds ratios among PA, sadness, suicidal ideation, and suicide attempts, stratified by whether students were bullied. Overall, 30.0% of students reported sadness for 2or more weeks, 22.2% reported suicidal ideation, and 8.2% reported suicide attempt in the previous 12 months. Bullied students were twice as likely to report feeling sad and 3 times as likely to report suicidal ideation or attempt. Students who reported exercising 4 to 5 days a week had lower adjusted odds of sadness, suicidal ideation, or suicide attempts than students who exercised 0 to 1 day a week (p≤ .0001). After stratifying by bullying, similar but attenuated associations were observed. Overall, exercise for 4 or more days per week was associated with an approximate 23% reduction in suicidal ideation and attempt in bullied students. PA is inversely related to sadness and suicidality in adolescents, highlighting the relationship between PA and mental health in children, and potentially implicating PA as a salient option in the response to bullying in schools.

Relationship Between Affective and Cognitive Factors in Self-Reported Physical Activity and Food Intake in Adolescents

Objective: This study examines how affective associations and cognitive beliefs are related to diet and physical activity in adolescents. Design, Setting and Participants: A convenience sample of approximately 1500 students in 9th-12th grades attending Detroit Public Schools completed a questionnaire during February 2015. The instrument was 18 closed-ended questions to measure feelings and beliefs about food, National YouthRiskBehavior Survey(YRBS)questions regarding diet and physical activity, and demographic information. Outcome Measures and Analysis: Questions measuring beliefs, positive feelings and negative feelings regarding four domain activities (eating fruits, eating vegetables, drinking soda pop, being physically active) and cognitive questions are predictor variables. YRBS questions assessing behavior related to the four domains are criterion variables. Descriptive statistics report frequencies, means and standard deviations. Chi-square tests assess relationships in the categorical independent variables. Results: Preliminary results show that approximately 65% of students are not consuming enough fruits and vegetables. Results showed that as student’s negative feeling about vegetables (e.g. disgust and sadness) increased, student self-report of eating vegetables decreases (p<0.05). Also, as positive feelings towards pop soda (e.g. joy and delight)increased, reported pop consumption also increases (p<.01). Conclusions and Implications: The results can improve understanding of how feelings and cognitive beliefs are related to diet and activity behaviors in high school students. This research, in a racially and ethnically diverse population of inner city adolescents, provides the opportunity to study individuals not often included in health behavior studies. The findings can be used to develop more comprehensive and effective interventions to change behaviors associated with chronic disease. Funding: None.

State all-driver distracted driving laws and high school students' texting while driving behavior

ABSTRACTObjective: Texting while driving is highly prevalent among adolescents and young adults in the United States. Texting while driving can significantly increase the risk of road crashes and is associated with other risky driving behaviors. Most states have enacted distracted driving laws to prohibit texting while driving. This study examines effects of different all-driver distracted driving laws on texting while driving among high school students.Methods: High school student data were extracted from the 2013 National Youth Risk Behavior Survey. Distracted driving law information was collected from the National Conference of State Legislatures. The final sample included 6,168 high school students above the restricted driving age in their states and with access to a vehicle. Logistic regression was applied to estimate odds ratios of laws on texting while driving.Results: All-driver text messaging bans with primary enforcement were associated with a significant reduction in odds of texting while driving among high school students (odds ratio = 0.703; 95% confidence interval, 0.513–0.964), whereas all-driver phone use bans with primary enforcement did not have a significant association with texting while driving (odds ratio = 0.846; 95% confidence interval, 0.501–1.429).Conclusions: The findings indicate that all-driver distracted driving laws that specifically target texting while driving as opposed to all types of phone use are effective in reducing the behavior among high school students.

Brief report: Associations between in-person and electronic bullying victimization and missing school because of safety concerns among U.S. high school students

Although associations between bullying and health risk behaviors are well-documented, research on bullying and education-related outcomes, including school attendance, is limited. This study examines associations between bullying victimization (in-person and electronic) and missing school because of safety concerns among a nationally representative sample of U.S. high school students. We used logistic regression analyses to analyze data from the 2013 national Youth Risk Behavior Survey of students in grades 9–12. In-person and electronic victimization were each associated with increased odds of missing school due to safety concerns compared to no bullying victimization. Having been bullied both in-person and electronically was associated with greater odds of missing school compared to electronic bullying only for female students and in-person bullying only for male students. Collaborations between health professionals and educators to prevent bullying may improve school attendance.

Teen Dating Violence in US High School Students

Research Article| June 01 2015 Teen Dating Violence in US High School Students AAP Grand Rounds (2015) 33 (6): 65. https://doi.org/10.1542/gr.33-6-65 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Teen Dating Violence in US High School Students. AAP Grand Rounds June 2015; 33 (6): 65. https://doi.org/10.1542/gr.33-6-65 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: high schools, violence Source: Vagi KJ, Olsen EO, Basile KC, et al. Teen dating violence (physical and sexual) among US high school students: findings from the 2013 National Youth Risk Behavior Survey. JAMA Pediatrics. 2015; 169(5): 474– 482; doi: https://doi.org/10.1001/jamapediatrics.2014.3577Google Scholar Investigators from the Centers for Disease Control and Prevention sought to determine the prevalence of teen dating violence (TDV) and to assess associations of TDV with health-risk behaviors. Researchers used data from the Youth Risk Behavior Surveillance (YRBS), which is administered to a nationally representative sample of students in grades 9 to 12. New questions in the 2013 YRBS addressed physical TDV (“How many times did someone you were dating or going out with physically hurt you on purpose? Count such things as being hit, slammed into something, or injured with an object or weapon”) and sexual TDV (“How many times did someone you were dating or going out with force you to do sexual things that you did not want to do? Count such things as kissing, touching or being physically forced to have sexual intercourse”) in the previous 12 months. Responses to the TDV questions were dichotomized into 0 times or 1 or more times. The physical and sexual TDV question responses were combined to create a 4-level TDV measure (“physical TDV only,” “sexual TDV only,” “both physical and sexual TDV,” and “none”) and a 2-level TDV measure (“any TDV” indicating either or both physical and sexual TDV and “none”). Associations of TDV and health-risk behaviors (suicidal ideation and attempts, violence and bullying, alcohol and other drug use, and sexual risk behaviors) were assessed by logistic regression models and presented as adjusted prevalence ratios (aPR). Data from 13,097 surveys were analyzed. Seventy-five percent and 72.8% of females and males, respectively, had dated in the previous 12 months, respectively. Among females, the prevalence of TDV was 6.6% for physical only, 8.0% for sexual only, 6.4% for both physical and sexual, and 20.9% for any TDV in the 12 months prior to the survey. Among males, the prevalence of TDV was 4.1% for physical only, 2.9% for sexual only, 3.3% for both physical and sexual, and 10.4% for any TDV. Most students who experienced TDV experienced >1 incident. Every risk behavior was more prevalent among students who had experienced both physical and sexual TDV (eg, female attempted suicide aPR = 39.5 [95% CI, 32.2–47.3]) and least prevalent among students who experienced no TDV. The investigators conclude that both physical and sexual TDV are prevalent among US high school students and that the experience of TDV is associated with health-risk behaviors. Dr Wong has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. TDV is a form of intimate partner violence that includes physical, sexual, psychological, or emotional violence within a dating relationship. With recent prominent coverage of sexual assault on college campuses and data demonstrating... You do not currently have access to this content.

Teen Dating Violence (Physical and Sexual) Among US High School Students: Findings From the 2013 National Youth Risk Behavior Survey.

National estimates of teen dating violence (TDV) reveal high rates of victimization among high school populations. The Centers for Disease Control and Prevention's national Youth Risk Behavior Survey has provided often-cited estimates of physical TDV since 1999. In 2013, revisions were made to the physical TDV question to capture more serious forms of physical TDV and to screen out students who did not date. An additional question was added to assess sexual TDV. To describe the content of new physical and sexual TDV victimization questions first administered in the 2013 national Youth Risk Behavior Survey, to share data on the prevalence and frequency of TDV (including the first-ever published overall "both physical and sexual TDV" and "any TDV" national estimates using these new questions), and to assess associations of TDV experience with health-risk behaviors. Secondary data analysis of a cross-sectional survey of 9900 students who dated, from a nationally representative sample of US high school students, using the 2013 national Youth Risk Behavior Survey. Two survey questions separately assessed physical and sexual TDV; this analysis combined them to create a 4-level TDV measure and a 2-level TDV measure. The 4-level TDV measure includes "physical TDV only," "sexual TDV only," "both physical and sexual TDV," and "none." The 2-level TDV measure includes "any TDV" (either or both physical and sexual TDV) and "none." Sex-stratified bivariate and multivariable analyses assessed associations between TDV and health-risk behaviors. In 2013, among students who dated, 20.9% of female students (95% CI, 19.0%-23.0%) and 10.4% of male students (95% CI, 9.0%-11.7%) experienced some form of TDV during the 12 months before the survey. Female students had a higher prevalence than male students of physical TDV only, sexual TDV only, both physical and sexual TDV, and any TDV. All health-risk behaviors were most prevalent among students who experienced both forms of TDV and were least prevalent among students who experienced none (all P < .001). The 2013 TDV questions allowed for new prevalence estimates of TDV to be established that represent a more complete measure of TDV and are useful in determining associations with health-risk behaviors among youth exposed to these different forms of TDV.

Medical Marijuana Laws and Teen Marijuana Use

While at least a dozen state legislatures are considering bills to allow the consumption of marijuana for medicinal purposes, the federal government has recently intensified its efforts to close medical marijuana dispensaries. Federal officials contend that the legalization of medical marijuana encourages teenagers to use marijuana and have targeted dispensaries operating within 1,000 feet of schools, parks and playgrounds. Using data from the national and state Youth Risk Behavior Surveys, the National Longitudinal Survey of Youth 1997 and the Treatment Episode Data Set, we estimate the relationship between medical marijuana laws and marijuana use. Our results are not consistent with the hypothesis that legalization leads to increased use of marijuana by teenagers.

Cigarette Taxes and Youth Smoking: Updated Estimates Using Yrbs Data

Using data from the state and national Youth Risk Behavior Surveys for the period 1991-2005, Carpenter and Cook (2008) found a strong, negative relationship between cigarette taxes and youth smoking. We revisit this relationship using four additional waves of YRBS data (2007, 2009, 2011, and 2013). Our results suggest that youths have become much less responsive to cigarette taxes since 2005. In fact, we find little evidence of a negative relationship between cigarette taxes and youth smoking when we restrict our attention to the period 2007-2013.

Building Resilience on Adolescent Mental Health Associated with Emerging Risk and Protective Factors among Ethnic Groups

A bulk of studies have focused on systematically catalogued risk and protective factors (e.g., parental monitoring, peer, neighborhood support) in terms of adolescent mental health status concerning resilience; however, they did not display any improvement regarding adolescent mental health, particularly in school-based interventions. Therefore, I suggested that whether other emerging factors (e.g., nutrition, physical activity) could be beneficial to promote effective school-based interventions. Hence, I examined adolescent mental health outcomes (depression and suicidality) associated with dietary patterns, physical activity, social support, watching TV, video/computer games, and sleeping habits factors regarding resilience approach. A secondary data analysis was employed based on the 2011 national Youth Risk Behavior Survey (YRBS) among 15,364 12-18 year-old African American, Asian, and Caucasian adolescents. Regarding nutrition, low levels of fruit, vegetable, potato, and fruit juice were associated with higher odds of depression, suicidal ideation, suicide attempts, for the most part among diverse ethnicities. Similarly, greater green salad intake resulted in lower odds of poor mental health outcomes among Asians and Caucasians. Next, consistent with current literature, low levels of social support in schools and higher levels of joining a sport team were strong predictors of poor mental health outcomes among overall ethnic groups. Lastly, healthy sleeping patterns, greater physical activity, low levels of being bullied in school, cyber bullied, and video/computer games increased the risk of poor mental health outcomes among adolescents.

The Meth Project and Teen Meth Use: New Estimates from the National and State Youth Risk Behavior Surveys

In this note, we use data from the national and state Youth Risk Behavior Surveys for the period 1999 through 2011 to estimate the relationship between the Meth Project, an anti-methamphetamine advertising campaign, and meth use among high school students. During this period, a total of eight states adopted anti-meth advertising campaigns. After accounting for pre-existing downward trends in meth use, we find little evidence that the campaign curbed meth use in the full sample. We do find, however, some evidence that the Meth Project may have decreased meth use among White high school students.

Staying Away From School

Perceptions of school safety, fear of crime among students, and school avoidance have received increasing research attention in recent decades. Feeling unsafe at school impacts mental health, absenteeism, and academic success. We focus on a behavioral indicator of heightened concern about safety among high school students. Using 2011 National Youth Risk Behavior Survey data, we examine how crime victimization, bullying, drug use, weapon carrying, defensibility, media exposure, social integration, and school disorder affect school avoidance. Complementary log–log regression results indicate differences in predictors across sex, race/ethnicity, and class year. Implications for policy and future research on school avoidance are discussed.

Indoor Tanning Among High School Students in the United States, 2009 and 2011

Indoor tanning is associated with an increased risk of skin cancer, including melanoma, and is particularly dangerous for younger and more frequent indoor tanners. To examine the prevalence of indoor tanning and frequent indoor tanning (≥10 times during the 12 months before each survey) and their association with health-related behaviors. A cross-sectional study examined data from the 2009 and 2011 national Youth Risk Behavior Surveys, which used nationally representative samples of US high school students representing approximately 15.5 million students each survey year. The study included 25,861 students who answered the indoor tanning question. The prevalence of indoor tanning and frequent indoor tanning were examined as well as their association with demographic characteristics and health-related behaviors using multivariable logistic regression modeling. The prevalence of indoor tanning was greater among female, older, and non-Hispanic white students. Indoor tanning was highest among female students aged 18 years or older, with 31.5% engaging in indoor tanning in 2011, and among non-Hispanic white female students, with 29.3% engaging in indoor tanning in 2011. Among female students, the adjusted prevalence of indoor tanning decreased from 26.4% in 2009 to 20.7% in 2011. Among female and male students, indoor tanning was associated with other risk-taking behaviors, such as binge drinking (P < .001 and P = .006, respectively), unhealthy weight control practices (P < .001, for both), and having sexual intercourse (P < .001, for both). Additionally, indoor tanning among female students was associated with using illegal drugs (P < .001) and having sexual intercourse with 4 or more persons (P = .03); use among male students was associated with taking steroids without a physician's prescription (P < .001), smoking cigarettes daily (P = .03), and attempting suicide (P = .006). More than half of respondents engaging in indoor tanning reported frequent use of the devices. Indoor tanning is common among high school students. Public health efforts are needed to change social norms regarding tanned skin and to increase awareness, knowledge, and behaviors related to indoor tanning. The clustering of risky behaviors suggests a need for coordinated, multifaceted approaches, including primary care physician counseling, to address such behaviors among adolescents.

Associations of school violence with physical activity among U.S. high school students.

This study investigated associations of violence-related behaviors with physical activity (PA)-related behaviors among U.S. high school students. Data from the 2009 national Youth Risk Behavior Survey, a cross-sectional survey of a nationally representative sample of 9th-12th grade students, were analyzed. Sex-stratified, adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated for associations between violence-related behaviors and being physically active for ≥60 minutes daily, sports participation, TV watching for ≥3 hours/day, and video game/computer use for ≥3 hours/day. Among male students, at-school bullying victimization was negatively associated with daily PA (aOR: 0.72; 95% CI: 0.58-0.87) and sports participation; skipping school because of safety concerns was positively associated with video game/computer use (1.42; 1.01-2.00); and physical fighting was positively associated with daily PA. Among female students, at-school bullying victimization and skipping school because of safety concerns were both positively associated with video game/computer use (1.46; 1.19-1.79 and 1.60; 1.09-2.34, respectively), and physical fighting at school was negatively associated with sports participation and positively associated with TV watching. Bullying victimization emerged as a potentially important risk factor for insufficient PA. Schools should consider the role of violence in initiatives designed to promote PA.

Trends in weight management goals and behaviors among 9th-12th grade students: United States, 1999-2009.

To examine trends in weight management goals and behaviors among U.S. high school students during 1999-2009. Data from six biennial cycles (1999-2009) of the national Youth Risk Behavior Survey were analyzed. Cross-sectional, nationally representative samples of 9th-12th grade students (approximately 14,000 students/cycle) completed self-administered questionnaires. Logistic regression models adjusted for grade, race/ethnicity, and obesity were used to test for trends in weight management goals and behaviors among subgroups of students. Combined prevalences and trends differed by sex and by race/ethnicity and weight status within sex. During 1999-2009, the prevalence of female students trying to gain weight decreased (7.6-5.7 %). Among female students trying to lose or stay the same weight, prevalences decreased for eating less (69.6-63.2 %); fasting (23.3-17.6 %); using diet pills/powders/liquids (13.7-7.8 %); and vomiting/laxatives (9.5-6.6 %) for weight control. During 1999-2009, the prevalence of male students trying to lose weight increased (26.1-30.5 %). Among male students trying to lose or stay the same weight, the prevalence of exercising to control weight did not change during 1999-2003 and then increased (74.0-79.1 %) while the prevalence of taking diet pills/powders/liquids for weight control decreased (6.9-5.1 %) during 1999-2009. Weight management goals and behaviors changed during 1999-2009 and differed by subgroup. To combat the use of unhealthy weight control behaviors, efforts may be needed to teach adolescents about recommended weight management strategies and avoiding the risks associated with unhealthy methods.

A Dual Pathway Model of Steroid Use among Adolescent Boys: Results from a Nationally Representative Sample.

Anabolic-androgenic steroid (AAS) use is associated with medical and psychiatric complications; however, despite the identification of psychosocial correlates of AAS use, comprehensive models have rarely been assessed. Thus, AAS use as a function of self-perceived weight status, victimization, and depressive symptoms was examined via simultaneous multiple mediation with non-parametric bootstrapping. Data from the 2009 National Youth Risk Behavior Survey (YRBS) was utilized. The target population consisted of all public, Catholic, and other private school students in grades 9 through 12 in the United States. The sample comprised 8,065 adolescent high school males. The global and individual indirect effects of self-perceived underweight status to AAS use through depressive symptoms and victimization were significant. However, the victimization pathway was revealed to be stronger in magnitude than the depressive pathway. Depressive symptoms and victimization are two pathways in which self-perceived underweight status predicts AAS use among adolescent boys.

Inaccurate Weight Perception Is Associated With Extreme Weight‐Management Practices in US High School Students

The objective of the present study was to examine whether adolescents' weight perception accuracy (WPA) was associated with extreme weight-management practices (EWPs) in differing body mass index (BMI) categories. WPA, overassessment, and underassessment were determined by comparing self-reported BMI and weight perception among U.S. high school students in the 2009 National Youth Risk Behavior Survey. BMI was classified as follows: underweight (<5th percentile), healthy weight (5th to <85th), overweight (≥85th to <95th), and obese (≥95th). WPA was considered inaccurate if BMI and weight perception were discordant. Overassessors thought they were heavier than they were (among underweight/healthy groups); underassessors thought they were lighter than they were (among healthy/overweight/obese groups). EWPs included ≥1 of fasting, use of diet pills, or purging/laxative use. Logit models were fitted for different BMI sex strata. In the final sample of 14,722 US high school students with complete data, 20.2%, 85.7%, 5.8%, and 80.9% of those who were underweight, healthy weight, overweight, and obese, inaccurately assessed their weight, respectively. In turn, 11.4% and 17.6% of accurate and inaccurate assessors engaged in EWPs, respectively. After adjustment, underweight girls who overassessed their weight had 12.6 times higher odds of EWPs (95% confidence interval 3.4-46.6). Moreover, there were elevated odds of EWPs among healthy weight students who overassessed their weight. Overassessing healthy weight students and underweight girls had higher odds of ≥1 EWPs, likely related to an unhealthy desire to lose weight. The present study demonstrates a need to further educate clinicians on WPA and its relation to EWPs even among those of healthy weight who may be seen as not at risk.