National Youth Risk Behavior Survey Research Articles

Substance Use and Disparities in Teen Dating Violence Victimization by Sexual Identity Among High School Students.

Sexual minority youth (SMY) report more substance use and experience more physical and sexual dating violence victimization than heterosexual youth; however, few studies have explored the relationship between substance use and disparities in teen dating violence and victimization (TDVV) using national-level estimates, and examined if these relationships vary by sexual minority subgroups. Data from the nationally representative 2015 and 2017 national Youth Risk Behavior Surveys were used to examine differences in TDVV and substance use by sexual identity, and to determine if substance use was associated with TDVV disparities between SMY and heterosexual high school students who dated 12months prior to the survey (n = 18,704). Sex-stratified logistic regression models generated prevalence ratios adjusted for demographic characteristics and substance use behaviors to determine if substance use mediated the relationship between sexual identity and TDVV. Compared with their heterosexual peers, SMY experienced higher rates of TDVV and were more likely to report using most types of substances, although differences were more pronounced among female students compared with male students. Disparities in TDVV were reduced for male gay and bisexual students as well as for female bisexual students once substance use was entered into the model, suggesting that there is a relationship between substance use and some of gay and bisexual students' risk for experiences of TDVV. Comprehensive efforts for violence prevention among sexual minority students may benefit from incorporating substance use prevention, given its relationship to disparities in TDVV.

Electronic Vapor Product Usage and Substance Use Risk Behaviors Among U.S. High School Students.

Objectives: The initiation of substance use at a young age increases one's likelihood of developing substance use disorders (SUDs). Understanding trends in youth substance-related risk behaviors is important in identification and prevention of SUDs. The objective of this study was to assess, in a nationally representative sample of U.S. high school students, how current electronic vapor product (EVP), cigarette, and dual-product usage as well as EVP usage frequency are related to other substance use behaviors. Methods: Respondents (N = 12,667) of the 2017 National Youth Risk Behavior Survey were categorized by previous 30-day EVP and cigarette usage into one of four groups: nonuse, cigarette only, EVP only, or dual use. Separately, respondents were categorized by 30-day EVP usage frequency: 0, 1-9, 10-29, or 30 days. Thirteen substance use behaviors were selected as dependent variables. Adjusted prevalence ratios (aPRs) were calculated using multivariable modified Poisson regression to determine associations between outcome behaviors and both current EVP/cigarette usage and EVP usage frequency. Linear contrasts were conducted to compare aPRs across categories. Results: Cigarette, EVP, and dual users were more likely to engage in 12 of 13 substance use behaviors compared to nonusers (p < 0.001). Dual-users were more likely than EVP-only users to engage in 12 of 13 behaviors. Past 30-day EVP users at any frequency were also more likely to engage in nearly all risk behaviors examined. Occasional EVP users were similarly likely as frequent and daily users to engage in 11 of 13 behaviors. Conclusions: Adolescent EVP use, with or without concurrent cigarette smoking, is associated with a higher likelihood of engagement in several substance use behaviors. Prevalence of risk behaviors is generally greater for dual users than EVP-only users, but prevalence proportions do not significantly differ among occasional, frequent, or daily EVP users for most behaviors.

Relationship between unhealthy weight control behaviors and substance use patterns among Korean adolescents: results from the 2017 national youth risk behavior survey

ObjectiveUnhealthy weight control behaviors (UWCBs) can lead to numerous health problems. Adolescents who engage in UWCB are more likely to abuse substances than other adolescents. However, few studies have examined the relationship between UWCB and substance use, despite the fact that their co-occurrence can result in greater morbidity and mortality. The aim of this study was to examine the association between UWCB and substance use patterns among Korean adolescents using nationally representative data. Study designThis study involved an analysis of statistical data collected from 27,284 adolescent participants (13–18 years old) in the 2017 Korean Youth Risk Behavior Web-based Survey. MethodsThe Chi-squared test and multiple logistic regression analysis were performed to demonstrate the association between substance use patterns (energy drink intake, alcohol use, cigarette smoking, electronic cigarette use, and drug use) and UWCB (one-food diets, fasting, diet pill use, and purging). All statistical analyses were performed to reflect complex sampling weights. ResultsMore female than male adolescents reported to be engaged in any of the following UWCBs: one-food diets (female: 9.6%, male: 4.8%), fasting (female: 11.6%, male: 7.4%), diet pill use (female: 2.9%, male: 1.5%), and purging (female: 4.1%, male: 2.2%). The prevalence of all UWCBs tended to increase as energy drink intake (P < 0.001), cigarette smoking (P < 0.001), and electronic cigarette use (P < 0.001) increased. ConclusionsHealth professionals who work with adolescents need to be aware of the importance of screening for UWCB, including one-food diets, fasting, diet pill use, and purging, especially as a co-occurrence with substance use.

Adolescent Health Behaviors and Difficulty Concentrating, Remembering, and Making Decisions.

The purpose of this study was to examine the associations among physical activity, dietary behaviors, and other salient health behaviors such as smoking, alcohol consumption, and sleeping with self-reported adolescent mental health on the 2017 National Youth Risk Behavior Survey (YBRS). A multistage cluster sampling procedure was employed to yield a representative sample of US adolescents. The number of sampled adolescents with usable data was 14 765. Weighted logistic regression models were employed to examine the predictive utility of independent health behaviors associating with reported mental health problems (difficulty concentrating, remembering, or making decisions), and meeting multiple health behavior criteria with reported mental health problems adjusting for age, sex, body mass index percentile, and race/ethnicity. Meeting physical activity guidelines, consuming breakfast every day, not smoking and/or consuming alcohol in the past 30 days, and sleeping at least 8 hours per night independently associated with lower odds of mental health problems (P < .01). For every one additional positive health behavior met, there were significantly lower odds of reported mental health problems (OR = 0.73, 95%CI 0.68-0.78, P < .001). Meeting salient positive health behavior criteria and meeting multiple positive health behavior criteria associated with lower odds of self-reported difficulty concentrating, remembering, or making decisions on the 2017 National YRBS.

Impact of State Laws Governing Physical Education on Attendance Among US High School Students, 2003 to 2017.

This study assessed the influence of state laws governing physical education (PE) on weekly PE class attendance among US high school students. Cross-sectional. 2003 to 2017 US national Youth Risk Behavior Survey (YRBS). A total of 533 468 high school students. Data on state laws governing PE came from National Cancer Institute's Classification of Laws Associated with School Students (CLASS). Eight distinct state PE policies were scored, with higher scores denoting stronger laws. Individual-level YRBS data were merged with CLASS data based on students' residential state and survey year. State fixed-effect negative binomial regressions were performed, adjusting for individual-level characteristics and YRBS survey design. A 1-score increase in state laws governing PE class time, staffing for PE, joint use agreement for physical activity, assessment of health-related fitness, and PE curriculum was associated with an increase in weekly PE attendance by 0.30, 0.28, 0.22, 0.20, and 0.13 days (P < .001), respectively. In contrast, a 1-score increase in state laws governing moderate-to-vigorous-intensity physical activity time in PE, PE proficiency, and recess time was associated with a reduction in weekly PE attendance by 0.25, 0.15, and 0.09 days (P < .001), respectively. The effects of most state PE policies on PE class attendance were larger among girls than boys. State PE policies differentially impacted US high school students' PE class attendance, with larger effects on female students.

Substance Use Patterns Among Adolescents: A Latent Class Analysis.

BACKGROUND: Substance use among adolescents remains a major public health concern, which is correlated with mortality. AIMS: The purpose of this study was to (1) examine risk factors predisposing adolescents to substance use and (2) identify patterns of simultaneous drug exploration among adolescents. METHOD: Data (N = 15,624; collected in 2015) were drawn from the Centers for Disease Control and Prevention, National Youth Risk Behavior Survey, which is a national school-based survey of 9th- to 12th-grade students to monitor health risk behaviors. Substance use was assessed using self-reported questionnaires, and latent class analysis and logistic regression were used for data analysis. RESULTS: Five latent patterns of substance use were identified: (1) abstinent (64%); (2) 1st-step social experimenter (25%) (i.e., used alcohol, e-cigarettes, and/or marijuana); (3) 2nd-step social experimenter (6%) (i.e., used alcohol, cigarettes, e-cigarettes, marijuana, synthetic marijuana, and/or prescription pills); (4) pill experimenter (4%), (i.e., used prescription pills); (5) full experimenter (2%) (i.e., likely to use all assessed substances). Gender, race, grade, and depressive mood were strong predictors of membership in a particular substance use class. CONCLUSION: Adolescents presenting for care may possess symptoms associated with various substances beyond those being managed. Mental health nurses can leverage these results in reducing adolescent substance use through primary and secondary prevention. A longitudinal study of not only substance use patterns but also the progression to substance use disorders among adolescents is warranted.

Prevalence of Indoor Tanning Among U.S. High School Students from 2009 to 2017.

Indoor tanning exposes users to high levels of ultraviolet radiation, increasing skin cancer risk. The risk is greatest for those who begin indoor tanning at a young age. The objective of this study was to assess changes in indoor tanning prevalence over time among U.S. high school students, by sex, age, and race/ethnicity. We used cross-sectional data from the 2009, 2011, 2013, 2015, and 2017 national Youth Risk Behavior Survey to examine changes in indoor tanning prevalence from 2009 to 2017 and from 2015 to 2017. From 2009 to 2017 indoor tanning declined overall (15.6 to 5.6%; p < 0.001), across all age groups, and among white (37.4 to 10.1%; p < 0.001) and Hispanic (10.5 to 3.0%; p < 0.001) female students, and white (7.0 to 2.8%; p < 0.001) and Hispanic (5.8 to 3.4%; p < 0.001) male students. From 2015 to 2017, indoor tanning declined overall (7.3 to 5.6%; p = 0.04) and among white (15.2 to 10.1%; p = 0.03) and Hispanic (5.8 to 3.0%; p = 0.02) female students, and 16-year-old students (7.2 to 4.7%; p = 0.03). Indoor tanning has continued to decrease, particularly among white and Hispanic female students, dropping well below the Healthy People 2020 target for adolescents. However, continued efforts are needed to further reduce and sustain reductions in adolescent indoor tanning and address remaining research gaps.

College affirmative action bans and smoking and alcohol use among underrepresented minority adolescents in the United States: A difference-in-differences study.

BackgroundCollege affirmative action programs seek to expand socioeconomic opportunities for underrepresented minorities. Between 1996 and 2013, 9 US states—including California, Texas, and Michigan—banned race-based affirmative action in college admissions. Because economic opportunity is known to motivate health behavior, banning affirmative action policies may have important adverse spillover effects on health risk behaviors. We used a quasi-experimental research design to evaluate the association between college affirmative action bans and health risk behaviors among underrepresented minority (Black, Hispanic, and Native American) adolescents.Methods and findingsWe conducted a difference-in-differences analysis using data from the 1991–2015 US national Youth Risk Behavior Survey (YRBS). We compared changes in self-reported cigarette smoking and alcohol use in the 30 days prior to survey among underrepresented minority 11th and 12th graders in states implementing college affirmative action bans (Arizona, California, Florida, Michigan, Nebraska, New Hampshire, Oklahoma, Texas, and Washington) versus outcomes among those residing in states not implementing bans (n = 35 control states). We also assessed whether underrepresented minority adults surveyed in the 1992–2015 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) who were exposed to affirmative action bans during their late high school years continued to smoke cigarettes between the ages of 19 and 30 years. Models adjusted for individual demographic characteristics, state and year fixed effects, and state-specific secular trends. In the YRBS (n = 34,988 to 36,268, depending on the outcome), cigarette smoking in the past 30 days among underrepresented minority 11th–12th graders increased by 3.8 percentage points after exposure to an affirmative action ban (95% CI: 2.0, 5.7; p < 0.001). In addition, there were also apparent increases in past-30-day alcohol use, by 5.9 percentage points (95% CI: 0.3, 12.2; p = 0.041), and past-30-day binge drinking, by 3.5 percentage points (95% CI: −0.1, 7.2, p = 0.058), among underrepresented minority 11th–12th graders, though in both cases adjustment for multiple comparisons resulted in failure to reject the null hypothesis (adjusted p = 0.083 for both outcomes). Underrepresented minority adults in the TUS-CPS (n = 71,575) exposed to bans during their late high school years were also 1.8 percentage points more likely to report current smoking (95% CI: 0.1, 3.6; p = 0.037). Event study analyses revealed a discrete break for all health behaviors timed with policy discussion and implementation. No substantive or statistically significant effects were found for non-Hispanic White adolescents, and the findings were robust to a number of additional specification checks. The limitations of the study include the continued potential for residual confounding from unmeasured time-varying factors and the potential for recall bias due to the self-reported nature of the health risk behavior outcomes.ConclusionsIn this study, we found evidence that some health risk behaviors increased among underrepresented minority adolescents after exposure to state-level college affirmative action bans. These findings suggest that social policies that shift socioeconomic opportunities could have meaningful population health consequences.

Old-for-Grade Status and Suicide Risk in U.S. High School Students

Health-risk behaviors associated with increased risk of suicide are more prevalent in old-for-grade students compared to age-appropriate-for-grade peers; however, the association between old-for-grade status and suicidal behavior is largely unknown. This study investigated sex-specific differences in suicidal ideation, planning, attempts, and other risk behaviors by old-for-grade status. Secondary analyses utilizing bivariate and logistic regression methods for complex samples were conducted using data from the 2011, 2013, and 2015 National Youth Risk Behavior Survey for 16,579 female and 17,282 male high school students in grades 9 through 11. Among both males and females, students considered old-for-grade reported increased drug use, feeling sad/hopeless, violence, sexual activity, and limited/no seatbelt use compared with their peers. Old-for-grade students were also more likely to report a suicide attempt with increased suicidal ideation and planning observed only in old-for-grade males. Associations between old-for-grade status and suicide risk–related outcomes were attenuated in both sexes after adjusting for demographic characteristics and other health-risk behaviors. Findings suggest that common risk factors (e.g., sadness, substance use) may explain increased rates of suicidal behaviors in old-for-grade students.

Adolescent prescription opioid misuse, illicit opioid use and overdose

Adolescent prescription opioid misuse, illicit opioid use and overdose

Substance use, violence experiences, and mental health issues: are these health risks associated with HIV testing among sexually experienced U.S. high school students?

ABSTRACTHIV testing is a critical strategy for prevention of HIV yet testing among sexually experienced adolescents is sub-optimal. The purpose of this study is to examine associations between risk behaviors and experiences related to substance use, violence, and mental health and suicide and receipt of testing. We analyzed cross-sectional data from the 2017 national Youth Risk Behavior Survey, a nationally representative sample of U.S. high school students in grades 9–12. Analyses were limited to sexually experienced participants (n = 5192). Measures included nine indicators related to substance use, violence, and mental health and suicide. Unadjusted and adjusted prevalence ratios were calculated for each indicator to examine associations with testing. Adjusted models controlled for same-sex sexual behavior, sexual risk, and demographic characteristics. Prevalence of HIV testing was 17.2%. In adjusted models, forced sexual intercourse, injection drug use, other illicit drug use, and persistent feelings of sadness or hopelessness were associated with a higher likelihood of testing. Prevalence of HIV testing in this sexually experienced sample was low. Some behaviors and experiences that may be indicative of HIV risk, including sexual dating violence and prescription opioid misuse, were not associated with testing.

Trends in the use of cigarettes, cigars, and marijuana among students with and without asthma, 2003–2017

Aim: Asthma has symptoms that can be exacerbated by using combustible products such as tobacco and marijuana. This study assessed the prevalence and trends in current use of cigarettes, cigars, and marijuana among U.S. high school students with and without asthma. Methods: The national Youth Risk Behavior Survey (YRBS) is a biennial, school-based, nationally representative survey of U.S. students in grades 9–12. Trends during 2003–2017 in current (past 30-day) use of cigarettes, cigars, and marijuana among students with and without asthma were examined using logistic regression. Asthma was defined as reporting that a doctor or nurse ever told the student they had asthma. T-tests were used to compare cigarette, cigar, and marijuana use by asthma status and year, frequency of use, and student characteristics. Results: During 2003–2017, both current cigarette and cigar smoking decreased (p < 0.05) with rates that were similar among students with and without asthma. There was no significant linear change in current marijuana use, irrespective of asthma status. During most years, cigarette, cigar, and marijuana use were more common among students with asthma than without. In 2017, the most frequent use of cigarettes, cigars, and marijuana was among those with asthma than without. Differences in cigarette, cigar, and marijuana use by asthma status were apparent by demographic subgroups. Conclusions: Given the adverse respiratory effects of tobacco and marijuana smoking, efforts to educate all youth about the dangers of using these substances is critical, particularly among those with asthma.

Does the association between substance use and sexual risk behaviors among high school students vary by sexual identity?

ObjectiveLimited information exists on whether associations between substance use behaviors (SUBs) and sexual risk behaviors (SRBs) vary by sexual identity. MethodsData from the 2015 national Youth Risk Behavior Survey (n = 15,624), were analyzed to assess associations between SUBs (cigarette smoking, alcohol use, binge drinking, marijuana use, prescription drug misuse, injection drug use, illicit drug use) and SRBs (sexual activity, number of partners, condom use). Logistic regression models calculated adjusted prevalence ratios (aPR), stratified by sexual identity, and interaction effects for sexual identity were introduced to models to determine if associations varied by sexual identity. ResultsAll SUBs had significant associations with current sexual activity and 4+ sexual partners for both heterosexual and LGB students. No condom use during last sexual intercourse was significantly associated with all SUBs except alcohol use among heterosexual students, while no condom use was only significantly associated with injection drug use among LGB students. Associations between current sexual activity and SUBs were significantly stronger among heterosexual compared to LGB students for smoking (aPR = 2.39;95% CI:2.15,2.65 vs aPR = 1.49;95% CI:1.14,1.95), marijuana use (2.41;2.15,2.71 vs 1.86;1.58,2.19) and prescription drug misuse (2.10;1.93,2.28 vs 1.60;1.28,2.00). Associations between no condom use and SUBs were significantly stronger for heterosexual compared to LGB students only for smoking (1.32;1.16,1.50 vs 0.96;0.73,1.25) and marijuana use (1.22;1.07,1.38 vs 0.90;0.72,1.12). ConclusionsThe relationship between most SUBs and SRBs did not vary significantly by sexual identity. These findings underscore the importance coordinating school-based programs to prevent substance use and promote sexual health.

70. Sexual Health Behaviors By School Level Socioeconomic Status And Urbanicity, National Youth Risk Behavior Survey (YRBS) 2015-2017

The economic and social conditions in which high school students live and learn (i.e., social determinants of health [SDOH]) influence both academic achievement and health outcomes. Although the Youth Risk Behavior Survey (YRBS) is the longest established, nationally representative, comprehensive surveillance system monitoring health-related behaviors among high school students, the survey does not include individual-level indicators for SDOH. This is the first study to stratify YRBS data by school-level socio-economic status (SES) and urbanicity to examine their association with sexual health behaviors. The national YRBS is a cross-sectional survey conducted biennially among a nationally representative sample of public and private students in grades 9–12. YRBS data from 2015 (N= 15,624, response rate= 60%) and 2017 (N= 14,765, response rate= 60%) were combined, and then linked with extant data to identify school-level estimates for SES (percentage of students eligible for free- and reduced-price meals [%FRPM]) and urbanicity (urban, suburban/town, or rural) among students attending public schools. %FRPM was categorized as low poverty (25% of students or less), average (26%-75%), and high poverty (more than 75%). This study examined whether sexual health behaviors (currently sexually active, 4+ lifetime sexual partners, condom use during last sexual intercourse, hormonal birth control during last sexual intercourse, condom and hormonal birth control during last sexual intercourse [dual use protection], and drank alcohol or used drugs before last sexual intercourse) varied by %FRPM and urbanicity. Adjusted Prevalence Ratios (APR) were calculated using logistic regression models that controlled for sex, race/ethnicity, and grade. Associations were considered significant at p <0.05 level. Compared to students in low poverty schools, students in average (APR=1.33, 95% CI= 1.17-1.51) and high poverty schools (1.44, 1.19-1.73) were more likely to be sexually active, and students in average (1.44, 1.16-1.78) and high poverty schools (1.68, 1.22-2.32) were more likely to have four or more sexual partners. Compared to students in low poverty schools, students in high poverty schools were less likely to use a condom (0.84, 0.74-0.96) or hormonal birth control (0.78, 0.64-0.96) during last sexual intercourse, and students in average (0.79, 0.64-0.97) and high poverty schools (0.71, 0.54-0.94) were less likely to have used alcohol or drugs during last sex. Some sexual health behaviors differed by urbanicity. Compared to students in rural schools, students in suburban/town schools were less likely to be sexually active (0.89, 0.80-0.98); and students in urban schools were less likely to have used hormonal birth control (0.85, 0.73-0.99) and dual use protection (0.72, 0.56-0.92) during last sexual intercourse. High school students attending rural or high poverty schools have a higher prevalence of some sexual health behaviors that increase their risk for teen pregnancy and STIs, including HIV/AIDS. The Centers for Disease Control and Prevention’s YRBS provides an opportunity to examine the relationship between sexual behaviors and SES and urbanicity, key measures for adolescent social determinants of health.

269. Bullying, Weapon Carrying And Mental Health Outcomes Among U.S. High School Students - Results From A Nationally Representative Survey

Research has well established a link between bullying and weapons carrying, and between bullying and poor mental health. We connect these bodies of literature, using data from a large nationally representative study of U.S. high school students to examine how weapons carrying mediates the association between bullying and mental health outcomes. Data were 2007-2017 cycles of the national Youth Risk Behavior Survey (YRBS), a biennial, nationally representative survey of health risk behaviors among US high school students. Our analytic sample included 2,569 (2.9% of larger sample; N=88,189) who reported any kind of bullying in the past 12 months and had complete information on whether or not they carried a weapon. We dichotomized four bullying outcomes (past 12 months: school, electronic, got into physical fight, and threatened at school with a weapon) and one weapon carrying variable (past 12 months) – from here, we created one new carried a weapon after being bullied (CWB) (no/yes; e.g. did not carry a weapon post-bullying vs. did carry a weapon post-bullying) for each bullying type. Mental health outcomes included (all dichotomized, past 2 weeks, no/yes): felt sad or hopeless, seriously considered suicide, had a plan for suicide and attempted suicide. We used binary logistic regression adjusted for YRBS sampling methods and weighting to examine the influence of CWB on mental health outcomes (Stata 15.0). Data are publically available and de-identified; therefore, they are classified as exempt by the first author's institution. About half the sample was male (53.1%), one-quarter were in each high school grade, about half were White (46.4%) and one-fifth were sexual minority. Students most frequently carried a weapon if they had been threatened at school with a weapon (25.6%) or if they had been in a physical fight (21.5%). About half as many youth carried a weapon after they had been bullied at school (7.2%) or electronically bullied (8.1%). Carrying a weapon after being school bullied (OR=0.59, p<.001) or threatened with a weapon (OR=0.67, p<.01) was associated with lower odds of feeling sad or hopeless. Students were less likely to consider suicide if they carried a weapon after being threatened with a weapon (OR=0.59, p<.01). Weapons carrying after electronic bullying (OR=0.74, p<.05) or after being threatened with a weapon was associated with lower odds having a plan for suicide. However, carrying a weapon after all types of bullying (electronic: OR=2.91, p<.001; school: OR=3.23, p<.001; being threatened with a weapon: OR=2.16, p<.01; getting into a fight: OR=2.42, p<.01) doubled the odds of attempting suicide. Weapons carrying has a complex relationship with mental health after bullying. Clinicians’ assessing weapons carrying in response to bullying as a part of history taking during routine adolescent health care visits may supplement understanding of the impact of bullying on mental health.

Health risk behaviors, violence exposure, and current asthma among adolescents in the United States.

Asthma may worsen during adolescence, due to both health risk behaviors and psychosocial stressors commonly encountered during this life stage. Cross-sectional study of 24 612 high school students who participated in the 2009 and 2011 National Youth Risk Behavior Survey. Multivariable logistic regression was used to examine the relation between self-reported health risk behaviors or psychosocial stressors and current asthma. Mediation analysis was performed to assess whether depressive symptoms or suicidal behavior contribute to the link between psychosocial stressors and asthma. Current asthma was reported by 13.1% of the study participants. In a multivariable analysis, female sex, obesity, shorter sleep duration, frequent soda/pop consumption, and marijuana use were each significantly associated with 14-36% increased odds of asthma. Any violent behavior (adjusted odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.02-1.24), any victimization (OR = 1.43, 95%CI = 1.29-1.58), any suicidal behavior (OR = 1.41, 95%CI = 1.22-1.64) and having felt sad or hopeless in the past year (OR = 1.57, 95%CI = 1.40-1.75) were each associated with current asthma. In a mediation analyses, having felt sad/hopeless and suicidal behaviors accounted for 21% and 14%, respectively, of the victimization-asthma association. Potentially modifiable risk factors, including obesity, short sleep duration, frequent soda/pop consumption, and psychosocial stressors are associated with asthma in US adolescents. Promoting healthier lifestyles, as well as screening for violence exposure and treating depressive symptoms, could help reduce asthma burden in this population.

Sexual Orientation Enumeration in State Antibullying Statutes in the United States: Associations with Bullying, Suicidal Ideation, and Suicide Attempts Among Youth.

The aim was to assess the associations of antibullying U.S. state statutes that enumerate sexual orientation with exposure to bullying and other stressors and with suicidal ideation and suicide attempts in sexual minority and non sexual minority youth. We analyzed data from the 2015 national school-based Youth Risk Behavior Survey, representative of 9th through 12th grade students attending public and private schools in the United States. We reviewed each state's antibullying statutes and classified them on enumeration. Antibullying state laws that enumerate sexual orientation were associated with lower risk for suicide attempts and serious attempts requiring medical attention and lower risk for forced sexual intercourse. They were also associated with feeling safe at school or on the way to or from school. Results did not differ by sexual orientation. Enumeration of sexual orientation was associated with reduced stressors and suicide attempts, but it is insufficient to remove significant disparities based on sexual orientation. Additional policies and practices are required to address persistent sexual orientation disparities in exposure to bullying and suicidal behavior.

Violence Victimization, Substance Use, and Suicide Risk Among Sexual Minority High School Students - United States, 2015-2017.

Youths identifying as lesbian, gay, bisexual, or another nonheterosexual identity (sexual minority youths) report more violence victimization, substance use, and suicide risk than do heterosexual youths (1). These disparities are generally attributed to minority stress (the process through which stigma directed toward sexual minorities influences health outcomes) (2,3). Sexual minority youths might experience negative outcomes associated with minority stress differently across sexual identities, but to date, no nationally representative study has examined differences in victimization, substance use, and suicide risk within sexual minority youth. Using pooled data from the 2015 and 2017 national Youth Risk Behavior Surveys (YRBS), relationships between sexual identity groups and victimization, substance use, and suicide risk were evaluated with sex-stratified logistic regression models. Compared with heterosexual students, bisexual females and all sexual minority males reported more victimization; lesbian and bisexual females reported more use of alcohol, cigarettes, and marijuana; and all sexual minority youths reported elevated high-risk substance use and suicide risk. Programmatic efforts to reduce and prevent victimization, substance use, and suicide risk among sexual minority youths might benefit from consideration of issues within group differences.

Association between psychological distress and elevated use of electronic devices among U.S. adolescents: Results from the youth risk behavior surveillance 2009-2017

ObjectiveThe purpose of this study was to provide updated information about the prevalence and temporal trends of elevated use of electronic devices (EUED) in leisure time (i.e., 3 h or more on an average school day) in nationally representative samples of U.S. adolescents in recent years and to determine whether there is a significant association between EUED and psychological distress. MethodsWe used the national Youth Risk Behavior Survey (YRBS) data from 2009, 2011, 2013, 2015, and 2017 (N = 75,807). Propensity score matching was used to reduce selection bias due to potential confounding factors with EUED. Ordinal logistic regression analyses were performed for the matched samples to predict the association between EUED and psychological distress. ResultsThe prevalence of EUED in U.S. youth has substantially increased from 24.9% in 2009 to 43.1% in 2017 (p < .001). Boys had higher rates of EUED than girls only in 2009 and 2011 but not in 2013, 2015, and 2017. A significant association between EUED and psychological distress was identified throughout all the five survey years. The odds of having a higher level of psychological distress increased approximately 1.5 times among youth with EUED than those without. ConclusionsThe prevalence of U.S. youth with psychological distress and EUED has increased simultaneously in the past several years. Future longitudinal studies are warranted to examine causal and/or reciprocal relationship between the two.

Sexual Risk Behavior Differences Among Sexual Minority High School Students — United States, 2015 and 2017

Sexual minority youths (i.e., those identifying as gay, lesbian, bisexual, or another nonheterosexual identity or reporting same-sex attraction or sexual partners) are at higher risk than youths who are not sexual minority youth (nonsexual minority youth) for negative health behaviors and outcomes, including human immunodeficiency virus (HIV) infection, other sexually transmitted diseases (STDs), pregnancy (1),* and related sexual risk behaviors (2). Less is known about sexual risk behavior differences between sexual minority youth subgroups. This is the first analysis of subgroup differences among sexual minority youths using nationally representative Youth Risk Behavior Survey (YRBS) data. CDC analyzed pooled data from the 2015 and 2017 cycles of the national YRBS, a cross-sectional, school-based survey assessing health behaviors among U.S. students in grades 9-12. Analyses examined differences in eight sexual risk behaviors between subgroups of sexual minority youths and nonsexual minority youths, as well as within sexual minority youths. Logistic regression models controlling for race/ethnicity and grade found that bisexual females and "not sure" males reported higher prevalences for many behaviors than did heterosexual students. For behavior-based subgroups, the largest number of differences were seen between students who had sexual contact with both sexes compared with students with only opposite-sex sexual contact. Findings highlight subgroup differences within sexual minority youths that could inform interventions to promote healthy behavior.