National Youth Risk Behavior Survey Research Articles

Factors Associated with Distinct Patterns of Suicidal Thoughts, Suicide Plans, and Suicide Attempts Among US Adolescents.

The current study examined demographic, psychosocial, and substance use factors associated with distinct patterns of past 12-month suicide thoughts, plans, and attempts among adolescents drawn from a nationally representative sample of high schoolers. Data were from the 2015, 2017, and 2019 National Youth Risk Behavior Survey. Four mutually exclusive 12-month suicidal behavior patterns were identified: suicide thoughts only (pattern 1), suicide thoughts and plans without suicide attempt (pattern 2), suicide attempt with thoughts and/or plans (pattern 3), and suicide attempt without thoughts or plans (pattern 4). Multinomial logistic regression analyses were conducted to examine factors correlated with these distinct patterns. Psychosocial and substance use factors were modeled as independent predictors, controlling for demographic characteristics, as well as simultaneously to represent the potential for co-occurrence. The analytic sample included 7491 respondents. About 24% (n = 1734) of youth endorsed pattern 1, 38% (n = 2779) pattern 2, 35% (n = 2716) pattern 3, and 3% (n = 262) pattern 4. All psychosocial and substance use factors measured were individually associated with greater odds of suicide attempts with thoughts or plans (pattern 3) than patterns 1 or 2. Black and male youth were at greater odds of suicide attempts without thoughts or plans (pattern 4) than all other patterns. When modeled simultaneously, respondents who were bullied online, sad or hopeless, had a history of sexual violence, used cigarettes, and misused prescription opiates retained greater odds of suicide attempts with thoughts or plans (pattern 3) than patterns 1 or 2. Findings suggest screening for suicidal behaviors should include factors that differentiate between varying suicidal expressions and that may cue providers to intervene in the absence of suicide thoughts and plans.

Does geographic location matter for transportation risk behaviors among U.S. public high school students?

IntroductionTeen motor vehicle crash fatality rates differ by geographic location. Studies assessing teen transportation risk behaviors by location are inconclusive. Therefore, we explored the role of census region and metropolitan status for driving prevalence and four transportation risk behaviors among U.S. public high school students. MethodsData from 2015 and 2017 national Youth Risk Behavior Surveys were combined and analyzed. Multivariable models controlled for sex, age, race/ethnicity, grades in school, and school socioeconomic status. ResultsOverall, 41% of students did not always wear a seat belt. Students attending schools in the Northeast were 40% more likely than those in the Midwest to not always wear a seat belt. Among the 75% of students aged ≥16 years who had driven during the past 30 days, 47% texted/e-mailed while driving. Students in the Northeast were 20% less likely than those in the Midwest to text/e-mail while driving, and students attending suburban or town schools were more likely to text/e-mail while driving (20% and 30%, respectively) than students attending urban schools. Nineteen percent of students rode with a driver who had been drinking alcohol, and 7% of drivers aged ≥16 years drove when they had been drinking alcohol, with no significant differences by location for either alcohol-related behavior. ConclusionsWe found few differences in teen transportation risk behaviors by census region or metropolitan status. Age at licensure, time since licensure, driving experience, and the policy and physical driving environment might contribute more to variation in teen fatal crashes by location than differences in transportation risk behaviors. Regardless of location, teen transportation risk behaviors remain high. Future research could address developing effective strategies to reduce teen cell phone use while driving and enhancing community implementation of existing, effective strategies to improve seat belt use and reduce alcohol consumption and driving after drinking alcohol.

Sex-Stratified Trends in Meeting Physical Activity Guidelines, Participating in Sports, and Attending Physical Education Among US Adolescents, Youth Risk Behavior Survey 2009-2019.

During the past decade, guidelines for youth aerobic and muscle-strengthening physical activity remained unchanged. Active People, Healthy NationSM highlighted school and youth strategies (eg,sports and physical education [PE]) to increase physical activity. Sex, grade, and race/ethnicity disparities exist. This study examines sex-specific trends and differences by grade and race/ethnicity for the prevalence of 5 youth physical activity behaviors from 2009 to 2019. The national Youth Risk Behavior Survey assesses adolescents (grades 9-12) meeting the aerobic, muscle-strengthening, and both guidelines (2011-2019) and sports participation and daily PE (2009-2019). Sex-stratified logistic regression assessed trends and 2009 or 2011-2019 differences by grade and racial/ethnic subgroups. Decreases in meeting the aerobic, muscle-strengthening, and both guidelines were observed for nearly all male subgroups by grade and race/ethnicity, whereas female subgroups exhibited declines or no change to low prevalence. Sports and PE participation remained mostly constant; select subgroups showed decreases (ie,Hispanic males [sports]; Black males and ninth-grade females [PE]). Past decade prevalence and patterns suggest that school-based and other strategies for all adolescents and tailored interventions for sex-specific subgroups may be needed to supplement sports and PE in promoting high school youth physical activity.

Association between First Sexual Intercourse and Sexual Violence Victimization, Symptoms of Depression, and Suicidal Behaviors among Adolescents in the United States: Findings from 2017 and 2019 National Youth Risk Behavior Survey.

The objective of this study was to investigate the association between first sexual intercourse and sexual violence victimization, symptoms of depression, and suicidal ideation among sexually active adolescents in the United States. Data for this study came from the U.S. 2017 and 2019 iterations of the National Youth Risk Behavior Survey. An analytic sample of 6252 adolescents aged 14–18 years old (49.5% female) who reported ever having sexual intercourse was analyzed using Poisson regression. The outcome variables investigated in this study were sexual violence victimization, symptoms of depression, suicidal ideation, a suicide plan, and suicide attempts, and the main explanatory variables were age at first sexual intercourse and forced sexual intercourse. We also analyzed differences by gender and race. Of the 6252 adolescents who reported ever having sexual intercourse, 7.1% had their first sexual intercourse before age 13, and 14.8% experienced forced sexual intercourse. About 16% of adolescents experienced sexual violence during the past year, 42.6% reported symptoms of depression, 23.9% experienced suicidal ideation, 19.3% made a suicide plan, and 11.1% attempted suicide during the past year. In the regression analysis, early sexual intercourse was significantly and positively associated with suicidal ideation (relative risk (RR) = 1.15, 95% Confidence Interval (CI) = 1.02–1.30), suicide plan (RR = 1.18, 95% CI = 1.00–1.38), and suicide attempts (RR = 1.36, 95% CI = 1.15–1.61). Controlling for the effects of covariates, history of forced sexual intercourse was positively associated with the five outcomes examined with the relative risk ranging between 1.59 and 6.01. Findings of this study suggest that history of early or forced sexual intercourse is associated with poor mental health outcomes among adolescents and underscores the importance of developing interventions that offer psychological support in reducing the adverse impact of early sexual intercourse and forced sexual intercourse on adolescent health.

Health Risk Behaviors, Experiences, and Conditions Among Students Attending Private and Public High Schools.

Approximately 8.8% of US high school students attended private schools in 2015. Few studies have characterized health risk behaviors among these students or compared prevalence of behaviors between students in private and public schools using a contemporary, nationally representative sample. Pooled 2007-2017 national Youth Risk Behavior Survey data were used to estimate the prevalence of 35 health risk behaviors for 89,848 public and private high school students. Unadjusted prevalence ratios were used to compare prevalence by school type. Differences in behaviors by school type were explored by sex and grade. Among private school students, the prevalence ranged from 5.0% to 31.9% for sexual risk behaviors; from 0.8% to 30.1% for substance use behaviors; from 0.7% to 21.8% for behaviors related mental health and suicide; from 3.2% to 6.8% for violence victimization experiences; and from 3.1% to 52.9% for behaviors related to unhealthy diet and physical inactivity. Private school students were less likely than public school students to report most behaviors; differences by school type were generally consistent across sex and grade. Students in both public and private schools reported health risk behaviors. Findings might inform prevention activities by identifying behaviors to prioritize in each school setting.

Trends in Sunscreen Use Among US Middle and High School Students, 2007-2019.

Objective: The purpose of this project is to analyze trends in sunscreen usage among middle and high school students from the Centers of Disease Control’s National Youth Risk Behavior Surveys (YRBS) from the years 2007 to 2019.Methods: Data from the 2007-2019 National YRBS were analyzed. YRBS is a cross-sectional survey of health risk behaviors among middle and high school students (grades 6-12) in the United States. Students were asked questions regarding sunscreen usage and demographic information, including age, race/ethnicity, and gender.Results: From 2007 to 2019, the average mean sunscreen usage for all students increased by 4% between every consecutive year studied. Mean sunscreen usage among all racial groups studied, other than Native Hawaiian or Other Pacific Islanders, increased. Females were 92.7% more likely to use sunscreen than males each year. The mean sunscreen usage decreased by 5% with an increase in a student’s age.Conclusions: Though overall sunscreen use in adolescents increased over the time period from 2007 to 2019, sunscreen use still remains limited due to a variety of factors possibly including cost, tanning, and different socio-cultural perceptions of sunscreen.

Temporal Trends in Suicidal Ideation and Attempts Among US Adolescents by Sex and Race/Ethnicity, 1991-2019

Disparities by sex and racial/ethnic group in suicide death rates are present in US adolescents. Whether disparities in suicide death extend to groups targeted for suicide prevention efforts, namely, those with suicidal ideation or nonfatal suicide attempts, is unknown. To examine differences in temporal trends between suicidal ideation and suicide attempts in US adolescents from 1991 through 2019 by sex and race/ethnicity subgroups. A cross-sectional analysis of the national Youth Risk Behavior Survey, weighted to represent US adolescents from 1991 to 2019, included 183 563 US high-school students in grades 9 to 12. Data were analyzed from September 16, 2020, through April 12, 2021. Calendar year, sex, race/ethnicity, and interactions of sex and race/ethnicity. Survey-weighted prevalence estimates, annual percentage changes (APCs) and average APC in the survey-weighted prevalence of suicidal ideation and nonfatal suicide attempts, constructed from self-reported suicidal ideation, plan, and attempts in each survey year, by sex, race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian or Pacific Islander and Native Hawaiian, American Indian/Alaska Native), and their interactions (sex × race/ethnicity). In 183 563 (unweighted) included adolescents (mean [SD] age, 16.07 [1.23] years; 94 282 females [weighted percentage, 49.4%; 95% CI, 48.8%-50.1%]), the prevalence of suicidal ideation decreased from 1991 to 2019 (from 19.4% to 15.8%; 95% CI, 0.7%-0.9%), whereas the prevalence of nonfatal suicide attempts increased from 1991 to 2019 (from 7.3% to 8.9%; 95% CI, 1.0%-1.4%). Joinpoint regression indicated a -3.1% (95% CI, -3.7% to -2.6%) annual decrease in suicidal ideation between 1991 and 2009, followed by a 3.4% annual increase (95% CI, 1.9% -4.8%) between 2009 and 2019. Decreasing followed by increasing trends in suicidal ideation showed modestly different turning points in female (1991-2009, 2009-2019), White (1991-2009, 2009-2019), Hispanic (1991-2007, 2007-2019), and Black (1991-2005, 2005-2019) adolescents. Although no significant trends were observed in suicide attempts from 1991 through 2019, male (68.4% increase; 95% CI, 0.2% -1.2%) and Black (79.7% increase; 95% CI, 0.1%-1.5%) adolescents had greater increases in the prevalence of suicide attempts. Interaction of sex and race/ethnicity revealed increases in suicidal ideation in White females from 2009 to 2019 (APC, 4.3%; 95% CI, 1.5%-7.1%), Black females from 2005 to 2019 (APC, 3.4%; 95% CI, 1.4%-5.4%), and Hispanic females from 2009 to 2019 (APC, 3.3%; 95% CI, 1.0%-5.6%) and suicide attempts in White females from 2009 to 2019 (APC, 3.1%; 95% CI, 0.3%-6.0%). The findings of this study show apparent sex and racial/ethnic differences in trends in suicidal ideation and suicide attempts. Increases in suicidal ideation since 2009 were observed in female individuals; changes in male and Black adolescents represented the largest increase in the prevalence of suicide attempts between 1991 and 2019. Evidence-based suicide prevention programs need to be tailored by sex and race/ethnicity, calling for greater diversification of health care system, school, and community prevention approaches.

Effects of Condom Use on Human Immunodeficiency Virus Transmission Among Adolescent Sexual Minority Males in the United States: A Mixed Epidemiology and Epidemic Modeling Study.

We examined condom use patterns and potential population-level effects of a hypothetical condom intervention on human immunodeficiency virus (HIV) transmission among adolescent sexual minority males (ASMM). Using 3 data sets: national Youth Risk Behavior Survey 2015 to 2017 (YRBS-National), local YRBS data from 8 jurisdictions with sex of partner questions from 2011 to 2017 (YRBS-Trends), and American Men's Internet Survey (AMIS) 2014 to 2017, we assessed associations of condom use with year, age, and race/ethnicity among sexually active ASMM. Using a stochastic agent-based network epidemic model, structured and parameterized based on the above analyses, we calculated the percent of HIV infections averted over 10 years among ASMM ages 13 to 18 years by an intervention that increased condom use by 37% for 5 years and was delivered to 62% of ASMM at age 14 years. In YRBS, 51.8% (95% confidence interval [CI], 41.3-62.3%) and 37.9% (95% CI, 32.7-42.3%) reported condom use at last sexual intercourse in national and trend data sets, respectively. In AMIS, 47.3% (95% CI, 44.6-49.9%) reported condom use at last anal sex with a male partner. Temporal trends were not observed in any data set (P > 0.1). Condom use varied significantly by age in YRBS-National (P < 0.0001) and YRBS-Trends (P = 0.032) with 13- to 15-year-olds reporting the lowest use in both; age differences were not significant in AMIS (P = 0.919). Our hypothetical intervention averted a mean of 9.0% (95% simulation interval, -5.4% to 21.2%) of infections among ASMM. Condom use among ASMM is low and appears to have remained stable during 2011 to 2017. Modeling suggests that condom use increases, consistent with previous interventions, have potential to avert 1 in 11 new HIV infections among ASMM.

Electronic Vapor Product Use and Sexual Risk Behaviors in US Adolescents.

Adolescent electronic vapor product (EVP) usage continues to increase and is associated with heightened engagement in other risk behaviors. However, there is limited research on associations between youth EVP use and sexual risk behaviors (SRBs). In this study, we examined how current youth EVP and/or cigarette usage, as well as EVP usage frequency, is related to several SRBs. Respondents (N = 12 667) of the 2017 National Youth Risk Behavior Survey were categorized by previous 30-day EVP and/or cigarette usage: nonuse, EVP use only, cigarette use only, or dual use. Separately, respondents were categorized by previous 30-day EVP usage frequency: 0, 1 to 9, 10 to 29, or 30 days. Ten SRBs were identified as dependent variables. Adjusted prevalence ratios were calculated by using modified Poisson regression to determine associations between SRBs and both current EVP and/or cigarette usage and EVP usage frequency. Linear contrasts compared adjusted prevalence ratios across usage and frequency categories. Youth EVP-only users and dual users were more likely than nonusers to engage in 9 of 10 SRBs. Prevalence proportions did not differ between EVP-only users and dual users for 7 of 10 behaviors. Occasional EVP users were more likely than nonusers to engage in 9 of 10 SRBs and were similarly as likely as frequent and daily users to engage in all 10 SRBs. EVP usage among US high school students, with or without concurrent cigarette use, was associated with heightened engagement in several SRBs. Prevalence of engagement in most SRBs did not differ among occasional, frequent, and daily EVP users.

Bullying Victimization is Associated with a Significantly Greater Risk of Illicit Substance Use among US Female Adolescents: YRBS 2011 to 2017

Bullying victimization among adolescents is associated with increased illicit substance use. This research estimates whether the association between bullying victimization and substance use is significantly greater among female adolescents. Using R software and the national Youth Risk Behavior Survey (2011, 2013, 2014, and 2017), interactions were estimated to determine the association between self-reported school or electronic bullying victimization and previous 30-day alcohol use, binge drinking, marijuana use, cigarette smoking, and electronic vaping product use. Bullying victimization was significantly associated with each of the substance use variables, Effects were significantly greater in female students. Efforts should be put in place in schools and communities to reduce bullying, mitigate the harmful effects of this form of victimization, and reduce illicit substance use.

Temporal Trends and Disparities in Suicidal Behaviors by Sex and Sexual Identity Among Asian American Adolescents

Although suicide is the second leading cause of death among Asian American adolescents, there is a dearth of studies examining overall and possible sex and sexual orientation disparities in the trends in suicidal behaviors among Asian American adolescents. Such information is crucial to inform targeted efforts of suicide prevention among Asian American adolescents. To examine temporal trends and sex and sexual orientation disparities in trends of nonfatal suicidal behaviors in Asian American adolescents from 1991 through 2019. This cross-sectional study used data from the national Youth Risk Behavior Survey from 1991 through 2019, analyzing a representative sample of US adolescents in grades 9 through 12 using a 3-stage cluster-sampling design. Data were analyzed from October through November 2020. Calendar year, sex, sexual identity, sex of sexual contact, and interaction terms of these factors. Crude prevalence and annual percentage changes (APCs) in self-reported suicidal ideation, suicide plan, suicide attempts, and injury by suicide attempt for the overall sample and by sex, sexual identity, and sex of sexual contacts were calculated. Sexual minorities were defined as individuals whose sexual identity was gay or lesbian, bisexual, or not sure. Among 7619 Asian Americans who participated in the Youth Risk Behavior Survey from 1991 to 2019 (mean [SD] age, 16.09 [1.29] years; 3760 [47.1%] female adolescents), 1576 individuals completed the sexual identity and behaviors questions after 2015 (mean [SD] age, 15.97 [1.28] years; 810 [49.2%] female adolescents). From 2009 through 2019, there was a 1.3-fold (95% CI, -0.8 to 3.3; P = .22) increase in suicide attempts and a 1.7-fold (95% CI, -2.6 to 5.9; P = .45) increase in injury by suicide attempt among Asian American female adolescents, although these increases were not statistically significant. Among 39 Asian American adolescents who identified as gay, lesbian, or bisexual or who were attracted to and had sexual contact with partners of the same sex or both sexes, compared with 1556 Asian American adolescents who were heterosexual, prevalence was greater for suicidal ideation (24 individuals [68.2%] vs 223 individuals [15.0%]; P < .001), suicide plan (15 individuals [57.7%] vs 179 individuals [11.9%]; P < .001), suicide attempts (14 individuals [41.0%] vs 74 individuals [5.5%]; P < .001), and injury by suicide attempt (5 individuals [17.6%] vs 23 individuals [1.7%]; P < .001) between 2015 and 2019. These sexual minorities identified by sexual identity and sexual contact also had an increasing rate over this period in suicide plan (APC, 10.5%; 95% CI, 4.4% to 16.9%; P < .001). This study found significant increases in rates of suicide plan among Asian American adolescents who were sexual minorities identified by sexual identity and sexual contact together. These findings suggest that suicide screening needs to inquire about sexual minority status in terms of sexual identity and sex of sexual contact when identifying Asian American adolescents who are at risk for suicidal behaviors. Culturally relevant suicide-prevention programs addressing unique risk and protective factors, racial discrimination, and sexual orientation-related stigma may be needed for Asian American adolescents.

Past 6-Year Trends in Current Alcohol Use among Cyberbullied Adolescents

ABSTRACT Background Most of the research on alcohol use and being cyberbullied has focused on the correlation between the two. Less is known about the recent epidemiology of adolescent current alcohol use. Objective: To describe the trends in current alcohol use among adolescence that self-report being cyberbullied across sex and racial/ethnic groups. Methods: The data from the present study came from the national Youth Risk Behavior Surveys (YRBS) from 2011 to 2017. We estimated the prevalence of current alcohol use across years by biological sex and race/ethnicity. Further we tested for linear and quadratic trends. Results: We observed statistically significant decreases in alcohol use cyberbullied (b= −0.12, p < 0.00), and non-cyberbullied individuals (b=-0.15, p < 0.00). Further, we found significant decreases for cyberbullied males (b= −0.10, p < 0.01), females (b= −0.17, p < 0.01) blacks (b= −0.39, p < 0.00), and Hispanics (b= −0.17, p < 0.01). Whites and other races were did not have a significant change. We also found significant decreases for cyberbullied white males and females, black males (b=-0.46, p < 0.03) and females (b= −0.37, p < 0.02), Hispanic males (b=-0.33, p < 0.00). White males and females and other males and females did not have significant changes in alcohol use prevalence. Conclusions: Consistent with national trends, alcohol use among adolescents is decreasing. The decrease is occurring within those that are being cyberbullied. Further research with different data are necessary to further validate these results.

Bullying and Cyberbullying among LGBQ and Heterosexual Youth from an Intersectional Perspective: Findings from the 2017 National Youth Risk Behavior Survey

ABSTRACT While LGBTQ youth may be victims of bullying at greater rates than heterosexual youth, research examining in-school bullying and cyberbullying victimization disparities through an intersectional framework is limited. Using the 2017 Youth Risk Behavior Survey, the present study examined the prevalence of in-school bullying and cyberbullying victimization across sexual orientation, gender, race, and grade (N = 13,567). Results position sexual minority youth at higher odds of experiencing in-school bullying and cyberbullying than heterosexual youth and show that bisexual youth were more likely than gay/lesbian youth to be cyberbullied. Findings from intersectional analyses show within-group variation in bullying victimization across sexual orientation based on gender, grade, and race. Specific intersectional results and implications for in-school bullying and cyberbullying prevention and intervention efforts are discussed.

Vital Signs: Prevalence of Multiple Forms of Violence and Increased Health Risk Behaviors and Conditions Among Youths - United States, 2019.

IntroductionExperiencing violence, especially multiple types of violence, can have a negative impact on youths’ development. These experiences increase the risk for future violence and other health problems associated with the leading causes of morbidity and mortality among adolescents and adults.MethodsData from the 2019 national Youth Risk Behavior Survey were used to determine the prevalence of high school students’ self-reported experiences with physical fighting, being threatened with a weapon, physical dating violence, sexual violence, and bullying. Logistic regression models adjusting for sex, grade, and race/ethnicity were used to test the strength of associations between experiencing multiple forms of violence and 16 self-reported health risk behaviors and conditions.ResultsApproximately one half of students (44.3%) experienced at least one type of violence; more than one in seven (15.6%) experienced two or more types during the preceding 12 months. Experiencing multiple types of violence was significantly more prevalent among females than among males and among students identifying as gay, lesbian, or bisexual or not sure of their sexual identity than among heterosexual students. Experiencing violence was significantly associated with higher prevalence of all examined health risks and conditions. Relative to youths with no violence experiences, adjusted health risk and condition prevalence estimates were up to seven times higher among those experiencing two types of violence and up to 21 times higher among those experiencing three or more types of violence.Conclusions and implications for public health practiceMany youths experience multiple types of violence, with potentially lifelong health impacts. Violence is preventable using proven approaches that address individual, family, and environmental risks. Prioritizing violence prevention is strategic to promoting adolescent and adult health.

Suicide Attempts in Association With Traditional and Electronic Bullying Among Heterosexual and Sexual Minority U.S. High School Students

PurposeThe aim of this study was to compare the association between bullying (traditional, electronic, and both) and suicide attempt in heterosexual and lesbian, gay, or bisexual (LGB) U.S. high school students. MethodsData were obtained from 2015–2017 National Youth Risk Behavior Survey. ResultsNearly 25% of students reported experiencing bullying. Approximately 5.9% of heterosexual and 25.7% of LGB students attempted suicide. Heterosexual students who experienced either traditional or electronic bullying had a higher risk of attempting suicide (1.54 [95% confidence interval 1.19–1.98] and 1.64 [1.23–2.19], respectively). The associations were similar but weaker among LGB students (1.49 [1.08–2.04] and 1.43 [.90–2.27], respectively). Students who experienced both forms of bullying had the highest prevalence of suicide attempt, but the interaction was not statistically significant. ConclusionsLGB students had higher rates of both suicide attempts and experiencing bullying. Traditional and electronic bullying are not synergistic in the risk of attempting suicide, although each form increases that risk.

Percentage of Adolescents Meeting Federal Fruit and Vegetable Intake Recommendations - Youth Risk Behavior Surveillance System, United States, 2017.

According to the 2020-2025 Dietary Guidelines for Americans, persons should consume fruits and vegetables as part of a healthy eating pattern to reduce their risk for diet-related chronic diseases, such as cardiovascular disease, type 2 diabetes, some cancers, and obesity.* A healthy diet is important for healthy growth in adolescence, especially because adolescent health behaviors might continue into adulthood (1). The U.S. Department of Agriculture (USDA) recommends minimum daily intake of 1.5 cups of fruit and 2.5 cups of vegetables for females aged 14-18 years and 2 cups of fruit and 3 cups of vegetables for males aged 14-18 years.† Despite the benefits of fruit and vegetable consumption, few adolescents consume these recommended amounts (2-4). In 2013, only 8.5% of high school students met the recommendation for fruit consumption, and only 2.1% met the recommendation for vegetable consumption (2). To update the 2013 data, CDC analyzed data from the 2017 national and state Youth Risk Behavior Surveys (YRBSs) to describe the percentage of students who met intake recommendations, overall and by sex, school grade, and race/ethnicity. The median frequencies of fruit and vegetable consumption nationally were 0.9 and 1.1 times per day, respectively. Nationally, 7.1% of students met USDA intake recommendations for fruits (95% confidence interval [CI]=4.0-10.3) and 2.0% for vegetables (upper 95% confidence limit=7.9) using previously established scoring algorithms. State-specific estimates of the percentage of students meeting fruit intake recommendations ranged from 4.0% (Connecticut) to 9.3% (Louisiana), and the percentage meeting vegetable intake recommendations ranged from 0.6% (Kansas) to 3.7% (New Mexico). Additional efforts to expand the reach of existing school and community programs or to identify new effective strategies, such as social media approaches, might help address barriers and improve adolescent fruit and vegetable consumption.

Sports- and Physical Activity–Related Concussion and Risk for Youth Violence

Sports and physical activities are an important cause of traumatic brain injury among adolescents. Childhood traumatic brain injury has been associated with cognitive impairment, emotional problems, and impaired behavior control, and these neuropsychological changes may place these youth at increased risk for engagement in violence-related behaviors. Data from the 2017 National Youth Risk Behavior Survey (N=14,765), a nationally representative survey of U.S. high school students, were analyzed in 2019 to examine the associations between sports- and physical activity-related concussion and violence-related behaviors occurring in the community and at school. Multivariable logistic regression models were used to calculate sex-stratified, adjusted (for race/ethnicity, grade, athlete status, impaired cognitive functioning, feeling sad/hopeless, and current substance use) prevalence ratios. Prevalence ratios were considered statistically significant if p<0.05. Male students (17.1%) were more likely than female students (13.0%) to experience a sports- and physical activity-related concussion during the 12 months preceding the survey. Compared with students who did not have a concussion, those who experienced ≥1 sports- and physical activity-related concussion were more likely to be in a physical fight (male students, adjusted prevalence ratio=1.45; female students, adjusted prevalence ratio=1.55), carry a weapon (male students, adjusted prevalence ratio=1.24; female students, adjusted prevalence ratio=1.79), and fight at school (male students, adjusted prevalence ratio=1.40; female students, adjusted prevalence ratio=1.77). In addition, male students were more likely to carry a gun (adjusted prevalence ratio=1.62) and carry a weapon at school (adjusted prevalence ratio=1.73). Although the direction of these associations is unknown, return-to-school programs may benefit from inclusion of assessment and counseling around issues of psychological and social functioning, conflict resolution, and coordination with violence prevention programs.

Substance Use and Sports- or Physical Activity-Related Concussions Among High School Students.

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

Racial and Ethnic Differences in the Relationship Between Risk-Taking and the Effectiveness of Adolescents' Contraceptive Use.

Little is known about whether adolescents' risk-taking in areas other than sex is associated with the effectiveness of their contraceptive method use, or whether any such associations vary by race and ethnicity. Data from the 2011, 2013 and 2015 National Youth Risk Behavior Surveys were used to examine nonsexual risk behaviors and contraceptive method choice among 5,971 sexually active females aged 13-18. Risk-taking profiles for White, Black and Hispanic adolescents were identified using latent class analysis. Multinomial logistic regression was used to estimate the associations between these risk profiles and use of less- or more-effective contraceptive methods at last sexual intercourse. Three distinct risk-taking profiles were identified for White and Hispanic adolescents and two for Black adolescents. Compared with their counterparts in the low-risk "abstainer" group, White adolescents in the "high substance use and violence" group were less likely to use condoms alone (relative risk, 0.4) or a prescription contraceptive paired with condoms (0.3) rather than no contraceptive at all, and more likely to use withdrawal or no method rather than condoms alone (2.4 each). However, higher risk-taking among Whites was positively associated with using prescription contraceptives rather than condoms (1.9). Among Black and Hispanic females, lower risk-taking was associated only with more condom use. Future studies should examine whether interventions designed to reduce adolescent risk-taking improve the effectiveness of contraceptive use, particularly among White females. However, efforts to increase Black and Hispanic adolescents' use of more-effective contraceptives should target barriers other than risk-proneness. Perspectives on Sexual and Reproductive Health, 2020, 52(4):TK, doi:10.1363/psrh.12165.

Differences in Adolescent Experiences of Polyvictimization and Suicide Risk by Sexual Minority Status.

Sexual minority adolescents (SMA) report more suicide risk behaviors than heterosexual adolescents. Polyvictimization (co-occurrence of multiple types of victimization) may be an important, underresearched correlate of this disparity. With the 2017 national Youth Risk Behavior Survey (N=13,179), national estimates of polyvictimization and suicide risk were assessed among high school students by sexual minority status (SM vs. heterosexual), and multivariate relationships between sexual minority status, polyvictimization, and suicide risk were tested. Additionally, risk profiles of those who experienced polyvictimization (2+types of victimization; n=1,932) were compared across sexual minority status. Results confirm that SMA are more likely to experience polyvictimization than heterosexual adolescents (31.8% v. 12.9%, respectively); however, also indicate that polyvictimization does not fully explain elevated suicide risk among SMA.