National Youth Risk Behavior Survey Research Articles

Co-occurring risk factors among U.S. high school students at risk for suicidal thoughts and behaviors

BackgroundSuicidal thoughts and behaviors (STBs) are increasing among adolescents in the United States and are challenging to predict and prevent. The current study identifies subtypes of youth at risk for suicidal thoughts and behaviors (STBs) in school-based settings. MethodData are from the CDC's 2015 and 2017 National Youth Risk Behavior Survey of US high school students. Among students reporting depression symptoms, latent class analysis is used to identify subtypes at risk for STBs based on personal characteristics, risk behaviors and environments. ResultsTwo distinct subtypes of youth were found to be at high risk for STBs: The first, larger subtype (22%) is predominately females in early high school, many of whom identify as bisexual, experienced past-year bullying, and are likely to have experienced sexual victimization. These students have low levels of externalizing risk behaviors making them difficult to detect. The second high-risk subtype (7%) is characterized by students with significant social integration challenges, with extremely high levels of substance abuse, fighting, physical and sexual victimization and poor academic performance. Many of these students have low English fluency, and identify as sexual minority. LimitationsDue to attrition or language barriers, experiences of some students at high-risk for STBs may not have been captured by this survey. ConclusionUniversal screening in clinical settings, and universally focused suicide prevention programs in school-based settings are needed and should be introduced early on. Interventions should be tailored to reach high-risk students with language, cultural and social integration challenges.

The Role of Depression, Anxiety and Illness Characteristics on Risky Sexual Behaviour among People Living with HIV in A Malaysian Tertiary Reference Hospital

Background: People living with HIV (PLHIV) have a longer lifespan with treatment and continue to be sexually active. To date, the extent of risky sexual behaviour among local PLHIV and its associated factors were undetermined. Objective: To examine the role of depression, anxiety and illness characteristics on risky sexual behaviour among PLHIV attending care in a Malaysian tertiary reference hospital (N= 406). Method: It was a cross-sectional study. Subjects were recruited by systematic random sampling. Risky sexual behaviour was determined by using the modified National Youth Risk Behaviour Survey. PHQ-9 and GAD-7 were used to measure the depressive and anxiety symptoms, respectively. Chi-square test was used to examine the association between the variables. Multiple logistic regression was used to examine the predictors of the study. A p value of less than 0.05 was considered significant and odds ratio was used as the measure of risk association. Results: Our study showed that 29.3% had risky sexual behaviour. Meanwhile, 21.9% and 26.4% had depressive and anxiety symptoms, respectively. Risky sexual behaviour was significantly associated with age, religion, education level, duration of HIV diagnosis, depressive and anxiety symptoms. From multivariate logistic regression, duration of HIV diagnosis and anxiety symptoms significantly predicted risky sexual behaviour. Conclusion: This study highlights that a substantial number of PLHIV had risky sexual behaviour and psychological symptoms. It is important for psychological interventions that reduce risky sexual behaviour among PLHIV who attend treatment, especially during the early phase.

Sports Participation Correlates With Academic Achievement: Results From a Large Adolescent Sample Within the 2017 U.S. National Youth Risk Behavior Survey.

This study sought to examine associations between (a) sports team participation; (b) lifestyle behaviors (e.g., sleeping, alcohol, and tobacco use); and (c) dietary behaviors with self-reported academic achievement using data derived from the 2017 U.S. National Youth Risk Behavior Survey. A multistage cluster sampling procedure was employed to obtain a representative sample of U.S. adolescents from among whom the number with usable data was 14,765. We used weighted logistic regression models to examine the associations between sports participation, lifestyle behaviors, and diet with reported academic achievement (mostly A’s and B’s), adjusting for age, sex, body mass index, and race/ethnicity. After controlling for lifestyle behaviors, diet, and other potentially confounding variables, we found that adolescents participating in one or more sport teams throughout the past year also reported higher academic achievement (A’s and B’s) compared with adolescents participating in zero sports teams (odds ratio [ OR] = 1.39 to 2.40, p < .001). This relationship was dose-dependent, as participating in multiple sports teams (i.e., > 3) showed a stronger association with academic achievement than participating on only one sports team ( p < .001). Other independent behavioral correlates with similarly high grades included daily breakfast consumption ( OR = 1.40, p < .001), sleeping at least eight hours per night ( OR = 1.21, p < .001), and regular consumption of vegetables ( OR = 1.56, p < .001) and salads ( OR = 1.30, p < .001). We discuss the meaning and implication of these findings.

National Instant Criminal Background Check and Youth Gun Carrying.

Despite being unable to purchase firearms directly, many adolescents have access to guns, leading to increased risk of injury and death. We sought to determine if the National Instant Criminal Background Check System (NICS) changed adolescents' gun-carrying behavior. We performed a repeated cross-sectional study using National Youth Risk Behavior Survey data from years 1993 to 2017. We used a survey-weighted multivariable logistic regression model to determine if the NICS had an effect on adolescent gun carrying, controlling for state respondent characteristics, state laws, state characteristics, the interaction between the NICS and state gun laws, and time. On average, 5.8% of the cohort reported carrying a gun. Approximately 17% of respondents who carried guns were from states with a universal background check (U/BC) provision at the point of sale, whereas 83% were from states that did not have such laws (P < .001). The model indicated that the NICS together with U/BCs significantly reduced gun carrying by 25% (adjusted relative risk = 0.75 [95% confidence interval: 0.566-0.995]; P = .046), whereas the NICS independently did not (P = .516). Adolescents in states that require U/BCs on all prospective gun buyers are less likely to carry guns compared with those in states that only require background checks on sales through federally licensed firearms dealers. The NICS was only effective in reducing adolescent gun carrying in the presence of state laws requiring U/BCs on all prospective gun buyers. However, state U/BC laws had no effect on adolescent gun carrying until after the NICS was implemented.

School-Level Poverty and Persistent Feelings of Sadness or Hopelessness, Suicidality, and Experiences with Violence Victimization among Public High School Students.

To examine the association between school-level poverty status and students' persistent feelings of sadness or hopelessness, suicidality, and experiences with violence victimization among U.S. high school students. Public schools captured in the 2015 and 2017 national Youth Risk Behavior Surveys were categorized as high-, mid-, or low-poverty based on the percentage of students eligible for free or reduced-price meals (N=29,448). Students in high-poverty schools were significantly more likely than students in low-poverty schools to experience persistent feelings of sadness or hopelessness, experience suicidal thoughts and attempts, not go to school because of safety concerns, be threatened or injured with a weapon on school property, be bullied on school property, be physically forced to have sexual intercourse, and be victims of sexual and physical dating violence. School and community approaches to address suicide and violence victimization may be especially important for students living in poverty.

Cigarette Taxes and Teen Marijuana Use

The spillover effect of cigarette taxes on youth marijuana use has been the subject of intense public debate. Opponents of cigarette taxes warn that tax hikes will cause youths to substitute toward marijuana. On the other hand, public health experts often claim that because tobacco is a “gateway” drug, higher cigarette taxes will deter youth marijuana use. Using data from the National and State Youth Risk Behavior Surveys (YRBS) for the period 1991-2017, we explore the relationship between state excise taxes on cigarettes and teen marijuana use. In general, our results fail to support either of the above hypotheses. Rather, we find little evidence to suggest that teen marijuana use is sensitive to changes in the state cigarette tax. This null result holds for the sample period where cigarette taxes are observed to have the largest effect on teen cigarette use and across a number of demographic groups in the data. Finally, we find preliminary evidence that the recent adoption of state e-cigarette taxes is associated with a reduction in youth marijuana use. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

The Association Between State Physical Education Laws and Student Physical Activity

This study examined the association between state physical education time requirements and physical activity and physical education outcomes among high school students. State physical education time requirement laws for 2004-2016 from the Classification of Laws Associated with School Students database were linked with 2005-2017 national Youth Risk Behavior Survey data using state and year identifiers. Analyses were conducted between 2018 and 2019 to assess associations between physical education time requirement laws and physical activity or physical education outcomes using multinomial logistic regressions, while controlling for sociodemographic characteristics, year-fixed effects, and state confounders. State laws requiring ≥90 minutes of physical education per week were associated with 3.1 percentage points lower probability of no days of physical activity ≥60 minutes (95% CI= -5.0, -1.1), 3.7 percentage points lower probability of no days of moderate exercise ≥30 minutes (95% CI= -6.2, -1.3), 4.2 percentage points lower probability of no days of vigorous exercise ≥20 minutes (95% CI= -5.2, -3.3), and 19.3 percentage points lower probability of not attending physical education class (95% CI= -34.4, -4.2). The laws were associated with a 2.4 percentage point higher probability of daily moderate exercise ≥30 minutes in male students (95% CI=0.6, 4.2) and a 3.4 percentage point higher probability in female students (95% CI=1.9, 4.9), with larger associations for female students (p<0.01). Findings from this study help support the role that physical education state requirements can play in enhancing adolescents' ability to meet recommended amounts of daily physical activity and the related public health benefits.

Associations of adolescent lifestyle behaviors with body mass index within a nationally representative sample of US adolescents: a quantile regression analysis

ObjectivesThe purpose of this study was to examine the associations between lifestyle behavior variables such as physical activity, television watching, computer use, and school night sleep duration with body mass index percentile (BMI%) using quantile regression within a representative sample of adolescents who completed the 2017 US National Youth Risk Behavior Survey. Study designThe study design was a cross-sectional study. MethodsA multistage cluster sampling procedure obtained a representative sample of US adolescents. The number of sampled adolescents submitting questionnaires with BMI% data was 13,146. To examine the associations between lifestyle behaviors and BMI%, simultaneous quantile regression was used. ResultsWhen relationships were modeled at every 10th percentile, more precise parameter estimates were observed at higher percentiles. Across the interquartile range, physical activity associated with lower BMI% at the 50th and 75th percentiles (brange = −2.27% to −5.24%, P < 0.05), television watching associated with higher BMI% at the 25th to 75th percentiles (brange = 2.29%–4.16%, P < 0.05), sleep durations less than 8 h per school night associated with higher BMI% at the 25th and 50th percentile (brange = 2.81%–8.26%, P < 0.05), and 10 or more hours of school night sleep associated with higher BMI% at the 50th and 75th percentile (brange = 3.43%–7.53%, P < 0.05). ConclusionsHigher levels of physical activity associated with lower BMI% and longer time watching television, school night sleep durations less than 8 h, and school night sleep durations of 10 h or more at higher quantiles associated with higher BMI% in adolescents. Estimates of association were more precise within higher quantiles.

History of Concussion and Nonfatal Suicidal Behaviors in U.S. High School Students: Findings from the 2017 National Youth Risk Behavior Survey

ObjectiveTo examine the association between concussion history and suicidal behaviors in adolescents from the 2017 National Youth Risk Behavior Survey (YRBS).BackgroundResearch indicates that behavioral changes such as impulsivity and lack of emotional control are common following youth concussion. Additional evidence suggests that poor behavioral regulation may contribute to altered mood states that precede possible self-injury or fatality. To date, the relation between adolescent concussion and suicidal behaviors has not been explored on a national scale.Design/MethodsData from 14,765 high school students were cross-sectionally analyzed. Weighted multivariate logistic regressions were conducted to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI) of suicidal behaviors in students with and without a history of concussion. Age, sex, and alcohol use were controlled for in the regression model.ResultsAdolscents with history of concussion were at greater odds of reporting suicidal ideation (AOR = 1.39, CI 1.16, 1.65), suicide planning (AOR = 1.34, CI 1.14, 1.57), suicidal attempts (AOR = 1.68, CI 1.36, 2.09), and injurious suicidal attempts (AOR = 2.42, CI 1.82, 3.22). In addition, females with a history of concussion demonstrated greater odds of reporting poor mental health than males with history of concussion (p’s &lt; 0.05). Further, history of concussion among individuals aged 16 years or older was significantly associated with increased suicidal behaviors, whereas this association was not observed in younger adolescents (p’s &lt; 0.05).ConclusionsOur findings indicate that adolescents who sustain a concussion have greater odds of suicidality than their uninjured counterparts. Further, suicidality was better predicted by concussion exposure in females than males, and in older students. Consequently, these results indicate the importance of examining mental health following youth concussion, and highlight the need for further longitudinal research.

Energy balance-related factors associating with adolescent weight loss intent: evidence from the 2017 National Youth Risk Behavior Survey

BackgroundThe purpose of this study was to examine specific energy balance-related behaviors (sedentary behaviors, physical activity, and dietary) associating with adolescent weight loss intent using data from the 2017 US Youth Risk Behavior Survey (YRBS).MethodsThis was a cross-sectional study that employed a multi-stage cluster sampling procedure to obtain a representative sample of US adolescents. The target population consisted of public and private high schoolers from grades 9 through 12. The number of sampled adolescents was 18,324 with 14,765 of the 18,324 sampled students (Mean age = 15.9 (1.3) years) submitting questionnaires with usable data (81% response rate). The outcome was intent to lose weight with specific energy-balance related behaviors examined as predictor variables. A weighted logistic regression model was employed to examine the associations between sedentary behaviors, physical activity, and dietary-related variables with weight loss intent controlling for age, sex, BMI percentile, and race/ethnicity.ResultsVariables associating with adolescent intent to lose weight included 3 or more hours of video game playing (OR = 1.15, 95%CI: 1.01–1.31, p = 0.028), achieving 60 min of physical activity daily (OR = 0.66, 95%CI: 0.59–0.73, p < 0.001), daily breakfast consumption (OR = 0.76, 95%CI: 0.67–0.87, p < 0.001) and weekly salad consumption (OR = 1.30, 95%CI: 1.12–1.52, p = 0.001).ConclusionsMeeting physical activity guidelines and regular breakfast consumption associated with lower odds of weight loss intent and video game playing and salad consumption associated with higher odds of weight loss intent in a representative sample of US adolescents. Therefore, there is a discordance between adolescent weight loss intent and the engagement in specific energy balance-related health behaviors, particularly physical activity.

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