State Youth Risk Behavior Surveys Research Articles

Adolescent Mental Health and Suicidal Behaviors in the Context of Expanded Supplemental Nutrition Assistance Program Eligibility

PurposeFood insecurity is a risk factor for poor mental health and suicidal behaviors among adolescents. Prior research shows that states with policies that expand Supplemental Nutrition Assistance Program (SNAP) eligibility have a lower prevalence of food insecurity. The primary aim of this study was to compare the prevalence of feelings of sadness or hopelessness, suicidal ideation, and suicide attempts among adolescents in states that had the asset test eliminated and the income limit increased for SNAP eligibility to adolescents in states that did not have either policy. MethodsUsing 2013-2021 data from state Youth Risk Behavior Surveys (N = 855,119) and the SNAP Policy Database, we conducted log-binomial regression with generalized estimating equations and adjusted for confounders. ResultsThe prevalence of persistent feelings of sadness or hopelessness was similar among adolescents in states that had the asset test eliminated only and among adolescents in states that had both the asset test eliminated and the income limit increased (i.e., both policies) compared to adolescents in states that did not have either policy. While the prevalence of suicidal thoughts was similar among adolescents in states that had the asset test eliminated only compared to adolescents in states that did not have either policy, the prevalence of suicidal thoughts (prevalence ratio = 0.91, 95% CI 0.88, 0.94) and suicide attempts (prevalence ratio = 0.82, 95% CI 0.78, 0.86) was lower among adolescents in states that had both policies compared to adolescents in states that did not have either policy. DiscussionStates with policies that expand SNAP eligibility have a lower prevalence of suicidal behaviors among adolescents.

Vaping Regulations and Mental Health of Teenagers

While depression and suicide rates have been on the rise in the United States, so has the use of e - cigarettes, commonly known as vaping. E-cigarettes are considered to be safer than traditional cigarettes, yet there is growing evidence that nicotine and other toxins contained in e-cigarettes may have adverse psychological effects on teenagers. For instance, e-cigarette use has been associated with mental health problems in adolescents such as symptoms of depression and suicidal tendencies. This evidence suggests that vaping could contribute to deteriorating mental health of teenagers. In contrast, the antidepressant and mood modulating properties of nicotine could cause teens with underlying conditions to turn to vaping as a way to self-medicate. Existing studies find evidence of a strong negative correlation between vaping and adolescent mental health; none examine if the relationship is causal. This study exploits exogenous changes in state policies restricting youth access to e- cigarettes and a difference-in-differences methodology to identify changes in e-cigarette use and mental health outcomes of teens. Using data from the 2005-2017 national and state Youth Risk Behavior Surveys, results suggest that MLSA laws reduce vaping but worsen the mental well-being of adolescents. For instance, between 2015-2017, MLSA laws are associated with a 3.0 and 1.8 percentage point increase in depression and suicidal attempts, respectively. These are meaningful increases relative to the overall sample averages of 29% and 8.4%, respectively. The findings are primarily consistent with the self-medication hypothesis. Adverse unintended consequences of the MLSA policy on youth mental health call for the need to address diverse concerns when formulating vaping related regulations for minors.

State‐mandated school‐based BMI assessments and self‐reported adolescent health behaviors

AbstractI provide novel evidence on the role of imperfect information in shaping childhood obesity. Between 2003 and 2017, 24 states began requiring schools to perform Body Mass Index assessments on students. Using the 1991 to 2017 National and State Youth Risk Behavior Surveys and a stacked difference‐in‐differences identification strategy, I show that these state‐mandated school‐based BMI assessments were associated with an increase in the likelihood that teens described themselves as overweight and reported that they were trying to lose weight. The relationship was most pronounced for overweight teens, suggesting that the assessments improved awareness about BMI status among this group, though I also find that non‐overweight teen girls were subsequently more likely to incorrectly describe themselves as overweight. While I do not detect meaningful changes in exercise or calorie‐limiting behaviors, I do find that these state‐mandated school‐based BMI assessments were associated with a modest reduction in BMI.

Seat belt laws and prevalence of use among high school students in the United States

To examine the association between state seat belt laws and the prevalence of seat belt use among a nationally representative sample of teenagers in the United States, taking into consideration state-specific child restraint laws that could affect teenagers of different ages. Data were from the 2019 state Youth Risk Behavior Survey. We estimated prevalence ratios using modified Poisson regression with robust variance estimates to evaluate associations between state seat belt laws and seat belt use. Among, 81,929 high school students under 18 from 36 states, 56% always wore a seat belt when someone else was driving. Relative to students in states with secondary enforcement of seat belt laws, students living in states with primary enforcement were 5% more likely (aPR=1.05, 95% CI: 0.99, 1.11), and students covered by a child restraint law were 6% more likely to always wear a seat belt (aPR=1.06, 95% CI: 0.99, 1.12) after adjusting for age, sex, race/ethnicity, and graduated driver licensing laws. States with secondary seat belt enforcement should consider upgrading seat belt laws to potentially improve the prevalence of seat belt use among adolescents, potentially reducing injuries and deaths due to motor vehicle crashes.

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.

Cellphone laws and teens\u2019 calling while driving: analysis of repeated cross-sectional surveys in 2013, 2015, 2017, and 2019

BackgroundDistracted driving among teens is a public health and safety concern. Most states in the U.S. have sought to restrict cellphone use while driving by enacting laws. This study examines the difference in prevalence of self-reported calling while driving (CWD) between states with different cellphone bans.MethodsDemographics and CWD data were extracted from state Youth Risk Behavior Surveys (YRBS) from 14 states in 2013, 2015, 2017, and 2019. The state YRBS is conducted every 2 years with a representative sample of 9th through 12th grade students attending public school. States were grouped by type of cellphone law(s): no ban (the absence of both handheld calling ban and young driver ban), young driver ban (a ban on all forms of cellphone use while driving, for young drivers only), or concurrent ban (a young driver ban plus a ban on handheld calling for all drivers irrespective of age). Poisson regression models with robust variance were used to estimate prevalence ratios comparing CWD prevalence across ban types.ResultsIn total, 157,423 high school students participated in the surveys, and 65,044 (45%) participants reached the minimum age to obtain an intermediate license and drove during the 30 days prior the survey. Approximately 53% of participants reported CWD at least once during the previous 30 days, and the percentages varied widely by states (range: 51–55%). Compared to students from states with no ban, those from states with concurrent bans were 19%(95% CI: 14–24%) less likely to engage in CWD. Students in states with concurrent bans were 23% less likely to engage in CWD compared to students in states with young driver bans (95% CI:17–27%).ConclusionsEngaging in CWD is common among teen drivers. The concurrent implementation of a handheld calling ban and a young driver ban was associated with a lower prevalence of CWD.

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.

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.

Marriage Equality Laws and Youth Mental Health

Since the landmark ruling in Goodridge v. Department of Public Health in 2004, the legalization of same-sex marriage (SSM) has proliferated throughout the United States via either legislative action or court order. Advocates of SSM laws argue that marriage equality will generate important health benefits not only for adult same-sex couples, but also for LGBQ-identifying youths. Using data from the State Youth Risk Behavior Surveys for the period 1999-2017, we explore the relationship between marriage equality and suicidal behaviors among LGBQ-identifying youths. We find little evidence that SSM laws have reduced suicide attempts among teen sexual minorities, nor have they decreased the likelihood of suicide planning, suicide ideation, or depression. Instead, we find some evidence that SSM legalization via judicial mandate is associated with worse mental health for these individuals.

Texting/Emailing While Driving Among High School Students in 35 States, United States, 2015

PurposeDetermine the prevalence and explore individual- and state-level factors associated with texting/emailing while driving (TWD) among adolescent drivers in the United States. MethodsData from 35 states that administered the 2015 state Youth Risk Behavior Survey were analyzed. We used Poisson regression models with robust error variance to estimate prevalence ratios (PRs) for TWD. ResultsAmong the 101,397 high school students aged ≥ 14 years who had driven a vehicle during the past 30 days, 38% reported TWD at least once. TWD prevalence ranged from 26% in Maryland to 64% in South Dakota. TWD prevalence was higher in states with a lower minimum learner's permit age and in states where a larger percentage of students drove. Multivariable analyses revealed that the likelihood of TWD increased substantially with age, and white students were more likely to engage in TWD than students of all other races/ethnicities. Infrequent seatbelt users were 21% more likely to engage in TWD compared with frequent seatbelt users (adjusted PR = 1.21, 95% confidence interval: 1.16–1.26), and students who reported drinking and driving were almost twice as likely to TWD as compared to students who did not (adjusted PR = 1.91, 95% confidence interval: 1.79–2.04). ConclusionsPrevalence of TWD among US high school students varied by more than two-fold across states. TWD prevalence was higher in states with lower minimum learner's permit ages and in states where a larger percentage of students drove. Older age, white race/ethnicity, and other risky driving behaviors were associated with TWD.

Risk factors for diabetes are higher among non-heterosexual US high-school students.

Low physical activity (PA), high sedentary behavior (SB), and overweight and obesity have been shown to associate with increased Type 2 diabetes risk among adolescents. We investigated PA, SB, and overweight and obesity among Youth Risk Behavior Survey (YRBS) respondents to determine if non-heterosexual youth may be at increased diabetes risk compared to heterosexual youth. Weighted city and state YRBS data were pooled across 44 jurisdictions biennially from 2009 to 2015, resulting in a sample size of 350 673 students. Overall, 88.4% identified as heterosexual, 2.1% as gay or lesbian, 5.7% as bisexual, and 3.7% as unsure. With the exception of lesbian female students, after adjusting for age, race/ethnicity, body mass index, and survey year, all non-heterosexual youth reported significantly fewer days per week of PA compared to their sex-matched heterosexual counterparts. Similarly, compared to heterosexual female youth, bisexual and not sure female youth reported significantly more hours per day of SB. These PA and SB findings remained significant after adjustment for depressive symptoms and in-school bullying among bisexual female youth only. In fully adjusted models, lesbian students were 1.85 times more likely to be overweight and lesbian, bisexual, and not sure female youth were 1.55 to 2.07 times more likely to be obese than heterosexual female students. No significant differences in SB, overweight, or obesity were found among gay, bisexual, or unsure male youth compared to heterosexual male youth. Non-heterosexual youth may be at increased risk for developing type 2 diabetes mellitus compared to heterosexual youth. Future studies should characterize diabetes prevalence among non-heterosexual youth.

Cannabis decriminalization: A study of recent policy change in five U.S. states

BackgroundA number of public health professional organizations support the decriminalization of cannabis due to adverse effects of cannabis-related arrests and legal consequences, particularly on youth. We sought to examine the associations between cannabis decriminalization and both arrests and youth cannabis use in five states that passed decriminalization measures between the years 2008 and 2014: Massachusetts (decriminalized in 2008), Connecticut (2011), Rhode Island (2013), Vermont (2013), and Maryland (2014). MethodsData on cannabis possession arrests were obtained from federal crime statistics; data on cannabis use were obtained from state Youth Risk Behavior Survey (YRBS) surveys, years 2007–2015. Using a “difference in difference” regression framework, we contrasted trends in decriminalization states with those from states that did not adopt major policy changes during the observation period. ResultsDecriminalization was associated with a 75% reduction in the rate of drug-related arrests for youth (95% CI: 44%, 89%) with similar effects observed for adult arrests. Decriminalization was not associated with any increase in the past-30 day prevalence of cannabis use overall (relative change=−0.2%; 95% CI: −4.5%, 4.3%) or in any of the individual decriminalization states. ConclusionsDecriminalization of cannabis in Massachusetts, Connecticut, Rhode Island, Vermont, and Maryland resulted in large decreases in cannabis possession arrests for both youth and adults, suggesting that the policy change had its intended consequence. Our analysis did not find any increase in the prevalence of youth cannabis use during the observation period.

Diabetes Risk Behaviors Are Higher among Sexual Minority U.S. High School Students

Low physical activity (PA) and high sedentary behavior (SB) are associated with increased type 2 diabetes risk among youth. We investigated PA and SB among Youth Risk Behavior Survey (YRBS) respondents to determine if sexual minority youth may be at increased diabetes risk compared to heterosexual youth. Weighted city and state YRBS data were pooled across 44 jurisdictions biennially from 2009-2015, resulting in a sample size of 97 jurisdiction-years (350,673 students). Respondents had a median age of 16 years, were 50.3% male, and 46.8% white. Overall, 88.4% identified as heterosexual, 2.1% as gay/lesbian, 5.7% as bisexual, and 3.7% as unsure; more female (15.3%) than male (7.7%) students reported a non-heterosexual identity. Among females, bisexual and unsure (but not lesbian) youth reported significantly more hours per day of SB compared to heterosexual peers. We found no significant differences in SB among males. Both female and male sexual minority youth reported significantly fewer days per week of PA compared to sex-matched heterosexual peers. All unadjusted PA and SB findings remained significant after adjusting for age, BMI, race/ethnicity, and survey year, except among lesbian youth. Studies of type 2 diabetes and risk factors among youth need to assess and account for sexual identity to ensure sexual minority populations are a priority target for prevention. Table I. Bold text: Unadjusted p-value significant; *Adjusted p-value <0.001; hetero=referenceSB (95%CI) Hours/DayPA (95% CI) Days/WeekSexual IdentityMaleFemaleMaleFemaleHeterosexual3.7 (3.7-3.8)3.6 (3.6-3.7)4.4 (4.3-4.4)3.4 (3.4-3.6)Gay/Lesbian3.7 (3.4-4.0)3.9 (3.7-4.2)2.8* (2.6-3.1)3.1 (2.9-3.4)Bisexual4.0 (3.7-4.3)4.3* (4.1-4.4)3.1* (2.7-3.4)3.0* (2.8-3.1)Unsure4.0 (3.7-4.4)4.3* (4.0-4.6)3.0* (2.7-3.3)3.0* (2.7-3.4) Disclosure L.B. Beach: None. B. Turner: None. R. Marro: None. G. Phillips: None.

Cannabis Decriminalization: A Study of Recent Policy Change in Five States

Background: A number of public health professional organizations support the decriminalization of cannabis due to adverse effects of cannabis-related arrests and legal consequences, particularly on youth. We sought to examine the associations between cannabis decriminalization and both arrests and youth cannabis use in five states that passed decriminalization measures between the years 2008 and 2014: Massachusetts (decriminalized in 2008), Connecticut (2011), Rhode Island (2013), Vermont (2013), and Maryland (2014). Methods: Data on cannabis possession arrests were obtained from federal crime statistics; data on cannabis use were obtained from state Youth Risk Behavior Survey (YRBS) surveys, years 2007-2015. Using a “difference in difference” regression framework, we contrasted trends in decriminalization states with those from states that did not adopt major policy changes during the observation period. Results: Decriminalization was associated with a 75% reduction in the rate of drug-related arrests for youth (95% CI: 44%, 89%) with similar effects observed for adult arrests. Decriminalization was not associated with any increase in the past-30 day prevalence of cannabis use overall (relative change=-0.2%; 95% CI: -4.5%, 4.3%) or in any of the individual decriminalization states. Conclusions: Decriminalization of cannabis in Massachusetts, Connecticut, Rhode Island, Vermont, and Maryland resulted in large decreases in cannabis possession arrests for both youth and adults, suggesting that the policy change had its intended consequence. Our analysis did not find any increase in the prevalence of youth cannabis use during the observation period.

The design of medical marijuana laws and adolescent use and heavy use of marijuana: Analysis of 45 states from 1991 to 2011

ObjectivesTo assess the association between U.S. state medical marijuana laws (MML), the most liberal category of marijuana policies before legalization, their specific provisions, and adolescent past-30-day use and heavy marijuana use. MethodsThis quasi-experimental study used state Youth Risk Behavior Survey (YRBS) data collected during 1991–2011 from 45 states (N=715,014) to examine MML effects, taking advantage of heterogeneity across states in MML status and design. Multiple logistic regression modeling was used to adjust for state and year effects, and youth demographics. ResultsUnadjusted analyses found that MMLs were associated with higher rates of adolescent past-30-day marijuana use (odds ratio [OR]=1.08, 95% confidence interval, [(CI)=1.03,1.13]) and heavy marijuana use (OR=1.12, [CI=1.05,1.21]). However, analyses adjusting for state/year effects found a 7% lower odds of use (OR=0.99, [CI=0.98,0.999]) and no difference in heavy use. In the adjusted models, years since MML enactment (OR=0.93, [CI=0.86,0.99]) and MML inclusion of more liberalized provisions (OR=0.98, [CI=0.96,0.998]) were associated with slightly lowered odds of past-30-day marijuana use. Conversely, allowance for ≥2.5 usable marijuana ounces was associated with higher past-30-day marijuana use odds (OR=1.21, [CI=1.09,1.34]) and a voluntary vs. mandatory patient registration with higher odds of both past-30-day use (OR=1.41, [CI=1.28,1.56]) and heavy use (OR=1.23, [CI=1.08,1.40]). ConclusionsMML enactment, years since enactment, and inclusion of more liberalized provisions were not associated with increased adolescent marijuana use in this dataset after adjusting for state and year effects; however, higher possession limits and a voluntary registration were. It is possible that state norms are the impetus for MML enactment.

The effect of parental involvement laws on teen birth control use

In Volume 32, Issue 5 of this journal, Colman, Dee, and Joyce (CDJ) used data from the National Youth Risk Behavior Surveys (NYRBS) and found that parental involvement (PI) laws had no effect on the probability that minors abstain from sex or use contraception. We re-examine this question, augmenting the NYRBS with data from the State Youth Risk Behavior Surveys (SYRBS), and use a variety of identification strategies to control for state-level time-varying unmeasured heterogeneity. Consistent with CDJ, we find that PI laws have no effect on minor teen females’ abstinence decisions. However, when we exploit additional state policy variation unavailable to CDJ and use non-minor teens as a within-state control group, we find evidence to suggest that PI laws are associated with an increase in the probability that sexually active minor teen females use birth control.

Medical Marijuana Laws and Teen Marijuana Use

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

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

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

CIGARETTE TAXES AND HOW YOUTHS OBTAIN CIGARETTES

Using state Youth Risk Behavior Survey data for the period 1995–2011, we examine the relationship between state cigarette taxes and how high school students obtain their cigarettes. Our estimates s...

Medical Marijuana Laws and Teen Marijuana Use

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