US High School Students Research Articles

Usual source of cigarettes and alcohol among US high school students.

Cigarette and alcohol use are common among youth. We examined sources of cigarettes and alcohol among youth who were current cigarette and alcohol users. We analyzed nationally representative data from the 2009 and 2011 national Youth Risk Behavior Surveys-biennial, school-based surveys of high school students in the United States. Students completed anonymous, self-administered questionnaires. Overall response rates were 71% for both years. Among the 17.3% of current cigarette users <18 years, 27.3% usually gave someone else money to buy their cigarettes and 27.7% usually borrowed (bummed) them. Fewer (14.1%) usually bought their own cigarettes in a store. Among the 40.3% of current alcohol users, 24.3% usually gave someone else money to buy it and 41.2% usually had someone give it to them. A few (4.5%) usually bought their own alcohol in a store. Age and intensity of use were positively associated with students buying their own cigarettes or alcohol, but negatively associated with students borrowing or having someone else give it to them. Because social and commercial sources of cigarettes and alcohol are common, multiple strategies are needed to reduce the ability for youth to obtain them and reduce their desire for them.

Adolescent Electronic and Conventional Cigarette Use

Research Article| July 01 2014 Adolescent Electronic and Conventional Cigarette Use AAP Grand Rounds (2014) 32 (1): 4. https://doi.org/10.1542/gr.32-1-4 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Adolescent Electronic and Conventional Cigarette Use. AAP Grand Rounds July 2014; 32 (1): 4. https://doi.org/10.1542/gr.32-1-4 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cigarette smoking, electronic cigarettes, smoking cessation, cigarettes Source: Dutra LM, Glantz SA. Electronic cigarettes and conventional cigarette use among US adolescents [published online ahead of print March 6, 2014]. JAMA Pediatrics; doi: https://doi.org/10.1001/jamapediatrics.2013.5488 Investigators from the University of California, San Francisco conducted a study to examine the relationship between electronic cigarette (e-cigarette) use and both conventional cigarette use and smoking cessation among US adolescents. The researchers used data from the 2011 and 2012 National Youth Tobacco Survey, a nationally representative, cross-sectional sample of US middle and high school students (grades 6–12) for the study. The self-administered questionnaire included indicators of tobacco use, intention to quit, and smoking cessation. Conventional cigarette users were defined as experimenters (ever tried ≥1 puff), ever smokers (≥100 cigarettes smoked), or current smokers (≥100 cigarettes smoked in last 30 days). Conventional cigarette abstinence was measured at 30 days, 6 months, and 1 year. Participants who responded that they had used “electronic cigarettes or e-cigarettes, such as Ruyan or NJOY” were defined as ever e-cigarette users (ever tried) or current users (used on ≥1 day in the past 30 days). Multivariable logistic regression was used to evaluate the relationship between e-cigarette use and tobacco cigarette use and cessation. The investigators analyzed data from 17,353 respondents in 2011 and 22,539 in 2012. Among cigarette experimenters, ever e-cigarette use was associated with higher odds of being classified as an “ever smoker” (OR = 6.31; 95% CI, 5.39–7.39) and current cigarette smoking (OR = 5.96; 95% CI, 5.67–6.27). Current e-cigarette use was also associated with higher odds of ever having smoked cigarettes (OR = 7.42; 95% CI, 5.63–9.79) and current cigarette smoking (OR = 7.88; 95% CI, 6.01–10.32). For 2011 study participants, current cigarette smokers who had ever used e-cigarettes were more likely to intend to quit smoking within the next year (OR = 1.53; 95% CI, 1.03–2.28). Among cigarette experimenters and ever cigarette smokers, ever e-cigarette use and current e-cigarette use was associated with lower odds of abstinence from cigarettes at 30 days, 6 months, and 1 year. The investigators conclude that e-cigarettes do not discourage use, and may be encouraging use, of conventional cigarettes among US adolescents. They suggest that their results contradict claims that e-cigarettes are effective as smoking cessation aids. Dr Wong has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Adult and youth e-cigarette use has been rapidly rising. In another analysis of the NYTS data, e-cigarette use among youth in grades 6 to 12 doubled, from 3.3% in 2011 to 6.8% in 2012.1 With these increasing rates, the public debate on the impact of e-cigarettes and other electronic nicotine delivery systems on public health has intensified. Other nicotine delivery systems include emerging e-cigarette-like devices marketed under different names, such as “e-hookahs” or “vape pipes,” which may result in considerable underestimates of youth e-cigarette use.2 While e-cigarettes contain fewer toxins and lower levels of these toxins compared to conventional cigarettes, they... You do not currently have access to this content.

Electronic cigarettes and conventional cigarette use among U.S. adolescents: a cross-sectional study.

To examine e-cigarette use and conventional cigarette smoking. Cross-sectional analyses of survey data from a representative sample of US middle and high school students in 2011 (n = 17 353) and 2012 (n = 22 529) who completed the 2011 and 2012 National Youth Tobacco Survey. Ever and current e-cigarette use. Experimentation with, ever, and current smoking, and smoking abstinence. Among cigarette experimenters (1 puff), ever e-cigarette use was associated with higher odds of ever smoking cigarettes (100 cigarettes; odds ratio [OR] = 6.31; 95% CI, 5.39-7.39) and current cigarette smoking (OR = 5.96; 95% CI, 5.67-6.27). Current e-cigarette use was positively associated with ever smoking cigarettes (OR = 7.42; 95% CI, 5.63-9.79) and current cigarette smoking (OR = 7.88; 95% CI, 6.01-10.32). In 2011, current cigarette smokers who had ever used e-cigarettes were more likely to intend to quit smoking within the next year (OR = 1.53; 95% CI, 1.03-2.28). Among experimenters with conventional cigarettes, ever use of e-cigarettes was associated with lower 30-day (OR = 0.24; 95% CI, 0.21-0.28), 6-month (OR = 0.24; 95% CI, 0.21-0.28), and 1-year (OR = 0.25; 95% CI, 0.21-0.30) abstinence from cigarettes. Current e-cigarette use was also associated with lower 30-day (OR = 0.11; 95% CI, 0.08-0.15), 6-month (OR = 0.11; 95% CI, 0.08-0.15), and 1-year (OR = 0.12; 95% CI, 0.07-0.18) abstinence. Among ever smokers of cigarettes (100 cigarettes), ever e-cigarette use was negatively associated with 30-day (OR = 0.61; 95% CI, 0.42-0.89), 6-month (OR = 0.53; 95% CI, 0.33-0.83), and 1-year (OR = 0.32; 95% CI, 0.18-0.56) abstinence from conventional cigarettes. Current e-cigarette use was also negatively associated with 30-day (OR = 0.35; 95% CI, 0.18-0.69), 6-month (OR = 0.30; 95% CI, 0.13-0.68), and 1-year (OR = 0.34; 95% CI, 0.13-0.87) abstinence. Use of e-cigarettes was associated with higher odds of ever or current cigarette smoking, higher odds of established smoking, higher odds of planning to quit smoking among current smokers, and, among experimenters, lower odds of abstinence from conventional cigarettes. Use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among U.S. adolescents.

Accessibility over availability: associations between the school food environment and student fruit and green vegetable consumption.

No national studies have examined associations between (1) school food availability and accessibility and (2) secondary student fruit and vegetable (FV) consumption. This article uses 5 years of nationally representative data from secondary school students to examine associations between the school food environment and student fruit and green vegetable consumption. From 2008 to 2012, cross-sectional, nationally representative data from US middle and high school students were collected annually on self-reported fruit and green vegetable consumption. Each year, data from administrators at each relevant school were collected on food item availability (any venue) and accessibility (total number of school sources). Data were obtained from 10,254 eighth-grade students in 317 schools and 18,898 tenth- and 12th-grade students in 518 schools. Associations were estimated by multi-level models controlling for student- and school-level characteristics. Availability showed minimal association with student consumption. Candy/regular-fat snack accessibility was associated negatively with middle school fruit consumption. Salad bar availability and accessibility were positively associated with middle school green vegetable consumption; FV accessibility was associated positively with high school fruit and green vegetable consumption. Significant associations were consistent across student racial/ethnic and socioeconomic groups. Forthcoming USDA nutrition standards for school foods and beverages sold outside of reimbursable meal programs should result in the removal of school candy/regular-fat snacks. In deciding which items to make available under the new standards, schools should consider increasing the number of FV sources-including salad bars-thereby potentially increasing student FV consumption.

Discrepant body mass index: behaviors associated with height and weight misreporting among US adolescents from the National Youth Physical Activity and Nutrition Study.

The accuracy and reliability of self-reported height and weight among adolescents in the process of calculating BMI is usually subject to bias. The aim of this study was to determine whether over- and under-reporting of self-reported height and weight existed among US high school students by weight category; if so, to examine anthropometric, behavioral, and demographic factors associated with over- and under-reporting. Data were retrieved from the National Youth Physical Activity and Nutrition Study, 2010, a nationally representative sample (7160 students, grades 9-12). Analysis of variance was performed to determine any significant difference between weight categories in misreporting. Discriminant function analysis and sequential logistic regression were executed to detect behavioral and demographic predictors of reporting accuracy, respectively. The mean over-reporting of height and under-reporting of weight were 1.1 cm and 1.020 kg, respectively, which underestimated BMI and BMI percentile by 0.671 and 2.734, respectively. Use of self-reported height and weight for BMI calculation overestimated prevalence of healthy weight by 3.8% and underestimated prevalence of obesity by 4.1%. Underweight students under-reported height and over-reported weight, whereas overweight and obese students over-reported height and under-reported weight. Reporting accuracy of females was significantly higher. Weight loss behaviors, both healthy and unhealthy, were associated with BMI underestimation, whereas fast foods and screen time were associated with overestimation. Whenever possible, measuring height and weight is essential. However, because many studies must rely on self-reported values alone, additional research should examine the relationships between misreport of anthropometric data and lifestyle features in diverse adolescent samples to better interpret self-reported anthropometric data.

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

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

HIV testing among United States high school students at the state and national level, Youth Risk Behavior Survey 2005-2011.

BackgroundHuman immunodeficiency virus (HIV) remains an important public health issue and CDC recommends routine HIV screening for Americans aged 13–64. Adolescents and young adults are disproportionately affected compared to the overall population. We analyzed self-reported HIV testing and related risk behaviors at the state and national level among youths who had sexual intercourse, with a focus on state level differences.MethodsThis study used the state and national Youth Risk Behaviors Surveys 2005–2011. It included a total of 59,793 national-level observations and 39,421 state-level observations of US high school students, of which respectively 28,177 and 13,916 reported ever having sexual intercourse.The outcome of interest was having ever been tested for HIV. The risk behaviors were condom use at last intercourse, number of sexual partners in lifetime, age at first intercourse, ever forced sexual intercourse, and ever illegal injection drug use. Analyses performed included logistic regression and t-test analyses.ResultsHIV testing was positively associated with HIV-related risk behaviors among sexually active high school students. However, HIV testing remained relatively low (22%) between 2005 and 2011, even for those engaging in risk behaviors. Results differed among the only 7 states that monitored HIV testing through YRBS, most commonly with respect to HIV testing and condom use.ConclusionsRoutine HIV testing is critical for early identification of HIV, which was set as a priority in a recent Executive Order. Our data suggest further efforts are needed to achieve widespread uptake of HIV testing among high school students. Furthermore, differences observed across states likely reflect different needs and should be followed up closely by states. Finally, having accurate data that reflects the reality of youths’ lives is crucial for efficient prevention planning. Thus, more states should consider collecting HIV testing data to evaluate uptake of HIV testing among youth.

Factors that Influence Physicians’ and Medical Students’ Confidence in Counseling Patients About Physical Activity

Less than half of US adults and two-thirds of US high school students do not meet current US guidelines for physical activity. We examined which factors promoted physicians' and medical students' confidence in counseling patients about physical activity. We established an online exercise survey targeting attending physicians, resident and fellow physicians, and medical students to determine their current level of physical activity and confidence in counseling patients about physical activity. We compared their personal level of physical activity with the 2008 Physical Activity Guidelines of the US Department of Health and Human Services (USDHHS). We administered a survey in 2009 and 2010 that used the short form of the International Physical Activity Questionnaire. A total of 1,949 individuals responded to the survey, of whom 1,751 (i.e., 566 attending physicians, 138 fellow physicians, 806 resident physicians, and 215 medical students) were included in this analysis. After adjusting for their BMI, the odds that physicians and medical students who met USDHHS guidelines for vigorous activity would express confidence in their ability to provide exercise counseling were more than twice that of physicians who did not meet these guidelines. Individuals who were overweight were less likely to be confident than those with normal BMI, after adjusting for whether they met the vigorous exercise guidelines. Physicians with obesity were even less likely to express confidence in regards to exercise counseling. We conclude that physicians and medical students who had a normal BMI and met vigorous USDHHS guidelines were more likely to feel confident about counseling their patients about physical activity. Our findings suggest that graduate medical school education should focus on health promotion in their students, as this will likely lead to improved health behaviors in their students' patient populations.

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

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

Altitude Does Not Reduce Concussion Incidence: Response.

Altitude Does Not Reduce Concussion Incidence: Response.

Commercialism in US Elementary and Secondary School Nutrition Environments

Schools present highly desirable marketing environments for food and beverage companies. However, most marketed items are nutritionally poor. To examine national trends in student exposure to selected school-based commercialism measures from 2007 through 2012. Annual nationally representative cross-sectional studies were evaluated in US public elementary, middle, and high schools with use of a survey of school administrators. School-based commercialism, including exclusive beverage contracts and associated incentives, profits, and advertising; corporate food vending and associated incentives and profits; posters/advertisements for soft drinks, fast food, or candy; use of food coupons as incentives; event sponsorships; and fast food available to students. Changes over time in school-based commercialism as well as differences by student body racial/ethnic distribution and socioeconomic status. Although some commercialism measures-especially those related to beverage vending-have shown significant decreases over time, most students at all academic levels continued to attend schools with one or more types of school-based commercialism in 2012. Overall, exposure to school-based commercialism increased significantly with grade level. For 63.7% of elementary school students, the most frequent type of commercialism was food coupons used as incentives. For secondary students, the type of commercialism most prevalent in schools was exclusive beverage contracts, which were in place in schools attended by 49.5% of middle school students and 69.8% of high school students. Exposure to elementary school coupons, as well as middle and high school exclusive beverage contracts, was significantly more likely for students attending schools with mid or low (vs high) student body socioeconomic status. Most US elementary, middle, and high school students attend schools where they are exposed to commercial efforts aimed at obtaining food or beverage sales or developing brand recognition and loyalty for future sales. Although there have been significant decreases over time in many of the measures examined, the continuing high prevalence of school-based commercialism calls for, at minimum, clear and enforceable standards on the nutritional content of all foods and beverages marketed to youth in school settings.

State Indoor Tanning Laws and Adolescent Indoor Tanning

Recently, several state indoor tanning laws, including age restrictions, were promulgated to reduce indoor tanning among minors. We examined the effects of these laws on adolescent indoor tanning. We used nationally representative data from the 2009 and 2011 national Youth Risk Behavior Surveys (n = 31 835). Using multivariable logistic regression, we examined the association between state indoor tanning laws and indoor tanning among US high school students. Female students in states with indoor tanning laws were less likely to engage in indoor tanning than those in states without any laws. We observed a stronger association among female students in states with systems access, parental permission, and age restriction laws than among those in states without any laws. We found no significant association among female students in states with only systems access and parental permission laws or among male students. Indoor tanning laws, particularly those including age restrictions, may be effective in reducing indoor tanning among female high school students, for whom rates are the highest. Such reductions have the potential to reduce the health and economic burden of skin cancer.

School-based HIV/AIDS education is associated with reduced risky sexual behaviors and better grades with gender and race/ethnicity differences

Although studies indicate school-based HIV/AIDS education programs effectively reduce risky behaviors, only 33 states and the District of Columbia in US mandate HIV/AIDS education. Ideally, school-based HIV/AIDS education should begin before puberty, or at the latest before first sexual intercourse. In 2011, 20% US states had fewer schools teaching HIV/AIDS prevention than during 2008; this is worrisome, especially for more vulnerable minorities. A nationally representative sample of 16 410 US high-school students participating in 2009 Youth Risk Behavior Survey was analyzed. Multiple regression models assessed the association between HIV/AIDS education and risky sexual behaviors, and academic grades. HIV/AIDS education was associated with delayed age at first sexual intercourse, reduced number of sex partners, reduced likelihood to have forced sexual intercourse and better academic grades, for sexually active male students, but not for female students. Both male and female students who had HIV/AIDS education were less likely to inject drugs, drink alcohol or use drugs before last sexual intercourse, and more likely to use condoms. Minority ethnic female students were more likely to have HIV testing. The positive effect of HIV/AIDS education and different gender and race/ethnicity effects support scaling up HIV/AIDS education and further research on the effectiveness of gender-race/ethnicity-specific HIV/AIDS curriculum.

Associations of body mass index with sexual risk-taking and injection drug use among US high school students.

The purpose of this study was to determine if body mass index (BMI) is associated with behaviors that may increase risk for HIV and other sexually transmitted diseases (STDs) among US high school students. We analyzed nationally representative data from the 2005–2011 national Youth Risk Behavior Surveys (YRBS) to examine associations of BMI categories with sexual risk behaviors and injection drug use among sexually active high school students, using sex-stratified logistic regression models. Controlling for race/ethnicity and grade, among female and male students, both underweight (BMI < 5th percentile) and obesity (BMI ≥ 95th percentile) were associated with decreased odds of being currently sexually active (i.e., having had sexual intercourse during the past 3 months). However, among sexually active female students, obese females were more likely than normal weight females to have had 4 or more sex partners (odds ratio, OR = 1.59), not used a condom at last sexual intercourse (OR = 1.30), and injected illegal drugs (OR = 1.98). Among sexually active male students, overweight (85th percentile ≤ BMI < 95th percentile) was associated with not using a condom at last sexual intercourse (OR = 1.19) and obesity was associated with injection drug use (OR = 1.42). Among sexually active students, overweight and obesity may be indicators of increased risk for HIV and other STDs.

Comparing Methods for Assessing Beverage Intake among High School Students

To compare 7 beverage intake survey questions against criterion data from 24-hour dietary recall interviews (24HrDRIs) among adolescents. Data were available from 610 US high school students completing a survey and ≥3 24HrDRIs. Analyses compared mean intake (times/day) calculated from the survey to intake (servings/day) from the 24HrDRIs. Proportions of students reporting intake of ≥1 times/day were compared to the 24HrDRI results. Survey data significantly correlated with 24HrDRI data (all corrected r: 0.26-0.49). Survey results differed from 24HrDRI results on reported intake of 5 beverages. Intake from these beverage questions should be reported in times/day, which is related to, but not a proxy for, servings/day. These questions are useful for population-level surveillance of beverage intake and monitoring trends over time.

Sexual Orientation, Gender, and Racial Differences in Illicit Drug Use in a Sample of US High School Students

We evaluated drug use differences between sexual minority and heterosexual students, including interactions with gender and race/ethnicity. We used 2005 and 2007 Youth Risk Behavior Survey data pooled from Boston, Massachusetts; Chicago, Illinois; Delaware; Maine; Massachusetts; New York City, New York; Rhode Island; and Vermont to evaluate drug use (marijuana, cocaine, inhalants, heroin, methamphetamine, and MDMA [Ecstasy]) using 2 aspects of sexual orientation (identity and sex of sexual partners). Sexual minority students had higher prevalence of drug use than did heterosexuals on both sexual orientation dimensions, and differences were particularly pronounced among bisexual students on both dimensions. Differences between sexual minority and heterosexual male students in prevalence were generally larger than were differences between sexual minority and heterosexual female students. Racial minority students generally reported lower prevalence of drug use. However, the protective effect of African American race was less pronounced for some sexual minorities. Sexual minority youths are at increased risk for drug use. Intervention is needed at the institutional and individual levels to address these disparities.

Disparities in Safety Belt Use by Sexual Orientation Identity Among US High School Students

We examined associations between adolescents' safety belt use and sexual orientation identity. We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys (n = 26,468 weighted; mean age = 15.9 years; 35.4% White, 24.7% Black, 23.5% Latino, 16.4% other). We compared lesbian and gay (1.2%), bisexual (3.5%), and unsure (2.6%) youths with heterosexuals (92.7%) on a binary indicator of passenger safety belt use. We stratified weighted multivariable logistic regression models by sex and adjusted for survey wave and sampling design. Overall, 12.6% of high school students reported "rarely" or "never" wearing safety belts. Sexual minority youths had increased odds of reporting nonuse relative to heterosexuals (48% higher for male bisexuals, 85% for lesbians, 46% for female bisexuals, and 51% for female unsure youths; P < .05), after adjustment for demographic (age, race/ethnicity), individual (body mass index, depression, bullying, binge drinking, riding with a drunk driver, academic achievement), and contextual (living in jurisdictions with secondary or primary safety belt laws, percentage below poverty, percentage same-sex households) risk factors. Public health interventions should address sexual orientation identity disparities in safety belt use.

Impaired-driving prevalence among US high school students: associations with substance use and risky driving behaviors.

We examined the prevalence of impaired driving among US high school students and associations with substance use and risky driving behavior. We assessed driving while alcohol or drug impaired (DWI) and riding with alcohol- or drug-impaired drivers (RWI) in a nationally representative sample of 11th-grade US high school students (n = 2431). We examined associations with drinking and binge drinking, illicit drug use, risky driving, and demographic factors using multivariate sequential logistic regression analysis. Thirteen percent of 11th-grade students reported DWI at least 1 of the past 30 days, and 24% reported RWI at least once in the past year. Risky driving was positively associated with DWI (odds ratio [OR] = 1.25; P < .001) and RWI (OR = 1.09; P < .05), controlling for binge drinking (DWI: OR = 3.17; P < .01; RWI: OR = 6.12; P < .001) and illicit drug use (DWI: OR = 5.91; P < .001; RWI: OR = 2.29; P = .05). DWI was higher for adolescents who drove after midnight (OR = 15.7), drove while sleepy or drowsy (OR = 8.6), read text messages (OR = 11.8), sent text messages (OR = 5.0), and made cell phone calls (OR = 3.2) while driving. Our findings suggest the need for comprehensive approaches to the prevention of DWI, RWI, and other risky driving behavior.

Risk factors for multiple forms of violent experiences: Analyses of the 2009 Youth Risk Behavior Survey

There is a growing body of empirical research indicating a significant co-occurrence of multiple forms of experiences with violence among US youth. However, very little information is available about shared risk factors across forms of violence. Current analyses were based on cross-sectional data from the 2009 Youth Risk Behavior Survey (YRBS). The YRBS includes a nationally representative sample (n = 16,410) of high-school students in 9–12th grades in the US. Multinomial regression analyses were conducted to test the associations between risk factors and reports of multiple violence exposures (i.e. physical fights, dating violence, forced sex, and being bullied at school). Among high-school students, 33.0% reported one experience, 11.4% reported two experiences, and 4.0% reported 3–4 experiences with violence. Multinomial regression analyses indicate that experience with 3–4 forms of violence were highly associated with sadness, feeling too unsafe to go to school, early alcohol use, binge drinking, drug use, weapon carrying, asthma, low academic grades, and suicide attempts relative to those who did not report any experience with violence. These findings underscore that multiple experiences with violence are relatively common among US high-school students. Moreover, multiple experiences with violence are associated with a relatively broad range of risk factors. Youth who report multiple experiences with violence seem to be particularly vulnerable and in need of assistance, in particular because of the strong association between multiple violent experiences and suicidal behaviors.

Use of Conventional and Novel Smokeless Tobacco Products Among US Adolescents

To assess the prevalence and correlates of use of conventional and novel smokeless tobacco products among a national sample of US middle and high school students. Data from the 2011 National Youth Tobacco Survey were analyzed to determine national estimates of current use of conventional ("chewing tobacco", "snuff," or "dip"), novel ("snus" and "dissolvable tobacco products"), and any smokeless tobacco products (novel and/or conventional products) within the past 30 days. The overall prevalence of current use of any smokeless tobacco product was 5.6% (n = 960). Among all students, 5.0% used chewing tobacco, snuff, or dip; 1.9% used snus; and 0.3% used dissolvable tobacco products. Among users of any smokeless tobacco, 64.0% used only conventional products, 26.8% were concurrent users of novel plus conventional products, whereas 9.2% exclusively used novel products. Approximately 72.1% of current any smokeless tobacco users concurrently smoked combustible tobacco products, and only 40.1% expressed an intention to quit all tobacco use. Regression analyses indicated that peer (adjusted odds ratio [aOR]: 9.56; 95% confidence interval [CI]: 7.14-12.80) and household (aOR: 3.32; 95% CI: 2.23-4.95) smokeless tobacco use were associated with smokeless tobacco use, whereas believing that all forms of tobacco are harmful was protective (aOR: 0.55; 95% CI: 0.38-0.79). Conventional smokeless tobacco products remain the predominant form of smokeless tobacco use. Most users of novel smokeless tobacco products also concurrently smoked combustible tobacco products. Smokeless tobacco use was associated with lower perception of harm from all tobacco products and protobacco social influences, indicating the need to change youth perceptions about the use of all tobacco products and to engage pediatricians in tobacco use prevention and cessation interventions.