US High School Research Articles

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

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

The Harms of Structural Whiteness on Weapon Carrying, Policing, and Child Health.

The Harms of Structural Whiteness on Weapon Carrying, Policing, and Child Health.

Don’t forget to assess: How teachers check for new and deeper learning when integrating virtual reality in the classroom

Teachers consider learning goals as they implement new technologies like Virtual Reality in the classroom, but may overlook or struggle with verifying whether new learning actually occurred. We interviewed six US high school teachers and surveyed 277 of their students to understand the pedagogical implications and challenges of coordinating assessments with the integration of VR in their classrooms. Some teachers devised new assessment strategies to capture the deep, constructivist, learning they saw occurring in their students as a result of VR. Students’ responses suggest they needed more explicit goals for the VR class activities, but students provided insights about the benefits they perceived for their retention of relevant information. Future work should continue to explore the alignment of learning objectives, technology, and assessment. Supplemental data for this article is available online at https://doi.org/10.1080/15391523.2021.1950083 .

Weapon Carrying Among Boys in US Schools by Race and/or Ethnicity: 1993–2019

High adolescent gun-related mortality, gun violence, pro-gun policies, white supremacy, and the long-term socioeconomic and other effects of racial oppression are intricately linked in the United States. Racist prejudice depicts male individuals of color as more prone to criminality than white male individuals. We described long-term patterns of weapon carrying in US schools among non-Hispanic (NH) white, NH Black/African American, and Hispanic boys, hypothesizing that in contrast to racist stereotypes, boys of color did not bring weapons into schools more often than NH white boys in recent years. We conducted a time series analysis using 1993-2019 Youth Risk Behavior Surveillance System data comparing boys' self-reported weapon carrying in a nationally representative sample of US high schools by race and/or ethnicity, age, and self-reported experience of safety and violence at school. Weapon carrying in schools has declined among all boys. Comparing all schools, we found no significant differences in weapon carrying (4%-5%) by race and/or ethnicity in 2017 and 2019. Boys who reported experiencing violence or feeling unsafe at school were at least twice as likely to bring a weapon into school, and such negative experiences were more common among boys of color (8%-12%) than among NH white boys (4%-5%). In schools perceived as safer, NH white boys have been more likely to bring weapons into schools than NH Black/African American or Hispanic boys in the past 20 years. Our findings contradict racist prejudice with regard to weapon carrying in schools, particularly in more favorable school environments. Making schools safer may reduce weapon carrying in schools where weapon carrying is most common.

The Effects of Foreign-Born Peers in US High Schools and Middle Schools

The multi-decade growth and spatial dispersion of immigrant families in the United States has shifted the composition of US schools, reshaping the group of peers with whom students age through adolescence. US-born students are more likely to have foreign-born peers and foreign-born students are more likely to be educated outside of enclaves. This study examines the short-term and long-term impact of being educated with immigrant peers, for both US-born and foreign-born students. We leverage a quasi-experimental research design that uses across-grade, within-school variation in cohort composition for students in the Add Health study. We describe effects on a broad set of education, social, and health outcomes. For US-born students, we find little evidence that having immigrant peers affects a wide array of outcomes, either in adolescence or in adulthood. For foreign-born students, attending school with other immigrant students is protective against risky health behaviors and social isolation, relative to native born students. However, foreign-born students’ language skills measured with Picture-Vocabulary Test scores are negatively affected by attending school with a larger share of other immigrant students. The negative effect on vocabulary scores persists through young adulthood but does not translate into reductions in most longer-run socioeconomic outcomes, including earnings or the economic status of their residential neighborhoods.

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

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

Prevalence of Gender-Diverse Youth in an Urban School District.

In many studies on gender-diverse youth (GDY), those whose gender identity and sex assigned at birth do not fully align, researchers cite the 2017 Youth Risk Behavior Survey finding that 1.8% of US high school students identify as “transgender.”1 This was the first nationally representative prevalence estimate of GDY and was higher than previous estimates. However, the question assessing gender identity (“Do you identify as transgender?”) likely underrepresents the prevalence of GDY because many do not identify with the word “transgender.” As an alternative, researchers recommend a 2-step question: (1) What was your sex assigned at birth? (2) Which of the following best describes your gender identity?2,3Much of the research involving GDY has been conducted in clinical settings, in which there is a predominance of white and masculine-identified youth.4–7 GDY of color, specifically Black and Hispanic transgender women, are more likely than other gender-diverse people to experience violence and socioeconomic disadvantage because of systemic racism and transmisogyny.8 These systemic inequities likely result in decreased access to gender-affirming care. Because access to gender-affirming care is associated with improved health outcomes,9 identifying groups who are not receiving care is vital to creating more equitable access to care for all GDY, but especially Black and Hispanic transgender women. The goal of this study was to assess the prevalence of GDY in a school-based sample to (1) document the prevalence of GDY by using a 2-step approach and (2) examine prevalence by race and ethnicity and gender identity.In October of 2018, a modified version of the Youth Risk Behavior Survey was distributed to ninth- to 12th-graders in 13 high schools, reaching 91% of the ∼4930 students in a Northeastern midsized city school district. The survey included a 2-step gender identity question: (1) “What is your sex (the sex you were assigned at birth, on your birth certificate)?” with the options “female” and “male” and (2) “Which of the following best describes you (select all that apply)?” with the options “girl,” “boy,” “trans girl,” “trans boy,” “genderqueer,” “nonbinary,” and “another identity.” Of 4730 returned surveys, 37 were found to be unreadable, and 243 were deemed mischievous responders or had <20 answered questions. An additional 1282 participants skipped questions regarding race and ethnicity or gender identity and were excluded from this analysis. Descriptive statistics were calculated by using Stata/SE, version 15.1 (Stata Corp, College Station, TX).Of 3168 surveys analyzed, incongruence between gender identity and sex assigned at birth was identified in 291 participants (9.2%; Table 1). This prevalence was 7.1% among white youth and higher among American Indian, Alaskan Native, Asian American, Pacific Islander, and/or Native Hawaiian, Hispanic, Black, and multiracial youth (13.4%, 14.4%, 9.9%, and 8.7% respectively). Gender identity among GDY was split between masculine (29.9%), feminine (38.8%), and nonbinary identities (31.3%), with 38 (13.1%) selecting >1 identity (Table 2).Nearly 10% of high school students surveyed reported a gender-diverse identity. The prevalence of GDY in this study is 5 times higher than current national estimates from a study involving 10 states and 9 urban school districts.1 Although these data were collected from a single urban school district, the findings may approximate a less biased estimate of the prevalence of youth with gender-diverse identities, given how gender identity was operationalized.Additionally, the demographics of GDY in this school-based study differ from those of GDY accessing gender-affirming care in the same region. A 2018 survey from the only pediatric gender clinic in the region found the majority of patients identified as white (88%) and masculine (65%).10 This clinic’s findings are consistent with other pediatric gender clinics across the United States4–7 and highlight the lack of diversity among youth receiving gender-affirming care, especially with respect to race and/or ethnicity and gender. These disparities suggest that gender clinics may not be reaching youth at the highest risk of experiencing violence, victimization, socioeconomic disadvantage, and health disparities: Black and Hispanic transgender women. Researchers should consider using a 2-step approach, as outlined above, to better reflect prevalence of GDY, particularly in statewide and national level surveys, with sample sizes allowing analysis of potential differences in gender identity by race and/or ethnicity and age. In addition to encouraging continued refinement of gender identity measures, particularly for youth, these findings underscore the need to re-evaluate systems and structures that continue to perpetuate inequities in access to gender-affirming care.We thank the Allegheny County Health Department for their role in data collection and for the use of these data. We are grateful to Pittsburgh Public School Board leadership for their collaboration.

Cannabis Legalization and Adolescent Use of Electronic Vapor Products, Cannabis, and Cigarettes.

Cannabis legalization may have unintended consequences, such as effects on prevalence of adolescent use of other substances. We hypothesize that in states that have legalized recreational cannabis (RCL states), electronic vapor product use ("vaping"), cannabis, and cigarette use among adolescents is more prevalent than in states that have only legalized medical cannabis (MCL states) and states that have neither legalized recreational nor medical cannabis (NL states). Data are from the Center for Disease Control's 2017 Youth Risk Behavior Surveillance Survey (n = 107,665), a nationally representative survey of US high school students. We categorized student responses by cannabis legalization status of the state in which they lived at time of survey, then tested associations between cannabis legalization status and adolescent vaping, cannabis, and cigarette use, using logistic regressions. Students in RCL states were significantly more likely to report current vaping behaviors compared to NL students [odds ratios (OR's) 2.07-2.21]. Students in cannabis-legal states were significantly more likely to report ever or currently using cannabis compared to NL students (OR's 1.27-1.40). MCL students were significantly less likely to report current cigarette smoking (OR = 0.86) compared to NL students. Adolescents in cannabis-legal states were more likely to report vaping and cannabis use compared to adolescents in NL states. Public health officials, policymakers, and clinicians should consider the associations between cannabis legalization and adolescent vaping, cigarette, and cannabis use patterns.

Current Prescription Opioid Misuse and Suicide Risk Behaviors Among High School Students.

In previous studies, researchers have reported that youth with a lifetime history of prescription opioid misuse (POM) are at an increased risk for suicidal ideation, planning, and attempts. In this study, we investigate whether the association between youth POM and suicide outcomes differs by recency of POM (ie, none, past, or current misuse). In this report, we use data from the 2019 Youth Risk Behavior Survey to examine associations between recency of POM (current POM, past POM, and no POM) and suicide risk behaviors among US high school students. After controlling for demographics, alcohol, and other drug use, both current POM and past POM were significantly associated with all suicide risk behaviors compared with no POM. Students who reported current POM had the highest adjusted prevalence ratios (aPRs) for suicidal ideation (aPR: 2.30; 95% confidence interval [CI] 1.97-2.69), planning (aPR: 2.33; 95% CI 1.99-2.79), attempts (aPR: 3.21; 95% CI 2.56-4.02), and feeling sad or hopeless (aPR: 1.59; 95% CI 1.37-1.84). Students who reported current POM also were significantly more likely than youth who reported past POM to report that they had seriously considered attempting suicide, made a suicide plan, and attempted suicide. Although POM, particularly current POM, is associated with increases in the risk for suicide-related behaviors and experiences of youth, comprehensive prevention approaches that address the intersections between suicide and POM provide a promising path forward for addressing these public health challenges among youth.

COVID-19 pandemic: Challenges among rising high school seniors, Class of 2021 and effect on stress regarding college admissions

The high school Class of 2021, already facing challenges of their stressful junior year has had multiple changes to their academic routines, athletic &amp; extracurricular opportunities and standardized testing amid the COVID-19 pandemic. With the lockdown, it is also facing unprecedented changes in the college admissions process. &#x0D; This study was undertaken as a survey of rising seniors in US high schools to understand handling of academic challenges, students’ stress regarding college admissions, changing landscape of the application cycle and attitudes towards strength of applications due to the pandemic. Survey was designed on google forms and was circulated among rising seniors through social media and snowballing methods. The data was analysed using descriptive and inferential statistics. &#x0D; A total of 331 students responded, majority were females, white and from public schools. Significant stress regarding college admissions was reported by students (63.6%) before pandemic and increase in stress (72.3%) afterwards. About 75% had already taken ACT/SAT, the majority was not satisfied with their scores but 90% planned to re(take) despite colleges declaring a test optional process. 60% of participants with change in summer plans and 70% of students unable to visit colleges reported increase in stress. Level of access correlated with perceived support from college counselors (r=0.677) and uncertainty regarding financial aid and athletic scholarships contributed to stress. &#x0D; Two broad themes emerged while studying COVID-19 related increase in stress levels and factors contributing to that change: uncertainty about one’s own application strength and stress due to changes in institutional policies.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Interactions Between Race/Ethnicity and Gender on Physical Activity Among US High School Students: Youth Risk Behavior Survey 2011–2017

Background/purposeMost adolescents do not meet the recommended amount of physical activity. Female, Black, and Hispanic students have significantly less physical activity than White male students. Physical activity of Asian or Multiple Race students have not been reported. The purpose of this research is to estimate differences in physical activity by race/ethnicity and gender among US high school students to examine whether Black Hispanic, Asian and multiple race female students and 11th grade and 12th grade female students have significantly lower physical activity levels. Design/methodsThis study is a secondary analysis of cross-sectional data from the high school Youth Risk Behavior Survey, a biennial, nationally representative survey of US high school students. Four waves of data were pooled from 2011 to 2017 YRBS (N = 59,397). Dependent variables were the number of active days per week a student was physically active, and whether the student was physically active for zero, 5 or more, or 7 days per week. Data were analyzed using R software. ResultsAsian students and students in grade 12 had the fewest number of physically active days per week. Female students were less physically active than male students. Significant negative interactions were measured in female gender by race/ethnicity (Black or Hispanic) and female gender by grade levels for the number of physically active days per week and for zero physically active days per week. The gender disparity in physical activity was significantly more pronounced among Black and Hispanic students. The reduction in physical activity by grade level was also significantly greater among female students. DiscussionEfforts to increase physical activity are especially needed among Asian, Black, and Hispanic, and upper-grade female students. Practical implicationsFurther research is needed to identify explanations and solutions for the significantly lower physical activity among Asians, female minority students, and students in upper grades.

Association Between Design Elements of Concussion Laws and Reporting of Sports-Related Concussions Among US High School Athletes, 2009-2017.

Studies that evaluate the effectiveness of concussion laws often use only a single variable (ie, presence of the law), failing to account for law complexity. We examined the association between multiple design elements of state concussion laws and rates of sports-related concussion reporting among US high school athletes. We derived 3 design elements of concussion laws from the 2009-2017 LawAtlas database: (1) strength of law, (2) number of law revisions, and (3) speed of law adoption. We examined the association between these design elements and rates of new and recurrent sports-related concussion reporting from the 2009-2010 through 2016-2017 academic years in a nationally representative sample of high school athletes participating in High School Report Information Online, an online data collection tool. A total of 7064 sports-related concussions (6332 [89.6%] new and 732 [10.4%] recurrent concussions) were reported during the study period, with an overall rate of 39.7 sports-related concussions per 100 000 athletic exposures (eg, game or practice). Rates of new concussion reporting were higher among high schools in states with medium- or high-strength concussion laws than in states with low-strength concussion laws and in states with at least 1 concussion law revision than in states with no concussion law revisions. Rates of recurrent concussion reporting were lower among high schools in states with ≥2 concussion law revisions than in states with <2 concussion law revisions. Early law adoption was associated with higher rates of new and recurrent concussion reporting, and late law adoption was associated with lower rates of new and recurrent concussion reporting. Our findings may help inform legislators of the public health effect of concussion laws.

Sex differences in the relationship between prescription opioid misuse and gun and other weapon-carrying behaviors

BackgroundPrevious research shows that adolescent prescription opioid misuse is strongly associated with weapon carrying. MethodFor this research, data from the nationally representative 2017 Youth Risk Behavior Survey were analyzed. Average marginal predictions were estimated for gun and weapon carrying as a function of prescription opioid misuse and sex. As per STROBE guidelines, additive interactions with risk differences—in addition to multiplicative interactions with odds ratios and risk ratios—were estimated to investigate sex disparities in the effects of prescription opioid misuse on gun and other weapon-carrying. ResultsMale US high school students who misused prescription opioids had an especially high prevalence of gun and other weapon carrying. Additive interactions show significantly greater risk differences associated with prescription opioid misuse among male students compared to female students for gun carrying, weapon carrying, and weapon carrying at school. In contrast, multiplicative interactions show lower odds ratios and risk ratios among male students for these same weapon-carrying variables. DiscussionPrescription opioid misuse is a significantly greater risk factor for gun and other weapon carrying among male US high school students, which disproportionately increases the risk for violence perpetration, including suicide among these students. Researchers should follow STROBE guidelines and report additive interactions and risk differences separately by sex when investigating risk factors associated with gun and other weapon carrying.

Fewer US Adolescents Playing Football and Public Health: A Review of Measures to Improve Safety and an Analysis of Gaps in the Literature.

Physical activity during adolescence is associated with positive health outcomes, yet only 26% of US middle and high school students report daily physical activity. Moreover, the number of high school students playing a sport is declining, with the largest decline in football. One reason for this decline in playing football may be increased attention to the risk of head injury. For public health, the decline is alarming because football offers a physical activity opportunity for millions of young people every year. In response, efforts have been made to institute measures to enhance the safety of football. The objective of this topical review was to review these measures and the data supporting their effectiveness. We conducted a search of scientific literature supplemented by a web search to identify safety measures. We used the Indiana University library electronic database, PubMed, and web browser searches with specific search terms. In addition to peer-reviewed studies, we searched news stories and reports from sport-related organizations. We summarized the measures and evaluations of effectiveness and categorized the measures by type (game rules, practice guidelines, equipment innovations, strategic initiatives) and target age group (elementary/middle school, high school, college, professional). We found that attempts are being made to improve the safety of football at all levels. However, many measures lack scientific evidence to support their effectiveness. Therefore, researchers need to systematically evaluate safety measures. By implementing evidence-based interventions, we can balance the public health risk of playing football versus the public health risk of continued declines in participation.

Gender differences in the relationship between prescription opioid misuse and depressive symptoms and suicidality among US High School Students

BackgroundPrescription opioid misuse and suicide among adolescents are significant health challenges. PurposeThis study investigated whether effects of prescription opioid misuse on depressive symptoms and suicidality are greater among female than male students. MethodsUsing the 2017 Youth Risk Behavior Survey (N = 14,765), this research estimated additive interactions using risk differences as well as multiplicative interactions using odds ratios. DiscussionResults showed prescription opioid misuse was associated with significantly greater risks among females than males for depressive symptoms (31.1% vs. 20.8%), suicidal ideation (27.3% vs. 19.1%), suicide attempts (18.1% vs. 11.9%) and suicide attempts requiring treatment (8.5% vs. 4.4%). In contrast, multiplicative interactions using odds ratios were all nonsignificant. ConclusionsAmong students who misused prescription opioids, females compared to males had much higher average predicted margins of depressive symptoms, suicidal ideation, suicide attempts, and suicide attempts requiring treatment. Screening for depression and suicidality among adolescents who misuse prescription opioids, and vice versa, is paramount.

Impacts of Changing Sexual Behavior on Chlamydia and Gonorrhea Burden Among US High School Students, 2007 to 2017.

Rates of adolescent sexual activity have long been declining in the United States. We sought to estimate the number of cases of gonorrhea and chlamydia averted over 1 decade associated with these declines and associated costs saved. We analyzed data from the Centers for Disease Control and Prevention's Youth Risk Behavior Survey of US high school students from 2007 to 2017 and combined it with epidemiological estimates drawn from the literature to parameterize a dynamic population transmission model. We compared transmissions from observed behavioral trends with a counterfactual scenario that assumed sexual behaviors from 2007 remained constant for 10 years. We calculated outcomes by age and for 3 racial/ethnic groups (Hispanic, non-Hispanic Black, and non-Hispanic White adolescents) who vary on underlying burden and amount of behavioral change. We estimated 1,118,483 cases of chlamydia and 214,762 cases of gonorrhea were averted (19.5% of burden across all ages). This yielded $474 million (2017 dollars) savings in medical costs over the decade. The largest number of averted cases (767,543) was among Black adolescents, but the largest proportion (28.7%) was among Hispanic adolescents. Whatever its origins, changing sexual behavior among adolescents results in large estimated reductions in STI burden and medical costs relative to previous cohorts. Although diagnoses among adolescents have not declined at this rate, multiple explanations could make these apparently divergent trends consistent. Efforts to continue supporting effective sex education in and out of school along with STI screening for adolescents should reinforce these gains.

Associations of the residential built environment with adolescent sleep outcomes.

Over 75% of US high school students obtain insufficient sleep, placing them at risk for adverse health outcomes. Identification of modifiable determinants of adolescent sleep is needed to inform prevention strategies, yet little is known about the influence of the built environment on adolescent sleep. In this prospective study, actigraphy was used to assess sleep outcomes among 110 adolescents for 14 days each in eighth and ninth grades: duration (hours/night), onset and offset, and sleeping ≥8 hours. Home addresses were linked to built environment exposures: sound levels, tree canopy cover, street density, intersection density, population density, and housing density. Mixed-effects regression estimated associations of built environment measures with sleep outcomes, adjusting for sex, race, parent education, household income, household size, grade, weeknight status, and neighborhood poverty. A 1-standard deviation (SD) increase in neighborhood sound was associated with 16 minutes later sleep onset (β = 0.28; 95% confidence interval (CI): 0.06, 0.49) and 25% lower odds of sleeping for ≥8 hours (odds ratio (OR) = 0.75, 95% CI: 0.59, 0.96). A 1-SD increase in neighborhood tree canopy was associated with 18 minutes earlier sleep onset (β = -0.31, 95% CI: -0.49, -0.13) and 10 minutes earlier sleep offset (β= -0.17, 95% CI: -0.28, -0.05). No associations were observed for density-based exposures. Higher neighborhood sound level was associated with lower odds of sufficient sleep, while higher tree canopy cover was associated with more favorable sleep timing. Neighborhood sound levels and tree canopy cover are potential targets for policies and interventions to support healthier sleep among adolescents.

Dependence on nicotine in US high school students in the context of changing patterns of tobacco product use.

Background and AimThere have been substantial recent changes in youth tobacco product use in the United States—including, notably, a rapid increase in use of e‐cigarettes. It is not known whether, and if so how far, these changes are reflected in levels of nicotine dependence. This study used data from a large, nationally representative sample of US adolescents to (i) estimate the annual prevalence of nicotine dependence in relation to current use of tobacco products, (ii) describe trends in dependence over time and (iii) evaluate whether the increase in youth use of tobacco products has been paralleled by a similar increase in the population burden of nicotine dependence.DesignSecondary analysis of National Youth Tobacco Surveys conducted annually, 2012–19.SettingUnited States.ParticipantsA total of 86 902 high school students.MeasurementsPrevalence of (i) strong cravings to use tobacco in the past 30 days and (ii) wanting to use nicotine products within 30 minutes of waking, in relation to type of product used (cigarettes, other combustible tobacco, smokeless tobacco, e‐cigarettes).FindingsBetween 2012 and 2019 there was a marked decline in past 30‐day cigarette smoking and a surge in use of e‐cigarettes. Different products were associated with differing levels of nicotine dependence, with cigarettes characterized by highest dependence (strong craving 42.3%; wanting to use within 30 minutes 16.8% among exclusive users in 2019) and e‐cigarettes in otherwise tobacco‐naive students by low dependence (16.1 and 8.8% respectively in 2019). The overall 33.8% increase in population use of nicotine products between 2012 and 2019 (from 23.2 to 31.2%) was not accompanied by an equivalent increase in overall population burden of dependence {percentage reporting craving 10.9% [95% confidence interval (CI) = 9.8–12.2%] in 2012 and 9.5% (95% CI = 7.5–12.0%) in 2019; wanting to use within 30 minutes 4.7% (95% CI = 4.0–5.5%) in 2012, 5.4% (95% CI = 4.0–7.2%) in 2019}.ConclusionsAmong US high school students, increases in the prevalence of nicotine product use from 2012 to 2019 do not appear to have been accompanied by a similar increase in the population burden of nicotine dependence. This may be at least partly attributable to a shift in the most common product of choice from cigarettes (on which users are most dependent) to e‐cigarettes (on which users are least dependent).

Association between e-cigarette use initiated after cigarette smoking and smoking abstinence: a cross-sectional study among adolescent established smokers in the USA

BackgroundRecent years have seen a rapid increase in the popularity of electronic cigarettes (e-cigarettes) among adolescents in the USA. Evidence on their role in the continuation of or abstinence from...

Toward a More Comprehensive Index of Youth Cigarette Smoking: Average Number of Cigarettes Smoked per Day among Students in the United States over Two Decades.

Reliance on 30-day prevalence as the principal means of assessing trends in youth cigarette smoking may understate the magnitude of the decrease in youth smoking, because prevalence does not account for smoking frequency or intensity. We analyzed Youth Risk Behavior Survey (YRBS) data from 1997 through 2017 and estimated cigarette smoking prevalence (any smoking in the previous 30 days), frequency (number of smoking days in the previous 30 days), and intensity (cigarettes per day on smoking days). We calculated average cigarettes smoked per day (ACSD) as the product of frequency and intensity, divided by 30. We estimated ACSD among all high school students and by smoking frequency group (i.e., 1–5, 6–9, 10–19, 20–29, or 30 of the previous 30 days), sex, grade level, and race/ethnicity. Among US high school students, ACSD declined by 86.7% from 1997 to 2017, while prevalence declined by 75.8%. Within smoking frequency groups, smoking intensity remained similar over the two decades. However, changes in ACSD over time varied by race/ethnicity; ACSD increased among Hispanic and non-Hispanic Black daily smokers while it decreased among daily smokers of other race/ethnicity groups. ACSD declined more substantially than smoking prevalence over two decades but remained virtually unchanged within smoking frequency groups, indicating that changes in frequency, rather than intensity, drove this decline. Prevalence estimates alone understate the degree to which youth in the United States have rejected smoking, and racial/ethnic disparities in smoking intensity are hidden when we limit our lens to prevalence-only measures.