Youth Risk Behavior Surveillance Survey Research Articles

Examining Associations Between School Connectedness, Social Support, Violence, and Firearm Carrying.

Firearms are the leading cause of pediatric deaths. Few studies have identified protective factors that reduce the risk of firearm violence. Interpersonal factors, including school connectedness and social support, protect against multiple health-affecting risk behaviors. Therefore, this study examines associations of school connectedness and social support with firearm and weapon violence involvement. Data were gathered through an anonymous survey conducted across 13 high schools within an urban school district in 2018 (n = 2,604) modeled on the Centers for Disease Control and Prevention Youth Risk Behavior Surveillance Survey. Separate hierarchical logistic regression models examined associations between school connectedness and social support, and the outcomes of firearm carrying and engaging in violence with a weapon on school property in the past 12 months. Models were adjusted for age, race, and covariates representing basic needs, education, and mental health. The mean age was 15.7 years, and 57.5% of youth were female. 5.8% of youth had carried firearms and 5.5% engaged in violence with a weapon on school property in the past 12 months. School connectedness was significantly inversely associated with engaging in violence with a weapon on school property (odds ratio [OR] 0.225, 95% confidence interval [CI] [0.080, 0.632] and high levels of social support were significantly inversely associated with firearm carrying (OR 0.522, 95% CI [0.313, 0.870]). School connectedness and social support may be important in protecting youth from firearm and weapon-related violence. Interventions that strengthen safe and supportive interpersonal relationships within school environments and broader support systems across contexts may help reduce firearm and weapon violence involvement.

Preliminary Reporting Patterns of Suicide Ideation and Attempt Among Native American Adolescents in Two Samples

ABSTRACT Objective Native American adolescents are disproportionately burdened by suicidality. Here, we examine patterns of reporting of suicide ideation and suicide attempt among Native American youth compared to those from other ethnoracial backgrounds, as this data is important for grounding commonly subscribed to frameworks of suicide risk (e.g., ideation-to-action). Method Data are from the Youth Risk Behavior Surveillance Survey (N = 54,243; grades 9–12; 51.0% female) and Minnesota Student Survey (N = 335,151; grades 8, 9, 11; 50.7% female). Comparing Native American youth to peers from other ethnoracial backgrounds, we examined two suicide reporting patterns: 1) odds of reporting suicide attempt among those who reported ideation and 2) odds of reporting suicide ideation among those who reported an attempt. Results Across both samples, when reporting suicide ideation, youth from other ethnoracial backgrounds were 20–55% less likely than Native American youth to also report attempt. While few consistent differences were observed between Native American youth and those from other racial minority backgrounds in patterns of co-reporting suicide ideation and attempt across samples, White youth were between 37% and 63% less likely than Native American youth to report a suicide attempt without also reporting ideation. Conclusions The increased odds of engaging in a suicide attempt with or without reporting ideation question the generalizability of widely held frameworks of suicide risk to Native American youth and have important implications for suicide risk monitoring. Future research is needed to illuminate how these behaviors unfold over time and the potential mechanisms of risk for engaging in suicide attempts in this disproportionately burdened group. Abbreviations: YRBSS: Youth Risk Behavior Surveillance Survey; MSS: Minnesota Student Survey

Prevalence and predictors of suicidal behaviours among primary and secondary school going adolescents in Botswana.

There is a scarcity of studies on the prevalence and predictors of suicide behaviors among primary and secondary school going adolescents aged 10-19 years in Botswana hence, this study would fill that gap. This study used cross-sectional secondary data from Botswana Youth Risk Behavior and Biological Surveillance Survey (BYRBBSS), 2010. Multivariable binary logistic regression models were used to investigate the predictors of suicide behaviours. The study shows that 51.5% of the respondents reported having ever contemplated suicide while 40.1% of the respondents attempted suicide in the last 12 months before the survey. The study found that male learners (AOR = 0.61, 95% CI = 0.44-0.83), learners who were not attacked or threatened or injured by someone (AOR = 0.35, 95% CI = 0.17-0.72), who were not bullied (AOR = 0.22, 95% CI = 0.13-0.39), and who were confident of themselves (AOR = 0.55, 95% CI = 0.39-0.76) were less likely to contemplate suicide. Whereas learners with primary school level education were more likely to contemplate suicide (AOR = 2.12, 95% CI = 1.14-3.95). Males were less likely than their female counterparts to attempt suicide (AOR = 0.68, 95% CI = 0.47-0.97). Regarding attempt, learners who had self-confidence (AOR = 0.35, 95% CI = 0.24-0.50), not being bullied (AOR = 0.20, 95% CI = 0.11-0.35), not being attacked or threatened or injured by someone (AOR = 0.35, 95% CI = 0.18-0.69), not engaging in a physical fight that led to injury (AOR = 0.34, 95% CI = 0.19-0.61) were less likely to attempt suicide. Whereas being at primary school (AOR = 5.29, 95% CI = 2.58-10.86), and missing classes once or more in a week (AOR = 1.70, 95% CI = 1.05-2.76) were associated with increased likelihood of suicide attempt. The study shows that suicide behaviours as big challenges in Botswana among primary and secondary school going adolescents aged 10-19 years. Thus, the study recommends policy interventions aiming at including education on peer bullying or fighting or attack at primary and secondary education levels if not already in existence. There should also be interventions aiming at educating guardians and teachers on consequences of bullying or fighting so that they should consistently remind their children not to bully and for them to open up if they are being bullied. The study further recommends that schools and communities at large should have a psychosocial system for bullying or fighting reporting, follow-up, and appropriate corrective interventions for the offenders. There should also be self-confidence instilling education as well as sex/gender-specific interventions for instance girls can be given platform (private if necessary) to express peculiar problems to them that need specific help.

Oral healthcare visits among sexual minority adolescents ages 14-18, 2019, USA.

Health disparities persist among sexual minority (SM) adolescents (i.e., bisexual, lesbian/gay) compared to heterosexual adolescents, however, research is limited on oral health. The purpose of this study was to examine reported recency of dental visits by sexual orientation among a national sample of adolescents. Data from the 2019 Youth Risk Behavior Surveillance Survey (n=12,673 adolescents, 14-18 years old) were analyzed. We assessed dental care in the past 12 months or more based on sexual orientation ("lesbian/gay," "bisexual," "not sure"). Adjusted, sex-stratified, multinomial logistic regression analyses were used to determine conditional associations. Bisexual boys (aRR:2.50), "not sure" boys (aRR:3.55), and "not sure" girls (aRR:2.32) were at increased relative risk for not going to the dentist compared to heterosexual adolescents. Findings indicate gaps in oral healthcare access among SM adolescents, specifically bisexual and not sure youth. Results can be used to increase access to preventive dental care among SM adolescents.

The impact of adverse childhood experiences on adolescent health risk indicators in a community sample. Correction to Meeker et al. (2021).

The sample included 1,532 adolescents who completed the Youth Risk Behavior Surveillance Survey in their local high schools. By local consensus, this national survey was augmented with questions exploring prevalence of 11 commonly identified ACEs. After controlling for age, gender, and race, youth with multiple ACEs reported 3 to 15 times the odds of a range of negative health experiences. Findings indicate a serious burden of ACEs on adolescent social emotional well-being. This study did not include youth in out of school placements or who were not present the day the survey was given, and thus represent youth who may benefit from universal prevention and intervention programs. Universal screening of ACEs and health-related outcomes suggests that reporting multiple ACEs is strongly related to a wide range of mental health, violence, and substance use histories. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

43.4 Cannabis Legalization and Adolescent Other Substance Use

Opinions regarding cannabis legalization have shifted over the past decade, with nearly one-third of US states legalizing recreational cannabis use. Such policy changes may have unintended consequences for adolescents, including changes in other substance use patterns. Our study aims to evaluate relationships between cannabis legalization and the use of a broad range of substances by adolescents. We hypothesize that state cannabis legalization status will be significantly associated with differences in adolescent substance use. Data are from the CDC’s 2019 Youth Risk Behavior Surveillance Survey (n = 182,491), a nationally representative sample of US high school students. Students were categorized by the cannabis legalization status of the state in which they lived during survey completion, and associations with use of each substance (yes/no) were evaluated with logistic regressions, adjusting for demographic characteristics to provide adjusted ORs (aORs) and 95% CI (α = 0.05). Students in states in which recreational cannabis was legal (RCL states) were significantly more likely than students in states in which only medical cannabis was legal (MCL states) to report methamphetamine, cocaine, or ecstasy use (aORs 1.31-2.64). Compared to students in which neither recreational nor medical cannabis was legal (NL states), students in MCL states were significantly more likely to report cannabis use (aOR 1.15; 95% CI, 1.07-1.24; p = 0.0002) but significantly less likely to report cocaine, inhalant, ecstasy, or opioid use (aORs 0.72-0.88). Students in both RCL and MCL states were significantly less likely to report cigarette use compared to students in NL states (aORs 0.54 [95% CI, 0.44-0.67] and 0.74 [95% CI, 0.68-0.81], respectively; p < 0.0001). This mixed landscape of adolescent substance use indicates interesting potential adolescent substance use patterns depending on the cannabis policies enacted in their state that deserve further study.

Combined Associations of Smoking and Bullying Victimization With Binge Drinking Among Adolescents in Beijing, China.

Background: Binge drinking and smoking among adolescents are serious public concerns. However, very few studies have explored the reinforcement of bullying victimization by such behavior. Our study aimed at examining the individual and combined associations of smoking and bullying victimization with binge drinking among adolescents in Beijing, China.Methods: A total of 33,694 students aged 13–17 years old in Beijing, China were anonymously investigated via the cross-sectional Chinese Youth Risk Behavior Surveillance Survey from April to May 2014. A three-stage stratified sampling was used to select participants. Factors such as sociodemographic variables and indicators of smoking, bullying victimization, and binge drinking were analyzed with multiple logistic regressions, and joint and additive interaction effects were tested.Results: Overall, ever-drinking prevalence was 59.1% (boys: 64.4%; girls: 53.7%). Past 30-day binge drinking was 11.5% (boys: 15.6%; girls: 7.4%) and frequent binge drinking was 2.3% (boys: 3.3%; girls: 1.0%). Past 30-day smoking was 10.7% (boys: 16.4%; girls: 5.0%) and past 30-day bullying victimization was 48.7% (boys: 57.3%; girls: 40.1%). The combined effects of smoking and bullying victimization on occasional binge drinking (OR = 6.49, 95% CI = 5.60–7.52) and frequent binge drinking (OR = 10.32, 95% CI = 7.52–14.14) were significant, and the additive interaction effect was significant for current smoking and bullying victimization on frequent binge drinking (OR = 10.22, 95% CI = 9.43–11.07). The additive interaction effect for current smoking and bullying victimization on frequent binge drinking was significant among boys.Conclusion: Bullying victimization reinforced the association of smoking with frequent binge drinking, especially with findings specific to boys. Programs to prevent smoking or bullying or both may reduce binge drinking among adolescents in China.

Bullying and suicide risk among sexual minority youth in the United States

Bullying is associated with increased suicide risk and maladaptive development for sexual minority youth (SMY). The purpose of this study is to determine whether multiple forms of bullying mediate the relationship between biological sex and suicide risk among SMY and to determine whether sexual identity moderates these relationships (i.e., moderated mediation). Data from the 2015–2019 National Youth Risk Behavior Surveillance Survey was analyzed using multiple group structural equation modeling with the 5967 youth that self-identified as Lesbian/Gay, Bisexual, or Not sure of their sexual identity. All forms of bullying were associated with suicide risk. After controlling for bullying, Male SMY reported less suicide risk in comparison to female SMY. Female SMY were more likely to be cyberbullied while male SMY were more likely to be threatened or injured with a weapon. Sexual identity did not moderate these relationships. These finding align with the minority stress theory which posits the victimization experiences are linked to negative mental health outcomes among minority youth. Although sexual identity did not moderate these relationships, this study reveals new mechanistic pathways influencing sex-based suicide risk disparities among SMY. Findings can inform future research and the development of suicide prevention interventions that address the unique needs of SMY occurring at the intersection of sex and sexual identity.

Self-reported history of intensity of smoking is associated with risk factors for suicide among high school students.

ObjectiveTo examine the relationship between current cigarette smoking patterns and three established risk factors for suicide using nationally representative data of high school students in the United States.MethodsWe analyzed cross-sectional data from the national Youth Risk Behavior Surveillance Survey (YRBSS)–United States, 2017. Multivariable, logistic regressions examined the association between 3 cigarette smoking behaviors [i.e., past 30-day cigarette (n = 13,731), frequent (n = 1,093) and heavy (n = 880) smoking] and 3 risk factors for suicidal outcomes [feeling sad or hopeless, suicidal ideation, suicide plan] assessed over the previous year.ResultsAmong high school cigarette smokers, smoking 11 or more cigarettes per day (i.e., heavy smoking) was associated with 3.43 (95% CI: 1.69, 6.94) greater odds of reporting feeling sad or hopeless, 2.97 (95% CI: 1.60, 5.51) greater odds of reporting suicidal ideations, and 2.11 (95% CI: 1.34, 3.32) greater odds of reporting having ever planned a suicide attempt, controlling for covariates.ConclusionsOur study shows that it is not simply cigarette smoking, but heavy cigarette smoking that is a risk factor for suicidal outcomes among adolescents.Public health implicationsA comprehensive plan is needed to accommodate heavy adolescent smokers who are at increased suicidal risk.

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.

Dental health awareness in patients feeling sad or hopeless- an estimate from youth risk behavior surveillance survey

IntroductionResearch has found that low mood including sadness and hopelessness is an important factor for decreased awareness in one’s oral health and lowered frequency of visit to the dental office, this relationship is not well studied in national representative samples. Poor mental wellbeing can lead to poor oral health.ObjectivesAim is to examine the relationship between feeling sad or hopeless and awareness for dental care.MethodsData were obtained from the Youth Risk Behavior Surveillance Survey (YRBS-CDC), USA, for years 2009-2017. All ages from 12 to 18 years, feeling sad or hopeless and dental visits were identified. Univariable relationship between feeling sad or hopeless (&gt;2 weeks in the past year) and dental office visits for all dental care (during the past 12 months, 12-24 months, &gt;24 months, and never) was evaluated using chi-square test.ResultsOut of a total of 53,098 youths, 30.5% of youths were feeling sad or hopeless. Within the youths feeling sad or hopeless, the prevalence of youth who never received dental care was higher at 37.1% in comparison to youths who received dental care &gt;24 months ago 36.4%,12-24 months 33.7%, and visited the dental office in the past 12 months 28.9%. (p&lt;0.0001). In youths who had dental care in the last 12 months, the prevalence of sadness or hopelessness was lower at 65% vs 70%, while it was higher in youths who had never had dental care at 3.3% vs 1.7%.ConclusionsFurther research is warranted to evaluate reduced oral health care awareness among participants feeling sad or hopeless.

Role of sex on the relationship between sexual minority status and past 30-day marijuana use among high school students (YRBS, 2015–2019)

BackgroundSexual minority status (SMS) is a known risk factor for marijuana use among youth in the United States (US). Limited research has examined the differing relationship between SMS and marijuana use across males and females. This study examined the modifying effect of sex on the relationship between sexual minority status (SMS) and past 30-day marijuana use among youth. MethodsData were pooled from the 2015, 2017, and 2019 Youth Risk Behavior Surveillance survey. Participants were 9th through 12th grade students in the US (n = 37,870). An interaction model (SMS*sex) and models stratified by sex tested effect modification. Covariates included race/ethnicity, grade, tobacco use, illicit drug use, and survey year. ResultsThe association between SMS and past 30-day marijuana use differed statistically by sex assigned at birth. Among females, SMS was associated with 1.33 greater odds of past 30-day marijuana use. Conversely, among males, SMS was associated with 0.70 lower odds of past 30-day marijuana. Interaction model was statistically significant. ConclusionSMS is associated with greater odds of being a past 30-day marijuana user among females but lower odds among males. Prevention and education programs aimed at youth should consider these factors during development and implementation. Longitudinal research is needed to further examine the nuances of the relationship observed in this analysis.

Disparities in Adolescent Dating Violence and Associated Internalizing and Externalizing Mental Health Symptoms by Gender, Race/Ethnicity, and Sexual Orientation.

The current study examined the prevalence and mental health associated with physical and sexual dating violence among adolescents using an intersectional analysis. Data were obtained from 88,219 adolescents in the Youth Risk Behavior Surveillance Survey. Gender, race/ethnicity, sexual orientation, and experiences with teen dating violence were measured for each youth. Tested two- and three-way interactions demonstrate varied outcomes by social identification and emphasize the need for an intersectional approach in dating violence research. Adolescent dating violence was most prevalent among girls (10% physical, 13% sexual); adolescents were racially identified as Native North American (13% physical, 10% sexual), Hawaiian/Pacific Islander (12% physical, 14% sexual), or multiracial (11% physical, 12% sexual), and lesbian, gay, bisexual, or questioning their sexual orientation (LGBQ) adolescents (19% physical, 20% sexual). The intersectional groups with the highest rates of physical and sexual dating violence included Latinx GBQ boys (26% physical, 26% sexual) and Hawaiian/Pacific Islander GBQ boys (29% physical, 32% sexual). Among girls, highest rates were observed among Hawaiian/Pacific Islander LBQ (24% physical, 23% sexual). Externalizing symptoms associated with physical dating violence were most robust for risky sexual behavior (OR = 4.0), followed by physical fighting (OR = 3.0), and weapon carrying (OR = 2.5); they were also associated with sexual dating violence (ORs = 1.9-2.2). Internalizing symptoms were comparably associated with both types of dating violence (ORs = 2.6-2.9 physical and ORs = 2.4-2.8 sexual). Findings suggest first that an intersectional approach is especially informative in teen dating violence prevention and intervention and second that teen dating violence interventions and prevention programming should use a trauma-informed, gender-responsive, culturally sensitive, and LGBQ inclusive approach.

The impact of adverse childhood experiences on adolescent health risk indicators in a community sample.

Despite growing awareness of the high prevalence of adverse childhood experiences (ACEs) in community samples of adolescents, little work has examined the impact of ACEs on adolescence and well-being during this critical period of development. Much research has focused on retrospective reports of ACEs by adults and adult physical and mental health, finding that ACEs contribute to a range of diseases and mental health disorders in adulthood. This study examined differences in self-reported mental health, nonsuicidal self-injury, suicidality, violence, and substance use between adolescents without self-reported history of ACEs, youth with one self-reported ACE, and youth with self-reported multiple (2 or more) ACEs. The sample included 1,532 adolescents who completed the Youth Risk Behavior Surveillance Survey in their local high schools. By local consensus, this national survey was augmented with questions exploring prevalence of 11 commonly identified ACEs. After controlling for age, gender, and race, youth with multiple ACEs reported 3 to 15 times the odds of a range of negative health experiences. Findings indicate a serious burden of ACEs on adolescent social emotional well-being. This study did not include youth in out of school placements or who were not present the day the survey was given, and thus represent youth who may benefit from universal prevention and intervention programs. Universal screening of ACEs and health-related outcomes suggests that reporting multiple ACEs is strongly related to a wide range of mental health, violence, and substance use histories. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

LGB-Affirming School Climates and Sexual Health Outcomes Among U.S. High School Students 2015–2017: Differences by Sex and Sexual Identity

PurposeLesbian, gay, and bisexual (LGB) adolescents face disparities in sexual health outcomes compared to their heterosexual peers, which has implications for health outcomes and developmental trajectories. We examined whether adolescents living in jurisdictions with school climates that were more exclusionary toward LGB individuals engaged in higher risk sexual behaviors than those in jurisdictions with more inclusive school climates. MethodsData on sexual identity, age at first sex, condom use at last sex and the number of lifetime partners came from the 2015 (20 jurisdictions) and 2017 (19 jurisdictions) Youth Risk Behavior Surveillance Surveys. Data on LGB climates in schools, aggregated to the state level, came from the School Health Profile Survey of the Centers for Disease Control and Prevention. Multilevel multivariable regressions examined the association between LGB school climate and sexual behaviors, including effect modification. ResultsOverall, living in jurisdictions with more exclusionary LGB school climates was significantly associated with a lower age at first sex (β = –.04[–.07, –.02]) and a lower likelihood of condom use (OR = .94[.90, .98]), but not the number of lifetime partners. Associations differed by subgroup: sexual identity modified the relationship between school climate and age at first sex (β = –.09[–.15, –.03]) for bisexual adolescents, and school climate and condom use for bisexual (OR = .86[.76, .98]) and gay adolescents (OR = .66[.64, .68]). ConclusionsExclusionary LGB school climates are associated with a lower age at first sex and a lower likelihood of condom use for all adolescents, and particularly bisexual individuals. Additional research and practice should address school-level climates to support adolescents’ healthy sexual development.

Intra-and Interpersonal Factors Buffer the Relationship Between Food Insecurity and Mental Well-Being Among Middle Schoolers.

Food insecurity (FI) is a significant predictor of feelings of isolation in children, as well as suicide ideation and depression. Using a census of public middle school-aged children, we seek to determine whether FI is associated with suicide ideation and feelings of hopelessness and how individual and school community factors can alleviate or exacerbate this relationship. We analyzed data from the 2015 Youth Risk Behavior Surveillance Survey, conducted statewide by the Vermont Department of Health and administered to all public middle schoolers (N=13,648). Questions were asked about FI, suicidal thoughts, feelings of hopelessness, perceptions of teaching and community care, physical activity, breakfast consumption, and demographics. Bivariate and cross-tabular analyses were conducted in SPSS, and regressions and Sobel tests were conducted in STATA. Results show that FI is associated with decreases in psychological well-being as measured by suicide ideation and feelings of hopelessness in students. However, students who reported eating breakfast regularly, feeling connected to their community or having a positive relationship with a teacher had significantly lower instances of suicide ideation and hopelessness. Suicide prevention programs should focus on enhancing community connection and student-teacher relationships and increasing funding for breakfast programs in schools.

Locked, Loaded, and Ready for School: The Association of Safety Concerns With Weapon-carrying Behavior Among Adolescents in the United States.

There is limited, if any, prior research exploring the potential link between adolescents' safety concerns and their predisposition to possess weapons has been limited. This study aimed to examine the relationship between high school students' perceived lack of safety and their weapons carrying behavior in a multiyear nationally representative sample of high school students. Information on self-reported weapons carrying in past month and gun carrying in past year, perceived lack of safety at school or during commute, being bullied and/or threatened, involvement in physical fights, and demographic characteristics were retrieved from Youth Risk Behavior Surveillance Survey data for 1991-2017. Generalized linear mixed models were used to address data clustering by survey year. Sampling design and sample weights were accounted for. Of a total number of 195,280 respondents with valid responses during 1991-2017, 18%, 7%, and 5%, respectively, carried weapon(s) in general, weapon(s) to school, and gun. On an average, 5% skipped school due to safety concerns. Missing ≥2 school days was associated with weapon (adjusted odds ratio [AOR]: 2.25; 95% confidence interval [CI]: 1.94 -2.61) and gun (AOR: 3.18; 95% CI: 1.81 -5.58) possessions, as well as weapons possession in school (AOR: 2.47; 95% CI: 1.96 -3.12). Experiences of weapons-induced injury(ies) or threat(s), and involvement in physical fights were other significant covariates in adjusted analyses. Compared with non-Hispanic whites, students of other racial/ethnic groups had significantly lower odds of possessing weapons. Perceived lack of safety emerged as a potential determinant of weapon carrying, a behavior with far-reaching public health concerns. While future research looking into the psychological motivations of possessing weapons is recommended, our findings offer a unique opportunity to address the crucial problems of school absenteeism induced by experiences of aggression and fears for safety as well as preempt the consequences of weapons-possession by adolescents.

The Association of Asthma, Sexual Identity, and Inhaled Substance Use among U.S. Adolescents.

Rationale: Minority sexual identity appears to confer asthma risks. Although associations between inhaled substances and asthma are established, these have not been examined among sexual minority youths. Given sexual minority adolescents' disproportionately high rates of substance use, research is needed to fill this important gap.Objectives: Using a representative sample of adolescents from the United States, we 1) examined associations among asthma, sexual identity, and inhaled substance use and tested 2a) whether sexual identity moderates relationships between asthma and inhaled substance use and 2b) whether inhaled substance use mediates associations between sexual identity and asthma.Methods: Data are from the 2015 and 2017 Youth Risk Behavior Surveillance Survey. Adolescents (n = 30,113) reported if they were ever diagnosed with asthma, current use of cigarettes, cigars and/or cigarillos, marijuana, and electronic vapor products and if they ever used inhalants or synthetic marijuana. We used logistic regression to examine associations between asthma, sexual identity, and inhaled substance use controlling for age, race or ethnicity, and body mass index percentile, stratified by sex.Results: Lesbian, gay, and bisexual respondents had higher relative risks for asthma than heterosexual youth. Sexual minority female youths had significantly higher relative risks than heterosexual female youths for use of every inhaled substance. There were few sexual identity differences in inhaled substance use among male youths. Inhaled substance use was significantly associated with higher risks for asthma. In general, associations between each individual inhaled substance and asthma did not differ between sexual minority and heterosexual youths. However, when all inhaled substances were added into the models concurrently, inhaled substance use appeared to mediate associations with asthma among lesbian and bisexual female youths, and partially mediated these associations among sexual minority male youths.Conclusions: Sexual identity and inhaled substance use appear to play important roles in asthma risk. However, these variables do not fully explain the risk, suggesting that other unmeasured variables (e.g., stress and victimization) may be implicated in risks for both inhaled substance use and asthma. It is important that clinicians providing care to adolescents ask about sexual identity and inhaled substance use. Effective approaches to reducing inhaled substance use among adolescents, especially sexual minorities, are needed.

Role of Sex on the Relationship Between Sexual Minority Status and Misperceptions of Body Weight Among High School Students

PurposeMisperception of body weight during adolescence is a risk factor for negative self-image, harmful eating/dietary habits (e.g., binge eating and purging), and body dysmorphia. Sexual minority youth, particularly males, may be at increased risk for misperceptions of body weight, relative to youth who do not identify as a sexual minority. This study examines the risk for misperception of body weight among sexual minority youth and explores biological sex as an effect modifier in this relationship. MethodsWe pooled data from the 2015 and 2017 Youth Risk Behavior Surveillance Surveys. Participants were 18,634 high school students who were not overweight/obese. Multivariable logistic regression examined the association between sexual minority status (i.e., gay, lesbian, bisexual, and unsure) and misperceptions of body weight (i.e., self-perceived as overweight/severely overweight). Weighted multivariable logistic regression analyses, stratified by biological sex, were used to compare this relationship across males and females. Covariates included race/ethnicity, grade, bullying victimization, television/electronic screen time, and tobacco use. ResultsOverall, 16.6% of the sample self-reported misperceptions of body weight. Sexual minority youth had 1.49 (95% confidence interval [CI]: 1.28–1.73) greater odds of misperception of body weight, adjusting for covariates; this relationship was found across biological sex, but that the main effect was significantly greater among sexual minority males (adjusted odds ratio: 2.24, 95% CI: 1.65–3.03) relative to sexual minority females (adjusted odds ratio: 1.33, 95% CI: 1.11–1.59). ConclusionsSexual minority youth had greater odds of overestimating their weight status. Biological sex appears to modify this relationship with sexual minority males being at particularly high risk for overestimating their weight status.

Teen Dating Violence and Suicide Risk Among Bisexual Adolescents

PurposeSuicide is a public health problem that disproportionately affects bisexual youth more than heterosexual, lesbian/gay, and other sexual minority youth. Teen dating violence (TDV) consists of physically, emotionally, and/or psychologically aggressive behavior in adolescent relationships and has been linked to increased suicidality among sexual minority youth. Although biological sex differences in suicide and TDV have been noted, limited research currently exists regarding the importance of these differences in bisexual youth. MethodsThis study employed a cross-sectional descriptive design to investigate the relationship between biological sex, TDV, and suicide risk among bisexual youth in grades 9–12. This study used structural equation modeling to conduct a secondary analysis of pooled 2015 and 2017 national Youth Risk Behavior Surveillance Survey data that examined whether TDV mediated the relationship between biological sex and suicide risk among bisexual youth. ResultsResults indicated that TDV did not mediate the relationship between biological sex and suicide risk among bisexual youth. Biological sex was a significant predictor of suicide risk with male youth reporting lower suicide risk than female youth, when controlling for dating history, TDV, age, and race. TDV predicted suicide risk, with youth reporting TDV having higher suicide risk, when controlling for dating history, biological sex, age, and race. In addition, black and Hispanic youth reported lower suicide risk compared to white youth. ConclusionThere is a dire need for research that addresses issues of TDV and suicide among bisexual youth. Understanding factors influencing suicide risk following TDV experiences among bisexual youth will inform interventions to mitigate negative mental health outcomes.