Youth Risk Behavior Surveillance Research Articles

The effect of vertical identification card laws on teenage tobacco and alcohol use.

We study the impact of vertical identification card laws, which changed the orientation of driver's licenses and state identification cards from horizontal to vertical for those under 21years, on teenage tobacco and alcohol use. We study this question using four national datasets (pooled national and state Youth Risk Behavior Surveillance System, National Youth Tobacco Survey, Current Population Survey to Tobacco Use Supplements, and Behavioral Risk Factor Surveillance System). We improve previous databases of vertical ID law implementation by using original archival research to identify the exact date of the law change. We estimate models using standard two-way fixed effects and stacked difference-in-differences that avoid bias from dynamic and heterogeneous treatment effects. Using data through 2021, we do not find evidence of reductions in teenage tobacco and alcohol use. While these laws reduce retail-based purchasing, they also increase social sourcing, thus leading to no net impact on use.

The Prevalence of and Trend in Drug Use among Adolescents in Mississippi and the United States: Youth Risk Behavior Surveillance System (YRBSS) 2001-2021.

Mississippi youth are demographically unique compared to those of the nation. The aim of the study was to examine the drug use among adolescents in Mississippi compared to that in the US, which included determining prevalence and trends in drug use as well as drugs on school property and estimating the differences in drug use prevalence by gender and by race. National and Mississippi Youth Risk Behavior Surveillance System (YRBSS) data from 2001 to 2021 were obtained for analysis. Summary statistics, prevalence ratio, and survey Chi-squared tests of independence statistics were generated for the comparison for all students, and by gender and race separately. Trend analysis was conducted using logistic regression combined with joinpoint regression. The six survey questions being studied were the following: have you ever used marijuana, an inhalant, heroin, methamphetamines, or injected drugs, and were you offered, sold, or given an illegal drug on school property during the last 12 months. Survey packages in R were used to account for the complex sampling design of YRBSS data. On the national level, all six drug-related risk behaviors being studied showed a significant decrease from 2001 to 2021. In Mississippi, however, only "ever used marijuana" showed a decrease trend, while three remain unchanged, and two increased. The 2021 YRBSS data show that Mississippi adolescents exhibited a significantly higher prevalence of drug use, and are more likely to be offered, sold or given an illegal drug on school property. This research showed detailed findings on drug use-related issues in Mississippi, which is alarming. This poses an important challenge for public health in Mississippi and sounds an urgent call for drug use intervention among Mississippi adolescents. More concerted actions at the community, school and government level are needed for reducing youth drug use and controlling the drug traffic on school property.

Factors Predicting In-School and Electronic Bullying among High School Students in the United States: An Analysis of the 2021 Youth Risk Behavior Surveillance System.

Bullying is a global public health problem with severe adverse effects on behavioral health. Understanding the predictors of victimization by bullying is essential for public policy initiatives to respond to the problem effectively. In addition to traditional in-person bullying, electronic bullying has become more prevalent due to increasing social interaction and identity formation in virtual communities. This study aims to determine the predictors of in-school and electronic bullying. We employed multivariable logistic regression to analyze a nationally representative sample of 17,232 high school students in the United States, the 2021 Youth Risk Behavior Surveillance System national component. The survey was conducted during the COVID-19 pandemic, from September through December 2021. The factors examined included sociodemographic characteristics (age, gender, race), appearance (obesity), physically active lifestyles (being physically active, spending a long time on digital games), and risk-taking behavior (using marijuana). Our results indicated that sociodemographic characteristics were strong predictors of being bullied in school and electronically. Being obese is more likely to result in bullying in school (AOR = 1.32, p = 0.003) and electronically (AOR = 1.30, p = 0.004). Adolescent students showing marijuana use had higher odds of being bullied in school (AOR = 2.15, p < 0.001) and electronically (AOR = 1.81, p < 0.001). While spending a long time on digital devices raises the risk of being electronically bullied (AOR = 1.25, p = 0.014), being physically active is not associated with being bullied. Neither of the two lifestyle factors was associated with in-school bullying. Interventions addressing violence among adolescents can benefit from empirical evidence of risk factors for bullying victimization in high school.

Trends in adherence to the 24-h movement guidelines among US adolescents from 2011 to 2019: Evidence from repeated cross-sectional cycles of the Youth Risk Behavior Surveillance System.

Adherence to the 24-h movement guidelines is associated with various health benefits, but given the novelty of these integrative recommendations, little is known about year-to-year trends in guideline adherence in adolescents. This study investigated trends of adherence to the 24-h movement guidelines among US adolescents. Data from 2011 to 2019 cycles of the Youth Risk Behavior Surveillance System were used, which included 62 589 US adolescents aged 14-17 years (female: unweighted sample size = 31 876, 51%; weighted% = 50.1%). Participants self-reported their demographic information (i.e., sex, age, race/ethnicity), physical activity, screen time and sleep duration. Meeting the 24-h movement guidelines was operationalized as simultaneously engaging in 60 min or more of moderate-to-vigorous physical activity, no more than 2 h of screen time, and 8-10 h of sleep per day. Trend analysis was used to examine the secular changes in adherence to the integrated guidelines from 2011 to 2019. Downward trends in adherence to the 24-h movement guidelines were observed among adolescents from 2011 (3.6%) to 2019 (2.6%). After stratification by sex, age, and race/ethnicity, similar downward trends in the guideline adherence were observed in females and Black/African American adolescents. The lowest prevalence of meeting the individual guidelines was for the PA guidelines (25.6%). Movement guideline adherence was consistently lowest among females, older adolescents, and those who identified as Black/African American. Adherence to the 24-h movement guidelines has declined among US adolescents over the past decade. Interventions should prioritize an integrative approach that could increase concurrent adherence to each of the 24-h movement guideline, particularly among female, older and minority adolescents.

Breaking the Silence: An Epidemiological Report on Asian American and Pacific Islander Youth Mental Health and Suicide (1999-2021).

Limited studies have focused on recent trends in Asian American and Pacific Islander (AAPI) youth suicide. This study aimed to evaluate epidemiological trends in AAPI youth suicide and reports of depressive symptoms among Asian and Pacific Islander youth in the USA. This cross-sectional study analyzed mortality data from the Centers for Disease Control Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) and reports of depressive symptoms from the Youth Risk Behaviour Surveillance System (YRBSS). Data from 1999 to 2021 were analyzed for suicide rates and methods used among AAPI youth aged 5-24 years. YRBSS data from 1991 to 2021 were analyzed for depressive symptoms reported by Asian American (AA) 9th-12th graders. From 1999 to 2021, 4747 AAPI youth died by suicide in the USA. Rates of suicide doubled from 3.6 to 7.1 per 100,000 during 1999-2021, with an increasing trend observed from 2014 onwards. The most common methods of suicide deaths in this population were suffocation, firearms and poisoning. Rates of suicide were higher among AA males than females, although more AA females reported depressive symptoms, including suicidal planning and attempts. This study shows a concerning increase in suicide rates among AAPI youth over 1999-2021. Suffocation, firearms and poisoning were the most common methods used. While more AAPI males died by suicide, AA females reported higher rates of depressive symptoms. These findings highlight the urgent need for targeted prevention strategies and clinical interventions for this vulnerable population. The study also emphasizes the importance of addressing mental health stigma to improve reporting and support for Asian American, Native Hawaiian and Pacific Islander (AANHPI) youth.

Mediation of the association between screen time and suicidality by overweight/obesity and perceived overweight: results from the youth risk behavior surveillance system of the United States.

Adolescent suicide is a major public health concern, and modifiable risk factors associated with adolescent suicide remain poorly understood. This study aimed to assess the association between screen time and overweight/obesity and self-perceived overweigh and suicidality in adolescents. Adolescents from the United States Youth Risk Behavior Surveillance System (YRBSS) between 2013 and 2019 were included in this cross-sectional study. The outcome was suicidality, including considered suicide, made a suicide plan, attempted suicide, and injurious suicide attempt. Multivariable logistic regression model was used to investigate the associations between screen time, overweight/obesity, self-perceived overweight, and suicidality, and expressed as odds ratio (OR) and 95% confidence interval (CI). Mediation analysis was used to explore the role of overweight/obesity and self-perceived overweight on the association between screen time and suicidality. A total of 30,731 adolescents were included, of which 6,350 (20.65%) had suicidality, including 5,361 (17.45%) with considered suicide, 4,432 (14.42%) with made a suicide plan, 2,300 (7.45%) with attempted suicide, and 677 (2.21%) with injurious suicide attempt. Adolescents with screen time ≥3h were related to higher odds of suicidality (OR=1.35, 95%CI: 1.23-1.46), overweight/obesity (OR=1.27, 95%CI: 1.19-1.38), and self-perceived overweight (OR=1.38, 95%CI: 1.30-1.48) after adjusting confounders. Adolescents with overweight/obesity (OR=1.30, 95%CI: 1.19-1.43) and self-perceived overweight (OR=1.54, 95%CI: 1.39-1.70) were associated with higher odds of suicidality. The association between screen time and suicidality was 4.67% mediated by overweight/obesity and 9.66% mediated by self-perceived overweight. Moreover, the mediating role of overweight/obesity was observed only in females, whereas there were no sex differences in the mediating effect of self-perceived overweight. Both overweight/obesity and self-perceived overweight mediated the association between screen time and suicidality.

Informing Equitable Prevention Practices: A Statewide Disaggregated Analysis of Suicide for Ethnoracially Minoritized Adolescents

The increase in adolescent suicide rates in the United States is a pervasive public health issue, and ethnoracial youth with diverse identities are disproportionately impacted, yet less studied. National planning efforts reinforce state-level approaches to suicide prevention through an equitable lens to prevent adolescent suicide. This study examined disaggregated state-level data over time to determine changes to suicide outcomes based on race/ethnicity, sex, sexual orientation, and the intersection of these identities and determined which sub-groups had higher odds of suicide outcomes. Data from the 1991–2019 Centers for Disease Control and Prevention Youth Risk Behavioral Surveillance System were analyzed for 17,419 ethnoracially minoritized high school adolescents in North Carolina. Descriptive analyses and multinominal logistic regression models were employed. Findings indicated that subgroups within categories of ethnoracial populations, specifically Black female adolescents unsure of their sexual orientation, reported higher rates of suicide attempts. Additionally, Multiracial adolescents reported higher means for suicide consideration and attempts over time. Recommendations for investigating state-level suicide data by focusing on diverse intersecting identities to illuminate areas for potential prevention efforts and support health equity are provided.

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.

The association of sexual minority status and bullying victimization is modified by sex and grade: findings from a nationally representative sample

BackgroundSexual minority status is associated with face-to-face bullying and cyberbullying victimization. However, limited studies have investigated whether such a relationship differs by sex or grade in a nationally representative sample.MethodsWe concatenated the national high school data from the Youth Risk Behavior Surveillance System (YRBSS) chronologically from 2015 to 2019, resulting in a sample of 32,542 high school students. We constructed models with the interaction term between sexual minority status and biological sex assigned at birth to test the effect modification by sex on both the multiplicative and additive scales. A similar method was used to test the effect modification by grade.ResultsAmong heterosexual students, females had a higher odds of being bullied than males, while among sexual minority students, males had a higher odds of being bullied. The effect modification by sex was significant on both the multiplicative and additive scales. We also found a decreasing trend of bullying victimization as the grade increased among both heterosexual and sexual minority students. The effect modification by the grade was significant on both the multiplicative and the additive scale.ConclusionsTeachers and public health workers should consider the difference in sex and grade when designing prevention programs to help sexual minority students.

Student Homelessness in High School: Prevalence, Individual Characteristics, and Profiles of Risk and Multidomain Functioning

We estimated the prevalence of high school homelessness and examined associations among homelessness, demographic factors, victimization experiences, and poor functioning using variable- and person-centered approaches. Anonymous self-report survey data from the 2019 Youth Risk Behavior Surveillance System represented approximately 6.5 million high school students in 29 regions of the United States. An estimated 9.32% of students experienced homelessness. Path analysis found homelessness was related to poor functioning, accounting for victimization and demographic factors. Latent class analysis found the highest risk profiles had high levels of homelessness, victimization, and poor functioning and an overrepresentation of multiracial, Native, and Hispanic/Latino students, and students with LGBT identities. Interventions to prevent, identify, and respond to youth homelessness should address sources of marginalization and adversity.

Evolving Disparities in Cannabis Use Among Youth by Demographics and Tobacco and Alcohol Use in the U.S.: 2013–2021

IntroductionThe current study investigated the prevalence of past 30-day cannabis use among US youth by cigarette use, alcohol use, demographics and state-of-residence cannabis legal status in 2021, and examined whether changes in prevalence were modified by these factors from 2013 to 2021. MethodsData were drawn from the 24 states that collected cannabis use data participating in the Youth Risk Behavior Surveillance System (YRBSS) from 2013-2021. Logistic regression analyses estimated past 30-day cannabis prevalence in 2021 and produced adjusted odds ratios (AOR) by current cigarette, alcohol, state-of-residence cannabis legal status. The same method was used with year as the exposure, adjusting for sex, race and ethnicity, to assess trends in prevalence from 2013 to 2021. ResultsIn 2021, cannabis use was more common among female (16.75% vs. 13.83%, AOR=1.26 (95% CI: 1.16, 1.37)), Non-Hispanic (NH) Black and Hispanic youth relative to NH White youth (17.19%, 16.14% vs. 14.60%; AOR=1.25 (95% CI: 1.12, 1.39); AOR=1.16 (95% CI: 1.04, 1.29)), respectively. Cannabis use was much more common among youth who reported any past 30-day cigarette or alcohol use (44.90% vs. 6.48%, AOR=11.80 (95% CI: 10.57, 13.18)). Declines in cannabis use were observed independent of state-level cannabis law from 2013 to 2021 and cannabis use prevalence did not differ significantly by state-of-residence cannabis legal status among the 24 participating states in 2021. ConclusionsPublic health officials should carefully consider the potential differential impact of expanding commercialization of cannabis and US state government endorsement of cannabis as a “wellness” product on youth, especially with regard to co-use with tobacco and alcohol. National and state-level public health education on cannabis use and youth-oriented prevention of cannabis uptake are long overdue.

Asthma prevalence among US 9th-12th graders who report past 30-day cannabis use in 2019.

Little is known about the relationship between cannabis use and asthma among youth in the US. The aims of this study were to estimate prevalence of asthma among youth who reported any cannabis use in the past 30 days, relative to those who did not, and to investigate the relationship between frequency of cannabis use and prevalence of asthma, adjusting for demographic characteristics and cigarette use. Data were drawn from the 2019 Youth Risk Behavior Surveillance System (YRBSS), a CDC national high school survey, which collects data from students in grades 9-12 across the US bi-annually. Logistic regression was used to examine the prevalence of asthma among youth who reported any past 30-day cannabis use, relative to no use, and by frequency of cannabis use, adjusting for demographic characteristics and cigarette use. Asthma was more common among youth who reported any cannabis use, relative to youth who reported no use (29.07% vs. 23.62%; AOR = 1.25 (1.20, 1.30)). Asthma was greater among youth who reported more frequent cannabis use; asthma was highest among youth who reported having used cannabis "40 or more times" in the month (31.38%; AOR = 1.35 (1.25, 1.45)) CONCLUSION: Asthma is more common among youth who use cannabis, relative to those who do not, and the prevalence of asthma increases with frequency of use among 9th-12th graders in the US. More public health and clinical research is needed quickly to produce scientific data that can inform clinical guidelines and public health policy, as well as parents and youth, on the potential relationship between cannabis use and respiratory health among youth.

Soda taxes, consumption, and health outcomes for high school students

This paper uses new data from the Youth Risk Behavioral Surveillance System (YRBS) survey to assess whether the sugar-sweetened beverage taxes passed in Philadelphia, San Francisco, and Oakland have led to health improvements among high school students in these cities. I find that students in Philadelphia reduced their consumption by over one soda per week and that this reduction has remained constant or even grown over the first four years since the tax was implemented. I estimate that average BMI went down by 1.3% by 2021 across the three cities and that these effects are larger among female and non-white students.

Comparison of Paper-and-Pencil Versus Tablet Administration of the 2021 National Youth Risk Behavior Survey (YRBS)

PurposeAs part of efforts to modernize the Youth Risk Behavior Surveillance System, the national Youth Risk Behavior Survey (YRBS) is moving from paper-and-pencil instrument (PAPI) administration to electronic administration using tablets. This study aimed to examine differences in demographic characteristics and the reporting of health behaviors and experiences between the PAPI- and tablet-administered 2021 national YRBS questionnaire. MethodsHigh school students (grades 9–12) in classrooms from 57 schools participating in the 2021 national YRBS were assigned randomly to complete the survey using PAPI (n = 4,684 students) or using tablets (n = 3,645 students). Eighty-nine behavior and experience items were examined to compare the missingness in reporting and the prevalence estimation (i.e., proportions) by administration mode. ResultsDemographic characteristics (sex, race/ethnicity, grade, and sexual identity) did not differ by mode (PAPI vs. tablet). For the majority (93.2%, 83 out of 89) of YRBS behavior and experience items, mode was not significantly associated with the reported proportions, adjusting for sex, race/ethnicity, grade, and sexual identity. However, 30 out of 89 (33.7%) items showed significant variation in missingness by mode; 10 items had higher missingness with PAPI administration while 20 had higher missingness with tablet administration. DiscussionSurvey administration mode was not significantly associated with behavior and experience reporting among high school students. More research is needed to understand differential patterns of missingness by mode. Aligning with Centers for Disease Control and Prevention's Public Health Data Modernization Initiative, findings from this study provide evidence to support electronic survey administration for the national YRBS, particularly using tablet data collection.

Investigating the association between multiple substance Use and dating violence involvement among U.S adolescents

Adolescent dating violence and substance use are clinical and public health concerns. Prior meta-analytic studies indicate that about 20% of adolescents reported having experienced physical dating violence (PDV) and 10% reported sexual dating violence (SDV). This study aims to assess the prevalence of dating violence, and the association between substance use and dating violence among adolescents. Our study population is derived from the 2019 Youth Risk Behavior Surveillance System (YRBSS)a cross-sectional, nationally representative survey of United States (U.S) adolescents. The sample comprised 13,677 adolescents between the ages of 13–19 years currently enrolled in school. Descriptive analysis estimated the prevalence of dating violence and substance use. Multiple logistic regression adjusted for confounders of the association between substance use and dating violence. The confounders adjusted for include sex, school grade, race, academic grade, and duration of night sleep. The prevalence of PDV and SDV was each 8.2%. Only 2.6% of this nationally representative sample had experienced both PDV and SDV. Adolescents who used three or more substances had 2.1 times higher odds of PDV (OR = 2.10, 95% CI = 1.27–3.47, p < 0.0001), and SDV (OR = 2.11, 95% CI = 1.34–3.34, p < 0.0001) respectively, and 2.8 (OR = 2.75, 95% CI = 1.34–5.61, p < 0.0001) times higher odds of both PDV and SDV in the past month. Multiple substance use increases the odds of dating violence. Policy and interventions should be focused on preventing substance use initiation among substance-naïve adolescents and to advocate abstinence and gradual reduction of substances used to mitigate the prevalence of dating violence.

Relationship between suicide ideation and attempts, bully victimization, dating violence, and depressive symptoms among Black and Hispanic youth.

Suicide rates among Black and Hispanic youth have been increasing over the past decade in the United States. The objective of this study was to identify risk factors for suicide ideation and attempt among Black and Hispanic youth in the United States using intersectionality theory and minority stress theory as a framework. Data from the CDC Youth Risk Behavior Surveillance System (YRBSS; 2015-2019) were analyzed and delimited to include only Black and Hispanic youth. About 37% of the subsample identified as Black and 63% of the subsample identified as Hispanic; mean age was 16 years (SE = 0.02). Weighted multivariate logistic regressions were used to explore associations between suicide ideation and attempt, depressive symptoms, bullying, dating violence, and being threatened with a weapon. Black and Hispanic youth who had depressive symptoms, experienced bullying, dating violence, or threatened with a weapon all had increased odds of having suicide ideation and suicide attempt. Hispanic youth had the higher odds of suicide ideation and attempt than Black youth. Girls in the study also had elevated odds of suicide ideation. This study adds to the literature on risk factors of suicide in Black and Hispanic youth and bringing to awareness the gender disparities in suicide ideation and attempt among youth.

Measuring Population-Level Adolescent Mental Health Using a Single-Item Indicator of Experiences of Sadness and Hopelessness: Cross-Sectional Study.

Population-level monitoring of adolescent mental health is a critical public health activity used to help define local, state, and federal priorities. The Youth Risk Behavior Surveillance System includes a single-item measure of experiences of sadness or hopelessness as an indicator of risk to mental health. In 2021, 42% of high school students reported having felt sad or hopeless for 2 weeks or more during the past 12 months. The high prevalence of US high school students with this experience has been highlighted in recent studies and media reports. This study seeks to examine associations between this single-item measure of experiences of sadness or hopelessness with other indicators of poor mental health including frequent mental distress and depressive symptoms. We analyzed survey data from a national sample of 737 adolescents aged 15-19 years as a part of the Teen and Parent Surveys of Health. Participants were recruited from AmeriSpeak, a probability-based panel designed to be representative of the US household population. Feeling sad or hopeless was operationalized as a "yes" response to the item, "During the past 12 months, did you ever feel so sad or hopeless almost every day for 2 weeks or more in a row that you stopped doing some usual activities?" Unadjusted and adjusted prevalence ratios (aPRs) were calculated to examine associations between the single-item measure of having felt sad or hopeless almost every day for 2 weeks with moderate to severe depressive symptoms, frequent mental distress, and functional limitation due to poor mental health. Adjusted models controlled for age, race and ethnicity, sex assigned at birth, and sexual identity. Overall, 17.3% (unweighted: 138/735) of adolescents reported that they felt sad or hopeless for 2 weeks or more during the past 12 months, 30.2% (unweighted: 204/716) reported moderate to severe depressive symptoms, 18.4% (unweighted: 126/732) reported frequent mental distress, and 15.4% (unweighted: 107/735) reported functional limitation due to poor mental health. After adjusting for demographics, adolescents who reported that they felt sad or hopeless for 2 weeks or more were 3.3 times as likely to report moderate to severe depressive symptoms (aPR 3.28, 95% CI 2.39-4.50), 4.8 times as likely to indicate frequent mental distress (aPR 4.75, 95% CI 2.92-7.74), and 7.8 times as likely to indicate mental health usually or always interfered with their ability to do things (aPR 7.78, 95% CI 4.88-12.41). Associations between having felt sad or hopeless for 2 weeks or more and moderate to severe depressive symptoms, frequent mental distress, and functional limitation due to poor mental health suggest the single-item indicator may represent relevant symptoms associated with poor mental health and be associated with unmet health needs. Findings suggest the single-item indicator provides a population-level snapshot of adolescent experiences of poor mental health.

Association between steroid use and concussions among high school athletes: a cross-sectional analysis of the Youth Risk Behavior Surveillance System.

In 2017, there were almost 2.5 million high school students who experienced a concussion while playing a sport, raising concern for the neurologic problems that theycould face. Some of these athletes may seek to gain a competitive advantage in their sport by utilizing substances like steroids. However, steroid use can cause increased aggression and body mass index (BMI), which might lead to heightened risk for concussions. Despite extensive research, we found no previous evidence linking these two factors. This analysis aims to investigate steroid use trends in high school athletes and to determine whether there is an association between steroid use and concussions in these athletes. We conducted a cross-sectional analysis of the cumulative Youth Risk Behavior Surveillance System (YRBSS). Respondents were added if they participated in sports and answered the steroid and concussion prompts. Demographic variables were assessed including age, grade, BMI, gender, and race/ethnicity. We found that 3.7 % (n=2991) of high school athletes reported previous steroid use and that 20.7 % (n=2273) reported having sustained a concussion. There was a statistically significant difference in steroid use by race/ethnicity (p<0.001), with the highest rate of use (7.2 %) among American Indian/Alaska Natives (AI/AN). A significantly higher prevalence of steroid use occurred in athletes who were males (4.7 %) than females (2.5 %) and inathletes with a BMI>95 % (5.2 %) compared with those with a BMI between 85 and 95 % (3.9 %) and <85 % (3.5 %) (χ2=135.1, p<0.001 and χ2=16.3, p<0.001, respectively). Further, our results showed that the prevalence of steroid use among high school athletes decreased from 3.4 % in 1999 to 1.9 % in 2019, with the most drastic drop occurring between 2015 and 2019-declining 1.9 %. Whereas 19.6 % of athletes reported a concussion without steroid use, 54.6 % of steroid-utilizing athletes reported having experienced a concussion-a statistically significant finding (adjusted odds ratio [AOR]=4.3; 95 % CI: 3.2-5.9). Finally, compared with White athletes, we found that AI/AN athletes were significantly more likely to have sustained a concussion (AOR=2.3; 95 % CI=1.2-4.3). Although our study found decreasing rates of steroid use among high school athletes from 1999 through 2019, our results also show that steroid use is significantly associated with sustaining a concussion. Additionally, the data from YRBSS also demonstrates that AI/AN high school athletes are more likely to utilize steroids and sustain a concussion. Given the long-term consequences of traumatic brain injuries, we recommend that coaches should be aware of potential steroid use among players, and that coaches, athletic trainers, and physicians should all be aware of concussion protocols and remove players from games for evaluation when a concussion is suspected.

Combined aerobic and muscle-strengthening activity guidelines and their association with obesity in US adolescents.

Most of the evidence on physical activity for maintaining a healthy weight in adolescents is based solely on aerobic physical activity alone, with little attention given to the muscle strength component. This study aimed to investigate the associations between aerobic activitiesand muscle-strengthening activities (MSA) and overweight/obesity among a representative sample of adolescents. Data from the United States-based Youth Risk Behavior Surveillance System for the 2011-2019 cycle were used in this cross-sectional study. Adolescents self-reported their adherence to aerobic and MSA guidelines, as well as their height and weight. Overweight and obesity were defined using the age- and sex-specific criteria of the Centers for Disease Control and Prevention, with a body mass index (BMI) ≥85th and ≥95th percentiles, respectively. We examined the associations between adherence to physical activity guidelines (reference: not meeting either of the physical activity guidelines) and overweight/obesity or obesity using binary logistic regressions. These analyses were adjusted for race/ethnicity, sex, age, screen time, sleep duration, tobacco, alcohol, fruit, vegetables, and soda consumption. A total of 42 829 adolescents (48.98% girls) were included in the study. Of these, 22.23% met both guidelines for physical activity, 30.47% had overweight/obesity, and 14.51% had obesity. Compared with meeting neither guideline, meeting both aerobicand MSA guidelines was associated with lower odds of having overweight/obesity (odds ratio [OR] = 0.64, 95% confidence interval [CI], 0.60 to 0.68) and obesity (OR = 0.52, 95% CI 0.48 to 0.56). These results were consistent across years of assessment, sex, and race/ethnicity. In conclusion, our results highlight the importance of MSA, which is often overlooked in physical activity recommendations in many studies, in combating childhood obesity in the United States.

Validity and reliability of the Persian version of the machiavellian personality scale and its association with social adjustment and risky behaviors in Iranian college students

ObjectiveThe present study aims to develop and assess the psychometric properties of the Persian version of the Machiavellian Personality Scale (P-MPS), and evaluate its relationship with social adjustment and risky behaviors in Iranian college students.MethodsParticipants were 500 healthy college students (270 females and 230 males) from medical and non-medical universities in Sanandaj, Iran. They completed the P-MPS, the social adjustment subscale of the Bell Adjustment Inventory, and the Youth Risk Behavior Surveillance System (YRBSS) questionnaire. The factor structure of the P-MPS was evaluated by exploratory factor analysis followed by confirmatory factor analysis (CFA). Cronbach’s alpha coefficient was used to examine the internal consistency of the P-MPS and Pearson correlation test was used to investigate the relationship of the P-MPS score with the scores of social adjustment subscale and YRBSS.ResultsThe P-MPS showed good content validity (Content validity ratio = 0.73, content validity index = 0.90), construct validity, and internal consistency (α = 0.802). The CFA results supported the four-factor solution of the questionnaire. The total score of P-MPS and its dimensions showed a significant negative relationship with social adjustment (p < 0.05). Moreover, its score was significantly correlated with risky behaviors (p < 0.05).ConclusionThe Persian version of MPS can be used for assessing Machiavellianism in the Iranian population.