Youth Risk Behavior Survey Research Articles

Study objective: Electronic vapor product (EVP) use remains prevalent among adolescents in the United States. EVP use may be associated with high-risk substance use behaviors. This study investigates the association between current EVP use and current opioid misuse in high school students. Methods: We conducted a secondary analysis of the 2021 Youth Risk Behavior Survey (YRBS) (n = 7471). We first examined the prevalence rates of current prescription opioid misuse between participants ages 14 to 19 who reported any EVP use compared to those who did not report any EVP use. We conducted an adjusted Poisson regression analysis to determine whether EVP use was associated with prescription opioid misuse after controlling for multiple variables, including age, biological sex, race, ethnicity, alcohol use, other tobacco use, marijuana use, and depressive symptoms. Results: Among participants, 17.2% (95% confidence interval (CI): 15.4–19.1%) reported current EVP use. The prevalence of current opioid misuse was higher in the group of students who use EVPs (13.3%) as compared to students who do not use EVPs (3.2%) (p < 0.0001). Compared to participants who did not use EVPs, those with EVP use had an 80% greater prevalence of opioid misuse, after adjusting in regression analyses (adjusted prevalence rate ratio: 1.8, 95% CI: 1.4–2.3, p < 0.0001). Conclusions: Our findings highlight the significantly increased prevalence of opioid misuse among this population and the need to educate adolescents about the additional risks associated with nicotine and EVP use. Longitudinal studies are needed to test causal relationships and better understand the biobehavioral mechanisms that connect EVP use and opioid misuse.

PurposeGender nonconformity (GNC) describes the degree of misalignment between individual’s gender expression and gender norms and is often linked to negative health outcomes. We aimed to investigate the association between GNC and adolescent indoor tanning, the most preventable cause of skin cancer, among U.S. high school students.MethodsThis study examined cross-sectional data from the 2017 state Youth Risk Behavior Survey in Maryland. Participants included 25,432 female and 25,060 male students in grades 9 through 12. The primary outcome was the prevalence of self-reported 12-month history of indoor tanning before survey. The GNC was measured by self-perceived gender expression (from “very feminine” to “very masculine”) and sex (“female” or “male”). The logistic regression analysis for weighted survey data was performed to estimate the association between GNC and adolescent indoor tanning.Results Among 50,492 high school students in Maryland, the prevalence of indoor tanning was 6.8(95% CI, 6.4-7.3), and varied by demographic characteristics and sexual orientation. Among male students, indoor tanning was significantly associated with moderate GNC (AOR, 1.55; 95% CI, 1.13-2.13; P=0.007) and high GNC (AOR, 4.92; 95% CI, 4.04-5.99; P<0.001). However, among female students, indoor tanning was not associated with moderate and high GNC in the adjusted models. Furthermore, indoor tanning was also significantly associated with transgender identity, the AOR was 7.16 (95% CI, 5.89-8.72; P<0.001) compared with cisgender female students, and 9.31(7.44-11.64; P<0.001) compared with cisgender male students.ConclusionsGender nonconforming adolescent males and transgender adolescents report higher risk of indoor tanning than gender conforming adolescent males and cisgender adolescents respectively. Skin cancer prevention efforts targeted at gender minorities might reduce indoor tanning, a preventable risk factor for skin cancer.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-25033-9.

BackgroundViolence and mental health have a large proportion within the global burden of disease for children and youth, especially with the growing magnitude of suicidal behaviour and non-suicidal self-injury. This longitudinal study examined for the effects of physical and psychological family and community violence during childhood, adolescence and youth and the emergence of suicidal behaviour and non-suicidal self-injury among young people.Methods129 participants, from a cohort of 500 students (mean age 8 years, SD 1.2) sampled at schools in a Brazilian metropolis (2005), were followed up for 16 years (2006, 2008, 2012, 2021). Suicidal behaviour/non-suicidal self-injury by the youth was the dependent variable assessed at the fifth wave of the study by Adult Self Report/Achenbach System of Empirically Based Assessment (ASR/ASEBA) and Youth Risk Behavior Survey Scale (YRBSS). The independent variables were 193 questions on violence (Conflict Tactics Scale - CTS - and “Things I have seen and heard”), which were assessed longitudinally. Three groups of violence (physical family violence, psychological family violence and community violence), plus the three stages of development studied (childhood, adolescence and youth), resulted in nine violence events, which were examined descriptively and input to structural equation modelling.ResultsThe outcome was found in 37% of the participants, combining all time points. The forms of violence that occurred in childhood, adolescence and youth were, respectively: physical family violence: 84.5%, 14% and 15.5%; psychological family violence: 76.7%, 3.9% and 76.7%; and community violence: 18%, 12.4% and 40.3%. The modelling revealed a network between types of violence: community and psychological (0.348; p < 0.001) in childhood; community and psychological (0.302; p < 0.001) and physical and psychological (0.374; p = 0.001) in youth; and among all types of violence in adolescence. Regarding the outcome, the following factors were prominent: psychological family violence in childhood (0.656; p = 0.006), community violence in adolescence (0.517; p < 0.001) and psychological family violence in youth (0.398; p < 0.001).ConclusionsThe study highlighted the effect of different forms of violence longitudinally with suicidal behaviour and non-suicidal self-injury in youth, underlining the value of preventing violence as an important vector in related intervention.

Objectives: This study aimed to clarify the risk factors for tooth fracture among Korean adolescents using data from the 20th Korea Youth Risk Behavior Survey (2024). Methods: A total of 54,648 adolescents were included in this study. Data were analyzed using IBM SPSS Statistics 25.0. Results: The prevalence of tooth fracture was higher among male students; high school students; and those with lower academic achievement, lower economic status, unhealthy status, and insufficient recovery from sleep. The risk of tooth fracture increased with greater participation in physical activities such as ≥60 min of physical activity per week, vigorous-intensity physical activity, and more frequent muscle-strengthening exercises. Additionally, risky behaviors such as not wearing seat belts or helmets; history of injury or hospital treatment; lack of safety education; and history of violence, binge drinking, or drug use significantly increased the likelihood of tooth fracture. Conclusions: Tooth fractures in adolescents are influenced by multiple factors rather than a single cause. The findings suggest that prevention strategies should comprehensively address physical activity management, enhance safety awareness, and reduce risky behaviors.

This study investigated the relationships between rape victimization and suicidality among Black adolescent girls. Data from the 2019 Youth Risk Behavior Survey was used, with a sample of 1,029 Black girls aged 14 to 18. Using multivariate logistic regression, the results indicated that Black girls who experienced rape were 2.52 times more likely to have a suicide plan and 3.94 times more likely to have attempted suicide compared to Black girls who were not raped. These findings highlight the urgent need to prioritize prevention and intervention efforts to support the needs of Black girls in schools.

ABSTRACT This study examines whether exposure to mass shooting events is associated with changes in high school students’ perceptions of safety and weapon-carrying behaviors with a focus on differences by race/ethnicity, sex, and age. We used individual-level data from the Youth Risk Behavior Survey (YRBS) and state-level data from the Gun Violence Archive (GVA), applying a generalized difference-in-differences analysis. We find increased weapon carrying and feelings of unsafety among high school students following such events. Notably, among several demographic differences, Black and Hispanic students are more likely to carry weapons, though Hispanic students report reduced carrying at school. These findings highlight the need for targeted, demographic-specific interventions to improve school safety and student well-being.

Background/Objectives: Skipping breakfast is common among adolescents. Providing breakfast at school is a potential solution; however, its effectiveness remains unclear. This study aimed to compare breakfast skipping between dormitory- and home-residing high school students, analyze trends over time, and identify reasons for skipping breakfast. Methods: This study analyzed data from high school students who participated in the Korea Youth Risk Behavior Survey between 2018 and 2024, and who lived either in dormitories (n = 11,394) or at home (n = 164,446). The frequency of breakfast consumption over the previous seven days was surveyed; breakfast skipping was defined as missing breakfast on at least five of these seven days. Results: Students living in dormitories had more breakfast days than those living at home (4.6 ± 0.04 vs. 3.7 ± 0.01, p < 0.001). The prevalence of breakfast skipping among students living in dormitories was approximately half of that among students living at home. The association between breakfast skipping and residence type remained significant after adjusting for potential confounders (odds ratio: 0.37; 95% confidence interval: 0.34–0.39). The prevalence of breakfast skipping increased more rapidly between 2018 and 2024 among students living in dormitories (15.1–25.0%, annual percent change = 8.7%, p < 0.05) than in those living at home (35.3–45.3%, annual percent change = 4.0%, p < 0.05). In 2022, the main reasons for skipping breakfast among students living in dormitories and at home were oversleeping (32.2%) and lack of time (39.6%), respectively. Conclusions: Students living in dormitories were less likely to skip breakfast than those living at home. However, even when breakfast is provided, a substantial and increasing proportion of adolescents skip breakfast. These findings suggest that creating a supportive environment alone is insufficient and that strategies are needed to enhance awareness of the importance of breakfast.

Racial/ethnic disparities in the dose-response relationship between syndemic risk factors and increased gun carrying odds among male high school students in the United States

HighlightsWhat are the main findings?Allergic rhinitis was significantly associated with shorter weekday sleep duration among Korean adolescents.Asthma and eczema were not significantly associated with sleep duration.What is the implication of the main finding?Allergic rhinitis management may be essential in improving sleep health among adolescents.Future studies should examine objective physiological measures of sleep to complement self-reported data.Background: Allergic diseases, such as allergic rhinitis, eczema, and asthma, are prevalent among adolescents and are associated with various health concerns, including poor sleep quality and mental health problems. Although previous research has investigated the general association between allergic conditions and sleep disturbances, few studies have examined how allergic diseases relate to sleep duration. Methods: We performed secondary analysis of the data obtained from the 19th Korea Youth Risk Behavior Survey (2023), which included 52,880 middle and high school students. Data was analyzed using complex sample design techniques, descriptive statistics, t-tests, and analyses of variance and covariance conducted to explore associations between allergic diseases and sleep duration on weekdays. Covariates included sex, school type, academic performance, socioeconomic status, and residential type. Results: The average weekday sleep duration among adolescents was 6.2 h, which was significantly shorter than that recommended by the U.S. Centers of Disease Control and Prevention (8–10 h). Among allergic conditions, allergic rhinitis was significantly associated with reduced sleep duration (p = 0.001), unlike asthma (p = 0.119) and eczema (p = 0.586). Additional differences in sleep duration were observed by sex, academic performance, socioeconomic status, and living arrangements. Conclusions: Managing allergic rhinitis may be crucial to promoting adequate sleep during adolescence. Furthermore, future research should incorporate physiological indicators to assess sleep quality, as self-reported measures may not capture sleep disturbances such as night-time awakenings. These findings can inform the development of integrated health strategies to enhance physical and psychological well-being of adolescents.

Adolescence is a critical period for young people's sexual and reproductive health (SRH), emphasizing the need for support with regards to the prevention of unintended pregnancy or sexually transmitted infections. Multi-level, community-wide initiatives are a widely promoted approach to support young peoples' SRH, yet research evaluating their impact is scarce, limiting the opportunity for these initiatives to be incorporated into evidence-based practice. This study responds to this evidence gap by estimating the early effects of a city-wide youth sexual health initiative on population-level youth sexual health indicators (condom use, birth control use, combined method use, abstinence, early sex (<15 years), number of sexual partners). A quasi-experimental, difference-in-differences design with propensity weighting was employed using a nearby city as a comparison group and Youth Risk Behavior survey data from from 6,978 high school students. Estimates were generated using logistic regression. Overall, no statistically significant effects on youth sexual health indicators were detected, although the direction of non-significant findings was promising. Effect heterogeneity was detected by grade and race, suggesting that younger and Black/African American youth experienced more favorable impacts of the initiative. This study contributes to the small but growing evaluation research on multi-level, community-wide youth sexual health initiatives and provides a blueprint approach to evaluate similar initiatives using a publicly available data source. Findings highlight the potential for community-wide sexual health initiatives to address disparities in adolescent SRH, support continued effect estimation over longer time periods, and emphasize the value of culturally responsive sexual health programming.

Mental health challenges and suicidal behaviors represent a significant public health concern. This study examines the associations between school connectedness, perceived racial discrimination, and mental health outcomes among U.S. high school students. Data were drawn from the 2023 Youth Risk Behavior Survey, a nationally representative survey of high school students in the United States. Primary independent variables included school connectedness and perceived racial discrimination, with a composite measure derived to represent the intersection of these two factors. Dependent variables were poor mental health, suicidal thoughts, and suicide attempts. Multivariable logistic regression models were employed to analyze these relationships. The findings indicate that lower school connectedness and higher perceived racial discrimination are significantly associated with poor mental health, suicidal thoughts, and suicide attempts. Specifically, students reporting lower school connectedness and higher perceived racial discrimination had significantly higher odds of poor mental health (OR = 1.39, 95% CI = 1.32 - 1.46), suicidal ideation (OR = 1.42, 95% CI = 1.35 - 1.50), and suicide attempts (OR = 1.37, 95% CI = 1.29 - 1.45). Furthermore, a dose-response association was observed, wherein the frequency of perceived racial discrimination was associated with progressively higher odds of experiencing adverse mental health outcomes. This study reveals significant associations between lower school connectedness, perceived racial discrimination, and adverse mental health among adolescents. These findings underscore the importance of fostering supportive school environments to promote positive adolescent health.

Inequities in sleep duration among gender and sexual minority adolescents.

5.50 Impact of Substance Use, Social Media Use, and Bullying on Suicide Among Adolescents: Results From the Youth Risk Behavior Survey 2023

Illicit drug use and associated health risk behaviors among sexual minority youth.

5.41 Factors Affecting the Experience of Suicidal Thoughts Among Korean Adolescents Under Significant Stress: Based on the Korea Youth Risk Behavior Survey

Towards a valid and reliable smartphone overdependence scale: Factor analysis, and measurement invariance testing.

Mukbang refers to livestreamed videos in which hosts consume large amounts of energy-dense, nutrient-poor foods while interacting with viewers. Mukbang is widely viewed by Korean adolescents and has been associated with adverse health outcomes. To inform efforts to prevent excessive engagement with mukbang content among Korean adolescents, this study examined personal, community, and societal factors associated with excessive mukbang viewing (≥7 times/wk) and explored gender differences in these associations. Data were drawn from the 2022 Korea Youth Risk Behavior Survey (n=36,990; mean age, 15.1±1.7 years; 48.6% girls; 53.2% attending middle school). Self-reported measures included personal (e.g., perceived health, weight, stress, depression, anxiety), community (e.g., living arrangement), and societal factors (e.g., socioeconomic status) and mukbang viewing frequency. Logistic and modified Poisson regression models were used to examine associations with excessive mukbang viewing and to evaluate differences by gender. Intrapersonal factors-namely perceived health, weight, stress, depression, and anxiety-were associated with excessive mukbang viewing (adjusted prevalence ratios, 1.18 to 1.44), with more pronounced relationships among girls. A community-level factor-living arrangement-displayed a significant association in boys but not in girls. Boys living on campus had 1.42 times the prevalence of excessive mukbang viewing than boys residing with family members (95% confidence interval, 1.08 to 1.88) after adjustment. Further mutual adjustment attenuated estimates toward the null. Societal factors were not significantly associated with excessive mukbang viewing among adolescents. Personal and community factors were associated with excessive mukbang viewing. Future research should investigate the mechanisms underlying these associations.

BackgroundIdentifying preventive measures for adolescent mental health is a global public health priority, as poor mental health heightens the risk of early death from related issues, including suicide. This study examined the associations between adherence to the 24-Hour Movement Guidelines and anxiety among a nationally representative sample of South Korean adolescents, using an intersectional identity framework.MethodsData from the 2020–2022 Korea Youth Risk Behavior Surveys were analyzed. Adolescents aged 12–17 years were grouped based on adherence to guidelines: none, physical activity (PA), sedentary behavior (SB), sleep, two guideline combinations, and all three. Anxiety was the mental health outcome. Logistic regression analyses were conducted by intersectional identity groups, adjusting for age, academic performance, family economic status, and body mass index.ResultsAmong 122,284 adolescents (48.3% female, mean age 14.8 ± 1.5 years), anxiety prevalence was higher in females. Sleep adherence was associated with lower odds of anxiety for both sexes, with stronger associations observed in males (OR: 0.50, 95% CI: 0.38–0.66) and females with high academic performance on weekdays (OR: 0.48, 95% CI: 0.36–0.64). Stronger associations were seen in females from high-income families (OR: 0.48, 95% CI: 0.37–0.63). While SB adherence alone was not linked to lower anxiety, combined adherence to sleep and SB was associated with lower odds of anxiety. PA adherence was associated with increased odds of anxiety, particularly among females across academic and economic groups.DiscussionAdherence to sleep guidelines was linked to reduced anxiety, highlighting the crucial role of sleep duration in anxiety management. This underscores the need to consider adolescents’ diverse backgrounds when recommending movement behaviors, warranting further investigation in implementation studies.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24215-9.

Supplemental Nutrition Assistance Program Expansion and Risk of Bullying Among Adolescents.

The Relationship Between Forced Sexual Intercourse and Contraceptive Use Among Sexually Active High School Students in the United States.