Youth Risk Behavior Survey Research Articles

Skipping Breakfast and Academic Grades, Persistent Feelings of Sadness or Hopelessness, and School Connectedness Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Breakfast consumption is positively associated with academic achievement and diet quality among students, whereas skipping breakfast has been linked with poor mental health. Data from CDC's 2023 nationally representative Youth Risk Behavior Survey were used to describe how often high school students ate breakfast in the past 7 days and the associations between skipping breakfast every day (ate breakfast on 0 of the past 7 days), experiencing persistent feelings of sadness or hopelessness, school connectedness, and self-reported grades. Prevalence estimates and corresponding 95% CIs were calculated, and t-tests were used to identify differences within demographic groups (e.g., sex, race and ethnicity, and sexual identity). Logistic regression analyses were conducted to calculate prevalence ratios describing breakfast skipping, adjusting for demographics, and stratified by sex and race and ethnicity. Most students missed breakfast ≥1 time in the past 7 days (72.6%), and 17.9% of students skipped breakfast every day, with differences by sex, sexual identity, and race and ethnicity. Overall, and among both males and females, students who experienced persistent feelings of sadness or hopelessness were more likely to skip breakfast every day. The association between feelings of sadness and hopelessness and skipping breakfast was generally consistent across racial and ethnic groups. In contrast, greater levels of school connectedness and earning mostly As or Bs were inversely associated with skipping breakfast. Students who had higher school connectedness were approximately 30% less likely to skip breakfast on all 7 days. Skipping breakfast and poor mental health co-occur among many adolescents and might impede students' readiness to learn. School efforts to make breakfast accessible and appealing to high school students might yield multiple benefits and help reinforce school administrators' efforts to recover student learning losses that occurred during the COVID-19 pandemic. Parents, school decision-makers, and organizations that partner with schools and families can use these findings to guide efforts to promote breakfast consumption.

Physical Activity Behaviors and Negative Safety and Violence Experiences Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Schools are in a unique position to offer opportunities for students to be physically active throughout the school day and promote health and well-being. However, experiences that threaten safety or perceptions of safety might affect students' physical activity behaviors. Using the 2023 national Youth Risk Behavior Survey, six physical activity behaviors and five negative safety and violence experiences were examined from a nationally representative sample of U.S. high school students. This report updates national estimates for physical activity behaviors overall and by sex, grade, race and ethnicity, and sexual identity. In addition, associations between negative experiences and physical activity behaviors were examined, stratified by sex, via unadjusted and adjusted prevalence ratios. Regardless of negative safety and violence experiences, male students had a higher prevalence of meeting aerobic, muscle-strengthening, and both aerobic and muscle-strengthening physical activity guidelines compared with female students. In adjusted models among female students, a positive association was observed between being threatened or injured with a weapon at school and meeting the aerobic guideline, meeting the muscle-strengthening guideline, and playing on ≥1 sports team. Among male students, positive associations were observed between witnessing neighborhood violence and meeting the aerobic guideline and the muscle-strengthening guideline. A negative association was observed between attending physical education classes on all 5 days and witnessing neighborhood violence among female students and being bullied electronically among male students. Physical activity might serve as a mechanism that students employ to cope with negative safety and violence experiences. Understanding current physical activity behaviors among students with these negative experiences will be useful for school leaders, teachers, and public health practitioners who influence physical activity infrastructure and programming in schools and work to support safe, supportive, and inclusive school environments for student health. Although future research is needed to further explore these associations, physical activity continues to be an important behavior to prioritize for adolescent health in the school setting.

Disparities in School Connectedness, Unstable Housing, Experiences of Violence, Mental Health, and Suicidal Thoughts and Behaviors Among Transgender and Cisgender High School Students - Youth Risk Behavior Survey, United States, 2023.

Transgender high school students (those whose gender identity differs from their sex assigned at birth) experience disparate health outcomes and challenges in school, including violence and discrimination, compared with cisgender students (those whose gender identity aligns with their sex assigned at birth). Until recently, population-based data describing the experiences of transgender students and students questioning whether they are transgender (questioning) have been limited. In 2023, the national Youth Risk Behavior Survey assessed transgender identity, providing the first nationally representative data about transgender students. This report describes the demographic characteristics of transgender and questioning high school students and examines differences in the prevalence of experiences of violence, poor mental health, suicidal thoughts and behaviors, school connectedness, and unstable housing among transgender, questioning, and cisgender high school students nationwide. In 2023, 3.3% of U.S. high school students identified as transgender, and 2.2% identified as questioning. Transgender and questioning students experienced a higher prevalence of violence, poor mental health, suicidal thoughts and behaviors, and unstable housing, and a lower prevalence of school connectedness than their cisgender peers. Compared with 8.5% of cisgender male students, 25.3% of transgender students and 26.4% of questioning students skipped school because they felt unsafe. An estimated 40% of transgender and questioning students were bullied at school, and 69% of questioning students and 72% of transgender students experienced persistent feelings of sadness or hopelessness, a marker for experiencing depressive symptoms. Approximately 26% of transgender and questioning students attempted suicide in the past year compared with 5% of cisgender male and 11% of cisgender female students. Intervention opportunities for schools to create safer and more supportive environments for transgender and questioning students can help address these disparities. The findings of this report suggest that more effort is necessary to ensure that the health and well-being of youths who are socially marginalized is prioritized.

Asking for Verbal Sexual Consent and Experiences of Sexual Violence and Sexual Behaviors Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Adolescents' sexual consent behaviors are critical for developing healthy sexual relationships and preventing experiences of sexual violence. This report uses 2023 Youth Risk Behavior Survey data to describe prevalence of asking for sexual consent verbally at last sexual contact among U.S. high school students. Differences in prevalence of asking for sexual consent verbally by sex, age, race and ethnicity, sexual identity, sex of sexual contacts, and gender identity were examined. Differences in asking for sexual consent verbally also were examined by experiences of sexual violence and sexual behaviors. Sex-stratified logistic regression analyses were performed to determine the association between asking for sexual consent verbally with experiences of sexual violence and sexual behaviors. In addition, data were analyzed using adjusted logistic regression models controlling for age, race and ethnicity, and sexual identity. Among high school students who reported ever having sexual contact, 79.8% reported asking for sexual consent verbally at last sexual contact. A lower percentage of female students (74.5%) reported asking for sexual consent verbally than male students (84.6%). In adjusted sex-stratified analyses, female students who asked for sexual consent verbally had higher prevalence of ever having had sexual intercourse. Male students who asked for sexual consent verbally had higher prevalence of ever having had sexual intercourse and being currently sexually active. Female and male students who asked for sexual consent verbally had higher prevalence of having first sexual intercourse before age 13 and using condoms. In addition, female students who asked for sexual consent verbally during last sexual intercourse had lower prevalence of using alcohol or drugs at last sexual intercourse. Public health researchers and practitioners, health care providers, schools, and youth-serving organizations can use these findings to better understand high school students' verbal sexual consent, improve complex measurement of consent-seeking behaviors, and guide multicomponent sexual health and violence prevention efforts across various settings.

Experiences of Racism in School and Associations with Mental Health, Suicide Risk, and Substance Use Among High School Students - Youth Risk Behavior Survey, United States, 2023.

Racism is a fundamental determinant of health inequities among racial and ethnic groups and is understudied among adolescents. In 2023, the national Youth Risk Behavior Survey questionnaire included an item assessing experiences of racism in the school setting among students in grades 9-12 in the United States. This report estimates the prevalence of students who reported ever having experienced racism in school and compares prevalence by racial and ethnic groups. For each racial and ethnic group, prevalence differences and prevalence ratios were estimated comparing the prevalence of indicators of poor mental health, suicide risk, and substance use among students who reported that they have ever versus never experienced racism in school. In 2023, approximately one in three high school students (31.5%) said that they had ever experienced racism in school. Reported experiences of racism were most prevalent among Asian (56.9%), multiracial (48.8%), and Black or African American (Black) (45.9%) students and least prevalent among White students (17.3%). Black and Hispanic or Latino (Hispanic) students who reported experiencing racism had a higher prevalence of all health risk behaviors and experiences investigated, including indicators of poor mental health, suicide risk, and substance use compared with students of their racial and ethnic group who reported never experiencing racism. Many of these associations were also found among multiracial and White students. Student reports of racism were associated with indicators of mental health and suicide risk among American Indian or Alaska Native (AI/AN) and Asian students. Among students of color, including AI/AN, Asian, Black, Hispanic, and multiracial students, the prevalence of seriously considering and attempting suicide was more than two times higher among students who ever compared with never experienced racism. These findings demonstrate that racism in the school setting is experienced by high school students attending public and private schools and continues to disproportionately affect students of color. Students who reported experiencing racism had a higher prevalence of indicators of poor mental health, suicide risk, and substance use. Schools can incorporate policies and practices to prevent unfair treatment on the basis of race and ethnicity and offer resources to help students cope with these experiences.

Social Support and Suicidal Ideation among Children of Cross-Border Married Couples

Abstract Marriage-related migration by women from less developed to high-income nations has been increasing rapidly in Asia, and the proportion of children born to these foreign-born women is increasing as well. Using a unique dataset based on the Korean Youth Risk Behavior Survey, we investigate the relationship between social support and suicidal ideation among children with foreign-born mothers. We find that both maternal advice and teachers’ advice are significantly associated with a reduction in suicidal ideation among these children, with a further decrease of 3.2 and 4.9% points, respectively, compared to children with native Korean mothers. These findings imply that more government attention should be focused on educating and training foreign-born mothers and schoolteachers to improve their capacity to advise these children.

A Multi-State Examination of School District Policies to Address Teen Dating Violence.

In 2021, 13.6% of United States (U.S.) high school students reported experiencing teen dating violence (TDV). Most states have at least one law for addressing TDV in high schools through policies and/or educational programs. Limited research has been done to analyze the content and variability of school district TDV policies across the U.S., and its association with TDV victimization. Twenty-three large urban school districts across the U.S. were included in the analysis. School district TDV policies were obtained through an online search and were coded for the presence or absence of information pertaining to the scope, prevention education, response to TDV, and implementation of the policy. Self-reported TDV victimization was also obtained for each school district from the 2021 Youth Risk Behavior Survey. Overall, 18 school districts had a written TDV policy available online, with 15 school districts defining TDV in the policy. In terms of prevention education, only two school districts used culturally responsive language for diverse populations in the policy. Although 17 school districts included disciplinary consequences for TDV perpetration in the policy, only 6 school districts specified the consequences. All school districts with a TDV policy designated a liaison for TDV coordination. Overall, the prevalence and odds of self-reported TDV victimization was higher in school districts without a TDV policy compared to school districts with a TDV policy. Although most of the school districts had a TDV policy, there was substantial variation in the content of these TDV policies. Identifying and addressing gaps in school district TDV policies can potentially lead schools to preventing and responding to TDV more comprehensively, ultimately creating safer school environments.

Does Stress Affect Adolescent Anxiety by Mediating Sleep Time?

Background: Health is essential for the sustainable well-being, yet high stress, anxiety, and lack of sleep among Korean adolescents have become significant social concerns.Methods: This study examined the impact of stress on anxiety and investigated whether sleep time mediates this relationship in 46,870 male and female adolescents, ranging from first-year of middle school students to third-year high school students. Data were obtained from the "18th Korea Youth Risk Behavior Survey" conducted by the Korea Disease Control and Prevention Agency.Results: The analysis showed that increased stress was associated with reduced sleep time and higher anxiety levels, stress was found to heighten anxiety, partly by reducing sleep time.Conclusions: Based on these findings, the study recommends: ① developing mental health indicators to quickly identify adolescents at risk for mental health issues, ② encouraging cooperation between schools, government agencies, healthcare providers to enhance access to mental health programs for adolescents, and ③ implementing policies that promote healthy behaviors, ensure adequate sleep, and improve overall well-being.

Analysis of traumatic dental injury experience and related factors among Korean adolescents: using the 19th (2023) Korea Youth Risk Behavior Survey data

Analysis of traumatic dental injury experience and related factors among Korean adolescents: using the 19th (2023) Korea Youth Risk Behavior Survey data

Comparative analysis of toothbrushing practices among multicultural adolescents and mono-cultural Korean adolescents: data from 19th Korea Youth Risk Behavior Survey

Comparative analysis of toothbrushing practices among multicultural adolescents and mono-cultural Korean adolescents: data from 19th Korea Youth Risk Behavior Survey

Community Asset Density and Past-Year Mental Health Symptoms Among Youths

ImportanceMany youths experience mental health challenges. Identifying which neighborhood and community factors may influence mental health may guide health policy and practice.ObjectiveTo explore associations between community assets (eg, schools, parks, libraries, and barbershops) and past-year mental health symptoms among youths.Design, Setting, and ParticipantsThis cross-sectional study leveraged 3 datasets, which were linked by 26 zip codes: the Western Pennsylvania Regional Data Center, the Child Opportunity Index 2.0 database, and the Allegheny County Youth Risk Behavior Survey (YRBS). The YRBS was administered during the study period in 2018 to youths across 13 high schools in Allegheny County, Pennsylvania; the study dates were from October 15 to October 19, 2018. Dates of analysis were from August 1, 2023, to July 15, 2024.ExposuresAsset density in each zip code across 8 asset categories (transportation, education, parks and recreation, faith-based entities, health services, food resources, personal care services, and social infrastructure) was calculated.Main Outcomes and MeasuresThe main outcomes were mental health measures included in the past 12 months, which comprised feelings of hopelessness (feeing so sad or hopeless that you stopped doing activities), nonsuicidal self-injury (hurt yourself on purpose without wanting to die), and suicidal ideation (seriously considered attempting suicide). All were operationalized to any or none. Data were analyzed using multivariable generalized linear mixed models and were adjusted for age, sex assigned at birth, race and ethnicity, and identification as sexually or gender diverse.ResultsAmong 6306 students who were eligible for the YRBS based on their enrollment in participating high schools, 4487 students completed surveys, and 2162 were included in the analytic sample (mean [SD] age, 15.8 [1.2] years; 1245 [57.6%] were assigned female sex at birth). Over one-third of the participants (811 [37.5%]) reported past-year feelings of hopelessness; 587 (27.2%), past-year nonsuicidal self-injury; and 450 (20.8%), past-year suicidal ideation. High total asset population density (adjusted odds ratio [AOR], 0.85 [95% CI, 0.75-0.97]; P = .01), as well as population density of transportation assets (AOR, 0.77 [95% CI, 0.66-0.90]; P < .001), educational resources (AOR, 0.78 [95% CI, 0.67-0.92]; P = .002), and health services (AOR, 0.74 [95% CI, 0.60-0.91]; P = .006), were associated with lower odds of past-year hopelessness after adjusting for covariates. There were no correlations between asset density, Child Opportunity Index, and other mental health measures.Conclusions and RelevanceThe findings of this cross-sectional study suggest that access to certain community assets was associated with lower odds of feelings of hopelessness among youths. Ongoing work is needed to characterize other forms of social and cultural capital, which may mitigate negative mental health outcomes among adolescent youths.

Factors associated with generalized anxiety disorder in adolescents with cultural diversity: secondary data analysis

BackgroundThe number of culturally diverse adolescents in South Korea has reached 290,000 and is increasing every year; however, they still represent only 2.5% of the total adolescent population in middle and high schools, making them a minority. Adolescents experiencing cultural diversity are psychologically vulnerable because they grow up in bicultural environments and experience prejudice. Given the nature of generalized anxiety disorder, which can be exacerbated by stress, these adolescents may face an increased risk of developing the disorder not only because of developmental stress but also because of the stress of cultural adaptation. To identify the prevalence of generalized anxiety disorder among adolescents with cultural diversity, we analyzed related factors. Based on the results, strategies have been proposed to reduce anxiety in adolescents with cultural diversity and generalized anxiety disorders.MethodsThis study used data from the 16th − 18th Korea Youth Risk Behavior Survey. Factors associated with generalized anxiety disorders were identified based on the social determinants of the health framework. Statistical analyses were conducted using IBM SPSS 25.0, and statistical methods were used for complex samples.ResultsAmong adolescents with cultural diversity, 12.8% exhibited generalized anxiety disorders. Among the structural factors, economic status, mother’s education level, and gender were significantly associated with the disorder, whereas among the psychosocial factors, suicidal ideation, depressive mood, loneliness, perceived stress level, and subjective health status were significant factors influencing it.ConclusionThe factors identified in our research can be used as a resource for the early identification of culturally diverse adolescents who are vulnerable to generalized anxiety disorders. To prevent generalized anxiety disorder among adolescents with cultural diversity, school or community nurses can implement interventions to reduce loneliness or stress management programs.

The association between weight loss behaviors and body weight perception in Chinese adolescents: 2007–2022

BackgroundWeight misperceptions are common in children and adolescents, which is related to the engagement of weight loss behaviors. The aim of this study was to investigate the association between body weight perception and weight loss behaviors of lower-calorie diets and increased levels of physical activity (PA).MethodsThe Ningbo Youth Risk Behavior Survey was conducted from 2007 to 2022. A multistage, stratified cluster sampling procedure was utilized to draw target adolescents aged 12 to 18 years participating in each survey wave (2007, 2012, 2017, 2022). Data of anthropometry, weight perception, and weight loss behaviors were collected through self-administered questionnaires. A binary generalized linear model was used to examine associations between body weight perception and weight loss behaviors of lower calorie diets and increased levels of PA.ResultsThe sample sizes for each survey wave were 777, 885, 1588 and 2638. The prevalence of overweight (OW)/obesity (OB), self-perception of OW/OB and overestimated perception increased from 7.6%, 27.0% and 29.1% in 2007 to 16.3%, 39.9% and 41.4% in 2022, respectively. Adolescents that perceived themselves as OW/OB had higher odds of lower-calorie diets (OR: 4.2, 3.3–5.4) and increased level of PA (OR: 3.8, 2.9-5.0), whereas adolescents that perceived themselves as underweight had lower odds of lower-calorie diets (OR: 0.371, 0.253–0.542) and increased levels of PA (OR: 0.381, 0.295–0.559).ConclusionOW, self-perception of OW/OB and overestimated perception were prevalent in Chinese adolescents. Self-perception of OW/OB was positively associated with lower-calorie diets and increased levels of PA. The results can support public health specialists to promote health education of body perception and improve self-esteem in Chinese children and adolescents.

School-Based Protective Factors for HIV Prevention in the United States: Secondary Analysis of the Youth Risk Behavior Survey 2015-2019.

This secondary analysis of the National Youth Risk Behavior Survey (years 2015-2019) examines associations between school-based protective factors (i.e., safe school environments and academic achievement) and HIV risk behaviors among sexually experienced adolescent gay and bisexual men ( n = 644), a population with the highest prevalence of undiagnosed HIV infections. Demographics included Hispanics/Latinos (25%, n = 158), Other race/ethnicity (14%, n = 88), and non-Hispanic Blacks/African Americans (13%, n = 81). Adjusted models showed that protective factors reduced odds for early sexual debut, multiple sexual partners, sex under the influence of drugs/alcohol, and condomless sex, with an additive effect demonstrated when two protective factors were present. Hispanics/Latinos had greater odds of reporting multiple sexual partners and HIV testing, indicating opportunities for school-based HIV prevention and further research. Our findings provide support for school-based programs that aim to improve social and structural determinants of health and ultimately reduce adolescent HIV burdens.

Bullying Vulnerability among Adolescents Reporting Food Allergies: A Nationwide US Study.

Adolescents with food allergies (FA) face unique challenges, including an increased risk of bullying, yet comprehensive national studies on this intersection are lacking. Our study examines the prevalence and association between FA and bullying among US high-school adolescents, utilizing Youth Risk Behavior Survey (2015-2019) data. Analyzing responses from 27,781 adolescents, we found that 19.1% reported on-campus bullying, and 14.9% reported electronic bullying, while 15.8% reported FA. Food allergy was significantly more common among those who reported bullying (23% vs. 13.9%, p < .001). Logistic regressions revealed that adolescents with FA were more likely to experience on-campus (adjusted odds ratio [AOR] 1.51, 95% CI 1.35-1.69) and electronic bullying (AOR 1.42, 95% CI 1.27-1.58) compared to their peers without FA. These findings underscore the vital role of school nurses in identifying and addressing bullying among FA adolescents, thereby ensuring supportive environments, promoting well-being, and fostering academic success.

Association Between Sports Team Participation and Sunburn Among U.S. High School Students, National Youth Risk Behavior Survey, 2021

Association Between Sports Team Participation and Sunburn Among U.S. High School Students, National Youth Risk Behavior Survey, 2021

Association Between Sports Team Participation and Sunburn Among U.S. High School Students, National Youth Risk Behavior Survey, 2021

Association Between Sports Team Participation and Sunburn Among U.S. High School Students, National Youth Risk Behavior Survey, 2021

Sex differences among U.S. high school students in the associations of screen time, cyberbullying, and suicidality: A mediation analysis of cyberbullying victimization using the Youth Risk Behavioural Surveillance Survey 2021

AbstractThe objective of the study is to explore the associations of screen time, cyberbullying victimization, and suicidality during the COVID‐19 pandemic in female and male high school schools, especially the sex differences in the mediation effect of cyberbullying on the relation between screen time and suicidality. This study analysed the direct paths and mediation effects between variables among the 13,982 participants (female: 49%; male: 51%; age 15–17: 74%) in the Youth Risk Behaviour Survey 2021 (YRBS) using the Structural Equation Model and the Monte Carlo methods in Stata. Multiple‐group analysis was conducted to compare sex differences in the mediation effects. Elevated screen time increased the likelihood of suicide ideation (male: OR: 1.50, 95% CI: 1.26–1.79; female: OR: 1.47, 95% CI: 1.28–1.70), suicide plan (male: OR: 1.56, 95% CI: 1.29–1.89; female: OR: 1.45, 95% CI: 1.24–1.69), suicide attempts (female: OR: 1.23, 95% CI: 1.02–1.48). Cyberbully victims had higher odds of suicide ideation (female: OR: 3.69, 95% CI: 3.25–4.17; male: OR: 4.50; 95% CI: 3.80–5.34), suicide plan (female: OR: 3.74; 95% CI: 3.28–4.25; male: OR: 5.03; 95% CI: 4.22–6.01), and suicide attempt (female: OR: 4.24; 95% CI: 3.66–4.92; male: OR: 4.70; 95% CI: 3.81–5.79). Sex differences were revealed in the mediation effects on suicide ideations (χ2(2) = 8.72, p &lt; .05), suicide attempts (χ2(2) = 8.80, p &lt; .05), and suicide overall (χ2(2) = 6.42, p &lt; .05), where the effects were stronger in female students than in males. Screen time and cyberbullying victimization were directly associated with suicide‐related behaviours in adolescents. Cyberbullying victimization in females had stronger mediation effects than in males. These findings emphasized the importance of understanding the new hybrid psychosocial dynamics and creating a healthy hybrid psychosocial environment, especially for female adolescents.

Sex Differences in the Associations of mental Health, Suicidality, Screentime, and Sleep: A Mediation Effect Analysis of Sleep Using Youth Risk Behavioral Surveillance Survey 2021.

Objective: This study was conducted to explore the sex differences in the direct and indirect associations among mental health/suicidality, sleep, and screen time. Methods: Using the 2021 Youth Risk Behavior Survey (YRBS) data, 9408 participants were included in the analyses. The associations of endogenous variables (mental health and suicidality), exogenous variable (screen time), mediator (sleep), and covariates (demographic features and risky behaviors) were analyzed using the Structural Equation Model and "medsem" package, as well as logistic regression and bootstrapping methods. To explore the sex differences in the mediation effect, the Likelihood Ratio Test was used for the multiple-group analysis to compare the unconstrained model with the mediation path-constrained model. Results: Screen time had a significant negative association with sleep duration (female: β = -.09, p < .001; male: β = -.04, p < .001), positive relations to mental health problems (female: β = .10, p < .001; male: β = .12; p < .001), and suicidality (female: OR: 1.07, 95% CI: 1.02-1.13; male: OR: 1.06, 95% CI: 1.01-1.23). Sleep duration is negatively associated with mental health problems (female: β = -.16, p < .001; male: β = -.14; p < .001) and negatively associated with the likelihood of suicidality (female: .89, 95% CI: .85-.94; male: OR: .84, 95% CI: .79-.90). Furthermore, female adolescents had higher frequencies in mental health problems, higher odds ratio in suicidality, shorter sleep duration, and bigger mediation effects of sleep, compared to their male counterparts. Conclusion: Mental health and suicidality were affected differently by screen time and sleep between female and male adolescents. Future research may continue to explore sex differences and their underlying reasons.

Risk and Protective Factors for Driving Under the Influence of Alcohol, Marijuana, and Both Substances in a Population-Based Sample of High School Students

Using results from the 2017 Nevada Youth Risk Behavior Survey, this research aims to understand factors associated with driving under the influence of alcohol (DUIA), marijuana (DUIM), and both alcohol and marijuana (DUIB) among students who reported they drove and used alcohol and/or marijuana recently. DUIM was the most prevalent behavior (16.4%), followed by DUIB (9.3%) and DUIA (4.9%). Weighted multinomial logistic regression analysis showed more risk and protective factors were associated with DUIB than DUIM and DUIA. To decrease motor vehicle crashes among adolescents, interventions should address modifiable factors for driving under the influence of both alcohol and marijuana.