This article relies largely or entirely on a single source .(February 2023) |
The Youth Risk Behavior Surveillance System (YRBSS) is an American biennial survey of adolescent health risk and health protective behaviors such as smoking, drinking, drug use, diet, and physical activity conducted by the Centers for Disease Control and Prevention. The YRBSS is a key public health monitoring program in the United States that tracks various health behaviors in high school students, including a comprehensive national Youth Risk Behavior Survey (YRBS) and local surveys conducted by states, tribes, territories, and school districts. [1] It surveys students in grades 9–12 at their high schools. [2] [3] It is one of the major sources of information about these risk behaviors, and is used by federal agencies to track drug use, sexual behavior, and other risk behaviors.
The YRBSS was created in 1990 [2] in order to monitor progress towards protecting youth from HIV infection. There are only two repeated nationally-representative surveys which give all the information in existence about youth risk behavior; YRBSS and the University of Michigan's Monitoring the Future (MTF). In 2021, these surveys were conducted amidst the COVID-19 pandemic, highlighting the need for timely data to understand shifts in youth health risks and meet evolving public health needs. [1] Every academic research study which evaluates national US trends over time in adolescent smoking, drinking, drug use, sexual activity, or other health behaviors is based on these two studies. There are no other nationally-representative sources of information about these behaviors other than YRBSS and MTF.
The YRBSS is the official source of information about adolescent risk behaviors used to evaluate federal, state, and local public health initiatives to decrease these risk behaviors. The survey targets students from grades 9 through 12 attending both public and private high schools across the United States. To ensure varied representation, schools are chosen through a national sampling process, and within each selected school, classes are randomly picked for participation. Students complete the survey using a computer-readable questionnaire booklet designed for anonymity, requiring about one class period, or roughly 45 minutes, to finish. [1]
In 2019, the YRBS questionnaire featured a total of 99 questions, with 89 included in the standard survey used across different sites. An additional 10 questions, focusing on specific topics of interest to the CDC and its stakeholders, were incorporated to form the national 99-question version. Each cycle of the YRBS includes updates to ensure that new and existing risk behaviors among high school students are accurately measured.
CDC subject matter experts and other professionals suggest modifications to the questionnaire, including addition, removal, or adjustment of questions. Proposed changes are rigorously reviewed to enhance format, clarity, and ease of reading, followed by cognitive testing to assess effectiveness. CDC then refines the questions based on these testing outcomes.
All survey questions, except those measuring height, weight, and race, were designed in a multiple choice format, providing up to eight distinct answer options with one correct response per question. Reliability was validated through test-retest analysis, yielding strong consistency. [4]
In 2019, the Youth Risk Behavior Survey (YRBSS) sampling framework included all standard public, charter, parochial, and select nonpublic schools with students in grades 9–12 across the 50 U.S. states and the District of Columbia. School data sourced from Market Data Retrieval, Inc., and the National Center for Education Statistics (NCES), utilizing the Common Core of Data for public schools and the Private School Universe Survey for nonpublic institutions.
The 2019 Youth Risk Behavior Survey (YRBSS) employed a three-stage sampling approach to achieve a broad, representative snapshot of U.S. high school students in grades 9-12:
This three-tiered sampling ensured that the YRBSS captured a national sample reflecting a wide range of student demographics and school sizes. [1]
The CDC’s 2023 Youth Risk Behavior Survey (YRBS) report highlights concerns for several sub-groups at heightened risk for adverse health outcomes. Students from minority groups, for instance, face elevated risks related to mental health issues, substance use, and experiencing or witnessing violence compared to their peers. Additionally, students with disabilities or those with lower socioeconomic backgrounds often report higher instances of bullying, reduced access to health resources, and increased substance use. The CDC’s YRBSS report from 2023 highlights particular concerns for sub-groups experiencing higher risks, including female and LGBTQ+ students, who report higher instances of violence, poor mental health, and suicidal thoughts compared to their heterosexual and cisgender peers. [5]
Students from racial and ethnic minority backgrounds often experience systemic inequities that contribute to their health risks. For instance, Black and Hispanic students report higher levels of anxiety, depression, and involvement in violence compared to their white peers. According to a 2022 report by the American Psychological Association, Black youth are more likely to experience trauma and adverse childhood experiences, which can have long-term implications for mental health. A study conducted by the National Institute of Justice found that youth of color face higher rates of victimization and involvement with the criminal justice system, further exacerbating mental health issues.
Students with disabilities, particularly those who are on Individualized Education Programs (IEPs), face heightened risks regarding mental health and victimization. Studies using YRBSS data have indicated that youth with disabilities, identified through IEP status, may face elevated risks for certain health behaviors. For instance, students with IEPs in Connecticut have shown higher rates of bullying victimization, cyberbullying, and drug use compared to their peers without IEPs. Data from the Connecticut YRBSS for the years 2013, 2015, 2017, and 2019 was analyzed. The sample included over 9,200 students, with 850 reporting IEP status. Logistic regression was applied to examine links between IEP status and various health risk behaviors. These findings underscore the unique health risks experienced by students with disabilities and highlight potential areas for targeted interventions. [6]
These results substantiate the adaptability of YRBSS data at state levels. Connecticut’s inclusion of a disability measure showcases how YRBSS can be tailored to meet specific needs, an approach that could be extended to the national survey. [6]
Students from low socioeconomic backgrounds are also at a disadvantage, reporting higher rates of substance use, mental health problems, and exposure to violence. The National Center for Children in Poverty notes that these students often lack access to essential health services, which can contribute to a cycle of poverty and poor health outcomes. [7] The YRBS data reveal that students from lower-income families are more likely to engage in risky behaviors, including substance use, as a coping mechanism for their challenging environments. [8]
Female students experience distinct health risks, including higher rates of sexual violence and mental health challenges. The YRBS report shows that nearly 1 in 5 female students reported experiencing sexual violence during their lifetime, which is significantly higher than their male counterparts. This increased vulnerability often correlates with mental health struggles, such as depression and anxiety, leading to detrimental effects on their academic performance and overall well-being. [9]
LGBTQ+ youth are particularly vulnerable, facing elevated rates of bullying, mental health issues, and suicidal ideation. The YRBS indicates that LGBTQ+ students report higher instances of violence, including physical and sexual harassment, compared to their heterosexual and cisgender peers. [10] A study published in JAMA Network Open found that LGBTQ+ youth are more likely to experience severe mental health crises and report feelings of hopelessness, with 40% seriously considering suicide. [11] A study in Pediatrics found that transgender and gender diverse (tgd) youth were more likely to be bullied and have attempted suicide than cisgender youth. Further, the rates of bullying for tgd youth was significantly higher compared to cisgender sexual minority youth, who themselves experienced significantly higher rates of bullying than cisgender heterosexual youth. [12]
Each of these sub-groups not only faces unique challenges but also requires targeted interventions to mitigate health risks and improve overall well-being. Addressing the disparities highlighted in the YRBS can contribute to a healthier and more equitable environment for all students.
Transphobia consists of negative attitudes, feelings, or actions towards transgender people or transness in general. Transphobia can include fear, aversion, hatred, violence or anger towards people who do not conform to social gender roles. Transphobia is a type of prejudice and discrimination, similar to racism, sexism, or ableism, and it is closely associated with homophobia. People of color who are transgender experience discrimination above and beyond that which can be explained as a simple combination of transphobia and racism.
Youth is the time of life when one is young. The word, youth, can also mean the time between childhood and adulthood (maturity), but it can also refer to one's peak, in terms of health or the period of life known as being a young adult. Youth is also defined as "the appearance, freshness, vigor, spirit, etc., characteristic of one, who is young". Its definitions of a specific age range varies, as youth is not defined chronologically as a stage that can be tied to specific age ranges; nor can its end point be linked to specific activities, such as taking unpaid work, or having sexual relations.
According to a 2023 Centers for Disease Control and Prevention study, suicide is the second leading cause of death for adolescents between the ages of 10 and 14, and the third leading cause of death for those between 15 and 25
Violence against transgender people includes emotional, physical, sexual, or verbal violence targeted towards transgender people. The term has also been applied to hate speech directed at transgender people and at depictions of transgender people in the media that reinforce negative stereotypes about them. Trans and non-binary gender adolescents can experience bashing in the form of bullying and harassment. When compared to their cisgender peers, trans and non-binary gender youth are at increased risk for victimisation and substance abuse.
School violence includes violence between school students as well as attacks by students on school staff and attacks by school staff on students. It encompasses physical violence, including student-on-student fighting, corporal punishment; psychological violence such as verbal abuse, and sexual violence, including rape and sexual harassment. It includes many forms of bullying and carrying weapons to school. The one or more perpetrators typically have more physical, social, and/or psychological power than the victim. It is a widely accepted serious societal problem in recent decades in many countries, especially where weapons such as guns or knives are involved.
Sex is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.
The sexuality of US adolescents includes their feelings, behaviors and development, and the place adolescent sexuality has in American society, including the response of the government, educators, parents, and other interested groups.
Teen dating violence is the physical, sexual, or psychological / emotional abuse within a dating relationship among adolescents. Intimate partner violence (IPV) has been a well examined and documented phenomenon in adults; however, there has not been nearly as much study on violence in adolescent dating relationships, and it is therefore not as well understood. The research has mainly focused on Caucasian youth, and, as of 2013, there are no studies which focus specifically on IPV in adolescent same-sex relationships.
Adolescent health, or youth health, is the range of approaches to preventing, detecting or treating young people's health and well-being.
School bullying, like bullying outside the school context, refers to one or more perpetrators who have greater physical strength or more social power than their victim and who repeatedly act aggressively toward their victim. Bullying can be verbal or physical. Bullying, with its ongoing character, is distinct from one-off types of peer conflict. Different types of school bullying include ongoing physical, emotional, and/or verbal aggression. Cyberbullying and sexual bullying are also types of bullying. Bullying even exists in higher education. There are warning signs that suggest that a child is being bullied, a child is acting as a bully, or a child has witnessed bullying at school.
Youth suicide is when a young person, generally categorized as someone below the legal age of majority, deliberately ends their own life. Rates of youth suicide and attempted youth suicide in Western societies and elsewhere are high. Female youth are more likely to attempt suicide than male youth but less likely to die from their attempt. For example, in Australia, suicide is second only to motor vehicle accidents as its leading cause of death for adolescents and young adults aged 15 to 25.
Estimates of sexual violence are surveys of victims of sexual violence crime that have been undertaken to estimate the prevalence of sexual violence. The prevalence of sexual violence differs from the reported sexual violence statistics according to the law enforcement agencies due to the dark figure of crime and under-reporting of crime. The surveys use a common methodology to aid comparability.
Various issues in medicine relate to lesbian, gay, bisexual, transgender and queer (LGBTQ) people. According to the US Gay and Lesbian Medical Association (GLMA), besides HIV/AIDS, issues related to LGBTQ health include breast and cervical cancer, hepatitis, mental health, substance use disorders, alcohol use, tobacco use, depression, access to care for transgender persons, issues surrounding marriage and family recognition, conversion therapy, refusal clause legislation, and laws that are intended to "immunize health care professionals from liability for discriminating against persons of whom they disapprove."
Research has found that attempted suicide rates and suicidal ideation among lesbian, gay, bisexual, transgender and queer (LGBTQ) youth are significantly higher than among the general population.
Disability abuse is when a person with a disability is abused physically, financially, sexually and/or psychologically due to the person having a disability. This type of abuse has also been considered a hate crime. The abuse is not limited to those who are visibly disabled or physically deformed, but also includes those with learning, intellectual and developmental disabilities or mental illnesses.
Bullying and suicide are considered together when the cause of suicide is attributable to the victim having been bullied, either in person or via social media. Writers Neil Marr and Tim Field wrote about it in their 2001 book Bullycide: Death at Playtime.
Risky sexual behavior is the description of the activity that will increase the probability that a person engaging in sexual activity with another person infected with a sexually transmitted infection will be infected, become unintentionally pregnant, or make a partner pregnant. It can mean two similar things: the behavior itself, and the description of the partner's behavior.
Due to the increased vulnerability that lesbian, gay, bisexual, transgender and queer (LGBTQ) youth face compared to their non-LGBTQ peers, there are notable differences in the mental and physical health risks tied to the social interactions of LGBTQ youth compared to the social interactions of heterosexual youth. Youth of the LGBTQ community experience greater encounters with not only health risks, but also violence and bullying, due to their sexual orientation, self-identification, and lack of support from institutions in society.
Kathleen A. Ethier is an American social psychologist and public health official with the Centers for Disease Control and Prevention (CDC). In 2016, she was appointed the Director of CDC's Division of Adolescent and School Health in the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. As of 2020, Ethier is also head of the CDC's community mitigation task force for the COVID-19 pandemic.
Violence against transgender people in the United States includes sexual, physical, and emotional violence. These acts of gender-based violence may result in the death of a transgender person. Transgender people are more likely to be violently attacked than cisgender ones. Between 2008 and 2020, 271 murders on trans people were reported in USA, giving c. 0.83 murders per 1,000,000 inhabitants and placing USA somewhere in the middle between "safe" and "unsafe" states, with reservation for inaccuracies and possible underreporting from some locations.