Emily O’Malley Olsen

Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015

PROBLEM Sexual identity and sex of sexual contacts can both be used to identify sexual minority youth. Significant health disparities exist between sexual minority and nonsexual minority youth. However, not enough is known about health-related behaviors that contribute to negative health outcomes among sexual minority youth and how the prevalence of these health-related behaviors compare with the prevalence of health-related behaviors among nonsexual minorities. REPORTING PERIOD September 2014-December 2015. DESCRIPTION OF THE SYSTEM The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-related behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections, including human immunodeficiency virus infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma and other priority health-related behaviors. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. For the 2015 YRBSS cycle, a question to ascertain sexual identity and a question to ascertain sex of sexual contacts was added for the first time to the national YRBS questionnaire and to the standard YRBS questionnaire used by the states and large urban school districts as a starting point for their YRBS questionnaires. This report summarizes results for 118 health-related behaviors plus obesity, overweight, and asthma by sexual identity and sex of sexual contacts from the 2015 national survey, 25 state surveys, and 19 large urban school district surveys conducted among students in grades 9-12. RESULTS Across the 18 violence-related risk behaviors nationwide, the prevalence of 16 was higher among gay, lesbian, and bisexual students than heterosexual students and the prevalence of 15 was higher among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. Across the 13 tobacco use-related risk behaviors, the prevalence of 11 was higher among gay, lesbian, and bisexual students than heterosexual students and the prevalence of 10 was higher among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. Similarly, across the 19 alcohol or other drug use-related risk behaviors, the prevalence of 18 was higher among gay, lesbian, and bisexual students than heterosexual students and the prevalence of 17 was higher among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. This pattern also was evident across the six sexual risk behaviors. The prevalence of five of these behaviors was higher among gay, lesbian, and bisexual students than heterosexual students and the prevalence of four was higher among students who had sexual contact with only the same sex or with both sexes than students who had sexual contact with only the opposite sex. No clear pattern of differences emerged for birth control use, dietary behaviors, and physical activity. INTERPRETATION The majority of sexual minority students cope with the transition from childhood through adolescence to adulthood successfully and become healthy and productive adults. However, this report documents that sexual minority students have a higher prevalence of many health-risk behaviors compared with nonsexual minority students. PUBLIC HEALTH ACTION To reduce the disparities in health-risk behaviors among sexual minority students, it is important to raise awareness of the problem; facilitate access to education, health care, and evidence-based interventions designed to address priority health-risk behaviors among sexual minority youth; and continue to implement YRBSS at the national, state, and large urban school district levels to document and monitor the effect of broad policy and programmatic interventions on the health-related behaviors of sexual minority youth.

Texting while driving and other risky motor vehicle behaviors among US high school students

OBJECTIVE: To assess the prevalence of texting/e-mailing while driving (TWD) and association of TWD with other risky motor vehicle (MV) behaviors among US high school students. METHODS: Data were used from the Centers for Disease Control and Prevention’s 2011 national Youth Risk Behavior Survey, which assessed TWD during the 30 days before the survey among 8505 students aged ≥16 years from a nationally representative sample of US high school students. TWD frequency was coded into dichotomous and polychotomous variables. Logistic regression assessed the relationship between TWD and other risky driving behaviors, controlling for age, race/ethnicity, and sex. RESULTS: The prevalence of TWD on ≥1 days during the 30 days before the survey was 44.5% (95% confidence interval: 40.8%–48.2%). Students who engaged in TWD were more likely than their non-TWD counterparts to not always wear their seatbelt (prevalence ratio; 95% confidence interval: 1.16; 1.07–1.26), ride with a driver who had been drinking alcohol (1.74; 1.57–1.93), and drink alcohol and drive (5.33; 4.32–6.59). These other risky MV behaviors were most likely to occur among students who frequently engaged in TWD. CONCLUSIONS: Nearly half of US high school students aged ≥16 years report TWD during the past 30 days; these students are more likely to engage in additional risky MV behaviors. This suggests there is a subgroup of students who may place themselves, their passengers, and others on the road at elevated risk for a crash-related injury or fatality by engaging in multiple risky MV behaviors.

State Indoor Tanning Laws and Adolescent Indoor Tanning

OBJECTIVES Recently, several state indoor tanning laws, including age restrictions, were promulgated to reduce indoor tanning among minors. We examined the effects of these laws on adolescent indoor tanning. METHODS We used nationally representative data from the 2009 and 2011 national Youth Risk Behavior Surveys (n = 31 835). Using multivariable logistic regression, we examined the association between state indoor tanning laws and indoor tanning among US high school students. RESULTS Female students in states with indoor tanning laws were less likely to engage in indoor tanning than those in states without any laws. We observed a stronger association among female students in states with systems access, parental permission, and age restriction laws than among those in states without any laws. We found no significant association among female students in states with only systems access and parental permission laws or among male students. CONCLUSIONS Indoor tanning laws, particularly those including age restrictions, may be effective in reducing indoor tanning among female high school students, for whom rates are the highest. Such reductions have the potential to reduce the health and economic burden of skin cancer.

School Violence and Bullying Among Sexual Minority High School Students, 2009–2011

PURPOSE School-based victimization has short- and long-term implications for the health and academic lives of sexual minority students. This analysis assessed the prevalence and relative risk of school violence and bullying among sexual minority and heterosexual high school students. METHODS Youth Risk Behavior Survey data from 10 states and 10 large urban school districts that assessed sexual identity and had weighted data in the 2009 and/or 2011 cycle were combined to create two large population-based data sets, one containing state data and one containing district data. Prevalence of physical fighting, being threatened or injured with a weapon, weapon carrying, and being bullied on school property and not going to school because of safety concerns was calculated. Associations between these behaviors and sexual identity were identified. RESULTS In the state data, sexual minority male students were at greater risk for being threatened or injured with a weapon, not going to school because of safety concerns and being bullied than heterosexual male students. Sexual minority female students were at greater risk than heterosexual female students for all five behaviors. In the district data, with one exception, sexual minority male and female students were at greater risk for all five behaviors than heterosexual students. CONCLUSIONS Sexual minority students still routinely experience more school victimization than their heterosexual counterparts. The implementation of comprehensive, evidence-based programs and policies has the ability to reduce school violence and bullying, especially among sexual minority students.

Sleep Duration and Injury-Related Risk Behaviors Among High School Students — United States, 2007–2013

Insufficient sleep is common among high school students and has been associated with an increased risk for motor vehicle crashes (1), sports injuries (2), and occupational injuries (3). To evaluate the association between self-reported sleep duration on an average school night and several injury-related risk behaviors (infrequent bicycle helmet use, infrequent seatbelt use, riding with a driver who had been drinking, drinking and driving, and texting while driving) among U.S. high school students, CDC analyzed data from 50,370 high school students (grades 9-12) who participated in the national Youth Risk Behavior Surveys (YRBSs) in 2007, 2009, 2011, or 2013. The likelihood of each of the five risk behaviors was significantly higher for students who reported sleeping ≤7 hours on an average school night; infrequent seatbelt use, riding with a drinking driver, and drinking and driving were also more likely for students who reported sleeping ≥10 hours compared with 9 hours on an average school night. Although insufficient sleep directly contributes to injury risk, some of the increased risk associated with insufficient sleep might be caused by engaging in injury-related risk behaviors. Intervention efforts aimed at these behaviors might help reduce injuries resulting from sleepiness, as well as provide opportunities for increasing awareness of the importance of sleep.

HIV Testing Among US High School Students and Young Adults

BACKGROUND: We assessed HIV testing trends among high school students and young adults. METHODS: We analyzed National Youth Risk Behavior Survey (YRBS) and Behavioral Risk Factor Surveillance System (BRFSS) data to assess HIV testing prevalence among high school students and young adults aged 18 to 24, respectively. Logistic regression models for each sample stratified by gender and race/ethnicity were estimated to assess trends in the percentages ever tested, with year as a continuous linear variable. We report absolute differences in HIV testing prevalence and model results for 2005–2013 (YRBS) and 2011–2013 (BRFSS). RESULTS: During the study periods, an average of 22% of high school students (17% of male and 27% of female students) who ever had sexual intercourse and 33% of young adults reported ever being tested for HIV. Among high school students, no change was detected in HIV testing prevalence during 2005–2013, regardless of gender or race/ethnicity. Among young adult males, an average of 27% had ever been tested, and no significant changes were detected overall or by race/ethnicity during 2011–2013. Significant decreases in testing prevalence were detected during 2011–2013 among young adult females overall (from 42.4% to 39.5%), young adult white females (from 37.2% to 33.9%), and young adult black females (from 68.9% to 59.9%). CONCLUSIONS: HIV testing prevalence was low among high school students and young adults. No increase in testing among young adult males and decreased testing among young adult black females is concerning given their higher risk of HIV infection.

Associations of teen dating violence victimization with school violence and bullying among US high school students

BACKGROUND Teen dating violence (TDV) negatively impacts health, mental and physical well-being, and school performance. METHODS Data from a nationally representative sample of high school students participating in the Centers for Disease Control and Prevention (CDC)s 2013 Youth Risk Behavior Survey (YRBS) are used to demonstrate associations of physical and sexual TDV with school violence-related experiences and behaviors, including bullying victimization. Bivariate and adjusted sex-stratified regressions assessed relationships between TDV and school violence-related experiences and behaviors. RESULTS Compared to students not reporting TDV, those experiencing both physical and sexual TDV were more likely to report carrying a weapon at school, missing school because they felt unsafe, being threatened or injured with a weapon on school property, having a physical fight at school, and being bullied on school property. CONCLUSIONS School-based prevention efforts should target multiple forms of violence.

Association of UV index and sunscreen use among White high school students in the United States.

BACKGROUND When used appropriately, sunscreen decreases the amount of ultraviolet (UV) radiation exposure to the skin and is recommended to prevent skin cancer. This study examined the association between annual average UV index and sunscreen use among White, non-Hispanic youth. METHODS The 2007 and 2009 national Youth Risk Behavior Survey (YRBS) data were analyzed. The YRBS is a school-based, cross-sectional study that uses a 3-stage cluster sample design to obtain a nationally representative sample of public and private high school students in the United States. Overall response rates were 68% and 72% (N = 14,041 and 16,410, respectively). Logistic regression analyzes, controlling for grade, examined whether annual average (mean) UV index where students attend school, a proxy measure of potential sunlight exposure, was associated with sunscreen use. RESULTS Among White male students, as the mean UV index increased, the adjusted odds of never wearing sunscreen increased (adjusted odds ratio, AOR = 1.15 [95% CI = 1.04, 1.27], p < .01) and the adjusted odds of most of the time or always wearing sunscreen decreased (AOR = 0.85 [0.78, 0.94], p < .01). There was no association between sunscreen use and mean UV index among White female students. CONCLUSION These findings suggest a need for renewed public health efforts among school, clinical, and public health professionals to promote sunscreen use as part of a comprehensive approach to prevent skin cancer. School and community approaches that passively protect young people from the sun should be considered as a complement to efforts to increase sunscreen use.

Physical and Sexual Teen Dating Violence Victimization and Sexual Identity Among U.S. High School Students, 2015:

Lesbian, gay, and bisexual (LGB) youth are at risk for many negative behaviors associated with teen dating violence victimization (TDVV). This study describes the prevalence of physical and sexual TDVV by sexual identity and quantifies the increased risk for TDVV among LGB youth compared with heterosexual youth. The participants for this study were students in Grades 9 to 12 participating in the 2015 national Youth Risk Behavior Survey (YRBS) who responded to questions ascertaining sexual identity and both physical and sexual TDVV. Data were analyzed by sexual identity, stratified by sex, and controlled for race/ethnicity and grade in school. Frequencies of physical and sexual TDVV and prevalence of TDVV from a combined TDVV measure were calculated. Associations between these behaviors and sexual identity were identified. Generally, LGB youth had greater prevalence and frequency of TDVV compared with heterosexual youth. Prevalence of TDVV within sexual identity subgroups further differed by sex. Students who were not sure of their sexual identity had the highest risk of most categories of TDVV when adjusting for sex, race/ethnicity, and grade in school. These results are the first to use a nationally representative sample to describe frequency of TDVV and to determine prevalence of a combined physical and sexual TDVV measure by sexual identity among youth. Schools, communities, and families can help prevent teen dating violence and ameliorate the potential impacts of these victimizations.

Trends in School-Related Victimization of Lesbian, Gay, and Bisexual Youths—Massachusetts, 1995–2015

Objectives To compare changes over time in prevalence of school victimization among lesbian, gay, and bisexual (LGB) students compared with heterosexual students. Methods We analyzed data from 11 Youth Risk Behavior Surveys conducted among representative samples of students in grades 9 through 12 in Massachusetts during 1995 to 2015. We used multivariable logistic regression models to identify trends over time by sexual identity. Results During 1995 to 2015, the prevalence of missing school decreased overall (from 5.6% to 4.8%) and among heterosexual (from 4.3% to 3.8%) and LGB (from 25.0% to 13.4%) students. The prevalence of having been threatened decreased overall (from 7.8% to 4.1%) and among heterosexual (from 6.5% to 3.5%) and LGB (from 32.9% to 6.7%) students. Conclusions We identified evidence of a significant decrease in victimization among all students regardless of sexual identity and a steep decline among LGB students. Additional actions to improve school climate may help eliminate the disparities and decrease victimization for all youths.