Jo Anne Grunbaum

Youth risk behavior surveillance--United States, 2001

PROBLEM Priority health-risk behaviors contribute to the leading causes of morbidity and mortality among youth and adults. Population-based data on these behaviors at the national, state, and local levels can help monitor the effectiveness of public health interventions designed to protect and promote the health of youth nationwide. REPORTING PERIOD COVERED September 2014-December 2015. DESCRIPTION OF THE SYSTEM The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health 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 (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma and other priority health 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. This report summarizes results for 118 health behaviors plus obesity, overweight, and asthma from the 2015 national survey, 37 state surveys, and 19 large urban school district surveys conducted among students in grades 9-12. RESULTS Results from the 2015 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10-24 years in the United States. During the 30 days before the survey, 41.5% of high school students nationwide among the 61.3% who drove a car or other vehicle during the 30 days before the survey had texted or e-mailed while driving, 32.8% had drunk alcohol, and 21.7% had used marijuana. During the 12 months before the survey, 15.5% had been electronically bullied, 20.2% had been bullied on school property, and 8.6% had attempted suicide. Many high school students are engaged in sexual risk behaviors that relate to unintended pregnancies and STIs, including HIV infection. Nationwide, 41.2% of students had ever had sexual intercourse, 30.1% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 11.5% had had sexual intercourse with four or more persons during their life. Among currently sexually active students, 56.9% had used a condom during their last sexual intercourse. Results from the 2015 national YRBS also indicated many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. During the 30 days before the survey, 10.8% of high school students had smoked cigarettes and 7.3% had used smokeless tobacco. During the 7 days before the survey, 5.2% of high school students had not eaten fruit or drunk 100% fruit juices and 6.7% had not eaten vegetables. More than one third (41.7%) had played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day and 14.3% had not participated in at least 60 minutes of any kind of physical activity that increased their heart rate and made them breathe hard on at least 1 day during the 7 days before the survey. Further, 13.9% had obesity and 16.0% were overweight. INTERPRETATION Many high school students engage in behaviors that place them at risk for the leading causes of morbidity and mortality. The prevalence of most health behaviors varies by sex, race/ethnicity, and grade and across states and large urban school districts. Long-term temporal changes also have occurred. Since the earliest year of data collection, the prevalence of most health-risk behaviors has decreased (e.g., riding with a driver who had been drinking alcohol, physical fighting, current cigarette use, current alcohol use, and current sexual activity), but the prevalence of other behaviors and health outcomes has not changed (e.g., suicide attempts treated by a doctor or nurse, smokeless tobacco use, having ever used marijuana, and attending physical education classes) or has increased (e.g., having not gone to school because of safety concerns, obesity, overweight, not eating vegetables, and not drinking milk). Monitoring emerging risk behaviors (e.g., texting and driving, bullying, and electronic vapor product use) is important to understand how they might vary over time. PUBLIC HEALTH ACTION YRBSS data are used widely to compare the prevalence of health behaviors among subpopulations of students; assess trends in health behaviors over time; monitor progress toward achieving 21 national health objectives for Healthy People 2020 and one of the 26 leading health indicators; provide comparable state and large urban school district data; and help develop and evaluate school and community policies, programs, and practices designed to decrease health-risk behaviors and improve health outcomes among youth.

The co-morbidity of violence-related behaviors with health-risk behaviors in a population of high school students

PURPOSE To describe the frequency of violence-related behaviors and their association with other health behaviors among high school students. METHODS The Youth Risk Behavior Survey was administered to all ninth and eleventh graders (n = 2075) of a school district in Texas. It provided information regarding violence-related behaviors and other health behaviors. Students were classified into four mutually exclusive, violence-related categories according to whether they were involved in a physical fight and/or carried a weapon. RESULTS Overall, 20% of the students were involved in a physical fight but had not carried a weapon, 10% carried a weapon but had not been involved in a physical fight, and 17% had been involved in a physical fight and had carried a weapon. Prevalence of weapon-carrying and fighting were higher among males than females, and among ninth graders than eleventh graders. Among males, 48% had carried a weapon the month prior to the survey. Students who both fought and carried a weapon were 19 times more likely to drink alcohol six or more days than students who did not fight nor carried a weapon. Logistic regression analyses showed that drinking alcohol, number of sexual partners, and being in ninth grade were predictors of fighting. These three variables plus having a low self-perception of academic performance and suicidal thoughts were predictors of fighting and carrying a weapon. CONCLUSIONS The data indicate that violence-related behaviors are frequent among high school students and that they are positively associated with certain health behaviors. Interventions designed to reduce violence should also address coexisting health-risk behaviors and target high-risk groups.

Prevalence of health risk behaviors among Asian American/Pacific Islander high school students.

PURPOSE [corrected] To compare the prevalence of selected risk behaviors among Asian American/Pacific Islander (AAPI) students and white, black, and Hispanic high school students in the United States. METHODS The national Youth Risk Behavior Survey conducted in 1991, 1993, 1995, and 1997 by the Centers for Disease Control and Prevention produced nationally representative samples of students in grades 9 through 12 in all 50 states and the District of Columbia. To generate a sufficient sample of AAPI students, data from these four surveys were combined into one dataset yielding a total sample size of 55, 734 students. RESULTS In the month preceding the survey, AAPI students were significantly less likely than black, Hispanic, or white students to have drunk alcohol or used marijuana. AAPI students also were significantly less likely than white, black, or Hispanic students to have had sexual intercourse; however, once sexually active, AAPI students were as likely as other racial or ethnic groups to have used alcohol or drugs at last intercourse or to have used a condom at last intercourse. AAPI students were significantly less likely than white, black, or Hispanic students to have carried a weapon or fought but were as likely as any of the other groups to have attempted suicide. CONCLUSIONS A substantial percentage of AAPI students engage in risk behaviors that can affect their current and future health. Prevention programs should address the risks faced by AAPI students using culturally sensitive strategies and materials. More studies are needed to understand the comparative prevalence of various risk behaviors among AAPI subgroups.

Prevalence of Health-Related Behaviors Among Alternative High School Students as Compared With Students Attending Regular High Schools

PURPOSE To provide national data on health-risk behaviors of students attending alternative high schools and compare the prevalence of these risk behaviors with data from the 1997 national Youth Risk Behavior Survey. METHODS The national Youth Risk Behavior Survey uses a three-stage cluster sampling design. Data were collected from 8918 students in alternative high schools in 1998 (ALT-YRBS) and 16,262 students in regular high schools in 1997 (YRBS). The health-risk behaviors addressed include behaviors that contribute to unintentional injuries and violence, tobacco use, alcohol and other drug use, sexual behaviors, unhealthy dietary behaviors, and physical inactivity. A weighing factor was applied to each student record to adjust for nonresponse and varying probabilities of selection. SUDAAN was used to compute 95% confidence intervals, which were considered significant if the 95% confidence intervals did not overlap. RESULTS Students attending alternative high schools were at significantly greater risk than students in regular high schools for violence-related injury; suicide; human immunodeficiency virus infection or other sexually transmitted diseases; pregnancy; and development of chronic disease related to tobacco use, unhealthy dieting practices, and lack of vigorous activity. CONCLUSIONS Many students in alternative high schools are at risk for both acute and chronic health problems. Because these youth are still in a school setting, alternative high schools are in a unique position to provide programs to help decrease the prevalence of risk-taking behaviors.

A New Taxonomy for Stakeholder Engagement in Patient-Centered Outcomes Research

Despite widespread agreement that stakeholder engagement is needed in patient-centered outcomes research (PCOR), no taxonomy exists to guide researchers and policy makers on how to address this need. We followed an iterative process, including several stages of stakeholder review, to address three questions: (1) Who are the stakeholders in PCOR? (2) What roles and responsibilities can stakeholders have in PCOR? (3) How can researchers start engaging stakeholders? We introduce a flexible taxonomy called the 7Ps of Stakeholder Engagement and Six Stages of Research for identifying stakeholders and developing engagement strategies across the full spectrum of research activities. The path toward engagement will not be uniform across every research program, but this taxonomy offers a common starting point and a flexible approach.

Perceived Racial/Ethnic Discrimination Among Fifth-Grade Students and Its Association With Mental Health

OBJECTIVES We sought to describe the prevalence, characteristics, and mental health problems of children who experience perceived racial/ethnic discrimination. METHODS We analyzed cross-sectional data from a study of 5147 fifth-grade students and their parents from public schools in 3 US metropolitan areas. We used multivariate logistic regression (overall and stratified by race/ethnicity) to examine the associations of sociodemographic factors and mental health problems with perceived racial/ethnic discrimination. RESULTS Fifteen percent of children reported perceived racial/ethnic discrimination, with 80% reporting that discrimination occurred at school. A greater percentage of Black (20%), Hispanic (15%), and other (16%) children reported perceived racial/ethnic discrimination compared with White (7%) children. Children who reported perceived racial/ethnic discrimination were more likely to have symptoms of each of the 4 mental health conditions included in the analysis: depression, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. An association between perceived racial/ethnic discrimination and depressive symptoms was found for Black, Hispanic, and other children but not for White children. CONCLUSIONS Perceived racial/ethnic discrimination is not an uncommon experience among fifth-grade students and may be associated with a variety of mental health disorders.

Cultural, social, and intrapersonal factors associated with substance use among alternative high school students

The purpose of this study was to identify cultural, social, and intrapersonal factors associated with tobacco, alcohol, and illicit drug use among students attending dropout prevention/recovery high schools. Four mutually exclusive categories of substance use were used as outcome measures, and religiosity, educational achievement, educational aspiration, family caring, others caring, self-esteem, optimism, coping, depression, loneliness, and self-efficacy were used as predictor variables. In the final multivariate model more family caring and loneliness were inversely associated with marijuana use; young age, more family caring, less coping ability, church attendance, and low educational aspirations were significantly associated with cocaine use. This study demonstrates the importance of health education and health promotion programs for students attending alternative high schools which include prevention of initiation, as well as treatment.

Physical activity, energy intake, sedentary behavior, and adiposity in youth.

BACKGROUND It is unclear to what extent factors affecting energy balance contribute to the development of body fatness in youth. The objective of the current study was to describe the relationship of physical activity, energy intake, and sedentary behavior to BMI, fat free-mass index (FFMI), and fat mass index (FMI) in children aged 10-18 years. METHODS In the subsample studied, participants were 245 girls and 227 boys (aged > or =10 years at entry or during follow-up assessments, or aged 11-14 years at entry) followed for 4 years from entry at ages 8, 11, or 14 years. At baseline and anniversary examinations, trained interviewers used a questionnaire to assess time spent daily in moderate-to-vigorous physical activity (MVPA), sedentary behavior, and energy intake (kcal/day). Sexual maturation was assessed by direct observation of pubic-hair development (Tanner Stages 1-5). Triplicate recordings of height and weight were used to estimate BMI by the standard formula (kg/m(2)); bioelectric impedance was used to estimate percent body fat for calculating FFMI and FMI (kg/m(2)). Multilevel models were used to examine the association of MVPA, energy intake, and sedentary behavior with BMI, FFMI, and FMI. Data were analyzed in 2007-2008. RESULTS Energy intake was unrelated to FMI or FFMI in models adjusted for age or sexual maturation or in any model to BMI. Sedentary behavior was unrelated to FMI in any model or to FFMI or BMI in models adjusted for age or sexual maturation. MVPA was inversely related to FMI. CONCLUSIONS In children aged 10-18 years, MVPA was inversely associated with fat mass and with BMI. Investigations in youth of dietary intake and physical activity, including interventions to prevent or reverse overweight as represented by BMI, should address its fat and lean components and not BMI alone.

Blood Lipids in Children: Age-Related Patterns and Association with Body-Fat Indices: Project HeartBeat!

BACKGROUND Longitudinal data on the normal development of blood lipids and its relationships with body fatness in children and adolescents are limited. Objectives of the current analysis were to estimate trajectories related to age for four blood lipid components and to examine the impact of change in body fatness on blood lipid levels, comparing estimated effects among adiposity indices, in children and adolescents. METHODS Three cohorts, with a total of 678 children (49.1% female, 79.9% nonblack) initially aged 8, 11, and 14 years, were followed at 4-month intervals (1991-1995). Total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride levels were determined in blood samples taken following fasting. Body fatness was measured by five adiposity indices-BMI; percent body fat (PBF); abdominal circumference; and the sums of six and of two skinfold thicknesses. Trajectories of change in blood lipid levels from ages 8 to 18 years were estimated by gender and race. The impact of change in body fatness on lipid levels was evaluated for each index, adjusting for gender, race, and age. RESULTS All lipid components varied significantly with age. Total cholesterol decreased by approximately 19 mg/dL from ages 9 to 16 years in girls and more steeply from ages 10 to 17 years in boys. LDL-C decreased monotonically, more steeply in boys than in girls. It was higher among nonblacks than among blacks. HDL-C increased monotonically in girls, mainly from ages 14 to 18 years, but fluctuated sharply among boys. Levels of HDL-C were higher among blacks than among nonblacks. The levels of triglycerides increased from ages 8 to 12 years among girls and, almost linearly, from ages 8 to 18 years among boys. The levels of triglycerides were higher among nonblacks than among blacks. Increase in body fatness was significantly associated with increases in total cholesterol, LDL-C, and triglyceride levels. Significant interactions between the adiposity indices (except for BMI) and gender indicated smaller impacts of change in body fatness on total cholesterol and LDL-C in girls than in boys. The estimated impact on triglycerides was weaker among blacks than among nonblacks, except for PBF. Change in body fatness was negatively associated with HDL-C. The results remained essentially unchanged after adjustments for energy intake, physical activity, and sexual maturation. CONCLUSIONS Patterns of change with age in blood lipid components vary significantly among gender and racial groups. Increase in body fatness among children is consistently associated with adverse change in blood lipids. Evaluation of blood lipid level should take into account variation by age, gender, and race. Intervention through body-fat control should help prevent adverse lipid levels in children and adolescents.

Development of Cardiovascular Risk Factors From Ages 8 to 18 in Project HeartBeat! Study Design and Patterns of Change in Plasma Total Cholesterol Concentration

BACKGROUND Project HeartBeat! is a longitudinal study of the development of cardiovascular risk factors as growth processes. Patterns of serial change, or trajectories, from ages 8 to 18 years for plasma total cholesterol concentration (TC) and percent body fat illustrate the design and synthetic cohort approach of the study. METHODS AND RESULTS Six hundred seventy-eight children (49.1% female, 20.1% black) entered the study at ages 8, 11, and 14 years and were followed up with examinations every 4 months for < or = 4 years. Multilevel analysis demonstrated trajectories for population mean values of TC and percent body fat in sex-specific synthetic cohorts from ages 8 to 18 years. Polyphasic patterns of change in TC were confirmed, with notable sex differences in age patterns and with minimum mean values of TC of 3.85 mmol/L for females and 3.59 for males. As illustrated by data for males, the approximate 75th percentile values of mean TC ranged from 4.78 mmol/L at its early peak to 4.06 at its late-teen nadir. Percent body fat exhibited a trajectory closely parallel with that for TC only for males and appeared to be unrelated for females. CONCLUSIONS The polyphasic trajectory for TC from ages 8 to 18 years differs between females and males, indicates marked age variation in 75th percentile values and, in males only, closely parallels the trajectory for percent body fat. These and other results indicate the value of both follow-up every 4 months across age intervals to detect rapid risk factor change and the synthetic cohort approach for gaining new insights into the dynamics and possible determinants of this change from ages 8 to 18 years.