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CDC 2007 National Youth Risk Behavior Survey Telebriefing

June 4, 2008, 12:00 p.m. EST

OPERATOR:  Good afternoon and thank you all for holding.  At this time, your lines have been placed on listen-only until we open up for question-and-answer.  Please be advised today′s conference is being recorded, if you have any objections, you may disconnect at this time.  I would now like to turn the conference over to Ms. Karen Hunter, CDC Senior Press Officer, please go ahead.

KAREN HUNTER:  Thank you.  And welcome to the 2007 National Youth Risk Behavior Survey telebriefing.  A couple of quick notes, Veronica Garcia, the Secretary of Education with the New Mexico Public Education Department who had been scheduled to participate in this briefing had a sudden illness in her family and will unable to participate.  I want to also let folks know that the full youth risk behavior survey report, as well as a number of fact sheets and other materials are available on the CDC Web site.  The Web address is www.cdc.gov/yrbs.  A transcript of this press briefing will be posted to CDC′s press room site, later this afternoon.  And that Web address is www.cdc.gov/media.

And right now, I′m going to turn it over to our speakers.  We′ll be hearing from Howell Wechsler who is the Director of CDC′s Division of Adolescent and School Health.  And then we′ll also be hearing from Dr. Glenn Flores who is a Professor of Pediatrics and Public Health, University of Texas Southwestern Medical Center, Children′s Medical Center of Dallas and his area of expertise is racial ethnic health disparities.  Howell.

HOWELL WECHSLER:  Good morning and thank you for joining us. I′m here to provide a summary of the report that CDC will release today on the 2007 National Youth Risk Behavior Survey and for short we call it YRBS.  The YRBS tells us what high school students across the nation are doing related to the behaviors that most affect their health both in the short term and throughout their lifetime.  It also enables us to report on the national prevalence of risk behaviors among high school students in three racial and ethnic groups, African American or black students, Hispanic or Latino students, and white students.  CDC has been conducting the survey every two years since 1991.  The data being released today were collected in Spring 2007 from a national representative sample of more than 14,000 high school students in public and private schools throughout the United States.  And for the first time, we′re releasing analysis of trends and behavior change over time for African American, Hispanic and white students and you can see that in fact sheets available on our Web site.

So the new report tells us that while large numbers of today′s high school students continue to engage in behaviors that place their health at risk, the percentage of students engaging in many of these risk behaviors is lower today than it was in the early 1990s.  However, even though the study documents substantial improvements over time in many health risk behaviors among all high school students, our Hispanic students remain at greater risk than white and black students for certain health related behaviors and have not matched the progress made over time by black and white students in reducing some sexual risk behaviors.

Hispanics are the largest and fastest growing minority group in the United States and according to recent U.S. Census Bureau estimates, Hispanics comprise 17 percent of the population aged 15 to 19-years-old, but about 25 percent of the population younger than 5 years old.  It′s extremely important that our schools and community programs understand and address the health related needs of our Hispanic students.

Results from the 2007 YBRS indicate that Hispanic students were more likely than black and white students to engage in a number of key health risk behaviors such as attempting suicide, riding with a driver who had been drinking alcohol, using cocaine, heroine or ecstasy and not eating for 24 hours or more to lose or maintain their weight.  In addition, Hispanic students were more likely than black or white students to not go to school because of safety concerns, to be offered or sold illegal drugs on school property and to drink alcohol on school property.  It is particularly troubling to see that our Hispanic students appear to be at a disadvantage in terms of the safety of their school campuses.  All of our students should be able to learn in a healthy and safe environment.

The good news is that compared with Hispanic students in the 1990s, Hispanic students in 2007 were less likely to engage in a number of key health risk behaviors.  In 2007, Hispanic students were less likely to smoke cigarettes, to use drugs such a marijuana and methamphetamines, to drink alcohol and to ride with a driver who had been drinking alcohol.  And they were more likely to wear a seatbelt at least some of the time, and to use condoms during sexual intercourse.

Black and white students have made progress over time in most of these behaviors, as well. However, the percentage of Hispanics who had ever had sexual intercourse and the percentage who have had sex with four or more persons during their life have not declined between 1991 and 2007.  There has been no decline in those two risk areas for our Hispanic students.

During the same time period, significant declines have been seen in the percentage of white and black students engaging in these behaviors.  So the percentage of white high school students who had ever had sexual intercourse declined from 50 percent in 1991, to 44 percent in 2007.  The percentage who had sex with four or more persons during their life declined from 15 percent to 12 percent.  Meanwhile, for the nation′s black high school students, the percentage who had ever had sexual intercourse declined from 82 percent in 1991 to 66 percent in 2007.  And the percentage who had sex with four or more persons during their life declined from 43 percent to 28 percent. 

It′s important to note that the percentage of white and black high school students who were taught about HIV/AIDS in school was higher in 2007 than it was in 1991.  But there was no such increase seen among our Hispanic students.  These data underscore the fact that all of our children would benefit from participation in evidenced-based instruction on preventing HIV/AIDS, other sexually transmitted diseases and unintended pregnancy that′s delivered by well-trained teachers. 

Now, the reasons for the youth risk behavior differences across racial and ethnic groups are very complex.  They might include factors such as socioeconomic status, parents educational levels, the environment of the communities in which students live and cultural factors.  More research is clearly needed to understand why different racial and ethnic groups do better or worse than others on different health risk behaviors.  This kind of knowledge can help us design and implement health promotion strategies that can reduce risk behavior levels across the entire youth population and eliminate the differences across groups.

CDC works to improve the help of young people and to address the differences in risk behaviors across groups by collecting and analyzing health risk data, by supporting research related to health differences across groups, by providing evidence based guidance on effective strategies for narrowing and ultimately eliminating those differences. And by targeting our program funding and technical assistance to where they′re most urgently needed.

I want to close by pointing out that I′ve been talking about the National Youth Risk Behavior Survey data.  But the report also includes data from separate surveys conducted on representative samples of high school students in 39 states and 22 large urban school districts.  Public health professionals, educators, youth service providers, and policy makers can use these data to guide their health promotion planning decisions in each of those states in urban areas.

And now, I′m delighted to ask Dr. Glenn Flores, one of our nation′s leading experts in health disparities among adolescents to share his thoughts on the results of the 2007 Youth Risk Behavior Survey.  Dr. Flores.

GLENN FLORES:  Thank you, Dr. Wechsler and good morning.  Latinos are the largest and fastest growing racial and ethnic minority group in our nation numbering 45.5 million and comprising 15 percent of the U.S. population.  There are about 8 million Latino adolescents accounting for about 19 percent of all U.S. adolescents and 17 million Latino children overall which make up about 20 percent of all American children.

It is thus alarming that the 2007 YRBS documents multiple disparities for Latino youth in America and that few of these disparities have changed since the last Youth Risk Behavior Survey in 2005.  Compared with white and African American youth, Latinos are significantly more likely than other racial and ethnic groups to use drugs.  For example, one in nine Latino youth reports lifetime cocaine use, one in 14 lifetime ecstasy use, one in 27 lifetime heroine use, and one in 11 lifetime illegal injection drug use.

Over the past 16 years there have been significant decreases in the proportions of white and African American youth who have ever had sexual intercourse or who had sex with four or more persons during their life.  For Latino youth over the last 16 years, however, there has been no change in the proportions who had ever had sexual intercourse at 52 percent or had sex with four or more persons during their life at 17 percent.  In addition, Latino youth are least likely to have been taught in school about AIDS or HIV infection at 85 percent.  And this percentage has not changed in the last 16 years in contrast to white and African American youth.  In addition, 48 percent of sexually active Latina females did not use condoms during last sexual intercourse, the highest rate of any group.  These findings are particularly concerning given that these persistent disparities are associated with high risk of teen pregnancy, HIV/AIDS and other serious sexually transmitted diseases.

Latino youth are significantly more likely than white youth to be overweight or obese at 35 percent overweight or obese versus 25 percent overweight or obese in white youth.  Seventy percent of Latino youth don′t meet recommended levels of physical activity.  Seventy-four percent don′t have daily physical education classes in their schools.  And 43 percent watch, at least, three hours of television on an average school day.

Latino youth are most likely to report feeling sad or hopeless at 36 percent overall and 42 percent in Latina girls.  Latino teens have the highest rates of having made a suicide plan in the past year at 13 percent overall and one in six Latina girls end up actually attempting suicide at 10 percent overall and 14 percent among Latina girls.  Indeed, in the past year, one out of every 25 Latina teens made a suicide attempt that resulted in an injury, poisoning or overdose that had to be treated by a doctor or a nurse, twice the rates of white and African American female teens. 

Other national data paint a similarly bleak picture of multiple health disparities for Latino youth and children.  Latinos have the highest high school drop out rate at 23 percent versus 6 percent in whites and 11 percent in African Americans.  Latina girls have the highest teen birthrate at 83 per 1,000 girls.  Latinos are the most uninsured racial and ethnic group with 22 percent uninsured versus seven percent of whites, and 14 percent of African Americans.  One in three Latino children has no usual source of medical care, and 33 percent experienced problems getting specialty care.  Half of Latino children have teeth that are not in excellent or very good condition and 30 percent made no dental visit in the past year.

Although 11 million American school children speak a language other than English at home, 71 percent of which is Spanish, a study revealed that language problems are the single greatest barrier to healthcare for Latino children and one in six Latino children was not brought in for needed medical care due to language and cultural issues.

What can we do to reduce and ultimately eliminate these disparities for Latino youth?  More research is needed so that we can better understand these disparities.  But available data indicate that effective solutions for reducing disparities already exist.  Critical to eliminating disparities are programs that are adequately funded, sustained, culturally appropriate, and community driven.  A crucial first step is to identify all such racial and ethnic disparities and monitor their change over time by requiring all healthcare institutions to collect data on patient′s race and ethnicity, primary language spoken at home and parental English proficiency.  Regularly eating dinner together with the family can be a powerful intervention for eliminating disparities for youth.  Compared with children who have dinner with their families, zero to two times weekly, those who have dinner with their family five to seven times per week have half the risk for substance abuse and high stress, are significantly less likely to have tried marijuana, alcoholic beverages and cigarettes and are twice as likely to receive As in school, and are more likely to eat five daily servings of fruits and vegetables and to consume less soda, fried food and fat.

Affordable and culturally accessible after school programs are needed targeting minority youth and prevention of risky behaviors including organized sports, dance, the arts and job training.  Health lifestyle interventions and education are needed in all U.S. schools including regular physical education, elimination of soda vending machines, healthier school lunches, and mandatory health education classes.  Greater use is needed of evidenced based culturally appropriate health curricula in schools and community centers such as the Quidaté (ph) intervention which has been shown to reduce HIV sexual risk behaviors among Latino youth and meets the CDC requirements for an evidence based intervention.

Only 13 states provide Medicaid and SCHIP reimbursement for medical interpreters.  So it is time for us to eliminate language barriers to healthcare for Latino youth by providing reimbursement nationwide for language services.  And 9 million U.S. children have no health insurance and Latino children are at greatest risk.  Every American child should have heath and dental insurance and access to quality health and dental care through regular health and dental care providers. 

Our research team has documented the successful elimination of a racial and ethnic disparity for Latino children.  Community-based case managers ensured 96 percent of uninsured Latino children versus only 57 percent of children ensured using traditional Medicaid and SCHIP outreach and enrollment strategies.  And the community-based case managers ensure children substantially quicker, more continuously and with much higher parental satisfaction.

Eliminating racial and ethnic disparities and the health and well-being of our youth should be an urgent national priority for two reasons.  First, it′s just the right thing to do, given how much Americans value equality and justice.  And second, the future health and productivity of our nation are at stake given that the number of racial and ethnic minority children will exceed the number of white children in the U.S. by the year 2030.  Thank you. 

KAREN HUNTER:  Thank you, Howell and Dr. Flores.  And I think we can open it up for reporter questions now.

OPERATOR:  Thank you.  We will now begin the question-and-answer session.  If you would like to ask a question please press star, followed by one on your touch-tone phone.  To withdraw your request, you may press star two.  And once again, to ask a question, please press star followed by one.  One moment please, for the first question.

Our first question comes from Brian Thompson (ph), Kansas Public Radio, please go ahead.

BRIAN THOMPSON (ph), KANSAS PUBLIC RADIO:  Hi.  I wonder if you could explain what you know about the relationship of cultural assimilation to these disparities and perhaps immigration status as well.

WECHSLER:  This is Dr. Wechsler.  Our study does not get that information.  So we′re not able to comment on that.  But Dr. Flores, I know, has done a lot of research on this and I′m sure he′ll be able to comment.

FLORES:  Yes, it′s a very interesting question because the fascinating phenomenon that you see in now multiple studies is that the less acculturated you are, particularly for Latinos the better your health outcomes.  So in other words, the less Americanized you are, the better you tend to do.  And this is whether you look at outcome such as prematurity and low birth weight.  It′s looking at vaccination rates.  It′s looking at the age for sexual intercourse.  So being less acculturated you′re more likely to delay that.  It′s use of alcohol and drugs and, you know, there are a number of outcomes for adults that have shown similar, what they call healthy immigrant effects. 

And so I like to always remind people that, yes, there are a lot of racial and ethnic disparities where minorities are at a disadvantage but we could probably learn a lot about keeping all of our children healthy by examining what it is that′s protective in the less acculturated families and children.  Now, that having been said, I think you′re also alluding to the fact that for immigrant children you usually have higher risks for other health outcomes and healthcare issues.  So, for example, we know that immigrant children are much more likely to be uninsured and that′s whether they themselves are U.S. citizens or not.  So if they′re in a mixed family where the parents are not U.S. citizens and the children are citizens, they′re still less likely to have health insurance.  And that, of course, can lead to poor quality of care and poor access to care, and then lead to many of the health risk behaviors that we have discussed. 

But as Dr. Wechsler mentioned we don′t have access to data in the YBRS that allow us to look specifically at that population. 

HUNTER:  Thank you.  Next question.

OPERATOR:  Thank you.  Our next question comes from Mike Stobbe with the Associated Press, please go ahead.

MIKE STOBBE, THE ASSOCIATED PRESS:  Hi.  Thanks for taking the question.  Could you say a little more about the schools and the survey and the racial demographics?  I guess, what I′m wondering I′d like to hear a little more on whether there was a lot of predominantly Hispanic schools and predominantly black and predominantly white? Or if most of them were mixed?  And if they were mixed, why is that Hispanics were more afraid of coming to school?  I′m just trying to understand why the experience is different and if that had to do with how the school demographics were.

WECHSLER:  Sure, the sampling process is done in a very rigorous way to ensure that the population of students surveyed is representative of the national population.  We don′t particularly have breakdowns in terms of the percentages of different ethnic groups in each of the schools but the important thing is that this nationally representative and, of course, some schools are well integrated and other schools are largely one racial ethnic group or another.  It varies, of course, across the nation.

Again, the important point is that this sample that is surveyed is representative of the nation as a whole.

HUNTER:  Did you have a follow up question?

STOBY (ph):  I guess not.  I just – I′m still puzzled as to – no I guess not.

HUNTER:  OK.  Next question, please.

OPERATOR:  Thank you.  Our next question comes from Will Dunham with Reuters, please go ahead.

WILL DUNHAM, REUTERS:  Yes, hello.  This is Will Dunham with the Reuters Washington Bureau.  I notice on some of the categories, especially the sexual behavior categories that there′s been a lot of progress from 1991 through 2007.  But when you break it down and look from 2001 to 2007 it′s been basically static.  So all of the progress, basically, occurred in the 1990s, and then during the current decade stagnation.  Have you noticed that?  And if so, what′s going on?

WECHSLER:  You know, there are different ways to analyze these things statistically.  And in the overall trends analysis, it has gone down throughout this time period.  We have conducted separate analysis upon request, looking at whether there have been changes specifically from 2001 to 2007 and for most of the sexual risk behaviors, what we see is that it′s pretty much flat.  It′s not going down.  It′s not going up since 2001.  For the use of condoms, that flattening out point started in 2003. 

Now, again, the YRBS tells us what′s going on.  It doesn′t give us indication as to what are the factors behind that.  I′m sure there are many different factors.

HUNTER:  Next question.

OPERATOR:  Thank you.  Our next question comes from Miriam Falco, CNN, please go ahead.

MIRIAM FALCO, CNN:  Hi.  Thanks for taking the question.  I was a little confused about what Dr. Wechsler was explaining at the beginning.  I thought you said that the – among Hispanics the riding with drivers drinking alcohol, and a couple of other factors had gone up.  And then you also said in 2007, they were less likely to drink alcohol and be riding with drivers drinking alcohol. 

WECHSLER:  Yes, let me clarify that.  Hispanic high school students in 2007 were less likely to ride with a driver who had been drinking alcohol compared with Hispanic students in 1991.  However, in 2007 Hispanic students were more likely than black or white students to ride with a driver who had been drinking alcohol.

HUNTER:  Does that clarify it for you, Miriam? 

FALCO:  Actually, it doesn′t but maybe I just have to read it, I′m just being a little dense.  But what I don′t understand and this is going back to Mike Stobbe′s question which is a very good, are the curricula in the schools where Hispanics are taught different from those in schools teaching African American or white children?  Why aren′t they getting the education about HIV and AIDS, for instance, that the other students evidently are getting and therefore their risk to behavior is going down.

WECHSLER:  There could be two explanations, and of course, with this study we can′t answer either of them.  The first one is to recognize that curricula decisions for American schools are made at the local school district level.  So different school districts might be making different decisions as to what′s taught. 

And then, of course, within a particular school or within a particular school district it′s possible that Hispanic students are not receiving the same type of instruction that the other students are receiving but we don′t have answers to which extent is one or the other. 

FLORES:  Yes, and this is Dr. Flores. Maybe I can have some insight on that.  I think one way to look at this is in tough economic times those with little resources have even fewer resources.  And we′ve seen an interesting phenomenon in the healthcare field whereby when you′re at a minority predominant hospital everybody has bad outcomes even white patients.  So we know this from, for example, higher mortality rates for all mothers who are delivering in terms of infant mortality at hospitals that have higher proportions of minorities and those are usually inner city and often don′t have as much funding as some of the private hospitals and we′ve seen that in adults, as well, where there are higher mortality rates and higher complication rates in hospitals that are minority predominant.  And a lot of healthcare research haS postulated that the quality of care isn′t as good.  And, I think, if possible we could be seeing a similar phenomenon in a lot of the minority dominated schools where there′s less funding and less quality and a higher student to teacher ratios.  And so there′s less supervision and you see more health risk behaviors and more safety issues at school.

WECHSLER:  And if I may go back to your first question, I hate to leave you unclear on that, let me say it another way and that is that today′s Hispanic students are doing much better.  They′re much less likely to ride with a driver who had been drinking alcohol but they′re still doing considerably worse than our black and Hispanic students today. 

FLORES:  Yes, I agree, it′s a good news, bad news.  Overtime, the secular trend is improving.  But if you still look at who has the highest risk among the three racial and ethnic groups looked at in the YBRS it′s, by far, significantly greater risk for Latinos.  So, you know, it′s the question of is the glass half empty or half full?

WECHSLER:  And I′m sorry, I meant to say versus black and white students, Hispanics are more likely to engage in that risk.

HUNTER:  Next question, please.

OPERATOR:  Our next question comes from Sharon Jayson, USA Today, please go ahead. 

SHARON JAYSON, USA TODAY:  Hi, thank you.  What – this is kind of even a follow up to what we′ve just been talking about.  Your fact sheetS suggest that and the focus of this has been on the greater risk for Hispanics.  But when you look at the fact sheets comparing, there are some areas in which black and students are more likely at risk than Hispanics and whites and others where white students are more likely at greater risk.  So, I mean, doesn′t it really just depend on which risk behaviors you′re looking at?  Or can you effectively say that in all cases, Hispanics are at greater risk than blacks or whites?

WECHSLER:  No, you′re absolutely right, Sharon.  Each of the groups is a greater risk for some risk behaviors, for different types of risk behaviors. So it′s important to study the whole report.  We just wanted to highlight the specific needs of Hispanic students as our fastest growing student population.  And, in particular, because there was that inconsistency in the trends over time, which we had not reported on before related to the sexual risk behaviors.  So, you know, when we see consistently the black and white students, and most of the variables Hispanic students improving over time, and then there′s that one cluster of areas and behaviors related to sexual risk where the black and white students are improving but the Hispanic students are not, that′s why we wanted to raise concern about that.

FLORES:  And when you look at the research on racial and ethnic disparities and health and healthcare, you′re right, there are some disparities for white children, but when you adjust for all of the relevant variables in large data sets when you can do that, you see over and over again both for African American and Latino children, many, many disparities in health, use of health services, access to care, and risk behaviors.  And so it′s not a matter of, you know, the three groups have different disparities and it′s just a mosaic. It′s that sure, there are some disparities for white kids, and we certainly should pay attention to those, but there are some disparities that we′re talking about today for Latino kids that have persisted and they continue to have the highest risk.

For example, the one that really troubles me is you have over a third of Latino youth who are feeling sad of hopeless and it′s 42 percent of Latino growth.  That′s almost half of all of the Latino girls who are adolescents in our country.  And for us to be having 13 percent overall and one in six girls among Latinos making a suicide plan, I mean that′s not my idea of the way a childhood should be going for any child in the United States.  But if you have a particular risk group who has such a high prevalence of feeling sad and hopeless and thinking about suicide and as I mentioned before, actually attempting suicide, that to me is alarming and unacceptable.  And we need to do something now.  The way that we improve everybody′s health usually is to first look at who is act highest risk and start to reduce the risk among that group.  And then, hopefully eventually reduce the risk among all of our children.

HUNTER:  Thank you.  Next question, please.

OPERATOR:  Thank you.  Our next question comes from Shannon Pettipese (ph), Bloomberg News, please go ahead.  Shannon, please check your mute feature or life your handset.

SHANNON PETTIPESE (ph) BLOOMBERG NEWS:  Hi, here I am.  Sorry.  I just wanted to go back to something you said in the very beginning about how sometimes immigrants or minorities do better the less like adapted to the culture they are, the less Americanized they are.  Could you elaborate on that a little bit?  I guess, I′m just wondering about the idea that, you know, is it that as these teenagers spend more time in the U.S. and in schools here and stuff, they start to develop more risky behaviors.  Is that what seems to be a trend?

FLORES:  Yes, you know, we′re still trying to figure this out.  We′re still studying it.  But there are some interesting hypotheses and some interesting evidence about this.  So some researchers have said, look, probably what you′re seeing is that there′s a traditional normative cultural value in Latino culture for the family.  And that, you know, there′s a tightness in the family. There′s that social support.  And we know that that sort of social support reaps fantastic benefits in one′s health and healthcare.  So that might have something to do with it.

The other thing that a lot of people point to is that there′s a tremendous amount of positive aspects to American culture, our technology and our focus on knowledge, but being poor in America can be a very rough road to travel on.  And so transitioning from another country to being poor in this country can be very difficult for one′s health and healthcare.  And so that′s why you see this sort of juxtaposition, this contradiction where you see these protective aspects which may relate to, again, the central focus on the family and being there for your kids and focusing on kids.

But then as you′ve been in the United States and economic times are tough and it puts stresses on families, then you see an erosion of that. 

The other interesting tension that you see is and I see this in my practice when I care for Latino families is you have adolescents who are caught between two cultures.  So, you know, at home they may be speaking Spanish and doing some of the traditional customs.  And then, at school, they′re trying to fit in and they′re trying to be as American as possible and that stress, that tension between the two cultures and trying to fit into both and meld that and grow and development and learn at school can be, I think, a tremendous burden.  And it may be why we′re seeing such a high risk of feeling sad or hopeless among Latino youth and why there′s a higher suicidality component to them.  I think that′s an important part of it.  And it relates back to this interesting relationship with lower acculturation, higher acculturation.

HUNTER:  Thank you.  Do we have additional questions?

OPERATOR:  Yes, our next question comes from Karen Springen (ph), Newsweek, please go ahead.

KAREN SPRINGEN (ph), NEWSWEEK:  Hi.  I just wondered if there′s any breakout on whether the students went to Catholic schools that didn′t teach about birth control and the rest?  I mean with Hispanic students you think most of them are Catholic if there′s any breakout on that?

WECHSLER:  We can do breakdowns by public and private school.   What you should know is that the study includes private schools as well as public schools.  But we have no way of knowing whether it′s a parochial school or not.

HUNTER:  Does that answer your question, Karen?

SPRINGEN (ph):  I just wondered how many of the Latinas who were at risk went to Catholic schools?

WECHSLER:  That′s a very, very good question but we′re not able to determine that.

SPRINGEN (ph):  Thanks.

FLORES:  Yes, and I′d like to – it′s a fascinating issue. We have a faculty member at our institution who′s looking at data and sexual practices both among Latinos and Asians.  And he′s done a little more work on Asians and there is this interesting dichotomy between what the parents believe is happening with their kid and what their kid is actually doing, and a lot of the kids when they grow up in strict environments have to do a lot of these risky behaviors without their parents knowledge.  And, I think, that creates some serious concerns about where they′re going to be getting their education, what kind of behaviors they′re going to be participating in.  And, I think, it emphasizes the importance of dialogue. 

Again, you know, we′re talking about acculturation earlier particularly when there are, perhaps, generational divides and different norms and values and that, I think, would be an interesting subset to look at in terms of some of the risk behaviors we′re talking about.

HUNTER:  Thank you.  Next question, please.

OPERATOR:  Thank you.  Our next question comes from John Geever (ph) with Med Page Today, please go ahead.

JOHN GEEVER (ph), MED PAGE TODAY:  Hi, thank you.  Leaving aside the issue of racial disparities for a moment, I noticed that in some cases, many cases, there are a number of trends, healthy trends that we′ve seen over the long period seem to have flattened out in recent years such as in alcohol use, I see that there′s been very little change between 2005 and 2007.

Are these areas of concern?  Should we concerned that there′s no more to be gained in terms of promoting health behaviors in high school students?

WECHSLER:  We don′t get terribly troubled over a two-year trend. So it′s unusual to see many, many changes from one administration of the survey to the other.  So the fact that there′s not much change from 2005 to 2007 doesn′t concern us.  But if it goes back to 2003, 2001, 1999, where we′re not seeing changes, then we do get concerned.  And we are particularly concerned about what appears to be a flattening out in reductions of sexual risk behaviors.  We wish that tobacco use, the cigarette use rate would be going down more dramatically than it has.  It seems to be on the verge of flattening out. 

So there are a number of areas where we′re not seeing the types of reductions that we saw in the 1990s. 

HUNTER:  Next question, please.

OPERATOR:  Thank you.  Our next question comes from Judith Graham (ph), the Chicago Tribune, please go ahead. 

GRAHAM (ph):  Actually this is – you were just speaking about the subject that I was interested in which is are there any notable changes between the last survey and this one that you would like to call to my attention? 

I think, given what you just said, I would like to add to that, in addition to sexual behaviors and tobacco use, you said you′re not seeing the reductions that you saw in the 1990s.  What other areas would you like to highlight?

WECHSLER:  Well, some of the violence areas.  You′ll see that, for instance, the percentage of students that carried a weapon has not changed since 1999 and that′s the case in other areas.  Physical education participation.  That′s somewhat of the reverse in that it went down dramatically in the early part of the 1990s and it′s pretty much stayed flat every since.  There′s been a lot of concerned focus on obesity and yet we′re not seeing increases yet in the percentage of high school students who are getting daily physical education.  That′s a great concern for us.

HUNTER:  Thank you.  Next question.

OPERATOR:  Thank you.  We have a follow up question from Mike Stobbe, Associated Press, please go ahead.

STOBBE:  Hi.  Thanks, again.  Do you have any data on the student′s parents′ income or educational level?  And if you don′t can you speak to that, was that – was that an explanation that was as great, more great, less great, than the rates of the students?

WECHSLER:  Yes, unfortunately this is a student survey and we simply have not find a credible scientific way to ask students questions that would enable us to identify their parents socio-economic status. So no, we don′t have the answer to that.

There are other smaller scale studies that are not done on a national basis that perhaps Dr. Flores could refer to.

FLORES:  Yes, well, there are actually other larger national databases like the National Survey of Children′s Health didn′t specifically look adolescent risk behaviors but has found numerous disparities in health status, use of health services, access to care, after you adjust for, as you pointed out the important variables of parental education, family income.  We′ve also adjusted for number of children in the family and language issues. And you do see disparities whether you′re talking about being in poor or fair health or having health insurance or having seen a doctor or a dentist in the past year, having a regular healthcare provider.  We actually see persistent disparities.  There′s a number of data sets when you adjust for these factors in terms of referral to specialist, to specialist physicians.  And it′s particularly concerning because if you have a higher proportion of minority kids who have fair or poor health but they′re also getting a lower proportion of referrals to needed care, then that shows a big inequity.

So when one is able to adjust for those factors you see many, many disparities.  In fact, right now, I′m at the American Academy of Pediatrics about to review a technical report that we′re doing where we′ve reviewed over 100 articles on this.  And we do see consistent disparities across the board even with the number of adolescent health issues.

KAREN HUNTER:  Thank you.  Next question.

OPERATOR:  Thank you.  Our final question is a follow up from Sharon Jayson, USA Today, please go ahead.

JAYSON:  Hi, thanks, again.  I just wanted to follow up on this issue of whether or not the Hispanics were overall in most areas at greater risk?  Or whether it was just really these sexual behaviors?  I was trying to determine whether we′re seeing say, blacks also having greater risk in a lot of these areas?  Or whether it is really just a Hispanic issue?

WECHSLER:  In terms of the sexual risk behaviors, the data clearly illustrate that black students are at greater risk for most of the sexual risk behaviors, although they also are the group that′s most likely to use a condom. So they do engage in some of the protective factors on a greater level.  But in terms of ever having sex and sex with multiple partners and sex before the age of 13, it is the African American students who are at the highest risk.

However, what we wanted to highlight was that we′ve made substantial progress in these areas with the African American students over the past few decades or so.  And we have not seen that progress even – they were, of course, starting at a much lower level than Hispanic students.  But it′s troubling that we′re not seeing progress for them as we are with the others.

FLORES:  And I′d like to highlight that when you are looking for disparities that were significantly different for Latinos that you see it sort of across the board, unfortunately, for drug use.  We mentioned lifetime cocaine, ecstasy and heroine use and illegal injection drug use.  And then we also discuss feeling sad or hopeless and having a suicide plan actually attempting suicide and a suicide attempt that resulted in injury, poisoning or overdose that needed a treatment by a doctor or nurse.

So there are some particularly stark disparities.  And again, also Dr. Wechsler pointed out that there are number that have persisted over the last 16 years.  So, you know, it′s one thing to have severe disparity but for it to persist for so long, I think, is cause for extra attention.

WECHSLER:  I do want to point out we have a fact sheet that′s on our Web site entitled health risk behaviors by race/ethnicity and that lays out very, very clearly which areas, which groups are at greater or lesser risk.

HUNTER:  OK, thank you.  That′s going to conclude the 2007 National YRBS survey – YRBS telebriefing.  Anyone who has follow up questions or needs assistance in accessing the information on the Web site, can call CDC′s main press office, at 404-639-3286.  And thanks for joining us this afternoon.

OPERATOR:  Thank you.  This does conclude today′s conference call.  We thank you for your participation.  And you may now disconnect your lines.

END

####

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

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