Laura Kann, Ph.D. (1) Steven A. Kinchen (1) Barbara I. Williams, Ph.D. (2) James G. Ross, M.S. (3) Richard Lowry, M.D., M.S. (1) Carl V. Hill, M.P.H. (1) Jo Anne Grunbaum, Ed.D. (1) Pamela S. Blumson, M.S.N. (1) Janet L. Collins, Ph.D. (1) Lloyd J. Kolbe, Ph.D. (1) State and Local YRBSS Coordinators

1 Division of Adolescent and School Health, National Center for

Chronic Disease Prevention and Health Promotion, CDC 2 Westat Incorporated, Rockville, Maryland 3 Macro International, Calverton, Maryland

Abstract

Problem/Condition: Priority health-risk behaviors, which contribute to the leading causes of mortality and morbidity among youth and adults, often are established during youth, extend into adulthood, and are interrelated.

Reporting Period: February-May 1997.

Description of the System: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults -- behaviors that contribute to unintentional and intentional injuries; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs) (including human immunodeficiency virus {HIV} infection); unhealthy dietary behaviors; and physical inactivity. The YRBSS includes a national school-based survey conducted by CDC as well as state, territorial, and local school-based surveys conducted by education and health agencies. This report summarizes results from the national survey, 33 state surveys, 3 territorial surveys, and 17 local surveys conducted among high school students from February through May 1997.

Results and Interpretation: In the United States, 73% of all deaths among youth and young adults 10-24 years of age result from only four causes: motor vehicle crashes, other unintentional injuries, homicide, and suicide. Results from the national 1997 YRBSS demonstrate that many high school students engage in behaviors that increase their likelihood of death from these four causes -- 19.3% had rarely or never worn a seat belt; during the 30 days preceding the survey, 36.6% had ridden with a driver who had been drinking alcohol; 18.3% had carried a weapon during the 30 days preceding the survey; 50.8% had drunk alcohol during the 30 days preceding the survey; 26.2% had used marijuana during the 30 days preceding the survey; and 7.7% had attempted suicide during the 12 months preceding the survey. Substantial morbidity among school-age youth, young adults, and their children also result from unintended pregnancies and STDs, including HIV infection. YRBSS results indicate that in 1997, 48.4% of high school students had ever had sexual intercourse; 43.2% of sexually active students had not used a condom at last sexual intercourse; and 2.1% had ever injected an illegal drug. Of all deaths and substantial morbidity among adults greater than or equal to 25 years of age, 67% result from two causes -- cardiovascular disease and cancer. Most of the risk behaviors associated with these causes of death are initiated during adolescence. In 1997, 36.4% of high school students had smoked cigarettes during the 30 days preceding the survey; 70.7% had not eaten five or more servings of fruits and vegetables during the day preceding the survey; and 72.6% had not attended physical education class daily.

Actions Taken: These YRBSS data are already being used by health and education officials to improve national, state, and local policies and programs to reduce risks associated with the leading causes of morbidity and mortality. YRBSS data also are being used to measure progress toward achieving 21 national health objectives and 1 of the 8 National Education Goals.

INTRODUCTION

In the United States, 73% of all deaths among youth and young adults 10-24 years of age result from only four causes -- motor vehicle crashes (30%), other unintentional injuries (10%), homicide (20%), and suicide (13%) (1). Substantial morbidity and social problems also result from the approximately 1 million pregnancies that occur each year among adolescents (2) as well as the estimated 3 million cases of sexually transmitted diseases (STDs) that occur each year among the same age group (3). In the United States, 67% of all deaths and substantial morbidity among adults greater than or equal to 25 years of age result from two causes -- cardiovascular disease (43%) and cancer (24%) (1). Therefore, six categories of behaviors contribute to the leading causes of morbidity and mortality in the United States -- behaviors that contribute to unintentional and intentional injuries; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and STDs (including human immunodeficiency virus {HIV} infection); unhealthy dietary behaviors; and physical inactivity. These behaviors, which frequently are interrelated, often are established during youth and extend into adulthood.

To monitor the priority health-risk behaviors in each of these categories among youth and young adults, CDC developed the Youth Risk Behavior Surveillance System (YRBSS) (4). The YRBSS includes national, state, territorial, and local school-based surveys of high school students. National surveys were conducted in 1990, 1991, 1993, 1995, and 1997. * Comparable state and local surveys were first conducted in 1990, when 23 states and 9 large cities participated. In 1991, 26 states, 2 territories, and 11 large cities conducted surveys; in 1993, 40 states, 2 territories, and 14 large cities; in 1995, 40 states, 4 territories, and 17 large cities; and in 1997, 38 states, 4 territories, and 17 large cities conducted surveys. This report summarizes the results from the 1997 national school-based survey and trends from 1991 through 1997 in selected risk behaviors. Data from 33 state, 3 territorial, and 17 local school-based surveys conducted during 1997 also are included. Data from 1 territorial and 5 state surveys conducted during 1997 were not included in this report because of their low overall response rate.

METHODS

Sampling

The 1997 national school-based survey employed a three-stage cluster sample design to produce a nationally representative sample of students in grades 9-12. The first-stage sampling frame contained 1,719 primary sampling units (PSUs), consisting of large counties or groups of smaller, adjacent counties. From the 1,719 PSUs, 54 were selected from 16 strata formed on the basis of the degree of urbanization and the relative percentage of black and Hispanic students in the PSU. The PSUs were selected with probability proportional to school enrollment size. At the second sampling stage, 191 schools were selected with probability proportional to school enrollment size. To enable separate analysis of data for black ** and Hispanic students, schools with substantial numbers of black and Hispanic students were sampled at higher rates than all other schools. The third stage of sampling consisted of randomly selecting one or two intact classes of a required subject (e.g., English or social studies) from grades 9-12 at each chosen school. All students in the selected classes were eligible to participate in the survey.

A weighting factor was applied to each student record to adjust for nonresponse and for the varying probabilities of selection, including those resulting from the oversampling of black and Hispanic students. Numbers of students in other racial/ethnic groups were too low for meaningful analysis in this report. The weights were scaled so that a) the weighted count of students was equal to the total sample size and b) the weighted proportions of students in each grade matched national population proportions. SUDAAN *** was used to compute 95% confidence intervals, which were used to determine differences between subgroups at the p less than 0.05 level (5). Differences between prevalence estimates were considered statistically significant if the 95% confidence intervals did not overlap. The national data are representative of students in grades 9-12 in public and private schools in the 50 states and the District of Columbia.

The 1997 state, territorial, and local school-based surveys employed a two-stage cluster sample design to produce representative samples of students in grades 9-12 in their jurisdictions. In most states, territories, and cities, the first-stage sampling frame consisted of all public schools containing any of grades 9-12. Schools were selected with probability proportional to school enrollment size. At the second sampling stage, intact classes of a required subject or a required period (e.g., second period) were randomly selected. All students in the selected classes were eligible to participate in the survey. Some states, territories, and large cities modified these procedures to meet their individual needs. For example, either classes were selected as the first stage of sampling, or all schools -- rather than a sample of schools -- were selected to participate.

For the surveys from 24 states, 3 territories, and 15 large cities, each with an overall response rate of at least 60% and appropriate documentation, the data were weighted (Table_1). Weighted data from most of these states and cities can be generalized to all public-school students in grades 9-12 in the respective jurisdiction. For the surveys that did not have an overall response rate of at least 60% and appropriate documentation, the data were not weighted. The unweighted data from nine states and two large cities apply only to the students participating in the survey. The California survey excludes students from the Los Angeles Unified School District.

For the national survey, 16,262 questionnaires were completed in 151 schools. The school response rate was 79%, and the student response rate was 87%, resulting in an overall response rate of 69% (Table_1). For the state, territorial, and local surveys, sample sizes ranged from 334 to 6,964. School response rates ranged from 49% to 100%; student response rates ranged from 60% to 97%; and overall response rates ranged from 44% to 89%. In the national, state, territorial, and local surveys, students were evenly distributed across grades and between sexes.

Incidence rates for two variables were calculated to provide data for monitoring relevant year 2000 national health objectives (6). For weapon carrying, students who reported that they had carried a weapon 2-3 days during the 30 days preceding the survey were assigned a weapon-carrying frequency of 2.5; 4-5 days, 4.5; and greater than or equal to 6 days, 6.0. For physical fighting, students who reported having fought 2 or 3 times during the 12 months preceding the survey were assigned a fighting frequency of 2.5; 4-5 times, 4.5; 6-7 times, 6.5; 8-9 times, 8.5; 10-11 times, 10.5; and greater than or equal to 12 times, 12.0.

The findings in this report are subject to at least two limitations. First, these data apply only to youth who attend high school and, therefore, are not representative of all persons in this age group. Second, these data apply only to youth who were in school on the day of survey administration.

Data Collection

Survey procedures were designed to protect the students' privacy by allowing for anonymous and voluntary participation. The students completed the self-administered questionnaire in their classrooms during a regular class period, recording their responses directly on a computer-scannable booklet or answer sheet. The core questionnaire contained 84 multiple-choice questions. State, territorial, and local education agencies added or deleted items to meet individual needs. Local parental permission procedures were followed before survey administration.

RESULTS

Behaviors That Contribute to Unintentional Injuries

Seat Belt Use

Nationwide, 19.3% of students had rarely or never worn seat belts when riding in a car or truck driven by someone else (Table_2). Overall, male students (23.2%) were significantly more likely than female students (14.5%) to have rarely or never worn seat belts. White **** male students (22.0%) were significantly more likely than white female students (10.8%) to have rarely or never worn seat belts, and male students in grades 9 and 12 (25.9% and 24.5%, respectively) were significantly more likely than female students in the same grades (16.0% and 13.5%, respectively) to have rarely or never worn seat belts. Overall, black students (31.3%) were significantly more likely than white students (17.1%) to have rarely or never worn seat belts. Black female students (28.3%) were significantly more likely than Hispanic and white female students (17.0% and 10.8%, respectively) to have rarely or never worn seat belts, and black male students (34.4%) were significantly more likely than white male students (22.0%) to have rarely or never worn seat belts. The prevalence rates across the state ***** surveys varied sixfold from 6.1% to 36.5% (median: 23.3%) (Table_3). Across the local surveys, the prevalence rates varied sixfold from 7.3% to 45.1% (median: 31.1%).

Motorcycle Helmet Use

Nationwide, 21.0% of students had ridden a motorcycle during the 12 months preceding the survey. Of these students, 36.2% rarely or never wore a motorcycle helmet (Table_2). Overall, Hispanic students (54.7%) were significantly more likely than white students (34.2%) to have rarely or never worn a motorcycle helmet. Prevalence rates of rarely or never wearing a motorcycle helmet varied across the state surveys threefold from 23.6% to 72.9% (median: 40.0%) (Table_3). Across the local surveys, prevalence rates ranged from 30.2% to 73.1% (median: 42.0%).

Bicycle Helmet Use

Nationwide, 75.4% of students had ridden a bicycle during the 12 months preceding the survey. Of these students, 88.4% had rarely or never worn a bicycle helmet (Table_2). Overall, black students (95.8%) were significantly more likely than white students (87.1%) to have rarely or never worn a bicycle helmet. Black male students (96.1%) were significantly more likely than white male students (86.9%) to have rarely or never worn a bicycle helmet. The prevalence rates of rarely or never wearing a bicycle helmet ranged from 63.9% to 97.7% (median: 92.2%) across the state surveys and from 75.6% to 96.6% (median: 94.1%) across the local surveys (Table_3).

Riding with a Driver Who Had Been Drinking Alcohol

During the 30 days preceding the survey, more than one third (36.6%) of students nationwide had ridden one or more times with a driver who had been drinking alcohol (Table_2). Male students in grade 10 (35.6%) were significantly more likely than female students in grade 10 (28.2%) to have ridden with a driver who had been drinking alcohol. Overall, Hispanic students (42.8%) were significantly more likely than black students (33.5%) to have ridden with a driver who had been drinking alcohol. Hispanic female students (40.6%) were significantly more likely than black female students (29.8%) to report this behavior. Female students in grade 12 (39.1%) were significantly more likely than female students in grade 10 (28.2%) to have ridden with a driver who had been drinking alcohol. Male students in grade 11 (42.9%) were significantly more likely than male students in grade 9 (31.8%) to report this behavior. Prevalence rates across the state surveys ranged from 19.4% to 52.5% (median: 36.0%) and across the local surveys from 20.7% to 43.1% (median: 32.1%) (Table_3).

Driving After Drinking Alcohol

During the 30 days preceding the survey, 16.9% of students nationwide had driven a vehicle one or more times after drinking alcohol (Table_2). Overall, male students (21.0%) were significantly more likely than female students (12.0%) to have driven after drinking alcohol. This significant difference was identified for all racial/ethnic subgroups and for students in grades 10 and 11. Overall, white and Hispanic students (18.9% and 18.1%, respectively) were significantly more likely than black students (9.4%) to have driven after drinking alcohol. This significant difference was identified for both female and male students. Female students in grade 12 (18.8%) were significantly more likely than female students in grades 9 and 10 (7.5% and 7.5%, respectively) to report this behavior. Male students in grades 11 and 12 (25.1% and 30.4%, respectively) were significantly more likely than male students in grades 9 and 10 (11.7% and 14.8%, respectively) to have driven after drinking alcohol. Prevalence rates across the state surveys varied sevenfold from 4.6% to 33.2% (median: 15.1%) (Table_3). Prevalence rates across the local surveys varied nearly threefold from 4.6% to 13.7% (median: 8.5%).

Behaviors That Contribute to Intentional Injuries

Carrying a Weapon

Almost one fifth (18.3%) of students nationwide had carried a weapon (e.g., a gun, knife, or club) on greater than or equal to 1 of the 30 days preceding the survey (Table_4). Overall, male students (27.7%) were significantly more likely than female students (7.0%) to have carried a weapon. This significant difference was identified for all racial/ethnic and grade subgroups. Overall, Hispanic students (23.3%) were significantly more likely than white students (17.0%) to have carried a weapon. Black female students (14.7%) were significantly more likely than white female students (4.4%) to report this behavior. Female students in grade 9 (10.9%) were significantly more likely than female students in grades 11 and 12 (5.7% and 5.3%, respectively) to have carried a weapon, and male students in grade 9 (33.2%) were significantly more likely than male students in grade 12 (23.3%) to have done so. State prevalence rates ranged from 14.1% to 27.5% (median: 20.3%), and local prevalence rates ranged from 14.2% to 31.8% (median: 20.7%) (Table_5).

Nationwide, 5.9% of students had carried a gun on greater than or equal to 1 of the 30 days preceding the survey (Table_4). Overall, male students (9.6%) were significantly more likely than female students (1.5%) to have carried a gun. This significant difference was identified for all racial/ethnic and grade subgroups. Overall, Hispanic and black students (10.1% and 9.2%, respectively) were significantly more likely than white students (4.4%) to have carried a gun. Black male and female students (16.3% and 2.5%, respectively) and Hispanic male students (16.9%) were significantly more likely than white male and female students (7.2% and 0.8%, respectively) to report this behavior. State prevalence rates ranged from 4.1% to 11.4% (median: 6.8%), and local prevalence rates ranged from 3.3% to 10.6% (median: 7.0%) (Table_5).

An estimated 74.2 separate incidents of weapon carrying had occurred per 100 students on greater than or equal to 1 days during the 30 days preceding the survey (Table_4). Overall, the weapon-carrying incident rate was significantly higher for male students (115.5 per 100 students) than for female students (25.0 per 100 students). This significant difference was identified for all racial/ethnic and grade subgroups. The weapon-carrying incident rate was significantly higher for black and Hispanic female students (51.0 and 32.5 per 100 students, respectively) than for white female students (14.9 per 100 students). State incidence rates ranged from 47.8 per 100 students to 123.3 per 100 students (median: 82.1 per 100 students), and local incidence rates ranged from 53.1 per 100 students to 133.5 per 100 students (median: 77.6 per 100 students) (Table_5).

Physical Fighting

Among students nationwide, 36.6% had been in a physical fight one or more times during the 12 months preceding the survey (Table_6). Overall, male students (45.5%) were significantly more likely than female students (26.0%) to have been in a physical fight. This significant difference was identified for all racial/ethnic and grade subgroups. Overall, black and Hispanic students (43.0% and 40.7%, respectively) were significantly more likely than white students (33.7%) to have been in a physical fight. Black and Hispanic female students (37.7% and 30.3%, respectively) were significantly more likely than white female students (21.4%) to report this behavior. Male and female students in grade 9 (56.0% and 32.4%, respectively) were significantly more likely than male students in grades 11 and 12 (43.5% and 36.6%, respectively) and female students in grade 12 (18.9%) to have been in a physical fight. Male and female students in grade 10 (48.2% and 30.4%, respectively) were significantly more likely than male and female students in grade 12 (36.6% and 18.9%, respectively) to report this behavior. Across the state surveys, the prevalence rates ranged from 27.6% to 50.4% (median: 33.3%) (Table_7). Across the local surveys, the prevalence rates ranged from 26.6% to 48.8% (median: 39.4%).

Nationwide, 3.5% of students had been treated by a doctor or nurse for injuries sustained in a physical fight during the 12 months preceding the survey (Table_6). Overall, male students (4.6%) were significantly more likely than female students (2.2%) to have been injured in a physical fight. This significant difference was identified for white and Hispanic students and for students in grades 9, 11, and 12. Overall, black and Hispanic students (5.7% and 4.3%, respectively) were significantly more likely than white students (2.5%) to have been injured in a physical fight. Black female students (4.4%) were significantly more likely than white female students (1.2%) to have been injured in a physical fight, and black and Hispanic male students (7.1% and 6.2%, respectively) were significantly more likely than white male students (3.4%) to report this behavior. Across the state surveys, the prevalence rates of injurious physical fighting ranged from 2.4% to 8.9% (median: 3.6%) (Table_7). Across the local surveys, the prevalence rates ranged from 2.9% to 8.7% (median: 5.0%).

Nationwide, an estimated 115.1 incidents of physical fighting had occurred per 100 students on greater than or equal to 1 days during the 12 months preceding the survey (Table_6). Overall, male students (153.1 per 100 students) were significantly more likely than female students (69.4 per 100 students) to have been in a physical fight. This significant difference was identified for all racial/ethnic and grade subgroups. Incidence rates were significantly higher for female students in grades 9 and 10 (103.1 and 81.6 per 100 students, respectively) than for female students in grade 12 (40.6 per 100 students). Incidence rates were significantly higher for male students in grade 9 (200.2 per 100 students) than for male students in grade 11 (126.1 per 100 students). State incidence rates ranged from 89.8 per 100 students to 213.0 per 100 students (median: 108.9 per 100 students), and local incidence rates ranged from 90.1 to 157.5 (median: 126.5) (Table_7).

School-Related Violence

Nationwide, 4.0% of students had missed greater than or equal to 1 days of school during the 30 days preceding the survey because they had felt unsafe at school or when traveling to or from school (Table_8). Overall, Hispanic and black students (7.2% and 6.8%, respectively) were significantly more likely than white students (2.4%) to have felt unsafe. Hispanic and black male (6.8% and 7.5%, respectively) and female (7.7% and 6.1%, respectively) students were significantly more likely than white male and female students (2.3% and 2.5%, respectively) to have missed school because they felt unsafe. Male and female students in grade 9 (5.2% and 5.8%, respectively) were significantly more likely than male and female students in grade 12 (2.3% and 3.0%, respectively) to have missed school for this reason. A nearly fivefold difference was observed in prevalence rates across the state surveys, which ranged from 2.7% to 13.1% (median: 4.8%) (Table_9). The prevalence rates across the local surveys ranged from 5.7% to 13.9% (median: 9.0%).

The prevalence of weapon carrying on school property on greater than or equal to 1 of the 30 days preceding the survey was 8.5% nationwide (Table_8). Overall, male students (12.5%) were significantly more likely than female students (3.7%) to have carried a weapon on school property. This significant difference was identified for white and Hispanic students and all grade subgroups. Black female students (7.8%) were significantly more likely than Hispanic and white female students (4.3% and 2.1%, respectively) to have carried a weapon on school property. State prevalence rates varied nearly threefold from 5.4% to 15.2% (median: 8.5%), and local prevalence rates varied nearly threefold from 5.8% to 16.5% (median: 9.3%) (Table_9).

Nationwide, the prevalence of students who had been threatened or injured with a weapon on school property one or more times during the 12 months preceding the survey was 7.4%. Overall, male students (10.2%) were significantly more likely than female students (4.0%) to have been threatened or injured with a weapon on school property. This significant difference was identified for all racial/ethnic subgroups and students in grades 9, 11, and 12. Overall, black and Hispanic students (9.9% and 9.0%, respectively) were significantly more likely than white students (6.2%) to have been threatened or injured with a weapon on school property. Black and Hispanic male students (14.0% and 12.7%, respectively) were significantly more likely than white male students (8.2%) to have experienced this. Female students in grade 9 (6.1%) were significantly more likely than female students in grades 11 and 12 (2.3% and 2.5%, respectively) to have been threatened or injured with a weapon on school property, and female students in grade 10 (5.2%) were significantly more likely than female students in grade 12 (2.5%) to have experienced this. Across the state surveys, prevalence rates ranged from 5.2% to 9.6% (median: 7.5%) (Table_9). Across the local surveys, prevalence rates ranged from 7.5% to 13.3% (median: 9.4%).

Nationwide, 14.8% of students had been in a physical fight on school property one or more times during the 12 months preceding the survey (Table_8). Overall, male students (20.0%) were significantly more likely than female students (8.6%) to have been in a physical fight on school property. This significant difference was identified for white and Hispanic students and all grade subgroups. Overall, black and Hispanic students (20.7% and 19.0%, respectively) were significantly more likely than white students (13.3%) to have been in a physical fight on school property. Black and Hispanic female students (17.0% and 12.3%, respectively) were significantly more likely than white female students (5.9%) to report this behavior. Female students in grades 9 and 10 (12.4% and 11.3%, respectively) were significantly more likely than female students in grade 12 (4.9%) to have been in a physical fight on school property, and female students in grade 9 (12.4%) were significantly more likely than female students in grade 11 (6.2%) to report this behavior. Male students in grades 9 and 10 (29.3% and 21.6%, respectively) were significantly more likely than male students in grade 12 (13.1%) to have been in a physical fight on school property, and male students in grade 9 (29.3%) were significantly more likely than male students in grade 11 (17.8%) to report this behavior. Across the state surveys, prevalence rates ranged from 11.3% to 33.6% (median: 13.5%) (Table_9). Across the local surveys, prevalence rates ranged from 11.2% to 26.7% (median: 16.3%).

Approximately one third (32.9%) of students nationwide had had property (e.g., a car, clothing, or books) stolen or deliberately damaged on school property one or more times during the 12 months preceding the survey (Table_8). Overall, male students (36.1%) were significantly more likely than female students (29.0%) to have had property stolen or damaged on school property. This significant difference was identified for students in grade 10. Male students in grades 9 and 10 (39.8% and 39.7%, respectively) were significantly more likely than male students in grade 12 (30.0%) to have experienced this. State prevalence rates ranged from 25.3% to 50.2% (median: 31.7%), and local prevalence rates ranged from 23.6% to 41.4% (median: 33.7%) (Table_9).

Suicide Ideation and Attempts

Nationwide, 20.5% of students had seriously considered attempting suicide during the 12 months preceding the survey (Table_10). Overall, female students (27.1%) were significantly more likely than male students (15.1%) to have considered attempting suicide. This significant difference was identified for all racial/ethnic and grade subgroups. Overall, Hispanic students (23.1%) were significantly more likely than black students (16.4%) to have considered attempting suicide. This significant difference was identified for both male and female students. Prevalence rates ranged from 16.3% to 29.7% (median: 22.9%) across the state surveys and from 15.5% to 23.2% (median: 18.3%) across the local surveys (Table_11).

More serious suicide ideation was observed among the 15.7% of students nationwide who, during the 12 months preceding the survey, had made a specific plan to attempt suicide (Table_10). Overall, female students (20.0%) were significantly more likely than male students (12.2%) to have made a suicide plan. This significant difference was identified for all racial/ethnic subgroups and for students in grades 10 and 11. Overall, Hispanic students (19.6%) were significantly more likely than white and black students (14.3% and 12.5%, respectively) to have made a suicide plan. Hispanic female students (23.9%) were significantly more likely than black female students (16.0%) to have made a suicide plan. Hispanic male students (16.0%) were significantly more likely than white and black male students (11.0% and 8.8%, respectively) to report this behavior. Female students in grade 10 (24.2%) were significantly more likely than female students in grade 12 (15.3%) to have made a suicide plan. Prevalence rates across the state surveys ranged from 14.0% to 28.6% (median: 17.6%) (Table_11). Prevalence rates across the local surveys ranged from 11.0% to 21.1% (median: 14.4%).

Nationwide, 7.7% of students had attempted suicide one or more times during the 12 months preceding the survey (Table_10). Overall, female students (11.6%) were significantly more likely than male students (4.5%) to have attempted suicide. This significant difference was identified for white and Hispanic students and students in grades 9-11. Overall, Hispanic students (10.7%) were significantly more likely than white students (6.3%) to have attempted suicide. Hispanic male students (7.2%) were significantly more likely than white male students (3.2%) to report this behavior. Female students in grades 9 and 10 (15.1% and 14.3%, respectively) were significantly more likely than female students in grade 12 (6.2%) to have attempted suicide. The percentage of students attempting suicide ranged from 7.8% to 22.0% (median: 9.1%) across the state surveys and from 7.5% to 12.6% (median: 10.2%) across the local surveys (Table_11).

Nationwide, 2.6% of students reported having made a suicide attempt during the 12 months preceding the survey that resulted in an injury, poisoning, or overdose that had been treated by a doctor or nurse (Table_10). Female students in grade 9 (5.0%) were significantly more likely than female students in grade 12 (2.0%) to have made a suicide attempt that required medical attention. The prevalence of injurious suicide attempts varied sixfold from 1.3% to 7.8% (median: 3.0%) across the state surveys and varied nearly twofold from 2.5% to 4.6% (median: 3.4%) across the local surveys (Table_11).

Tobacco Use

Cigarette Use

Nationwide, 70.2% of students had ever tried cigarette smoking (even one or two puffs) (Table_12). Hispanic male students (76.9%) were significantly more likely than white male students (70.4%) to have ever tried cigarette smoking. State prevalence rates ranged from 38.1% to 79.1% (median: 72.0%), and local prevalence rates ranged from 59.2% to 71.4% (median: 68.2%) (Table_13).

More than one third of students (36.4%) nationwide had smoked cigarettes on greater than or equal to 1 of the 30 days preceding the survey (i.e., current cigarette use) (Table_12). Black male students (28.2%) were significantly more likely than black female students (17.4%) to report current cigarette use. Overall, white students (39.7%) were significantly more likely than Hispanic and black students (34.0% and 22.7%, respectively) to report current cigarette use, and Hispanic students (34.0%) were significantly more likely than black students (22.7%) to report this behavior. White female students (39.9%) were significantly more likely than Hispanic and black female students (32.3% and 17.4%, respectively) to report current cigarette use, and Hispanic female students (32.3%) were significantly more likely than black female students (17.4%) to do so. White male students (39.6%) were significantly more likely than black male students (28.2%) to report current cigarette use. Across the state surveys, prevalence rates varied more than sevenfold from 6.3% to 47.0% (median: 36.5%) (Table_13). Across the local surveys, prevalence rates ranged from 19.0% to 29.4% (median: 24.2%).

Nationwide, 16.7% of students had smoked cigarettes on greater than or equal to 20 of the 30 days preceding the survey (i.e., frequent cigarette use) (Table_12). Black male students (10.1%) were significantly more likely than black female students (4.3%) to report frequent cigarette use. Overall, white students (19.9%) were significantly more likely than Hispanic and black students (10.9% and 7.1%, respectively) to have done so. White female students (20.1%) were significantly more likely than Hispanic and black female students (8.1% and 4.3%, respectively) to report frequent cigarette use, and white male students (19.8%) were significantly more likely than black male students (10.1%) to report this behavior. Female students in grade 12 (19.0%) were significantly more likely than female students in grade 9 (11.6%) to report frequent cigarette use. State prevalence rates ranged from 0.3% to 27.6% (median: 19.1%), and local prevalence rates ranged from 5.8% to 13.7% (median: 7.9%) (Table_13).

Smokeless Tobacco Use

Nationwide, 9.3% of students had used smokeless tobacco (chewing tobacco or snuff) on greater than or equal to 1 of the 30 days preceding the survey (Table_12). Overall, male students (15.8%) were significantly more likely than female students (1.5%) to have used smokeless tobacco. This significant difference was identified for white and Hispanic students and for all grade subgroups. Overall, white students (12.2%) were significantly more likely than Hispanic and black students (5.1% and 2.2%, respectively) to have used smokeless tobacco. White male students (20.6%) were significantly more likely than Hispanic and black male students (8.3% and 3.2%, respectively) to have used smokeless tobacco, and Hispanic male students (8.3%) were significantly more likely than black male students (3.2%) to report this behavior. State prevalence rates ranged from 0.5% to 22.5% (median: 7.9%), and local prevalence rates ranged from 0.9% to 4.6% (median: 2.4%) (Table_13).

Access to Cigarettes

Data about access to cigarettes are reported only for those students less than 18 years of age who reported current cigarette use. Nationwide, 29.8% of these students had purchased their cigarettes in a store or gas station during the 30 days preceding the survey (Table_14). Male students in grade 9 (23.7%) were significantly more likely than female students in grade 9 (10.8%) to have purchased cigarettes in a store or gas station. For both male and female students, the percentage of students who purchased cigarettes in a store or gas station significantly increased as grade level increased. State prevalence rates varied more than threefold from 10.5% to 36.6% (median: 22.6%), and local prevalence rates varied nearly threefold from 17.6% to 51.4% (median: 30.0%) (Table_15).

Nationwide, 66.7% of students who purchased cigarettes in a store or gas station had not been asked to show proof of age (Table_14). Male students in grade 9 who purchased cigarettes in a store or gas station (83.0%) were significantly more likely than male students in grades 11 and 12 (54.6% and 50.8%, respectively) not to have been asked to show proof of age. State prevalence rates ranged from 52.4% to 76.3% (median: 63.7%), and local prevalence rates ranged from 55.1% to 80.4% (median: 67.6%) (Table_15).

Alcohol and Other Drug Use

Alcohol Use

Nationwide, 79.1% of students had had at least one drink of alcohol during their lifetime (Table_16). Overall, Hispanic and white students (83.1% and 81.3%, respectively) were significantly more likely than black students (73.0%) to have had at least one drink of alcohol during their lifetime. Hispanic female students (82.1%) were significantly more likely than black female students (73.8%) to have had at least one drink of alcohol, and Hispanic and white male students (83.9% and 82.4%, respectively) were significantly more likely than black male students (72.2%) to report this behavior. Female students in grade 12 (82.3%) were significantly more likely than female students in grade 9 (73.6%) to have had at least one drink of alcohol. Male students in grade 12 (85.3%) were significantly more likely than male students in grades 9 and 10 (70.5% and 77.9%, respectively) to have had at least one drink of alcohol, and male students in grade 11 (83.4%) were significantly more likely than male students in grade 9 (70.5%) to have done so. The prevalence of lifetime alcohol use across the state surveys ranged from 41.3% to 84.3% (median: 78.2%) (Table_17). The prevalence rates across the local surveys ranged from 59.2% to 78.2% (median: 72.5%).

Nationwide, half (50.8%) of all students had had at least one drink of alcohol on greater than or equal to 1 of the 30 days preceding the survey (i.e., current alcohol use) (Table_16). Male students in grade 11 (57.8%) were significantly more likely than female students in grade 11 (47.8%) to report current alcohol use. Overall, white and Hispanic students (54.0% and 53.9%, respectively) were significantly more likely than black students (36.9%) to report current alcohol use. This significant difference was identified for both male and female students. Male students in grades 11 and 12 (57.8% and 60.2%, respectively) were significantly more likely than male students in grades 9 and 10 (44.7% and 48.7%, respectively) to report this behavior. State prevalence rates ranged from 24.3% to 61.1% (median: 50.5%), and local prevalence rates ranged from 27.5% to 48.7% (median: 40.0%) (Table_17).

One third (33.4%) of all students nationwide had had five or more drinks of alcohol on greater than or equal to 1 occasions during the 30 days preceding the survey (i.e., episodic heavy drinking) (Table_16). Overall, male students (37.3%) were significantly more likely than female students (28.6%) to report episodic heavy drinking. This significant difference was identified for all racial/ethnic subgroups and for grade 11. Overall, white and Hispanic students (37.7% and 34.9%, respectively) were significantly more likely than black students (16.1%) to report episodic heavy drinking. This significant difference was identified for both male and female students. Male students in grades 11 and 12 (45.2% and 44.0%, respectively) were significantly more likely than male students in grades 9 and 10 (25.5% and 32.7%, respectively) to report this behavior. Prevalence rates across the state surveys varied more than fourfold from 10.7% to 45.2% (median: 31.2%) and across the local surveys from 12.6% to 27.1% (median: 19.8%) (Table_17).

Marijuana Use

Nationwide, 47.1% of students had used marijuana during their lifetime (Table_16). Overall, male students (50.7%) were significantly more likely than female students (42.9%) to have ever used marijuana. This significant difference was identified for black students and students in grade 11. Black male students (59.3%) were significantly more likely than white male students (48.3%) to have ever used marijuana. Male students in grades 11 and 12 (55.6% and 56.1%, respectively) were significantly more likely than male students in grade 9 (41.3%) to report this behavior. Lifetime marijuana use varied twofold from 24.8% to 51.9% (median: 45.3%) across the state surveys and ranged from 31.2% to 51.5% (median: 44.7%) across the local surveys (Table_17).

One fourth (26.2%) of all students had used marijuana one or more times during the 30 days preceding the survey (i.e., current marijuana use) (Table_16). Overall, male students (30.2%) were significantly more likely than female students (21.4%) to report current marijuana use. This significant difference was identified for all racial/ethnic subgroups and for grade 11. Current marijuana use varied nearly threefold from 12.3% to 35.3% (median: 25.3%) across the state surveys and ranged from 15.7% to 29.3% (median: 23.6%) across the local surveys (Table_17).

Cocaine Use

Nationwide, 8.2% of students had used some form of cocaine (e.g., powder, "crack," ****** or "freebase" *******) during their lifetime (Table_18). Overall, Hispanic students (14.4%) were significantly more likely than white and black students (8.0% and 1.9%, respectively) to have ever used cocaine, and white students (8.0%) were significantly more likely than black students (1.9%) to have done so. Hispanic and white female students (12.5% and 7.5%, respectively) were significantly more likely than black female students (1.0%) to have ever used cocaine. Hispanic male students (16.1%) were significantly more likely than white and black male students (8.5% and 2.9%, respectively) to have ever used cocaine, and white male students (8.5%) were significantly more likely than black male students (2.9%) to have ever done so. Lifetime cocaine use ranged from 0.5% to 12.8% (median: 7.0%) across the state surveys and from 1.1% to 12.3% (median: 3.7%) across the local surveys (Table_19).

Nationwide, 3.3% of students had used some form of cocaine at least once during the 30 days preceding the survey (i.e., current cocaine use) (Table_18). Overall, male students (4.0%) were significantly more likely than female students (2.4%) to report current cocaine use. This significant difference was identified for students in grade 10. Overall, Hispanic students (6.2%) were significantly more likely than white and black students (3.1% and 0.7%, respectively) to report current cocaine use, and white students (3.1%) were significantly more likely than black students (0.7%) to do so. These significant differences were identified for male students. Among female students, Hispanic and white students (5.3% and 2.3%, respectively) were significantly more likely than black students (0.2%) to report current cocaine use. Current cocaine use ranged from 0.2% to 5.8% (median: 3.5%) across the state surveys and from 0.6% to 4.4% (median: 1.8%) across the local surveys (Table_19).

Nationwide, 4.7% of students had used "crack" or "freebase" forms of cocaine during their lifetime (Table_18). Overall, Hispanic students (8.0%) were significantly more likely than white and black students (4.5% and 1.2%, respectively) to have ever used "crack" or "freebase," and white students (4.5%) were significantly more likely than black students (1.2%) to have done so. These significant differences were identified for male students. Among female students, Hispanic and white students (7.7% and 4.3%, respectively) were significantly more likely than black students (0.9%) to have ever used "crack" or "freebase." Lifetime "crack" or "freebase" use ranged from 0.4% to 8.4% (median: 4.6%) across the state surveys and from 0.9% to 8.1% (median: 2.7%) across the local surveys (Table_19).

Steroid Use

Nationwide, 3.1% of students had used illegal steroids (i.e., without a doctor's prescription) during their lifetime (Table_20). Overall, male students (4.1%) were significantly more likely than female students (2.0%) to have ever used illegal steroids. This significant difference was identified for white and black students and students in grade 11. Overall, Hispanic and white students (3.4% and 3.1%, respectively) were significantly more likely than black students (1.5%) to have ever used illegal steroids. Among female students, Hispanic students (2.8%) were significantly more likely than black students (0.7%) to have ever used illegal steroids. Lifetime illegal steroid use ranged from 0.5% to 6.7% (median: 4.2%) across the state surveys and from 1.8% to 4.6% (median: 3.4%) across the local surveys (Table_21).

Injecting-Drug Use

Nationwide, 2.1% of students had injected illegal drugs during their lifetime ******** (Table_20). State prevalence rates ranged from 0.3% to 4.2% (median: 2.5%) across the state surveys and from 0.8% to 3.5% (median: 2.0%) across the local surveys (Table_21).

Other Illegal Drug Use

Nationwide, 17.0% of students had used other illegal drugs during their lifetime (e.g., LSD {lysergic acid diethylamide}, PCP {phencyclidine}, "ecstasy" {methylenedioxymethamphetamine}, mushrooms, "speed" {a stimulant, especially an amphetamine}, "ice" {methamphetamine}, or heroin) (Table_20). Overall, white and Hispanic students (19.1% and 17.5%, respectively) were significantly more likely than black students (3.4%) to have ever used other illegal drugs. This significant difference was identified for both male and female students. Across the state surveys, prevalence rates ranged from 0.9% to 26.4% (median: 16.4%) (Table_21). Across the local surveys, prevalence rates ranged from 2.6% to 15.9% (median: 7.6%).

Inhalant Use

Nationwide, 16.0% of students had sniffed glue, breathed the contents of aerosol spray cans, or inhaled paint sprays to become intoxicated during their lifetime (i.e., inhalant use) (Table_20). Overall, male students (17.6%) were significantly more likely than female students (14.1%) to report inhalant use. This significant difference was identified for white students and students in grades 11 and 12. Overall, white and Hispanic students (18.0% and 17.4%, respectively) were significantly more likely than black students (6.6%) to report inhalant use. This significant difference was identified for both male and female students. White male students (20.0%) were significantly more likely than Hispanic male students (17.7%) to report this behavior. Female students in grade 9 (19.9%) were significantly more likely than female students in grades 11 and 12 (11.2% and 9.5%, respectively) to report this behavior. State prevalence rates varied nearly fourfold from 7.4% to 28.4% (median: 18.3%), and local prevalence rates varied nearly threefold from 6.2% to 17.7% (median: 12.1%) (Table_21).

Initiation of Risk Behaviors

Cigarette Smoking

Nationwide, one fourth (24.8%) of students had smoked a whole cigarette before 13 years of age (Table_22). Overall, male students (28.0%) were significantly more likely than female students (20.9%) to have smoked a whole cigarette before 13 years of age. This significant difference was identified for students in grade 11. Overall, white and Hispanic students (25.6% and 24.9%, respectively) were significantly more likely than black students (17.4%) to have smoked a whole cigarette before 13 years of age. White male students (28.5%) were significantly more likely than black male students (19.5%) to have done so. Female students in grades 9 and 10 (28.8% and 23.8%, respectively) were significantly more likely than female students in grades 11 and 12 (17.1% and 14.6%, respectively) to have smoked a whole cigarette before 13 years of age. Male students in grade 10 (30.5%) were significantly more likely than male students in grade 12 (21.8%) to have done so. State prevalence rates varied threefold from 12.0% to 37.9% (median: 25.6%), and local prevalence rates ranged from 14.2% to 23.5% (median: 18.0%) (Table_23).

Alcohol Use

Nationwide, nearly one third (31.1%) of students had first drunk alcohol (more than a few sips) before 13 years of age (Table_22). Overall, male students (35.7%) were significantly more likely than female students (25.7%) to have drunk alcohol before 13 years of age. This significant difference was identified for all racial/ethnic and grade subgroups except for grade 9. Overall, Hispanic students (37.9%) were significantly more likely than white students (28.8%) to have drunk alcohol before 13 years of age. This significant difference was identified for male students. Female students in grade 9 (38.6%) were significantly more likely than female students in grades 10-12 (27.5%, 23.3%, and 15.1%, respectively) to have drunk alcohol before 13 years of age, and female students in grades 10 and 11 (27.5% and 23.3%, respectively) were significantly more likely than female students in grade 12 (15.1%) to have done so. Male students in grade 9 (44.9%) were significantly more likely than male students in grades 11 and 12 (35.4% and 28.8%, respectively) to have drunk alcohol before 13 years of age. State prevalence rates varied more than twofold from 17.2% to 41.5% (median: 31.5%), and local prevalence rates ranged from 26.3% to 38.4% (median: 33.0%) (Table_23).

Marijuana Use

Approximately one in ten students (9.7%) nationwide had tried marijuana before 13 years of age (Table_22). Overall, male students (12.2%) were significantly more likely than female students (6.7%) to have tried marijuana before 13 years of age. This significant difference was identified for black and Hispanic students and students in grades 11 and 12. Overall, Hispanic students (13.2%) were significantly more likely than white students (7.5%) to have tried marijuana before 13 years of age. Among males, Hispanic and black students (17.2% and 15.6%, respectively) were significantly more likely than white students (9.0%) to have done so. Female students in grade 9 (10.6%) were significantly more likely than female students in grades 11 and 12 (4.6% and 3.6%, respectively) to have tried marijuana before 13 years of age, and male students in grade 9 (18.9%) were significantly more likely than male students in grade 12 (7.6%) to have done so. State prevalence rates varied fourfold from 4.8% to 19.3% (median: 10.0%), and local prevalence rates varied more than twofold from 6.2% to 14.7% (median: 10.5%) (Table_23).

Cocaine Use

Nationwide, 1.1% of students had tried cocaine (including powder, "crack," or "freebase" forms of cocaine) before 13 years of age (Table_22). Overall, Hispanic students (1.4%) were significantly more likely than black students (0.4%) to have tried cocaine before 13 years of age. This significant difference was identified for female students. State prevalence rates varied more than threefold from 0.8% to 2.6% (median: 1.5%), and local prevalence rates varied more than sixfold from 0.4% to 2.7% (median: 1.3%) (Table_23).

Tobacco, Alcohol, and Other Drug Use on School Property

Nationwide, 14.6% of students had smoked cigarettes on school property on greater than or equal to 1 of the 30 days preceding the survey (Table_24). Black and Hispanic male students (12.4% and 15.3%, respectively) were significantly more likely than black and Hispanic female students (5.5% and 7.7%, respectively) to have smoked cigarettes on school property. Overall, white students (15.8%) were significantly more likely than black students (8.8%) to have smoked cigarettes on school property. White female students (14.9%) were significantly more likely than Hispanic and black female students (7.7% and 5.5%, respectively) to have engaged in this behavior. Across the state surveys, prevalence rates ranged from 0.7% to 25.3% (median: 17.0%) (Table_25). Across the local surveys, prevalence rates ranged from 8.9% to 18.8% (median: 10.7%).

Smokeless tobacco (chewing tobacco or snuff) use on school property on greater than or equal to 1 of the 30 days preceding the survey was reported by 5.1% of students nationwide (Table_24). Overall, male students (9.0%) were significantly more likely than female students (0.4%) to have used smokeless tobacco on school property. This significant difference was identified for white and Hispanic students and for all grade subgroups. Overall, white students (6.5%) were significantly more likely than black students (1.4%) to have used smokeless tobacco on school property. This significant difference was identified for male students. An eightfold variation was observed across the state surveys, with prevalence rates ranging from 1.9% to 15.2% (median: 5.0%) (Table_25). A nearly fivefold variation was observed across the local surveys, with prevalence rates ranging from 0.6% to 2.9% (median: 1.6%).

Nationwide, 5.6% of students had had at least one drink of alcohol on school property on greater than or equal to 1 of the 30 days preceding the survey (Table_24). Overall, male students (7.2%) were significantly more likely than female students (3.6%) to have drunk alcohol on school property. This significant difference was identified for white students and students in grade 12. Overall, Hispanic students (8.2%) were significantly more likely than white students (4.8%) to have drunk alcohol on school property. This significant difference was identified for female students. Female students in grade 9 (5.3%) were significantly more likely than female students in grade 12 (2.2%) to have engaged in this behavior. Prevalence rates across the state surveys varied more than fourfold from 2.9% to 12.9% (median: 6.2%), and prevalence rates across the local surveys varied more than twofold from 5.1% to 12.1% (median: 7.7%) (Table_25).

Nationwide, 7.0% of students had used marijuana on school property one or more times during the 30 days preceding the survey (Table_24). Overall, male students (9.0%) were significantly more likely than female students (4.6%) to have used marijuana on school property. This significant difference was identified for all racial/ethnic subgroups and students in grades 10 and 12. Overall, Hispanic students (10.4%) were significantly more likely than white students (5.8%) to have used marijuana on school property. Hispanic and black male students (14.1% and 13.0%, respectively) were significantly more likely than white male students (7.3%) to have used marijuana on school property. Female students in grade 9 (6.5%) were significantly more likely than female students in grade 12 (2.6%) to have done so. Prevalence rates across the state surveys varied threefold from 4.0% to 12.6% (median: 7.7%), and prevalence rates across the local surveys varied more than twofold from 5.9% to 13.6% (median: 9.6%) (Table_25).

Nearly one third (31.7%) of students had been offered, sold, or given an illegal drug on school property during the 12 months preceding the survey (Table_24). Overall, male students (37.4%) were significantly more likely than female students (24.7%) to have been offered, sold, or given an illegal drug on school property. This significant difference was identified for all racial/ethnic subgroups and students in grades 10-12. Overall, Hispanic students (41.1%) were significantly more likely than white and black students (31.0% and 25.4%, respectively) to have been offered, sold, or given an illegal drug on school property. This significant difference was identified for both male and female students. White female students (24.5%) were significantly more likely than black female students (16.7%) to have been offered, sold, or given an illegal drug on school property. Prevalence rates across the state surveys varied more than twofold from 15.2% to 42.2% (median: 30.1%), and prevalence rates across the local surveys varied more than twofold from 18.4% to 46.1% (median: 28.4%) (Table_25).

Sexual Behaviors That Contribute to Unintended Pregnancy and STDs, Including HIV Infection

Sexual Intercourse

Nationwide, nearly half (48.4%) of all students had had sexual intercourse during their lifetime (Table_26). Black and Hispanic male students (80.3% and 57.7%, respectively) were significantly more likely than black and Hispanic female students (65.6% and 45.7%, respectively) to have had sexual intercourse. Overall, black students (72.7%) were significantly more likely than Hispanic and white students (52.2% and 43.6%) to have had sexual intercourse, and Hispanic students (52.2%) were significantly more likely than white students (43.6%) to have done so. These significant differences were identified for male students. Black female students (65.6%) were significantly more likely than Hispanic and white female students (45.7% and 44.0%, respectively) to have had sexual intercourse. Among male and female students, students in grade 12 were significantly more likely than students in grades 9 and 10 to have had sexual intercourse. Prevalence rates ranged from 37.2% to 69.5% (median: 47.8%) across the state surveys and from 40.0% to 74.2% (median: 56.5%) across the local surveys (Table_27).

The percentage of students nationwide who had initiated sexual intercourse before 13 years of age was 7.2% (Table_26). Overall, male students (9.4%) were significantly more likely than female students (4.5%) to have initiated sexual intercourse before 13 years of age. This significant difference was identified for black and Hispanic students and students in grades 9-11. Overall, black students (21.7%) were significantly more likely than Hispanic and white students (7.7% and 4.0%, respectively) to have initiated sexual intercourse before 13 years of age, and Hispanic students (7.7%) were significantly more likely than white students (4.0%) to have done so. These significant differences were identified for male students. Black female students (11.0%) were significantly more likely than Hispanic and white female students (3.4% and 3.2%, respectively) to have initiated sexual intercourse before 13 years of age. Female students in grade 9 (6.5%) were significantly more likely than female students in grade 12 (2.9%) to have initiated sexual intercourse before 13 years of age, and male students in grade 9 (14.7%) were significantly more likely than male students in grades 11 and 12 (8.2% and 6.0%, respectively) to have done so. Across the state surveys, prevalence rates varied sixfold from 3.8% to 22.6% (median: 7.1%) (Table_27). Across the local surveys, the prevalence rates varied more than fivefold from 4.6% to 24.0% (median: 14.3%).

The percentage of students nationwide who had had sexual intercourse during their lifetime with four or more sex partners was 16.0% (Table_26). Black and Hispanic male students and male students in grade 9 were significantly more likely than female students in the same race/ethnicity and grade subgroups to have had four or more sex partners during their lifetime. Overall, black students (38.5%) were significantly more likely than Hispanic and white students (15.5% and 11.6%, respectively) to have had four or more sex partners. Black female students (25.4%) were significantly more likely than white and Hispanic students (12.1% and 10.2%, respectively) to have had four or more sex partners. Black male students (52.8%) were significantly more likely than Hispanic and white male students (20.1% and 11.3%, respectively) to have had four or more sex partners, and Hispanic male students (20.1%) were significantly more likely than white male students (11.3%) to have done so. Female students in grades 11 and 12 (15.8% and 20.6%) were significantly more likely than female students in grade 9 (7.9%) to have had four or more sex partners, and female students in grade 12 (20.6%) were significantly more likely than female students in grade 10 (11.7%) to have done so. Prevalence rates across the state surveys varied more than threefold from 9.1% to 31.4% (median: 13.7%) (Table_27). Prevalence rates across the local surveys varied more than fourfold from 8.8% to 38.2% (median: 21.7%).

More than one third (34.8%) of students nationwide had had sexual intercourse during the 3 months preceding the survey (i.e., currently sexually active) (Table_26). Black male students (60.5%) were significantly more likely than black female students (47.3%) to be currently sexually active. Overall, black students (53.6%) were significantly more likely than Hispanic and white students (35.4% and 32.0%, respectively) to be currently sexually active. This significant difference was identified for both male and female students. Female students in grades 10-12 (31.2%, 41.5%, and 49.5%, respectively) were significantly more likely than female students in grade 9 (22.4%) to be currently sexually active, and female students in grade 12 (49.5%) were significantly more likely than female students in grade 10 (31.2%) to be so. Male students in grade 12 (43.1%) were significantly more likely than male students in grades 9 and 10 (25.9% and 27.6%, respectively) to be currently sexually active. Prevalence rates across state surveys ranged from 21.4% to 52.1% (median: 33.0%) (Table_27). Prevalence rates across the local surveys ranged from 19.7% to 59.0% (median: 39.3%).

Among students who had had sexual intercourse during their lifetime, more than one fourth (27.8%) had been abstinent during the 3 months preceding the survey (i.e., currently abstinent) (Table_26). Overall, male students (31.5%) were significantly more likely than female students (23.4%) to report current abstinence. This significant difference was identified for white students and students in grade 11. Black female students (27.9%) were significantly more likely than white female students (20.2%) to report current abstinence, and Hispanic male students (35.2%) were significantly more likely than black male students (24.6%) to do so. Female students in grade 9 (33.3%) were significantly more likely than female students in grades 11 and 12 (17.5% and 20.0%, respectively) to report current abstinence. Prevalence rates across the state surveys ranged from 22.9% to 42.5% (median: 29.2%) and across the local surveys from 20.4% to 36.2% (median: 29.5%) (Table_27).

Condom Use

Nationwide, among currently sexually active students, 56.8% reported that either they or their partner had used a condom during last sexual intercourse (Table_28). Overall, male students (62.5%) were significantly more likely than female students (50.8%) to report condom use. This significant difference was identified for white and black students and students in grade 12. Overall, black students (64.0%) were significantly more likely than white and Hispanic students (55.8% and 48.3%, respectively) to report condom use. Black female students (58.9%) were significantly more likely than white and Hispanic female students (49.2% and 40.0%, respectively) to report condom use, and black male students (68.4%) were significantly more likely than Hispanic male students (54.7%) to do so. Female students in grades 9 and 11 (58.3% and 55.4%, respectively) were significantly more likely than female students in grade 12 (43.0%) to report condom use. Prevalence rates across the state surveys ranged from 30.4% to 68.1% (median: 57.2%) and across the local surveys from 50.1% to 73.5% (median: 64.0%) (Table_29).

Birth Control Pill Use

Nationwide, among currently sexually active students, 16.6% reported that either they or their partner had used birth control pills before last sexual intercourse (Table_28). Overall, female students (20.5%) were significantly more likely than male students (13.0%) to report birth control pill use. This significant difference was identified for students in grades 10 and 12. Overall, white students (20.6%) were significantly more likely than black and Hispanic students (11.9% and 9.5%, respectively) to report birth control pill use. White female students (24.7%) were significantly more likely than black female students (14.7%) to report birth control pill use. White male students (16.7%) were significantly more likely than Hispanic male students (6.9%) to report birth control pill use. Among both male and female students, students in grade 12 were significantly more likely than students in grades 9 and 10 to report birth control pill use. Prevalence rates varied nearly sevenfold from 4.4% to 29.8% (median: 18.3%) across the state surveys and more than twofold from 6.5% to 14.9% (median: 9.1%) across the local surveys (Table_29).

Alcohol or Drug Use at Last Sexual Intercourse

Nationwide, among students who were currently sexually active, one fourth (24.7%) had used alcohol or drugs at last sexual intercourse (Table_28). Overall, male students (30.5%) were significantly more likely than female students (18.5%) to report this behavior. This significant difference was identified for all racial/ethnic subgroups and for grades 10-12. Overall, white students (26.0%) were significantly more likely than black students (18.1%) to have used alcohol or drugs at last sexual intercourse. This significant difference was identified for male and female students. Prevalence rates ranged from 10.9% to 36.1% (median: 26.6%) across the state surveys and from 15.5% to 28.4% (median: 20.0%) across the local surveys (Table_29).

Pregnancy

Nationwide, 6.5% of students reported that they had been pregnant or had gotten someone else pregnant. Overall, female students (8.5%) were significantly more likely to have been pregnant than male students (4.7%) were to have gotten someone else pregnant. This significant difference was identified for white students and students in grade 12. Overall, black students (14.9%) were significantly more likely than Hispanic and white students (7.1% and 4.5%, respectively) to have been pregnant or to have gotten someone else pregnant. This significant difference was identified for both male and female students. Hispanic male students (6.3%) were significantly more likely than white male students (3.0%) to have gotten someone else pregnant. Female students in grade 12 (11.1%) were significantly more likely than female students in grade 9 (5.1%) to have been pregnant. Prevalence rates ranged from 3.5% to 12.1% (median: 5.7%) across the state surveys and from 4.6% to 19.5% (median: 10.2%) across the local surveys (Table_29).

HIV Education

Nationwide, 91.5% of students had been taught about acquired immunodeficiency syndrome (AIDS) or HIV infection in school (Table_30). Overall, white students (93.3%) were significantly more likely than black and Hispanic students (89.7% and 85.9%, respectively) to have received HIV education in school. White female students (92.8%) were significantly more likely than Hispanic female students (85.1%) to have received HIV education in school, and white male students (93.6%) were significantly more likely than black and Hispanic male students (89.1% and 86.6%, respectively) to report this. Prevalence rates ranged from 79.9% to 96.5% (median: 91.6%) across the state surveys and from 82.7% to 93.8% (median: 88.6%) across the local surveys (Table_31).

Nationwide, 62.8% of students had talked about AIDS or HIV infection with parents or other adult family members (Table_30). Overall, female students (67.4%) were significantly more likely than male students (59.1%) to report having done so. This significant difference was identified for students in grades 11 and 12. Overall, black students (72.7%) were significantly more likely than white and Hispanic students (62.0% and 60.5%, respectively) to have talked with parents or other adult family members about AIDS or HIV infection. This significant difference was identified for both male and female students. Across the state surveys, prevalence rates ranged from 49.6% to 69.8% (median: 62.1%) (Table_31). Across the local surveys, prevalence rates ranged from 53.1% to 75.7% (median: 66.2%).

Dietary Behaviors

Consumption of Fruits and Vegetables

Nationwide, 29.3% of students had eaten five or more servings of fruits and vegetables ********* during the day preceding the survey (Table_32). Overall, male students (32.1%) were significantly more likely than female students (25.7%) to report this behavior. This significant difference was identified for black students and students in grade 11. Across the state surveys, prevalence rates ranged from 18.7% to 41.6% (median: 28.5%) (Table_33). Across the local surveys, prevalence rates ranged from 20.4% to 34.1% (median: 28.8%).

Consumption of Foods Typically High in Fat Content

Nationwide, 62.3% of students had eaten two or fewer servings of foods typically high in fat content ********** during the day preceding the survey (Table_32). Overall, female students (70.6%) were significantly more likely than male students (55.5%) to have eaten two or fewer servings of such foods. This significant difference was identified for all racial/ethnic and grade subgroups. Overall, Hispanic and white students (63.8% and 62.9%, respectively) were significantly more likely than black students (54.9%) to have eaten two or fewer servings of foods typically high in fat content. White female students (73.0%) were significantly more likely than black female students (62.5%) to report this behavior, and Hispanic male students (60.0%) were significantly more likely than black male students (47.0%) to do so. Female students in grade 12 (77.1%) were significantly more likely than female students in grade 9 (65.2%) to have eaten two or fewer servings of foods typically high in fat content. Male students in grade 12 (58.9%) were significantly more likely than male students in grade 10 (51.6%) to have eaten two or fewer servings of foods typically high in fat content. Male students in grade 11 (60.7%) were significantly more likely than male students in grades 9 and 10 (49.7% and 51.6%, respectively) to have done so. Across the state surveys, prevalence rates ranged from 46.5% to 81.3% (median: 61.6%) (Table_33). Across the local surveys, prevalence rates ranged from 48.6% to 72.3% (median: 59.8%).

Perceived Overweight

More than one fourth (27.3%) of students nationwide thought they were overweight (Table_32). Overall, female students (33.5%) were significantly more likely than male students (22.2%) to consider themselves overweight. This significant difference was identified for white and black students and students in grades 9, 10, and 12. Overall, Hispanic students (30.4%) were significantly more likely than black students (23.5%) to consider themselves overweight. Among male students, Hispanic and white students (27.4% and 21.9%, respectively) were significantly more likely than black students (14.8%) to consider themselves overweight. Across the state surveys, prevalence rates ranged from 21.1% to 33.5% (median: 28.6%) (Table_33). Across the local surveys, prevalence rates ranged from 21.2% to 30.3% (median: 24.1%).

Attempted Weight Control

Nationwide, 39.7% of students were trying to lose weight during the 30 days preceding the survey (Table_34). Overall, female students (59.7%) were significantly more likely than male students (23.1%) to be trying to lose weight. This significant difference was identified for all racial/ethnic and grade subgroups. Overall, Hispanic students (45.7%) were significantly more likely than black students (35.7%) to be trying to lose weight. White and Hispanic female students (62.2% and 61.1%, respectively) were significantly more likely than black female students (50.7%) to be trying to lose weight, and Hispanic male students (32.7%) were significantly more likely than white and black male students (22.0% and 20.0%, respectively) to report this. Prevalence rates ranged from 31.1% to 51.0% (median: 42.4%) across the state surveys and from 33.0% to 46.1% (median: 38.0%) across the local surveys (Table_35).

The percentage of students nationwide who had taken laxatives or had vomited either to lose weight or to keep from gaining weight during the 30 days preceding the survey was 4.5% (Table_34). Overall, female students (7.5%) were significantly more likely than male students (2.1%) to have taken laxatives or to have vomited to lose weight or to keep from gaining weight. This significant difference was identified for white and Hispanic students and for all grade subgroups. Overall, Hispanic students (6.5%) were significantly more likely than white students (4.2%) to have taken laxatives or to have vomited to lose weight or to keep from gaining weight. Hispanic female students (10.4%) were significantly more likely than black female students (6.3%) to have taken laxatives or to have vomited to lose weight or to keep from gaining weight, and black male students (4.0%) were significantly more likely than white male students (1.6%) to have done so. Prevalence rates ranged from 3.1% to 9.8% (median: 6.1%) across the state surveys and from 3.6% to 8.3% (median: 5.2%) across the local surveys (Table_35).

Nationwide, 4.9% of students had taken diet pills either to lose weight or to keep from gaining weight during the 30 days preceding the survey (Table_34). Overall, female students (8.0%) were significantly more likely than male students (2.4%) to have taken diet pills to lose weight or to keep from gaining weight. This significant difference was identified for white and Hispanic students and all grade subgroups. Prevalence rates ranged from 2.8% to 9.5% (median: 7.1%) across the state surveys and from 2.2% to 7.0% (median: 4.6%) across the local surveys (Table_35).

Nearly one third (30.4%) of students had dieted either to lose weight or to keep from gaining weight during the 30 days preceding the survey (Table_34). Overall, female students (45.7%) were significantly more likely than male students (17.6%) to have dieted to lose weight or to keep from gaining weight. This significant difference was identified for all racial/ethnic and grade subgroups. Overall, Hispanic and white students (33.4% and 30.4%, respectively) were significantly more likely than black students (25.0%) to have dieted to lose weight or to keep from gaining weight. White and Hispanic female students (47.9% and 46.3%, respectively) were significantly more likely than black students (33.8%) to have dieted to lose weight or to keep from gaining weight, and Hispanic male students (22.6%) were significantly more likely than white and black male students (16.6% and 15.6%, respectively) to have done so. Prevalence rates ranged from 21.1% to 44.0% (median: 31.1%) across the state surveys and from 22.3% to 35.8% (27.4%) across the local surveys (Table_35).

Approximately half (51.5%) of students had exercised either to lose weight or to keep from gaining weight during the 30 days preceding the survey (Table_34). Overall, female students (65.4%) were significantly more likely than male students (39.9%) to have exercised to lose weight or to keep from gaining weight. This significant difference was identified for all racial/ethnic and grade subgroups. Overall, Hispanic and white students (55.5% and 52.2%, respectively) were significantly more likely than black students (43.5%) to have exercised to lose weight or to keep from gaining weight. White and Hispanic female students (69.7% and 64.5%, respectively) were significantly more likely than black female students (49.2%) to have exercised to lose weight or to keep from gaining weight, and Hispanic male students (47.9%) were significantly more likely than white and black male students (38.6% and 37.5%, respectively) to have done so. Across the state surveys, prevalence rates ranged from 38.4% to 62.3% (median: 53.0%) (Table_35). Across the local surveys, prevalence rates ranged from 42.4% to 54.9% (median: 48.5%).

Physical Activity

Vigorous and Moderate Physical Activity

Nearly two thirds (63.8%) of students nationwide had participated in activities that made them sweat and breathe hard for at least 20 minutes on greater than or equal to 3 of the 7 days preceding the survey (i.e., vigorous physical activity) (Table_36). Overall, male students (72.3%) were significantly more likely than female students (53.5%) to have participated in vigorous physical activity. This significant difference was identified for all racial/ethnic and grade subgroups. Overall, white students (66.8%) were significantly more likely than Hispanic and black students (60.4% and 53.9%, respectively) to have participated in vigorous physical activity, and Hispanic students (60.4%) were significantly more likely than black students (53.9%) to do so. Among both male and female students, white students were significantly more likely than black students to have participated in vigorous physical activity. Female students in grade 9 (66.1%) were significantly more likely than female students in grades 10-12 (55.7%, 49.4%, and 43.6%, respectively) to have participated in vigorous physical activity, and female students in grade 10 (55.7%) were significantly more likely than female students in grade 12 (43.6%) to do so. Male students in grade 9 (78.7%) were significantly more likely than male students in grades 11 and 12 (68.9% and 68.4%, respectively) to have participated in vigorous physical activity. Across the state surveys, prevalence rates ranged from 50.6% to 71.2% (median: 61.2%) (Table_37). Across the local surveys, prevalence rates ranged from 42.6% to 67.4% (median: 52.3%).

One fifth (20.4%) of students nationwide had walked or bicycled for at least 30 minutes on greater than or equal to 5 of the 7 days preceding the survey (i.e., moderate physical activity) (Table_36). Overall, black and Hispanic students (28.3% and 26.7%, respectively) were significantly more likely than white students (16.8%) to have participated in moderate physical activity. This significant difference was identified for both male and female students. Among male and female students, students in grade 9 were significantly more likely than students in grades 11 and 12 to have participated in moderate physical activity, and students in grade 10 were significantly more likely than students in grade 12 to have done so. Across the state surveys, prevalence rates ranged from 13.2% to 34.8% (median: 20.5%) (Table_37). Across the local surveys, prevalence rates ranged from 24.2% to 44.2% (median: 32.5%).

Stretching Exercises

Nationwide, 51.3% of students had done stretching exercises (e.g., toe touching, knee bending, and leg stretching) on greater than or equal to 3 of the 7 days preceding the survey (Table_36). Black male students (54.0%) were significantly more likely than black female students (41.8%) to have participated in stretching exercises. White female students (53.4%) were significantly more likely than black female students (41.8%) to have participated in stretching exercises. Female students in grade 9 (59.8%) were significantly more likely than female students in grades 11 and 12 (46.9% and 41.0%, respectively) to have participated in stretching exercises, and female students in grade 10 (54.6%) were significantly more likely than female students in grade 12 (41.0%) to have done so. Across the state surveys, prevalence rates ranged from 34.8% to 58.8% (median: 48.6%) (Table_37). Across the local surveys, prevalence rates ranged from 36.1% to 58.6% (median: 44.1%).

Strengthening Exercises

Approximately half (51.4%) of students nationwide had done strengthening exercises (e.g., push-ups, sit-ups, and weightlifting) on greater than or equal to 3 of the 7 days preceding the survey (Table_36). Overall, male students (58.1%) were significantly more likely than female students (43.2%) to have participated in strengthening exercises. This significant difference was identified for all racial/ethnic and grade subgroups. Overall, Hispanic students (53.3%) were significantly more likely than black students (46.7%) to have participated in strengthening exercises. White female students (46.1%) were significantly more likely than black female students (34.8%) to have participated in strengthening exercises. Female students in grades 9 and 10 (52.0% and 44.5%, respectively) were significantly more likely than female students in grade 12 (34.3%) to report this behavior. Prevalence rates ranged from 31.2% to 60.3% (median: 46.8%) across the state surveys and from 33.7% to 52.5% (median: 44.0%) across the local surveys (Table_37).

Participation in Physical Education Class

Nationwide, 48.8% of students were enrolled in a physical education (PE) class (Table_38). Black male students (53.7%) were significantly more likely than black female students (39.4%) to be enrolled in a PE class. Among both male and female students, students in grade 9 were significantly more likely than students in grades 11 and 12 to be enrolled in a PE class. The percentage of students enrolled in a PE class varied nearly threefold from 31.3% to 91.9% (median: 50.0%) across the state surveys and more than threefold from 26.8% to 90.2% (median: 58.1%) across the local surveys (Table_39).

Nationwide, 27.4% of students attended PE class daily (Table_38). Overall, Hispanic students (38.4%) were significantly more likely than white students (23.8%) to attend PE class daily. This significant difference was identified for both male and female students. Female students in grades 9 and 10 (42.1% and 28.1%, respectively) were significantly more likely than female students in grades 11 and 12 (15.5% and 13.9%, respectively) to attend PE class daily, and male students in grade 9 (43.0%) were significantly more likely than male students in grades 11 and 12 (22.5% and 23.2%, respectively) to do so. The percentage of students who attended PE class daily varied more than eightfold from 7.3% to 62.2% (median: 28.0%) across the state surveys and varied more than twelvefold from 6.6% to 80.7% (median: 31.4%) across the local surveys (Table_39).

Nationwide, 73.9% of students enrolled in PE class reported exercising greater than or equal to 20 minutes during an average PE class. Overall, male students enrolled in PE class (78.5%) were significantly more likely than female students enrolled in PE class (67.5%) to report exercising greater than or equal to 20 minutes during an average PE class. This significant difference was identified for students in grade 11. The percentage of students enrolled in PE class who reported exercising greater than or equal to 20 minutes during an average PE class ranged from 41.9% to 85.4% (median: 73.9%) across the state surveys and from 44.6% to 79.0% (median: 66.1%) across the local surveys (Table_39).

Participation on Sports Teams

Half (49.5%) of students nationwide had played on sports teams run by their school during the 12 months preceding the survey (Table_38). Overall, male students (55.5%) were significantly more likely than female students (42.3%) to have played on sports teams run by their school. This significant difference was identified for black and Hispanic students and students in grades 10-12. Overall, white students (54.6%) were significantly more likely than black and Hispanic students (44.3% and 40.2%, respectively) to have played on sports teams run by their school. This significant difference was identified for female students. Among male students, white and black students (58.7% and 56.4%, respectively) were significantly more likely than Hispanic students (46.9%) to have played on sports teams run by their school. Across the state surveys, the percentage of students who had played on sports teams run by their schools ranged from 27.2% to 60.3% (median: 46.4%) (Table_39). Across the local surveys, the percentage ranged from 31.4% to 42.2% (median: 38.0%).

Nationwide, 38.3% of students had played on sports teams run by organizations unaffiliated with their school during the 12 months preceding the survey (Table_38). Overall, male students (45.4%) were significantly more likely than female students (29.8%) to have played on sports teams run by organizations unaffiliated with their school. This significant difference was identified for all racial/ethnic and grade subgroups. Overall, white students (41.4%) were significantly more likely than Hispanic students (32.9%) to have played on sports teams run by organizations unaffiliated with their school. White female students (34.7%) were significantly more likely than black and Hispanic female students (25.1% and 24.0%, respectively) to have played on sports teams run by organizations unaffiliated with their school, and black male students (51.8%) were significantly more likely than Hispanic male students (40.5%) to have done so. Female students in grade 9 (36.8%) were significantly more likely than female students in grades 11 and 12 (26.4% and 21.9%, respectively) to have played on sports teams run by organizations unaffiliated with their school, and female students in grade 10 (34.7%) were significantly more likely than female students in grade 12 (21.9%) to have done so. The percentage of students who played on sports teams run by organizations unaffiliated with their school ranged from 30.1% to 61.4% (median: 37.9%) across the state surveys and from 26.4% to 38.7% (median: 33.1%) across the local surveys (Table_39).

DISCUSSION

Many high school students continue to practice behaviors that place them at risk for serious health problems. Some risk behaviors are more likely to be found among particular subgroups of students. For example, male students were more likely than female students to report

• rarely or never wearing seat belts;

• driving after drinking alcohol;

• weapon carrying;

• gun carrying;

• participating and being injured in a physical fight;

• weapon carrying on school property;

• being threatened or injured with a weapon on school property;

• being in a physical fight on school property;

• having property stolen or deliberately damaged on school property;

• smokeless tobacco use;

• episodic heavy drinking;

• lifetime and current marijuana use;

• current cocaine use;

• lifetime illegal steroid and inhalant use;

• initiating cigarette, alcohol, and marijuana use before 13 years of age;

• smokeless tobacco, alcohol, and marijuana use on school property;

• being offered, sold, or given an illegal drug on school property;

• not talking with parents or other adult family members about AIDS or HIV infection;

• initiating sexual intercourse before 13 years of age;

• their partner not using birth control pills;

• alcohol or drug use at last sexual intercourse; and

• eating more than two servings of foods typically high in fat content daily.

In contrast, female students were more likely than male students to report

• suicide-related behaviors;

• not using a condom;

• not eating fruits and vegetables daily;

• using laxatives or vomiting and taking diet pills either to lose weight or to keep from gaining weight;

• not participating in vigorous physical activity;

• not participating in strengthening exercises;

• exercising for less than 20 minutes during PE class; and

• not participating on sports teams.

White students were more likely than black or Hispanic students to report

• driving after drinking alcohol;

• current and frequent cigarette use;

• initiating cigarette use before 13 years of age;

• cigarette use on school property;

• smokeless tobacco use;

• smokeless tobacco use on school property;

• lifetime and current alcohol use;

• episodic heavy drinking;

• lifetime and current cocaine use;

• lifetime "crack," steroid, inhalant, and other illegal drug use;

• not talking with parents or other adult family members about AIDS or HIV infection;

• not using condoms;

• alcohol or drug use at last sexual intercourse;

• not participating in moderate physical activity; and

• not attending PE class daily.

Black students were more likely than white or Hispanic students to report

• rarely or never wearing seat belts or bicycle helmets;

• gun carrying;

• participating and being injured in a physical fight;

• being in a physical fight on school property;

• being threatened or injured with a weapon on school property;

• feeling too unsafe to go to school;

• not being taught about AIDS or HIV infection in school;

• having had sexual intercourse during their lifetime;

• being currently sexually active;

• initiating sexual intercourse before 13 years of age;

• having had four or more sex partners during their lifetime;

• not using birth control pills;

• ever being pregnant or getting someone else pregnant;

• eating more than two servings of foods typically high in fat content daily;

• not participating in vigorous physical activity;

• not participating in strengthening exercises; and

• not participating on school-sponsored sports teams.

Hispanic students were more likely than white or black students to report

• rarely or never wearing motorcycle helmets;

• riding with a driver who had been drinking alcohol;

• driving after drinking alcohol;

• weapon and gun carrying;

• being threatened or injured with a weapon on school property;

• participating and being injured in a physical fight;

• being in a physical fight on school property;

• feeling too unsafe to go to school;

• suicide-related behaviors;

• current cigarette use;

• lifetime and current alcohol use;

• episodic heavy drinking;

• lifetime and current cocaine use;

• lifetime "crack," steroid, inhalant, and other illegal drug use;

• initiating cigarette, alcohol, marijuana, and cocaine use before 13 years of age;

• alcohol and marijuana use on school property;

• being offered, sold, or given an illegal drug on school property;

• not being taught about AIDS or HIV infection in school;

• not talking with parents or other adult family members about AIDS or HIV infection;

• having had sexual intercourse during their lifetime;

• initiating sexual intercourse before 13 years of age;

• not using condoms or birth control pills;

• using laxatives or vomiting either to lose weight or to keep from gaining weight;

• not participating in vigorous physical activity; and

• not participating on sports teams.

Students in grades 9 and 10 were more likely than students in grades 11 and 12 to report

• weapon carrying;

• being threatened or injured with a weapon on school property;

• participating in a physical fight;

• being in a physical fight on school property;

• having property stolen or deliberately damaged on school property;

• feeling too unsafe to go to school;

• suicide-related behaviors;

• lifetime inhalant use;

• initiating cigarette, alcohol, and marijuana use before 13 years of age;

• initiating sexual intercourse before 13 years of age;

• not using birth control pills; and

• eating more than two servings of foods typically high in fat content daily.

Students in grades 11 and 12 were more likely than students in grades 9 and 10 to report

• driving after drinking alcohol;

• lifetime and current alcohol use;

• episodic heavy drinking;

• lifetime marijuana use;

• having had sexual intercourse during their lifetime;

• having had four or more sex partners during their lifetime;

• being currently sexually active;

• ever being pregnant or getting someone else pregnant;

• not participating in vigorous and moderate physical activity;

• not participating in stretching and strengthening exercises;

• not being enrolled in a PE class;

• not attending PE class daily; and

• not participating on nonschool-sponsored sports teams.

  These subgroup findings can assist in identifying the need

for education and services based on a higher prevalence of risk behaviors. However, the underlying causes (e.g., education levels, economic factors, or cultural influences) for subgroup differences (7) could not be addressed in this analysis.

Considerable variation occurs from state to state and from city to city for some priority health-risk behaviors. For example, across the state surveys, a fivefold variation or greater was identified for

• rarely or never wearing seat belts;

• driving after drinking alcohol;

• feeling too unsafe to go to school;

• injurious suicide attempts;

• current and frequent cigarette use;

• smokeless tobacco use;

• lifetime and current cocaine use;

• lifetime "crack," steroid, injecting-drug, and other drug use;

• cigarette and smokeless tobacco use on school property;

• initiating sexual intercourse before 13 years of age;

• birth control pill use; and

• attending PE class daily.

Across the local surveys, a similar level of variation was found for

• rarely or never wearing seat belts;

• smokeless tobacco use;

• smokeless tobacco use on school property;

• lifetime and current cocaine use;

• lifetime "crack" and other illegal drug use;

• cocaine use before 13 years of age;

• initiating sexual intercourse before 13 years of age; and

• attending PE class daily.

  These variations may occur, in part, because of differences

in state and local laws and policies, enforcement practices, access to illegal drugs, the availability of effective intervention programs, prevailing behavioral norms, and adult practices.

The YRBSS continues to be used at the national, state, and local levels to improve health-related polices and programs for youth. For example, YRBS data are used to monitor 21 national health objectives (6) and National Education Goal 7, which focuses on safe, disciplined, and drug-free schools (8). In Massachusetts, YRBS data are being used to identify high-risk youth and target programs appropriately. In Nevada, YRBS data are being used by state and local agencies and organizations to support the need for increased funding of health programs for youth. In Wisconsin, YRBS data are being used to support the implementation of a statewide pregnancy prevention initiative. In Philadelphia, YRBS data are being used as the framework for health education teacher-training programs, and YRBS data are being incorporated into math and English curricula. In San Diego, YRBS data are being used to encourage colleges and universities to become actively involved in reducing alcohol use among teenagers throughout their community. Continued support for the YRBSS is critical to the success of these and other public health and school health programs.

References

1. National Center for Health Statistics. Report of final mortality statistics, 1995. Hyattsville, MD: US Department of Health and Human Services, CDC, 1997. (Monthly vital statistics report; vol 45, no. 11, suppl 2).

2. National Center for Health Statistics. Trends in pregnancies and pregnancy rates: estimates for the United States, 1980-92. Hyattsville, MD: US Department of Health and Human Services, CDC, 1995. (Monthly vital statistics report; vol 43, no. 11{S}).

3. CDC. National Center for HIV, STD, and TB Prevention: Annual report, 1992. Atlanta, GA: US Department of Health and Human Services, Public Health Service, CDC, 1993.

4. Kann L, Kolbe LJ, Collins JL, eds. Measuring the health behavior of adolescents: the Youth Risk Behavior Surveillance System. Public Health Rep 1993;108(suppl 1).

5. Shah BV, Barnwell BG, Bieler GS. SUDAAN: software for the statistical analysis of correlated data; user's manual, release 7.0. Research Triangle Park, NC: Research Triangle Institute, 1996.

6. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--midcourse review and 1995 revisions. Washington, DC: US Department of Health and Human Services, Public Health Service, 1995.

7. Lowry R, Kann L, Collins JL, Kolbe LJ. The effect of socioeconomic status on chronic disease risk behaviors among US adolescents. JAMA 1996;276:792-7.

8. National Education Goals Panel. The national education goals report: building a nation of learners, 1995. Washington, DC: National Education Goals Panel, 1995.

* The school-based components of the YRBSS were implemented in 1990 and 1991 and biennially during odd-numbered years thereafter.

** In this report, black students refers to black, non-Hispanic students.

*** SUrvey DAta ANalysis, a computer software for the statistical analysis of correlated data; for additional information, contact Research Triangle Institute, 3040 Cornwallis Road, Research Triangle Park, NC 27709 (Telephone: 919-541-6000).

**** In this report, white students refers to white, non-Hispanic students.

***** In this report, state refers to both states and U.S. territories.

****** Pellet-sized pieces of highly purified cocaine.

******** A process whereby cocaine is dissolved in ether or sodium hydroxide and the precipitate filtered off.

******** Students were classified as injecting-drug users only if they a) reported injecting-drug use not prescribed by a physician and b) answered "one or more" to any of the following questions:

"During your life, how many times have you used any form of cocaine, including powder, crack, or freebase?" "During your life, how many times have you used any other type of illegal drug, such as LSD, PCP, ecstasy, mushrooms, speed, ice, or heroin?" Or, "During your life, how many times have you taken steroid pills or shots without a doctor's prescription?"

********* Fruit, fruit juice, green salad, or cooked vegetables.

********** Hamburgers, hot dogs, or sausage; french fries or potato chips; and cookies, doughnuts, pie, or cake.

TABLE 1. Size, response rates, and demographic characteristics of samples -- United States and selected U.S. sites, Youth Risk Behavior Surveys, 1997
=======================================================================================================================================================================
                                            Response                   Sex (%)                Grade (%)                                  Race/Ethnicity
                                             rate (%)                                                                                          (%)
                        Sample    -----------------------------    --------------    -------------------------------      ---------------------------------------------
Site                     size      School    Student    Overall    Female   Male        9        10     11      12         White *      Black *  Hispanic   Other
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------
NATIONAL SURVEY         16,262       79         87        69        45.2    54.8      23.6      23.9   25.2    27.2         62.4         12.5       9.8      15.3

STATE SURVEYS

Weighted data
 Alabama                3,787        90         86        78        50.1    49.9      30.4      25.3   22.7    19.8         66.1         30.4       0.8       2.7
 American Samoa +       1,038       100         89        89        55.9    44.1      30.3      25.1   22.9    21.6          7.8          4.5       1.6      86.1
 Arkansas               1,991        76         87        66        48.9    51.1      28.5      27.0   23.5    20.8         67.4         25.5       1.6       5.6
 Connecticut            1,690        75         82        62        49.8    50.2      29.6      25.9   23.3    21.0         77.7          6.4       8.0       7.9
 Guam+                    334        NA &       67        67        52.6    47.4      40.3      26.2   18.2    15.4          6.1          2.0       2.0      89.9
 Hawaii                 1,409       100         63        63        48.1    51.9      31.3      25.4   23.6    19.7         13.5          2.1       3.4      81.1
 Iowa                   1,521        78         91        71        48.9    51.1      26.2      25.8   24.4    22.8         92.2          2.2       1.3       4.3
 Kentucky               1,465        72         86        62        49.9    50.1      29.8      26.1   23.3    20.8         87.7          8.1       0.7       3.4
 Louisiana              3,897        97         81        79        49.7    50.3      32.0      25.8   22.1    19.4         52.8         39.0       1.8       6.4
 Maine                  1,837        86         97        83        48.6    51.4      27.9      25.6   24.1    22.3         91.6          1.6       0.9       5.9
 Massachusetts          3,982        88         79        70        49.2    50.8      28.7      26.1   23.8    21.2         72.9          6.8       8.8      11.5
 Michigan               3,933        85         74        63        49.8    50.2      29.9      26.2   23.1    20.7         74.3         15.0       2.5       8.2
 Mississippi            1,532        78         80        62        50.5    49.5      32.4      26.1   21.6    19.2         36.9         58.4       0.6       4.0
 Missouri               1,483        81         80        65        49.2    50.8      28.4      26.3   23.7    21.2         75.9         17.0       1.5       5.6
 Montana                2,457        72         83        60        48.5    51.5      27.9      26.1   23.9    22.1         84.8          0.6       2.1      12.5
 Nevada                 1,464        96         62        60        48.8    51.2      28.9      27.1   23.7    20.2         65.1          6.5      13.0      15.4
 New York               3,741        79         81        64        49.7    50.3      31.4      26.4   23.0    19.0         60.2         13.9      11.8      14.2
 Ohio                   2,188        87         85        74        49.2    50.8      29.6      25.9   23.2    21.3         73.3         18.6       2.7       5.4
 Rhode Island           1,528        72         83        60        50.2    49.8      30.0      26.1   23.1    20.5         73.4          4.3       9.1      13.2
 South Carolina         5,539        72         88        63        49.4    50.6      33.5      26.0   20.9    19.4         49.1         44.3       1.8       4.8
 South Dakota           1,604        84         80        67        49.2    50.8      28.1      25.9   24.1    21.8         93.1          0.6       0.8       5.5
 Utah                   1,388        96         74        71        49.0    51.0      26.4      26.3   23.0    23.5         87.9          1.4       4.5       6.2
 Vermont                8,636        87         82        71        48.4    51.6      28.3      25.7   23.8    22.1           NA           NA        NA        NA
 Virgin Islands +         824       100         76        76        50.3    49.7      39.7      19.4   23.5    17.5          0.7         86.1       6.5       6.7
 West Virginia          1,818        98         83        81        51.2    48.8      27.5      26.0   24.1    22.4         92.1          2.8       1.0       4.1
 Wisconsin              1,325        72         85        61        49.0    51.0      28.0      26.5   24.0    21.5         84.4          4.3       3.8       7.5
 Wyoming                2,081        83         81        67        49.0    51.0      26.9      26.2   23.9    22.7         85.1          1.3       6.6       7.0

Unweighted data
 California@            2,596        72         72        52        54.0    46.0      20.8      24.7   26.0    28.3         38.6          6.8      25.0      29.6
 Colorado               1,170        54         85        46        51.0    49.0      40.8      19.5   21.4    18.2         79.6          1.7       9.4       9.3
 Delaware               2,433        77         76        59        51.9    48.1      34.8      18.0   28.5    18.4         65.5         22.9       3.7       7.9
 Florida                2,555        80         73        58        50.6    49.4      40.1      31.4   19.4     9.0         67.0         13.6      11.5       7.9
 New Hampshire          1,600        52         87        45        52.8    47.2      33.6      24.5   24.0    17.8         92.6          1.1       1.3       5.0
 New Jersey             1,986        58         87        50        52.2    47.8      32.3      26.2   22.7    18.7         69.0         12.4       8.7       9.9
 North Carolina         2,340        72         81        58        54.1    45.9      40.0      21.5   20.9    17.5         55.0         35.3       2.5       7.2
 North Dakota           1,097        49         90        44        49.7    50.3      26.8      31.1   25.9    16.2         94.2          0.9       0.9       4.0
 Tennessee              1,418        67         82        55        52.9    47.1      29.9      27.1   26.1    16.8         72.0         21.3       1.5       5.2


LOCAL SURVEYS

Weighted data
 Boston                 1,393        96         68        65        50.5    49.5      30.6      25.3   24.3    19.3         16.4         36.7      20.5      26.4
 Chicago                1,423        95         72        68        54.3    45.7      34.1      28.5   21.0    16.0          8.1         47.8      34.7       9.4
 Dallas                 1,583       100         70        70        51.0    49.0      38.7      24.3   19.3    17.7         11.4         51.4      33.1       4.1
 Detroit                2,113        98         70        69        53.5    46.5      36.9      25.4   20.4    17.0          3.4         85.0       3.3       8.3
 District of            1,356       100         70        70        49.1    50.9      18.9      33.5   22.3    23.9          1.8         83.2       7.6       7.4
   Columbia
 Ft. Lauderdale         1,628       100         80        80        49.5    50.5      32.1      26.6   22.3    19.0         39.8         31.3      18.6      10.3
 Houston                1,262        92         80        73        53.2    46.8      37.9      22.0   17.9    22.1          9.7         39.1      43.4       7.9
 Jersey City            1,095       100         85        85        52.5    47.5      36.1      24.3   20.3    18.8          4.0         42.0      32.0      22.0
 Los Angeles            1,761       100         77        77        53.3    46.7      29.7      29.4   19.0    21.7         10.0         10.7      61.9      17.3
 Miami                  2,029        81         82        66        48.9    51.1      32.6      27.0   20.5    17.6         10.5         25.7      55.6       8.3
 New Orleans            1,666        96         68        65        53.0    47.0      31.4      25.4   22.5    20.5          7.1         86.5       1.5       4.9
 New York City          2,014       100         78        78        50.5    49.5      37.5      27.8   21.9    12.6         27.7         24.2      25.9      22.1
 Philadelphia           1,729       100         78        78        50.5    49.5      38.7      25.9   20.0    15.3         23.9         53.8       8.1      14.1
 San Diego              2,445       100         75        75        49.6    50.4      29.1      27.5   24.3    18.9         31.7         16.4      25.8      26.0
 San Francisco          1,914       100         61        61        48.7    51.3      28.1      26.8   27.5    17.3          7.8         11.9      17.4      62.9

Unweighted data
 Baltimore                999        89         60        53        57.6    42.4      28.5      19.2   28.1    24.1          8.8         82.4       1.6       7.1
 Newark                 2,033       100         68        68        57.7    42.3      16.2      15.0   35.4    33.0          6.7         61.8      23.4       8.1
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------
* Non-Hispanic.
+ U.S. territories are included as states.
& Not available.
@ Survey did not include students from the Los Angeles Unified School District.
=======================================================================================================================================================================

TABLE 2. Percentage of high school students who rarely, or never wore seat belts, * motorcycle helmets, + or bicycle helmets, & who rode with a driver
who had been drinking alcohol, @ and who drove after drinking alcohol, @ by sex, race/ethnicity, and grade -- United States, Youth Risk Behavior Survey, 1997
===========================================================================================================================================================================================================================
                              Rarely or                               Rarely or                            Rarely or                                  Rode with a                               Drove after
                              never wore                              never wore                             never                                    driver who                                 drinking
                              seat belts                              motorcycle                             wore                                      had been                                   alcohol
                                                                       helmets                              bicycle                                    drinking
                                                                                                            helmets                                     alcohol
                ------------------------------------     ----------------------------------    --------------------------------------    ---------------------------------------    ---------------------------------------
Category           Female         Male       Total        Female         Male       Total       Female        Male           Total         Female          Male         Total        Female        Male          Total
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Race/Ethnicity
  White **          10.8          22.0        17.1         29.5          36.6        34.2        87.3         86.9           87.1           34.5           38.9         36.9          14.0         22.8          18.9
                  (+/-3.5) ++   (+/-5.0)    (+/-4.2)     (+/-13.4)     (+/-7.9)    (+/-8.6)    (+/-5.6)     (+/-4.7)       (+/-4.8)       (+/-3.2)       (+/-3.4)     (+/-2.8)      (+/-3.7)     (+/-4.1)      (+/-3.7)

  Black **          28.3          34.4        31.3         51.4          41.8        44.7        95.4         96.1           95.8           29.8           37.3         33.5           4.8         14.3            9.
                  (+/-5.0)      (+/-7.0)    (+/-5.3)     (+/-12.6)    (+/-10.6)    (+/-7.9)    (+/-2.5)     (+/-2.0)       (+/-1.6)       (+/-4.4)       (+/-6.4)     (+/-4.3)      (+/-1.2)     (+/-3.5)      (+/-2.0)

  Hispanic          17.0          23.1        20.3         52.7          55.4        54.7        91.3         92.0           91.7           40.6           44.6         42.8          11.0         24.2          18.1
                  (+/-5.8)      (+/-7.7)    (+/-6.2)     (+/-16.6)    (+/-12.6)    (+/-9.9)    (+/-2.9)     (+/-4.5)       (+/-3.2)       (+/-4.5)       (+/-6.5)     (+/-4.0)      (+/-2.4)     (+/-5.5)      (+/-3.2)
Grade
   9                16.0          25.9        21.