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Youth Risk Behavior Surveillance- United State, 2005

Thursday, June 8, 2006, 12:00 p.m.

OPERATOR: Welcome and thank you for standing by. At this time all participants are in a listen-only mode. During the question-and-answer session you may press star one on your touch-tone phone. Today’s conference is being recorded. If you have any objections, you may disconnect at this time.

Now I will turn the meeting over to Ms. Karen Hunter. Thank you. You may begin.

MS. HUNTER: Thank you very much for joining us today for the 2005 National YRBS media briefing.

We’re going to hear from three speakers. They are Howell Wechsler. And I will spell his name. The first name is spelled H-O-W-E-L-L, Wechsler, W-E-C-H-S-L-E-R. He is director of CDC’s Division of Adolescent and School Health.

Then we’ll be hearing from Dr. Renee Jenkins. That’s R-E-N-E-E. Last name is spelled J-E-N-K-I-N-S. Dr. Jenkins is the professor and chair Department of Pediatrics and Child Health at Howard University. She’s also the Howard principal investigator of the D.C. Baltimore Research Center on Child Health Disparities and president-elect of the American Academy of Pediatrics.

Then we’ll hear from Dr. Glenn Flores. He’s director of the Center for the Advancement of Underserved Children. He’s a professor with tenure of Pediatrics, Epidemiology and Health Policy at Medical College of Wisconsin and Children’s Hospital of Wisconsin.

So, let’s begin now with Howell Wechsler – Howell.

DR. WECHSLER: Thank you, Karen. Good afternoon.

I’m here to provide a summary of the report that CDC will be releasing today on the 2005 National Youth Risk Behavior Survey, or YRBS. The YRBS tells us what high school students across the nation are doing related to the behaviors that most affect their health both in the short-term and throughout their lifetime. CDC has been conducting the survey every two years since 1991. The data being released today were collected in spring 2005 from a national representative sample of nearly 14,000 high school students in public and private schools throughout the United States.

The new report highlights some very good news. The percentage of high school students engaging in many of the critical health risk behaviors has declined significantly over time. Compared with high school students in the 1990s, fewer students in 2005 are engaging in risk behaviors related to motor vehicle safety, violence, sexual activity, tobacco use and alcohol use.

One dramatic example of this progress is seatbelt use. The percentage of students who rarely or never wore a seatbelt has decreased from 26 percent in 1991 to only 10 percent in 2005. Lives are being saved because young people are getting the message to buckle up.

Now, these trends show we’re making progress in reaching our youth about positive health choices. However, too many young people still engage in activities that place them at risk for serious injury and diseases. We need to use evidence-based strategies to provide our young people with the information and skills that could help them make the right choices today so that they can live long and healthy lives.

Now, another important finding from the 2005 survey is that there are many differences in the rates of risk behaviors among racial and ethnic groups. And the groups at greatest and lowest risk vary considerably across the different risk behaviors.

The YRBS enables us to report on the national prevalence of risk behaviors among high schools in three racial and ethnic groups – African American or black students, Hispanic or Latino students, and white students. I’d like to provide a few examples of some of the differences that we found among these three groups. And these can also be found on the fact sheet that was sent along with the press release.

Among the three groups, black students are least likely to report use of tobacco, alcohol, cocaine, inhalants, hallucinogens, methamphetamine and ecstasy. The rates of use of each of these substances is lowest in the black high school students. And black students are also least likely to drive when drinking alcohol.

However, among the three groups, black students are most likely to report sexual risk behaviors and sedentary behaviors, such as watching television three or more hours per day.

White high school students are least likely to report physical fighting, sexual risk behaviors, sedentary behaviors, and being overweight; but they are most likely to report frequent cigarette use, smokeless tobacco use, and episodic heavy drinking.

And among the three groups, Hispanic students are most likely to report attempted suicide and use of cocaine, heroine, methamphetamine, and ecstasy.

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

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

I want to close by pointing out that I’ve been talking about the national YRBS data. But the report released today also includes data from separate surveys conducted on representative samples of high school students in 40 states and 21 large urban school districts. Public health professionals, educators, youth service provides, and policymakers can use these data to guide their health promotion planning decisions in each of those states and urban areas.

And now I’m delighted to ask Dr. Jenkins and Dr. Flores, two of our nation’s leading experts in health disparities among adolescents, to share their thoughts on the results of the 2005 Youth Risk Behavior Survey. Dr. Jenkins?

DR. JENKINS: Thank you, Howell. I want to thank the CDC for the opportunity to comment on the recent Youth Risk Behavior Survey data and the disparities revealed for African-American youth.

In the brief time I have, I want to make three points. First, I think the data dispels myths that our African-American youth have negative health behaviors at all areas, noting specifically the substance abuse data of less use and also some surprises, I think, in the nutrition area, where African-American youth report the highest percentages of eating fruits and vegetables more than five times a day.

Point number two, while it points up areas of continued disparity in sexual behavior, physical activity and violence, this data compels us to really look at additional health measures that fill in the picture of these trends. For example, teen births to 15 to 19-year-old black women have dropped significantly since 1991. All teen births have dropped by a third, but black teen births dropped 45 percent overall and 55 percent in 15 to 17-year-olds. At the same time, however, we also have to recognize continued associated disparities in HIV and other STD rates.

The rates of homicide deaths of black males is also of concern. As we look at the violence data we must also take into account context that black males have two to 10 times higher rates of deaths by homicide than other ethnic groups.

The third point I wish to make is that the data needs to reinvigorate our commitment to do something about these trends. I was privileged to participate in a session with the CDC partners this morning, talking about things like the National Initiative on Adolescent Health, which looks broadly at programs and policies that impact on healthy outcomes.

We need to recognize the context of the communities of color in which some of these observations exist. For example, the issue around sedentary behavior, the higher rates of TV watching and computer use for African-American youth, we have to remember this is in the context of the less than safe communities that they live in. So, the choices that some parents need to make or have to make about how their children spend time is really determined to some extent by the communities they live in. So, the implementation or the resolution of some of these disparities really do not exist in individuals, but exist in community responses to these disparities.

An example of state responses to disparities exists – two examples I’d like to point out. One is in Arkansas where they have taken the strategy to look at health disparities overall in children and in adults and have a strategy specifically related to minority communities. On the other hand, New Mexico has chosen to look at children under the health umbrella and to form a children’s cabinet that looks at issues that impact more healthy outcomes for children; looking at juvenile justice, at educational, at supplemental income, and at housing.

So, I think we have to decide how to look at this data and what each state or community needs to do in response to the data. But certainly we are – we need to keep our promise to young people that we are here to protect their health and to secure a productive adult life for their future.

So, these are the comments that I think are useful to how we can take this very, very important data on disparities and utilize it.

Now Dr. Flores will comment.

DR. FLORES: Thank you, Dr. Jenkins, and good afternoon.

Latinos are the largest and fastest growing racial and ethnic minority group in our nation, numbering 43 million and comprising 14 percent of the U.S. population. There are 7 million Latino adolescents, accounting for 18 percent of U.S. adolescents, and 15 million Latino children, making up 20 percent of U.S. children. It is thus alarming that the 2005 Youth Risk Behavior Survey documents multiple disparities for Latino youth in America.

Compared with white and African American youth, Latinos are significantly more likely to use drugs. For example, one in eight Latino youth reports lifetime cocaine use, one in 10 lifetime ecstasy use, one in 11 lifetime methamphetamine use, and one in 28 lifetime heroine use.

Latinos are most likely to have not used a condom during last sexual intercourse, with 42 percent not using condoms. This is particularly concerning given that not using condoms is associated with high risk of teen pregnancy, HIV/AIDS, and other serious sexually transmitted diseases.

Latino youth have the highest rate of being overweight, at 17 percent versus 12 percent overweight in white youth. Two-thirds of Latino youth don’t meet recommended levels of physical activity. Sixty-two percent don’t have daily physical education classes in school and 46 percent watch at least three hours of TV on an average school day.

Latino youth are most likely to report feeling sad or hopeless, at 36 percent overall and 47 percent in Latino girls. Latino teens have the highest rates of seriously considering attempting suicide, at 18 percent overall and in one in four girls, and of actually attempting suicide at 11 percent overall and 15 percent among Latino girls.

Other national data from other studies besides the YRBS paint a similarly bleak picture of multiple health disparities for Latino youth in children. Latinos have the highest high school dropout rate at 24 percent versus 7 percent whites and 12 percent in African-Americans.

Latino girls have the highest teen birth rate at 83 per 1,000 girls.

Latinos are the most uninsured racial and ethnic group, with 21 percent uninsured versus 8 percent of whites and 13 percent of African-Americans. One in three Latino children has no usual source of medical care and 33 percent experience problems getting specialty care. Half of Latino children have teeth that are not in excellent or very good condition and 30 percent made no dental visit in the past year.

Although 10 million American schoolchildren speak a language other than English at home, 71 percent, of which is Spanish, a study revealed that language problems are the single greatest barrier to healthcare for Latino children. And one in six Latino children was not brought in for needed medical care due to language and cultural issues.

What can we do to reduce and ultimately eliminate these disparities for Latino youth? More research is needed so that we can better understand these disparities, but available data indicate that effective solutions for reducing disparities already exist. Critical to eliminating disparities are programs that are adequately funded, sustained, culturally appropriate, and community driven. A crucial first step is to identify all such racial and ethnic disparities and monitor change over time by requiring all healthcare institutions to collect data on patients’ race, ethnicity, primary language spoken at home and parental English proficiency.

Regularly eating dinner together with a family can be a powerful intervention for eliminating disparities for youth. Compared with children who have dinner with their families zero to two times weekly, those who have dinner with their family five to seven times per week have half the risk for substance abuse and high stress, are significantly less likely to have tried marijuana, alcoholic beverages, and cigarettes, are twice as likely to receive A’s in school, and are more likely to eat five daily servings of fruits and vegetables and consume less soda, fried food and fat.

Affordable and culturally accessible after school programs are needed targeting minority youth and prevention of risky behaviors, including organized sports, dance, the arts and job training. Healthy lifestyle interventions in education are needed in all U.S. schools, including regular physical education, elimination of soda vending machines, healthier school lunches and mandatory health education classes.

Only 13 states provide Medicaid and SCHIP reimbursement for medical interpreters. So, it is time for us to eliminate language barriers to healthcare for Latino youth by providing reimbursement nationwide for language services.

Eight point three million U.S. children have no health insurance, and Latino children are at greatest risk. Every American child should have health and dental insurance and access to quality health and dental care through regular health and dental care providers. Our research team documented the successful elimination of a racial and ethnic disparity for Latino children. Community-based case managers insured 96 percent of uninsured Latino children versus only 57 percent of children insured using traditional Medicaid and SCHIP enrollment strategies. And the community case managers insure children substantially quicker, more continuously, and with much higher parental satisfaction.

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

Thank you.

MS. HUNTER: Thank you, Dr. Flores.

And now we can open it up for reporter questions.

OPERATOR: Thank you. At this time if you’d like to ask a question you may press star followed by one on your touch-tone phone. You will be prompted to record your name. And I will announce you prior to asking your question. Again, if you would like to ask a question at this time you may press star followed by one on your touch-tone phone.

Our first question is from Betsy McKay (Wall Street Journal). Your line is open.

MS. MCKAY: Hi. Can you hear me?



MS. MCKAY: Thanks very much. Well, there’s a lot of really interesting data here, and so I’ll limit it to a couple of questions.

And one is I was interested in why – what may be known about why Latino teens are significantly more likely to use drugs. Anything you can share on that.

And secondly, in terms of the data on high school students reporting sexual intercourse, there – I was interested in what the reasons may be behind the flattening of the decline. I see here that the data is pretty much – the percentage is pretty much the same from 2003 to 2005 after a sharp decline. Is there – do you have any insights into why that may be occurring?


DR. FLORES: Hi. This is Dr. Glen Flores.

In terms of why Latino youths are at greater risk for using drugs, we really don’t understand this phenomenon as well as we should. And so, we need to do more research, particularly longitudinal research.

But we do know a couple of things. One of them is that the more acculturated you are, so the more Americanized you are, the higher your risk is of substance abuse. So, in other words, it’s protective to be less acculturated, in other words less Americanized. And it’s unclear why that is, but we need to understand that better because then we can learn about how we can protect all of our youth against – of getting involved with drugs.

Some of the hypotheses include that the less acculturated youth have better social support. So, what we might be seeing is that the adolescents who are Latinos are having erosion of their social support.

And also, anecdotally, in treating my patients in various practices who are Latino, I noticed that particularly in the inner city, not just for Latinos but for minority youth in general, it’s sometimes very difficult to identify after school programs, simple things like Little League. It can be very difficult, for example when I was in Boston, to find a Little League program for a Latino child who’s interested in participating in sports. And you can see the natural cascade from not having after school activities to be involved with and having a social network to then having idle time and perhaps having a higher risk of getting involved with using drugs.

DR. JENKINS: In terms of the flattening out of the sort of flattening out of the curve of decline for sexual intercourse, I would suspect that it may have to do with seeing that sharp decline probably by the mid ‘90s. I think it was primarily related to the HIV/AIDS prevention programs that were initiated in schools. There was a big push to do this across the nation. And now these programs are pretty consistently in place in many school districts.

So, I don’t think we have identified a new strategy to take that curve down further. I think people are looking at the youth development model in a number of settings to see if trying to give young people other options in terms of their behavior other than early sexual activity more outlets in terms of creative outlets, positive citizenship kinds of activities, character building programs. These are not as consistently available across schools.

So, I think the HIV and AIDS prevention programs were probably one of the reasons for the sharp decline that we saw. And now I think that’s sort petered out.

MS. HUNTER: And that was Dr. Jenkins.

We’ll take our next question.

OPERATOR: Thank you. Mike Stobbe, your line is open. Please state your affiliation.

MR. STOBBE: Hey. It’s Mike Stobbe from the Associated Press. Thank you for doing this.

I had two questions. One, I just wanted – this is a survey. The YRBS comes out every two years. I was wondering have these racial differences been reported the last go around? Or what’s the most pronounced difference in this report as compared to last time?

Also, I want to ask Dr. Flores if he could define just a little more for me what acculturated means.

DR. WECHSLER: This is Howell Wechsler. I’ll take your first question, Howell Wechsler from the CDC.

We have reported on these differences before. They are not dramatically different than they were in 2003. What we have not done before is really put them all together in one place so people can – don’t have to dig through the entire report. So, we’ve made it clearer and people can see where it stands.

Dr. Flores?

DR. FLORES: In terms of acculturation, there are some instruments that I like to look at. And I won’t get into the complex scientific variables and the science that’s validating that. But essentially the instruments focus on a couple of areas.

One of them is the language that you typically speak and think in and is typically spoken at home. There’s also some questions about cultural identity in terms of which of the cultures would you identify more with. And there are even some interesting things about, for example, the kinds of celebrations you do, whether you do a traditional Latino celebration to traditional American celebration. So, people have for a couple of decades been coming up with ways to measure this, but those are the essential elements of that particular issue.

And just a comment on the prior YRBS trends. Just having looked at some of the data myself, I think the one disturbing thing for me is this persistence of the trend for Latino girls in how they’re always at the top in terms of actually attempting suicide. This has changed very little over the years that I’m familiar with. And I’m concerned that this is an ongoing trend and it’s not decreasing by any means.

MS. HUNTER: Thank you, Dr. Flores. Next question, please.

OPERATOR: The next question is from Andrew Herrmann. Please state your affiliation.

MR. HERRMANN: Hi. I’m with the Chicago Sun Times.

I had a question about – or two questions actually about the survey itself. Teenagers are very conscious about being part of the norm. How do we know that the teens are telling the truth in the surveys and not just saying what they think other teens are doing or, maybe the flip side, answering how they think adults want them to answer?

DR. WECHSLER: That’s a great question. This is Howell Wechsler from CDC.

We do a number of things to make sure that students or the great majority of students are telling the truth. We do what’s called psychometric studies, which really examine the data quality. So, for instance, we’ll make sure that the kids are responding in the same way when they take it again a couple weeks later. The whole thing is done confidentially and anonymously. And the whole way it’s set up there are no teachers roaming the rows of the classroom. The teachers – the administrators stand apart. The students conceal their questionnaire.

We do all sorts of edits and logic checks so that very, very rarely when we get answers that don’t make sense we get to take them out. We know that the data over time have been very congruent with health outcomes. So, Dr. Jenkins was talking about the pregnancy outcomes. That has paralleled the decline in sexual behavior that we’ve seen in the YRBS. And there are a number of other examples of that.

And we see that the subgroup differences are logical and they’re constant over time and place. So, there are a whole number of things in place that they give us great confidence. And the scientific community certainly endorses that – this high quality data. And it’s a very good reflection of the reality.

MS. HUNTER: Andrew, did you have a follow-up question?

MR. HERMAN: It looks like the ’91 survey involved 37 state and local surveys – or the ’91 report involved 37 state and local surveys. The most recent report here used 67 state and local surveys. Can you legitimately compare the two given the differences in the numbers?

DR. WECHSLER: Yes. Those state and local surveys are completely separate from the national survey. So, the national survey is conducted with the same methodology in 2005 as it was in 1991 and is perfectly comparable. So, you would need to compare a survey within a state to a previous administration within that same state. So, the administrations of the survey are completely different things.

So, for instance, in Illinois that will be a representative sample of Illinois high school students, whereas the national survey is a representative sample of national data. And we don’t add the state data together to do the national survey. They’re just completely different samples.

We’re excited, though, that the fact that – increasing number of states and cities that are participating. This is by far the largest number of states and cities that have what we call weighted data. And that means high quality data, a very large response rate. So, we can state authoritatively that this is truly representative of high school students within that state or, in the case of the national survey, of the nation.

MS. HUNTER: Next question, please.

OPERATOR: Thank you. Again, if you’d like to ask a question press star followed by one on your touch-tone phone. And our next question is from Jia-Rui Chong. Your line is open. And please state your affiliation.

MS. CHONG: Hi. I’m from the LA Times.

I was wondering how surprising you guys find this data to be. I think that a lot of people think that teens are worse today than they have been in the past. It seems like for a lot of these risky behaviors they’ve gone down a bit.

And I was also wondering why the rates of alcohol consumption have gone down.

And I was also hoping for – I have three questions – what the situation with the suicides among Latinos seems to point to, why that might be true.

DR. FLORES: This is Glen Flores.

I wouldn’t – in terms of disparities, I’m not comfortable painting this as a positive picture. As I mentioned, for Latinos there are a lot of disparities that we can see. And some of these have persisted. And as Dr. Wechsler mentioned, overweight in general is on the rise for American children, and particularly for Latino children.

And it disturbs me as a Latino and as a Latino pediatrician to see the extent and variety of drug use that’s occurring in the Latino community and the lack of use of condoms. And, as you alluded to, the unacceptably high rate of depression, of sadness and hopelessness, as well as the – whatever suicide metric you look at, the high rates of attempting suicide and suicide-related issues for Latino kids.

And so, I’m very concerned about the fact that although the general trends when you sort of clump everything aggregately look good, that when you look at specific groups, particularly for Latinos, there are a lot of concerning disparities that I think we urgently need to address.

In terms of why there is such a high rate of the sadness and the suicide attempts in Latino girls, no one really can figure it out at this point. So, we really need to understand this process better.

But I think this is sort of a sentinel indicator for us to say there’s something wrong with a childhood that we’re giving to our Latino kids because we’re seeing a trend of kids who are sad, who are hopeless, who are using drugs, who are getting overweight, and who are not only considering suicide but attempting suicide. And that is very disturbing to me because that means we could have a very troubled future generation.

And, as I pointed out in my talk, since our nation will soon become a minority majority by the year 2030 when you’re talking about kids, we’re talking about our whole nation’s future productivity and health.

DR. WECHSLER: This is Howell Wechsler.

As to whether the positive trends and most risk behaviors is surprising, we need to keep in mind that our science base for what are effective strategies for influencing the health behaviors of young people has grown tremendously in the past two decades or so. So, we’re delighted that we’re seeing some progress, but the reality is that the risk behavior levels are just way too high.

We want to celebrate the fact that some – many of things, most of the risk behaviors are going in the right direction, but they’re not going down fast enough. So, we have a lot more work to do.

DR. JENKINS: This is Renee Jenkins.

I also think many of the new intervention programs are really aiming at more global skills of competency for young people on social skill building so that we’re not seeing sort of a silo of interventions that only look at specific behaviors. So, once you start to make a kid more competent, they’re usually likely to make better decisions about a number of high risk behaviors. And I think this is the current trend that we’re going toward in terms of prevention programs.

MS. HUNTER: I think we have time for one more question. Is there another question from the phone?

OPERATOR: Thank you. Andrew Herrmann, your line is open. And please state your affiliation.

MR. HERMAN: It’s Andrew Herrmann from the Chicago Sun Times. I was wondering if you saw any differences in the data when you looked at suburban kids versus city kids versus rural.

DR. WECHSLER: This is Howell Wechsler from CDC.

No, unfortunately, we were not able to collect that data, that kind of a breakdown. We can look at some of the differences across states. There are some states that are very rural and we can compare them with the large cities, for instance, but we haven’t done that yet. There are many, many stories that will continue to come out of this data set.

MS. HUNTER: All right. Thank you. I think that’s going to wrap this up.

I’d like to thank all three of the speakers – Howell Wechsler, Dr. Renee Jenkins, and Dr. Glenn Flores. The full YRBS as well as the racial and ethnic differences fact sheet – and there’s also a fact sheet on gender differences and the state fact sheets are up on the Web site. That address is That stands for Youth Risk Behavior Survey.

If you have follow-up questions or you’re having trouble finding anything on the Web site, feel free to call CDC’s main press office at 404-639-3286.

Thank you very much for joining us today.

OPERATOR: Today’s conference has concluded. Thank you for joining. You may disconnect at this time.




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